Acid Reflux and Diet

How does LPR differ from heartburn?
Laryngopharyngeal reflux is not the same as heartburn. In fact, less than 30 percent of people with LPR have heartburn. Most people with heartburn do not develop the symptoms listed above. Nobody is quite sure why some patients develop heartburn and others develop LPR symptoms, but part of the answer is probably due to differences in the ability to resist acid in the voice box and esophagus.

People who have weak defenses in the esophagus probably get heartburn, while those who are susceptible to acid injury in the larynx get the symptoms listed above. Many patients develop symptoms following minor trauma to the larynx from a cold, excessive coughing, intubation for anesthesia or even due to eating something sharp like a fish bone. This injury decreases the ability of the larynx to resist acid exposure.

Treatment of LPR
There are two major ways to treat LPR, medications and changes to your behavior. Both of these are very important. In rare cases, surgery may be recommended to help prevent acid reflux.

Medical Treatment of LPR
Most patients with LPR will be given medications called proton pump inhibitor (PPIs). These medications are extremely effective at preventing the production of acid by the stomach. Common side effects of these medications include headaches and stomach upset or diarrhea. If you develop side effects, switching to another proton pump inhibitor may allow acid control without side effects.

There are five proton pump inhibitors currently available:
�� Aciphex (rabeprazole)
�� Nexium (esomperazole)
�� Prevacid (lansoprazole)
�� Prilosec (omperazole)
�� Protonix (pantoprazole)

Currently, only omeprazole is available as a generic. PPIs are quite expensive, and your insurance company may ask you to use a specific medication. Because Protonix is currently the cheapest of these medications, most insurance companies want their patients on Protonix. If your insurance company requests that you use a different medication than what was prescribed, please call the office and we will provide a new prescription. Some insurance companies require pre-authorization for these medications, so we kindly ask that you send any necessary paperwork to the office so we can fill it out the necessary forms.

Other medications are occasionally used to treat LPR. Ranitidine (Zantac) is occasionally used instead of PPIs or in conjunction with PPIs. In addition, bicarbonate gum is available over-the-counter and is a useful adjunct to medical therapy with PPIs. Chewing two to three pieces after each.