GERD (gastroesophageal eflux disease) or acid reflux is a common condition where contents from the stomach regurgitate back into the esophagus and throat. The refluxed gastric contents can cause numerous symptoms including heartburn, regurgitation, dysphagia (swallowing difficulty), cough, chest and throat pain, burning tongue syndrome, excessive throat mucus, globus (a lump in the throat), and hoarseness. In addition, reflux can cause esophageal injury (esophagitis), throat inflammation (laryngitis and pharyngitis), tooth erosion, and throat and esophageal cancer.
Laryngopharyngeal Reflux (LPR) is a disorder caused by regurgitation of gastric contents all the way back up into the larynx (voice box) and pharynx (throat). The larynx and pharynx do not have the protective mechanisms that the esophagus and stomach have and are more sensitive to damage from gastric acid and pepsin. Therefore, even a small amount of reflux into the throat or larynx is enough to cause damage. Symptoms of LPR include hoarseness, throat clearing, excessive throat mucus, globus (foreign body sensation), chronic cough, swallowing difficulty (dysphagia), and throat pain. Sometimes people suffering from acid reflux disease (GERD) suffer from both heartburn and symptoms of LPR. Frequently, however, the reflux may bypass a normal esophagus without causing heartburn and only cause symptoms of LPR. Such patients are said to have “silent reflux.”
How do you get Acid Reflux?
Reflux is a normal physiologic process that allows the stomach to vent gas (air). We all reflux. Up to 50 reflux episodes per day can be considered normal. If the reflux becomes excessive, however, painful symptoms and tissue injury may occur (gastroesophageal and laryngopharyngeal reflux disease). Common risk factors for GERD and LPR include:
- Unhealthy eating habits
- Spicy, fried, and fatty foods
- Carbonated and alcoholic drinks
- Numerous medications
- Hiatal hernia
- Tight fitting clothing
The lower esophageal sphincter (LES) is a 3cm valve of high pressure located at the junction of the esophagus and stomach. The LES must relax to allow food to pass safely from the esophagus into the stomach. The LES must also contract to prevent regurgitation of stomach contents back into the esophagus. If the LES relaxes excessively or becomes incompetent as in the case of hiatal hernia, excessive reflux may occur.
The esophagus does not share the same protection from the strong acidic content as the stomach. The throat and larynx even have less protective mechanisms than the esophagus. Even small amounts of acidic gastric contents are enough to cause symptoms and tissue injury.
Do you have acid reflux?
Some of the most common symptoms of acid reflux are:
- Chronic throat pain
- Chronic cough
- Difficulty swallowing and breathing
- Excessive throat mucus
- The sensation of a lump in the throat (globus)
These symptoms often occur at night, after meals—particularly heavy ones as well as making movements such as bending over, lifting and straining, and lying down on your back.
People suffering from acid reflux may also experience pain, bloating, and discomfort in the abdomen (dyspepsia).
Complications of Acid Reflux
Acid reflux may become a serious condition if ignored and left untreated. Some of the more serious complications of reflux include:
Leaving GERD untreated can lead to cancer of the esophagus, which is currently the seventh most common cause of death from cancer in men. An estimated 16,080 deaths from esophageal cancer occur each year in the United thee States alone. Unfortunately, the survival for people diagnosed with esophageal cancer is poor with only 5-19% of individuals still alive 5-years after diagnosis.
GERD can cause inflammation of the esophagus (esophagitis). If left untreated, esophagitis can not only result in pain and discomfort but can cause chronic scarring and stricture which adversely affects the ability of the esophagus to transport food. This may result in difficulty swallowing (dysphagia).
If acid reflux is left untreated for many years, a condition called Barrett’s esophagus may develop. Barrett’s esophagus may or may not have dysplasia, which is a precancerous condition of the esophagus. One in 200 people with Barrett’s esophagus will develop esophageal cancer each year.
When to See Your Physician
A person who experiences heartburn more than twice per week should go to see a physician. Any individual with difficulty swallowing, chronic cough, hoarseness, unexplained weight loss, or coughing up blood should also seek medical care immediately.
Diagnosis of GERD and LPR
The following tests are the most common methods that your doctor may use to diagnose acid reflux and other related conditions. One or several methods may be necessary depending on the severity of your condition and other contributing factors.
X-ray Swallow Study
An X-ray swallow study of the upper digestive system may be recommended to evaluate the esophagus, stomach, and upper intestine. A chalky substance called barium is swallowed which allows the clinician to visualize the function of the throat and esophagus. Alternative names for an X-ray swallow study include the “Barium Swallow” and “Esophagram.” This is the preferred test to evaluate for sources of esophageal narrowing (webs, strictures, rings) and hiatal hernia. This test is insufficient to diagnose esophagitis, Barrett’s esophagus and esophageal cancer.
