Gastroesophageal Reflux Disease (GERD) occurs when there is backward flow of stomach contents up into the esophagus. A related problem, addressed by ENT’s and gastroenterologists, is Laryngo Pharyngeal Reflux (LPR). Normally, the lower esophageal sphincter (LES), a ring-shaped muscle at the opening of the stomach, acts as a valve. This valve prevents backward flow of food and acid from the stomach. If the LES opens at the wrong time, the acidic contents of the stomach are allowed up into the esophagus, causing irritating symptoms and rarely more serious problems. The symptoms of LPR manifest when the acidic contents reach higher, into the back of the throat (Pharynx) and voice box (Larynx). This is a very common problem and is sometimes termed “silent reflux” due to lack of heartburn symptoms.

Symptoms
LPR can present with many symptoms. Typically it is one or a combination of the following recurrent symptoms:

• coughing (typically worse at night or on awakening)
• hoarseness or voice changes
• excessive throat secretions (can feel like post-nasal drip)
• recurrent sore throat
• difficulty swallowing
• feeling of a “lump in the throat”
• constantly clearing the throat

These symptoms can occur at any age, including in children. Heartburn can also be present, although this is found in less than 50% of patients with LPR.

The treatment of acid reflux consists of 3 stages:

1. Changes in lifestyle
2. Medication
3. Surgery

Changes in lifestyle
This is by far the most important part of the treatment. Often, this alone helps relieve the symptoms of reflux. Try following the next steps as closely as possible (listed in order of importance).

• If you smoke, Quit
• Do not eat anything for at least 3 hours before lying down (an empty stomach is less likely to reflux its content into your esophagus).
• Avoid foods containing acid such as orange juice (and other citrus products), lemonade, vinegars, and tomato products (including tomato sauce), especially before bedtime.
• Eat small meals that are high in protein and low in fat.Other foods to avoid: chocolate, caffeine, alcohol, and mint products. These tend to worsen reflux.
• People with food sensitivities should also avoid their reactive foods which could cause indigestion or inflammation of the digestive tract.
• Raise the head of your bed 3 to 4 inches off the ground using bricks or blocks of cement (pillows will not work, as they will only bend your neck; the entire upper half of your body must be angled so that your upper body has an incline, preventing stomach acids from rising). A wedge, which can be purchased, is a good alternative.
• If overweight, lose weight.

This may imply a significant change in your lifestyle. However, once your symptoms have resolved (this may take up to 6 months) you may start reintroducing the things you liked (e.g. coffee, orange juice …) one at a time. If your symptoms recur, you’ll know that you need to stay away from those particular things.

Medication
Over-the-counter antacids, such as Maalox or Tums, provide marginal benefit, since they are only effective for a few hours. In cases not responding to lifestyle changes, a prescription medication may be recommended (such as Aciphex, Nexium, Prevacid, Prilosec, or Protonix). These may need to be taken once or twice a day, for an initial course of up to 6 months.

Surgery
This option, though very effective, is rarely necessary and is reserved for the most severe, refractory cases. It involves physically narrowing the lower esophageal sphincter to minimize reflux of stomach contents. Your doctor will discuss these options with you if necessary.