Acid Reflux in the Throat

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Acid Reflux in the Throat

Acid Reflux in the throat

What is Acid Reflux?

Reflux is short for Laryngopharyngeal Reflux, also abbreviated as LPR. It refers to the backward flow of acid and digestive enzymes from the stomach up through the oesophagus and into the throat at the level of the vocal folds. Most people experience acid reflux at some stage in their lifetime.

What are the symptoms of acid reflux?

The voice box lining is extremely sensitive to stomach contents. Acid reflux causes redness and swelling of the larynx. This creates a sensation of irritation or mucus in the throat which people may mistake for post-nasal drip. Coughing and chronic throat clearing also commonly occur. Less commonly people may experience pain or difficulty swallowing

Many people with LPR do not experience the classic symptoms associated with GORD including heartburn, chest pain or an acidic taste in the mouth. In fact 50% of people with LPR have no other symptom except irritation in the throat and/or cough. Often these symptoms are worse during the day (when upright) and after certain foods (see below) which may trigger an acid reflux episode.

How is acid reflux treated?

Acid Reflux symptoms can usually be controlled by a combination of dietary and lifestyle modifications in conjunction with medications.

Dietary modification

Certain foods are known to predispose to acid reflux. They do so by increasing acid production in the stomach or relaxing the valve between the oesophagus and the stomach which normally acts as a barrier to reflux.

Acid reflux – Lifestyle modification

Lifestyle modifications are also recommended. These may include changing the frequency or timing of meals or modifying sleeping conditions. Please consult your ENT surgeon for more advice

Acid reflux – Medical Treatment

There are a number of medications available to treat acid reflux. Some of them switch off acid production in the stomach whilst others provide a barrier or buffer against acid damage. Often it takes some weeks before the symptoms respond to treatment. Your ENT doctor will be able to give you further advice regarding appropriate medical therapy for acid reflux.

Acid reflux – Surgical Treatment

On rare occasions, in the presence of severe non-responsive acid reflux, surgery may be considered to tighten the valve between the stomach and the oesophagus.

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  1. Jonique

    I’ve been experiencing this since the first of the year. Did not know what triggered it, but the episodes began at night. I was unable to sleep at night and I would wake up in the middle of the night throwing up food that I had eaten 4 hrs before. I was prescribed Omeprazole which helped some. Then I began to experience bouts of nausea;certain smells would make me sick to my stomach. Still periodically experiencing the acid reflux. The one natural thing that has helped calm my stomach and allow me to eat a burger and ice cream, is an apple. I read somewhere that a long time ago this gentle had a bout with acid reflux- even though the condition was not named at that time.The only thing that would allow him to sleep was to eat a red delicious apple before bed time. So now I have one in the morning and midday. I havent take my medicine in a few days and feel great. I do get the cough during the day though. What can be done to resolve that?

  2. Interesting to hear about the red apple. I’ll look further into this. I suppose if you are still getting the cough then there is probably still some acid reaching the larynx (voice box) causing irritation. (There are also a lot of other causes for cough which need to be excluded). We have a lot of patients with cough who don’t have the “classic” symptoms of reflux – i.e. heartburn and nausea. It is important to realize that the lining of the throat is much more sensitive than the lining of the stomach so even small amount of reflux getting to the throat (as little as one reflux episode per week) can cause symptoms such as cough and a feeling of a lump in the throat without heartburn. This is known as “silent reflux” and occurs in up to 50% of people with chronic cough. In terms of treating this the first step is proper dietary and lifestyle modification to minimise reflux, second we would normally have a good trial of proper antireflux medication (such as the omeprazole class) on a regular basis in combination with an antacid – remembering that these may take up to 3 months to work fully. It is no good taking the medication without the dietary change in my experience. Failing this we would need to e4xclude other causes for the cough

  3. Soula Aroutsidis

    Ive been suffering with acid reflux for years, but had a lot of acid reflux until it became really really bad, constant burning bad taste and pain in throat and chest, i was under a lot of stress in the last 6 months as our daughter was diagnosed with cancer and it was a nightmare getting her to chemotherapy, now that she is in remission, I would like to get my life back.I have changed my diet and eat hardly anything and i am very careful, I’m finding it hard at work as I am 49 and cannot bend or move suddenly as it starts burning my throat and the taste in my mouth makes me want to throw up.
    I read and saw a news report in America of a new non invasive procedure that helps and is done with a new instrument, I would be interested to see if it is being used in Australia as the medications I am using give me mild side affects and often i am taking extra through the night which could not be healthy

    Thank you S

  4. Hi S,

    In general we have very good options for medical treatment of reflux and if your current medications are not working or causing side effects we would suggest review with your specialist about whether a different regime may be appropriate. One of the most common mistakes I see includes taking the right medication at the wrong time of the day e.g. after meals instead of before meals – thereby reducing effectiveness of treatment

    The other consideration is correct identification of any anatomical problems that may be correctable with surgery. In most cases there is no single procedure that treat/fit everyone’s reflux. Our usual approach would be looking into the oesophagus and stomach with an endoscope to assess the lower oesophageal valve (sphincter) which usually protects against acid reflux if this is loose (often known as a hiatus hernia) then surgery may be a more valid option. I also think it is important to confirm the diagnosis of reflux with a test known as a 24 hour ambulatory pH probe prior to considering any surgical intervention.

    It is always difficult comment on new procedures and I would discuss with your treating specialist about whether surgical options are appropriate for your condition and what the current best practice is in Australia. New devices have to go through very a stringent approval process here in Australia and I’m not sure that this procedure is currently available. You could always contact the company / doctor shown in the video to ask.

