A couple basic questions about LPR

I am not new to GERD or LPR, but I do have a couple questions that I have been wondering about for a while now.

First of all, is it common for people with LPR to have both LPR and GERD? I have been looking around on the forums for a while, but not very many other people talk about having symptoms of both heartburn and a constant cough. I have been diagnosed with GERD for more than four years and never treated for LPR, but I have both heartburn and the constant cough and post nasal drip.

This question might not be as relatable, but it is about LPR. For as long as I can remember, I have had this constant itch in my throat. It is not a pain, but it causes me to cough every couple seconds. As I remembered it a couple years ago, it used to be that if I resisted my need to cough or clear my throat, my brain would basically be convinced that I was choking. Choking is different from pain because pain is a suggestion to change what you're doing and choking is the brain's way of saying something has to change. I basically couldn't resist this urge for more than a couple seconds, causing me to cough or swallow roughly every 10 seconds.

I have not attempted to resist this urge for a long time because of the fact that it just brings on a worse feeling. Recently when I tried it though, I noticed that after a few seconds of not swallowing, my throat filled up with liquid. I tried resisting this for as long as I could, but basically I end up swallowing without consciously trying to swallow, because of the choking instinct. Does anyone else have this problem?

This last question is just about GERD, but it can still fit here. Of all the pains that come with heartburn, why does the most pain I experience feel like it is coming from the stomach and not the esophagus? From the tests that I have had, I know that I have a normal amount of gastric acid and that it is a normal pH. If both of these are normal, why should my stomach not be able to withstand acid? Am I just wrong and it is actually happening in the esophagus?

To clarify, I feel many pains in my stomach and my esophagus. I understand why acid damages the esophagus (since the cells are not designed to withstand it). My question was why acid damages the stomach if the pH and quantity is average.

The biggest question Im trying to search for an answer for at this point is which liquid is constantly filling my mouth. I could test the pH in a couple days, but for now I am still wondering whether it is mostly from saliva, post nasal drip, or actual acid.

Before my fundo, I was a firm believer that my "LPR" symptom (throat tightness) was caused by reflux making it up to the throat and irritating it, making me have the urge to swallow. I also had a nearly constant bitter taste, which I thought lent weight to the idea that reflux was making it up to my mouth. A PPI significantly reduced my throat tightness (maybe 80% decrease) but did nothing for the taste issue.

However post fundo, after months of recovery, my throat is much better but the sour taste remains. For the first few months (I am less than 4 months out), I had recurrent throat tightness, despite the fact that due to the surgery there was likely no reflux making it to my throat.

My case may be different because I had the sour taste and a tongue burning issue, but at least in my case I do not believe that direct contact of reflux is necessary to cause a globus sensation, which is a common LPR symptom. This is supported by literature indicating that irritation of the distal (near stomach) esophagus can trigger globus sensations in the throat. And LPR is usually described as damage due to proximally-reaching reflux, though, it isn't always.

As for why the stomach might be becoming inflamed (thus becoming sensitive to acid which it is designed to handle), it could be related to what you put into your stomach. It could be a food allergy or something else that doesn't agree with your stomach. Alcohol (I know you're young and probably don't drink, this is just an example) can also mess with people's stomachs. Taking antacid can help the gastritis feeling, and hopefully the person learns to not continually put what's irritating the stomach into it. I've also got direct experience with this. Before taking a PPI ever, I had these bad feelings in my stomach in the morning -- not an ache per se but more like I was scared of something. Only after I went to a Dr. complaining of throat tightness, was I prescribed a PPI, which much to my surprise, completely removed that feeling by the next morning.

I can only think that something I was eating or drinking was irritating my stomach lining, making it sensitive to acid. So taking the antacid gave me some relief. An endoscopy showed "chronic gastritis" even after 4 months of PPI though, and no effort was made at the time to determine what caused it.

drtinsac,

If you really like to read, heres a post I made a little while ago about all of the important details of what I have and haven't tried: https://www.healingwell.com/community/default.aspx?f=45&m=2706100

I have had problems with GERD, LPR, and EE, but currently they are not all active. After removing all milk, soy, and rice ingredients from my diet, my EE has gone away. This was confirmed in my 5th endoscopy two years ago and again in my 6th endoscopy two months ago. I have been prescribed with PPIs for as long as I've been seeing doctors, and they ultimately do not seem to help. Then again, during the two weeks that I had to be off them before and during the recent endoscopy and pH probe, I noticed just how much of a difference they make. Right now my pains are present, but without the PPIs they were about a 9 out of 10 on the pain scale, even after I waited a week for the rebound to lessen.

I have also tested how much pain I get without certain foods and without any food at all by doing a few 24 hour fasts and one 48 hour fast. Throughout the entire time that I was avoiding food, I continued to have stomach pains that felt like they were below the esophagus. Unless water has that much of an effect on my stomach's balance, I can say that most foods that are not major triggers do not make all that much of a difference to me.

First of all, having dealt with epilepsy since I was born, I have seen many neurologists and neurosurgeons. In the years that I have been dealing with both epilepsy and GI problems, the neurologists tend to not show any interest in wanting to discuss or analyze any reflux related questions. Being specialists in neurology, they have knowledge of the nerves throughout the body, but they say that they don't want to say anything they are bot sure about since they know nothing about GERD.

In terms of allergies, I have been avoiding milk for a number of years since I found out I was allergic to lactose and casein. Beyond that, the allergy test that I got from an allergist said I was allergic to corn, beans, peas, shrimp, rice, milk, and nuts. After several months of toying with the esophagitis, my doctor took me off all milk and soy products, and then layer all gluten and egg products. So I have shown no reactions to any of these foods beyond developing eosinophils. I do not think that they are all even related to inducing reflux since they are only intolerances and do not actually trigger reactions (other than dairy).

Bacon,

Before I went on PPIs I had terrible coughing/choking and water brash ( where you mouth fills with saliva); I never had heartburn. I read that the water brash in your body's response to acidic reflux in the esophagus..the saliva is acting as a buffer to reduce the pH of the reflux . And the extra saliva is the body's way to trigger the swallowing reflex to get rid of the reflux. The PPIs helped, and removing gluten and dairy from my diet helped even more.

I'm following the Fast Tract diet -the theory here is that small intestine bacterial overgrowth causes inflammation, gas etc that results in acid reflux. Limiting certain types of carbohydrates and sugars reduces the growth of the bad bacterial, and rebalances the gut flora. If I follow the diet I rarely cough, but if I cheat I cough and my voice gets really weak. I had some lentil salad a few weeks ago (a no no on this diet), and I coughed for 2 days afterwards.

Bacon: I am glad you came across good doctor and a legal thing that makes sense. You know I just try and blame things on others which is not nice of me to do, maybe it's all my frustration from being constantly consumed in worry about this whole thing. Anyways I rather just forget for this week and focus on getting ready for my "new doctors" appointment. How are you by the way when is your mamo again?