Laryngopharyngeal Reflux (LPR)
LPR is a fairly common condition, though often undiagnosed. The throat and larynx serve as a passage way, not only for air to go to the lungs, but also for food to reach the stomach, via the esophagus.
Not uncommonly, the contents of the stomach can regurgitate back into the esophagus, and can sometimes reach the upper esophagus and larynx. This form of involuntary regurgitation is known as LPR.
The regurgitated stomach content would include stomach acids, which could burn the sensitive larynx and irritate it, thus causing coughing.
LPR often leads to inflammation or ulcerations in the back of the larynx, where the larynx meets the upper esophagus. LPR is also known to reach the nasopharynx. If LPR reaches the Eustachian tubes (which links the nasopharynx to the ears), it can cause otitis media (middle ear infection).
During the night, while the patient lies horizontally, the stomach content may make its way up the esophagus to the back of the throat and collect there. Patients are often awoken by their own coughing, or wake up in the morning complaining of throat discomfort.
LPR (even a mild case) may exacerbate the severity of an existing cough.
The majority of LPR sufferers may have no symptoms of gastric pain or heartburn. Examination of the gastric system or barium swallow X-ray may show no abnormality.
Video endoscopic equipment can be used to examine the back of the larynx where it meets the esophagus. LPR may be indicated if there is redness, swelling, inflammation, polyp, ulceration or granulation in this area.
The only study presently available to positively diagnose LPR involves the insertion of a pH (acidity) catheter through the nose to the esophagus. The catheter is left for 24 hours to monitor the pH levels, during normal day and night activities. However, due to the inconvenience and high cost of performing this procedure, it is not often done.
Generally, LPR is diagnosed by actually treating the problem! A patient suspected of having LPR would often be treated with medication to lower gastric acid levels and would be advised to make lifestyle changes to reduce LPR, such as:
- Avoidance of stress (which increases gastric acidity)
- Avoidance of heavy meals
- To take smaller and more frequent meals
- To wear loose clothing
- To reduce weight (as obesity increases LPR)
- To avoid sleeping on a full stomach (preferably do not eat or drink 3-4 hours before going to bed)
- To sleep with the head of the bed elevated by 20-30º
If the above medication and lifestyle changes alleviate the patient's chronic cough, LPR is usually diagnosed as the likely cause of the cough. Get to know more about our ENT doctor today.
Our Singapore ENT clinic specialises in the end-to-end management of all ear, nose, and throat conditions while keeping the best ENT practices in mind.
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Mount Elizabeth Medical Centre
Singapore 228510
