This can occur if the stomach acid comes all the way up into the back of the throat or nasal airway. This condition is often referred to as laryngopharyngeal reflux (LPR).
Simply sleeping on extra pillows does not help since it flexes the stomach and could actually worsen reflux. If the entire bed is tilted upwards, gravity reduces the backflow of acid. Meals should be eaten at least two hours before bedtime. Food in the stomach stimulates the production of acid.
Various symptoms, functional and structural abnormalities that involve the larynx, and other contiguous structures positioned proximal to the esophagus constitute the spectrum of these disorders. Patients presenting with extraesophageal reflux-related signs and symptoms may account for up to 10% of an otolaryngologist’s practice. Barium esophagography and laryngoscopy are among the procedures used in determining the presence of reflux, with proton pump inhibitors (PPIs) being the mainstay of treatment for laryngopharyngeal reflux (LPR).
Individuals with persistent throat symptoms, such as hoarseness, frequent throat clearing, or coughing should seek medical attention. The feeling that there is something stuck in the throat, a globus sensation, is a classic symptom of LPR.
A new medical device (MarialÂ®), unique still now possessing the indication for both GERD and LPR, has been recently launched in the Italian market . It is an innovative gel compound, containing magnesium alginate and E-GastryalÂ®. E-GastryalÂ® is a complex of phyto-polymers, keratin, Tara and Xantana gums, that are natural polysaccharides with high molecular weight and partially hydrosoluble, and able to provide viscosity to the solution and to generate a support frame where keratin peptide chains and hyaluronic acid anchor.
The diagnostic work-up of patients presenting with symptoms of laryngopharyngeal reflux begins with a thorough history and a meticulous physical examination. Patients with laryngopharyngeal reflux present with symptoms related to the upper aerodigestive tract (Table 1) .
The apparent advantage of operative therapy is that it corrects the antireflux barrier at the gastroesophageal junction and prevents the reflux of most stomach contents, thus preventing acid and nonacidic material from coming in contact with the pharyngolaryngeal mucosa. Candidates for antireflux surgery are often patients who require continuous or increasing doses of medication to maintain their response to acid suppressive therapy.
Similar effects were demonstrated after ingestion of white wine and beer in patients with endoscopic evidence of reflux esophagitis and abnormal pH study [Pehl et al. 2006]. Few data are available for voluptuary habits such as cigarettes smoking and alcohol consumption. Smokers have an increased incidence of reflux symptoms compared with nonsmokers [Talley et al. 1994; Watanabe et al. 2003]. Nilsson and colleagues [Nilsson et al. 2004] revealed, in a multivariate analysis, that among individuals who had smoked daily for more than 20 years, the risk of reflux was significantly increased by 70%, compared with those who had smoked daily for less than a year (OR 1.7; 95% CI 1.5-1.9). A relation has been considered between smoking cigarettes and a prolonged acid exposure, a decrease in LES pressure, and diminished salivation, which decreases the rate of esophageal acid clearance [Kahrilas and Gupta, 1989].
When the lower esophageal sphincter is weakened, it allows the contents of the stomach to come up into the esophagus. There are other ways to find out whether a cough is related to GERD. Your doctor may try putting you on proton pump inhibitors (PPIs), a type of medication for GERD, for a period of time to see if symptoms resolve. PPIs include brand name medications such as Nexium, Prevacid, and Prilosec, among others.
What is acid
Other diagnoses should be entertained, while the drug is tapered to prevent rebound acid reflux. GERD has also been implicated in the development of leukoplakia and squamous cell carcinoma of the true vocal cords.3, 10, 11 Leukoplakia, defined as the presence of a whitish plaque on a mucosal surface, in itself does not carry any diagnostic implications. However, in the presence of GERD, leukoplakia is considered to be precancerous.
Can you experience LPR without any heartburn or other GERD symptoms? Yes!
Natural history of gastro-oesophageal reflux disease diagnosed in general practice . Double-blind, placebo-controlled trial with esomeprazole for symptoms and signs associated with laryngopharyngeal reflux . Different effects of white and red wine on lower esophageal sphincter pressure and gastroesophageal reflux . Clinical and pathologic response of Barrettâ€™s esophagus to laparoscopic antireflux surgery .
Weight loss has an independent beneficial effect on symptoms of gastro-oesophageal reflux in patients who are overweight . Abnormal lower esophageal sphincter pressure responses in patients with orange juice-induced heartburn . Respiratory physiotherapy can increase lower esophageal sphincter pressure in GERD patients .
Therefore, alginate has the special properties of protection of the esophageal and upper respiratory mucosa from acid and non-acid reflux and displacement of acid pocket away from the esophagus, all of which make alginate an attractive agent in the management of refractory reflux symptoms with a cause other than by acid, such as NERD . Compared with placebo, an alginate-antacid formulation demonstrated superior relief of reflux symptoms including heartburn and regurgitation in both patients with NERD and erosive esophagitis in a double-blind randomized controlled trial . In another double-blind randomized clinical trial comparing the efficacy of alginate to omeprazole in patients with NERD, alginate demonstrated non-inferiority to omeprazole and was as effective as omeprazole for symptomatic relief . Furthermore, adding alginate to a PPI can significantly relieve heartburn compared to using a PPI alone in patients with NERD, suggesting an additional benefit of alginate as add-on therapy in the management of refractory symptoms .