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Acid Reflux / GERD Message Board

Acid Reflux / GERD Board Index

Hi Seeking Sunrise,

Your case sounds very similar to mine. Last February I suffered two severe colds within a three week period. After the second cold, the cough lasted for nearly three weeks. Since then, I've had serious problems with my voice box - globus, excessive throat clearing, chronic throat irritation, painful speaking, and pain in my pharynx. An ENT unofficially diagnosed me with LPR, which I thought was odd due to the sudden onset of my symptoms and the fact that I have never in my life experienced heartburn. The only problems I've had with my digestive tract were occasional bloating after eating a heavy meal. I started taking PPIs in the middle of August and about a week after taking 80 mg of Prilosec a day, I started to feel considerably better. After six weeks, I started to feel A LOT better. However, the pain never fully subsided and neither did the other symptoms. Then, I got sick again in October. After about three weeks, I started getting some on again/off again burning in my larynx. I know that this was partially due to my use of a voice supplement called "Clear-Ease XL," which contains proteolytic enzymes to help thin mucus. The result was that it burned my throat so badly that my usual pain was three times worse for about a three and a half week period. I'm just starting to feel somewhat better, even though I continue to feel pain in my voice box, particularly upon speaking.

I think that LPR is PART of my problem, but I certainly don't think that it's the whole problem. I read over several of the articles to which you alluded and you may have provided me with an important piece of the puzzle. It had occurred to me that my pain could have been caused by nerve damage, but I didn't know how to explain that to my doctors, and I didn't think they'd be able to treat it with anything other than conventional painkillers, such as vicodin. I'm going to speak with my GP about the possibility that my condition is "Post Viral Vagal Neuropathy" and suggest a trial of Lyrica. I'll let you know what happens.

Thank you for all the research.
Thank you, Sunrise Seeking, for drawing attention to the possibility that many people diagnosed with LPR are actually suffering from LSN.

After reading your references I believe that I am far more likely to be suffering from LSN than LPR.

Like you, my chronic cough and post-nasal drip began with a cold and cough. The cough was one of the worst I have ever had, and it was followed by a repeated buildup of mucus in my bronchia which had to be coughed out every few minutes. I believe that the mucus originated in my nose, because it was white & frothy with a nasal smell. And it subsided into a post-nasal drip, which is still with me.

My ENT suggested that I might have LPR. I was doubtful. I have heartburn only a few times each year, and I sense stomach acid rising into my throat (typically as a result of a burp gone wrong) only about once a year. Still, he asked me to take a PPI for 6 months, and he gave me a free sample to start with, and two repeat-subscriptions.

I asked if my throat should be examined first, but he advised that it was less invasive to just take the drug. I asked how the PPI worked, and he said that it reduced stomach acid. But, I asked, wouldn't that affect digestion? No, he said, it had no effect on digestion. Did it work, I asked, by reducing the strength of stomach acid or by reducing its quantity? Both, he replied testily.

I don't think that he was lying deliberately. He just didn't want to appear ignorant. But his advice to take a PPI for 6 months, without inquiring about my clinical history, was irresponsible bordering on criminal, since I had been diagnosed with B12-deficiency 6 months earlier and PPIs are known to reduce B12 absorption.

In the event, after researching the side-effects of PPIs, I did not take it. Instead, I took B12-supplements, and this has steadily reduced the intensity of my post-nasal drip, to the point that it is little more than an annoying "frog" in the throat.

I now blame low B12 (167 pg/ml) for the whole succession of effects. First, I was somewhat anemic from lack of B12, which weakened my immune-system and caused my cough to last weeks rather than days. Second, low B12 is known to inflict neuropathic damage. I suspect that my laryngeal nerves, damaged by the flu, were inadequately repaired due to lack of B12. The nose produces several pints of mucus per day, which is normally swallowed unconsciously, but with nerve damage can pool in the throat or be misdirected to the bronchia.

