Reflux Laryngitis
And
Gastroesophageal Reflux
Why does reflux occur?
Reflux is caused by a weakness in the muscle at the junction of the esophagus (food tube) with the stomach. Normally, this muscular valve, or sphincter, functions to keep food and stomach acid from moving upward from the stomach to the esophagus and larynx. This valve opens to allow food to go down to the stomach and closes to keep the stomach's contents from coming back up. The backward movement of stomach contents (gastric contents) up into the esophagus is referred to as gastroesophageal reflux. In addition, any increase in abdominal pressure ( obesity ) which can push acid back from the stomach up the esophagus, or any patient with a hiatal hernia , will have an increased risk for reflux. When it causes symptoms, it is referred to as gastroesophageal reflux disease (or GERD). When the acid backs up into the voice box (larynx), the condition is referred to as reflux laryngitis.
Stomach acid can cause an irritation of the lining of the esophagus, larynx and throat. This can lead to erosion of the lining of the esophagus (erosive esophagitis), narrowing of the esophagus (stricture), chronic hoarseness , chronic throat clearing, difficulty swallowing, foreign body sensation, asthma or cough, spasms of the vocal cords, sinusitis , and growths on the vocal cords (granulomas). Rarely, reflux can lead to cancer of the esophagus and larynx.
What are the typical symptoms of reflux laryngitis and gastroesophageal reflux?
Heartburn is the most common symptom associated with reflux. However, almost 33% of patients with reflux will not have the typical heartburn symptom. Approximately 40% of the US population experiences heartburn at least monthly, and about 10% experience it daily. In addition to heartburn, other typical presentations of reflux include non- cardiac chest pain, chronic hoarseness, asthma, or a foreign body sensation in the throat (globus phenomenon).
How are reflux laryngitis and gastroesophageal reflux evaluated?
In most patients, the presumptive diagnosis is based on the typical history of heartburn. Definitive testing is usually reserved for those patients who do not respond to conservative therapy (as explained below) or drug therapy. Diagnostic tests includes an esophagram, endoscopy, pH monitoring, and esophageal motility studies.
What is the conservative therapy of reflux?
- Antacids neutralize stomach acid and give immediate relief. Popular choices include sodium bicarbonate (Alka Seltzer), calcium carbonate (Tums, Rolaids, Alka-Mints), and aluminum and magnesium antacids (Maalox, Mylanta, Riopan, Gavisconl). It is best to use antacids 30 to 60 minutes after each meal and at bedtime. If you need to be on a low sodium diet, you should avoid sodium bicarbonate. Calcium and aluminum can be constipating, while magnesium antacids can cause diarrhea . Patents with kidney disease should avoid magnesium and aluminum antacids. Check with your pharmacist or doctor for any interactions with other medications you may also be taking.
- Try to have your largest meal of the day at noon.
- Give the stomach several hours to empty before you go to bed. Try not to eat after your evening meal, and avoid bedtime snacks.
- Avoid spicy or fried foods, peppermint, citrus, tomatoes, onions, and chocolate, especially if these foods increase symptoms.
- Try eating a diet that is high-protein, high-carbohydrate, and low-fat.
- Avoid lying down after you eat. It is often helpful to elevate the head of your bed with wooden blocks under the bedposts to allow gravity to keep the acid in the stomach. Pillows under the head are of negligible benefit.
- Avoid alcohol, caffeinated beverages, and tobacco.
- Weight loss, if indicated.
- Avoid drugs such as nonsteroidal anti-inflammatory drugs, theophylline , anticholinergics, and calcium channel blockers , if feasible. Before discontinuing any medication, please discuss this with your doctor first.
What types of medications are used to treat reflux?
There are several different types of medications available over the counter or by prescription. The acid-blocking drugs ( famotidine , Pepcid; cimetidine , Tagamet; nizatidine , Axid; ranitidine , Zantac) are known as H2-blockers. These are now available without a prescription. However the dose strength may be inadequate. Consult your pharmacist or doctor about any potential side-effects or drug interactions with any of your other medications. Other valuable medications include: metoclopramide (Reglan), which helps to empty the stomach; or the protein pump inhibitors, such as omeprazole (Prilosec) and lansoprazole (Prevacid). sucralfate (Carafate) is another medication which may help to increase the resistance of the lining tissue of the stomach to acid.
If conservative therapy and medical therapy fail, surgery may be necessary. Traditionally, the fundoplication procedure, which serves to strengthen the muscle valve (lower esophageal sphincter), required significant surgical work and hospital stay. Recently, the surgery has been performed using a viewing tube instrument (endoscopic fundoplication). This has shortened both hospital stay and recovery. - Reflux laryngitis is inflammation of the voice box (larynx) caused by stomach acid backing up into the esophagus.
- Reflux laryngitis can cause chronic hoarseness and be associated with other symptoms of inflammation of the esophagus, such as heartburn.
- Many treatment options are available for reflux disease.
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