Suggest Treatment For Laryngeal Reflux That Is Not Responding To Proton Pump Inhibitors

Posted on Sun, 8 Mar 2015

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Sun, 8 Mar 2015 Answered on

Mon, 30 Mar 2015 Last reviewed on

Question : I was recently diagnosed with larngeal refulx. The ENT suspected this due to a red throat and a persisant productive cough for almost 6 months. I believe that stress triggered the cough/reflux as I had a very stressful situation occur around the time the cough developed. I have been dealing with health anxiety issues before and since the cough. I read into my symptoms and believe the worst (cancer etc). I do not have heartburn but do feel a spasm like symptom in my chest and throat and get fairly severe upper back muscle pain particularly in the evening. During the day my symptoms don't seem to be as noticeable. My cough has subsided substantially but I still have quite a bit of phlegm in my throat. (I have always had to clear my throat fairly often)

I suffered a bout of health anxiety around 15 years ago and took paxil which seemed to relieve my anxiety. I may have had similar chest sensations at the time but I can't recall exactly.

If I developed reflux/cough due to stress and anxiety would antidepressants like SSRI's be a better solution than PPI's which have not seemed to diminish my symptoms to date? I have taken PPI's for close to a month.

Answered by Dr. Paparaja S (4 hours later)

Brief Answer:
Yes, SSRI s could be better option.

Detailed Answer:
Hi,
Welcome to healthcare magic.
I had gone through your question.
I can understand your concern.
The reflux s not responding to proton pump inhibitors could be treated with SSRI s. That is selective setetonin reuptake inhibitor.
Apart from their antidepressant activity, they also reduce the reflux and could improve the symptoms. Consult your doctor and discuss regarding the same.
I also you recommend the following.
1) Avoid coffee, tea and carbonated drinks.
2) Avoid spicy and junk foods.
3) Avoid smoking and alcohol. If you don't have this habit kindly ignore this suggestion
4) Keep regular diet habits. Avoid skipping meals.
5) Take your dinner at least 3 hours before bedtime. Never lie down as soon as you take meals.
6) Regular exercises found to be beneficial in reflux.
You will be fine.
Hope I have answered your question. If you have any questions, I am happy to help.
Wish you a good health and speedy recovery.
Regards,
Dr Paparaja S MBBS MS
Consultant ENT Surgeon

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Paparaja S (21 hours later)

Would it make sense to take the SSRI at the same time as the PPI?

Also, for how long a duration would I need to take the SSRI. At what dosage would you recommend for the SSRI?

Once the symptoms resolve am I able to go off both the PPI and SSRI?

I have read conflicting information about SSRI's for reflux. I have read they help, but have also read that they can relax the lower esophageal sphincter. What is your opinion?
Also, does the upper back pain back relate to the reflux or should I see someone for my back?

Answered by Dr. Paparaja S (16 hours later)

Brief Answer:
Yes, upper back pain could be related.

Detailed Answer:
Hi,
Thanks for the follow up.
I can understand your concern.
Yes, upper back pain could be related to reflux.
SSRI will decrease the perception threshold of reflux and they could also work for your anxiety.
Since you are already refractory to PPI s you need not use them.
Citalopram 20 mg could be used a initial dosage them based on the results maintainance dose is decided. Consult your doctor for evaluation before starting.

Wish you a speedy recovery.

Take care.

Note: Consult an experienced Otolaryngologist / ENT Specialist online for further follow up on ear, nose, and throat issues - Book a Call now.

Above answer was peer-reviewed by : Dr. Pradeep Vitta