The suggestion here that LPR-like symptoms might actually be due to neuropathy therefore stikes a chord with me. And I suggest that people who suspect they might have LSN have their B12-levels checked, and perhaps try harmless B12-supplements before resorting to Lyrica. One problem is that the "normal" B12-level in the US is set too low, and is less than half of what would be regarded as low in Japan.
@seeking sunrise

I may have very similar problems but the doctor found ateroma (cystis sebacea)on right side of
my glottis and I ll go to surgery very soon...
but my symptoms are very similar to yours ...and everything started with a stupid cold 3 months ago ... there was horrible pain and they said sinusitis and pharyngitis ( that was my first diagnose) but after very strong antibiotics it wasnt any better ,then they sent me to allergologist and he said it has nothing to do with alergies but they can run some test ..then i went back to my otorhinolaryngologist and i ve said that i feel pain deep inside my throat and
he saw it ...I just wonder when they remove it will all my pains go away or no..
I am very worried ...
my symptoms are ...(from priority)
worst thing
1difficulty swallowing things ( pills water my own mucus ...)
2.feeling of something sticking in my throat
3.clearing my throat
4.some changes in my voice hoarseness but not some horrible problems nasal drip ( it is gone now I dont have any idea how or why)

but interesting thing is when i go to bed and i feel asleep I dont feel any of it
and I am happy during my sleep ...sometimes i wish i could sleep 24hr so i dont have to deal with it...I am so afraid that operation will not resolve my problems

can u help me guys ?
ps .sorry for my bad English ...
Five months ago I swore when I finally was symptom free I would create a website providing treatments options and direction on what tests are needed to help educate others like me with this condition. It’s been a long journey and while I am better then I was five months ago, I am not symptom free but hope and pray that day will eventually come. I will try to keep this as brief as possible but as we all know trying to explain to people what’s wrong with you is no easy task nor can you explain in a few sentences. I think it’s important to understand where as I was two and half years ago to where I am today and how something like this can manifest it into other symptoms.

Two and half years ago (36 years old) I started new sales job and had an expense account to go along with it. It was encouraged to wine and dine existing and perspective clients to help generate new business opportunities. I ate big lunches, foods rich in fat and calories, and did all the things that a typical LPR suffer should avoid doing. I began to get a lot of chest pains, difficulty breathing, and phlegm in my throat.. I had a history of heart disease in my family and figured it might be my heart. I went for a Stress test, ENT, EKG all negative. I figured if my hearts is working properly then it’s just gas and it’s not serious. After 4 months my chest pains were infrequent but my throat mucus in my throat increased substantially, so much so I had a hard time swallowing. I had to spit mucus out every few minutes (Yes it was that bad). I remember waking around my house with garbage bad that I used to jokingly call my Spittoon. I also got the typical lump in throat feeling and gained about 15lbs. I started to snore at night and used to wake up choking and feeling I couldn’t breathe. I knew then something wasn’t right. I got my lungs checked out and they were clear. I went to ENT, he looked looked down my throat and saw a lot of mucus. He gave me a food an allergy test, CT scan of my sinus to rule out post nasal drip as I have a slight deviate septum. All negative. He then gave me a FESS and Strobe test where you swallow a green dye. The liquid that was swallowed came back up and also pooled in my larynx. The technician told me I had LPR and I needed a PPI. At the time, I really didn’t get a clear understanding of how that test was interpreted and quite frankly I don’t think the Dr. or Technician really fully understood either. They could not give me an intelligent answer as to what was specifically causing the liquid to come back up. I mean how could it go into my stomach and then come up all in seconds? In any event I was prescribed 40mg of Nexium and was told to take it 30 mins before breakfast once a day.

After three months of Nexium I felt better. My mucas was almost gone and no more lump in throat. I had my life back. The pity of it all was that the doctor did not educate me on what I should be doing to minimize this for happening again, nor did he have any plans of weaning me off the PPI. Shame on me as well for not doing my own research on LPR, but like I said I was feeling pretty much symptom free except for some slight mucus in my throat once and a while.

