LPR which stands for Laryngopharyngeal Reflux or as it’s sometimes known as silent reflux is a condition where stomach contents come up from the stomach and damage the throat and larynx area. The main culprit behind this damage is pepsin – a digestive enzyme that causes inflammation and tissue injury when it reaches the throat, even in weakly acidic or non-acidic conditions.
Unlike regular acid reflux or GERD (Gastroesophageal reflux disease) you usually won’t have heartburn with LPR. That’s why it’s often called silent reflux – you don’t get the typical burning chest symptoms. Instead, the problems show up in your throat, sinuses and ears which makes it harder to diagnose and often leads to misdiagnosis.
I know this first-hand because it took me over 3 years of doctor visits, misdiagnoses and failed treatments before I figured out what was going on. If you are in a similar position right now, I want you to know that there are real solutions and this guide will walk you through everything you need to know.
Key Takeaways:
- Pepsin is the main driver of LPR symptoms, not acid alone – and recent research continues to confirm this
- PPIs (proton pump inhibitors) have been shown in clinical trials to be no better than placebo for LPR
- A low acid diet combined with mucosal protectors like alginates is the most evidence-based approach
- SIBO (Small Intestinal Bacterial Overgrowth) may be a hidden underlying cause – studies show up to 60% of reflux patients test positive
- Treating the root cause rather than just suppressing acid is key to lasting improvement
LPR Causes
There are a selection of different things that can cause LPR. Because of this there are also different ways to solve the problem depending on the root cause. Though it tends to be some causes are much more common than others.
Doctors and physicians alike will often assume reflux and prescribe anti-acid tablets like PPIs (proton pump inhibitors). This can help certain people and for others may not help at all and in fact make things worse. Below I am going to cover each of the different causes of LPR with advice on how to tackle each problem along with silent reflux treatment advice.
#1 Pepsin – The Real Problem Behind LPR
Pepsin is the main problem that is causing most if not all of your LPR symptoms. Not the acidity like a lot of doctors believe. Therefore treating or stopping pepsin is essential if you want to stop your LPR symptoms.
Pepsin is one of the digestive enzymes that the stomach produces and is used primarily to help break down proteins. Research has shown that people with LPR have pepsin present in the throat area whereas in a typical person this pepsin is not present. The problem with this is that pepsin is designed to digest proteins – so when it comes in contact with the throat tissues it basically tries to digest them. This is where you get most of the problematic symptoms from.
What Recent Research Tells Us About Pepsin (2024–2026)
Research into pepsin’s role in LPR has advanced significantly in recent years and continues to reinforce that pepsin is the primary villain:
Pepsin causes inflammation through specific pathways. A 2024 study published in Cytokine (Tan et al., 2024) found that pepsin triggers inflammation in the larynx through what’s called the ROS/NLRP3/IL-1β signaling pathway. In simple terms, pepsin activates an inflammatory cascade that damages throat tissue even in conditions that aren’t strongly acidic. This helps explain why PPIs often don’t help – they reduce acid but don’t stop pepsin from doing damage.
Even weak acid with pepsin causes real damage. A 2025 study in PLOS ONE (Hou et al., 2025) used animal models to demonstrate that even weakly acidic reflux combined with pepsin causes significant injury to the laryngeal mucosal barrier. The researchers found that pepsin breaks down E-cadherin – a protein that holds your throat cells together – which compromises the protective barrier of the throat lining. This is why you can still have symptoms even when your acid levels are well controlled.
The 2024 IFOS Consensus on LPR – a landmark international consensus published in The Laryngoscope (Lechien et al., 2024) – formally recognized that reflux damage is caused not just by acid but also by pepsin, bile salts and trypsin. The consensus stated that acid suppression should not be considered first-line therapy for patients with isolated throat symptoms and no typical GERD symptoms like heartburn. This is a major shift from how most doctors still practice.
Pepsin testing is becoming more useful. A 2024 review in Journal of Voice (Liu et al., 2024) found that patients who test positive for pepsin in their laryngeal mucosa respond significantly better to treatment. This supports the use of tests like Peptest for diagnosing LPR.
Diet combined with mucosal protectors works. A 2025 multicenter randomized trial published in Frontiers in Medicine (Gelardi et al., 2025) tested dietary modifications and mucosal protectors (like alginates) in LPR patients. The group that combined both approaches saw the greatest reduction in symptoms and measurable reduction in pepsin concentrations in the throat. This directly supports the approach I’ve been recommending on this site for years.
New treatments targeting pepsin directly. Researchers at the Medical College of Wisconsin led by Dr. Nikki Johnston are developing an inhaled version of fosamprenavir – a drug that directly inhibits pepsin activity. Their animal studies published in 2023 showed it reversed pepsin-induced damage in the larynx, and a Phase II clinical trial is planned for late 2026. While this isn’t available yet, it shows that the medical community is increasingly recognizing pepsin as the target, not acid.
How Pepsin Actually Works
The thing with pepsin is that it only becomes activated when in contact with something acidic. This is because it’s meant to be in the stomach and when acid is produced to help with digestion it becomes activated which is exactly its purpose.