  5. Ann

    I’ve been experiencing LPR for about a year and a half, last 7 months on Nexium 40mg. I haven’t been able to come off Nexium, everytime I do, the horseness, throat clearing etc comes back. Some days I get the symptoms even on Nexium. I have been given a referral to a gastroenterologist, but I am wondering if I need one to an ENT specialist as well, where to from here. Feeling quite hopeless. Thank you

  6. Hello Ann,

    Referral to a gastroenterologist is appropriate because they will be able to offer you an upper endoscopy examining the oesophagus and stomach. This is important because long term acid exposure to the oesophagus can lead to ulceration of the lining of the oesophagus known as Barret’s oesophagitis which can potentially turn into the more serious condition of oesophageal cancer. Early identification and treatment can help prevent the progression of this condition. The endoscopy will also help identify other anatomical conditions such as a hiatus hernia which can predispose to reflux. It is important to remember that even though the stomach and oesophagus look clear on endoscopy you can still be getting laryngopharyngeal reflux – also known as “silent reflux” because of the absence of heartburn and other classic reflux symptoms. In this case an ENT surgeon will be able to examine the larynx (voice box) to see whether there are any signs of reflux in this region.

    Other things to consider are the dietary causes of reflux, other causes of hoarseness and complimentary medications such as antacid / Alginate combinations which can also help people get better control of their symptoms.

  7. Dan

    Hi there.

    I had a bad case of tonsilitis about two and a half years ago and ever since my voice box has felt dry and like it’s on fire along with my sinuses towards the back where they meet the throat. Well after seeing around twenty different (useless) doctors and spending to date over $9000 on rubbish treatments since nobody seemed to know what they were doing I finally discovered LPR on the net and suggested it to my current GP (who has been fantastic) and he sent me to a specialist for an endoscopy who told me I had Barretts and prescribed some Nexium. I have been on PPIs now since March last year and they maybe reduce symptoms around 5% so my Gastroenterologist said it mustn’t be reflux otherwise I would be getting better from the PPIs. So I spent the next eight months exploring other avenues spending more money on other rubbish suggestions until I heard about Non Acidic LPR. I asked my GP about it and he sent me to another specialist who ordered a PH & Manomatory test (about time). My test showed that I experienced 328 episodes of reflux in a 24hr period with PH levels under 4 for 13.9% of the time and a resting LES pressure of between 5-10mmHG, pretty obvious that I have reflux although I was told by my Gastro that I mustn’t have it, he also doesn’t beleive in non acidic LPR! So now that I finally know what’s wrong with me I need to do something about it. I have been told that the first thing to do is lose weight, I am currently 81kgs (average height 35yr old male) however when my problems started I was 72kgs so I’m not sure how much difference losing weight will make. It seems to me that surgery may be my only option but I am concerned about the side effects of Fundoplication. Are there any other options?

  8. Veronica

    I think I am experiencing symptoms of LPR. I have sore throat, severe thick mucous and post nasal drip and constant throat clearing for the past 4 months. I also always wake up with a horrible taste in my mouth/throat. In February this year I was referred to an ENT specialist who diagnosed a sinus infection after a CT scan. He used the fibre optic scope but couldn’t see anything. He prescribed 3weeks antibiotics and steroids and afterwards i had follow up CT scan which showed the infection had cleared. However the PND, mucous and sore throat has stayed with me since so I followed up with another visit and had another CT scan which showed all clear again. In this visit he used the fibre optic scope again and then sent me on my way as i did not need sinus surgery. I did not know about LPR at the time otherwise I would’ve asked if there was any inflammation in my throat etc. He told me to go back to my GP to ‘sort it out’. Well, my GP suggested reflux based on my symptoms and prescribed ‘somac’ 40mg once per day in the morning. I have been taking this for 2 weeks with not much improvement at all. So my question is who do I see next if no improvement with this medication and diet changes? An ENT or a GI doctor? Also, how long does the medication usually take to work? It seems that in the States an ENT specialist treats LPR/reflux but the one I saw was only interested if I needed surgery. I live on the Gold Coast so any recommendations or suggestions would be appreciated. Thank you.

  9. Hi there and sorry for the delay, we have had some troubles with the website and have had to move to new servers.

    You may have LPR but there are other possible causes of your symptoms including nerve irritation in the throat. Most ENT surgeons should be fairly confident in treating LPR but if you have been non responsive to first line medications and dietary modification then it may be worthwhile seeing someone a little more specialised with an interest in the throat / voice. I can recommend a colleague of mine in Brisbane if you are interested.

    It is important to remember that the symptoms can take up to 3 months to improve so two weeks of medication is really not enough. Just from your post there is definitely room to escalate medical management

  10. Sorry for the delayed reply we have had trouble with our website and had to migrate to new servers.

    Your pH test suggests that reflux could is occurring. The question is whether it is affecting your throat and why you are not responding to standard treatment. I’m not sure what dose of PPIs you are on but would probably maximise this as well as use a barrier method of acid suppression (mainly over the counter products) to see how you respond. If you are still symptomatic on treatment the next test would be a dual pH probe AND impedance test whilst on treatment which may help identify non acid reflux. There is evidence to show that non acid reflux can produce throat symptoms and this is where the low acid diet comes into play. The theory is that pepsin from the stomach sticks to the throat and becomes reactivated when exposed to acidic foods. The other thing to remember is that using PPIs without proper dietary modification is like taking cholesterol tablets and eating fast food every day – the medication won’t work without adequate dietary and lifestyle modification.

