Experts Delve into Treatment Options for Laryngopharyngeal Reflux

Underscoring the role of non-pharmaceutical approaches, Dr. Czibulka invoked Thomas Edison, who said future doctors “will give no medicine, but will instruct his patient in the care of the human frame, in diet and in the cause and prevention of disease.”

Malcolm Taw, MD, FACP, associate clinical professor and director of the UCLA Center for East–West Medicine in Westlake Village, Calif., said it can be helpful to think about LPR treatment in terms of the Chinese medicine concepts of “hot” and “cold” foods. “Hot” foods and drinks include alcohol, spicy foods, fried foods, garlic, coffee, red meat, chocolate, cheese, and refined sugars. “Cold,” or cooling, foods that can ease or prevent reflux symptoms include melons, green-leaf vegetables like kale and Swiss chard, bananas, kelp, and celery. “The way that we treat reflux in Chinese medicine is that we cool the patient down,” Dr. Taw said. “The Chinese medicine version of hot versus cold foods is very consistent [with] or similar to the low-acid diet.”

In a small study, 20 patients with recalcitrant LPR were put on a low-acid diet for two weeks, during which time every food with a pH of less than 5 was eliminated. Reflux symptoms were measured before and after. Researchers found that 95% of the patients had improvement, with three having no symptoms at all by the end.

Dr. Taw also emphasized the importance of warming up the digestive tract before eating, by consuming something such as a tea or soup, and of eating in a relaxed environment. “If you’re rushing through your meal or you’re doing business over your meals, your body is in a low-grade fight or flight mode, so it has some of this adrenaline in the system, and your body’s not relaxed to have optimal digestion and assimilation of your nutrients.”

Evidence shows that acupuncture can also help, he said. In a study of 30 patients with refractory heartburn randomized either to standard PPI dosing plus acupuncture or double PPI dosing, those in the acupuncture group had significant decreases in daytime heartburn, nighttime heartburn, and acid regurgitation, while those in the double-dosing group did not (Aliment Pharmacol Ther. 2007;26:1333–1344).

Thomas Collins is a freelance medical writer based in Florida.