Gastroesophageal reflux disease, often referred to as GERD, occurs when acid from the stomach backs up into the esophagus. Normally, food travels from the mouth, down through the esophagus and into the stomach. A ring of muscle at the bottom of the esophagus, known as the lower esophageal sphincter (LES), contracts to keep the acidic contents of the stomach from “refluxing” or coming back up into the esophagus. In those who have GERD, the LES does not close properly, allowing acid and other contents of the digestive tract to move up – to “reflux” – into the esophagus.
When stomach acid touches the sensitive tissue lining the esophagus and throat, it creates irritation. GERD is often characterized by the burning sensation known as heartburn. A gastroenterologist, a specialist in treating gastrointestinal orders, will often provide initial treatment for GERD.
But there are ear, nose and throat problems that are caused by reflux reaching beyond the esophagus, such as hoarseness, laryngeal nodules in singers, croup, airway stenosis (narrowing), swallowing difficulties, throat pain, and sinus infections. During gastroesophageal reflux, the contents of the stomach and upper digestive tract may reflux all the way up the esophagus and into the back of the throat, and possibly, the back of the nasal airway. This is known as laryngopharyngeal reflux or LPR.
Adults with LPR often complain that the back of their throat has a bitter taste, a sensation of burning or something “stuck.” Some patients have hoarseness, difficulty swallowing, throat clearing and difficulty with the sensation of drainage from the back of the nose (“postnasal drip”). Some may have difficulty breathing if the voice box is affected.
These problems require specialists, like our doctors at the Rontal Akevall Clinic, who have extensive experience with the procedures that diagnose LPR. Our physicians also treat many of the complications of LPR, including inflammation of the voice box and throat and even secondary inflammation of the nose.
GERD and LPR can be diagnosed or evaluated by a complete history and physical examination. Other tests that may be considered include an endoscopic examination (a long tube with a camera inserted into the nose, throat or esophagus), biopsy, x-ray and examination of the esophagus. Endoscopic examination of the nose and throat is an in-office procedure performed with local anesthetic. Gastroenterologists most often do endoscopic examination of the esophagus.
Most people with GERD or LPR respond favorably to a combination of lifestyle changes and medication. Medications that may be prescribed include antacids, histamine antagonists, proton pump inhibitors, pro-motility drugs and foam barrier medications. Some of these products are now available over the counter and do not require a prescription.
Children and adults who fail medical treatment or have anatomical abnormalities may require surgical intervention. Such treatment includes fundoplication, a procedure where a part of the stomach is wrapped around the lower esophagus to tighten the LES, and endoscopy, where stitches or a laser are used to make the LES tighter.