Laryngopharyngeal Reflux

[gja1000]

Hi Guys. Well, it's my turn to have a health issue. I "think" I have Laryngopharyngeal Reflux - self-diagnosed, of course. I go to my family doc tomorrow. For the past few weeks I have been coughing after I eat, sometimes just a little, sometimes a lot, sometimes not at all. Everyone was after me to go to the doc, but I wanted to have an idea of what it was before I went. I googled, "cough after I eat" and got lots of medical message boards and lots of people had the problem, but no one seemed to get any help from physicians - no one had a diagnosis. So, I ignored it for a while. Yesterday it was really bad, so I put on my medical detective hat. Here is some information from a medical site which explains it pretty well.

Laryngopharyngeal Reflux

Symptoms
Hoarseness
Thick or too much mucous
Chronic throat irritation
Chronic throat clearing
Heartburn
Chronic cough
Cough that wakes you from your sleep
What is Laryngopharyngeal Reflux (LPR)?

Acid is normally produced in the stomach. It is prevented from backing up or refluxing into your esophagus (or food pipe) and throat by a band of muscle at the entrance of the stomach known as the lower esophageal sphincter. If this band of muscle is not functioning well, you can have a backflow of acid into your esophagus and into your throat and voice box, this is called laryngopharyngeal reflux (LPR).This causes the throat, particularly the larynx and vocal cords to swell and become inflamed. In turn, the inflammation creates mucus which is trapped in the voice box area.

Many people with LPR do not have symptoms of heartburn. Compared to the esophagus, the voice box and the back of the throat are significantly more sensitive to the affects of the acid on the surrounding tissues. Acid that passes quickly through the food pipe does not have a chance to irritate the area for too long. However, acid that pools in the throat and voice box will cause prolonged irritation resulting in the symptoms of LPR.

The symptoms of laryngopharyngeal reflux can consist of a dry cough, chronic throat clearing and a sensation of something being stuck in the throat. Another major symptom of LPR is "postnasal drip". The patients often have been told that their symptoms are abnormal nasal drainage or infections, however, this is rarely the cause of the irritation. In order for the "postnasal drip" to cause the complaints described, signs and symptoms of active nasal infection has to be present.

Guys, I have almost every symptom exactly as described here and at other medical sites. It is usually pretty easily treated with things like Prilosec and Zantac. The dosing is different from GERD (gastroesophageal reflux - which I have never had symptoms of) and it is irritated by acid forming foods, so I will have to change my diet. NO TOMATOES - I may die without my beloved tomatoes!!! NO CHOCOLATE - I may double die without my favorite food in the world. NO CAFFIENE - NO COLAS OR CARBONATED DRINKS. I may triple die without my flavored drinks (I do NOT like plain water). I LOVE coffee, diet coke, chocolate. No fried foods which is good, I don't need them. I do want this chronic coughing and feeling like something is in the back of my throat all the time to END, so I guess I'll be a good girl and do what I have to to get it to STOP!

[Janet]

I have GERD but I think having the feeling something is stuck in the back of my throat and coughing would be worse. I mean the medication I take...takes care of it. I wouldn't be very good at changing my diet at all. That would be really hard for me.

I'm so glad you're pretty sure what it is and the Dr. should be able to confirm it tomorrow right? Keeping you in my prayers Gayle....I love you ya know!

[judy]

I also have GERD. I have changed my diet, but can still have coffee, tomatoes, chocolate, etc. I limit myself to two cups of coffee/day now. I discovered that no sweeteners in the coffee help. (???) I think everybody's foods to avoid differ. I have been taking nexium for years for it.

It took 2 years for a diagnosis because I didn't have any heartburn, etc, symptoms. It was all in the throat.l I couldn't talk for long, which was bad for a teacher. I would be exhausted at the end of the day from trying to use my voice.

I would say a few weeks after starting the nexium, I was a different person. I hope your doctor diagnoses you easily, and that your symptoms disappear as fast!

