VOICE, LARYNX & SWALLOWING
Reflux & the Throat
Reflux occurs when acid and digestive enzymes from the stomach pass back up the oesophagus. Symptoms of heartburn are well-known. Less well-known, is the fact that reflux may lead to throat and larynx (voice box) problems, even in the absence of typical heartburn symptoms. Reflux gets more common as you get older, if you put on weight or if you have a weak sphincter at the top of the stomach (a hiatus hernia).
Laryngopharyngeal reflux (LPR) is different to Gastro-Oesophageal Reflux Disease (GORD), although the two conditions may overlap. Your throat and larynx are even more vulnerable to reflux damage than your oesophagus. LPR is a common and important cause of throat problems, even for patients who do not experience symptoms of heartburn.
How could reflux affect my throat?
If the throat and larynx are exposed to reflux on an ongoing basis, it can cause symptoms like:
- Persistent sore throat
- Hoarseness (which may be intermittent)
- Globus sensation (feeling of a lump in the throat)
- Throat Clearing and feeling that there is extra mucus
- Swallowing difficulties “effortful swallowing”
- Chronic cough
How is reflux diagnosed?
If you are referred to Dr McGuinness with any of these symptoms, your consultation will most likely include a flexible laryngoscopy. Laryngoscopy allows Dr McGuinness to view your throat and larynx and assess for signs of reflux. Laryngoscopy is also helps to exclude other conditions that may be causing your symptoms.
Other investigation that may be recommended include:
- Gastroscopy (endoscopy of the oesophagus and stomach)
- XR examinations – Either a barium swallow (an x-ray with contrast that shows your oesophagus) or video fluoroscopy a video examination of your swallowing
- H Pylori testing – A common stomach infection that may cause reflux
- 24hr pH measurement and manometry (a test to measure acid levels in your oesophagus).
How is reflux treated?
Reflux is generally treated with proton pump inhibitors (PPIs), like omeprazole. PPIs are safe, and don’t usually cause significant side-effects. LPR symptoms may take time respond to treatment. After a 12-week course of PPI therapy, Dr McGuinness will see you for a follow-up appointment to assess your treatment response.
As well as medications like PPIs it is important to recognize that our diet and lifestyles may be causing reflux. Lifestyle modifications are necessary if reflux is to be managed effectively.
Diet
This is one of the most important changes you can make.
Anti Reflux Diet
| FOODS TO AVOID | FOODS THAT HELP |
|---|---|
| Fried Foods | Whole grains- oatmeal, couscous and brown rice |
| Most fast foods incl Pizza, Curries | Root veggies - sweet potatoes, carrots and beets |
| Potato Chips and processed snacks | Green veggies- asparagus, broccoli and green beans |
| Chilli Powder and Spicy Foods | Bananas |
| Fatty and Processed Meats eg bacon | Melons |
| Cheese | Cauliflower |
| Tomato based sauces | Fennel |
| Citrus Fruits | Nuts |
| Chocolate | Celery |
| Fizzy Drinks (they contain carbonic acid) | Cucumber |
| Alcohol | Lettuce |
| Coffee and caffeine | Watermelon, Broth-based soups, Herbal tea |
Other things that help
- Maintain a healthy weight
- Giving up smoking
- Last meal three hours before bedtime
- Elevating the head of the bed
- Avoiding tight clothing
Other symptom treatments
- Gaviscon Dual Strength – used 30 minutes before meals and sparingly through the day
- Alkaline Water – available in supermarkets
Is reflux bad for my health?
Ongoing reflux is not good for your oesophagus or throat.
Chronic reflux can cause ongoing inflammation of the oesophagus and may increase your risk of developing cancer of the oesophagus. Reflux can lead to a narrowing of the oesophagus known as a stricture.
If untreated, LPR can cause ongoing throat and voice symptoms. LPR increases your risk of developing benign vocal cord growths, like polyps and granulomas. Swelling around your vocal cords may cause chronic laryngitis. There may also be a correlation between LPR and laryngeal cancer.
Reflux is one of the most common causes of throat and larynx symptoms and yet few people would consider it. However, there are more concerning causes so If you are suffering from an ongoing sore throat, hoarseness that comes and goes, or a feeling of a lump in your throat, it is important that you receive the correct diagnosis and treatment. You can request a specialist referral from your GP. Dr McGuinness would be happy to assist you with an appointment.