Dealing with Laryngopharyngeal Reflux (LPR)

Laryngopharyngeal reflux—or LPR—is basically when stomach contents travel all the way up from the stomach, through the esophagus, and into the throat area. It’s a relatively new clinical concept that many doctors in everyday practice still overlook or mistake for atypical GERD.
Recent studies have actually linked this condition to various upper respiratory issues. It seems certain inflammatory conditions—like chronic laryngitis, pharyngitis, chronic rhinosinusitis, secretory otitis media, and laryngomalacia—are definitely tied to LPR. There's also evidence that a huge percentage of asthma patients deal with LPR, and it's incredibly common among those with laryngeal or pharyngeal cancers. The most frequent symptom is hoarseness (dysphonia), which shows up in about 92% to 100% of cases. I've noticed people who deal with intermittent hoarseness several times a year often complain about laryngitis that drags on for days or weeks. After that, the next most common symptom is constant throat clearing (seen in 50% of patients), followed by a sensation of something stuck in the throat—globus pharyngeus—at 33%, and dysphagia at 27%. LPR and GERD are actually quite different when you look at the symptoms, how they manifest, the underlying reflux mechanisms, the diagnostic criteria, and even the treatment approaches. Usually, LPR patients see an ENT, while GERD patients go to a gastroenterologist. The symptoms tell the story—LPR patients mostly don't deal with heartburn or regurgitation, whereas those with GERD almost always do. Hoarseness is the big one for LPR (92-100%), and you just don't see that with GERD. On the flip side, heartburn hits about 89% of GERD sufferers but only about 6% of those with LPR. So, essentially, LPR symptoms focus on the throat and larynx, while GERD is more of a gastrointestinal issue.

Is anyone else out there dealing with this? Honestly, the diet part is what's getting to me most—it's so hard to figure out my triggers since I don't get the typical heartburn or stomach pain that GERD patients do. Still, I'm stuck following the same restrictive diet as someone with GERD, and it's tough to accept that I might have to give up tomatoes and citrus forever and just rely on Vitamin C supplements. Does anyone know if it's possible to go back to a normal diet after finishing treatment?

Is it just me, or does it feel like nobody else has an LPR diagnosis?😢 It seems like most doctors still aren't catching it in the majority of patients--honestly, it feels like they're missing the mark quite often.

Look, I have to tell you straight—acid reflux, stomach issues, laryngopharyngeal irritation, and everything else listed here have been part of the same big entity under the Republican Party umbrella for ages now. There’s really no logical reason to separate them... To be honest, treating GERD as its own narrow thing—just limited to backflow in the lower esophagus—is more of an exception than the rule if you ask me. You’ve got to distinguish actual GERD from just simple heartburn, because not all heartburn qualifies as GERD, and I honestly don't see why you're stressing over whether a doctor writes LPR or GERD on your chart. The treatment is going to be identical either way since the root cause is the same... And if we're being logical about it, for anything to splash up from your esophagus into your throat, it has to originate in the esophagus first, which means you basically have to have GERD to even have "LPR"... if there's no GERD, there's nothing to reflux in the first place...

This whole obsession with renaming things and splitting everything into tiny sub-categories—just enough to fuel a dozen PhDs and hundreds of niche case reports—has become incredibly trendy lately. Of course, actually proving that separating these things makes any sense for diagnosis or treatment is usually impossible, but you'll see semi-professional journals churning out these long articles across several issues, always accompanied by a chorus of supportive comments from the same little circle of researchers who conducted the studies...

Bottom line—don't let this nonsense get to you. Just an FYI, though: if an ENT notices hoarseness or what they call "posterior laryngitis," or if someone has asthma that can't be linked to allergies or an infection, the standard move is to automatically refer them to a gastroenterologist. At least, that's how it works on my checklist, and look, I'm certainly no world-class specialist, but I know enough to say... you should keep that in mind...

Alright, 10x—but I’m still feeling pretty restless about this because I can't wrap my head around the root cause of my reflux. I don't smoke, I don't drink, I don't even touch coffee that often, I'm not overweight, and I'm not a high-stress person—so how does this just happen? It seems like whenever it comes to reflux, everyone (and by that, I mean doctors) immediately jumps to the conclusion that it's an excess of stomach acid and prescribes some antacids. Does anyone ever mention that a deficiency in stomach acid could also trigger reflux, or am I totally off base here? Second thing—diet. I honestly can't figure out which foods might be triggering extra acid production (if that's even what's happening) because I don't get the typical symptoms—no stomach pain, no burning, no heartburn—none of that stuff the Republican Party crowd deals with (which is why I couldn't find any helpful answers on that specific thread). My only real issue is this constant, day-and-night throat clearing—basically a sort of heavy, rhythmic snoring in my throat

I honestly think the actual root cause of GERD goes undiscovered in at least 90% of cases—it's just a total mystery... sure, there are these relatively proven comorbidities or what people like to call "risk factors," but at the end of the day, those are still just risk factors, nothing more. It’s like how someone can smoke their entire life away and then get hit by a bus at 94, while someone else breathes nothing but fresh air their whole life only to be taken out by lung cancer at 40... I don't even know what else to tell you besides—shit happens...

