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Acid Reflux / GERD Message Board


Acid Reflux / GERD Board Index


Hi all.

Just wanted to post some cool info I found out for those of you suffering from LPR.

My backround quick for those new to this forum: I have been experiencing excessive mucous/phlegm in my throat for several months. Its pretty stubborn, as I usually have trouble bringing it up or moving it down. I cant typically get much, and it just always feels like its there. I also have excessive throat clearing, the feeling of globus (something stuck in throat), feelings of choking, sore throat in morning, etc.

I went to an ENT who did two scopes over a course of a couple months. He suggested this "silent reflux", also know as LPR (Laryngopharengeal Reflux). He started me on Zantac, which i came to found out is not a strong enough drug for this type of reflux. (the PPI's are the drug of choice for this). I was then put on Protonix 1x day for 5 weeks. I did some research on my own in ENT medical journals and found that 1x day is not enough for patients. A higher dose of 2x day of a PPI for 6 months, which I have now been on for one month. Up until this point, I had not seen any significant improvement in my symptoms (except for some waxing and waning which I wasnt sure if was the meds or the cyclical nature of the symptoms).

I finally got in to see a specialist of LPR this Friday. I went in blindly, not telling them much about my history. (I wanted to be seen with fresh eyes and not lead them to a diagnosis). He gave me a thorough exam and the Nasopharyngolaryngoscopy. He spent almost 10 minutes down in my throat looking all around, having me do certain exercises.

The first thing he said was, "You have bad acid reflux." He then went on to explain Silent reflux (LPR) and told me that my symptoms are synonomous with this disease. Thankfully, I have no lesions.

He explained that there is a valve in the stomach that turns off in your stomach to block acid from going back up. In people with both GERD and LPR, the valve does not close properly, therefore allowing acid to backflow. In people with GERD symptoms, the acid is mainly affecting the areas to cause heartburn and typically thought of symptoms associated with the word "reflux." However, with LPR, the acid flows all the way up into the throat and on to the delicate larynx and vocal cords.

Reflux medicines do not block ALL acid supression (usually its only around 40%). It takes a significant amount of acid to cause GERD symptoms like heartburn. So when someone takes a reflux medicine, the suppression is usually enough to stop enough of the acid to stop the heartburn symptoms pretty quickly. This is why people with GERD get relief so much faster than people with LPR. You see, as opposed to the amount of acid needed to cause heartburn ( alot), it only takes a teeny tiny amount of acid to cause the terrible symptoms of LPR. So even if most of your acid is being surpressed by the meds, it would only take 60 seconds of reflux once every 3rd night to continue the damage and symptoms of LPR. Pretty amazing, right?? The vocal cords and larynx are SO sensitive, they are SO much more easily damaged and affected by ANY acid.

With LPR, The vocal cords and voice box are damaged by the acid. This causes all the throat symptoms that people often complain of. What I learned though, is that there really isnt all that much more mucous than normal. In actuality, you are feeling the sweeling and inflamtion of the larynx/vocal cords which makes it FEEL like there is either a lump or mucous in your throat. Now there may BE mucous in your throat, but it is simply your body's way to compensate for the irritations. But what i thought was pooling mucous, was not. The doctor told me that during the scope, he saw some mucous on one of V.cords. He told me to swallow, I did, and he said it went RIGHT down. Nothing is pooling there.

He asked me, "When you fight and fight to bring mucous or the lump up, and you succeed in bringing up some mucous, do you feel like 'AHHH that is so much better?'" I said, "NO!" He said, "exaclty...the mucous isnt your problem."

So basically, here is the protocol. 4-6 months of TWICE a day PPI. It takes just this long for even the acid to be surpressed enough and for the healing to begin.

Also, YOU must STOP clearing your throat. No matter how much the urge is there. He said one of the keys with this is, People dont realize that clearing your throat just aggravates the problems, and can even prevent healing. Its like picking a scab. Whenever you feel the urge to clear your throat, drink a glass of water.

He also suggested some of the other things we all know: no caffeine, no eating 4 hours before lying down, raising the bed or wedge pillow, etc.

Oh and Zoot: I asked him about times of taking meds in relating to eating. He said it really didnt matter, in fact it may be good to even take it WITH food. I asked him about the 30 minute deal, and he said that related more to GERD, but he said he didnt even believe that theory and has not seen any real reseacrh to back that up. Again, thats just his take?? Thought I would pass it on.

I know I have so much more to tell you all. Maybe if anyone has questions, I can answer that way. This post is gettingway too long.

