Avoid tight clothing around your waist: It is best to take Gaviscon Advance as the Bending from the knees when lifting very last thing you take before going to and moving may also help. bed. It can also be of benefit after meals and before strenuous exercise. You should Some people find it helpful to keep a food not take it at the same time as taking your diary to identify any particular foods or PPI or other anti-acid medication, as it can eating habits which make their symptoms make them less effective. worse.

For advice on any medications you have Are there any medicines I can been prescribed or purchased over the take to help? counter speak to your GP or pharmacist. Your consultant or GP may have prescribed a medicine known as a PPI or Proton Pump Inhibitor. Examples include Lanzoprazole and Omeprazole. These prevent the secretion of acid into the stomach. For the most effective treatment of LPR these should be taken half an hour before meals. For the medication to be effective, you should take it for a continuous period of time once or twice a day, as prescribed. If The Trust provides free symptoms do not improve go to your GP to monthly health talks on a Reflux Advice review the type and amount of medication. variety of medical conditions It may take a couple of attempts to find and treatments. For more information visit the combination that works best for you. www.uhb.nhs.uk/health-talks.htm or Sheet call 0121 371 4323. Proton pump inhibitors (PPI) do not stop the production of , the key factor in LPR (silent reflux). As well as taking a Speech and Language Therapy Department PPI, taking an alginate such as Gaviscon Queen Elizabeth Hospital Birmingham Advance will protect the throat from the Mindelsohn Way, Edgbaston enzyme Pepsin. It works in two ways, Birmingham, B15 2GW UHB is a no smoking Trust firstly it forms a coating on the top of the Telephone: 0121 371 3483 stomach to reduce the number of reflux episodes and it reduces pepsin activity. Email: [email protected] To see all of our current When the alginate comes into contact patient information leaflets please visit www.uhb.nhs.uk/patient-information-leaflets.htm with pepsin it deactivates the enzyme and PI18/1556/04 Author: Cathy Gass protects the lining of your throat. Date: July 2019 Review date: July 2021 What is reflux? How does reflux affect the very hot or cold in temperature may over stimulate the gastric musculature and Reflux is the back flow of gastric juice throat? increase risk of reflux also. Chewing gum and enzymes from the stomach into the The lining of the stomach is designed to can also aggravate reflux. oesophagus (food pipe) and/or throat. cope with acid but the throat is not. In There are two main types of reflux. Gastro- LPR we now know that it is the digestive oesophageal reflux disease (GORD), enzyme Pepsin which when combined with 4. Avoid fizzy drinks, caffeinated drinks, or which is most commonly associated with acid from the stomach or from certain highly acidic drinks: and symptoms; foods and drink can damage the lining of This includes tea, coffee and fruit juices. and extra-oesophageal reflux, of which the throat. laryngopharyngeal reflux (LPR) is the type that affects the throat and voice. 5. Avoid alcohol: What can I do to help? You should avoid all alcohol but LPR is when stomach acid may flow all the 1. Avoid eating late at night: particularly white wine and spirits. way back up to your throat, commonly affecting the voice. It is often known Reflux is aggravated by bending, lying as ‘silent reflux’, as many people do not flat, lifting or straining. Eating before 6. Stop smoking: bedtime will therefore encourage gastric experience heartburn symptoms with this Smoking can increase the risk of back-flow. Try to allow at least three form of reflux. Symptoms may include: developing reflux and aggravate your hours between your last meal and lying symptoms. • a , down.

• excess mucus in the throat, 7. Try raising the head of the bed: • the feeling of a lump or tightness in the 2. Eat small frequent meals during the day: throat, Using blocks or wedges under the This will distribute the physical load on head of your bed to raise it by about • regular coughing or clearing the throat, the stomach and minimise the risk of six inches will alter the angle you sleep • dryness in the mouth and throat, reflux. Sipping water between meals may at. Using extra pillows alone may cause help, rather than drinking and eating • and hoarseness of voice. your stomach to become squashed and together. Sit and relax for a while after may increase the risk of reflux. Also, eating. Avoid drinking large amounts of try sleeping on your left side to reduce water all at once. Symptoms may be worse at night and early reflux. in the morning.

3. Avoid eating foods which can make 8. Try to lose weight if you are reflux worse: overweight: This includes high-fat foods, chocolate, The pressure of excess weight around prepared cakes and desserts, spicy foods, the stomach encourages a back-flow of citrus fruits and mint. Acidic foods should gastric contents into the oesophagus. be avoided, for example tomatoes and Taking regular exercise can help. any tomato based sauces. Food that is