LPR not controlled with ppis

I don't have a lot of advice regarding LPR, my advice would be to seek a second opinion, but there should be other members here that may have better answers to your questions.

Good luck, Sharon

I think I'll say something. I've never said anything here before and very rarely on other websites/forums.

I've had LPR probably, GERD etc, some esophageal inflammation near the stomach, cough-variant asthma?. But mainly >50 years of coughing and nose blowing. This is Canada so I actually got very little help.
A year ago I tried very low dose morphine and then gabapentin to see if I could get relief from intractable cough. They didn't work.
Around Xmas 2018 I was reading a ncbi.nlm.nih.gov article on cough and it mentioned that some patients with neurogenic cough got good relief from low dose (10mg) amitriptyline. I was very lucky. One 25mg pill turned my cough off in 2 hours. After >50 years, relief in two hours. I now take very low dosage amitriptyline daily.
I mention this also because indigestion, mild asthma, sore throat, dribbly rhinitis, all improved a lot when the provocation of violent cough and hoarseness were removed.
Looking forward to any comments.

My dads got gabepentin so I could try low dose of that at night until I get to see a doctor to try amytripline.

I’ve had all tests apart from barium do you think this is necessary?

MACS: I cant figure how to reply to a post, this is my attempt to reply to MACS, quoted bottom

I used to think I had the answer to everything, but now I realize people's illnesses can be complex, side-effects are numerous, I can only talk as best as I can about me. 73 male, semiretired, clerical work. I have begun house-dust desensitization, 2 months. Cough and rhinitis, maybe post nasal drip 60 years, have had relief years ago from desensitization, rabeprazole 2 x 20mg daily and mometazone for rhinitis, however late last year I was going downhill, nothing seemed to work and the coughing was worsening week by week. I just got lucky with low dose amitriptyline. I showed the research article to my GP and (since it is a low-risk test) I had no trouble convincing him to prescribe a few trial pills; I have gone to the same GP for 5 years so I would describe him somewhat as a 'professional friend'. Morphine and gabapentin had not helped so it was a nice surprise when amitriptyline did. However, I still take rabeprazole in the evening in the hope that if I have reflux at night then at least the reflux will not be acidic.
I find that sipping on a dilute warm solution of baking soda especially in the evening is relaxing for the throat and I imagine it helps hoarseness and throat clearing. 'dilute' means 1 tsp or less per cup of warm water, such that you can hardly notice the taste of the baking soda (NaHCO3).

As to whether these drugs are safe longterm, since I was in such misery I didn't care about long-term. BUT see this:

"Because this medication is the most sedating of cyclic antidepressants, amitriptyline has a high potential for substance misuse. Anecdotally, some patients have described taking Elavil for its euphoric effects. The medication dosage should be strictly followed to avoid a fatal overdose."

I use 6-18mg per day as needed right now. I find a 25mg pill has Very disagreeable sideeffects of mouth dryness and a 'spacey' feeling. I consider myself very unlikely to get addicted to something this unpleasant. But I sure stop coughing, fast. I was a desperate man. I have also improved my diet to about 80%+ vegan and lowfat. I also continue Advair inhaler although it is very marginal if I have any asthma.
We don't get much help from the doctors and must find our own ways home to a large degree.


" Thanks for the reply, really happy you found an answer to your problem I’m willing to try anything to be honest as have an appointment with a surgeon late May. I don’t have a cough but as you said could help other symptoms like hoarseness, just read the article you stated, are they safe long term? I have been bit down lately it’s kind of taking over my life and affecting marriage a bit not knowing what step to take next. Would my local doctor be able to prescribe the amytrpline or the ent consultant I see in 2 weeks?"

In this excerpt from an article (https://my.clevelandclinic.org/health/diseases/15024-laryngopharyngeal-reflux-lpr/management-and-treatment) it includes "Avoid clearing your throat."
I do this many times a day. Would any one know the reason/logic for the advice: "Avoid clearing your throat."

How is laryngopharyngeal reflux treated?
Most cases of LPR do not need medical care and can be managed with lifestyle changes, including the following:

Follow a bland diet (low acid levels, low in fat, not spicy).
Eat frequent, small meals.
Lose weight.
Avoid the use of alcohol, tobacco and caffeine.
Do not eat food less than 2 hours before bedtime.
Raise the head of your bed before sleeping. Place a strong, solid object (like a board) under the top portion of the mattress. This will help prop up your head and the upper portion of your body, which will help keep stomach acid from backing up into your throat.
Avoid clearing your throat.
Take over-the-counter medications, including antacids, such as Tums®, Maalox®, or Mylanta; stomach acid reducers, such as ranitidine (Tagamet® or Zantac®); or proton pump inhibitors, such as omeprazole (Prilosec®), pantoprazole (Protonix®), and esomeprazole (Nexium®). Be sure to take all medications as directed.