LPR “Silent” Reflux

LPR – Laryngopharyngeal Reflux

GERD prevalenceAcid reflux affects 1 in every 4-5 adults in North America!  That’s 20-25% of all adults.

But this number could be higher – it doesn’t include cases of another type of reflux called Laryngopharyngeal Reflux (LPR).  LPR goes by many names, including: Silent Reflux, Airway Reflux and Respiratory Reflux.  Still, LPR remains largely unrecognized.

Recognized or not, I see MANY cases of  LPR in practice, that have developed as a result of acid reflux.  LPR presents very differently from classic heartburn associated with GERD (Gastroesophageal Reflux Disease), and therefore, often goes undiagnosed by MDs.

Wondering if you have LPR or what are LPR symptoms?
Looking for the best treatment for LPR Silent Reflux?
Hoping to find out the foods that trigger LPR?

Look no further! I’ve got answers 🙂

Do YOU Have LPR Symptoms?

LPR differs from GERD, which presents with: heartburn, reflux, frequent belching and/or symptoms worse lying down, especially after a large meal.

Common Symptoms of LPR (Laryngopharyngeal Reflux)

  • chronic irritating cough, worse at night
  • frequent belching, worse after meals or drinking fluid on an empty stomach
  • halitosis
  • chronic laryngitis (hoarseness)
  • chronic unexplained sore throat
  • dental erosions
  • chronic sinusitis, post-nasal drip, frequent need/desire to clear throat
  • sensation of lump in throat, difficulty swallowing
  • above symptoms may occur any time of day & may or may not be relieved by antacids

Do you have LPR?

If you answered YES to several symptoms from the list, you may have LPR (Laryngopharyngeal Reflux).   Like GERD, LPR is caused by acid reflux.  But in LPR, the pharynx (area behind mouth and nasal cavity) and larynx (voicebox) are most affected.  A seemingly benign condition, chronic acid reflux can lead to serious complications. Seeking treatment for reflux is a good idea.

What Causes Acid Reflux?

The symptoms associated with LPR are due to the regurgitation of food that’s been in the acidic environment of the stomach. When stomach acid and pepsin enter the pharynx & larynx, they can cause tissue damage. A seemingly benign condition, chronic acid reflux can lead to: inflammation, esophageal/laryngeal erosions/ulcers and even cancer, if left untreated.

The cause of acid reflux is more complex, and stems from poor function of the body’s natural anti-reflux mechanisms.

In particular, poor function of the LES – lower esophageal sphincter is a major contributor. The LES normally shuts tightly to prevent the reflux of stomach contents into the esophagus and beyond. There are a number of reasons why the LES and other anti-reflux mechanisms fail.

When this occurs, materials from the stomach, including pepsin (an enzyme) and stomach acid (HCl – hydrochloric acid), can find their way into the esophagus. These substances trigger an inflammatory response that causes damage to the tissues in these areas. This sequence of events occurs in both GERD & LPR.

The difference is, that in LPR, the Upper Esophageal Sphincter (UES) also fails! Hence HCl and pepsin can find their way beyond the esophagus, and into the larynx & pharynx. These areas have NONE of the protective mechanisms found in the stomach and esophagus (secretions, swallowing, bicarbonate, etc), therefore damage ensues.


LPR Acid Reflux Treatment

The treatment for acid reflux can be broken down into three main categories:

  • Conventional Treatment
  • Natural Cures For GERD & LPR
  • Home Remedies For Acid Reflux

Conventional Treatment: PPIs (Proton Pump Inhibitors) & Antacids

proton pump inhibitors for GERD & LPR
Antacids are the third most commonly purchased OTC (over the counter) medication – after pain medications and relief from colds/coughs/allergies. They offer temporary relief by coating the esophagus with a buffer to the acid, or by neutralizing stomach acid.  Some GERD sufferers will experience symptoms relief with PPIs, but LPR sufferers are much less likely to.

A word about PPI drugs – Proton Pump Inhibitors.

Prescription antacids, like PPIs (proton pump inhibitors), take this a step further – because they BLOCK production of stomach acid. As a result, PPIs fail to address the cause of GERD, and may be associated with:

  • acute adverse effects (diarrhea, nausea, abdominal pain, headaches)
  • long-term risks (increased risk of gastroenteritis, stomach or small intestinal bacterial overgrowth, pneumonia, osteoporosis and/or spinal fracture, vitamin & mineral malabsorption)

In fact, this is something I now see more and more often in my practice – a patient starts off with acid reflux, gets prescribed a PPI, and comes in to see me with IBS (Irritable Bowel Syndrome) or some form of Dysbiosis (bacterial overgrowth in the gut). Now we have two digestive conditions to treat.