When it is in contact with something of a pH of 6 or above it starts to become inactivated. On a pH scale 7 is neutral with everything below being acidic and everything above being alkaline.
At a pH of 6 the pepsin is only about 10% active and shouldn’t bother you much if at all. At about a pH of 5 is when it really starts to become problematic – it’s about 40% activated at pH 5 and progressively gets more active as things get more acidic.
With somewhat limited but growing research it has been shown that pepsin can lay dormant in cells for 1-2 days. So if you refluxed the day before then ate something acidic, the acidity of the food merely passing over the dormant pepsin in the throat would reactivate it and give you LPR symptoms even if you never refluxed again.
How to Treat Pepsin Through Diet
The best way to treat pepsin is to simply lower the acidity of the foods and drinks you consume. Foods that are lower in acidity activate the pepsin less if not at all which then will lower and help your symptoms.
It’s clear that pepsin reactivates mostly from foods and drinks with a pH of 5 or less. If you lower the intake of foods and drinks like this, it will also stop the pepsin becoming reactivated and will therefore help your healing process. It also helps with direct reflux because of the lower acid intake so it’s a 2-in-1 benefit if you follow this approach.
Some quick tips about food choice –
- Drink only water (most other drinks such as soft drinks and alcohol are highly acidic)
- Eat a diet with as little processed food as possible
- Avoid acidic fruits (bananas and melon are exceptions and can be eaten)
- Avoid spicy food
- Avoid most condiments (high in preservatives and things like vinegar which will irritate the throat further)
- Avoid tomatoes and raw onions
- Avoid fatty foods and foods that are deep fried
- Avoid chocolate
For more advice check out my LPR Diet article, my article on the best food choices for LPR and my article on foods to avoid with LPR. For a complete tailored diet plan check out the Wipeout Diet Plan.
Alkaline Water for Pepsin
Water that you usually drink would typically be around a pH of 7 or about neutral on the pH scale. Alkaline water is water with a pH higher than 7. Water with a pH of 8 or above has been shown in studies to deactivate pepsin, so when you drink it, it should help deactivate pepsin in the throat.
There are a few ways to get alkaline water with a pH of 8 or higher. The best way is to get water that comes from the source and naturally has a higher pH. If doing this step alone without following the diet you will still likely be reactivating the pepsin through food so I would advise to combine it with the diet for the biggest benefit.
For more detailed information check out my article – Alkaline Water for LPR.
#2 Weak Sphincters
The number one structural cause of LPR is because of a weak or malfunctioning sphincter. There are a few sphincters that can have an effect.
Lower Esophageal Sphincter (LES)
The sphincter that most likely will be causing you the problem is called the Lower Esophageal Sphincter or LES for short. This sphincter is directly above the stomach and opens and closes as food passes through from the esophagus. The problem occurs when the LES is weak or relaxed when it should be closed and tight.
This causes the stomach contents to reflux up into the esophagus which then ends up reaching the throat where the main problems of LPR arise.
Unlike most muscles in the body the LES doesn’t get stronger with more usage but in fact gets weaker. Things like overeating and eating shortly before bedtime put more pressure on the LES and this can cause the problem over years of constant overworking.
How to Fix a Malfunctioning LES
Diet – The best way to treat a malfunctioning LES is by changing your diet. There are a host of foods which are known to make the LES weaker. The common foods you should avoid are drinks with caffeine particularly coffee and soft drinks, chocolate, fatty foods (fried foods, cream, ice cream, bacon etc). Coffee and chocolate both contain methylxanthine which makes muscles relax more and this in turn can affect the LES. Also foods that are high in fat take longer to digest which means more acid in the stomach for longer which makes the LES work harder. For more information – stomach sphincters important role in acid reflux.
Eating smaller sized meals with about the amount of food the size of your fist is more appropriate. You can still eat as much as you normally would but split it amongst more smaller meals instead of few larger ones.
Surgery – Surgery should only be considered by people who have tried all other options. The 3 most notable options are Nissen fundoplication, Linx and Stretta. Each works differently to tighten the LES area. For complete information check here – LPR Surgery.
Medication – Baclofen can reduce the number of times the LES relaxes, though it comes with side effects like drowsiness. Melatonin has been shown in studies to increase LES pressure and reduce reflux which makes it worth considering.
Upper Esophageal Sphincter (UES)
The UES is the sphincter between the throat and the esophagus. When it comes to reflux it is the last barrier before the acid and pepsin gets to the throat. The problem with the UES is that it really isn’t designed to be a strong barrier against acid reflux. The best way to help the UES is by following a lower acid diet which will allow it to heal and recover.
Pyloric Sphincter
The Pyloric sphincter sits between the stomach and the intestines. When it doesn’t function correctly, bile from the small intestine can pass up through the stomach and give you reflux symptoms. This is called bile reflux and it’s important to know about because PPIs do absolutely nothing for bile reflux.
#3 Too Much Acid – Why PPIs Usually Don’t Work for LPR
If you have been to your doctor about your LPR you will likely have been prescribed PPIs (proton pump inhibitors) like omeprazole, lansoprazole or esomeprazole. Or perhaps H2 blockers like famotidine or ranitidine.
