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Dear Dr. Roach: Can you give me information about laryngopharyngeal reflux? I develop a croaky voice at times and have lots of mucus in the morning (which doesn't get coughed up), among other things. Is diet alone enough to remedy the problem? I'm going in for a vocal cord vibration test. -- M.M.
Answer: Gastroesophageal reflux disease (GERD) is when the acid in the stomach doesn't stay where it belongs and goes backward into the esophagus. There's a structure called the lower esophageal sphincter (LES) that's supposed to keep the acid in the stomach, but sometimes it doesn't work right. This can cause the classic symptom of heartburn, as well as other symptoms.
Laryngopharyngeal reflux (LPR) is a special type of GERD where the acid gets all the way up into the back of the throat. Symptoms include throat clearing, hoarseness, a cough that's worse when lying down or after eating, excess mucus in the throat, a sour taste in the mouth, and voice changes such as hoarseness.
The vocal cord test will be looking for "paradoxical vocal cord motion disorder," which is strongly related to LPR. It usually causes trouble breathing, as well as a noise upon inspiration ("stridor"). Throat tightness and difficulty swallowing are also possible with this condition.
As far as treatment goes, dietary changes (and other lifestyle issues) are necessary but aren't always sufficient to solve the problem. The most helpful dietary changes include decreasing fatty and spicy foods, acidic foods (especially tomatoes, sodas and citrus juice), and substances that weaken the LES -- especially nicotine, caffeine (coffee, tea, chocolate) and alcohol.
Other lifestyle issues may be even more critical than food choices. Not eating for 2 or even 3 hours before bed ensures that the stomach is empty so it has less acid at night when it's most important. Keeping the head of the bed elevated uses gravity to help drain any acid that escapes the stomach. (A brick under the bed is more effective than pillows.) Smaller meals keep the stomach pressure down.
Some studies have found that these lifestyle changes are even more effective than medication. When lifestyle changes aren't enough, medications like proton-pump inhibitors are used.