Why the Stomach Sphincter Plays an Important Role in Laryngopharyngeal Reflux (LPR)

Why the Stomach Sphincter Plays an Important Role in Laryngopharyngeal Reflux (LPR)

If you didn’t already know our bodies have what is known as sphincters or sometimes known as valves. These sphincters play an important role in preventing reflux and more importantly Laryngopharyngeal Reflux (LPR) which is sometimes called silent reflux. This is because said sphincters are meant to close and prevent reflux from occurring in the first place.

If you have LPR there is a good chance it is because of 1 or more of your sphincters malfunctioning and not operating as it should. This malfunctioning usually ends up in throat related symptoms for an LPR sufferer.

Stomach Sphincter / Lower Esophageal Sphincter (LES)

stomach diagram

When I say the stomach sphincter the medical name for it is the Lower Esophageal Sphincter or LES for short. A malfunctioning LES is for the majority of LPR sufferers the number one reason why they have LPR in the first place. Of course, it can be related to other sphincters and I will cover them later in the article as well.

If you didn’t know the most important sphincter is the LES. This is because it is located directly above the stomach. It is the sphincter between esophagus and stomach as can be seen in the diagram. As you might have guessed this sphincter is designed to remain closed and restricted once food is in the stomach. When it is closed this will keep the acid/food inside the stomach where it is meant to be. Though with an LPR sufferer this valve will sometimes relax and open and this leads to acid being refluxed up into the esophagus and further up into the throat.

How a Malfunctioning LES is Caused

Usually one of the main reasons for this happening to the LES is from overeating. Overeating causes the stomach to become overloaded. When the stomach is overloaded like this that means more pressure on the LES to keep food and acid inside the stomach. This will often mean more pressure on the LES and this pressure will slowly cause the sphincter to malfunction and degenerate over time.

Of course, overeating once or twice won’t cause this. It’s from long term overeating and a consistent slow degeneration over months and years. When I say overeating I mean putting too much food in the stomach at one time. If you didn’t know the amount of food the stomach can hold at once is about the size of your fist. I’m sure a lot of people can eat portions much bigger than this frequently and this is the process that can lead to a malfunctioning LES and LPR symptoms.

stomach diagram close up

Below the stomach there is a sphincter called the pyloric sphincter. The pyloric sphincter location is just below the stomach and just before the small intestine.

This sphincter allows food to pass into the intestines from the stomach. How this process works is the pressure builds in the stomach and said pressure should force the food through the pyloric sphincter which is very narrow – even when opened is only a few millimeters wide. The problem is when this pressure gets strong the LES because it is weak will open and become relaxed because it cannot withstand the pressure instead of passing down through the pyloric sphincter. This leads to acid and food being refluxed up into the esophagus instead of being pushed down through the pyloric sphincter. Also if there is a pyloric sphincter malfunction this can to increase pressure in the stomach and lead to acid reflux as well.

digestive tract diagram

There is another sphincter called the Upper Esophageal sphincter or UES for short. This sphincter is located between the esophagus and the throat and is another barrier against reflux. The UES is usually tighter than the LES and this tightness makes it harder for the UES to open to protect the throat from reflux. An LPR sufferers UES can become more damaged from the acid reflux. It will try and get tighter to protect against reflux which can make it malfunction from this constant cycle similar to the LES. It is also hard for the UES to protect against gaseous reflux and this is a form of reflux that which will particularly bring on LPR symptoms.

Once acid and things like pepsin pass through the UES this is where LPR issues arise. It can affect the throat, the voice box, the mouth and even the ears in some people. The main reason for this is called pepsin. Pepsin is used to digest proteins in the stomach and this is refluxed into the throat in this case. This pepsin can cause inflammation and general irritation in the areas I mentioned above. You can read my full LPR guide which covers pepsin in more detail.

Treating a Malfunctioning LES

The best way to treat a malfunctioning LES is through diet. As I mentioned before overeating is one of the main reasons bringing it on in the first place. So, eating smaller meals with the food contents being about the size of your fist. You can still eat as much throughout the day as you do now but just not at one time. Instead of eating 3 big meals at day. Try 3 smaller meals and 2 snacks for example. This will put much less pressure on the LES which will allow for it to heal and return to its proper function. Also, once the LES is working correctly so will the UES as it won’t be being constantly forced to tighten to protect against acid as it was before.

