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backflow of the stomach content into the esophagus only -GERD
backflow  of the stomach content  beyond the esophagus into the throat -LPR
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Ear, Nose and Throat (ENT), Head and Neck Surgery
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Reflux Disorder Laryngopharyngeal Reflux (LPR) EDUCATION
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Last update:  10/1/13 
Reflux LPR GERD flyer -English
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Treatment: GERD & LPR Patient Education, Lifestyle Modifications. Take your prescribed medication  as directed o Proton pump inhibitors are commonly prescribed o Optimal time is 30 minutes before meal Lose weight through regular exercise and healthy eating. Obesity promotes reflux. Stop   smoking      -   smoking   increases   aerophagia   (air   ingestion   into   the   stomach),   belching,   and   acid exposure, and diminish the salivary base. Avoid or reduce alcohol consumption Avoid certain foods that may increase esophageal reflux: o chocolate o fatty food o spicy food o sour food o carbonated drinks o tomato-based products o red wines o caffeine/coffee o onions o peppermint o garlic   Avoid late-night meals, especially just before bedtime Avoid large meals. Instead, eat small meals, up to 6 times a day, instead of 3 large meals Eat at a slower pace to reduce aerophagia (air ingestion into the stomach) Avoid lying down within 3 hours of a meal Elevate the head of the bed by 6 to 10 inches or about 15o - an antigravity measure . Avoid tight clothing especially around the abdomen region, or stooping after meals. While reclining, avoid lying on their right side because this may increase reflux. Avoid vigorous exercise within 1 hour of eating. Use abdominal breathing. Let your abdomen expand with each breath in.
Doktor, Saya kerap rasa masam dalam mulut. Terasa gatal betul tekak saya ni. Sila nasihati. TQ Dear Doctor,  I have sour taste in my throat, my throat is irritated all the time and my voice is terrible. Please help me.          Desperate
This patient education is provided in good faith to help patients and their families learn more about their medical conditions, the options available to them and the possible consequences of their decisions. This information is not intended to be used for diagnosis, or treatment of any specific individual. Please consult with your ENT doctor regarding your particular circumstances.
(source of unlabelled diagram: Netter Atlas of Anatomy)
oral cavity/mouth
larynx (voice box area)
Ever felt that sour stomach content in your throat ? Ever felt that your throat is itchy or irriated all the time? Frequently awake with a hoarse voice ? If so, you may be having a reflux disorder. Please read on... What is GERD and LPR  ? Backflow of stomach/gastric contents happens. Backflow of stomach/gastric contents into the esophagus = Gastroesophageal Reflux Disease (GERD) while backflow of stomach/gastric contents past the esophagus into the laryngopharynx (the vocie box and throat region) = Laryngopharyngeal Reflux (LPR) While the esophagus can withstand the acid insult from reflux better, the larynx cannot tolerate any acid reflux and patient will commonly manifest with symptoms. What are the symptoms ? The most common LPR symptoms were: throat clearing persistent/chronic cough globus pharyngeus - sensation of a lump in the throat hoarseness - especially in the morning However, typical LPR symptoms (excessive throat clearing, cough, hoarseness, and globus pharyngeus ) are nonspecific and can also be caused by infections, vocal abuse, allergy, smoking, inhaled environmental irritants, and alcohol abuse. Other symptoms include: post nasal drip difficulty in swallowing bad breath throat tightness pain in the ear, and hypersalivation  (excessive salivation) Worsening of rhinosinusitis LPR differs from GERD in that it is often not associated with heartburn and regurgitation symptoms. Heartburn is a retrosternal burning pain in the epigastric area, neck, throat, or occasionally the back. Typically, it is frequently happens after a meal or at night Regurgitation is the movement of gastric contents into the esophagus without vomiting. The patient may describe a sudden acidic taste or a "sour" or "hot" belch. Regurgitation, especially at night is another highly specific finding for GERD. Chronic GERD is associated with Barrett's esophagus Barrett’s esophagus is a premalignant condition (i.e pre-cancerous change) where chronic acid exposure induces the original/native esophageal lining/mucosa to be replaced by a new lining that predisposes one to adenocarcinoma of the esophagus, a type of cancer of the esophagus. LPR is also found to be more common in those with obstructive sleep apnea (OSA). How is the diagnosis made? Usually from the patient’s history and endoscopic findings of the voice box and throat. There are certain findings on the endoscope which may suggest LPR, though it is not specific to LPR only. Some signs are also rather subtle. Sometimes, a 24hour pH monitoring may be necessary.
Flexible endoscopy of the upper airway. The black tube represent the scope (source of unlabelled diagram: Netter Atlas of Anatomy) NASAL CAVITY TONGUE POSTNASAL SPACE BRAIN SOFT  PALATE HARD  PALATE BASE OF TONGUE EPIGLOTTIS WINDPIPE/TRACHEA TONSIL CERVICAL SPINE VOCAL CORDS LOWER JAW/ MANDIBLE POSTERIOR PHARYNGEAL WALL © Vincent Tan ENT Flexible endoscopy of the upper airway in a real ENT clinic setting. Endoscopic view of a normal voice box  © Vincent Tan ENT Inflammation of the back of the throat a.k.a cobblestoning of the posterior pharyngeal wall (red arrow) © Vincent Tan ENT Endoscopic view of the cobblestoning of the posterior pharyngeal wall (red arrow) Endoscopic view showing inflammation over the back portion of the voice box -posterior commisure hypertrophy (red arrow)  Endoscopic view -the true vocal cords are inflammed (red arrow) Endoscopic view showing granuloma of the voice box (red arrow)  © Vincent Tan ENT © Vincent Tan ENT © Vincent Tan ENT © Vincent Tan ENT
Laryngopharyngeal Reflux (LPR)
An anatomic diagram from your mouth to your stomach
A 24-hour pH monitoring in place -a very tolerable and useful investigation. © Vincent Tan ENT
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D R. V INCENT T AN Consultant Ear, Nose and Throat, Head and Neck Surgeon, MD (UKM), MS ORL-HNS (UKM), DOHNS RCS Edinburgh (UK), MRCS Edinburgh (UK), Postgrad. Allergy (UK), A.M. (Mal), Fellowship in Rhinology (Singapore) Fellowship in Head and Neck Oncology & Surgery (Amsterdam)
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