Why does my throat irritation persist despite medication?

Question

Hello doctor,

I have been experiencing persistent throat irritation for about seven months. The symptoms fluctuate; sometimes it feels like a lump in my throat, sometimes just irritation or burning, and other times a lump sensation with mucus buildup.

Initially, I tested positive for H. pylori on a blood test. I was treated with triple therapy antibiotics, and during the course, my throat symptoms improved significantly. However, I developed mild stomach discomfort. A follow-up stool test came back negative for H. pylori, and for a short period, things seemed better.

After a few weeks, the throat irritation returned. A repeat blood test again showed H. pylori positive, so I was referred to a specialist. An endoscopy and biopsy were performed. The results showed a small hiatal hernia and mild H. pylori infection, but everything else was normal.

Since the throat irritation was not as severe as before, I was started on Pantoprazole 40 mg once daily, which was later increased to twice daily. I was also given another 10-day antibiotic course for H. pylori, probiotics (Probiflora), and a throat spray (Larri), although the spray did not help.

Once again, my throat symptoms improved only while I was on antibiotics. After completing the course, the irritation returned within a few weeks. Because there was no progress, I was prescribed Gaviscon to help with acid reflux, but it did not make a difference. I was then given Clacee 500 mg for two weeks, which provided little relief. A short three-day course of antibiotics temporarily improved the symptoms, but they returned after stopping them.

I sought a second specialist’s opinion, and another endoscopy was performed. This time, bile reflux and superficial gastritis were observed. The biopsy came back negative for H. pylori, but stomach inflammation was still present. I was prescribed slow-release Pantoprazole 40 mg twice daily, Clarithromycin and Amoxicillin three times daily for 10 days, Flomist nasal spray, paracetamol, and probiotics. Despite this treatment, my symptoms have not improved and sometimes feel worse, especially after eating.

Currently, when I wake up in the morning, I feel mucus in my throat. After drinking water, the irritation increases, and it becomes worse after meals, persisting throughout the day until I sleep. I also feel gassy most of the time, though the severe morning gassiness has slightly improved recently.

My runny nose has improved with Flomist, but I still experience occasional sneezing. I also have hip and back pain, but physiotherapy confirmed that it is muscular in origin and worsens only with certain movements.

I have made all recommended lifestyle changes since my first diagnosis, including dietary adjustments and reflux precautions, but nothing seems to completely resolve the problem. I am particularly concerned about the bile reflux finding.

I would like to understand why I was not prescribed specific medication for bile reflux, and whether bile reflux–targeted treatment might help in my case.

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query.

Thank you for sharing such a detailed history and being so patient through all these tests and treatments.

Based on everything you have described, the persistent throat irritation, lump sensation, and mucus build-up, it seems your symptoms are most likely related to a combination of bile reflux (duodenogastric reflux) and lingering inflammation from chronic gastritis (a long-term inflammation of the stomach lining that can cause irritation, discomfort, and digestive symptoms over time), even though your H. pylori (helicobacter pylori) is now negative.

One important point in your case is that PPIs (proton pump inhibitors) alone may not be enough. These medicines reduce stomach acid, but they do not stop bile from flowing backward into the stomach and esophagus. That may explain why you have only had partial or temporary relief despite multiple PPI and antibiotic courses.

In situations like yours, medications that specifically target bile reflux may help, such as:

Sucralfate forms a protective coating over the stomach lining.
Ursodeoxycholic acid (Ursodiol) helps reduce bile acid irritation.
Prokinetics (like Domperidone or Itopride) improve stomach emptying and reduce reflux episodes.

These options are sometimes overlooked unless bile reflux is strongly suspected.

Your ongoing throat symptoms may also be due to laryngopharyngeal reflux (LPR), a silent form of reflux that can irritate the throat without causing classic heartburn. An ENT evaluation could help confirm this.

Treatments such as reflux-targeted throat sprays or alginate-based formulations after meals may provide additional relief.

You are already doing the right lifestyle steps, such as small, frequent meals, avoiding lying down after eating, elevating the head of the bed, and limiting fatty or spicy foods. However, in bile reflux cases, lifestyle changes alone are often not enough.

Given how long this has been affecting you, a coordinated approach between a gastroenterologist and an ENT (ear, nose, and throat) specialist would likely give you the most comprehensive and lasting relief.

I hope this helps.

Kindly revert so I can assist you further.

Thank you.