Fast forward 18 months. I was 15lbs heavier than I was 18 months ago and while I didn’t have crazy lunches anymore my diet still was not a healthy one. I started to get a lot of chest pains and difficulty breathing. I said to myself it can’t be LPR, I am still taking 40mg Nexium. I schedualed an appointment with a heart Dr to get another (EKG,sonogram, and stress test) all negative. I figured it was my diet. I needed to lose weight. I was snoring and still occasionally waking up in the middle of the night gasping for air. My wife also told me I had a lot of siliva in my mouth when sleeping. My brother had just lost 35 lbs by eating no more than 50g of carbs a day and in 3 months and his blood work came back looking great. So over the next 4 months I went on low a carb diet. I lost 25lbs, my slightly fatty liver, cholesterol, and trygcylorides all became normal. While I cut out a lot of the sugar I was still eating a lot of meat and fat. I started to feel like my throat was closing up. All of a sudden out of nowhere my throat got really tight like someone had their hands around it. It wasn’t the typical lump in throat type feeling I had a couple of years ago. This was intense. After 10-15 minutes it would go away. This would happen 8-10 times a week and I was also getting more mucus in my throat, even though it wasn’t nearly as much as I had a few years back it was still enough to make me want to clear my throat alot.
I realized even though I was taking Nexium every day it had to be LPR related. I began to research LPR symptoms and treatments extensively. I went on a strict low fat diet and avoided foods that could loosen the LES. I also made sure to elevate my bed and to wait three hours before bedtime. I tried stopping Nexium cold turkey and substituted Nexium with Zantec, digestive enzymes, and Align. I didn’t know about the acid rebound effect stopping a PPI could cause and I was not success and had to get back on PPI’s.
At that point I realized I needed further testing to understand what was going on. I saw a GI doctor which preformed an Endoscopy. He told me my esophagus looked normal, no signs of damaged, no eosinophiilc esophagitis and the tightness feeling were in my head and I need to relax. I told him if your throat felt like mine you would be stressed out too. (What a Jack ass.) I didn’t have stress in my life except this illness. I did try meditation and hot baths which helps calm down but didn’t make the tightness in my throat go away.
I then went to a different ENT from the incompetent one I saw two years ago. He looked at my throat and told me it looked slight swollen but I did have a lot of mucus pooling. He told me diet was important and to follow it by the book which I knew anyway. He said the lump in my throat was because some people are just more hypersensitive to it than others. He also mentioned PPI’s don’t block pepsin and that was the cause for LPR suffers and not just acid. He wanted me to get a barium swallow to ensure I had no obstructions or abnormalities in my esophagus. So I did. It was negative, everything looked normal.
OK, well having a hypersensitive UES doesn’t make me feel any better. He mentioned Pepsin could be the root cause. So I began researching that and found out if Pepsin is indeed the cause the only thing aside from surgery that could help is by taking 10ml Galviscon Advance before meals and at bed. (UK version of med)
I used Gaviscon advance + low acid diet for a month. Went back in for a checkup and my mucas pooling was a lot better but I still had tightness. He told me I am going to have to live with the tightness and said I should be happy my throat is much improved.
I was utterly frustrated and decided to get another opinion as I could not imagine my life on this planet with tightness in my through for the rest of my life. While waiting for my appointment date for the new ENT my tightness suddenly went away. Could it be? No more tightness? Yes it’s gone but wait I have a new symptom. I have trapped gas in my throat and chest pains. Gas in throat? WTF. How can someone have gas in their throat? After further research it seems people who get the Nissan surgery have this as a side effect to the procedure (Something to do with the one way value it creates )

