I am a 22 year old female with what a doctor has diagnosed as possible LPR acid reflux. For about half of my life I have gotten bronchitis almost every season, which is a hacking cough with nothing coming up that lasts for 1-2 months, with or without medication. I also had/have a lot of trouble with voice loss and clearing my throat which has made me scratchy and hoarse on and off for about 3 years. I went to an ENT a few months ago and the following was found: had a CT scan of my sinuses, completely clear. Had blood tests for allergies, none. The ENT found vocal chord nodules in my throat, which she said was probably from acid reflux. I went to a speech therapist for about 2 months to try and help my voice, but it persisted because I can't stop clearing my throat. Over the past month and a half the throat clearing has gotten so excessive it is unbearable. I have tried taking Prilosec, Zantac, Tums, Prevacid, Mylanta, everything. It is ok in the morning, goes on and off throughout the afternoon, and then at night is consistent until around 12 pm. After recently seeing another doctor he gave me Protonix, which has not worked. I think I have to go to get a barium test to see if I actually have acid reflux to begin with. BASICALLY, my question is: If it isn't acid reflux, then what the heck is it??? I have nothing to cough up, but it feels like there is constantly something sitting in the back of my throat. When i clear it, it stays ok for a second, then comes back. I'm starting to think its mental, beacuse when I take my mind off of it, it seems to disappear for a bit, but when i do think about it, it doesn't stop. But there is definitely something in my throat, so I just don't know how that can be mental. SOMEONE PLEASE HELP. I sound ridiculous and its disrupting in my life. Hopefully someone can help- please give me any remedies or suggestions you can think of.

(Also, I have Raynaud's Phenomenon, I get it whenever I am cold in my fingers and toes. I read something about a more advanced version of it that can possible harm the esophagus. Could this be related?)

Thanks so much.

You've certainly tried the range of medications out there, but have you tried the proper dosage?

Not sure if you know this already, but the standard protocol for treating LPR, is not 1, but is 2 doses a day of a proton pump inhibitor. There is a lot of information about this dosing regimen at pubmed.

That means if you've tried a 40 mg dose of Nexium in the past, you need to double that and take 80 mg.

Timing is also important. About half of LPR patients take their pills together, and the other half do one in the morning one at night. Each group swears that not only is theirs the best way, but trying the other way led to a return of symptoms. I'm part of the former group - I take the double dose first thing in the morning.

The only way you'll know is by experimenting.

Can I suggest an order to the list of PPIs that you should try on a double dose schedule?:
1. Nexium
2. Aciphex
3. Prevacid
4. Zegerid
5. Prilosec Brand (By prescription only)
6. Protonix (not much good news about Protonix for LPR).

Finally, there is Prilosec OTC, which is a complete rip-off. It's cheaper and available OTC, but it's a rare soul with LPR who is succesfully treated with it. That's not to say it doesn't have its good points - for instance, it is effective in treating recurring but mild heartburn.


Please also lay off caffeine and anything with caffeine in it, as well as fried foods.

Thank so much for responding. I have been taking Protonix once in the morning and once at night, but maybe I'll try the double dosage in the morning and see how that goes. I have not yet tried Nexium, but I am going to an ENT soon so I will see if that can be prescribed. Also, in terms of diet, I am getting the problem basically the same whether I eat a bagel or pasta with tomato sauce. Could that still be what I eat though? Again thanks so much for your help.

I started on Protonix once a day and it did nothing for my LPR...

I am on Nexium now 2X a day now, morning and evening and I am starting to feel improvments to the point where most of the day I feel pretty good...

I even cheated with a few meals (had ice cream twice this week as a test) and so far, so good...Would be great to learn that ice cream is not a trigger food for me :D

Dalgolds,

I agree with Ken7. Protonix (along with prilosec OTC) are the 2 medications that specifically are the least helpful for LPR.

I strongly recommend that you immediately change your prescription to Nexium, and barring that, Aciphex.