[Janet]

I take Protonox for my GERD. Hope you don't have to take meds for the type of reflux you may have Gayle. Anxious to read the report on your Dr. visit today.

[DianaB]

So sorry, Gayle. There's always caffeine free colas and coffee. You don't get that caffeine rush but at least you get to have the drinks you want. As for chocolate.....hmmmm........I'll have to think about that for awhile. And tomatoes.....you could go with the yellow ones.....I think that they have lower acid. It won't be as bad as it seems once you figure out what to eat!! Hugs!!!

[gja1000]

Originally Posted by judy

I also have GERD. I have changed my diet, but can still have coffee, tomatoes, chocolate, etc. I limit myself to two cups of coffee/day now. I discovered that no sweeteners in the coffee help. (???) I think everybody's foods to avoid differ. I have been taking nexium for years for it.

It took 2 years for a diagnosis because I didn't have any heartburn, etc, symptoms. It was all in the throat.l I couldn't talk for long, which was bad for a teacher. I would be exhausted at the end of the day from trying to use my voice.

I would say a few weeks after starting the nexium, I was a different person. I hope your doctor diagnoses you easily, and that your symptoms disappear as fast!

JUDY! You don't have GERD, you have Laryngopharengeal Reflux (LPR), the same thing I have!!! The most common symptom is voice problems - along with NO heartburn or other GERD symptoms. I don't have voice problems but I have all the other symptoms, (feeling something is in my throat all the time, coughing after meals, clearing the throat throughout the day).

The doctor visit went well, but I could tell the he (probably ~65 years old) didn't really know much of anything about LPR which is very common with doctors who don't stay current with the literature. And in fact the treatment is the same as GERD, with a few exceptions, (e.g., some people are so bad by the time they get diagnosed (see Judy's 2 year saga), they are REALLY bad by the time they get a diagnosis and the recommendation is to dose twice a day with Nexium, Protonics, etc).

The doctor gave me 10 days worth of samples of Aciphex to see if it helps and that is why I think he doesn't know anything about it. It is rare that it improves in that short amount of time. But, I know what it is and I am going to diligently watch my diet and take the meds and see what happens. I'll just call before the 10 days are up and say I am better (whether I am or not) and get an RX for it. Aciphex was on the list of recommended meds in the Journal of the American Medical Association article that I have which outlines the diagnosis and treatment of the condition - so I know the medicine is appropriate. I offered the article to the doctor, but he didn't take it - which is typical of older docs - they don't want you to tell THEM anything. I've never gone to him before, I go to his nurse practitioner whom is ALWAYS reading the latest research. But she is out on maternity leave, so I'll see her later.

I have been a tiny bit better today (less coughing) with just the dietary changes from yesterday and today.

[Janet]

I think I would be afraid to go to an old Dr... But since you know what you're dealing with I'm sure you are more comfortable. I know you already know this, but just be careful diagnosing yourself....you are loved so much!!!!

[judy]

What do you know? I have a different disease than I thought! I was probably diagnosed before the symptoms were common enough for doctors to know what I had. After all, it did take 2 years! Then a lot of Baby Boomers had these symptons, and more research was done. I forgot about the throat clearing. I think I still do it, especially after coffee, but am used to it.

As long as you are on the right medication, you should feel better very soon. Don't worry if this medication does not work. Not all the medication works on everyone. I began on one med, maybe Prilosec, and then that stopped working after a year or so. Nexium does the trick for me.

This doctor sounds annoying. I hope you don't have to find another one, and that you just take the medicine, and feel better.