These tablets are used to lower the acidity in the stomach. For some people they may get some benefit but often this effect is limited. For most people with LPR they won’t get much benefit at all.
The reason is that these tablets don’t tackle the actual problem. They don’t stop the LES from opening and they don’t stop pepsin from being reactivated by even weakly acidic reflux. While the acidity in the stomach may be lower from taking these tablets, pepsin can still cause damage in weakly acidic conditions as confirmed by the 2025 Hou et al. study.
There have been multiple studies showing PPIs offer little to no benefit for LPR. A key study demonstrated this, and the landmark 2021 TOPPITS randomised controlled trial published in the BMJ – the largest of its kind with 346 participants – confirmed that PPIs are no better than placebo for treating LPR symptoms specifically. The 2024 IFOS consensus now formally states that acid suppression should not be considered first-line therapy for patients with isolated LPR symptoms.
Be wary of a doctor that prescribes PPIs for LPR
This is something I want to personally highlight because I myself took doctors’ advice for taking PPIs for LPR. I took them for 2-3 years with little to no benefit. Almost all doctors and even so-called specialists in the gastro area would prescribe PPIs, and if that didn’t work they would try another variant or up the dosage. I am sure plenty of you have a similar experience.
The reason I’m pointing this out is that most medical experts simply don’t have the knowledge about LPR specifically and they treat it as if it were GERD. The 2024 IFOS consensus and 2025 European CEORL-HNS guideline are starting to change this, but the majority of GPs and even many gastroenterologists are still behind on this.
Rebound Effect of PPIs
If you are currently taking PPIs with no success, you must taper off them slowly. I myself learned the hard way going from 40mg per day to 0mg which gave me tremendous reflux.
This happens because of rebound acid hypersecretion. The stomach adapts to the PPIs by trying to produce more acid and when you suddenly stop, this excess acid production continues temporarily. Studies have shown this rebound effect happens even in healthy people who never had reflux – once they stop PPI tablets they develop reflux symptoms they never had before. Here is the study.
It’s also important to know that long-term PPI use has been linked to an increased risk of SIBO (more on this below) which can actually make your LPR worse over time.
For a step-by-step tapering guide check my article – Acid Rebound and Getting Off PPIs.
#4 SIBO – The Hidden Cause Many People Are Missing
This section is something I feel strongly about because I have personally experienced this and the research in recent years has made the connection between SIBO and LPR much clearer.
SIBO stands for Small Intestinal Bacterial Overgrowth. When you have SIBO, there is an overgrowth of bacteria in the small intestine that produces excess gas through fermentation. This gas builds up pressure in the abdomen and can push stomach contents – including pepsin – back up through the LES and into the throat, giving you LPR symptoms.
What the Research Says
The connection between SIBO and reflux is no longer just a theory – there is now solid clinical research backing it up:
60% of reflux patients test positive for SIBO. A study published in Surgical Endoscopy in 2021 by researchers at RefluxUK found that 60% of patients referred for reflux surgery tested positive for SIBO on breath testing. That is a staggering number and suggests that for many people, their reflux may be driven or worsened by bacterial overgrowth in the gut rather than a problem with the stomach itself.
SIBO is specifically linked to worse LPR symptoms. A study published in the Gastrointestinal Tract journal (Haworth et al., 2023) directly examined the relationship between SIBO and LPR. They found that patients with SIBO had significantly greater LPR symptom severity on the Reflux Symptom Index (RSI) – particularly for throat clearing, cough and globus (lump in throat feeling). These are exactly the symptoms that LPR sufferers deal with daily.
Treating SIBO can eliminate the need for PPIs. A 2025 study published in Diseases of the Esophagus (Chidambaram et al., 2025) found that after treating SIBO with antibiotics in reflux patients, 95% of patients were able to stop taking PPIs completely and all patients avoided potential surgical interventions. Both GERD and LPR symptom scores improved significantly.
The mechanism makes sense. The gas produced by bacterial fermentation in SIBO distends the small bowel which increases abdominal pressure. This pressure causes increased transient lower esophageal sphincter relaxations (TLOSRs) – essentially the LES opens when it shouldn’t. The belching that results is like spraying an aerosol of stomach contents including pepsin up into the throat. This aerosol may be primarily non-acidic which explains why PPIs don’t help – the pepsin is still getting up there even without strong acid.
My Personal Experience with SIBO
Because I had a lot of gas and burping alongside my LPR symptoms I decided to test myself for SIBO by doing a hydrogen lactulose breath test which can be done quite easily at home and then sent back to the lab for results. My own result came back positive for hydrogen SIBO.
I followed the recommended course of antibiotics called rifaximin. Along with that I started following a low FODMAP diet which has been shown to help reduce SIBO symptoms. After the course of antibiotics and while following the diet I noticed a clear improvement in my LPR symptoms and noticeably about 50% less burping which proved that lessening the SIBO had helped.