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  12. Katie

    I started experiencing a ‘lump in the throat feeling’ 6 weeks ago, i was going through a stressful time when i noticed it and assumed it was Anxiety related.

    After a week of it i saw my GP, who said likely reflux and put me on somac 20mg a day (i am breastfeeding)as they were concerned about the meds and feeding baby. I did this plus dietary changes for two weeks with no change. I went back to my gp who took me off the somac and referred me to the ENT.

    I was diagnosed with LPR 3 weeks ago by an experienced ENT, following a ?nasendoscopy.He sent me home on a strict anti reflux diet plus somac 20mg BD for 2 weeks which i was religious with but had only minimal results. On Friday he changed my medications to pariet 20mg bd as i was complaining about fullness in my thraot and chest at times. I have commenced these plus he put me on a candidia diet, which i am following(although starving). The feeling in my throat has started to improve however tonight i have a white tongue which burns (i have had this previously, teated for oral thrush in my pregnancy, it comes and goes)and im assuming its reflux again.
    what I want to know is will this candidia diet have any affect?
    Is breastfeeding possibly exacerbating the problem?
    Is it ok to continue with this plan (he will see me in 5 weeks) or do i need to go to a gastro specialist regarding my reflux? what is the next step?

    As i am only 26 i am highly concerned about my future with this and really want this under control. Thankyou for reading

  13. Hello and thank you for your comment,
    It is difficult to make any recommendations or your treatment without having seen you but I would have the following comments to make on what you have told us:
    1) Your symptoms may be consistent with LPR but there are other diagnoses such as cricopharyngeal hyperfunction (which can be related to LPR or anxiety) which should be considered
    2) Two weeks on treatment is really not long enough. Often symptoms take months to settle
    3) Diet plays a very important part in LPR management. Taking medications without altering the diet is like taking cholesterol tablets and continuing to eat fast food. Caffeine (including chocolate), spicy foods, fried foods and carbonated drinks are all high risk. Some people also feel that ingestion of acidic foods can exacerbate the problem
    4) I’m not sure exactly what a candida diet is. The white burning tongue may indicate thrush (candida overgorwth) and may require specific treatment. Ask your doctor
    5) I am not aware of any relation to breastfeeding – this is not something that I commonly hear about from my patients
    6) The plan sounds reasonable. Addition of over the counter antacids with Alginate such as Gaviscon DS may be advisable – check with your doctor on the suitability of your current meds whilst breastfeeding
    7) It sounds like you may need an oesophagoscopy at some stage to exclude a structural cause such as a hiatus hernia. If your ENT cannot arrange this a gastroenterologist would be appropriate at some stage
    8) It is very difficult and unreliable to diagnose reflux on endoscopy alone and the person presentation must be evaluated as a whole. Some patients with LPR have normal looking voice boxes whereas some patients with signs of reflux on laryngoscopy have no symptoms. I find that using subjective indices such as the Reflux Symptom Index (normal score <13) more reliable than appearance alone

    I hope this helps!

    Dr Novakovic

  14. David Lavicka

    Hello Dr,

    Around 6 weeks ago I was diagnosed with LPR via gastroscopy after originally treated for GORD. For the GORD I had a laparscopic fundoplication in Jun 2013 which gave the symptoms of chronic cough, hoarseness, shortness of breath and reflux relief for around 6 months. The symptoms have now returned to the original debilitating intensity. Return of the symptoms have been attributed to abdominal strain. The recent gastroscopy revealed that the fundo was intact, but some aspiration is still present in the lung. Surgeon has recommended standard approach for LPR treatment PPI, diet, elevated bed, food and beverage restriction etc; but after 6 weeks I have no change in condition. Surgeon will not treat further and GP is at a loss for strategies. What are some alternate treatment options and if there is no improvement what is the long term prognosis. I’m getting quite distressed about the situation as it is affecting my continued employment and lifestyle. Many thanks for your time.

  15. Rohin Mckenzie

    Hi Dr.Novakovic
    I’m writing to you from Melbourne and I believe I suffer from Laryngopharyngeal Reflux.

    I am looking desperately for a doctor in Australia who knows and properly understands this condition. I have seen various different GP’s, ENT specialists and gastroenterologist’s without in my opinion correct diagnosis or treatment.

    I’m a 30 year old non-smoker of a healthy weight with no other medical conditions or allergies. I eat well by necessity and have stopped drinking altogether. I previously had a chronic chough which lasted for about 5 years and then eventually went away on its own, but was never diagnosed. I believe now this was the first sign of possible LPR.
    In January I contracted a bad cold, lost my voice temporarily and have had a sore throat ever since.

    My symptoms include:
    • Constant sore throat (sometimes unbearable)
    • Constant throat clearing (feels like there is always something there)
    • Sensation of mucous sticking in the throat
    • Post nasal drip
    • Occasional hoarseness
    • Fast foods and fatty foods and acidic foods
    • Chocolates and lollies
    • Tea and Coffee
    • Alcohol

    These symptoms have severally effected the quality of my life especially my social life and at times my mental health.

    I have tried treatment with PPI’s for 3-4 months without success of though at times they may have helped a little and I would be willing to trial again more aggressively. Unfortunately previous ENT specialists I have seen have not offered much advice on treatment and I was even told by one that this was most likely in my head.

