How Much Time Does it Take for LPR Treatment to Work?

Many patients with laryngopharyngeal reflux (LPR) wonder how long it takes before LPR treatments show an effect. Silent reflux damages the mucous membranes, and they need time to heal.

The time that it takes is very individual. Some patients see great improvements within weeks of adopting lifestyle changes. However, a time horizon of a few months is more realistic for a more complete recovery, particularly if treatment is started slowly rather than making sudden large changes to lifestyle and diet.

How LPR Treatment Improves Symptoms

Damage to the mucous membranes is caused by pepsin. Pepsin is a stomach enzyme that gets carried along with the reflux acid and thereby reaches the throat and airways.

The right LPR treatment reduces the symptoms over time in two ways:

  1. Reducing reflux itself: If less pepsin reaches the throat, the inflammation and LPR symptoms will subside over time.
  2. Reducing acidity in the throat: Pepsin causes more inflammation in acidic environments. That is why it is important to also limit the consumption of acidic foods and drinks, as this will limit the amount of additional harm pepsin that has already reached the throat can do.

Exactly how long it takes for the symptoms to improve or disappear is very individual. Treatment does not usually immediately eliminate all reflux events; it just reduces them. This means that less new damage occurs, but the mucous membranes still experience some irritation from pepsin. However, you do not need to eliminate all your reflux – just enough so your body’s natural reflux defences can deal with it.

It takes at least a few weeks for the inflammation to resolve and for the damaged cells to be replaced by new, healthy cells. Until this happens, you cannot expect a significant improvement in your symptoms.

The quicker you adopt changes in your lifestyle and eliminate the causes of your LPR, the sooner you will see results.

How Long Will Different LPR Treatments Take to Work?

Some treatment methods show results quicker than others.

Medication

Proton pump inhibitors (PPIs) are the most frequently prescribed medications for silent reflux. Unfortunately, they do not work any better than placebo for the treatment of LPR.[1] Studies have shown that symptoms can improve within 6 weeks, but the same improvement is seen with placebo pills, demonstrating that PPIs have little to no effect on the cause of the symptoms.[2]

In a different article, I explain in detail why PPIs don’t work for silent reflux.

Gaviscon Advance is one of the few medications that can indeed reduce reflux and improve LPR symptoms. It works by building a foam layer above the stomach contents, so preventing them from rising towards the esophagus.

One study has shown that symptoms improved from a mean RSI score of 23.9 (strong symptoms) to 11.2 (medium symptoms) within 2 months.[3]

Surgery

Surgery is only recommended in extreme cases because it always bears the risk of complications. Nevertheless, surgery can effectively reduce reflux and improve symptoms. The best-established surgery for LPR is the Nissen fundoplication. During this procedure, the upper part of the stomach is wrapped around the esophagus, thereby tightening the lower esophageal sphincter (LES). The LES is a sphincter that helps to keep food in the stomach.

The Nissen fundoplication can lead to an improvement of symptoms within a few weeks – provided it is successful.[4]

Diet

Dietary changes are very efficient in improving LPR symptoms within a short period. Compared to medication and surgery, though, there is less research done into this, simply because there is little money to be made from it. Still, there is at least some research. In one study, participants with LPR followed a low-acid, low-fat diet.[5]

Also, many readers are writing me that they get significant and quick results by adjusting what they eat and drink. This makes sense, as for most people, their eating habits are the most aggravating factor for their reflux.

If you bring the causes of your LPR under control, it is just a matter of time before the symptoms will vanish as well.


References

[1] Reimer C, Bytzer P. Management of laryngopharyngeal reflux with proton pump inhibitors. Ther Clin Risk Manag. 2008;4(1):225–233.

[2] Havas T; Huang S; Levy M, et al. Posterior pharyngolaryngitis. Double-blind randomised placebo-controlled trial of proton pump inhibitor therapy. Australian Journal of Otolaryngology. 2016;3(3):243–6.

[3] McGlashan JA, Johnstone LM, Sykes J, Strugala V, Dettmar PW. The value of a liquid alginate suspension (Gaviscon Advance) in the management of laryngopharyngeal reflux. Eur Arch Otorhinolaryngol. 2009;266(2):243–51.

[4] Carroll TL, Nahikian K, Asban A, Wiener D. Nissen Fundoplication for Laryngopharyngeal Reflux After Patient Selection Using Dual pH, Full Column Impedance Testing: A Pilot Study. Ann Otol Rhinol Laryngol. 2016;125(9):722–8.

[5] Koufman JA. Low-acid diet for recalcitrant laryngopharyngeal reflux: therapeutic benefits and their implications. Ann Otol Rhinol Laryngol. 2011;120(5):281–7.

Gerrit Sonnabend
 

Gerrit is a German data scientist & medical publisher. His formal education is in qualitative research. He had severe reflux himself. Read more about him here.