What to Do if You Suspect SIBO
If you find yourself with any of the following alongside your LPR symptoms then I’d highly recommend getting tested for SIBO:
- Excessive burping or belching
- Bloating especially after meals
- IBS-type symptoms (diarrhoea, constipation or alternating between both)
- Abdominal discomfort or cramping
- Symptoms that don’t improve with PPIs or diet alone
- A history of long-term PPI use (which is a known risk factor for developing SIBO)
The test is a simple hydrogen and methane breath test that you can do at home. If positive, treatment typically involves a course of rifaximin antibiotics and dietary changes – usually a low FODMAP diet. I’d recommend Monash University’s FODMAP guide for this.
For some people SIBO might only be part of the problem but if it helps symptoms then it’s absolutely worth addressing. And importantly – if you’ve been on PPIs long-term, know that PPI use has been shown to increase the risk of SIBO as backed up by medical studies. This can create a vicious cycle where the medication meant to help your reflux is actually contributing to an underlying cause.
#5 Too Little Acid
There is a theory based around the stomach having too little acid. This may seem confusing as most people are treated for having too much acid. As someone gets older the body produces less acid and this theory suggests that low acid leads to poor digestion, fermentation and ultimately reflux.
The idea has some logic to it – if your stomach acid is too low, food sits in the stomach longer, bacteria can overgrow (connecting to the SIBO point above) and gas buildup can force the LES open. Author Jonathan Wright covered this in his book “Why Stomach Acid is Good for You“.
There is a test called the Heidelberg stomach acid test that can measure your acid levels. Some people have found benefit from supplementing with betaine hydrochloric acid (HCL).
Though keep in mind for most people with LPR this won’t be the primary cause, but I wanted to make you aware of it as it may be relevant for some.
LPR Symptoms
Sore throat – probably the most common symptom. Generally what most people with LPR will have.
Need to clear throat – if you feel the need to constantly clear the throat, try to stop doing it. When you do it constantly throughout the day it can irritate the throat further. Instead try to take a sip of water. Once you start to do it less often you will slowly stop doing it over time.
Excess mucus in throat – this is often because the throat is trying to protect and heal itself and is totally natural. Sip water when needed to keep the throat clear.
Chronic cough – just like with throat clearing, try not to cough as much as it can further irritate the throat.
Lump in throat feeling – try not to be concerned with this feeling. It is almost never an actual lump but irritation caused by the pepsin. The 2023 SIBO study specifically found globus pharyngeus was significantly associated with SIBO-positive patients.
Hard to swallow
Sore to talk
Post nasal drip
Breathing problems / Sinus Congestion – the pepsin can enter the sinuses and cause irritation, inflammation or dryness. The 2025 Gelardi et al. multicenter study confirmed that pepsin is measurable in nasal secretions of LPR patients and that treatment reduces nasal pepsin concentrations.
Hoarseness – research estimates that up to 50% of patients with chronic hoarseness have LPR as the underlying cause.
Dry throat
Ear pain – pepsin and acid can cause irritation in your ears via the eustachian tube.
Dry lips – when pepsin gets into the mouth it can dry out the lips and cause irritation. Avoid licking your lips as this makes it worse. Apply regular vaseline twice per day.
Dental erosion – a lesser-known symptom but pepsin and acid reaching the mouth can erode tooth enamel over time.
Check out my article on LPR Symptoms for detailed information on each.
Advice for Throat Relief
As I have mentioned, drinking water and in particular alkaline water is best. A couple more options I would recommend are chamomile tea which will soothe the throat thanks to having anti-inflammatory properties, and marshmallow root tea which can coat and help heal the throat and digestive tract.
Also sometimes eating something cooling is a good idea. Foods like celery, cucumber and watermelon offer a cooling effect to the throat and won’t worsen acid reflux symptoms. For more options check out natural remedies for LPR.
LPR Treatment
As I mentioned above, PPIs have been shown to NOT help with LPR in clinical trials. The 2024 IFOS consensus and the 2025 European guideline both now state that acid suppression alone is not appropriate as first-line therapy for LPR. Luckily there are other options that actually work.
When it comes to treating LPR naturally it is definitely possible for a lot of people and usually the natural path is the best and fastest option. The following are what I recommend you get started with as soon as possible.
Gaviscon Advance (UK version)
Gaviscon Advance is one of the most effective things you can take for LPR. While it won’t fix the root cause, it will help give you relief while you work on solving the underlying problem.
The important thing to note is that you buy the UK version. Unlike the US version the UK version contains sodium alginate as the main ingredient. Alginate is extracted from seaweed and produces a foam raft on top of your stomach contents which helps create a barrier against reflux. This foam also filters pepsin and bile which are the main causes of LPR damage.
A study showed that Gaviscon Advance (UK version) had a significant positive effect on LPR symptoms. And the 2025 Gelardi et al. study confirmed that mucosal protectors like alginates combined with dietary changes provide the best results.
The best way to take Gaviscon Advance is 15-30 minutes after meals when stomach enzymes and digestion are most active. You can also take it before bedtime if needed.
To purchase the UK version in the US – it is available on Amazon here. An alternative with similar ingredients is Reflux Gourmet available here.