Anyway, I get my appointment with the new ENT and upon my throat examination which previous Dr. said was normal, was in actuality false. MY larynx was still swollen and one of the folds were not resting in the down position. The instrument used was incredible. It looked like an HD picture of my throat. You can actually see the bubbles in my mucus. It’s as if the other ENT’s were looking at my throat through coke bottles and I got a print out of my throat for my own records, something other doctors would not disclose to me. It was then recommend I do a manometry and PH test. The Manometry showed my UES mean residual pressure was elevated and there was dyssynchrony with my pharynxand . In other words my UES was closing prematurely before the pharyngeal contraction. However, my LES hypotensive(ever so slight relaxed) was functioning normal(Meaning it was closing and opening when it was supposed to). My 24 hour PH Test should I had one episode during the day that reached my throat. One thing noticed when I had that god forsaken probe hooked up to me is that the only time the ph went down under 4 is when I burped. When I say burp I mean an ever so slight quite burp. Seems like it happened after I drank water which then made me burp and seconds later made lower LES sensor go down.

So 2.5 years ago when I took that FEES test that why the liquid splashed back up and that’s why my throat felt tight. Based off the Manmotry, my UES is out of whack and what causes the swallowing mechanism? Ding Ding Ding. The Vagus Nerve. My PPI was switch to twice a day Prilosec 40mg but I could not tolerate it as I was getting Nauseas. I then went to Prevacid 15mg twice a day to get better coverage vs the typical 40mg Nexium once a day( as ppis only work for 12-16 hours),I also take domperidone 10mg 3x a day to help empty stomach faster and stimulate moltility, and continued my low fat/acid diet. After five months my throat Is completely normal! Hurray. Well not so fast.
Gas in throat and chest pain is still present. I was put on amitritlyne 10mg before bed to stimulate that Vegas nerve. I was told it has been prescribed to many patients who have had the reflux surgery who get that trapped in throat gas feeling. The drug has been slowly ramped up to 25mg and is has almost eliminated trapped gas in my throat it but I still have chest pains which come and go throughout the day. They are not fun.

I have done further research and they are classified as NCCP’s Non Cardiac Chest Pains and guess what the treatment is for that? TCA’s or SSRI’s. If you look for a book called The Forgut: Function-dysfunction and look at page 57 you will see what the drug treatment plans are for esophageal pain are. For the life of me I can’t say with a 100% certainty that these pains aren’t gas related but I don’t think they are. I think they are related to my Esophagus dsymotility. The NCCP symptoms happen quite often in a molity disorder called Achalasia in which the LES remains to tight not allowing food or acid to pass into the stomach in turn food ferments and acidis trapped above the LES causing (NCCP)chest pain, regurgitation and other fun symptoms. The bright side is there’s an easy fix as you can get a botox injection in the LES and loosen up the muscle but as said before my LES is working as intended and it’s the UES that’s the problem. Some people who have continued tightness in UES and don’t have any motility disorder could get a botox injection in to alleviate the tightness. I did not need this thankfully.
In my case I had acid/pepsin issues causing my throat LPR issues or so I think. The million dollar question is this. Are my reflux issue caused by the malfunctioning UES/Swallowing mechanism or is it two separate issues?
Something else this thread made me wonder about with talk of drugs that help treat NP conditions like Fibromyaliga. When I was a teenager I came down with mono. After that for about 2-3 years constantly got sore throats. I was on antibiotics every other month. The idiot GP doctor told me everything was normal and I just need to take antibodies as I was a teenager and got sick due to my age. My mom finally took me to an ENT. He told us that Dr. should not be practicing as my tonsils were badly infected and needed to be taken out immediately. After getting those out I didn’t get sore throats anymore. Over the course of the next five years I had two stressful times in my life. During the first time I had low grade fever for three weeks and they though I had leukemia. Turns out it was Epstein Barr. Next time I got a relapse. Thankfully it never turned into Chronic Fatigue and for the next fifteen years I never get sick that bad anymore but it makes you wonder if there was any damage done back then or if any of this is related to the Vagus nerve and my swallowing motility issue
How many people out there went for an endoscope, barium swallow, FEESS, 24 hour PH test all with no diagnosis? I wonder how many of you out there went for a High Def manometry to see if you have something screwy going on with your swallowing. Many GI doctors who perform manometrys do not measure UES and are only concerned with the LES. The drugs mentioned in this thread can hold the future for many people like us who are experiencing crazy symptoms in our throats because ultimately unless you have a physical abnormality in your throat or esophagus, it’s something related to that darn vagus nerve.

