Even If You Don’t Have Heartburn, You May Still Have Reflux
Most people do not realize there are two different conditions caused by reflux. Gastroesophageal Reflux Disease (GERD) is what immediately comes to mind for most patients, with symptoms of heartburn caused by the backflow of stomach contents into the esophagus. The other condition caused by gastric reflux is Laryngopharyngeal Reflux (LPR). This condition is very common, but it can have very different symptoms than GERD. Identifying which type of reflux symptoms you have is crucial to finding the proper treatment.
Is It GERD?
Classic GERD occurs when acid and digestive enzymes from the stomach travel back into the esophagus. This reflux often takes place when you are lying down, have a very full stomach or eat fatty foods. GERD symptoms are similar to the occasional heartburn that everyone experiences, but it is a more serious condition.
Symptoms of GERD include:
- Heartburn 2 or more times a week
- Heartburn that wakes you from sleep
- Difficult or painful swallowing
Is It LPR?
People with LPR may not experience heartburn at all. Instead, most of the symptoms are related to throat, voice and sometimes even sinus problems. It is estimated that up to 10% of all patients seen by ear, nose and throat specialists actually have LPR as at least one of their underlying conditions. About half of all diagnosed laryngeal (voice box) and voice disorders in adults may be associated with LPR.
Symptoms of LPR include:
- Frequent throat clearing
- Hoarseness
- Chronic sore throat
- Dry mouth
- Difficulty speaking or vocal fatigue
- Chronic cough
- Excessive throat mucus
Lifestyle Changes Can Reduce Reflux
Changing what you eat and drink can greatly reduce symptoms of reflux. Certain foods are acidic, while others stimulate acid production in the stomach or weaken the sphincter (valve) that keeps stomach contents from backing up into the esophagus.
Foods to avoid include:
- Dairy products
- Caffeine (Coffee, tea, soda)
- Citrus fruits and juices
- Foods high in fat
- Chocolate, peppermint, hard candy
Additional Lifestyle Recommendations
Avoid eating late at night – Do not eat or drink anything for 2 to 3 hours before lying down to sleep.
Elevate your head when sleeping – Acid reflux often occurs at night, when you are lying down and gravity is not helping keep the acid from rising out of your stomach. Use wood blocks or bricks to elevate the head of your bed 6 to 8 inches, or use a wedge-shaped pillow to keep your head elevated while you sleep. Your throat should be elevated above your heart, as is with a hospital bed.
Lose weight – If you are more than 20% heavier than your ideal body weight, even a modest weight loss can reduce reflux symptoms.
Avoid alcohol and tobacco – Alcohol increases acid production and directly irritates the throat. Along with numerous other health problems, tobacco also causes reflux.
Medical Treatment
If altering your diet and lifestyle are not enough to provide relief, medication may be necessary. H2 blockers, such as Tagamet and Zantac, reduce the amount of acid produced in the stomach and thus allow the esophagus to heal. For many patients, proton pump inhibitors (PPIs), such as Prilosec and Dexilant, which also reduce stomach acid levels, have proven to be effective. Patients with LPR can have varying results with PPIs. This is partly because LPR requires more aggressive and prolonged therapy than GERD does, due to the delicate nature of the larynx. It may be necessary, in some cases, to take medications throughout your life in order to relieve reflux symptoms. If medications are not effective, surgery may be recommended to tighten the sphincter (valve) that leads from the esophagus to the stomach.
