Gastroesophageal Reflux With Laryngopharyngeal Reflux

What Is Gastroesophageal Reflux With Laryngopharyngeal Reflux Disease?

You might have heard of acid reflux, which is a widely prevalent problem. When the acidic contents of the stomach travel back and reach up to your esophagus, it is called acid reflux. This is because the sphincter muscles, which should prevent the contents from entering the esophagus, do not work the way they should. Acid reflux is not always associated with symptoms of heartburn, such as burning sensation in the throat and chest pain. But it is also associated with chronic disease conditions like gastroesophageal reflux and laryngopharyngeal reflux disease.

When acid reflux occurs frequently and the stomach contents reach the esophagus, it is called gastroesophageal reflux disease (GERD). And if the acidic contents reach up the voice box (larynx) and throat (pharynx), it is called laryngopharyngeal reflux (LPR).

What Is the Prevalence Rate of Both GERD and LPR?

Comparatively, GERD is more common than LPR in adults, with about 20% of individuals suffering from GERD in the United States. On the contrary, LPR is common in infants because of two reasons:

• Infants spend more time lying down.

• Not fully developed stomach muscles.

What Are the Symptoms of GERD and LPR?

When you have symptoms twice or more than that in a week, it is a problem of concern that needs medical help. Although both GERD and LPR occur together, not all experience symptoms of both. In a few adults, symptoms of either GERD or LPR only occur. The following are the symptoms in adults:

• Burping or belching.

• Heartburn.

• Cough.

• Regurgitation of stomach contents into the esophagus.

• Presence of excess mucus.

• Frequent clearing up of throat.

• Sore throat or burning sensation in the throat.

• Bitter taste.

• Feeling of a lump in the throat.

• Hoarseness of voice.

• Difficulty in swallowing.

• Post-nasal drip.

• Difficulty in breathing.

• Difficulty in swallowing.

• Episodes of choking that can wake you from sleep.

In infants and children, the following are the symptoms:

• Cough

• Hoarseness.

• Asthma.

• Noisy breathing.

• Difficulty in feeding.

• Cyanosis or turning blue.

• Snoring.

• Apnea or experiencing pauses in breathing.

• In distress, there is arching of the back, which is a life-threatening condition.

• Difficulty in gaining weight or growth.

Can GERD and LPR Occur Together?

Both GERD and LPR can occur together, but these can also occur separately. It is believed by some that LPR itself is a symptom of GERD. However, few believe it to be two different problems.

Having the symptoms of GERD with no LPR symptoms is possible. Similarly, the converse is true. LPR symptoms can also occur without any heartburn.

What Are the Causes of GERD and LPR?

Both physical causes and lifestyle factors contribute to GERD and LPR.

Physical Causes:

• The lower end of the esophagus, which meets the stomach, has abnormal or weak muscles.

• Hiatal hernia.

• Slow emptying of the stomach.

• Abnormal esophageal spasms.

Lifestyle Factors:

• Pregnancy.

• Eating foods like citrus fruits, spicy foods, chocolate, fatty foods, etc.

• A habit of overeating.

• Eating late.

• Lying down soon after eating.

• Alcohol and tobacco use.

What Increases the Risk of GERD and LPR?

Both GERD and LPR are common conditions that can occur in an otherwise healthy individual. Some risk factors increase the chance of developing GERD and LPR. These share similar risk factors, which includes the following:

• Smoking.

• Alcohol.

• Obesity.

• Pregnancy.

• Overeating.

In addition to the above factors, GERD has another risk factor which includes taking some medications that can trigger the disease.

How Are GERD and LPR Diagnosed?

Diagnosis is usually made by a primary care physician. The symptoms, their time of occurrence, medical history, and intake of medications usually help in the diagnosis. For diagnosing GERD and LPR, there is no need for special diagnostic tests. However, the scarring or damage caused by these conditions can be checked by endoscopy. Endoscopy is a procedure in which a thin, flexible tube with a light and camera is inserted into the throat to reach the stomach through the esophagus. The camera attached helps in taking images that helps in diagnosis and planning the treatment.

Ambulatory acid probe test is another test that measures the following:

• The number of times the acid comes up into the esophagus.

• Amount of acid present.

• Duration of acid stays in the stomach.

In this test, a monitor placed on the esophagus measures the values. The monitor is attached to the computer that you can wear.

For GERD, treatment with a gastroenterologist may be needed, and referral to an otolaryngologist, also called ENT doctor, may be required for LPR.

What Is the Treatment for GERD and LPR?

Since GERD and LPR occur due to acid traveling up into the esophagus, treatment is almost similar for both conditions.

The treatment includes lifestyle modifications and medications.

Lifestyle Modifications:

• Limit the intake of fatty foods, spicy foods, and acidic foods.

• In obese people, losing weight is recommended.

• Avoid caffeine intake.

• Avoid the intake of alcohol.

• Avoid smoking.

Medications:

1. Antacids are recommended to provide immediate relief to heartburn. However, it does not prevent the occurrence of future heartburns or heal the damage caused.

2. Histamine-2 receptor blockers provide relief by reducing the acid production in the stomach. Instant relief cannot be obtained by these drugs.

3. Proton pump inhibitors are much more effective than H2 receptor antagonists. These also act by reducing acid production and also heal the damage caused by acid reflux.

When the above over-the-counter medications do not provide relief, strong versions of these medications may be prescribed.

If the medications are of no help, then surgical corrections are recommended. Surgery for GERD and LPR aims at preventing acid reflux by strengthening the sphincter muscles.

How Can We Prevent GERD and LPR?

GERD and LPR can be prevented by:

• Avoiding acidic, spicy, and fatty foods.

• Avoiding alcohol and tobacco.

• Avoiding the intake of caffeine.

• Avoiding mint or mint-flavored foods.

• Avoiding chocolate.

• Managing stress.

• Eating at least two hours before bedtime.

• Avoiding tight clothing.

• Maintaining a healthy body weight.

Conclusion:

Acid reflux is the cause of both gastroesophageal reflux disease and laryngopharyngeal reflux disease. Lifestyle modifications and some over-the-counter medications help in managing these conditions by reducing the production of acid. When you experience symptoms, it is advisable to reach out to your healthcare professional to get yourself treated.