    Most recently my gastroenterologist performed a 24-hour esophageal pH study and is of the opinion that or though I am refluxing it was not more than usual and not the issue. However the study did not measure the amount of reflux that made its way past the upper esophageal sphincter and into my throat, from my research only a VERY small amount of acid needs to pass into the throat to do a great deal of damage. This is where I believe the problem is.

    Currently my gastroenterologist has me on tricyclic antidepressants for nerve pain, 25mg at night (Amitriptyline & also tried Dosulepin) This is my 4th week and I admit they helped a small amount initially but leave my throat and mouth very, very dry and no longer seem to be doing anything.

    I was wondering what your opinion was and if you are able to recommend an ENT specialist or gastroenterologist in Melbourne?

  16. Hello,

    Thank you for your email regarding this very common and frustrating problem. I have emailed you the name of some well trained Laryngologists in Melbourne who should be able to get to the bottom of it. I think you would be best served by a careful laryngeal assessment with stroboscopy. The DeMeester cutoff scores which the gastroenterology literature literature uses for diagnosis of GERD is not necessarily valid for LPR. I suggest you obtain a copy of the pH probe results and take them with you to the laryngology consult.

    I would suggest really tightening up your diet as the foods you mentioned are classic reflux triggers and no amount if PPI will help if you don’t get the diet right. You may want to also consider alginate based antacids which can form a barrier / protective gel against acid and pepsinogen secretion and I suggest you do some reading about alkaline water.

    It sounds like there may also be a component of Laryngeal hypersensitivity. In this case the current tricyclic medications you are on will often be effective but can have significant side effects which limit their usage. A laryngeal desensitisation program administered by a speech pathologist with experience in voice would also be appropriate and has been shown in studies to give better long term outcomes. There are also other classes of medication which can be used but you should discuss this with the specialist

    Best Regards

    Dr Daniel Novakovic

  17. Hello,

    It is difficult to answer this without knowing if the diagnosis is correct. I would recommend that you see someone with expertise in laryngology for an examination, especially with the hoarse voice and aspiration which are concerning. The treatment advised seems appropriate for LPR. Strict dietary modification is imperative in your case. If you are still symptomatic despite medical therapy and a fundoplication either there is something else going on or the fundoplication has not been successful in stopping LPR. A post-operative pH probe is the other conisderation


    Dr Dan Novakovic

  18. Monika Bosnich

    Hi Dr Daniel Novakovic,

    I share the same symptoms as RM.

    I have a past history of Oesophageal Candidiasis, Gastritis and Oesphagitis. I have been taking Pantoprazole 40mg everyday for a number of months. Whilst most of my symptoms have eased, I am having terrible throat issues.

    I struggle to swallow all the time. It never goes away, it only goes from bad to worse. This has been the case for 2 years now. Like Rohin, I also have mucus stuck in my throat and as soon as I clear it, there is more to be cleared. I also feel like the mucus gets stuck there. I’ve had an ENT look down my throat 3 times over the past 2 years, and each time it has been inflamed and red, therefore there is clearly no improvement.

    I have extremely bad anxiety and my quality of life is extremely poor as I am not coping with the condition. Stress makes it worse as my throat starts to burn significantly when I start fearing the worst and I usually take something to calm me down as I am a nervous wreck.

    The ENT I saw in Melbourne pushed me away saying “it’s anxiety” even though he acknowledged my throat was red. Through anxiety treatments, my throat hasn’t even slightly improved. I am having another repeat Gastroscopy soon but I am most concerned about my throat symptoms as It has been ongoing for a few years now. I hate being told it’s in my head as I feel this is just an easy diagnosis for clinicians who cannot treat the real issue. Whilst I do stress, it is because of the pain in my throat which makes swallowing even difficult.

    I would also appreciate some contacts who can help me in Melbourne who you think could possibly help. I’m willing to see anyone and everyone at this point.

    Thank-you for providing such a helpful forum.

  19. Hello Monika,

    Thank you for your post. Many people with your symptoms find it frustrating and debilitating at times. Although reflux may be an important contributor, there may be an underlying neurological issue creating “laryngeal hypersensitivity syndrome”. You could probably improve your reflux control by tightening up the diet and lifestyle factors which contribute. Assessment by an ENT with expertise in laryngology and who works with a voice specialised speech pathologist would be valuable. I will email you some links in Melbourne


    Dr Dan Novakovic

  20. Selina Martin

    Hi Dr Dan Novakovic,

    I would like to see an ENT in Brisbane who specialises in LPR (silent reflux). I have a constant feeling of excess mucus in my throat and sometimes difficulty breathing. Initially I suffered greatly with symptoms of sour taste in the back of my throat, belching, gas, bloating, abdominal pain, feeling of fullness in my chest, and food coming back up etc. I was prescribed PPIs (Pantofast 40mgs) and it resulted in horrible side effects of extreme tiredness, weakness, muscle pain and dizziness. I went to a GP and she told me that in her 25years of experience that the medication was generally well tolerated, and with that she dismissed me.

    I had an endoscopy recently and the nurse commented that I may have been alergic to the medication. Results from the endoscopy were unremarkable but showed chemical gastritis in the gastric antrum and some sparse inflammation in cells. I believe it may have been the result of the PPIs as all my symptoms became significantly worse following medication. I ended up throwing the pills in the bin after 20 days and then I slowly began to improve with natural medicine (slippery elm and herbal teas) except for remaining problem with the excess mucus. I have been using a nasal saline solution in the hopes that it will help to clear the mucus even if I do not have post nasal drip. Prior to the use of the PPIs I never had an issue with swallowing or breathing and I do not suffer from asthma.