Hope some of this was helpful!

PS- Also some not so good news for those of you who have been on long term PPI High dose therapy (2x a day or more): Research shows that 50% of patients still have symptoms after 6 months!
Hey Zoot,

I have been wondering how you are doing.

I have hit a few road bumps with my meds. Had to go off for a few days (long story, but my first idiot doctors office dropped the ball). Anyway, I am stable, like you. I still have symptoms, but they arent getting worse. Thing is, not necessarily getting better either. I dont think they are as bad as they were on initial onset of meds, but I would think i should be ALL better. They are still there at times enough to annoy me.

Do you think being off the meds for a few days is enough to revert back to old damage. I am now back on, and still have symptoms same as before, but was wondering how that worked.

My prob is still mainly the excess mucous (feeling of phlegm), globus, irritation, etc.

What other health stuff are youealing with? Are you ok?
Ginger,
Wow, I really enjoy your posts. I love how thorough you are!

I still have alot of questions, as what the specialist told me conflicts with some of this. But I think most of the doctors play a guessing game most of the time, and hope the meds will prove them right.

I too have no nasal or sinus symptoms. Every once in awhile I can blow my nose, but honestly I dont think its anything other than what an asymptomatic person does. I certainly dont have sinus headaches or cold symptoms, per se.

When my symptoms first started, which was several years ago, i would have the mucous/globus feelings for a short period and go away. It would disappear for a long time, long enough for me to never think of seeing a dr. It would be a couple years sometimes. Then the last couple of years, the episodes were closer, longer, and more annoying. Then, this past fall, they came and never went away. In all the years, I always called this "problem" post nasal drip. I had never hard of or suspected LPR/reflux, and assumed the muscous MUST be coming from my nose. I mean, where else would it be coming from?? Mucous doesnt just 'show up". When I saw my first ENT in Nov 2004, and the dr told me "reflux", I was skeptical.

So does the article actually say that the normal nasal secretions mix with the mucous to make the phlegm, or is that your theory? My first doctor told me there was no mucous--the second doctor told me there was mucous, but not alot--the specialist told me mucous may be there, but what I am really feeling was the swollen larynx.

Are you able to bring up alot of mucous? Most times, I cannot bring up much. This has been strange for me. My fiance has COPD and always have an overabundance of mucous and is able to bring up whatever is in his throat. Yes I struggle and stuggle to bring up what I "feel" is there. When i CAN bring stuff up, its like little globs of clear gel. Like I had said in my one of my other posts: I actually had a scope at the moment I "felt" the accumulation of mucous, and the doctor told me at that time, there was no pooling of mucous, and even when he saw a little mucous of one of my V.cords, he just had me swallow and it went right down. This is when he told me most of what I am feeling is just the irritated larynx from the acid. Confusing, right??!

By the way, I tried the irrigator too, as well as several other nasal cleaning methods, none of which made a lick of a difference. I basically knew they wouldnt, since I never suspected my sinuses, but tried it anyway.

Tell me more about yuor symptoms? Are they constant or do they wax and wane? Do you have them every day? Are they worse or better when you eat?

To answer your questions: My symptoms besides the globus, mucous, and throat clearing are BB, sore throat upon wakening that goes away immediately, and sometimes feeling that food/pills get stuck in my throat.

It is great talking to you. Thanks for posting!
Hello everyone,

I had my tonsils out in october, and since then (well, since recovery) my throat has felt swollen, feels full of mucous and i'm constantly clearing my throat. I also have a bad taste in my mouth and bad breath. In addition, my throat feels particularly uncomfortable when i talk, and certain words 'catch' in the throat. I have seen ENT specialists (UK NHS so obviously no help) and they said that its just that having such large tonsils removed has resulted in a change in the shape back there, which feels foreign, and the swollen feeling is just scar tissue, nothing can be done.

that all seems to make sense, but it just doesn't seem to fit. the discomfort is really getting me down. I feel like i went through the severe pain of the operation only to have the discomfort in my throat worsen, and nobody takes it seriously!

Reading some of the posts in this thread, I thought maybe the tonsils were swollen due to LPR? Now that theyre gone, maybe I'm experiencing the other symptoms more? I used to have tonsil blobs, whatever theyre called, and i still seem to be bringing (admittedly much smaller) ones up in my phlegm.

help! am i crazy or was the tonsillectomy a complete waste of time? is there any way to fix this feeling that I have something caught in my throat?

thanks for ANY help!

Matt





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