Sore Throat from “Heatiness”? It May Be Laryngopharyngeal Reflux (LPR)

Ever indulged in heaty food like deep-fried snacks, chocolates, or durian, only to wake up with a sore throat in a few hours or the next day? While traditionally attributed to the “heaty” food that you consume, there is a likely medical explanation for this: Laryngopharyngeal Reflux (LPR).

According to medical professionals, these foods are actually acid-reflux-causing foods. In this article, Dr Gan Eng Cern, an ENT Specialist in Singapore, explains how these foods can trigger LPR and provides insights into its causes, symptoms, and potential treatments.

In Singapore, throat discomfort after eating certain foods is commonly described as “heatiness.” While “heatiness” is not a medical diagnosis, it is a widely used term to describe throat irritation, dryness, or soreness after food. From a medical perspective, this presentation is often related to laryngopharyngeal reflux (LPR), a condition that can cause a persistent or recurrent sore throat even without infection. Understanding this link helps explain why a “sore throat due to heatiness” may keep coming back.

What is Laryngopharyngeal Reflux (LPR)?

LPR is a medical condition that occurs when the stomach acid travels up the oesophagus (food pipe) and reaches the larynx (voice box), causing irritation and inflammation. This can lead to sore throat and various other symptoms.

Unlike a typical sore throat caused by viral or bacterial infection, laryngopharyngeal reflux (LPR) often results in a sore throat that does not go away or keeps recurring over time. This is why LPR is a common cause of chronic sore throat in Singapore.

Why Does Laryngopharyngeal Reflux Occur?

The oesophagus (food pipe) has 2 ring-like muscles, one in the upper part of the food pipe (upper oesophagal sphincter) and one in the lower part of the food pipe (lower oesophagal sphincter) that act as gatekeepers to prevent stomach contents from travelling up the oesophagus.

In a patient with LPR, both these sphincters are weak or relaxed, allowing reflux (backflow) of acidic stomach contents into the food pipe and throat (Figure 1a). Unlike the stomach, the food pipe and voice box have little defence mechanism against the strong acid from the stomach. It is believed that the voice box is more sensitive to acid than the food pipe. Hence, just a small amount of acid reflux once or twice a week is sufficient to cause significant problems in the throat.

Figure 1a – What happens in LPR

How is LPR Different From Gastroesophageal Reflux Disorder (GERD)?

GERD and LPR are similar but not exactly the same. While both involve acid reflux, LPR affects the throat and larynx, while GERD primarily affects the oesophagus and stomach (Figure 1b). Therefore, most GERD symptoms are in the stomach and chest regions (e.g. bloatedness, burping, indigestion).

This difference explains why patients with LPR may experience throat symptoms without classic acid reflux complaints, leading to confusion between a persistent sore throat and acid reflux-related throat irritation.

Figure 1b – What happens in GERD

Who Gets Laryngopharyngeal Reflux?

LPR can affect anyone, regardless of age or gender. Factors contributing to LPR include:

• Physical causes: Obesity, hiatus hernia, slow stomach emptying.
• Lifestyle causes: Diet (heaty food, alcohol, oily and spicy food), overeating, sleeping soon after meals.

What Are the Symptoms of Laryngopharyngeal Reflux?

Unlike GERD, many patients with LPR may not necessarily experience bloatedness, burping or indigestion. Common symptoms of LPR include:

• Globus sensation (feeling of something stuck in the throat)
• Choking sensation in the throat
• Itchy throat and frequent throat-clearing
• A hoarse or rough voice
• Sore throat or throat discomfort
• Cough
• Sour or bitter taste in the mouth (usually worse in the morning)
• Phlegm in the throat

Symptoms such as frequent throat clearing, hoarseness, and globus sensation are key features that help distinguish laryngopharyngeal reflux (LPR) from a simple infectious sore throat.

Because these symptoms persist, many patients describe their condition as a sore throat that “never fully recovers.”

Why Antibiotics Often Don’t Help

LPR is caused by acid reflux rather than infection. As a result, antibiotics usually do not help improve symptoms. This explains why patients with a chronic sore throat may notice little or no improvement despite repeated courses of antibiotics. Recognising this difference is important in understanding why a sore throat is not going away.

How is Laryngopharyngeal Reflux Diagnosed?

Diagnosis of LPR is usually made based on a combination of suggestive clinical history and findings from nasoendoscopy (passage of a small lighted tube with a camera into the nose and back of the throat done under local anaesthesia) (Figure 2).

On nasoendoscopy, common findings of LPR may include swelling and redness at the back of the larynx (voice box), indicating inflammation from acid reflux (Figures 3a &b). When the reflux is very severe, it can sometimes cause non-cancerous ulcers and growth called vocal process contact ulcers and granuloma (Fig 3c).

