04/28/2020 LaryngoPharyngeal Reflux (LPR): The Great Medical Masquerader
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- Опубликовано: 27 апр 2020
- Allergy and Immunology Teaching Series presentation by Ronald A. Simon, MD, Emeritus Head, Scripps Clinic, Division of Asthma, Allergy and Immunology; Adjunct Professor, Department of Experimental Medicine, The Scripps Research Institute
At the conclusion of this presentation, attendees should be able to:
1. Recognize the symptoms of LPR.
2. Identify patients with LPR.
3. Provide patients an effective management program.
This is the best LPR explanation I’ve seen online! I wish I had this dr close to me to help me 😞
Excellent and fascinating. Ronald clearly knows his stuff, possibly the best presentation Ive seen on LPR, I certainly learned a lot. Thanks for posting this.
This presentation was wonderful. It was very informative and helpful for someone who's never been able to get a right diagnosis. Thank you Dr. Ronald!
Thank you
Very insightful presentation. Well done!
I think the problem with allergists adopting this orphan disease is that we patients don't go to an allergist for our problems. ENT, GI, and pulmonology need to be on the front line. (But thanks, allergists, for caring! It's very interesting that you point out that allergists focus on treating the patient, no matter what/where the problem is.)
Thank you so very much for this video. I am so tired of being seen by doctors that are clueless, but yet I have studied up on my symptoms and I know that this is LPR. I do also have allergies to environmental like pollen's (trees, grass, dust). But this is so different and it's only been over the last, 5 years it's starting to ruin my quality of life. Thank you again, I am listening to everything, on LPR and this one looks like a winner.
How r u doing now? Have u got any treatment?
@@Shubham_68276 tum kaise ho bhai
@@Shubham_68276bhai thik hua
I hope there's some research going on, because it's unbearable and PPIs aren't working all too well. Also, no mentions of laryngospasms (unless I've missed it). I'd be a lab rat if there was anything promising to cure this nightmare.
This was a great presentation. I wish there was a cure for this demon! And also more doctors trained on it so your not being bounced around and frustrated.
I'm just figuring out this nightmare, baking soda/water spray to the throat/nose and alkaline water are now saving my life...
Alkaline water = theft
Hey man. Can you explain how you spray baking soda to throat?
@@TheDanger210 doesn’t seem to work as well as it did initially, now I’ll take a few sips of alkaline water/baking soda after something acidic like coffee. I use 1 teaspoon baking soda. Will post a RUclips video nexy
@@TheDanger210 ruclips.net/video/DKaxduSxQnI/видео.html
@@jasonteacherthailand might want to quit the coffee. I quit and it’s not that bad
I have had some form of reflux on and off for years and suddenly got clobbered with this insanity after a stressful time and holiday eating (way too much chocolate). I know all this throat stuff is related to my gut and reflux because I get queasy and feel the gas travelling up. Sometimes gas sits there like little balls lined up in a pinball machine, coming up one tiny burp at a time.Then get alot of throat symptoms half hour after eating. Nose drips, can pull mucous down, bad sore throats in the am especially, even tonsils ache and throat feels swollen. Globus alot. Occasionally get hoarse and have to clear throat. Tell me this is not LPR! Don't need a fancy test to convince me. I guess there are people without stomach issues who get this but I can taste what I am not digesting well when indigestion starts. Tomato the worst but my beloved onions and garlic also bad. Doc is right that I have no probs sleeping but am trying a wedge anyway. No heartburn but weird prickly sensations around esophagus or neck. I no longer know how to cook as I am missing my favorite foods. Bought empty nasal spray bottles on amzn and will try the baking soda/alkaline water spray to reduce throat pain. I don't want to have this orphan disease and am trying so hard with lifestyle changes but hate the idea of osteoporosis-causing PPI's. And he is right about not coming off those meds too fast. I did that years ago and vomited for weeks as the acid poured into my gut. We need the best holistic minds on this as traditional docs really don't have an answer.
At the 12:06 mark....the circle is around the laryngeal surface of the epiglottis. The intraarytenoid location is on top of that image. This is part of the problem when laryngeal anatomy is not well understood.
I'd like to know what is the reference "RAS" for Prolonged Cough following URI on the slide titled Other Manifestations (at 5:00).
Amazing presentation but where the heck is a pepsin inhibitor/treatment? We can cure certain cancers but we don't have a pepsin inhibitor? How is that possible?
15 years on protonix. One month off. Last two days lpr is kicking my ass.
Just. Wow! I learned sooooo much!
I’m at my wits end with LPR. I can’t sleep. I can’t breathe. I’ve ended up in urgent care, unable to get air, with blue lips due to this condition.
I’m hesitant to see an ENT. It’s a waste of money.
After covid im unfortunately on a high dose of PPI.... it helps, kind of, just like head of the bed elevation and eating 5 hours before sleep. How long do LPR / SERD patients stay on PPIs for? Life long? The titanium magnets looks pretty awesome but I'm guessing the masses aren't going to be getting that any time soon.
