A man in a mustard-coloured hoodie sits on his couch with a cup of tea, holding his throat in pain due to acid reflux
Do you sometimes have a sore or itchy throat? Or excess mucus in your throat so you need to clear your throat often? Maybe a persistent cough, or a raspy voice. Or asthma-like symptoms (chest tightness, wheezing, or difficulty breathing)? But you’re pretty sure you don’t have an allergy, cold, or any other respiratory condition?
You may have had allergy medications, cold and flu medications, or antibiotics, but the symptoms continue.
What could it be?
Reflux
You could have laryngopharyngeal reflux (LPR). LPR is like gastro-oesophageal reflux disease (GORD), but it affects the throat and larynx (voice box).
Both LPR and GORD can happen when stomach acid escapes from the stomach. It can travel up the oesophagus (the tube leading from the throat down to the stomach).
Stomach acid is a strong acid. On the pH scale that measures acidity, strong alkali is 14, neutral water is 7, and stomach acid has a pH between 1 and 2. That's acidic enough to damage strong materials such as teeth and bone.
GORD mostly affects the oesophagus. It produces symptoms such as heartburn and nausea.
With LPR, acid reflux makes its way even further up into your throat and voice box (larynx). It even gets into the nasal passages in some people.
The acid can cause the oesophagus, throat, or voice box to become red, inflamed, and irritated. If it continues for a long period of time (is chronic), it can cause other more serious health effects.
Causes
LPR is caused by stomach acid being where it shouldn’t be. Food that is swallowed goes down your throat, through your oesophagus and into the stomach. Just above where the oesophagus reaches the stomach there is a round muscle called the lower oesophageal sphincter that is normally closed but opens when you swallow food. If this muscle doesn’t close or doesn’t close properly, stomach contents including acid can leak back up into the oesophagus. This reversed flow is called reflux.
Symptoms of LPR
- a raspy voice
- a sore throat
- a red, inflamed, irritated voice box
- a feeling of mucus being in the throat and the need to clear the throat often
- asthma-like symptoms (chest tightness, wheezing, difficulty breathing)
- post-nasal drip – where mucous from your nose or sinuses drips down the back of your throat. It can sometimes cause a cough.
- a cough that won’t go away
- a feeling like there is a lump or blockage in the throat
- difficulty swallowing.
If you have symptoms for two weeks or more, you should see a doctor. If LPR is not treated it can lead to:
- swelling of the vocal cords
- ulcers of the vocal cords
- lumps (granulomas) in the throat or vocal cords
- chronic laryngitis
- worsening of asthma, emphysema, and bronchitis.
Diagnosis
Your doctor can often diagnose LPR from your symptoms and by examining your throat and back of the voice box for swelling and irritation. Tests are not always required.
If your doctor feels that testing is needed, they may use:
- a swallowing study where you swallow barium that coats the lining of the throat, oesophagus, and stomach. This is so the lining can be highlighted on an X-ray, showing how food moves from mouth to stomach
- flexible laryngoscopy—examination of the voice box and throat using an endoscope (a thin tube camera)
- an endoscopy—examination of the inside of the oesophagus and stomach with an endoscope
- an oesophageal pH test—a thin tube is put into your oesophagus (through your nose) and the tip is placed just above the lower oesophageal sphincter. The tip can sense acid, and the acid levels are recorded on a special recorder that the patient wears.
Treatment
LPR often responds very well to lifestyle changes such as:
- avoiding acidic, fatty, and spicy foods
- eating 2 – 3 hours before going to bed
- eating more frequent, smaller meals rather than large meals
- losing weight
- avoiding alcohol, tobacco, and caffeine (alcohol can cause the lower oesophageal sphincter to relax, allowing reflux to occur)
- not clearing your throat—even though you may have a strong urge to clear your throat, avoid doing it as much as possible as it only irritates it more
- raising the head of the bed slightly (15-20cm) so you sleep with your head and upper body slightly higher than your lower body, helping to avoid acid refluxing back up to the throat
- don’t wear tight or binding clothes
- trying to avoid becoming overly stressed—learn some stress management techniques.
Medication
In mild cases, over-the-counter medication such as antacids may help reduce symptoms.
In more serious cases, your doctor might prescribe stomach acid reducers and proton pump inhibitors to reduce the amount of acid your stomach produces.
Surgery
In severe cases surgery may sometimes be required.
Support for lifestyle changes
- Health and Wellbeing Queensland
- Adis – 24/7 support for people in Queensland with alcohol and other drug concerns
- Quitline