LPR · silent reflux

Everyone recognises reflux can cause symptoms in the oesophagus including heartburn, chest pain and regurgitation, but many people don’t realise it can also cause throat and respiratory symptoms.

Research suggest LPR is just as common as indigestion and heartburn symptoms, perhaps affecting over 20% of the adult population.

• Asthma
• Ear ache
• Sore throat
• Voice changes
• Throat clearing
• Post-nasal drip
• Persistent cough
• Shortness of breath
• Bad taste in the mouth
• Recurrent chest infections
• Globus (feeling a lump in the throat)

Symptoms can occur alongside heartburn but often appear in isolation.

For instance, the third most common cause of a persistent cough is thought to be reflux and yet, in half of these people, there will be no other symptoms.

Why some people develop heartburn and regurgitation and others LPR is is unknown. This might be because in patients with LPR, instead of liquid acid refluxing from the stomach into the oesophagus, an “aerosolised” gas is inhaled into the throat, larynx and sometimes lungs. This aerosol is rather like a spray and may well contain other substances found in the stomach as well as acid, including bile and pepsin. Pepsin is an enzyme that breaks down proteins and is very irritating to normal tissues in the throat and lungs. This may well explain why standard antacid treatments for reflux (including PPIs such as Omeprazole) work in less than 25% of patients with LPR symptoms, as pepsin remains active in relatively non-acidic conditions.

LPR can present with so many different symptoms which can be also be caused by other conditions. Due to this and because many doctors assume that, if reflux is to blame, antacids will effectively treat their patient, sufferers often go undiagnosed for years.

Many will have been to see multiple doctors to try and get relief from their symptoms and have been referred from GPs to gastroenterologists to ENT surgeons, respiratory physicians and even voice therapists. While reflux is often diagnosed, symptoms are still inadequately treated. This “cycle of frustration” is common and can be truly demoralising for patients who often feel that no-one has an answer to their problem.

We specialise in the diagnosis and treatment of all aspects of reflux including LPR.

Conventional reflux tests measure only acid in the oesophagus and so often come back negative. This is because the refluxate causing the LPR symptom is often non-acidic. So RefluxUK use a comprehensive set of tests tailored to individual patients. These tests include high resolution manometry and impedance pH monitoring, which measures the presence of both gas and liquid in the oesophagus. It can also tell us the level of acidic and non-acidic reflux at the bottom and top of the oesophagus, near the throat. Using these tests as well as others, we aim to get a definitive diagnosis.

Our team includes specialist consultant laryngologists as well as physiologists and reflux surgeons who work together to establish a definitive treatment plan. We believe this teamwork helps patients get the best results.

For effective diagnosis and expert treatment, RefluxUK is the choice for LPR patients.