Brief Answer: When symtoms don't relate with common diagosis Detailed Answer: LPR (laryngopharyngeal reflux) is an entity which is due to retrograde flow of gastric contents to the lower part of throat. It is important to rule out the possibility of LPR when the symptoms like cough, recurrent sore throat, post nasal drip, globus sensation, dysphagia, odynophagia and chronic hawking sensation in throat are troubling a patient and these symptoms can not be attributed to other cause which have been ruled out by clinical examination and investigations especially when these symptoms occur but there is no heart burn sensation. The diagnosis can be suggested on laryngoscopy findings of congestion of laryngeal inlet mucosa, edema or chronically inflamed picture in the lower throat (laryngopharynx). Measuring of pH by small catheter passed through nose into the throat and esophagus is one of the diagnostic methods by measuring pharyngeal exposure to acid. The cause is usually lax sphincters at the upper and lower end of esophagus which result if acid exposure of the lower throat. The strained muscle per se can not be a cause of LPR but analgesics taken for that strained muscle and be a contributing factor for this. Please avoid NSAIDs, use proton pump inhibitors, sucralfate and pro kinetics in consultation with your doctor. Stopping smoking (if doing), losing weight and decreasing the stomach content volume before lying down do help in decreasing symptoms. Hope this helps. Take care, Regards

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Brief Answer: when common diagnosis can't explain these symptoms Detailed Answer: Hi dear, What I meant by "when symptoms do not relate to common diagnosis" was that when the symptoms - cough, recurrent sore throat, post nasal drip ...................... can not be attributed to other causes. It just means that there are other cause for cough, recurrent sore throat (can be because of any focus of infection in throat or in vicinity), post nasal drip (can because of sinusitis) and so on. Each of these conditions need to be excluded before we label the diagnosis as LPR after performing endoscopy. In simple terms, your treating doctor should rule out other common causes of cough, sore throat and post nasal drip too. It's ok; if you want to avoid prokinetics. Please do not take NSAIDs for pain because of LPR; and use a local anesthetic antacid combination syrup like mucain gel (I hope its available without prescription). If your esophagus shows erosions on endoscopy, and GERD is very much troubling, only then go for fundoplication. Hope this helps. Feel free to ask for query if you have another one. Regards

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