Can a hiatial hernia cause this or oxycodone
How to diagnose LPR without having to sleep in supine position? I already have enough chest pain as is, I doubt I could even fall asleep if I tried to sleep supine. I tried to sleep supine yesterday but after a few minutes I felt so horrible I had to put the reflux pillow back.
EDIT: Nevermind, the ph test still showed significant drop in acidity.
The most interesting thing I found, due to a very good app called Snorlab, was that I slept ok BUT, the mucus made me snore and breath very badly. When I reduced my LPR, my snoring stopped. I can’t understand why snoring is not often correlated with LPR and highly recommended Snorlab to track mucus affected breathing.
Coughing for years, then hoarseness added. Dr didn't know why. Read much on the internet and thought I might have LPR. Made an app't. with a GI dr. for endoscopy. Esophagitis grade B, &, sudden return of hoarseness and cough. gastritis Dx. CT scan showed some lesions in upper lung fields- constant burning feeling in upper airway. Put on PPIs for the rest of my life. Would wean down, but symptoms would return. Two yrs. later, esophagitis grade C. Worried about continuing PPIs the rest of my life as already have osteopenia. Decided to have Linx vs tourpet fundoplication in 2017. Rocky start requiring TPN, then Dr reluctantly did dilation which resolve the problems with only occasional pooling/ vomiting to clear. LPR gone and esophagitis healed. Now, LPR symptoms returned 6 weeks ago. Had an esophagram revealing GERD up to clavicles and disconnected LINX. Trying to decide what to do. Am 79- still snow ski, SCUBA, and don't have time for a Nissen. Thoughts?
I think it's malpractice for doctors to put people on PPI's indefinitely. They aren't the answer and they cause horrible rebound GERD. If it's back, maybe get tested for LOW stomach acid? Take care of your digestion and gut microbiome first and foremost? Wow you are 79 and ski, SCUBA, etc? I have hope, I'm 47 and have LPR now.
Has anyone looked into using amino acids to help control this issue
I am carrying dx of LPR, but I do cough up a lot of phlegm, and never have had hoarseness. Maybe I have LRP and sinusitis. My major symptoms are Post Nasal Drip and cough. Any doctors who want to offer friendly advice, please do so; PPI trial for 2 months did not help at all. Also cough through the night, which speaker said is not typical of LPR.
You mentioned elevating the head of the bed by 6 inches. I have a 4 foot long wedge pillow that also reaches close to that. Is the elevating of the bed superior to a wedge pillow?
Also, could you comment on the use of melatonin, as some have seen success with? My LPR started at the same time as my sleep issues began.
Bed elevation is the best. Wedge might be similar to pillow propping which they don’t recommend because your body is in a bent position.
Thank you Doctor! This is an orphan issue and there are thousands of us . Please help us ! We need help. What is the best way to treat it? Thank you
Looks like diet more than anything else to me but I’m yet to see if it works for me.Drink nothing but water.
Ginger water
They talk about the cough a lot but here I am diagnosed by a ENT w/LPR and I only have Throat/chest burning, earaches, burping, and mucous buildup. For those new to this with similar symptoms, gargle some water(non alkaline worked for me) with 1/2 teaspoon of baking soda.
Trying this.
What was the symptoms you have faced during lpr
How often do you gargle?
@@raviyadav-zo7bdabi thik ho bhai
I found using a nasal spray of water and baking soda helps to clear it quickly.
Does someone know the best way to elevate the bed 6 inches? Also, how do we find allergists that are "up" on this information??
I was using jack safety stands used for working under cars. OF course it depends on your bed and how it is designed if this would work.
I use books
I have a “sleep number” bed. You can adjust it to any angle you want with a remote control.
I’ve put locks of 4”x4” wood under the end of the bed.
I have lump in throat sensation im diagnosed with lpr and hiatal hernia. Ppi and food restrictions like spicy sour mint tomato choco caffeine dont work
How r u doing now?
How r u now
Thanks for this presentation it's excellent. But nobody explains why the upper esophagus valve is not functioning properly. To me it's due to the vagus nerve. This nerve controls digestion and all the organs in the body. Stress can cause this disfunction, lack of sleep too, autoimmune disorders too. Check if you have other vagus nerve related diseases like pots, or parasites (lyme etc) /bacteria (pylori etc). Colloidal silver or ivm can help against parasites. I wonder if melatonin can help too as some people have reported on forums it cured their lpr.
Pepsin is going up the throat so it's also a lower esophagus valve problem. I think the vagus nerve has a key role here. What do you think?
Thanks
Anyway according to this presentation the best natural and non invasive treatments against this are: elevating the head of your bed, spraying baking soda water in throat, and alginate.