    Thank you for your help.

    Selina Martin

    Based on this, would you please be able to recommend the name of someone in Brisbane that specialises in this area and whose automatic response isn’t to prescribe PPIs?

  21. Ash

    Im also been diagnosed with LPR by ENT, the flexible nasolaryngoscopy found nothing apart from a bit of redness and irritation of my larynx.
    ENT has suggested a 2 week initial dose of 40mg Somac but said tablet after dinner.
    I just wanted to know if it would be more effective taking it in the mornings or just a bit before dinner to give it a chance to kick in.
    Also is gaviscon safe to take with somac?

  22. My approach is a little different in that
    1) I believe the proton pump inhibitor medication is best taken before breakfast. Acid secretion starts taking place as soon as we smell food and think about food. Taking it in morning will ensure suppression of acid secretion throughout the day.
    2) 2 weeks is nowehere near long wnough to get a response. The literature suggests that symptms may take up to 3 months to start improving
    3) There is no point trialling the medication alone without modification of dietary and lifestyle factors. The medicine does not stop reflux – it merely turns off acid. You can still have non acid reflux
    4) A combination antacid with Alginate (such as Gaviscon) is an important addition at night time to help with nocturnal acid secretion which can take place via a slightly different (histamine) pathyway

    I hope this helps

  23. As with any medication and with any natural therapy a small proportion of people will have an adverse reaction. If you are unable to tolerate PPIs then strict anti-reflux diet and antacids with Alginate are even more important.

    I cannot make recommendations for other ENT surgeons on the public forums but will email you directly.


  24. Betty

    I have read all your replies to queries but none seem to fit my problem. At times when eating, I have gagged on food and feel sort of choking. I went to a specialist and he said I had split vocal chords and to yodel to repair them. Little seems changed and I am frightened to eat solid foods (I chew and chew and chew before swallowing), but still sometimes I gag (which frightens me) and have difficulty breathing. Each episode seems to last about ten minutes. I now practically live on fluids. Can you help me please. Betty

  25. Hi Betty,
    This sounds debilitating and is not normal. I cannot determine whether I can help you or not without a formal consultation and but cricopharyngeal hyperfunction and eosinophilic oesophagitis are possible diagnoses that need to be excluded. I imagine that a barium swallow and an oesophagoscopy would be necessary at some stage

    Dr Novakovic

  26. Hi dr

    i am a 61 year old male in Brisbane. I recently had a little pain in my stomach and wet to see my GP. He referred me to a specialist who did a gastroscopy and i was found to have Barrets Esophagus. Since that day my life has changed. i have constant heartburn whenever i eat anything – pain in my chest, burning right across my chest and my arms, burping, swallowing difficulty and a lump in the back of my throat. i am now taking two 40 mg nexium a day. on a strict diet (no spice, alcohol, coffee etc) and i have raised the head of my bed. my question is how is it that i have Barretts but prior to the endoscopy i had absolutely no symptoms – i ate spicy food, drank whatever i wanted and never had heartburn, chest pain, or any other symptoms? also i have lost 16 kgs – and not that i am overweight. i was a regular at the gym. 6 feet tall i weighed 84 kgs. i am now down to just 68 kgs. the worst thing iis i have lost all my muscles since starting this PPI. Do you know why all this weight loss suddenly? Do you know the name of a good gastroenterologist in brisbane. i have just been told i have a hiatus hernia and i may need to have a fundoplication done.

  27. Peter Heasman

    Hello Dr Novakovic.
    I have had a problem swallowing for about 18 months and only recently have I noticed other symptoms such as a mild sore throat and hoarseness. I have had a problem also with throat-clearing for around a year. Although there is some nasal congestion I have no problem with mucus or post nasal drip. I have been investigated top-to-bottom and nothing, including endoscopy, has thrown any light on a diagnosis and on my suggestion, my GP put me on Omeprazole for 6 months. To cut what is becoming a long story short, I purchased online the PepTest which is available in the UK. This showed no pepsin in saliva on waking but moderate levels after lunch and a very high level after dinner. As I do suffer from belching (after food and drink)I wasn’t sure that the results of this test are reliable and I wonder whether you have any insight into, or knowledge of such an investigation.

  28. Avril

    Hi Dr Daniel Novakovic
    I’ve had an issue with a dry and bitter taste in my mouth for 3 years. It all started after a bout of whooping cough and subsequent candida in my Oesophagus (due to multiple antibiotics and sprays taken when whooping cough was misdiagnosed).
    I’ve had 2 endoscopies, neither of which showed anything other than the candida. An oral pathologist diagnosed it as Burning Mouth Syndrome and I’m taking 10mg of Endep every night.
    However, I recently had a peptic acid test done (salvia test) which shows I have a high level of peptic acid in my mouth. It actually tastes like I have bile in my mouth every day – pretty horrible.
    I’ve seen so many specialists over the years, but none have diagnosed LPR. I thought it might be worth making an appointment to see you? I’ve tried PPI’s, all brands, but they don’t help.
    Please could you let me know if you can help?
    Regards, Avril

  29. Avril

    Oh…and thank you, this forum is really valuable.

  30. Alex

    It seems to me that some of the people on this site could be suffering from Achalasia which is a rare disease of the oesophagus. I was diagnosed late last year after suffering from what I thought was gord – incredible amounts of mucous, coughing, particularly at night, difficulty swallowing, regurgitation of food,and no response to ppi. I am about to have a new treatment called a POEM – per oral esophagal manometry which uses a special knife to cut the lower sphincter via the oesophagus. As only one in 100,000 suffer from this there are not many of us in Australia and many doctors have not even heard of it.

