Gastroesophageal Reflux Disease
and Laryngopharyngeal Reflux Disease
Reflux (backflow of gastric contents) of stomach acid into the throat can cause a mild chemical burn of the throat without causing any heartburn. Your gastric acid can flow up to the throat at any time, but often occurs at night when gravity no longer helps to keep the stomach’s contents from slipping back up the esophagus and pooling in the back of the throat and the voice box.
Stomach fluids have increased ease to reach the upper airway when we lie down.
Patients awake with, a sore throat, a cough or hoarseness without knowing the cause.
Hiatal hernia- weakness of the muscle which acts like a valve between the stomach and esophagus Excess weight Poor diet Eating excessive amounts of food Eating within an hour of bedtime
Some common symptoms :
- voice changes
- swallowing problems
- a foreign body sensation
- throat clearing
- postnasal drip (the feeling of excess phlegm or mucus in their throats)
- throat pain or sore throat
• Difficult because most patients have no heartburn which is irritation of the lining of the stomach or esophagus
• An examination of the throat by an otolaryngologist - fiberoptic endoscopy
• 24 hr pH probe – involves a thin tube through the nose and into the esophagus
• trial of antacids at increasing doses for weeks or months – link in Q&A and next section: voice problems) will determine if stomach acid is causing irritation of the throat and voice box.
Lifestyle changes and nonprescription medicines may be all that is needed to treat mild reflux symptoms. However, if your symptoms last longer than 2 weeks, see your doctor.
Keep a record of your heartburn symptoms before and after making lifestyle changes or using nonprescription medicines so you can discuss any improvement with your doctor. See an example of a heartburn symptom record
- Eat smaller meals. Having a very full stomach increases your chances of having heartburn.
- Do not lie down or exercise for 2 to 3 hours after you eat. When you are sitting up, gravity helps drain food and stomach acid into your stomach.
- Avoid eating large meals and snacks just before bedtime.
- Avoid chocolate, fatty or fried foods, and peppermint- or spearmint-flavored foods.
- Do not drink alcohol (including beer or wine), coffee and other caffeinated drinks, or carbonated drinks.
- Limit acidic foods, such as grapefruit, oranges, tomatoes, or vinegar.
- Limit spicy foods that contain lots of pepper or chilies.
- Avoid tight clothing. Tight belts, waistbands, and panty hose that press on your stomach
- Put blocks underneath your bed frame or use a foam wedge under your mattress to raise the head of your bed 6 in. to 8 in. Using extra pillows to raise your head does not work because pillows cause you to bend at your waist, which squeezes stomach acid up farther and can make heartburn worse.
- Be careful when lifting and bending. Bending over tends to increase reflux. When lifting, bend at the knees.
- Do not take aspirin and similar drugs (meds that cause bleeding), which can irritate the esophagus and stomach, or take them with food or an antacid. For mild to moderate pain relief, try taking another nonprescription medicine, such as acetaminophen (for example, Tylenol).
- Make sure that you stand or sit up when you swallow pills. Take a few sips of water to moisten your throat before you swallow the medicine. Drink a full glass of water to swallow the medicine. Do not lie down right after you take a medicine.
- Do not smoke or use other tobacco products. Smoking causes the valve between the esophagus and the stomach to relax and not close completely. This allows stomach acid to back up (reflux) into the esophagus.
- Maintain a healthy weight. Lose weight if you are overweight. Being overweight puts added pressure on your stomach and increases the chances that stomach acid will back up into the esophagus. Even losing a few pounds can decrease your chance of developing heartburn or reduce your symptoms.
There are several types of antacids now available without a prescription. It may be valuable to understand the differences.
Acid Neutralizers (Tums, Mylanta, Maalox, Gaviscon, Pepto-Bismol, Kaopectate)
Many people take these nonprescription antacids for mild or occasional heartburn. If you use antacids more than just once in a while, talk with your doctor.
- Antacids, such as Tums, Mylanta and Maalox, neutralize some of the stomach acid for 30 minutes to 2 hours, depending on whether the stomach is full or empty. Liquid or dissolving antacids usually work faster than tablet forms.
- Some antacids, such as Gaviscon, have a foaming agent (alginate) that acts as a barrier between stomach acid and the esophagus.
- Antacids such as Pepto-Bismol coat the esophagus and act as a barrier to reflux acid. Pepto-Bismol should not be used for more than 3 weeks and you should not take it if you can't take aspirin. It may make your tongue or stools black. The black color is usually not serious. Brushing your teeth and tongue after taking Pepto-Bismol may keep your tongue from turning black. If your child or teen gets chickenpox or flu, do not treat the symptoms with nonprescription medicines that contain bismuth subsalicylate (such as Pepto-Bismol and Kaopectate). If your child has taken this kind of medicine and he or she has changes in behavior with nausea and vomiting, call your doctor. These symptoms could be an early sign of Reye's syndrome, a rare but serious illness. Ask your doctor if your child younger than 12 should take these medicines.
Acid neutralizers work faster than acid reducers (H2 blockers and Proton Pump Inhibitors ), but their effect lasts only 1 to 2 hours. H2 blockers can provide relief for up to 12 hours. Proton pump inhibitors can last up to 24 hours.
Acid neutralizer side effects: diarrhea, constipation or interfere with how your body absorbs other medicines.
If you have any health risks, talk with your doctor before you start taking an antacid. If you have kidney disease, it is especially important to discuss antacid use with your doctor. Regular use of antacids that contain magnesium or aluminum can cause a dangerous buildup of magnesium or aluminum in people who have kidney disease.
Stomach acid reducers: 2 types
Acid reducers can sometimes change the way other medicines work. If you are taking prescription medicines, be sure to talk with your doctor or pharmacist before you take a nonprescription acid reducer.
- H2 blockers (Pepcid AC, Tagamet HB, Zantac 75, or Axid AR) Acid reducers, also called histamine receptor (or H2) blockers, decrease the amount of acid that the stomach makes for 12 hours. This may reduce irritation to the stomach lining, decrease heartburn and symptoms of acid reflux.
- Proton pump inhibitors (Prilosec, Prevacid, Protonix, AcipHex, Nexium) Proton pump inhibitors (PPIs), such as omeprazole - Prilosec OTC, reduce stomach acid for 24 hours. You may need to use a PPI for several weeks or at a higher dose before you have relief of your acid reflux symptoms. To date, they have an excellent safety record for long-term use. They also are safe to use if you have kidney or liver problems. Some PPIs are available without a prescription.
Testimonial: I did not believe it when I was asked to take medication to eliminate acid in my stomach, but within one month I noticed a marked improvement in my sinuses, my cough, my excess mucus and my tightness in the chest. Gary Moroch