The vast majority of patients who suffer from Gastroesophageal Reflux complain of heartburn. Most of their symptoms relate to the stomach and the abdominal area sometimes manifesting with pain in the abdomen between meals, nausea, feeling of having an upset stomach, the sourness of the stomach and even excessive burping. If the esophagus is injured they may also complain of pain in the chest that can be mistaken for a heart attack. We tend to think of gastroesophageal reflux as reflux that happens when patients are lying down or in a head dependent position.
On the other hand, patients who suffer from Laryngopharyngeal Reflux (also known as Extra-Esophageal Reflux) complain of symptoms that refer to the throat/voicebox region such as hoarseness, chronic cough, chronic throat irritation, thick or too much mucus, chronic throat clearing and voice problems. Only about 35% of patients who suffer from LPR complain of heartburn. We tend to think of Laryngopharyngeal Reflux patients as upright refluxers (meaning refluxing throughout the day, especially after meals).
We are still learning much about how reflux causes symptoms in patients. As we mentioned in the previous blog post, although everyone refluxes, not everyone suffers from either Gastroesophageal Reflux or Laryngopharyngeal Reflux. We tend to only treat those patients who are symptomatic. It is also interesting to note that not all patients who suffer from Gastroesophageal Reflux will have symptoms of Laryngopharyngeal Reflux. It is also true that most patients who have Laryngopharyngeal Reflux do not complain of problems with their esophagus or stomach. Why would this be the case?
The esophagus and stomach were built to handle acid. The lining of the stomach has a thick layer of mucus that helps to protect it from the acidic environment that it finds itself in most of the time. The esophagus, like the skin, is made of resilient squamous epithelium, that is able to handle the elements, including stomach acid. The esophagus has the ability to secrete substances that are able to neutralize acids, further decreasing the chances that the esophagus will be injured by reflux. The esophagus is also able through peristalsis (the ability of the esophagus to contract rhythmically and move contents towards the stomach) to move the acidic contents back towards the stomach and decrease the amount of contact time it has with this acidic refluxate.
Unfortunately, the larynx is lined by more delicate and sensitive mucosa that does not have the same robustness and can be injured by as little as 4 reflux events a day (compared to 40 events or more in the esophagus). Although the larynx can create a mucus layer to help protect itself, this mucus is nowhere as thick or as effective as the mucus that the stomach makes. The larynx is unable to make the same acid neutralizing substances like the esophagus and it cannot get out of the way of acidic contents if they happen to get to the larynx like the esophagus can. This combination makes it possible for someone to have symptoms in the throat region with mild reflux and not complain of any difficulties in the esophagus or stomach.
Because reflux, regardless of the type, is a lifelong battle, we treat both Gastroesophageal Reflux and Laryngopharyngeal Reflux initially with diet and behavior modifications along with alginate therapy such as Mint Chocolate Rescue.