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!
Last edited by Neverenoughslee; 03-05-2005 at 12:49 PM.
The one question that occurs to me..is he claims it takes 4-6 months for the acid to be fully suppressed? I cant imagine any reason that would be? all the drug info i have read actually claims that acid suppression doesnt increase after one week of taking the drug,
Did he say anything about combining drugs?
Last edited by zoot_suit_brian; 03-05-2005 at 12:58 PM.
Maybe I stated thet wrong. I dont think it takes 4-6 months for the acid to be surpressed. I think it takes that long for the acid to be surpressed long enough for healing to occur. Like you said, the surpression begins right away. Does that make more sense? You know me, I am no doctor, and I was fed so much information, I was bound to misunderstand and forget stuff. Sorry.
I did ask about combining drugs. he suggested that after I use the PPI for that amount of time and if I dont get results, sometimes combining the PPI high dose and H2-Antagonists low dose (i think thats what they are called) may help be effective for some patients. he didnt go into much detail, but is that what you mean by combining drugs?
Thanks Zoot. It helps to have someone else who is going through this to bounce this stuff off of.
Oh and I just also wanted to add to those who have been diagnosed with LPR and are only on PPI once a day- why that is useless.
PPI's only surpress acid for a certain number of hours. If you are only taking one dose a day, it wears off and you begin refluxing all over again, deeming the meds useless. You are starting the damage cycle all over again by the evening.
Hope that helps someone!!
Last edited by Neverenoughslee; 03-05-2005 at 01:29 PM.
Never, thank you so very much! Your visit to your doc answers more of my questions than my visits to doctor after doctor, which is kind of sad, really. When you mention that some people, even on higher doses, are not seeing improvement after several months.....did your docotr go into that at all? I mean, did he say why some people do not seem to respond? Or did he just mean that it takes some longer to respond? Also did he mention candida ever being a factor? I have read conflicting studies, some of which suggest that candida can be a cause of our condition. I requested firther testing to evaluate me for a hernia, just to find out if that is part of what's causing my silent relfuxing. I guess unless a hernia is very large, they usually just proceed with treatment the same way as for reflux anyway, right?
Thanks very much for this post. I have many of the same problems with the throat clearing, have just released that although it feels like there is mucus there, it is very much likely to be related to the constant sore throat I have from my GERD etc.
I will now try and stop the contant clearing as you suggest
Last edited by Blasterboy; 03-07-2005 at 03:57 AM.
What about a constant "sore throat" below the voice box where the EnT said he could not see. He did see some reflux splash but claims that is as far as he could go and my pain is in the collarbone area. The gastro doc said he could not see the "throat area where I was talking about" so who can then???? I am just getting worse and worse -- stomach hurts with every night silent reflux to collarbone area. Gastritis is definitely getting worse with 30 mg Prevacid AM, 30 mg Prevacid PM and 300 mg Zantac PM. What to do???????? Really do not want fundo. Not in good health and don't even know if I would make it through the operation. Have Crohn's disease also, severe osteoporosis and had a mastectomy. Immune system very bad, low WBC and lymphocyte count, bad chronic sinusitis with post nasal drip and dry mouth which I suppose makes the reflux worse without the enzymes from the saliva. HELP!!!!!!!!
I went to an ENT and he said he thinks it is lpr. I have
Barretts too. I am on 2 protonix a day, just started Wed. He said if this doesn't help I will do allergy testing. I also have a pain in my chest that no one can figure out. It is awful to get old.....
Hi colgo57 & lisa 30777, I join you in your symptoms. I'm set to see my ent on Monday and I seem to have many of the symptoms many others have who are already diagnozed with lpr. I'm currently taking protonix 2/day, but still have the feeling of a lump in my throat, pain in my chest, left side, etc. My gp is the one who put me on the protonix, but he never said you have lpr. He said it was stress. I'm anxious to see the ent and I will mention to him the pain in chest along w/other symptoms I have. Will let you all know what he says.