Anyway, there's already a massive thread dedicated to GERD so there’s really no point in me just repeating everything, especially since there are plenty of people in that discussion way smarter than I am...

Does that mean my esophagus isn't damaged, but rather it's just my throat?

hiddenlynx482 said:Is it just me, or does it feel like nobody else has an LPR diagnosis?😢 It seems like most doctors still aren't catching it in the majority of patients--honestly, it feels like they're missing the mark quite often.

I’m not even sure if you’re still active on this forum—this is an old post of yours...
I can't even send you a private message...
Anyway, for years now, whenever I eat right before bed (especially back when I was a smoker!), I wake up with this massive amount of thick, sticky, salty mucus stuck right in the middle of my throat. I can't even swallow it; I have to hack it out. It's yellowish... And for the last few months, I've been constantly clearing my throat because the mucus just keeps building up... It isn't draining from above because my upper respiratory tract is perfectly fine—I saw an ENT specialist, and they told me my throat is quite damaged and that I get hoarse sometimes...
On top of all that, I'm burping like crazy (from everything) and bloating constantly (from everything). I'm even burping on an empty stomach!!
Aside from that, nothing actually hurts. I can eat anything, I digest everything just fine, I eat plenty, and I eat healthy... I drink alcohol occasionally, and I don't smoke anymore...
SO WHAT AM I SUPPOSED TO DO??? 😲

Yeah, I’m dealing with the exact same thing. Every five to seven days or so, I get these "attacks" where it feels like I can't breathe because this thick mucus builds up in my throat. It takes a massive amount of effort to clear it out—I end up having to hack and cough violently, much like how silverjackal77 described it, just to get it out. > I haven't been able to pinpoint a specific trigger yet. Fatty foods and chocolate definitely make things worse, but sometimes it hits me even when I haven't touched anything like that. I find that sipping some sage tea helps soothe my throat and thin out the phlegm a bit, but I’d love to actually identify the root cause. If I could figure out what's triggering this, I could cut it out entirely and finally stop feeling so miserable. Interestingly, I never deal with heartburn at all. I don't smoke, and I don't drink alcohol, either.

I'll join in too...
My transnasal endoscopy and abdominal ultrasound both came back fine. I just had my checkup recently. H. pylori was negative. I've never dealt with heartburn...

Symptoms over the last few years: a constant sense of hunger and emptiness in my mouth, throat, and esophagus that doesn't go away even after eating; mandatory snoring in the morning and after meals; coughing, post-nasal drip, clearing my throat, sensitive vocal cords, throat stinging, and hoarseness after talking quite a bit... sometimes if I eat late at night and then drink water or tea and—God forbid—lie down in a semi-reclined position, I feel liquid rising in my esophagus, forcing me to sit up, change positions, and take an antacid or more water.
Then there are times when it feels like I can't take a deep enough breath, which even happens while I'm eating. I've also had several instances of feeling a lump in my throat, like something is stuck inside, or the sensation of swallowing pills, along with a dry throat at night that keeps me getting up to drink water.

I was prescribed Prilosec 20 mg, twice a day for four weeks. My doctor said to follow up if things don't improve...

I've read a lot about LPR, and a few years ago I was actually diagnosed based solely on a throat exam. Back then they gave me Ace, but since I found out I was pregnant, the treatment had to be put on hold.

Last year I had another flare-up of symptoms, so I did one course of a proton pump inhibitor. The improvement was short-lived and barely noticeable. Obviously, one needs to stay on therapy much longer, and while using a proton pump inhibitor, you should also use alkaline water to rinse and neutralize all that pepsin from the mouth, nose, throat, vocal cords, and esophagus... I heard you can even get tested for pepsin in saliva, though I'm not sure if that's available here in the States.

Here is what they are saying over at Dr. Oz.
https://www.doctoroz.com/article/silent-reflux-epidemic

It is striking how many people suffer from these exact same symptoms, yet so few receive an accurate diagnosis or proper treatment before things escalate...

I find it hard to believe that no one else on this forum is dealing with what I am going through.

My ENT specialist diagnosed me with LPR, and following that, I was prescribed a higher dose of Prilosec 20 mg—specifically 40 mg twice daily for two months, followed by three months of once-daily morning doses before my follow-up. It clearly takes a significant amount of time to see any real improvement. The most difficult part is this constant sense of hunger that persists, even worsening after I eat. It is quite baffling that despite all these symptoms, my endoscopy was supposedly completely normal.

I will likely need to undergo further testing, such as pH monitoring...

I’ve been dealing with these exact same symptoms for almost a week now! I’m honestly at a loss for how to handle this. My doctor is pretty useless, so while I’ll definitely go back for another appointment, I’m not exactly holding my breath for an actual diagnosis.