[gja1000]

Thanks Judy, for the reminder that not every medicine works for everyone. Someone told me that Prilosec and Prevised do not work as well. I'm taking Aciphex and if it doesn't help, then I'll try Nexium. I won't have to change doctors, I will just have to wait till my nurse practitioner gets back from maternity leave. She's a good friend and a very good practitioner and when I give her the medical evidence on what meds/dosage works best, she will give it to me. I imagine she is more informed about LPR than the doctor is, because as you pointed out - it was an unknown when you were seeking a diagnosis years ago. She just graduated about 8 years ago, so she is much more likely to know about LPR.

[DianaB]

I'm glad that you're feeling better. Thank goodness you have an NP that you're comfortable with.

What is it with older doctors that don't listen? Thankfully my doctor is pretty young and I feel like she's pretty much on top of things. I have an appointment for next week to see her.

[gja1000]

Originally Posted by DianaB

I'm glad that you're feeling better. Thank goodness you have an NP that you're comfortable with.

What is it with older doctors that don't listen? Thankfully my doctor is pretty young and I feel like she's pretty much on top of things. I have an appointment for next week to see her.

Old doctors do not listen because they were not taught to listen. They were taught that they know what is best and their knowledge is superior to the patient's knowledge and preferences. That is the way medical education used to be, but it has changed to be more accepting of the information the patient gives. Also, younger doctors are trained to diagnose and manage conditions based on protocols from evidence-based practice. That is, they are trained to read the research and talk to the patients and treat them according to the best available evidence combined with patient preferences and idiocyncracies. The article that I had with me at the doctors office was the medical associations's accepted and published evidence-based protocol for treating my condition. Medical school did not used to teach that - so some older doctors rely on their "superior" knowledge. I have an endocrinologist that treats my low bone density and when I go to see her, I usually have research articles that I take to her and she usually has some for me. We respect each other's knowledge and she relies on the best evidence available to make treatment decisions.

[gja1000]

Originally Posted by judy

I also have GERD. I have changed my diet, but can still have coffee, tomatoes, chocolate, etc. I limit myself to two cups of coffee/day now. I discovered that no sweeteners in the coffee help. (???) I think everybody's foods to avoid differ. I have been taking nexium for years for it.

Judy, I am a bit concerned that you have been taking Nexium for years. Proton Pump Inhibitors like Nexium were initially meant for short term use, about 1 year. The literature does not say specifically how long to take them, but the research does show some adverse affects with long term use. I've copied something from the drug.com site:

People who take proton pump inhibitors such as esomeprazole may be more likely to fracture their wrists, hips, or spine than people who do not take one of these medications. The risk is highest in people who take high doses of one of these medications or take them for one year or longer. The risk may also be higher in people who are 50 years of age or older. Talk to your doctor about the risk of taking esomeprazole.

You can take the H2 inhibitors (Zantac 150, Tagamet, and Pepcid AC - the literature says Zantac 150 is the best), on a long term basis. I think some of the low dose (over the counter) drugs like Prilosec are OK to take on a longer term basis.

[Tiramisu]

Gayle are the samples still working? I have acid reflux that has been controlled by pre acid for 12 years now. Tried prilosec for awhile but it didn't last 24 hours. Only have problems if I eat greasy fried.

[gja1000]

Yes, I think I am a bit better - I am not coughing nearly as much and my throat feels better. BUT - I am trying to lose some weight and last night about 9:00 I was STARVING AND I MEAN STARVING - so I gave up and ate a snack. This morning I can feel mucus in my throat so I'm sure that stirred things up overnight. Bad girl. Bad girl. I won't do that again (well, I'll try not to anyway).

I think it's true Sandy, what works for one person, does not necessarily work very well for the next person. It's so individual.

[judy]

Thanks for the advice, Gayle. I will talk to my doctor when I see him. They used to think nexium caused cancer on a long term basis. It does have a bad reputation!

Have you tried sleeping with your head and chest raised (like on a wedge)?

You probably can snack in the evening. Try jello, or something bland. Bread also don't cause a lot of acid. You will figure it out soon. It is amazing how well we know out own bodies if we think about it.

Isn't aging fun?