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Laryngopharyngeal Reflux Disease: Not just heartburn Special

By Nikki Weingartner     Jun 19, 2009 in Health
It isn't just your father's heartburn anymore. With individuals being mistakenly treated for other disorders in relation to symptoms caused by the backup of stomach acid into the throat and sinus area, the potential for dangerous problems is rising.
It is a confusing and highly misdiagnosed disease that can go on for years and if left untreated, can be dangerous. It is Laryngopharyngeal Reflux, or LPR, which loosely translates to hydrochloric acid backing up into your throat, voice box and nasal cavity.
For ages, heartburn has been associated with pain in the chest area, excessive gas or a bloated feeling often related to multiple lifestyle habits such as excess weight, eating spicy foods and even pregnancy. It is often described as a burning sensation just below the breastbone, making it an identifiable pain that can be easily treated with diet modification, weight loss, alternative actions and even some over the counter or prescriptive antacids.
But what happens when the symptoms are more confusing, such as the feeling of the airway constricting, a perceived lump in ones throat, asthma attacks, chronic coughing and swallowing difficulties that come on without notice and in the absence of ingesting any foods?
One diagnosis provided by specialists of the ear, nose and throat, a commonly thrown around term known as Gastroesophageal Reflux Disease (GERD) seems to be the catch all phrase for digestive problems, including heartburn. However, the reality is that GERD is a severe form of digestive problems and can lead to bleeding ulcers in the esophagus, scar tissue which narrows the esophagus and even lead to the outcome of esophageal cancer, which is often fatal.
As for the causes, it isn't necessarily due to diet, debunking the stereotypes surrounding the disease. Problems with the diaphragm, a hiatal hernia and other unexplained reasons can lead to the problems associated with GERD.
In a more specialized diagnosis, explained by the stomach acids backing up past the esophagus and into the larynx and pharynx area, the problems and symptoms are even more difficult to identify as over half of those with Laryngopharyngeal Reflux (LPR) have no heartburn at all. The reason is that the acid doesn't have time to irritate the esophagus.
Even when small amounts of the reflux hit the throat and voice box area, this can set up the potential for more serious problems as that area is much more sensitive to injury and is not designed to withstand the effects of acid.
Symptoms of LPR are often confusing and vary from individual to individual:
sensation of drainage down the back of the throat or excessive mucus
feeling of something caught in the throat (sometimes a tickling or burning sensation)
throat clearing
chronic cough
post-nasal drip
sore throat
difficulty swallowing
Some of the symptoms come and go, such as an intermittent hoarseness that may be mistakenly attributed to strain or fatigue or perceived as multiple minor issues. Others have a feeling of too much phlegm or mucus caused by drainage and they never link it to a digestive disorder. Still others can experience the feeling of a lump or tumor in the throat, giving rise to anxiety. This confusion in symptoms could lead to inappropriate diagnosis by general practitioners who feel that it is a sinus or allergy problem, providing treatment drugs such as nasal steroids and even a course of regular steroids to treat inflammation.
For example, after visiting a general practitioner for an 8-month clearing of the throat, chronic cough and problems breathing that felt like asthma, I was prescribed a short course of steroids, nasal-steroids and a short course of antibiotics (Z-Pak) to treat the potential for atypical pneumonia. Although the breathing problems subsided, the throat clearing continued, causing a frightening episode of throat constriction and a lump on one side of the throat.
Again, a visit to a general practitioner dismissed the symptoms as possible Eustachian tube dysfunction, allergy responses and no throat problems whatsoever, prescribing another course of steroids and a sample pack of medications for the possibility of GERD.
A self-referral to a specialist immediately identified a severe level of inflammation of the voice box and throat consistent with LPR.
An ENT doctor, also known as an Otolaryngoloist, can quickly look at the voice box and throat to see if there is indeed irritation caused by the back flow of stomach acid. The most common way to diagnose is by sending a telescope in through the nose and down the back of the throat, where any irritation or inflammation can be immediately viewed.
For certain cases of LPR, a similar device that calculates the amount of acid refluxed is worn for a specified period of time.
Although treatment for LPR includes some lifestyle changes such as losing weight if applicable, avoid foods that are attributed to acid-reflux such as chocolate, fatty foods and red meat, most LPR patients require a proton-pump inhibiting drug that stops the production of acid or in mild cases, drugs that reduce the amount of acid produced. In fact, some research has shown that lifestyle and diet modifications as well as taking OTC antacids are relatively ineffective in most cases. The treatment plan can last up to several months and is targeted at healing the affected areas.
For life-threatening cases of LPR, patients experience:
airway obstruction, including glottic or subglottic stenosis (figure), webs, laryngospasm, severe paradoxical vocal fold movement, asthma, dysplasia, and laryngeal carcinoma.
In extensively severe cases or those that do not resolve with lifestyle changes and medication, patients require surgery, either known as a Laparoscopic Nissen Fundoplication where the general surgeon wraps "a part of the stomach known as the gastric fundus around the lower esophagus" to prevent acid from flowing into the esophagus or a procedure called "anti-reflux surgery" where a stomach valve replacement might be in order.
If left untreated, LPR can cause serious problems such as choking episodes, asthma attacks and bronchitis and cancer of the esophagus, throat or voice box. Cancer is very uncommon and occurs when the LPR is severe and is left untreated for many years.
LPR is more like having high blood pressure in that with appropriate treatment, the disease doesn't usually cause problems. However, it can have devastating consequences without the appropriate course of action. As for treatment, I will let you know how effective the first course of therapy is.
More about Laryngopharyngeal, Heartburn, Gerd
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