This is interesting ...

I just had a full upper endoscopy by a top GI doctor in Chicago.

NO acid damage (or any other kind of damage) was found. No Barrett's, strictures, etc. No hiatal hernia either.

He did biopsies to check for microscopic damage: none was found.

My TNE I had a month ago showed nothing.

So here is the deal: if you are suffering from symptoms that look like LPR (hoarse voice, globus, throat irritation, etc.) it may not be LPR at all. It may be a low-level infection of the maxillary sinus cavities, asthma, severe allergies, or some other issue. I've been getting nose bleeds in the morning when I wake up, so there is something up with my sinuses (again).

When big doses of PPIs and dietary restrictions were doing absolutely nothing to help my symptoms, I began to suspect that LPR was not the problem.

I did a lot of research on LPR (reading studies, clinical manuals, doctor's opinions, etc.) and realized that this condition is

a) WAY over-diagnosed
b) Frequently mis-diagnosed
c) Does not respond well to treatment (because it is often misdiagnosed: PPIs won't help you if your problem isn't LPR)
d) Does not respond well to surgery over the long-term

Dr. Jamie Koufman is the big cheerleader for LPR, but her theories are controversial and untested.

I am not a doctor, but my recommendation is this: if you have a clear upper endoscopy, no hiatal hernia, etc., you don't have an acid problem. Your issues are going top-down, not bottom up. Don't spend huge sums of money of reflux medications, special diets, silly books, and worry yourself sick. Your anxiety will go through the roof, causing more esophogeal spasms (happened to me: more I worried about it, the worse it got). Begin to focus on the real problem: get a CT scan of the sinuses if necessary (or an endoscopy), start irrigating, talk to an ENT.

Hi Silas,

As an allergy and asthma sufferer, I totally agree that LPR and sinus/allergy/asthma symptoms can be interchangable.  You can go on a wild goose chase with GERD/LPR worries, only to find out that your symptoms aren't acid-related.

That said, it's very possible to have a combination of problems--especially if you have a hiatus hernia and reflux symptoms.  It is definitely muddy waters, indeed.

Glad to hear you've gotten to the bottom of what's going on.  Good luck with getting things feeling better.  Allergy issues are mighty hard to deal with as well.

My sinuses are the first to react to pollen, and so far my allergist hasn't been all that successful in solving my problems.

Very best wishes,

Denise

Chuck:

I'm not sure what the issue is right now. I had sinus surgery back in 2004 and have a history of bad infections and out-of-this-world allergies (to the point of feeling like I have a headache all day long)

I recommend that anyone with throat problems try sinus irrigation using a machine (there are a few out there--just check amazon, etc.). Irrigate with sinus salt, cool distilled water, and Alkalol daily.

Decongestants and antihistamines don't really work for me: they just dry out my throat worse. Singulair can help with asthma issues.

GERD issues are a lot easier to diagnose, because heartburn is present, and the clinical evidence is obvious. But for LPR, it becomes important to rule out allergies and sinus problems as the real issue.

If there is a hiatal hernia present, that is certainly a red flag for reflux issues--I don't have one fortunately. I think our doctors really need to look for structural problems like hernias, and clear evidence of acid/pepsin damage. If PPIs are doing nothing, I think the issue is probably not reflux.

I have been suffering with throat symptoms for 6 years. I was diagnosed with LPR and thinking the same thing as you. I don't think I have it.

It just does not add up with me.

My symptoms started the morning after I kissed a woman who had a sore throat at a bar. The throat problems never went away.

I have zero stomach issues or heartburn. "Silent" reflux does not make sense to me.

I don't have any trigger foods. I can eat a greasy pepperoni pizza and nothing happens.

Although, I do have a burning throat. I don't know if a sinus issue can cause that.