Likely LPR

[Bluebest8]

No proper diagnosis of GERD or LPR, but certainly all the symptoms of LPR are there, constant throat clearing, phlegm and belching after meals. No heartburn as such and when I lay down at night there are no issues with heartburn, and funny enough no throat clearing either when laying or sleeping, BUT the minute I get out of bed in the morning it all starts again.

Got the go ahead for PPI Esomeprazole having seen an ENT specialist, as thought that was the original issue and he suggested LPR could the the main problem.

I have been on esomeprazole and doc finally decided to increase this to 40 mg twice daily for a spell of a month or so. She also suggested Gaviscon Advance after meals ?

Already noticing a difference after a couple of days or so. The main one being I can taste my food !!

Very strange.

Anyone else had experience of using Esomeprazole and it's success or other

thanks

[Jumpey]

Hi, I would read Dr. Louise Kaufman's book on acid reflux and how to deal with it. Be aware that Omeprazole inhibits the absorption of minerals so can have longterm affects such as osteoporosis. Good luck.

[mjames1]

Sound like LPR which often presents without heartburn. Did your ENT mention any inflammation/changes of your vocal chords?

PPI's, like Esomeprazole, often twice daily are the standard treatment. Alginates, like Gaviscon Advance, also can be helpful.

Hopefully, they also gave you lifestyle modfication tips, like diet, exercise, looser clothing, raising head of bed, etc, because ideally you do not want to be on daily PPIs for life.

Once you get some healing from the PPI's, they might want to change to a safer H2 Blocker like Pepsid and/or continue the Gaviscon Advance. Personally, I've done/taken all mentioned as well as the antacid Mylanta, when needed.

Jim

[ranges]

Hi, very interesting. I've had bad reflux starting 3 years ago (I'm 79 now). I had a TIF procedure 2 years ago that didn't work and finally a Nissen this past February. I have had a problem of throat clearing for many years and still do. My GI Dr. wanted me to see an Ent Dr. for the throat clearing to see if it was sinus dripping and the Ent , after an overnight test for reflux in my esophagus, said the reflux was still there. I knew I still had some reflux though it was not nearly as bad. Found another doctor commenting on Google that many times constant throat clearing with 'silent' reflux (which I have) should be treated by my GI doctor.

So I have an upcoming appointment with the GI doctor in early December. Dr. appointments are likely slow all over but in central Indiana it is bad at times.

Like you, I never have the problem when lying down and it's only after I get up. I have the problem of throat clearing before eating and after and at many odd times.

I've been taking Omeprazole or Pantoprazole which seem to work the same. Not familiar with Esomeprazole or the treatment for LPR. I found the term and explanation of LPR on Google after a search for throat clearing - neither doctor had even mentioned LPR or what it was..

Best of luck to you!! Mike

[Bluebest8 in reply to ranges]

Hi Mike,

That's really very interesting that you also do not have the issues when laying down, I don't get heartburn either, yes I certainly do have the throat issue probably from the minute I am out of bed throughout the whole day and even more especially after eating, when I am sometimes forced to make myself belch (sorry for the expression) . I have had various medications, ppi esomeprazole which to be honest, I am not sure if it really helps . Have you found the surgery has helped at all ?

thanks

[ranges in reply to Bluebest8]

The surgery helped very much with the actual reflux I was having (as I mentioned the actual reflux started 3 years ago). However, the constantly clearing my throat problem started many years ago and it hasn't changed a bit. Maybe I can find out more when I have my next doctor visit. I had heard LPR was associated with "Silent??" reflux. What I had read 3 or so years ago said throat clearing was related to gas fumes in the stomach reaching the upper esophagus and not the acid itself. I was also told constant throats clearing could just be a habit - I knew it wasn't a habit!!!. The ear/nose/throat doctor also said that, but he did a 24 hour reflux test at the back of my throat and it showed I still had reflux (or at least the fumes) and from that he knew it wasn't just a habit! I can still burp some after the surgery so it's just fumes that can still get thru even after the surgery???? I still have more questions than answers!

[Hidden]

LPR doesn't usually cause heartburn. I diagnosed myself, as I was doing a lot of coughing and choking, had a croaky voice, and throat clearing, but there was obviously no infection. Then discussed with GPs.I was already taking Pantoprazole because of a Hiatal Hernia, and increased it to two a day initially. Since then I have had swallowing problems, for which I have had help from a Speech and Language Therapist, and various tests. It appears I have a problem with a vocal fold not closing properly, but other one is compensating, and a tendency for food to get stuck round my epiglottis, and then go down the wrong way.

GP wanted me to reduce PPI to one a day if I could, and I have Peptac (NHS Gaviscon) on prescription. I have been doing swallowing exercises.

What has made the difference is knowing what the problem is , and knowing that it is manageable. There is a risk of acid eating away at the oesophagus, and I worried about that. I manage now with 1 Pantoprazole, Peptac before I go to bed, Alkaline Chewing Gum sometimes if I am affected when I am out and about. I still cough in the morning, and at other times, choke sometimes, but worry less now I know what I'm dealing with, and it feels as if it has improved because of that.

[Hidden]

What seems often overlooked is the role of pepsin… this is released to help the stomach acid digest proteins such as meat … when the LES is working properly.. then pepsin does not make its way into the esophagus… usually laying down before the three hour window after food increases the likelihood of pepsin making its way into the swallowing tube and even as high as the nasal cavity.. so when you rise the next day… nasal cavities drain.. hence that immediate reaction and eating anything acidic will trigger the pepsin that has lodged in tissue.. pepsin can remain in tissue for weeks.. and the best way to get it back out is to have nasal washes with sodium bicarbonate and sip a couple of mouthfuls during morning of bicarb and after main meal.. this removes the pepsin .. that peculiar lump in the throat the hoarseness all disappear within three days of treatment … if you ever wake up and have that lump in throat.. it is more likely you had reflux with pepsin… NOT acid!

Often this occurs during the sleeping cycle.. so the sufferer has no clue what triggered the new onset of symptoms..

Acid reacts with pepsin and lowering acid just leaves pepsin lodged in the cells of the mucosa…which still respond to acidic food and drinks… it’s a sure sign you are retaining Pepsin…a doctor wrote a book about this…

Dr Jonathon Aviv…The Acid Watcher Diet..

A 28 day reflux healing program… hope that helps you find a solution to this irritating issue.