If a person suffers from prolonged reflux symptoms, endoscopy may be recommended. Endoscopy involves passing a lighted tube with a camera through the mouth or nose, past the throat, and into the esophagus and stomach. Endoscopy is the preferred method to evaluate for esophagitis, Barrett’s esophagus, and esophageal cancer. Endoscopy is indicated in all persons with swallowing difficulty. A person can have symptomatic GERD even if the endoscopy is normal (non-erosive reflux disease or NERD).
A biopsy may be performed to evaluate an abnormality identified on endoscopy. This is a minor procedure during endoscopy where a small forceps is passed through the endoscope to sample a piece of tissue in the throat, esophagus, or stomach. The small tissue sample is then sent to the lab for a pathologist to evaluate under a microscope. A biopsy is necessary to diagnose certain types of esophagitis, Barrett’s esophagus and esophageal cancer. It is a painless addition to an endoscopic procedure.
Chronic GERD can affect the ability of your esophagus to contract. Esophageal manometry is a test of esophageal function that measures the muscle contractions of the esophagus during swallowing. This test is performed by placing a small catheter (tube) through your nose and into your esophagus. The catheter has specialized pressure sensors that measure the ability of the esophageal muscle to contract. It is the only test that provides objective measurements of esophageal function. It takes approximately 30 minutes to perform.
Ambulatory pH Testing
Ambulatory reflux testing is performed by placing a small sensor in the lower part of the esophagus to measure acidity. The normal pH of the esophagus is neutral (approximately pH 7). A drop in esophageal pH to < 4 indicates that a reflux event has occurred. The pH sensor may either be attached to a hardwired catheter (tube) that is placed through your nose or the sensor may be a stand alone wireless pH sensor that is attached directly to your esophagus without the need for a catheter. The pH sensor sends information directly to a computer and records data on reflux events over a 24-72 hour period. This is the only test that obtains objective measurements regarding the frequency and severity of reflux.
Acid Reflux Treatment
There are numerous treatment options available to help alleviate GERD and LPR.
While consulting a doctor is the best way to determine the right treatment, it is helpful to have an understanding of the currently available options that may be recommended. Depending on the severity of your reflux, numerous treatments may be required.
Making lifestyle changes can help reduce the symptoms of acid reflux and help prevent any further damage to the esophagus and throat. Making dietary changes is the first step in reducing acid reflux symptoms that may be triggered by different types of food. However, these foods may vary from one person to another. Avoiding fatty, fried, and acidic foods is beneficial.
Quitting smoking, avoiding alcoholic beverages, and losing excess weight will also help reduce the frequency of regurgitation of stomach contents into the esophagus. Eating an early dinner, a low-acid diet, elevating the head of the bed or a reflux bed wedge can help prevent reflux during sleep.
Over-the-counter (OTC) medications are available to help control mild acid reflux symptoms. The most common OTC drugs are antacids, which can help neutralize the acid content in the stomach and esophagus. Antacids may offer temporary relief of mild reflux symptoms.
Prescription medications may be required to treat moderate to severe GERD and LPR. The most common prescription drugs are H2 receptor antagonists (H2 blockers) and proton pump inhibitors (PPIs). These medications are highly effective at reducing the amount of stomach acid and may be required to heal a damaged throat or esophagus. Although some are available without a prescription, they can cause numerous side effects and are best taken under the supervision of a physician for short periods of time.
Alginate therapy is a safe and all-natural alternative to help manage acid reflux and its symptoms. It not only relieves the uncomfortable and painful symptoms of GERD and LPR but also helps prevent reflux from ever occurring. Alginates have been used safely as supplements in the food industry for over 100 years and have no known side effects. Alginates are safe for use in children and pregnant women. Just 2 teaspoons taken by mouth will form a protective coating on the throat and esophagus. Once in the stomach, the alginate forms a protective raft and an “esophageal cork” to prevent regurgitation. Reflux Gourmet’s Mint Chocolate Rescue harnesses the power of alginate therapy to provide an all-natural solution to reflux.
If reflux cannot be adequately controlled with medical or all-natural alginate therapy, surgery may be considered. The gold standard surgical treatment for GERD and LPR is a laparoscopic Nissen fundoplication. This surgery is performed through the abdomen with cameras and usually requires a one or two-night stay in the hospital. The surgery involves wrapping the stomach around the lower end of the esophagus to bolster (strengthen) the lower esophageal sphincter. If there is a hiatal hernia present, it is reduced (repaired) at the same time as the fundoplication. Less invasive endoscopic procedures are available such as Stretta and transoral incision-less fundoplication (TIF).
These procedures are performed entirely through the mouth without the need for any external incisions. In general, these endoscopic procedures are reserved for persons with mild reflux and no hiatal hernia. These procedures are best performed by an experienced surgeon as they are not without potential complications.