Laryngopharyngeal
Reflux (LPR)
Ryan M. Hendricker, MD, FACS
Midwest ENT Office: (309) 691-6616
OSF Voice and Swallowing Disorders Center: (309) 683-5080
Laryngopharyngeal Reflux (LPR)
This information sheet is designed to guide you through the basics regarding LPR (laryngopharyngeal reflux).
It is not intended to be comprehensive. If you have any questions, please ask your physician.
What is LPR?
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During gastroesophageal reflux, the acidic stomach contents may reflux all the way up the esophagus,
beyond the upper esophageal sphincter (a ring of muscle at the top of the esophagus), and into the
back of the throat and possibly the back of the nasal airway. This is known as laryngopharyngeal reflux
(LPR), which can affect anyone. Adults with LPR often complain that the back of their throat has a
bitter taste, a sensation of burning, or something “stuck.” Some may have difficulty breathing if the
voice box is affected. Other common symptoms may include hoarseness, chronic cough, and postnasal drainage. Heartburn is relatively uncommon in LPR.
Reflux is not just indigestion and heartburn.
Reflux is not always acid.
Our diets are likely playing a contributing role in the development of this disease. This may seriously
impact treatment.
In infants and children, LPR may cause breathing problems such as: cough, hoarseness, stridor (noisy
breathing), croup, asthma, sleep disordered breathing, feeding difficulty (spitting up), turning blue
(cyanosis), aspiration, pauses in breathing (apnea), apparent life threatening event (ALTE), and even a
severe deficiency in growth. Proper treatment of LPR, especially in children, is critical.
Tips to prevent LPR
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Do not drink alcohol
Lose weight
Quit smoking
Avoid problem foods such as:
o Caffeine (coffee, tea, etc.)
o Carbonated drinks (soda, etc.)
o Chocolate
o Peppermint
o Tomato and citrus foods
o Fatty and fried foods (high fat beef or pork)
o Hot sauces and pepper
o Butter, margarine, lard, shortening
o High fat nuts (peanut butter)
o Bacon, sausage, ribs
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o Cream sauces
Wear loose clothing
Eat small meals and slowly
Do not eat anything 3 hours before bedtime
Good foods for reflux include:
o Oatmeal
o Ginger
o Aloe vera
o Salad
o Banana
o Melon
o Fennel
o Chicken and turkey
o Fish/seafood
o Celery
o Parsley
o Couscous and rice
How is LPR diagnosed and treated?
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LPR can be diagnosed or evaluated by clinical observation and the patient’s response to a trial of
treatment with medication along with pH testing, laryngeal endoscopy, esophageal imaging, and/or
esophagoscopy.
While most people with LPR respond to a combination of lifestyle changes and medication,
occasionally, surgery is recommended.
Lifestyle changes include: losing weight, quitting smoking, wearing loose clothing around the waist,
raising the head of your bed (so gravity can help keep stomach acid in the stomach), eating your last
meal of the day three hours before bed, and limiting or completely avoiding certain foods such as spicy
and high fat foods, caffeine, and alcohol.
Medications your doctor may prescribe for GERD include: antacids (such as Tums, Rolaids, etc.),
histamine antagonists (H2 blockers such as Pepcid or Zantac), and proton pump inhibitors (such as
Prilosec, Prevacid, Aciphex, Protonix, and Nexium). Some of these products are now available overthe-counter and do not require a prescription.
Surgical treatment includes fundoplication, a procedure where a part of the stomach is wrapped
around the lower esophagus to tighten the LES.
In infants and children, chronic exposure of the laryngeal structures to acidic contents may cause long
term airway problems such as a narrowing of the area below the vocal cords (subglottic stenosis),
hoarseness, and possibly eustachian tube dysfunction causing recurrent ear infections, or persistent
middle ear fluid, and even symptoms of “sinusitis.”
Dr. Jamie Koufman is the world’s expert on LPR. Much of the contents of this handout are a product of
Dr. Koufman’s work. For further reading, I recommend Dropping Acid The Reflux Diet Cookbook and
Cure by Dr. Koufman. It is available from amazon.com for around $18.