Laryngopharyngeal Reflux (LPR): When Reflux Masquerades as Postnasal Drip
Many people who come to the ENT office with “postnasal drip” are surprised to learn that the problem may not start in the sinuses at all-it may start in the stomach.
Laryngopharyngeal reflux (LPR) occurs when stomach contents like acid, pepsin, and bile travel upward beyond the esophagus and reach the throat or even nasal passages. Because this reflux is often silent (without heartburn), it’s frequently mistaken for chronic sinus drainage, throat clearing, or allergies.
How LPR Differs from Classic GERD
While gastroesophageal reflux disease (GERD) primarily affects the lower esophagus, causing heartburn due to the acidity, LPR can be nonacidic and still impact the upper airway irritating the delicate tissues of the pharynx, larynx, and sinuses as well as stimulating sensitivity in the vagus nerve. This can lead to symptoms such as:
Persistent throat clearing or mucus sensation
Hoarseness or voice fatigue
Cough
Globus (the feeling of a “lump” in the throat)
Postnasal drip or thick mucus not explained by allergies
Studies suggest that over 60% of LPR patients do not respond well to acid-suppressing medications alone. That’s because reflux is more complex than acid. It involves mechanical, dietary, and inflammatory factors that benefit from a more integrative approach.
Nutrition and Lifestyle: The Foundation of LPR Management
Diet plays a major role in calming reflux-related inflammation. Evidence supports low-acid, low-fat, high-protein, high-fiber diets, which can reduce symptoms in 50–75% of patients. Small, mindful meals are key-eat slowly, chew thoroughly, and stop when satisfied rather than full.
Avoiding common triggers (such as caffeine, alcohol, carbonated drinks, citrus, tomatoes, chocolate, fried or spicy foods) can make a significant difference. Refraining from eating within 2–3 hours of bedtime and maintaining a healthy weight also helps reduce reflux pressure on the upper and lower esophageal sphincters.
Other simple habits make a big impact: avoid tight waistbands, elevate the head of the bed slightly, and minimize smoking or alcohol, both of which irritate mucosal tissues and delay healing.
Beyond PPIs: Alginates and Other Supportive Therapies
Some patients may still require short-term acid suppression (H2 blockers or PPIs) during healing phases, but long-term success often depends on combining medication with lifestyle change.
Because acid suppression alone is often insufficient, alginate therapy offers a unique advantage. Derived from seaweed, alginates react with stomach acid to form a protective gel “raft” that floats on top of gastric contents. This barrier helps prevent mechanical reflux and binds pepsin and bile acids, two key irritants in LPR.
Products like Reflux Gourmet and Reflux Raft combine alginate with soothing botanicals such as ginger, licorice, aloe, and melatonin, offering both protection and tissue repair.
The Role of the Microbiome and Nervous System
While there’s no specific probiotic proven to treat LPR alone, improving gut microbiome balance may reduce inflammation and motility issues. Stress and nervous system dysregulation can heighten throat sensitivity making respiratory retraining, breathing exercises, and mindful eating valuable tools for symptom control.
A Whole-Person Approach
LPR often represents more than a simple reflux problem-it’s a reflection of airway sensitivity, digestive imbalance, and lifestyle stress. By addressing the root causes rather than suppressing symptoms alone, we can help patients breathe, speak, and swallow more comfortably again.