  31. Gemma Rauch

    I have had 2 fundoplication surgeries, and I’m still suffering burning in my throat. My current Specialist is unable to help me, stating there is nothing he can do but continue to precricribe more medication, which I can no longer take as they cause me to feel unwell. I’m at the point I just do not feel like eating as it causing the burning feeling to get worse. I’m looking for some help in this as my Gp and specialist are unwilling to research this condition. Thanks

  32. Barrett’s oesphagitis is not necessarily always symptomatic but is definitely a condition that needs ongoing treatment and monitoring to prevent progression to more serious problems. I am not sure about the cause of your weight loss but suggest that you have this looked into closer. Fundoplication is usually done by and upper GI surgeon and not a gastroenterologist, but is usually reserved for failure to respond to medical therapy. I am unable to recommend anyone in Brisbane but suggest that you speak to your GP about this. You may need some more specific tests done prior to proceeding to surgery which may include pH probe / manometry.

  33. It is possible that reflux non responsive to medical therapy may be a contributing factor. Endoscopy may not always show up an abnormality in this case and you may need to move to more specific testing such as pH probe / oesophageal manometry which is usually done via specialized units. If you have predominantly throat symptoms I would suggest you get a specialist review by an ENT surgeon to make sure there is no laryngeal pathology. I am not certain about the diagnostic accuracy of the pep test as it is not available here. Also remember that medication is only part of the treatment for symptomatic reflux disease. Dietary and lifestyle modifications are also very important.

  34. Burning mouth syndrome is most common in middle aged women and may be a possible diagnosis. Unfortunately no easy cure for this one. Once again the peptic acid saliva test is not commonly performed here so I cannot comment on its accuracy and usefulness. Other useful tests to exclude reflux may include 24 hour pH / impedance probe or a nuclear medicine reflux aspiration test. These would be the first investigations I would recommend in your case without having seen you first

  35. Achalasia should be identifiable on Barium swallow (classic finding of bird’s beak oesophagus) and the main symptoms are those of difficulty swallowing (dysphagia). I would be very cautious about diagnosing other people’s conditions as this is best done after careful consideration of symptoms, physical examination and specialized knowledge. Good luck with your treatment. I am not familiar with this type of surgery in Australia

  36. Sorry to hear you are still having troubles. Medical therapy is often our first line and not everyone responds in the same way. You may want to keep searching for a second opinion from someone with an interest and apporpriate training in the field of laryngology.

  37. Susan

    Dear Dr Novakovic
    I was prescribed 40mg Nexium and Gaviscon for Laryngopharyngeal Reflux and a chronic cough but I suspect the Nexium and/or Gaviscon could be exacerbating my symptoms (however it’s hard to know for sure). I’ve tried cutting down to 20mg of Nexium but this didn’t work at all. I was recently prescribed 30mg Ausran Ranitidine tabs plus Gaviscon as it was thought I might also have allergies but this didn’t work at all. I’m back on 40mg Nexium (20mg at lunch and 20mg in the evening) and on an alkaline diet. In frustration, I’ve been fasting for the last 2 days (including taking the Nexium) to see if this will ease the acidic reaction and exhausting cough. This is the evening of the 2nd day of fasting and the acid build up and coughing has eased but has by now means gone away. The coughing occurs during the day and is keeping me awake most of the night every night even though I have the head of the bed raised and have been careful to avoid acidic food.
    I see an excellent GP in Brisbane however, I would appreciate any comments and/or advice.
    I would also appreciate it if you could pass on the name of the specialist in Brisbane if needed.
    Kind regards

  38. kate

    I’ve been having breathing issues
    They sent me to lung specialists but as I thought it’s not asthma, I have trouble breathing in not out. Sinus issues, cough etc. After reading your postings I’d like to get checked for silent reflux. Could you recommend someone to see in Melbourne please. I’m also going to start a the diet you’ve recommended, crossing my fingers. Thank you.

  39. I have had breathing issues (in not out) for 18mths with doctors putting me through all the asthma tests etc (but I didn’t think I had asthma, however the amount of exercise I used to do has dropped dramatically because of it). I have a lot of the other symptoms described in your forum as well. Could you please recommend someone to see in Melbourne as this has been going on for too long and quality of life slowly going down the drain (especially with a 2 year old). I’m also going to start the diet you recommend. Really appreciate the information on this forum. thanks Kate

  40. Hi Susan,

    It is difficult to say what the problem is without seeing you and knowing the history. Fasting will not help and is not advised. There are many other causes of cough and if you are not responding to strict antireflux diet and medications then these need to be further investigated by either seeing a respiratory or Ent specialist (or both). Your GP should be able to point you in the right direction

  41. Hi Kate, Reflux on its own shouldn’t cause difficulties breathing in. Your vocal cords +/- trachea (windpipe) need to be checked by an appropriate specialist (ENT). Possibilities include structural narrowing of the airways or paradoxical vocal fold movement disorder

