Reflux describes the movement of stomach acid contents to the esophagus or throat. The stomach produces acid to help in digestion of food particles. However, when the acid refluxes, or travels “backwards” from the stomach to the esophagus or throat it can produce of a number of symptoms.

GERD, or gastro-esophageal reflux disease, occurs when acid in the esophagus causes symptoms such as heartburn or chest pain. When acid reflux contents reach the mouth they may cause the waterbrash or acidic or metallic tastes in the mouth.

Reflux in the throat is often termed laryngopharyngeal reflux. Laryngopharyngeal reflux can cause symptoms such as:

• Voice changes
• Hoarseness
• Lump in the throat sensation
• Difficulty swallowing
• Cough
• Throat pain

Laryngopharyngeal reflux can occur without any of the “typical” gastroesophageal reflux disease (GERD) symptoms. In other words patients may not have heartburn, chest tightness, or burping and still have laryngopharyngeal reflux..

Because of this laryngopharyngeal reflux is often called SILENT REFLUX.

Laryngopharyngeal reflux diagnosis is supported by findings on a questionnaire known as the reflux symptom index. This scale has been shown to correlate with reflux disease

Reflux symptom index: Rate from 0-5 0 = no problem, 5 = severe problem.

Hoarseness or a problem with your voice? 0 1 2 3 4 5
Clearing your throat?
Excess throat mucus or postnasal drip?
Difficulty swallowing food, liquids or pills?
Coughing after you ate or lie down?
Breathing difficulties or choking episodes?
Troublesome or annoying cough?
Sensations of something sticking in your throat
or a lump in your throat?
Heartburn, chest pain, indigestion, or stomach acid
coming up?

Physicians may also diagnose laryngopharyngeal reflux with laryngoscopy. Certain features on laryngoscopy have been shown to correlate with laryngopharyngeal reflux – this scale is known as the reflux finding score.

Treatment

Treatment of reflux starts with diet and behavior. Much of the “modern” diet contains acidic foods – with life on the go, many people dine out, eating everything from fine dining to fast food. Soda is consumed more today than at any other time. All of these are sources of acidic foods.

Dietary changes include elimination of:

• Alcohol
• Soft drink and carbonated beverages
• Coffee
• Fruit Juices
• Onion
• Garlic
• Tomato
• Spicy foods

Behavioral modifications include weight loss, as increased weight has been related to reflux.

To prevent reflux after meals, it is important to wait at least 3 hours after eating before laying down. This means for many patients moving up the time dinner is normally eaten. Sleeping at an incline has also been shown to be beneficial – this is facilitated by propping the head of the bed up on blocks.

Medications are also an important part of reflux management. Proton pump inhibitors decrease the amount of acid production in the stomach.

H2 blockers, or histamine receptor blockers, also help in the management of acid reflux.

Surgical management of reflux disease is based on tightening the valve between the esophagus and stomach. This procedure, a Nissen fundoplication, is performed by general surgeons.