LPR Diet
The other essential thing I recommend is changing your diet. I recommend avoiding foods with a pH of 5 or below. As I explained in the pepsin section, pepsin becomes significantly reactivated at pH 5 and below. If you avoid these foods and drinks you aren’t reactivating the pepsin in your throat which directly helps your symptoms and healing.
For more advice check out my LPR Diet article and my article on the best food choices for LPR. I also have an article on what you can drink with acid reflux.
For a complete diet plan tailored to LPR check out my Wipeout Diet Plan.
Consider SIBO Testing
If you haven’t improved with diet and Gaviscon alone, or if you have bloating, excessive gas or IBS symptoms alongside your LPR, I strongly recommend getting tested for SIBO as covered in the section above. For many people this turns out to be the missing piece of the puzzle.
Also if you want tailored advice and guidance on how to treat your LPR consider a private consultation here.
General Tips to Help LPR
Losing Weight – someone who is overweight is more prone to LPR. More body fat around the stomach area causes more pressure on the LES which means more likelihood of reflux.
Use a Wedge Pillow When Sleeping – when sleeping you are more prone to reflux because you don’t have gravity helping keep contents in the stomach. I would recommend this wedge pillow. Also worth reading – advice on nighttime acid reflux.
Lowering Stress – someone who has lots of stress or anxiety in their life is more prone to reflux symptoms. A 2026 review in European Archives of Oto-Rhino-Laryngology confirmed that anxiety and stress are significantly higher in LPR patients compared with healthy controls and directly impact symptom severity. Meditation, chamomile tea and mindset work can help. For more information check out LPR and Anxiety.
Eat Smaller Meals – eating about the size of your fist per meal reduces pressure on the LES. Split your food across more frequent smaller meals.
Don’t Eat Close to Bedtime – leave at least 3 hours between your last meal and lying down.
Conclusion
I hope this guide has given you the insight and guidance you need to get started with properly treating your LPR. The research has moved forward significantly in recent years and the evidence is clear – pepsin is the primary driver, PPIs are not the answer for most LPR patients, and underlying causes like SIBO are worth investigating.
The approach I recommend is: start with a low acid diet alongside Gaviscon Advance (UK version), consider testing for SIBO if you have gut symptoms, and taper off PPIs if you’re on them without benefit. If you stay consistent with these changes most people will see meaningful improvement within a few weeks.
If you have any questions or concerns feel free to leave a comment below or contact me using the contact page. Best of luck on your healing journey and remember to stay positive!
Some more additional resources:
- Acid Reflux Sore Throat Healing Time
- GERD vs LPR – The differences between the 2
- Neutralize Pepsin in the Throat
- RSI Test – Check Your Reflux Symptom Index
References
- Tan JJ et al. (2024) “Pepsin-mediated inflammation in laryngopharyngeal reflux via the ROS/NLRP3/IL-1β signaling pathway.” Cytokine, 178:156568. PubMed
- Hou C et al. (2025) “Weak acid and pepsin reflux induce laryngopharyngeal mucosal barrier injury.” PLOS ONE, 20(1):e0315083. PLOS ONE
- Lechien JR et al. (2024) “The Dubai definition and diagnostic criteria of laryngopharyngeal reflux: the IFOS consensus.” The Laryngoscope, 134(4):1614-1624. PubMed
- Gelardi M et al. (2025) “Efficacy of dietary modifications and mucosal protectors in the treatment of laryngopharyngeal reflux: a multicenter study.” Frontiers in Medicine, 12:1488323. PMC
- Liu CP et al. (2024) “Predictive Value of Laryngeal Mucosa Pepsin in Therapeutic Response of Laryngopharyngeal Reflux.” Journal of Voice, 38(6):1412-1418. PubMed
- Haworth JJ et al. (2023) “Small intestinal bacterial overgrowth is associated with laryngopharyngeal reflux symptom severity and impaired esophageal mucosal integrity.” Gastrointestinal Tract. Full text
- Steven S, Sherwood P, Boyle N. (2021) “SIBO in reflux patients.” Surgical Endoscopy, 35(12). PubMed
- Chidambaram S et al. (2025) “Treatment of oesophageal and laryngo-pharyngeal symptoms of reflux in patients diagnosed with SIBO and IMO with antibiotics.” Diseases of the Esophagus, 38(2):doaf001. PubMed
- O’Hara J et al. (2021) “Use of proton pump inhibitors to treat persistent throat symptoms: multicentre, double blind, randomised, placebo-controlled trial.” BMJ, 372:m4903. BMJ
- Lechien JR et al. (2025) “European clinical practice guideline: managing and treating laryngopharyngeal reflux disease.” European Archives of Oto-Rhino-Laryngology. PubMed
- Johnston N, Samuels TL et al. (2023) “Oral and inhaled fosamprenavir reverses pepsin-induced damage in a laryngopharyngeal reflux mouse model.” Laryngoscope. PMC
David Gray
Content Researcher & Author
David Gray founded Wipeout Reflux to address a critical gap in reflux management. His research synthesizes over 100 peer-reviewed studies on laryngopharyngeal reflux (LPR), pepsin biology, and GERD pathophysiology. For LPR specifically—a condition most physicians misdiagnose—his work focuses on pepsin reactivation and why standard PPI therapy fails most patients. He develops evidence-based protocols targeting root causes of both LPR and GERD, integrating emerging research on sphincter dysfunction, dietary interventions, and newer clinical approaches. Wipeout Reflux represents practical application of clinical science for patients seeking real solutions.
