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Silas1066
Regular Member


Date Joined Feb 2012
Total Posts : 36
   Posted 2/20/2012 6:31 PM (GMT -6)   
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2503658/

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.

mudmagnetmum
Veteran Member


Date Joined Apr 2011
Total Posts : 1604
   Posted 2/21/2012 1:50 PM (GMT -6)   
Silas, have you looked at Sunbeam's thread on the Koufman diet for LPR?

MMM
New stuff: GERD, Recurrent cystitis/Overactive bladder
Lifelong stuff: Food allergies/intolerance, eczema, asthma

sunbeam48
Veteran Member


Date Joined Jun 2011
Total Posts : 795
   Posted 2/22/2012 7:04 PM (GMT -6)   
Here's a link to Dr. Koufman's articles on this topic, which I don't think agree with everything mentioned above. There is a lot of controversy surrounding this diagnosis. But I believe without Koufman's work, the term LPR would probably not be mentioned by the National Institutes of Health referenced above. For starters, I believe she describes silent reflux as an LPR hallmark, and that is not mentioned. She talks about pepsin being the villian, not the acid per se, for people with this diagnosis. There can be a neurological component for some, but not most. It has been awhile since I read these articles, I am sorry I can't summarize them right now.

http://www.voiceinstituteofnewyork.com/articles-and-publications/acid-reflux-15-groundbreaking-articles/


Her diet has been very beneficial to me, making my LPR symptoms mostly disappear very slowly.

Silas1066
Regular Member


Date Joined Feb 2012
Total Posts : 36
   Posted 2/22/2012 9:28 PM (GMT -6)   
Just out of curiosity, how long did it take for symptoms to improve on this diet? Were you also on medications?

The lifestyle changes related to this disorder are more bothersome to me than the disorder itself. Not being able to drink coffee, alcohol, even ginger ale ...not being able to eat good food, and having to sleep with a wedge pillow is just awful.

sunbeam48
Veteran Member


Date Joined Jun 2011
Total Posts : 795
   Posted 2/23/2012 5:38 AM (GMT -6)   
I saw a little improvement in the first two weeks, and continued gradual improvement over at least two months and probably longer. The most important thing for me is keeping the fat content of my food quite low. I also balance acidity with alkaline foods: if I have fruit or yogurt, which are both slightly acidic, I also eat a few low-fat crackers or bread. If you are interested in the diet, read my first post on that thread, it includes many important details:
http://www.healingwell.com/community/default.aspx?f=45&m=2210975

I started this diet on 80 mg Nexium, went down to 40 mg Nexium after a month, and recently changed to 40 mg Prilosec (which is less powerful). I have also implemented many lifestyle changes, including no eating for 3 hours before bed, and going to sleep in a pretty upright position. I recline after 6 hours have pased since I last ate, that's when all of the food will be out of your stomach.
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