Laryngopharyngeal reflux diet
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Laryngopharyngeal Reflux Diet: Effective Dietary Modifications and Their Impact
Introduction to Laryngopharyngeal Reflux (LPR)
Laryngopharyngeal reflux (LPR) is a condition where stomach contents reflux into the larynx and pharynx, causing symptoms such as throat clearing, a lump in the throat sensation, chronic cough, dysphonia, dysphagia, and sore throat . Unlike gastroesophageal reflux disease (GERD), LPR often does not present with heartburn, making it more challenging to diagnose and treat.
Importance of Dietary Modifications in LPR Management
General Dietary Recommendations
Dietary modifications play a crucial role in managing LPR symptoms. Studies have shown that patients with LPR benefit significantly from avoiding foods and beverages with high reflux potential, such as acidic, spicy, fermented, sweet, and fried foods, as well as carbonated drinks and juices 35. Instead, incorporating foods with low reflux potential and water can significantly reduce symptoms and improve the quality of life .
Alkaline, Low-Fat, and Low-Acid Diets
An alkaline, low-fat, and low-acid diet has been associated with better improvement of LPR symptoms. This diet helps by enhancing esophageal sphincter tonicity, reducing acid and pepsin production, and improving gastric emptying time . A study involving 65 patients demonstrated that adherence to such a diet, along with lifestyle modifications, led to significant symptom improvement .
Mediterranean Diet and Alkaline Water
A Mediterranean-style diet, which is 95% plant-based and includes fruits, vegetables, whole grains, and nuts, combined with alkaline water, has shown substantial improvements in LPR symptoms. This dietary approach not only helps in managing LPR but also improves overall health and well-being 78. A comparative study found that patients treated with a Mediterranean diet and alkaline water had a greater reduction in Reflux Symptom Index (RSI) scores compared to those treated with proton pump inhibitors (PPIs) .
Low-Acid Diet for Recalcitrant LPR
For patients with recalcitrant LPR who do not respond to PPIs, a strict low-acid diet can be beneficial. Eliminating foods and beverages with a pH less than 5 for a minimum of two weeks has shown significant symptom improvement in 95% of patients, with some becoming completely asymptomatic . This suggests that a low-acid diet could be a primary treatment for LPR, especially in PPI-resistant cases .
Development of Refluxogenic Diet Scores
To objectively assess the refluxogenic potential of foods and beverages, European experts developed the Refluxogenic Diet Score (REDS), Refluxogenic Score of a Dish (RESDI), and Global Refluxogenic Diet Score (GRES). These scores categorize foods and beverages based on their potential to cause reflux, helping in the dietary management of LPR patients . The GRES, in particular, has been shown to correlate with the occurrence of proximal reflux episodes, making it a valuable tool in dietary assessment and management .
Conclusion
Dietary modifications are a cornerstone in the management of laryngopharyngeal reflux. Avoiding high-reflux potential foods and beverages, adopting an alkaline, low-fat, low-acid diet, and considering a Mediterranean-style diet with alkaline water can significantly improve LPR symptoms and overall quality of life. The development of refluxogenic diet scores further aids in the objective assessment and management of dietary factors contributing to LPR. Future studies are needed to refine these dietary approaches and confirm their long-term benefits.
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