What is reflux?

The escape of acid and other digestive fluids from the stomach into the esophagus (the tube connecting the stomach to the throat) and up into the larynx (voice box).

What causes it?

When normal, healthy individuals eat or drink, swallowing propels food and liquid from the back of the mouth down into the esophagus. Two esophageal sphincters, or valves, open and close in such a way as to allow passage of food into the stomach and prevent it flowing back up the esophagus. Reflux occurs when the acid contents move from the stomach backwards up the esophagus, due to either improper functioning of one or both sphincters (which can be aggravated by a condition known as hiatus hernia) or due to muscular spasms of the esophagus.

Is it called anything else?

When the refluxing acid mainly affects the esophagus it may be called gastroesophageal reflux disease or GERD for short.

When the refluxing acids deposit in the larynx this is known as laryngopharyngeal reflux or LPR.

What are the typical symptoms?

GERD causes irritation and inflammation of the esophagus causing:

• a burning sensation (heartburn)
• burping
• a feeling of pressure in the chest

LPR – acid in the larynx and back of the throat – can cause:

• a choking sensation
• a sensation of something caught in the throat
• sore throat
• frequent coughing and throat clearing
• a sour or bitter taste in the mouth (especially in the morning)
• voice changes
• sometimes, if the reflux is severe, it can cause a non-cancerous growth on the back of the vocal cords called a granuloma

What can I do about it?

• Avoid large meals – it is better to eat little and often. Do not overeat, as filling the stomach can increase reflux.
• Identify which foods aggravate your condition: alcohol, bananas, tomatoes, citrus fruits, dairy products, chocolate, cocoa, greasy foods, peppermint, coffee, tea and drinks containing caffeine may all make your reflux worse. Not everyone reacts to these foods in the same way, so try and identify any that cause you difficulty and see if you can eliminate these.
• Do not lie down for two hours after meals: standing or walking is better than sitting.
• Avoid bedtime snacks.
• If you are overweight, try and lose some weight: many reflux problems are related to obesity. Before undertaking any weight loss programme, consult your doctor.
  
• Stop smoking! As well as causing cancer and voice problems, smoking decreases the efficiency of the sphincter separating the stomach and the esophagus.
• Elevate the head of your bed, using 10 cm blocks. Do not sleep with multiple pillows under your head, as this will increase the pr3essure in your abdomen and cause more reflux. Your bed should not be bent or jack-knifed but should be straight so that your entire body is sleeping at a tilt. This allows gravity to keep digestive juices in your stomach and prevents them from escaping into the lower esophagus.
• Do not sleep face down (on your abdomen) or on your right side, as these two positions may increase reflux.

Medications

Do not start, stop or change medications without first consulting your doctor.

• There are a number of over the counter antacids that help to neutralize stomach acid. These are typically fast acting and designed to treat infrequent symptoms. They can have side effects, particularly for people over 60 years of age. They can also mask other possible problems, such as esophageal ulcers. Unless advised by your doctor, do not take these for extended periods of time. If your problems persist, consult your doctor.
• If necessary, your doctor can prescribe stronger medicines such as proton pump inhibitors. These work by shutting down the ‘pump’ that releases acid into the stomach. They are often used for people who have not responded to other treatments.

References

With grateful thanks to:

Laryngopharyngeal Reflux (LPR) The Voice and Swallowing Institute, New York, USA.

Gastroesophageal Reflux (GER) www.reflux.org

Heartburn www.rowlandspharmacy.co.uk