Interview: Prof. Peter Dettmar – Symptoms of LPR

 

This post is the second part of the interview with Professor Peter Dettmar – a leading expert in the research around LPR.

The first one was about the crucial role of the stomach enzyme pepsin in laryngopharyngeal reflux.

 

Many patients can not find a doctor who knows how to identify silent reflux correctly.

That is why they analyze their problems themselves. Do they match LPR symptoms?

I have already written an article about 12 typical symptoms that can be caused by LPR. I recommend reading that article before moving forward to the interview.

Based on my existing investigation of the symptoms I had some more advanced questions to Professor Dettmar:

 

Part #2 – LPR Symptoms (advanced questions)

Question: What’s the role of lung diseases in silent reflux?

Prof. Peter Dettmar:

Research has investigated how reflux is distributed in the airways.

When we saw the reflux could also reach the airways in the form of very fine particles, we realized that reflux is also associated with various lung diseases. Examples are cystic fibrosis and COPD. The last one is a disease seen more in older people, certainly a disease that has been commonly associated with smoking. Now it’s also becoming associated with reflux.

We estimate that about 65–70% of those people presenting with COPD, which is a really chronic disease, have actually got also reflux disease. We and others have done clinical trials about this.

It doesn’t mean reflux disease caused the COPD in the first place. That might have been their lifestyle or smoking, but reflux can worsen and exacerbate all the symptoms.

Another disease that is now markedly associated with reflux is pulmonary fibrosis. So, some of the more pulmonary diseases are also associated with reflux.

 

What is the correlation between asthma and LPR?

The association of asthma and reflux is very high. There are a lot of studies in the literature correlating asthma with reflux.

That is typically the case for adult-onset asthma—asthma that starts when you are an adult. Children develop asthma often, but their disease is often caused by things other than reflux.

 

What other lung complications are there with LPR?

In the last 10 years, as transplants became common, especially lung transplant, there is a lot of rejection of transplanted organs.

And there’s also now a realization that the rejection of some of these organs is actually due to patients refluxing. They reflux their gastric contents into their lungs. That causes inflammation, and the new lungs are rejected.

So what happens now in transplant situations is that patients are put on anti-reflux medications or have a fundoplication even before the transplantation takes place.

If you look at transplant literature, you’ll see it is now well recognized that reflux is something that has to be prevented before you actually transplant the organ into the patient. People might even get an anti-reflux operation before they have a lung transplant, just as a preventive measure.

 

When we look at the patterns of LPR and what the damage from pepsin looks like, is there anything typical in how symptoms evolve?

For LPR, the pepsin damage is very prominent in the laryngeal areas: the larynx, the vocal cords, the pharynx and the throat areas. In those areas an ENT specialist will see a lot of redness from inflammation when the reflux is strong enough.

When you have this inflammation, it means that speaking – certainly shouting – is going to cause some sort of damage to that area.

We see a lot of this kind of damage more prominent in people who use their voices a lot. Examples are singers, actors, teachers, politicians, newsreaders & anyone who use their voice a lot. They are going to feel the symptoms of LPR more easily because of the irritation that is already caused by the pepsin.

And because the voice box is in the throat, everything you eat and drink, whether it’s hot or cold, is also going to cause you some irritation.

 

Is the voice box the typical area where you see symptoms? Or could you also have problems somewhere further up in the throat and sinuses without having laryngeal symptoms?

It’s likely that IF you get symptoms, your voice box or vocal cords will also be affected.

So an ENT specialist or surgeon will need to look at the damage around the voice box, but also particularly look at the muscles controlling the vocal cords. That could, for example, be done during a nasal gastric endoscopy. The muscles that control the voice border on the voice box and can, therefore, come into contact with pepsin. Also, the vocal cords themselves can become damaged.

Sometimes one of the treatments is obviously voice rest. That can be very difficult for patients, however.

 

Can people feel the moments when they have gas reflux?

No, usually they can’t.

You get some people who say, “I don’t think I’ve got reflux, but I do sometimes get a nasty taste in my mouth or the back of my throat.” That’s a sign of a gaseous refluxer, even if those people cannot feel the actual gas reflux.

 

I was constantly burping before I had my LINX implanted. I would burp about a hundred times per day. Sometimes very little burps, sometimes massive ones. Is this a definitive sign that you have reflux when you have such strong gas leaks?

It’s almost certainly related to reflux.

 

But for many people, air is just coming up without sensation?

Correct.

 

OK, thanks for the clarification. To come to a topic that is getting in the head of a lot of my readers: what is the importance of LPR as a cause of cancer?

Reflux disease can lead to more serious conditions.

The percentage of people that go on to more serious conditions is, as far as we’re aware, quite low, but there is strong evidence that patients who present with esophageal and laryngeal cancers do actually first present with reflux disease.

So there obviously has to be a link between these cancers and reflux.

It’s impossible to say how long a patient would have to have reflux before they may get cancers. You might have reflux for 10 years, 20 years, even 30 years and not actually present with those cancers.

We are not talking about big numbers here, rather that maybe 1% of refluxers might develop cancer in those areas in their life.

Compared to how many people get cancer, that is not a very big number. But reflux definitely increases the chances of developing cancer in these areas.

 

End of Part #2 of the Interview with Prof. Dettmar

The interview with Professor Peter Dettmar was packed with useful information. To make it easier to digest, I have split it into 4 parts.

The first part was about the crucial role of pepsin in LPR, part three is about the treatment of LPR, and part four about Peptest.

Do you want to find out whether you have LPR symptoms? Click here to calculate your reflux symptom score (RSI) online. It gives you a good first impression whether your symptoms fit the disease.

LPR Test