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RefluxTreatment: Last Part


Treatment of LaryngoPharyngeal Relux (LPR) depends mainly on the symptoms. I usually advise these three:

(1) Behavioral modification.
Maintain an ideal body weight. But, when you go on a diet, be sure to eat breakfast and have small, frequent feedings.

Also, avoid foods high in fat, spices, acid, alcohol and caffeine.

 Stop smoking!

Do not lie down three hours after eating.

 Elevating the head off the bed 6-8 inches may help prevent reflux.

Avoid drugs that promote reflux including calcium channel blockers, sedatives, or nitrates.

When busy and unable to grab a bite, chew gum. This increases salivary bicarbonate production and may neutralize the acid.

(2) Pharmacotherapy.
The proton pump inhibitors (e.g. omeprazole, esomeprazole), commonly taken two times a day, block the terminal stage of gastric acid secretion. They are the most potent inhibitors of acid secretion available today.
The H 2 blockers (e.g. ranitidine, cimetidine), typically taken two to three times a day, block the histamine receptor in the stomach and reduce acid secretion.

You will be under either or a combination of these medications for at least six weeks. Remember that these drugs work best when they are taken 30 minutes before a meal, and taken compliantly throughout the treatment.

(3) Surgery.
Nissen fundoplication. This procedure tightens the lower esophageal sphincter by wrapping the upper part of the stomach around the lower part of the esophagus.

Mild symptoms may be treated with H2-receptor antagonists and dietary and lifestyle modifications. Half of patients with mild LPR will have resolution of symptoms with the indicated lifestyle changes. Most patients will report significant improvement in symptoms within 2 to 3 months after treatment is initiated; however, studies show that healing takes 6 months or longer.Twice-daily dosing of a PPI for a minimum of 6 months may also be recommended in case where there are already tissue injury in the larynx.

Approximately 20% to 30% of patients do not respond to the standard regimen of twice-daily dosing with a PPI. A subgroup of patients may require prolonged or lifetime treatment if their symptoms recur when they stop the medication. Follow-up examinations will be scheduled every 2 weeks to every 3 months to monitor symptoms and response to treatment.

Reference: Linda Diamond, PA-C
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