There certainly are people who benefit from PPIs and other medications, and in severe or unrelenting cases of acid reflux, it makes sense to try to prevent damage to the esophagus and pharynx/larynx. However, those with LPR often find less benefit from PPIs, and do well with a dietary focus.

What is the best LPR treatment?

OK. Admittedly I’m a bit biased! But this stems from many years of experience and seeing the amazing results my patients are able to achieve.

A comprehensive and natural approach to treat LPR acid reflux should include dietary and lifestyle measures along with any recommended medications or supplements.

A Naturopathic Approach

A holistic approach to treatment sees the inextricable interconnectedness of the entire digestive system (and all body systems). 

A conventional medical approach zeroes in on treating symptoms through suppression (“Got heartburn? Let’s block acid production!”).  In contrast, a holistic or naturopathic approach says: “Got reflux? What’s causing it?” – and, consequently, seeks to return the organ system to normal function. As a result, the symptoms resolve.

It also upholds the precept: “First, do no harm”. In this case, suppressing acid production is seen as harm. Stomach acid, or HCl, serves MANY important functions in the body – and isn’t the CAUSE of acid reflux. Most of all, dysfunction of the LES and failure of the body’s anti-reflux mechanisms are to blame. So why not target these areas? That is exactly what a naturopathic approach does.

Now, just to be clear, I understand why antacids and acid blockers are prescribed for acid reflux. They are the only tools in the kit as far as conventional medical interventions go; and if the goal is to prevent cancer, there’s a pretty compelling case for them. Still, in so many cases, they can be avoided. And that’s where I LOVE to offer strategic support and guidance.

So instead of relying on antacids, I strongly encourage sufferers to seek naturopathic care – which has highly effective options for treatment that address all of the contributing factors:

  • reduce inflammation
  • avoid activating pepsin in the larynx/pharynx
  • heal the esophageal mucosa/lining
  • prevent progression to esophageal ulcers or cancer

LPR Diet Plan

low acid diet for LPR & GERD acid reflux
Most people have heard the conventional wisdom that acidic foods like tomatoes and citrus fruits can trigger heartburn and acid reflux.  But there is a more comprehensive list of foods to avoid, and each one has a specific reason.  These trigger foods are particularly important to prevent the symptoms of GERD, but also play a role in LPR prevention.

For those with GERD, and especially LPR, there are other factors that I consider when it comes to diet – in particular, the pH, or acidity of foods. A low acid diet seems to be particularly useful for those with LPR symptoms.

The reason for this, is that when materials are refluxed from the stomach, they may contain small amounts of the enzyme pepsin. Pepsin is activated by acids. When it finds its way into the esophagus, and especially the larynx & pharynx, it can cling to these tissues. Later, when we eat acidic foods, the acid can re-activate the pepsin – causing it to do damage as it tries to “digest” the tissues it comes in contact with.

End Acid Reflux Program

I cover common food triggers and a low acid diet for LPR in great detail in my comprehensive program for either GERD or LPR sufferers: End Acid Reflux. The program is available either online (self-directed), or with personalized support & guidance (in person or by phone – for those within Ontario).

Online Program

The program includes:

  • detailed LPR diet
  • comprehensive list of food triggers
  • many tips & tools to combat reflux via lifestyle
  • 3-week acid reflux meal plan
  • over 50 customized LPR diet recipes!
  • next steps to follow for maintenance & prevention

Learn more about the program, or get YOUR FREE trial here:   END ACID REFLUX – FREE TRIAL


In Person/Phone Consults

Prefer a more personalized approach?

I work with patients in person (in Toronto) or via telehealth throughout Ontario. I can help you identify if you have GERD or LPR, and create a personalized plan for you including diet, lifestyle modifications, and proven remedies. Go beyond symptom management, and get comprehensive guidance on how to heal & repair damaged tissues, and prevent complications of acid reflux like tissue erosion and cancer.

Ready to book an appointment? Click below to access my online booking system. Or request a FREE 15 minute phone consult to learn more about how I might be of service to you.