Hi David, lovely running into your article. One day I just could not swallow solids, no other symptoms I can recall. Doctor dilated my esophagus, placed me on PPI, told me I had gastritis and esophagitis, acid reflux from the endocospy. Then my ENT and STATED I had lingual tonsil pharyngitis and treated it this with steroids. 5 weeks later (today), I can eat better, but I’m stressed this would happen again, so I have start meditation. For over a year, I cleared my throat, coughed and released lots of mucus. Still my voice gets tired when talking and deal with a bit of hoarness.
Today with the low acid diet , I’m not experiencing any symptoms other than my throat feels a bit raw. I am confused about what symptoms I’m looking for , regarding triggers from foods. That is in order to keep them out my diet. Any suggestions. I will continue the diet but would like to start introducing some things back. What triggers should I look for? I’m also going to start lowering my PPI intake slowly. My dosage is super high. 80 mg a day. Other then the swallowing issue (which is better), I’m only clearing my throat once or twice in the morning.
Hey Jessica,
It is hard to exactly tell what could be causing any slight trigger for you without knowing your diet and daily routine. In the wipeout diet i include a list of foods that are allowed and won’t cause any issues that is the best thing I can really suggest. Also I think it’s a good idea for you to slowly lower your PPI dose that could actually help in the long run as well.
Hi David,
I believe that I have developed silent reflux due to this “sore throat” affecting my singing voice. I have been dealing with these symptoms for about a month or two before I did some research of my own. It has been really depressing dealing with these problems. Thank you so much for the information you have provided. I have a couple questions if you don’t mind answering.
1. Can silent reflux also cause a stuffy nose?
2. I read elsewhere about juice fasting, how effective is this treatment and with what fruits? Also how long should I put this method into practice? What other things should I be aware of before doing a juice fast?
3. Will I ever be able to eat normal things again? Is there no cure or will I have to constantly keep track of my acid levels and continue to diet? Are there any stories or references of people you can link who have survived through silent reflux and overcame it?
Hey Ian,
Let me answer your questions –
1. Yes it can cause a stuffy nose. Basically the acid and more importantly can get into your airways and can cause inflammation leaving your nose stuffy.
2. I don’t know anything personally about a juice fast.
3. It depends for each and every person it can be different. Some people may need to maintain a strict diet to remain feeling good whereas others after being healed can return to a normal diet. There are plenty of people who have overcame it, look on the likes of forums and facebook for them.
Hi David,
Thank you so much for taking the time to help others like myself.
My symptoms of tooth pain, chest pain and sore throat started 3 months ago. I’ve lost 45 pounds in 3 months and my last bloodwork I’ve have become anemic. On top of that I have kidney stone that will require a procedure to be removed in 5 days. I believe from a combination of taking 800 mg ibuprofen(knee surgery), antibiotics from a ear infection and stress/anxiety. I still haven’t officially been diagnosed with anything. I believe it’s lpr but my doctor thinks it’s cancer and is trying to find it. I’ve had bloodwork done many times, a MRI of my abdomen and head, a barium swallow and enema test, x-Ray of chest, ultrasound of my abdomen(3mm polyp on gallbladder), a endoscopy and now prepping for a colonoscopy in 2 days. Endoscopy came back completely clear. How can my throat be sore for 3 months and not even be red or swollen?
I’ve eliminated all possible reflux triggers and only drink alkaline water. I only eat whole foods with lots of fruits and vegetables. Eliminated all gluten and dairy. I take L-glutamine, digestive enzymes, 80b probiotic, bone broth, collagen and melatonin. But still haven’t seen any improvement at all. I plan to order the Gavison advance.
My questions.
Could a kidney stone be the cause of lpr?
Could lpr be a result of a vitamin/mineral deficiency?
Could lpr be caused by an intolerance?
I’m really struggling with this and not sure how much longer I can do it for without completely losing my mind. I really appreciate any advice that you have.
Thank you,
Steve
Hey Steve,
I think based on what you have said there is a good chance your symptoms have started from taking the ibuprofen and the anti-biotics. In fact I had a similar experience. If you are still taking either of them you should aim to stop them, both are known to be bad for the stomach particularly the ibuprofen. Consider curcumin (turmeric extract) as a natural alternative to ibuprofen that won’t negatively effect the stomach and digestive system.
Throat could be not swollen or red and still sore most likely because of LSN – you can read more about it here.
Kidney stone – I personally don’t think it can be the cause of LPR no.
Mineral deficiency – There is a probability that it could be though I think the chance of it is quite low. As an example some people being low in vitamin D can cause the LES to not function correctly.
LPR intolerance – it could be worsened by a food intolerance yes.