Eating smaller meals isn’t the only element to helping LPR. Following a low acid diet and avoiding certain foods that can make the LES weaker is also very important. To give you an example in chocolate there is a thing called methylxanthine which is a substance which causes certain tissues in the body to relax, one of these tissues is the LES and therefore avoiding chocolate would be a good decision. For everything about LPR including treatment advice and my diet recommendation check out my complete LPR guide here.

Luckily if you follow this advice the LES can slowly but surely return to normal function and your LPR symptoms should fade away. It may take some weeks if not months, but it most certainly will help over time.

18 thoughts on “Why the Stomach Sphincter Plays an Important Role in Laryngopharyngeal Reflux (LPR)”

  1. How long does it take to heal LPR if you follow the diet and do other suggestions? I am on a 20 mg ppi every morning but my throat and tongue still burns from time to time throughout the day. Plus I feel like like there’s a lump in my throat after eating. At night my tongue burns and my throat is dry and scratchy.

    1. There is no clear cut answer to this question but usually people who follow a strict low acid diet see improvement in under 2 weeks time. Some people will be completely healed from LPR over time whereas for others they will see an improvement but will not be completely healed – in this situation they will have to stay strict to the diet to keep symptoms greatly reduced.

  2. This a really informative article but I take exception with the notion that overeating causes malfunction of the LES. I”ve always been slim and healthy, I don’t overeat but I have ended up with silent reflux through no fault of my own. I believe that some of us are just unlucky and that parts of your body start to malfunction especially as you get older. Laying blame on people is not helpful to their mental health.

    1. Yes I agree not everyone is fortunate though it’s important to mention because there are people who are overweight and they later loose weight and most if not all their symptoms go away so it’s important for them in helping resolve their problem.

  3. I’m about to start gaviscon advance. My only concern is that it may not let me digest my food properly when taken after meals. I have sibo/ibs, so I’ve been really trying to focus on improving that too. What would your suggestion be? Maybe just at bedtime? Thanks!

    1. I would suggest maybe taking it 1-2 times per day and at bedtime. You should take it after you larger meals like at lunchtime and dinner time for example.

  4. Wow I’m your new fan. Reading this I feel I’m like in a group of people talking about the same problems and helping each other. I just found out I have mild LPR and I’m also an anxious person. Actually I woke up from a 3 hour sleep super anxious. Called a helpline, the person only gave me coping skills for anxiety and then I found this.

    I started Omeprazole? Prilosec generic yesterday and thank God I’ve read already few times it is bad. I’ve tried to change the diet and it’s difficult but I’m doing it. It’s difficult because, as an anxious person, I want results fast and I’ve learned also that it will come with time so I need patience.

    Every time I wake up anxious I will visit the page and it will remind me there is hope through diet and that this is real. Thank you.

    1. Hi Juana,
      I’m happy to help of course. It seems you are on the right track with your diet and ideally not taking the omeprazole. Definitely work on helping your anxiety because that could be related or making your acid reflux worse. I recommend some daily exercise for 30 minutes every day, even walking is a good choice. Also 10 minutes of guided meditation every day can also help and helps me too, you can easily search some on YouTube if you aren’t sure how to get started.

  5. Hi! I recently went to an ent and they told me I have lpr however it was a random onset I’ve never had digestion issues or anything like that before hand. I’m used to drinking soda and alcohol a lot. However I havent been recently because of the tongue and throat issues. But it feels like my throat is tight and my chest is tight. I’ve also had numbness and tingling and burning on my tongue. And enlarged taste buds.

    1. Hi Kyrsten,
      Yes some of them symptoms point to LPR. Of course as I am sure you know alcohol and soda are some of the worst things you can take if you have LPR so avoiding them is a must.

