This article points out the problems with diagnosing and treating LPR.
"The most common symptoms used to diagnose LPR include globus, throat clearing, cough, hoarseness, sore or burning throat, dysphagia, and dysphonia (Vaezi et al 2003). However, these symptoms are not specific for reflux induced damage and can also be associated with smoking, voice abuse, allergies, and viral infections. Prior reports have shown that less than 30% of patients with extra-oesophageal manifestations of reflux have endoscopic evidence of oesophagitis (Vaezi et al 2003; Ahmed et al 2006)."
This tells me that a lot of people think they have LPR when they really don't.
Some other interesting findings
1. PPIs are generally given a 3 month course before physicians begin ruling out acid-reflux as the problem.
2. PPIs should be taken twice daily
But the most amazing thing about this article is:
"Data from controlled treatment trials convincingly show that PPI therapy is no more effective than placebo in producing symptom relief in patients suspected of laryngo-pharyngeal reflux disease. Furthermore, neither symptoms, nor laryngoscopic findings or abnormal findings on pH monitoring will predict response to PPI therapy. A reliable diagnostic test for LPR or one that might predict response to a PPI does not exist."
I think there is a ton of confusion over this condition: reliable diagnostic methods are not available (even PH testing is unreliable), and people taking placebos often get as good results as those on PPIs. Healthy people with no LPR symptoms have been found to have even more esophogal manifestations of damage than those of us with the condition.
So here is my layman's interpretation of this condition: it most instances, it is not caused by acid reflux, but is rather a neurological/muscular disorder of the tissue surrounding the oesophagus. Now this neuro-muscular issue may be aggravated my PND, acid, bile, allergies, etc., but I think this is where the problem is. Your voice might be cracking and your throat dry from bad allergies, but then your hypersensitive muscles begin to seize up, causing a globus sensation that won't go away.
So I think before running off to surgery or many expensive tests, we should take a step back and try some different approaches.