Gastro-esophageal reflux disease, also known as reflux or GERD, is the medical term for stomach acid washing up into the esophagus and sometimes all the way up into the throat. The acid is irritating and can lead to symptoms such as:
- Cough/Asthma symptoms (shortness of breath, wheezing, chest tightness)
- Hoarseness or sore throat
- A “lump in the throat” or a sensation of “something hung in the throat”
- Throat clearing or post nasal drip
- Trouble swallowing or a choking sensation
- Sour or acidic taste in the mouth
How does stomach acid cause throat symptoms?
The esophagus, or feeding tube, begins in your throat and ends at your stomach. At each end of this tube, a muscle called a sphincter, acts as a “clamp” to keep stomach acid from “refluxing” back up the tube and into the throat and mouth. If the sphincter between the esophagus and the stomach does not work well, acid can back up into the esophagus. This may or may not cause heartburn or indigestion. If the sphincter between the esophagus and the throat, does not work well either, acid can travel all the way into the throat.
The tissue in the throat and around the vocal cords is highly sensitive. Therefore acids will cause swelling and inflammation in this area more easily than in the esophagus or stomach. Thus, a person can have throat symptoms long before symptoms are felt in the esophagus or stomach.
How do I know if Reflux is causing my symptoms?
Your otolaryngologist (ENT doctor) will perform a detailed history and physical exam in order to determine if you have reflux disease. He/she may also evaluate your throat/vocal cords with a special mirror or a small flexible scope. If you are having any type of asthma/cough symptoms, you may be asked to do a breathing test called a pulmonary function test (PFT).
Other tests, such as barium swallow or a pH evaluation can be done outside the office to evaluate for GERD. During a barium swallow, you will be asked to drink a dye or contrast while several x-rays are taken. The x-rays monitor the dye as it moves down your esophagus. A pH evaluation is done by placing a small probe into your esophagus that can measure acid levels. The probe stays in place for 24 hours and measures the amount of acid washing up into the throat.
How is Reflux treated?
Reflux disease can be effectively treated in most patients with a combination of dietary and/or lifestyle changes and medications.
Dietary changes
Certain foods tend to increase symptoms of reflux symptoms and should be AVOIDED. These include:
- High fat foods/fried foods
- Milk based foods
- Alcohol
- Chocolate
- Spicy or citrus foods
- Caffeine
- “Fizzy” beverages
- Peppermint
Most important: You should not eat for 3-4 hours before lying down or going to bed in the evening.
Snacking after dinner should be avoided.
Raise your head
One of the most important measures for controlling reflux is elevating the head of your bed by 6-8 inches. This is because reflux usually occurs at night when you are sleeping. When you are lying flat, there is added pressure on your stomach and you do not have the benefit of gravity to keep stomach acids down. It is very easy for acids to travel up the esophagus into the throat area. Raising your head helps prevent nighttime reflux.
You can either place a foam wedge under the head of the mattress or place a wooden block under the head of the bed frame. Do not simply raise your head with pillows; this may make reflux worse?
Other measures that help to control reflux include:
- Weight loss if necessary. Many people notice an improvement in their reflux with just a modest weight loss (10 pounds).
- Avoid tight fitting clothes that squeeze your mid-section.
- Establish an exercise routine of 30 minutes three to four times per week, BUT do not exercise right before bedtime.
- Avoid aspirin, anti-inflammatories (ibuprofen) or any other medications that irritate your stomach.
Stop smoking? Definitely
Smoking increases the amount of acid produced by the stomach. Quitting smoking will help significantly to control GERD.
What prescription medications can be used?
Some patients need medication to control their reflux. Medications may work to neutralize stomach acid (antacids), reduce stomach acid secretion (H2 Blockers) or block stomach acid production (proton pump inhibitors). Other medications may be used to strengthen the sphincters and/or help with stomach emptying.
The medications chosen for you will depend on your specific symptoms. You should always take your medication exactly as directed by your health care provider. Taking these types of medications incorrectly can drastically reduce their effectiveness.