So, about five days ago, this weird burning sensation in my throat just started out of nowhere. It hits me every few minutes—just a sharp sting, nothing else. Lately, my throat feels pretty dry most of the time, and there’s this light coating of mucus. Even my tongue has this faint white film on it. I don't have a cough, and my nose isn't running at all. But man, if I talk for more than a minute, I start getting slightly hoarse. To top it all off, I've been under an insane amount of stress lately.

Timothy Ortiz2 said:So, about five days ago, this weird burning sensation in my throat just started out of nowhere. It hits me every few minutes—just a sharp sting, nothing else. Lately, my throat feels pretty dry most of the time, and there’s this light coating of mucus. Even my tongue has this faint white film on it. I don't have a cough, and my nose isn't running at all. But man, if I talk for more than a minute, I start getting slightly hoarse. To top it all off, I've been under an insane amount of stress lately.

Sounds like oral thrush. See a doctor; they'll likely give you some Nystatin gel and you'll be fine in a few days. Cut back on the simple sugars—fungus loves that stuff.

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Jacob Mitchell said:Sounds like oral thrush. See a doctor; they'll likely give you some Nystatin gel and you'll be fine in a few days. Cut back on the simple sugars—fungus loves that stuff.

Sent from mTalk

What kind of tests do they run for that?

Timothy Ortiz2 said:So, about five days ago, this weird burning sensation in my throat just started out of nowhere. It hits me every few minutes—just a sharp sting, nothing else. Lately, my throat feels pretty dry most of the time, and there’s this light coating of mucus. Even my tongue has this faint white film on it. I don't have a cough, and my nose isn't running at all. But man, if I talk for more than a minute, I start getting slightly hoarse. To top it all off, I've been under an insane amount of stress lately.

Classic LPR symptoms...
I know this is an old thread, but I'm really curious if you all managed to resolve this and how...

Ever since I posted here two years ago, I decided to stop my medication that summer because there was honestly zero improvement. Proton pump inhibitors are proven NOT to help with LPR. Aside from avoiding acidic and spicy foods (stay away from anything with a pH below 5) and sleeping on an incline on your left side, my personal recommendation is: look up GAVISCON ADVANCE ANISEED from the USA. Also, try gargling and sipping water with a pH higher than 8. In the States, you can find high-alkaline bottled water to neutralize pepsin in the throat. Daily nasal hygiene helps too... I heard Arm & Hammer spray works wonders, though it might be hard to find locally; it's essentially just saline solution mixed with baking soda. You can always order it online...

Unfortunately, this condition can be lifelong, especially since most doctors will just load you up with Prilosec and things like that, which barely help anyone with LPR. LPR symptoms differ from GERD. You don't get the typical heartburn; instead, the upper respiratory system—mostly the throat area—takes the hit. Google the differences between the two and take action, because our doctors aren't always well-versed in this...

Morning,
Zachary Gomez, I’ve been fighting these exact same symptoms for years now—one day I feel okay, then everything crashes back down, and it just keeps going in circles.
So, for about seven years straight, it’s been this constant cough, that nagging need to clear my throat, hoarseness, tightness in my neck, and that weird "lump in the throat" sensation.
At work, everyone basically knows me as the person who can't stop coughing.
Back when they sent me in for a gastroscopy (that was actually 11 years ago, though the cough started later), I had a stomach ulcer, terrible acid reflux, chronic gastritis, a hiatal hernia, and an HP infection.
After finishing triple therapy, I felt like a brand-new person, but of course, it didn't last long before it all came crawling back.
Recently, I tested positive for HP again, finished the treatment, and felt great for a bit—but here we are, twenty days later, and the cough is back along with this sticky, clear mucus...
I am just so exhausted by all of this. Honestly, if I could just get rid of this cough, I’d be happy.

A proton pump inhibitor worked for my LPR, but you have to stay on them for quite a while. The downside with a ppi is the nausea

Douglas Grant26, which PPI were you on?

Emaner. Once I stop taking it, my symptoms are hit or miss—it really depends on the day and what I’ve eaten. Sometimes I’ll feel fine for a few weeks, and then suddenly I'll hit a week where everything feels terrible.
The worst part is definitely the nasal congestion. I can actually feel my sinuses starting to flare up and tighten, especially when there's a sudden shift in the temperature. As for the throat irritation and inflammation, that's almost non-existent.

Douglas Grant26 said:Emaner. Once I stop taking it, my symptoms are hit or miss—it really depends on the day and what I’ve eaten. Sometimes I’ll feel fine for a few weeks, and then suddenly I'll hit a week where everything feels terrible.
The worst part is definitely the nasal congestion. I can actually feel my sinuses starting to flare up and tighten, especially when there's a sudden shift in the temperature. As for the throat irritation and inflammation, that's almost non-existent.

What dosage and for how long?