My best advice is to lower and stop the anti-inflammatories and anti-biotics if you are still taking them along with following a low acid diet like the Wipeout Diet. Also getting the gaviscon as you said also will help.
Hey David,
Lots of info. which makes logical sense.
I have been suffering from LPR from past 2.5 months, never had it before and the symptoms started after a week of some serious stress. Been on PPI’s(Pantoprazole 20mg,3 times a day for 1st month,2 times for the next month, and now 1 time a day) till now and diet (no tea/coffee, tomato, chocolate, citrus fruits, soda, mint, alcohol and spicy/deep fried foods) as advised by my ENT. Not having Tea/Coffee and Alcohol is the most difficult part.
Symptoms have come down (say 50%) till now and the PPI’s was advised to me for 3 months.i think i won’t recover 100% in the remaining 15 days. Also i have started to take Melatonin (3mg) and DGL for the last 10 days, not sure if they are helping. Also i have an inflamed vocal cord for the last 2.5 months (as seen in laryngoscopy).
My concern is do people recover 100% from this condition? Also will i never be able to have fried/spicy food, chocolate, tea/coffee & alcohol again? Is this for lifetime?
I don’t have access to Gaviscon Advance (not available in India, even via Amazon), is there any alternate to it (natural or medical)?
Thanks,
Aman
Hey Aman,
Sounds like following the diet is helping which is good. Perhaps you could be making some mistakes even still because LPR really needs a strict diet to get the best effect(thats what I created the Wipeout Diet for). As for your question, yes you can absolutely recover and return to eating normal foods – for some people they may need to follow a strict diet to keep symptoms at bay whereas for others then can return to their normal diet once they are healed – important thing to remember is that everyone is different. As with Gavison advance if you can find any gaviscon like alternative with the important ingredient called (sodium) alginate, that is the important ingredient – if you have a couple of options choose the one with the higher dosage of that ingredient.
Hi David,
I did a Upper GI endoscopy as the symptoms are still there (not as severe as before) and the doctor said i have LAX (doc. said its medical term for kind of weak) LES everything else is fine. Also said that PPI’s and some basic diet control should help and if its not then surgery and believes LPR and GERD are the same thing.
I am 33 and don’t want to do a surgery, Can LES become normal on it own? Is there an option for me to stay without PPI’s and live a normal life with a normal diet?
Does diet alone can 100% cure LES?
Very very confused and tensed!!
If you just have LPR symptoms PPIs likely won’t help though they can help if you have GERD symptoms like heartburn. Yes diet is the most important factor for most people. For me personally diet improved my symptoms about 60% in under 1-2 weeks when I did a strict diet. A diet can help the LES I believe because if you have less reflux it will allow it to heal more easily and return to its normal function over time. I personally would never trust a doctor who says LPR and GERD are the same thing he is obviously lacking knowledge on the subject though that is quite common to be honest.
Thanks for the info. Started with bronchitis and sinus infection end of May 2019. No one really treated the “lump in the throat” and mild hoarseness until mid July 2019. I was given amitriptyline and omeprazole, which was changed to Nexium 40mg twice a day and Gaviscon at night. To make things worse, now I have developed anxiety/panic attack as a result. Have lost 25 pounds since May. Haven’t been eating much. Breakfast with oatmeal and no lactose milk. Lunch is rice with broth or an apple. Dinner rice and broth or apple. I also have pears or apple sauce. I only drink water. Hoarseness is gone. But I still have that “lump in the throat feeling.” The amitriptyline only worked for 3 days (completely no symptoms). Don’t know if I have LPR or LSN, although my ENT “thinks” I have reflux. Wondering if you ever heard of this one-symptom ordeal.
Hey Mari,
Yes I have heard of similar symptoms. Most likely following a strict low acid diet like the wipeout diet will be your best bet. You most likely have LPR but it is also possible you could have a mixture of both LPR and LSN. The best way to know is based on your symptoms, certain symptoms can mean LPR whereas others mean LSN, depending on them symptoms is a great way to know how to best treat your problem. I you would like to email me about your symptoms I can offer you some advice 🙂
Hi David
Is the Wipe Out Diet Plan workable if you are plant based? Thanks
Hi Anna,
Yeah it is workable. Many vegans and vegetarians can adjust it slightly to work well for them with success.
I’ve been battling issues with stomach/esophagus pain, heartburn, and the warm liquidy feeling in my throat for almost 2 months now. Some days it got/gets so bad that any activity would make it feel worse. I’ve been to 5 diff doctors and they just throw Ppis at me, which aren’t working fully, so then they tell me to take an H2 at bedtime also, still no full relief. It only seems to get worse, as now I have developed chest tightness and difficulty breathing intermittently throughout the day. In fact I should be sleeping right now, but I foolishly drank ONE beer tonite and the acid in my throat is going haywire STILL after my Omeprazole, pepcid, and 3 tums… Interestingly enough not one doctor recommended a diet change which seems obvious to me. I had to begin the quest on my own. Guess I’ll finally lose that extra weight I’ve been wanting to drop. Anyway, I just wanted to share my story bc I’m so grateful that I stumbled on this website. It’s great to read others stories, very similar to my own. It’s like a support group!! Thank you. You da’ man.
