December 13, 2009

New Treatment Options for Non-Acidic Reflux (LPR)?

It just came to my attention through anecdotal reports that there may be two additional options to treat non-acidic laryngopharyngeal reflux (LPR) causing symptoms of:

Throat clearing
Phlegmy throat
Globus (sense of swelling in the throat)

Non-acidic reflux is different from the more widely known acid reflux in that traditional medications such as prilosec, zantac, pepcid, etc do not help. Non-acidic reflux basically is when gastric secretions without acid refluxes up into the esophagus to as far as one's voicebox causing symptoms listed above. Heartburn does not occur.

Traditional treatments for non-acidic reflux include the medication reglan (which has gone out of favor) and gaviscon advance  as well as the surgical option Nissen fundoplication or LINX. However, there are now anecdotal reports that the medication robinul forte may be helpful by decreasing the overall amount of secretions the stomach produces as well as less invasive procedures called TOIF (Trans-Oral Incisionless Fundoplication) performed endoscopically without skin incisions.

Read more about non-acidic reflux here.

gaviscon advance nexium prilosec pepcid reflux band

Fauquier blog
Fauquier ENT

Dr. Christopher Chang is a private practice otolaryngology, head & neck surgeon specializing in the treatment of problems related to the ear, nose, and throat. Located in Warrenton, VA about 45 minutes west of Washington DC, he also provides inhalant allergy testing/treatment, hearing tests, and dispenses hearing aids.


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Anonymous said...


For about 8 months, I've been going through hell trying to find out what has been causing my chronic throat clearing. It all started after a series of sinus infections, bronchitis and the allergy seasons (hay fever).

After the whole nine yards of testing, I was finally told by an ORL and a GI that it was all in my head...

Now, I’m the first to believe that the human brain can cause things but my symptoms are real; chronic throat clearing, occasional phlegm in my saliva (slightly acidic tasting), a white infection like bump on my tongue which comes and goes with the level of “reflux” I have (almost a weekly cycle). One odd thing is that my throat clearing stops when I lie down which apparently isn’t consistent with a gastric reflux behavior?

So far, I’ve had:

• Chest scans: All good
• Lower abdominal echo: Nothing abnormal (get it? ab normal ;-))
• A gastrocopy : All ok in there.
• A 24hour ph and a motility test: Normal ph levels
• A sinus scan: Revealed a slightly deviated septum
• Allergy tests: Some grass, weed allergies (I have not had food allergy testing yet).
• Home based acidity test (saliva sticks): Almost always normal levels.

I’ve tried:

• Nexium: no effect
• Gaviscon: “seem” to help but not much
• Nasonex and sinux flushing: Clears the sinuses well and I haven’t had a sinus infection since

Let’s also note that I don’t smoke, I train regularly, I eat really well, and I’ve stopped drinking coffee and really cut out acidic foods like tomatoes and citrus fruits.

It’s at this point that one ORL declared this was a bad habit that probably started with the allergies and sinusitis and that I’d have to learn to retrain my brain into stopping the throat clearing over time. I even showed him my pretty disgusting tongue and mentioned that it sometimes burns in the back of it but he simply mocked that and said, “ah, the burning tongue syndrome …”. He suggested I simply brush off the whitish gunk on my tongue with a Popsicle stick or those special toothbrushes.

I went home and contemplated the fact that 1) he is apparently a renowned ORL (he is chief of the ORL department) and that 2) there simply was no irregular PH levels in my 24 PH test which itself was done by the chief of GI. For the record, the GI’s conclusion was that it was not GERD that caused my throat clearing problem. I weighed in the trials that I did over the months and concluded they must know what they are talking about and starting accepting that as a conclusion.

So, over the past week, I’ve stopped all medications and returned to my normal diet (nothing bad, just not watching the acidity levels as much). I noticed that the reflux is more frequent and I can especially see my tongue grossness factor increasing. I tried to brush it of but it hurts and it bleeds!
By sheer curiosity, I looked up “non acidic reflux” and found some interesting claims. From what I’m reading, this seems to be exactly what’s going on for me!