Figure 2 – A flexible nasoendoscope is inserted in the nasal cavity and is guided to the posterior nasal space (back of nose) and to the level of the larynx (voice box). The procedure is done in the clinic setting after the application of topical anaesthesia (numbing agent) and decongestant

Figure 3 – a) Normal voice box b) Swelling and redness on the back part of the voice box in patients with LPR (yellow arrows) c) Non-cancerous growth (vocal process contact ulcer and granuloma – yellow arrow) in patients with severe LPR 

Occasionally, additional tests may be required to confirm the presence of acid reflux or to rule out other causes that may mimic symptoms of LPR. These include:

1. Barium swallow

This involves drinking a dye and taking a series of X-rays to outline part of the digestive tract (mouth, throat, oesophagus and stomach).

2. Gastroscopy

This involves passing a scope through the food pipe and stomach to look for signs of acid reflux, growth, and strictures.

3. Double probe 24-hour pH monitoring (acid test)

This involves inserting a probe (small tube) from the nose down to the food pipe just above the lower oesophagal sphincter to determine the acid level in the food pipe and throat.

When Should You See an ENT Specialist?

You should consider seeing an ENT specialist in Singapore if you experience:

• A sore throat lasting more than 2–3 weeks
• Recurrent sore throat often described as “heatiness”
• Frequent throat clearing, hoarseness, or globus sensation
• A sore throat that does not improve with antibiotics
• Symptoms worse in the morning or after meals

An ENT Specialist evaluation helps determine whether laryngopharyngeal reflux (LPR) or another underlying throat condition is responsible for the chronic sore throat.

How Do I Treat or Prevent LPR?

LPR treatment is usually targeted at preventing the reflux of stomach contents into the food pipe, reducing acid production, and providing a protective barrier against the acid. These include:

1. Lifestyle Modifications

• Foot to avoid for sore throat: Minimise consumption of food that may aggravate LPR, such as heaty food, oily and spicy food, alcohol, chocolates, coffee, tea, carbonated soft drinks, citrus fruits (e.g. lemon, oranges), tomatoes, etc. (Figure 4)
• Eating habits: Take small meals (stop eating when about ¾ full). One can have multiple meals spread out during the day but never eat too full. Avoid eating 3 hours before bedtime.
• Sleeping position: Sleep slightly more upright by raising the head of the bed (e.g. by placing blocks or a wedge under the head end of the mattress). This allows gravity to prevent stomach contents from returning to the food pipe. Do not sleep on your abdomen, as this may worsen LPR. Also, it is best to wear loose clothing during sleep.
• Weight management: Lose weight if you are overweight or obese. Anything that puts extra pressure on your abdomen can worsen LPR. This includes tight clothing and exercising immediately after eating.
• Avoid throat-clearing: Clearing your throat may worsen the inflammation in the voice box region. Try to swallow or exhale forcefully rather than cough.
• Vocal hygiene: Avoid prolonged voice use, take frequent breaks and sips of water to keep the throat hydrated.

Figure 4 – “Heaty” or acid-reflux-causing diet

2. Medications

• Proton pump inhibitors (PPIs) like omeprazole, rabeprazole, esomeprazole and dexlansoprazole (Figure 5) may help reduce acid production.
• Histamine receptor antagonists (blockers) like ranitidine, famotidine, and cimetidine also help to reduce acid production.
• Prokinetic agents like domperidone help promote gastric emptying.
• Antacids like Gaviscon and Mylanta help provide a protective barrier against acid.

Figure 5 – Common proton pump inhibitors for the treatment of LPR

What Kills a Sore Throat Fast?

While there’s no magic cure to instantly address a sore throat, certain remedies can provide relief:

• Gargle with salt water: Soothes the throat and reduces inflammation.
• Suck on lozenges or hard candy: Increases saliva production, keeping the throat moist.
• Drink warm liquids: Soothe the throat and help thin mucus.
• Use a humidifier: Adds moisture to the air, preventing throat dryness.
• Rest your voice: Avoid excessive talking or shouting.
• Over-the-counter pain relievers: Ibuprofen or acetaminophen can reduce pain and inflammation.

These remedies may provide temporary relief but don’t address the underlying cause of LPR. If your sore throat is persistent or severe, consult an ENT specialist for proper diagnosis and treatment.

How to Cure a Sore Throat Overnight?

While completely curing a sore throat overnight may not be possible, combining the remedies mentioned above with adequate rest and hydration may significantly improve symptoms by morning.

If your sore throat is related to LPR, lifestyle modifications and medications are recommended for long-term relief. Don’t rely solely on quick fixes; address the root cause for lasting results.

Surgery for LPR

This is rarely indicated and is recommended for very severe cases of LPR that don’t respond to medical treatment. The surgery is known as gastric fundoplication, whereby part of the stomach is used to wrap around the lower food pipe to tighten the lower oesophagal sphincter.

Why bother about LPR?

While most LPR cases do not cause long-term complications, severe cases can lead to ulcers (contact ulcers) and non-cancerous ulcers and growths (vocal process contact ulcers and granulomas) that can worsen the quality of the voice. Severe LPR has also been associated with the worsening of asthma and sinusitis and may increase the risk of throat or oesophagal cancer.

If you experience a sore throat after consuming heaty food or have other symptoms suggestive of LPR, consider consulting an ENT doctor in Singapore for proper evaluation and treatment. Book a consultation with Dr Gan Eng Cern, our ENT Specialist in Singapore, to learn more about your treatment options.