  42. Sarah

    Dear Dr Novakovic,

    I have had a constant feeling of lump in my throat (and tightness and soreness) for 6 months now which gets worse as the day progresses. No coughing, but I do noticeably regurgitate during the day sometimes. After reading around online, I suspected LPR so went to see ENT, but he was quite dismissive, told me I had ‘globus’ and was too young to have reflux (I’m 30). He gave me some nexium anyway and said to take 40mg in evening for a month to see if it helps. I asked if diet changes were important, he said no. So my question is – do you think a month is long enough on nexium? Also, does it matter that gaviscon is peppermint flavoured (I read mint is bad for reflux)?! And do you have any colleagues that are more knowledgeable about LPR around the Northern Rivers area of NSW (Gold coast, Lismore, Brisbane even…)? Thanks

  43. Dear Sarah,

    In y opinion a month of medication alone is not a sufficient trial of antireflux therapy. We ould recommend at least 2 months of prescription acid supression + a neutraliser such as Gaviscon Dual action + reflux dietary and lifestyle modification. We usually track progress using the Reflux Symptom Index. If you are non responsive it may be something else such as sensory neurological dysfunction or non acid reflux. Unfortunately as my website is public I am not really permitted to recommend any specific clinicians in your area but you may want to look for someone specialising in laryngology or voice disorders in your nearest capital city!! Thumbs up for Gaviscon from me

  44. Yesenia


    I have been diagnosed with LPR by my ENT, he did the test where a tube is inserted through the nose to look into my throat. He said my throat was quite red and inflamed. He put me on aciphex 2 daily 40mg total. I have been back to see him once a month for the past two months, and he has done the same test. He says that my throat looks the same, I am making no progress. I have also been keeping the diet he recommended, drinking a lot of water, and raised my bed. How long will it take to see any results? Should I be worried about my condition not responding to treatment?

  45. Daniel Novakovic

    How your throat looks is not the way we decide whether you are getting better or not. It’s how you feel that’s important. You can’t see reflux reliably. We use the “reflux symptom index” to track the progress of our patients. It can take up to 3 months to get results

  46. Stephen


    I suffer from chronic LPR (diagnosed, 5 yrs plus). I’ve heard about a mimimally invasive procedure called Stretta, which can restore LES function. Do you have any experience of this or do you know of any surgeons using this procedure?

  47. Daniel Novakovic

    Stretta is used in the United States for GERD/ GORD. I am not sure about it’s efficacy for LPR. It is not widely available in Australia but a quick google search shows there is a gastroenterologist in Melbourne who performs this procedure

  48. Stephen

    Thanks for your reply – I will make further enquiries.

    I have read that there is a growing consensus that pepsin may be responsible for LPR, hence the reason why PPI’s don’t work. Is there screening test for pepsin?

  49. Vanessa Simpson

    Very interesting reading. I am a primary school teacher and speak a reasonable amount each day. Lovely students so rarely if ever shout. I find that even when not at work I have a hoarse throats (mild) as though been talking at a concert over loud music. A mild burning feeling in throat and mild feeling of mucus. No bitter taste. No cough or indigestion or sinus or nasal congestion. I thought perhaps the sore throat on waking was from mouth breathing or snoring but hubby says I don’t. 49 years old, 59 kilos, 5ft 5 . Have never drank, smoked or eaten spicy food. The only ther strange symptom I have is itchy ear canals. No ear pain or infection. Haven’t had a sick day in five years. But did lose my voice five y ars ago with a nasty virus. My voice just feels changed. Should I see voice coach, ent or gostroenerologist ? Could this be Silent reflux?

  50. Daniel Novakovic

    It’s possible that reflux may play a part but it is likely that there are other factors. From your story the possibilities of a post-viral vagal neuropathy or muscle tension dysphonia should be considered. I would recommend assessment by someone with experience in laryngology who ca do a proper voice assessment including stroboscopy. You would probably benefit from seeing a speech pathologist with expertise in treating voice disorders also

  51. Daniel Novakovic

    There is great debate over the role of pepsin in LPR and the role of non-acid reflux. There is a pepsin test available I think in the UK or Europe but not in Australia. The problem with the test is that we don’t understand the exact role or usefulness of this test and what it means when it is positive or how it may change our management. There are more established and validated methods of investigating reflux that you should discuss with your doctor.

  52. about a month ago i developed a feeling of something lodged in my throat. I suffer from GORD and take 40mg a day. I confess I do drink alcohol and coffee frequently. I also suffer from sore chest and a full feeling and burning mouth syndrome. I am waiting to see an ENT but wondered if I should talk to him about LPR.

  53. Daniel Novakovic

    The answer is yes! Try to tighten up the diet prior to see if this helps

  54. Sandra


    I am 40 years old and for the last couple of months I have been trying to work out what is going on with my throat. I have a lot of the LPR symptoms with the need to clear my throat, a burning sensation down one side of my throat, sometimes a feeling of a lump in my throat. I have seen an ENT doctor who said I could try Nexium and he has put me on 40mg twice a day for a month. When I went to get the script filled the pharmacist said that was a really high dose, which had me worried. He did not put me on gaviscon or any other meds. I have been on Nexium for roughly about a month now and while I think the post nasal drip feeling and to some extent the need to clear the throat has improved, I still feel the burn down the back of my throats or the lump in the throat feeling. Often these feelings are not triggered by any ‘reflux’ foods but still come on – mainly in the afternoon or night. Often just inhaling and breathing causes a burning feeling down my throat. The only test I have had is the camera down the nose to the throat which I was told was fine. I have not had any other tests done because to be quite honest I have not found the right doctor to help me. I guess my questions to you are
    1. Do my symptoms sound like LPR? (Half the battle is identifying what is going on)
    2. Is 80mg a day of Nexium too high a dose to be on?
    3. Why would I be feeling a burning sensation when I inhale or a feeling like there is a lump in the throats if I am on such a high dose of Nexium?
    4. Should I be symptom free?
    5. Do I need to include gaviscon to my regime and when in the day do I take it? I take the 40mg of Nexium an hour before breakfast and an hour before dinner.
    I do try very hard to follow the proper diet.