  6. Katherine Anne Lipp

    I just found out I have LPR after 6 months, no one knew.
    I have always been healthy, I did drink coffee one cup a day only, I stop drinking it 3 months ago, never ate junk food, I am 110lbs 5/7 always had green smoothies, I did have a lot off good fats in my diet so I cut then down.
    I only have burning in throat otherwise my test show good health. I always only drink water. I run business so I do a lot talking. I have been taken ACV which seen to be helping and HCL. ps will the time come when I can go back to drinking cup coffee. Thanks Kathy

    1. If you are taking ACV and HCL they are of course increasing the acidity level and if they are passing directly over the throat (not in capsules) then this will likely only make LPR symptoms worse because of the acidity reactivating the pepsin in the throat. If it’s in capsule form and it makes you feel better the HCL then likely you could have low stomach acid. If you are taking the ACV and it passes over the throat it’s much worse than taking coffee in reference. Therefore I would think about that.

      1. Katherine Anne Lipp

        I m coming off my Omeprazole, this medication I feel makes matters worst. I am doing Gaviscon advanced feeling better with your great tips and information.
        I did over eat and drink at friend party. Like I said my diet is good, what I did was spread the meals through out day that really make a difference smaller portions thanks for that great tip, it is making such a big difference.
        I swim every morning all year round helps great with my stress. I am hoping in future to have at least one cup coffee in morning. 🙂

        1. Oh sounds like you are on the right track Katherine, glad to hear that. The swimming is good and I agree it’s great for stress relief and overall wellness too. I think coffee can be reintroduced but at least initially I think it’s best to avoid to get the optimal healing effect.

  7. I read the LES is normally in the relaxed state. It takes acid to cause it to tighten. No one talks about the use of PPI’s and other ant-acids and how they are contrary to the operation of the LES. You also talk about a low acid diet. The older you get the lower the amount of stomach acid created. This is also contrary to an operating LES. Acid may re-activate pepsin, but it is also needed to tighten the LES, why ACV may work for some people. I am old. There is nothing in the list of things to avoid for Gerd that applies to me. Tried ACV and Betaine HCL. I used jalapeno peppers in my diet to to stop debilitating, sleep upright in a chair, heartburn (including LPR) 10 years ago. Probably coincidence but it stopped so I continued to use. LPR has returned without the heartburn. How do you reconcile a low acid diet for those that may already have low stomach acid. I have tried the spray bottle of baking soda water. It helps slightly during day. I’ve also used Gaviscon under my tongue at night to slowly dissolve over hours at night. It also has limited help. On month 4 of LPR. Nowhere near as bad as 10 years ago. Have Esophagitis, come and go sore throat, no blinding instantaneous headaches. I’m missing that little bit of help to get back over that relatively small hill this time.

    1. Yes you are right it does and can help some people. The root cause can be as you mentioned but there are also a selection of other root causes that are not related to either of them. To mention a couple of things it can mobility and also things like the pylorus valve not functioning properly all of which can cause the LES to open indirectly.

      If you know for sure you have low stomach acid then using betaine HCL should be your action and finding the right dose should be ideal for you.

  8. Steven Quinney

    I’am almost speechless about how much information you have put on this site
    I have had a dry aggravating cough for 2 years and have taking Omeprazole and then Esomprazole.
    Still my annoying cough persists.
    I’ve had a nerve swallowing test, a regular swallow test, an endoscopy, a chest x-ray and a chest cat scan.
    All have come back negative thank God.
    I even had extensive blood tests to rule out cancer, HIV, AIDS and any other immune system issues.
    All tests have been negative thankfully.
    I rarely cough at night while sleeping and within the first few hours after I awake.
    But sometimes a small amount of food or as crazy as it seems; just preparing something to eat gives me a pressure in my throat to cough.
    Maybe my brain is convincing me that I need to cough.
    I feel like I may need a psychiatrist. LOL
    But what a God send your information is.
    I can’t wait to try Gaviscon Advance from the UK.
    I already pretty much everything I eat.
    Although even an occasional sip of my favorite soda will cause me to cough.
    Thank you so much for giving me a glimmer of hope.
    I have passed on your info to many people.

    1. Hi Steven,
      Thank you I appreciate that! I can relate a lot to your story too, but I’m glad to hear that it’s all came back clear, likely as you may already know that it’s all related to LPR just from what you are talking about. I think we all need a psychiatrist when dealing with this at some point or another haha. In addition to the Gaviscon I would suggest to you to consider a low acid diet like my wipeout diet plan. You would see a good improvement with it within a months time.

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