Laryngopharyngeal Reflux (LPR) – Chronic Cough

The stomach is the reservoir for food and liquid that is consumed during the day. It serves as a holding area for the food while digestion begins. The average person consumes about 4 litres of food and liquid per day. In addition to this amount, the stomach produces about 2 – 5 litres of strong acid and digestive enzymes. Normally, the esophagus (swallowing tube) acts as a one way pathway for food. Occasionally, stomach acid flows back (reflux) up the esophagus and can even reach the throat and mouth. When the acid reaches the throat and larynx (voice box), the condition is called laryngopharyngeal reflux (LPR).

Symptoms of LPR

  1. Hoarseness, change in voice
  2. Chronic throat clearing
  3. Chronic sore throat or dry throat
  4. Chronic cough
  5. Sensation of foreign body in throat
  6. Difficulty or painful swallowing
  7. Possible heartburn or sour taste in mouth

Only about 40% of patients with LPR with complain of heartburn.

Causes

  • High fat, caffeine (coffee or tea), mint and chocolate in the diet
  • Smoking,  alcohol, carbonated drinks, citrus fruits and spicy foods
  • Stressful lifestyle
  • Eating before sleeping
  • Obesity and pregnancy
  • Helicobactor pylori infection in the stomach 

Treatment

  • Stop smoking and alcohol
  • Eliminate caffeine (coffee and tea), mint and chocolate, carbonated drinks, citrus fruits and reduce spicy foods
  • No eating and drinking 2 hours before bed-time
  • Weight loss
  • Stress reduction program (exercise)
  • Elevate head of bed 10cm with phone book under the legs of the head of bed. An extra pillow is not enough
  • Stomach-acid lowering medications like omeprazole (Losec) or Pantoprazole

Most patients would have relief of symptoms within 4 – 6 weeks. But lifestyle changes combined with medications may need to be continued for 3 – 6 months for long-term control.

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