DEAR MAYO CLINIC: My husband had a cough for months and eventually was diagnosed with laryngopharyngeal reflux. What is the best option for treatment? He is still constantly coughing and clearing his throat despite regularly taking omeprazole and antacids.
ANSWER: The medications you mention are standard treatment options often recommended for adults who have laryngopharyngeal reflux, or LPR. But, along with taking medications, if he hasn’t already done so, your husband also should consider making diet and lifestyle changes to ease his laryngopharyngeal reflux symptoms. Several complementary therapies may help, too.
Laryngopharyngeal reflux is a form of gastroesophageal reflux disease (GERD). Laryngopharyngeal reflux happens when stomach acid and other contents of the stomach flow all the way up the esophagus, into the back of the throat and, in some cases, into the back of the nasal passages. Frequent coughing and throat clearing are common symptoms. People with laryngopharyngeal reflux may feel as if they have something stuck in their throat. Laryngopharyngeal reflux can cause hoarseness and other voice problems, too.
Medications usually can reduce the symptoms of laryngopharyngeal reflux significantly. A class of drugs called proton pump inhibitors are typically the most effective. They work by decreasing the amount of acid the stomach produces. Omeprazole is a type of proton pump inhibitor.
Antacids and medications called histamine antagonists — which also decrease stomach acid — can be used to treat laryngopharyngeal reflux, as well. Medications that increase the movements or contractions of the stomach and bowels, sometimes called pro-motility drugs, may be recommended for people with laryngopharyngeal reflux.
Along with using medication, there are other steps your husband can take to help control laryngopharyngeal reflux. One of the most important is eating a diet that is low in acid. Research has shown that this type of diet often can reduce laryngopharyngeal reflux symptoms.
Examples of low-acid foods are melons, green leafy vegetables, celery and bananas. Foods that people with laryngopharyngeal reflux should avoid include spicy, fried and fatty foods; citrus fruits; tomatoes; chocolate; peppermint; cheese; and garlic. Foods that contain caffeine, carbonated beverages and alcohol also can worsen symptoms.
For people with laryngopharyngeal reflux, it helps to eat the largest meal of the day at midday or in the morning, rather than in the evening, and to avoid eating within three hours of bedtime. Don’t rush through meals. Take time to eat slowly, without distractions.
Other lifestyle changes that can make a difference for someone with laryngopharyngeal reflux include not smoking, maintaining a healthy weight, and reducing and managing stress in healthy ways.
Several complementary therapies also may be useful in managing laryngopharyngeal reflux. For example, some studies suggest that acupuncture — a therapy that involves inserting extremely thin needles through the skin at strategic points on the body — can reduce symptoms.
Taking a probiotic dietary supplement that contains good bacteria similar to bacteria already in your body may ease some symptoms, too. But they aren’t for everyone, and different supplements contain different types of probiotics. Before your husband takes a probiotic, he should ask his health care provider about the kind and amount that’s right for him.
Finally, voice therapy can be used to treat the effects of laryngopharyngeal reflux. Research has shown that people who take a proton pump inhibitor and participate in voice therapy show faster symptom improvement than people who only take medication.
Encourage your husband to talk to his health care provider about his persistent laryngopharyngeal reflux symptoms. They can discuss additional treatment options and lifestyle changes. In many cases, laryngopharyngeal reflux can be managed successfully. — Dr. Amy Rutt, Otorhinolaryngology, Mayo Clinic, Jacksonville, Florida