The others involve surgery which is not so good taking into accounta the risks
Another possibility is stress which releases too much cortisol. The cortisol weakens many muscles, including the ones lining the esophagus and it is not a mere coincidence that GERD and LPRD usually start in the 3rd decde of life and increase with age. This coincides with the slowign of metabolism and the increase in cortisol/DHEA and cortisol/testosterone ratios, which leads to generalized atrophy and muscle loss and weakness.
Yes I agree totally about vagus nerve. I am a bit obsessed with researching it currently. I have had fibromyalgia for over 30 years and take Melatonin for sleep. It does help that but not the LPR. My coughing is exhausting all the time and I am super sensitive to everything like temp.changes, cleaning teeth, a small drink of water even. Good luck with your's.
@@cynthiastogden7000 thanks Cynthia and sorry for what you have to endure. Yes i do think it's a nervous problem either vagus nerve or neurotransmitters. I switched to a more holistic approach, since nothing "tangible " seems to work to alleviate the symptoms (diet, yoga, relaxation, ...). Good luck my friend
Yes, something called Post Viral Vagal Neuropathy from Covid. After Covid I got 100 day cough, then throat clearing then sore throats. Thinking it’s LPR now which I never had an issue with until after Covid.
Thank you for the sharing your slides. Could you share your thoughts on a low stomach acid and its effects on the LPR?
I've had LPR for 8.5 years. Drinking 1 tbsp of diluted Apple cider vinegar per day has reduced my throat mucous by 95%. There's many other reasons for LPR but this might be worth a shot
@@GoVeganForTheAnimal bad bad very bad advice. Just read about pepsin....
@@99things45 results don't lie. This has helped me I have no reason to make it up
@@GoVeganForTheAnimal for you yeah
@@99things45 yeah I'd suggest checking if low stomach acid is something you test positive for before trying it but for me nothing else had helped so it's very pleasant to discover
I have an ent prescribing Xanax for me! Because she checked my throat and everything looked fine. So she said just don’t think about it
Many unanswered questions in this comment section 😐
Yes because causes are different.
so i understand that lpr is caused by weak ues muscles but i am 25 and i have so much spicy food and coke because of whic maybe i faced this problem but what i want to know is actually can the muscles regain their strength or is it that once it gets loose it will stay that way ?
It will heal
How r u doing now? Have u got any treatment for this?
How are you now? Any improvemnts?
@@tuanz8009 how long?
@@tuanz8009 how does it heal?
I have difficulty breathing from this and don’t respond well to bronchodilators 😢😢
Any updates??
@@katiesanchez4056 just being on ppi nothing else really works. I also gurgle in the morning and at night. Diagnosed with vocal chord dysfunction
@@HealingWithJas are you able to eat solids? And how long have you been on ppi?
@@katiesanchez4056 yes two months
I was recently diagnosed with LPR, my main symptoms are trouble swallowing solids and a feeling of a lump in the throat. It has been a long journey to get to this point.
I think stuff like Pepcid AC before bed and Gaviscon Advance can help with the swallowing part. Really have to watch what you eat. Something I found lately is sometimes taking an advil seems to help, like reducing inflammation either in the stomach or throat.
How r u doing now? Have u got any treatment?
Any updates
@@Shubham_68276 tumhe hai bhai
How r u now
I want this doctor to help me because i think that's is my problem. And i am a singer
I have gastritis from H Pylori infection for which i went thru the antibiotic course and the intensity of symptoms have significantly reduced if not completely. I dnt have heart burn,hoarseness, cough but have throat pain and slight burning sensation which stays for some time like 15/30mins. Never had a history of acid reflux though with spicy diet. Can i ever get normal.
I have the same situation did they put you on PPI therapy as well ? Were you diagnosed with LPR
@@Goca52284 no. They js gv PPI.. I took natural medicines and diet control so things are slowly improving by God's grace. Do not worry it will be fine. Takes time so need to have patience.
Ive had it for 4 months its horrible my main symptom now thats driving me insane is a feeling of something in my throat constantly. If I swallow a pill of any kind I feel it sitting in my throat for hours. Same goes for solids.
@@reyshaconsulting5550 I was diagnosed with h pylori and mild gastritis as well as LPR I hope that h pylori is causing these symptoms because I finished the antibiotic treatment over a month ago
@@Goca52284 take a urea breath test to confirm if H pylori is gone. If gone then it might be reflux, even I have odd throat issues. If h pylori is still there you might have to repeat the antibiotic treatment again with dfrnt medicine. Ive heard that it take a year or so for it all to become normal so hang in there.. There will be dfclt days and one day you will realize its gone. Have faith
Just add some HCL and poof, it's gone.
Are you using them every meal or day? Are you noticing any improvement?
LPR symptoms are gone. I used to take every day with meals (breakfast and dinner mostly, 600mg each) but now my gut is in better health so only occasionally when I feel a hint of LPR coming on or if I just feel like I should based on my eating habits at the moment. Bottom line is it worked, thankfully.
@@ranalloja that’s good to hear, which brand did you use?
You can have LPR and NOT have GERD...but you can't have GERD and NOT have LPR.