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Acid Reflux / GERD Message Board

Acid Reflux / GERD Board Index

Re: What is Lpr?
May 7, 2006
GERD is reflux that stays in your esophogous. LPR is laryngeal reflux - the acid escapes your esophogous and gets into your throat, causing a whole separate set of symptoms. Typical symptoms can be 1 or more of the following: Chronic cough, Chronic Throat Clearing, Constant Sore Throat, Feeling of "Lump" in Throat, Swallowing Difficulties. Another indirect diagnosis is when your dentist tells you that your enamel has suddenly worn off your teeth rapidly.

LPR is known as either laryngeal reflux or laryngopharyngeal reflux and there are a few other variations as well.

Most PCPs have not heard of or seen LPR. Even many local ENTs have never heard the name of it - it's better heard of in university teaching hospitals, that see everything.

Diagnosis is both visual and indirect. Most doctors feel that simply observing the larynx via scoping, (and finding that the larynx is really swollen and red) is sufficient diagnosis. You don't need any special 24 hour probes or monitoring tests, which are worthless for LPR. You just need an ENT to stick a scope up your nose and down your throat - this is an in-office procedure, doesn't hurt, and involves a inhaling a numbing spray into your throat. Uncomfortable - a little, painful - no.

If you have LPR, 1 PPI a day will not get rid of it. You're going to need 2 PPIs a day, indefinately.

There are 2 ways that LPR may occur. It has been thought that stomach content refluxes into the esophogous and some makes it up into the throat due to a weak upper esophageal spinchter. However, this is a theory only. There is another theory that is just gaining attention now - which is that the larynx is actually expressing acid itself, which may be a malfunction (It was previously thought that only the stomach expresses acid). The larynx expressing acid would be a problem because the larynx doesn't have any natural protection against acid - hence the reason for constant throat clearing and coughing.

Luckily, PPIs (proton-pump inhibitors) also suppress the acid formation in the larynx as well as the stomach. A proton pump is the biological mechanism in our stomachs (and possibly larynx) for pumping out acid - our acid is just protons - which are Hydrogen ions). And if you remember your high school chemistry, a hydrogen ion - rich environment is an acidic environment. Our stomach normally have a pH of about 2 (whereas a neutral pH is about 7) - so you can see that any acid that gets out of our stomach and into our esophogous would do some pretty heavy damage, because the esophogous normally has a pH level of around 5-6 I believe (it may be a little lower).

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