Just like research into chronic coughing there has to be more Dr. out there to look at some of these non-specific esophageal motility disorder stem from the brain but have no clue on why they act the way they do.
I am probably going to have to increase my dosage of TCA or try a different one if my NCCP pains doing get better. I should mention the side effects I am getting from the amitritlyne are constipation and jitters(like a caffeine rush) that happened between 10:30am every day and last for 15-20 mins. I hope and pray I do get relief and pray for many of the sufferers out there with LPR symptoms to finally get their lives back!
For the people who are on PPI's and have mucus/throat clearing problems have you gone for a manometry? If no,t how do you know if your LES and UES are working properly? As I mentioned earlier in this thread my LES was working properly and only slightly relaxed but had a screwy UES. I had severe mucus in my throat which was only eliminated by ppis along with low fat low acid diet and avoiding all food that would loosen LES and sleeping on an incline. If your mucus is caused by acid or pepsin you will never get rid of it without avoiding high acid foods. I am living proof of that.

The point I am making is people like us have complex problems. Doctors treat us for one thing but not multiple causing our frustration of not being cured of all our symptoms. We may have a nerve issues + LPR + motility ..... My LPR/GERD was probably resulted in damaging my vagus nerve which in turn gave me a motility issue. But lets just say I refluxed twice a week into my throat. Thats all it could take to prevent my nerves to heal or better yet over time continue to be damaged. So in turn I may have just had reflux and now I have LPR, vagus nerve damage and a motility problem. Symptoms manifest and things getting really complex to properly diagnose.

Dont stop one drug unless youve taken tests to properly diagnose what the root causes are.

I looked it up you put that stuff in your mouth and cheek. I do take digestive enzymes which contain those ingredients but its pill form. They are really ment to help breakdown food in your stomach. I would never put that stuff in your mouth. No wonder it was burning after a while.[/QUOTE]

That's correct. They are primarily meant to break down protein. Since mucus consists of proteins they break it down pretty quickly. But don't ever use it or you'll make whatever throat problems you have worse. I'm surprised more people who've taken it haven't complained of this problem. The company advertises it as "soothing the throat and ears." Scuba divers and pilots supposedly benefit from it since it clears the ears. It also contains slippery elm, but you would be better off just using slippery elm lozenges by themselves. They help quite a bit, but the relief doesn't last long. You could take up to ten a day and it wouldn't hurt your throat like the Clear-Ease does. I would have been better off just using Tylenol or Vicodin before I realized that Lyrica and Elavil could treat the problem.

Another product I use is called "Vocal-Eze." It's a throat spray with glycerin and aloe vera. It loosens the vocal cords and coats the throat. I use it before I have to lecture and it helps keep my throat lubricated. There are other vocal sprays, but this one is the best.
I had my ENT appt. today and I just want to try and help others who are having this extreme or excessive mucus dilemma. My ENT prescribed a new cortisone/steroid nasal spray for me as the PND and the mucus in the throat, globus feeling were scaring me to death and driving me crazy. I had actually developed a click in my throat on one side when I swallowed because of the excessive mucus and clearing of the throat all day and night. So it is called "Omnaris" and I spray two sprays in each nostril once a day. It is a miracle! I just started it when I got home and have not had to clear my throat for three hours now. The clicking feeling is not as bad and the globus feeling is easier to deal with now, it has become minimal. This is just one day's use guy's and gal's! So mention in to your ENT's if they have not said anything about it previously. For me it is like a miracle, with regard to the excess mucus issue. :-)

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