When you think of chronic cough, throat clearing, and hoarseness do you think of reflux? Probably not, but for many people, GERD cough can occur when acid reflux reaches the upper airway, resulting in a condition called LPR. Read on for helpful tips for managing this condition.
What is GERD cough and LPR?
More and more evidence is illustrating how acid reflux can escape the stomach and reach the upper airway. This condition is known as laryngopharyngeal reflux or LPR. Sometimes doctors will refer to this condition as extraesophageal reflux disease, or EERD. While we tend to think of acid reflux as heartburn and indigestion, other manifestations can develop. Acid can actually become “dissolved” in the air we breathe, causing problems in the throat and even the lungs. Hoarseness, chronic cough, throat clearing and worsening asthma are only some of these. Not everyone with symptoms from LPR have the usual GERD symptoms. Sometimes these throat symptoms occur alone without the discomfort from typical reflux.
Why LPR Symptoms Occur
The lining of the airway, the pharynx, larynx (voice box), and lungs are not equipped to deal with even very low levels of acid. To make matters worse, reflux contains enzymes in addition to acid from the stomach. Enzymes are chemicals in the stomach that are involved in the digestion of food. Without enzyme activity our food couldn’t be digested and crucial vitamins and nutrients wouldn’t be absorbed into our system. However, these “helpful” enzymes can cause tissue damage and LPR symptoms when displaced into the esophagus and upper airway.
One of these enzymes is called pepsin. The stomach is designed to handle pepsin, but the airway is not and can be damaged from pepsin exposure. Acid in the stomach activates pepsin to “digest,” so it is easy to imagine the damage that can be caused by both of these agents together! Another enzyme, Trypsin, also plays a role in this process. Once the airway is damaged, the healing process is often impaired if acid continues to reach the airway.
Tips for Managing LPR Symptoms
What can be done to avoid or repair damage in the airway? Can LPR be reversed? The answer is “it depends”. Lifestyle changes are the first line of defense, as well as acid suppressive medications. Simple changes that will help LPR are similar to advice provided for GERD:
Avoid certain beverages
Avoid beverages that seem to trigger symptoms or make them worse, such as:
- Coffee, tea or beverages containing caffeine – which relax smooth muscles (upper and lower esophageal sphincters)
- Carbonated beverages – which tend to expand in the stomach and put pressure on the lower esophageal sphincter.
- Alcohol – which relaxes the sphincters
Avoid eating 2 – 3 hours before bedtime
When you lay down, gravity works against keeping food in the stomach. A full stomach and a supine position increases reflux. Placing blocks of wood under the head of your bed may help alleviate nighttime reflux.
Avoid your triggers
Avoid foods that trigger your symptoms or make them worse, such as:
- Citrus fruits, such as oranges and lemons
- Tomatoes and products that contain tomatoes, such as tomato sauce and salsa
- Mint or peppermint
- Foods high in fat or spicy
- Onions and garlic
- Smoking may increase acid reflux by increasing the acid secretion and by relaxing muscles that help keep acid down.
Avoid Tight Clothing and bending over
- Don’t wear clothing that is tight around the stomach.
- If you’re overweight or obese, take steps to lose weight with exercise and diet changes.
The consequences of reflux disease
Reflux disease can have serious consequences. Often the mildest and best controlled symptoms can be the only indication of a more serious condition. Be certain to talk with your healthcare provider and be active in the assessment and care of your condition. Be aware of any changes should your condition worsen. If you are not able to control reflux disease through lifestyle and use of periodic medication, consult with your doctor about other therapeutic advances that can bring relief and greater quality of life.
If you feel you need to take heartburn medicine for more than two weeks, see your doctor. The FDA advises that proton pump inhibitors be used for a 14 day period.
If your symptoms are longstanding, or if you are not certain that your symptoms are caused by reflux, ask for specific testing. New technology enables your physician to test acid levels in your airway with a tiny sensor that sits in the back of your mouth. A small (about the size of thin spaghetti), soft probe holds the sensor in place. After 18-24 hours your physician can graph your pH levels to evaluate the frequency and severity of your condition. This enables more precise treatment, and avoiding taking medication until you are certain LPR is responsible for your symptoms.