    Hoping you can help.

  55. Daniel Novakovic

    Thank you for your post

    In response to your questions

    1) Its possible that this is all LPR related but there are other rarer causes
    2) Its high but not too high ibn the short term
    3) Nexium does not necessarily “stop” reflux. It just turns the acid off. You may also have someth8ing else going on
    4) No not after only one month of therapy. Guidelines are minimum 3 months of treatment. Nexium alone is not enough – you need to implement dietary and lifestyle changes and use a barrier mediation at night
    5) Yes, Dual Action, before bed. You can also have it after meals

    Hope you improve!


    Der Dan

  56. Sandra

    Thank you dr for your reply. I have booked in to have a gastroscopy done next week. If it was LPR that I am suffering from would signs show up in this examination?

    Thank you again.

  57. Sandra

    Thank you dr for your time. I just had one further question. Would you see signs of LPR by having an endoscopy done?


  58. Daniel Novakovic

    The answer is – not necessarily…

    In the throat endoscopy signs of LPR are non specific. i.e. they can be present without a patient feeling symptoms (in which case there is no need to treat) or sometimes the endoscopy can look entirely normal but the patient can have symptoms of LPR and respond to treatment

    In the oesophagus endoscopy can sometimes detect predisposing factors to LPR and GERD/GORD such as hiatus hernia. Ulcers at the lower oesophagus are indicative of damage due to reflux and need to be biopsied as some can show precancerous change. A normal oesophagoscopy / gastroscopy DOES NOT EXCLUDE Reflux / LPR which is a common mistake that people and some doctors make

  59. Darren


    I have been diagnosed with LPR after experiencing various systoms over the last few years. Been on Nexium for close to a year and whilst I have made improvements, two symptoms still remain which effect my quality of life. I can cope with the constant throat clearing but the one that causes me the most grief is the constant sniffing (sinus irritation/inflammation). This does not seem to be listed as a common symptom so I was wondering if you had ever heard or seen this in any of patients before.

    It doesn’t seem to matter which measures I take e.g. alkaline flushing of sinuses, Gaviscon at night, raising of bed head, this is the one symptom that constantly remains. Could this be a side affect of the nexium as it only started once I began taking this medication.

    Thanks in advance.

  60. Daniel Novakovic

    Sinusitis is a rare (4% incidence) side effect reported in people on this particular medication. It is more likely that you have sinusitis related to allergy or infection and this needs to be evaluated separately. Usual treatment is with steroid sprays with a CT scan if you don’t respond. You could always ask your doctor to change you over to another medication in this class to see if this helps.

    I have seen reflux tests that demonstrate stomach contents reaching the larynx, sinuses and even eustachian tubes so I am certain that reflux can be another potential cause of sinus inflammation. You sound like you may benefit from further investigations to check whether your reflux s under control such as gastroscopy or 24 hour ph / impedance study

  61. carmen spence

    I have severe burning throat and hot mouth from heartburn, but now for the last 4 years I have become very breathless, cannot walk too far without huffing and puffing or need to sit doe, get mucous in my throat not really any coughit is ruining my life as I have no energy and if I bend over it takes me 15 minutes to get my breath back.
    Can you please
    Eas3 advise me?

  62. Anne

    Have problems with throat, cough and croaky voice. Have been on ppi for a long time took them down to 10mg and wasnt too bad. I am gluten intolerant and cant take milk products either. I would just like someone to help me with this problem I think it is lpr. I live in canungra Qld is there anyone up here who could help Its making my life misrable

  63. Daniel Novakovic

    Could be many things causing your symptoms including possible reflux. You should really discuss with your GP for basic investigations to look for causes of shortness of breath. The GP may need to refer you onto a respiratory or gastroenterology specialist.

  64. Daniel Novakovic

    Suggest you ask your GP for a referral to an ENT. If voice is the main problem try to find someone in Brisbane or the Gold Coast who can also offer stroboscopy as part of the assessment

  65. Merinda

    To Carmen Spence (4/10/2017): I too had shortness of breath/lack of energy, but a simple blood test for haemoglobin levels confirmed a diagnosis of pernicious anaemia (another auto-immune disease to accompany my type 1 diabetes!) Haemoglobin is the substance in red blood cells which transports oxygen around the body. Absorption of B12 in the intestines depends on the presence of a substance called the ‘intrinsic factor’ which is secreted by the lining of the stomach. For unexplained reasons the secretion may stop and once this has happened it never corrects itself. Treatment then consists of injections of vitamin B12, which must be given regularly for life – and which I now have quarterly. I am also on Pantoprazole and was recommended to trial it for 6 months – half way through 4th month now with no improvement. My ENT also recommended I take it at night. However I’ve been saying to hubby that I thought having it before breakfast made more sense and will now try this as Dr Novakovic recommended it above! Will also try Gaviscon… Thanks for a brilliant forum Doctor – I feel so reassured knowing I can take my concerns further and where to seek further help. 🙂


  1. Vocal Nodules – an unusual case study | Sydney Voice and Swallowing - [...] that the ENT prescribed (months beforehand at his initial assessment) for possible underlying Laryngopharyngeal reflux (LPR- see previous posts…

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