Hey Michele,
Thank you for your kind remarks. Unfortunately a lot of doctors don’t know how to treat LPR properly but if you are following my advice you should be on the right track 🙂
Hi David,
Excellent website. I also have LPR and about 4 weeks ago went from taking PPIs to not taking them. The rebound was really bad right away, then calmed down, but I think I may still be rebounding weeks later because I have reflux now all the time, especially at night. You said you went to the emergency room twice during your rebound. A few questions: 1.) How long did your rebound last? 2.) Did you ever have a period where you refluxed almost all the time during your rebound, like I have?
Thank you so much!
-Ken
Hi Ken,
Thank you I am glad it’s been able to help you. As for the PPI’s and the rebound effect yes when I stopped them or lowered them a lot its when I had the worst reflux ever. The best way to stop them is gradually over a period of time. Basically I recommend slowly lowering the dosage over the period of 1 month. So if you where taking 40mg lower to 30, then 20 then 10, then stopped or something like that. That should be over a period of about 1 months time. I also recommend taking gaviscon advance the uk version with it which should make lowering the dosage easier and should also help symptoms.
Hope this helps,
David.
Thanks, David. Much appreciated. Unfortunately I went pretty much cold turkey due to my doctor not telling me about rebound – and I’m still paying the price a month later with horrible reflux. I have Gaviscon UK but it doesn’t help a ton. I just hope this passes.
Yeah unfortunately most doctors aren’t aware of that. If you are still having bad reflux that you feel is because of the rebound effect you could try taking some H2A’s like ranitidine until things are settled more with the gaviscon advance, anti-acids like ranitidine are less strong than PPIs and are much safer to take. That is what reflux expert Jaime Koufman recommends.
Hi David
I have had a good read through your website, thank you for your detail. About a week ago, I was eating an oreo mcflurry when a bit of the biscuit went down the wrong way making me choke/cough a bit, (not a
lot) but since then i have been left with a feeling of a lump in my throat or something stuck. I went to A&E as I thought something was stuck in there, and they could not see anything from a tube down my nose. I then had a burning throat for a few days and a headache, I have also been to the doctor (its driving me crazy) and they have given me a PPI to take 20mg 2 x a day. I have not taken this as i noted that once of the side effects was vertigo, which I have only just recovered from a couple of months ago, and the thought of bringing this on again filled me with dread. I have purchased Gaviscon Advance, and have avoided any of the foods mentioned, I am worried to eat at the moment, and have lost my appetite. My question is do you think I could have LPR or just an inflammation to the throat, I have never had a problem with acid reflux in my life. Does LPR suddenly come on later in life, I am 42. I am overweight by two stone, but I have been this weight for a long while. I am at my wits end! I do suffer with UTI’s and over the years have taken many antibiotics to treat these, I was wondering if Hiprex a drug i was recommended to use with Vitamin C 1000mg, and started last week, would cause this? It works in trying to make your urine more acidic!
Hi Amanda,
Perhaps you did damage your throat from something getting caught on your throat but it also could be from acid reflux. You mentioned you are taking a new high dose vitamin c tablet – ideally if you can I would avoid that because that could be causing you acid reflux. It’s because most vitamin c tablets are made up of ascorbic acid which is highly acidic and would likely irritate the throat and cause acid reflux perhaps. So probably remove that first and after some time if it doesn’t help consider the anti-biotics. Anti-biotics have also been shown to cause/irritate acid reflux so that could also be related but its better first to remove the vitamin c because thats the clear recent change you have made.
Hope this helps,
David.
Hi David, thank you for this wonderful information.
I have been having a burning pain in my throat and behind my nose for more than a year now. I have tried ppis and nothing seems to help. I have been on the low acid/high ph diet for a week now and have maybe seen a few small improvements, but I also feel like when I may “reflux” again the pain is actually worse than before. Could that be because I am starting to heal and the acid/pepsin just opens old wounds as it were? Also, how long should I follow the diet strictly before seeing true pain relief? You mentioned that you noticed improvements after just a few days, but how long before you knew that you were going heal eventually. I’m looking for a little hope I guess. Thank you!
-Claudia
Hi Claudia,
For everyone it is different but for people who follow my diet plan they usually see improvements within 2 weeks. The key is to make sure you are not eating or drinking anything that can further stimulate the pepsin and bring back or worsen symptoms.
Hi David! Your blog is so helpful, I was recently diagnosed with LPR because of a weak sphincter after years of restricting and then bingeing, and was advised PPIs despite having tried them already and having no relief. I have just come out of recovery and really want to be able to eat normally again, and what and whenever I want, so I was wondering if once the throat/sphincter heals, is it possible to go back to eating how I normally did with no bingeing/overeating or would I have to follow the diet for the rest of my life? Thanks!!
Hi Ellie,
Thanks for your kind words I am glad it has helped. As for your question – yes I do believe it is possible for some people to return to normal eating once they are healed. For some they may be able to eat whatever they like and for others they may have to avoid some of their triggers – it’s just different for each person.