According to the studies in the literature, pathological GERD can be found in 30% to 80% of patients with asthma. On the other hand, patients with esophagitis are more likely to have asthma than patients without esophagitis. In the ProGERD study, the occurrence of asthma depended on longer GERD duration and was more prominent in male and older subjects.
LPR frequently begins after an upper respiratory illness. However, some of the symptoms seem to linger after the cold or flu is better. The theory is that there is some reflux of stomach acid into the throat, which irritates the already irritated vocal cords.
Acid controlling medications donâ€™t treat the cause of acid reflux, they just reduce stomach acid. The only way to stop acid reflux completely is to correct the weakness in the LES with reflux surgery.
Stomach fluids contain acids and enzymes that help digest food in the stomach, but cause problems elsewhere in the food pipe [esophagus, throat, and voice box]. Reflux disease can be acid or non-acidic. For Acidic reflux, it is broken down into GERD and LPR.
GOR related cough has two main but not mutually exclusive pathogenetic mechanisms-microaspiration of gastric contents and a vagally mediated oesophageal-tracheobronchial reflex.9 When aspiration predominates, gastrointestinal symptoms are generally prominent and include heartburn, regurgitation, waterbrash, and sour taste; odynophagia, dyspepsia, night sweats, chest pain, and globus sensation may also be present.10 At the level of the extrathoracic airway, recurrent aspiration phenomena may lead to pharyngolaryngeal symptoms such as dysphonia, hoarseness, sore throat, as well as gum inflammation and dental erosion.11 Patients with pulmonary aspiration may report a variety of symptoms including chest pain, dyspnoea, sputum production, and wheeze.12 When GOR related cough is reflex in origin, the gastrointestinal manifestations may be less evident or even absent in up to 75% of cases13,14; cough as the sole presenting symptom of GOR has also been reported.7 A negative clinical history does not rule out GOR as the cause of chronic cough6 since, in some instances, GOR related cough may have no distinctive clinical features.8 However, an association between cough and GOR can be suspected on clinical grounds, most typically when cough is exacerbated by postural changes (especially stooping) or food intake. Most people do not know that acid reflux can also cause voice problems or symptoms in the pharynx (back of throat).
Ask the patient what their day-to-day job is. Many of these patients spend a lot of time on the telephone or are singers. I had 2 patients who were school teachers and had ongoing voice overutilization. The underlying presenting symptoms of heartburn, regurgitation, and indigestion may be the only predictors we have in patients who present with laryngopharyngeal reflux disease-associated symptoms. So, I consider these symptoms when I take a GERD history.
Laryngopharyngeal reflux is a form of gastroesophageal reflux disease (GERD). Laryngopharyngeal reflux happens when stomach acid and other contents of the stomach flow all the way up the esophagus, into the back of the throat and, in some cases, into the back of the nasal passages.
The barium swallow, once the most common test for GERD, is no longer recommended. There is also a small chance of developing cancer in the esophagus or throat due to long-term acid reflux. The following information is intended to help you understand acid reflux and the steps you may take to reduce this problem.
In susceptible patients, this exposure causes mucosal injury, damage to ciliated respiratory epithelium and mucus stasis, which result in a troublesome array of symptoms and signs termed LPR. Acid reflux that causes any respiratory symptoms, including wheezing, excessive mucus or chronic cough, should always be evaluated by a healthcare provider.
This is often done through medication. To diagnose GERD and an associated chronic cough, doctors will take a detailed case history and assess the individual’s symptoms. It can be more difficult to diagnose a chronic cough in those experiencing LPR without heartburn. The second mechanism proposes that reflux moves above the food pipe and causes tiny droplets of stomach acid to land in the voice box or throat. This type of reflux is known as laryngeal pharyngeal reflux (LPR).
Why? In order for refluxed acid to cause heartburn, it has to stay in the esophagus long enough to cause irritation. Also, the esophagus isn’t as sensitive to irritation as the throat is.
Therefore, if the acid passes quickly through the esophagus but pools in the throat, heartburn symptoms will not occur but LPR symptoms will. But what happens when the upper esophageal sphincter doesn’t function correctly either? As with the lower esophageal sphincter, if the upper esophageal sphincter doesn’t function properly, an acid that has back flowed into the esophagus is allowed into the throat and voice box.
Along with the accumulation of mucus can come other throat symptoms such as hoarseness, throat clearing and chronic cough, sore throat, sensation of having something stuck in the throat and trouble swallowing. Acid reflux can also cause a post-nasal drip, which may be related to sinusitis or inflammation of the sinuses. Acid reflux occurs when acidic stomach contents leak up into the esophagus, and it is most commonly associated with symptoms like heartburn. If stomach acid irritates the throat or goes into the lungs, it can cause problems like excessive mucus production and wheezing.
Our bodies are all made slightly different. We all have different weak spots. One person might have strong defenses against the damage of reflux in the throat.
Of new patient referrals to otolaryngologists, 1 in 10 receives a diagnosis of laryngopharyngeal reflux disease. It is believed that anything that refluxes into the larynx is attributable to gastroesophageal reflux disease (GERD), but that’s not the case.