LPR / Silent Reflux
What is LPR / Silent Reflux?
Laryngopharyngeal Reflux (LPR) is similar to another condition GORD but has quite different symptoms, such as a persistent cough, hoarseness, sore throat, a postnasal drip sensation, a ‘lump’ in the throat sensation and sometimes a constant swallowing/throat clearing urge. These symptoms are often mistaken for something else and as such LPR is difficult to diagnose. As patients may not present with the typical heartburn/reflux symptoms it is sometimes referred to as ‘silent reflux’.
When a person has LPR stomach acid is not contained in the stomach. Instead it rises up the oesophagus (the food pipe) into the back the of the throat (pharynx) or voice box (larynx), or even as far as the back of the nose (the nasal airway) causing inflammation and discomfort. Non-acidic contents from the stomach such as bile can also reflux to cause LPR symptoms
These symptoms can significantly impact a patient’s day to day quality of life, but there are also long term health complications to consider. It can scar and damage the voice box permanently and worsen any lung conditions, like asthma or COPD.
Areas outside of the stomach are not protected from the acid exposure so people with chronic GORD and LPR may have a higher chance of developing a condition called Barrett’s Oesophagus where the soft, pink lining of the food pipe becomes thick and red. The longer a person has reflux, the higher the risk of Barrett’s – which also increases the risk of oesophageal cancer. As such a growing number of LPR patients are looking at procedures to treat the condition permanently.
Questions and Appointments
For any enquiries about conditions, tests or treatments, please feel free to call Dr Rehan Haidry’s medical secretary Debra Hyams.
People with LPR may wish to see a specialist, a gastroenterologist, to better understand the severity of their condition and their treatment options. Bravo pH testing is the most cutting edge test available; a minimally invasive investigation that involves placement of a temporary capsule in the food pipe to measure how often stomach contents reflux into the oesophagus and how high the acidity levels are. This creates a highly accurate picture of the severity of the condition.
The patient can also have a gastroscopy – a test to look inside the throat, voice box, food pipe (oesophagus) and the stomach to investigate. This involves an endoscope (a thin flexible tube with a tiny camera) to look at the cell lining and see if there is signs of Barrett’s Oesophagus, biopsy cells (take a small sample for testing).
Have a question?
If you have a question and would like to find out more, please contact Dr. Haidry’s secretary
The first step is lifestyle modifications – such as avoiding trigger foods, eating smaller meals, reducing alcohol and stopping smoking – and a doctor may recommend chewing gum to increase salvia or over-the-counter antacids (such as Gaviscon).
If symptoms persist, a patient may need daily medications (PPIs, H2 blockers) to neutralise the stomach acid to minimise symptoms and are commonly prescribed (the NHS currently spends half a billion on these prescriptions) – but for some people with LPR they will have limited benefit. To avoid the long term complications of LPR, their GP will refer them to see a gastroenterologist for specialist treatment.
Dr Rehan Haidry is an experienced Consultant Gastroenterologist and interventional endoscopist, considered one of the country’s leading experts in LPR and offers a range of tests, therapies and treatments so patients are able to make informed and confident decisions about their care. Dr Haidry is the only doctor in Europe who offers a pioneering new alternative to anti-reflux surgery (called TIF).
During anti-reflux surgery (commonly performed on the NHS for patients with GORD or LPR) incisions are made in the abdomen and the surgeon wraps the stomach around the lowest portion of the food pipe to control reflux/regurgitation into the oesophagus (which means the cell lining damage is reduced and therefore the risk of oesophageal cancer developing). However this surgery is not without its side effects – the patient also loses the ability to belch (thereby increasing bloating/flatulence) and vomit which some patients find distressing. Some encounter swallowing issues.
Transoral incisionless fundoplication (TIF) is an advanced endoscopy procedure where Dr Haidry mimics what the surgeons do but in a minimally invasive way. It is all performed via endoscope and takes less than 30 minutes. The bottom of the food pipe is pushed into the stomach and stitched into place creating a new ‘anti reflux valve’ for the patient that prevents stomach contents leaking up. Unlike anti-reflux surgery the patient can still burp/vomit which many patients find reassuring.
In a recent study, published from the John Hopkins hospital in the USA, 49 patients with LPR and evidence of GORD had the TIF procedure and experienced an improvement in their symptoms.
TIF recovery is quick – most people are back home within 1 day and back at work within 4 days and it’s very safe, less than 0.5% patients will experience a serious problem. Studies have shown that for up to five years after the TIF procedure, symptoms are significantly reduced and ~80% patients can stop taking daily medications. The TIF procedure reduces the chronic acid reflux and reduces the harm to the cell lining (which may have turned cancerous over time).
Get In Touch
For any enquiries about conditions, tests or treatments, please feel free to call Dr Rehan Haidry’s medical secretary Debra Hyams on:
Tel: 0203 423 7609 | Email: email@example.com