I’m going to bring this up to yet another ORL in a few weeks and I’ll also seek the opinion of my family doctor (who is chief of internal surgery). I’m hoping this might be lead that the previous ORL and GI may have overlooked?

Is “non” acidic reflux a new thing in the
medical world?


Anonymous said...

Hi Danny

Just a shot posting here. I live in Denmark in Europe and have EXACTLY the same trouble as you the constant throat clearing. I have had it in 6 years and the doctors have told me too that its all in my head. I would really like if we could write together via e-mail so we could give eachtother some advice and support if you would like that. You can reach me by this mail: or you can write on this website.

Take care. Hope you are feeling better.


Anonymous said...

I too am trying to deal with this feeling of something in my throat and wantingn to clear it out. I have been seeing that the Gaviscon Advance and the English alternative may be even better. So I am going to try. It has been so many doctors and no help. Maybe the Non acid LPR is a start.

Anonymous said...

I have had the same problem for over 4 years..constantly clearing my throat, feeling of a lump in my throat, i cant sleep in bed, usually in a chair. I do not have heartburn, or indigestion, and i have been to five doctors. No medicine i have taken helps me, which is pretty much all of it. All i have been told to do is lose weight and pretty much live with it.
I am beside myself and thinking of going to Mayo Clinic. Has anyone found a solution??

Anonymous said...

HI, I have a form on non acidic LPR, had surgery heller myotomy for achalasia of esophagus with toupe fundoplication, but sour, salty taste in mouth and burning throat never went away. I was told by surgeon don't take proton inhibitors like prilosec, they don't help you anyway. It has been over 3 years, ENT MD.'s when stumped try to treat you with antidepressants, which I know isn't the problem had chronic sinus problems and recurrent Laryngitis all my life but going to Mayo made little difference, was told I had globus pharyngitis, started on low dose nortryptilene, which made throat soreness and burning even worse. I have little to look forward to, have done everything haven't a clue.

Anonymous said...

Does that mean the toupe isn't tight as it should be?

Anonymous said...

Hey I have been suffereing for the past 15 years from the same non acidic Reflux.I want to know the concrete cure of it...write me at

Anonymous said...

In a heller myotomy they don't want it too tight , because with achalasia food needs to get into the stomach a complete fundoplication would be the worst thing for you. Achalasia or aperistalsis is different than nissan in that food sits in esophagus for prolonged period of time damaging the esophagus, the heller creates a bigger opening into stomach to allow for more efficient emptying.

Sean McD said...

I have had LPR (classic syptoms) for the past three months. It all started after a night of bad reflux. Like most, it has very negative effects on my daily life...both physically and psychologically. I've tried just about every treatment.

Why is this not more of a priority in the ENT world?? This condition seems widespread. Yet there is no effective treatment available.

Any professional help here???

Anonymous said...

I've had LPR for years. I would usually get it only when sleeping. Even though I know it's caused by acid reflux I was given a CPAP to use. Only if I have very severe LPR (mabye twice a year) will it seem to get past the CPAP. Otherwise I sleep all night with the CPAP. No waking up unable to breathe or choking. I know feel like I've slept, with LPR I was starting to feel like I would fall asleep driving because I woke up 5-6 times a night.

Anonymous said...

hello danny,

non acidic reflux is a new thing....I don't know if I have it but after doing much research on my chronic cough for over 20 years, I have just made an appt. with my doctor and will be tested for non acid reflux...also want to turn you onto site look up Robert w bastian m.d. where he may describe your symptoms to a T. also look up laryngopharyngeal reflux and nissen fundoplication...and then there is a drug to treat nonacid email address is for more info...linda

Anonymous said...

the medicine that is new I guess for doctors to utilize for our problem is robinul forte, but if problem persist then trans oral incision less fundoplication is what some ent doctors are performing. to stop the nonacid reflux...if your not satisfied with your doctor definitely look for one who is up on the newest procedures because there are a lot of us who are suffering and out there, and the baby doctors don't have enough years under their belt to know and the old doctors are...well old.

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