Otolaryngology-Head and Neck Surgery
ENT manifestations of GERD have become more commonly recognized or suspected by physicians, although the direct association between symptoms and acid reflux has been difficult to establish. Most patients with suspected supraesophageal GERD do not have the typical symptoms of heartburn and acid regurgitation. Possible mechanisms of GERD-mediated damage to extraesophageal structures include direct-contact damage of mucosal surfaces by acid-pepsin exposure and a vagal reflex arc between the esophagus and the upper aerodigestive tract, triggered by acid reflux. Dual-channel ambulatory pH monitoring is the most sensitive and specific diagnostic test for determining transient reflux episodes, although demonstrating the presences of acid reflux alone does not prove that it is the cause of suspected GERD-relaed signs or symptoms.
Adults with LPR often complain that the back of their throat has a bitter taste, a sensation of burning, or something “stuck.” Some may have difficulty breathing if the voice box is affected. While this test may detect some complications of GERD, including esophagitis and Barrett’s esophagus, only about half the people with acid reflux disease have visible changes to the lining of their esophagus.
If significant weight loss has occurred medical attention should be sought. Recently, the specificity of laryngoscopic findings indicating acid reflux and assessed by the RFS has been challenged. Experience from clinical practice learned that many patients with these laryngeal signs do not respond to antireflux therapy and have no abnormal reflux on oesophageal and hypopharyngeal pH monitoring. A recent study reported that the majority (86%) of 105 healthy volunteers had one or more laryngoscopic findings included in the RFS and some of the signs reached a prevalence of 70%, thereby questioning the diagnostic specificity of laryngoscopic findings thought to indicate GORD.57 In a recent RCT by Vaezi et al, less than 30% of 145 patients with symptomatic suspected “reflux” laryngitis had abnormal pH results on initial pH monitoring and the presence of laryngeal signs or symptoms did not correlate with abnormal baseline pH.58 A need for further studies was highlighted to allow for better characterisation of the ENT patient population with EOR.
Salivary pepsin testing with a noninvasive rapid pepsin lateral flow device (LFD) uses 2 monoclonal antibodies to human pepsin to detect the presence of pepsin in the saliva. The primary premise of this test is that, as a constituent of gastric milieu, salivary pepsin would only be present if a patient has reflux; thus, a positive salivary pepsin test may confirm LPR. Esophageal manometry (muh-NOM-uh-tree) is a test that shows whether your esophagus is working properly. The esophagus is a long, muscular tube that connects your throat to your stomach. Children and adults who fail medical treatment or have anatomical abnormalities may require surgical intervention.
Some people experience GERD without heartburn and instead, have pain in the chest that can be severe to mimic the pain of a heart attack enough, hoarseness in the morning, or trouble swallowing. Others might feel like they have food stuck in their throat, or as if they’re choking. GERD can also cause a dry cough and bad breath.
It is therefore conceivable that even a single reflux episode extending beyond the oesophagus may be sufficient to cause pharyngeal, laryngeal, and respiratory symptoms and signs. A second mechanism responsible for EOR is activation of reflexes involving the airways by reflux of gastric contents into the oesophagus. Some doctors learn about both fields to treat laryngopharyngeal reflux proactively. Usually, those are ENTs, who educate themselves about the stomach and esophagus supplementally. But they are rare.
This allows digestive acid to enter the esophagus and can cause damage over time. Heartburn is the most common symptom of GERD, but other symptoms may include coughing, wheezing, chest pain, hoarseness, difficulty swallowing and frequent throat regurgitation and clearing. – GERD is one of the most common gastrointestinal conditions in the general US population. ENT manifestations of GERD have become more recognized or suspected by physicians commonly, although the direct association between symptoms and acid reflux has been difficult to establish.
When this occurs, an evaluation by an otolaryngologist is recommended. The Ear, Nose & Throat Institute provides exceptional treatment and care for ear, throat and nose disorders including balloon sinuplasty, allergy treatments, sleep apnea and snoring treatment, hearing aids, voice therapy, adenoids and tonsils and so much more.