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What is acid reflux?
Acid reflux refers to backflow of acid and digestive enzymes from the stomach into the oesophagus (food passage), pharynx (throat) and larynx (voice box). This usually occurs when the lower oesophageal sphincter is weak. This sphincter is a muscular valve which prevents backflow of stomach contents. Backflow into the oesophagus is known as gastroesophageal reflux (GERD) and may be accompanied by a burning sensation in the middle of the chest. If acid refluxes all the way to the throat and voice box, it is called laryngopharyngeal reflux (LPR).
What does it do?
 The throat and voice box are not well protected against stomach acid and digestive enzymes. If LPR occurs, these digestive juices can cause injury by digesting the voice box lining. This can induce swelling, excessive phlegm production, proneness to further injury, and muscle tightness around the throat. These events cause hoarseness and other symptoms such as a chronic sore throat and cough, throat clearing, and even the sensation of a lump in the throat. These symptoms may suggest LPR, and if they persist, you should consult your doctor. They’re usually reversible, but if unchecked can result in more permanent injury to the voice box.
How do doctors confirm the diagnosis?
Your doctor or specialist will usually take a detailed history and perform a physical examination. This may include an endoscopic examination of the throat and surrounding areas, during which a small camera is passed to the level of the voice box. It may seem a little scary, but most of the time, there is little discomfort. Your doctor may also discuss additional tests, such as 24-hour pH monitoring. This involves inserting a thin probe through the nose into the throat or oesophagus to measure acid reflux over a 24-hour period. Sometimes an upper GI endoscopy is recommended to examine the oesophagus and stomach with a camera. It may be possible to do this in the clinic.
What can I do about acid reflux?
If acid reflux is suspected, some lifestyle and dietary changes may be required. Achieving ideal weight decreases pressure and strain on the lower oesophageal sphincter and is effective in reducing reflux. Avoiding large meals has a similar effect and it may help to eat smaller, more frequent meals. Not eating and drinking for 3-4 hours before lying down, and elevating the head of the bed with a mattress wedge can be effective, as it uses the effect of gravity to reduce reflux. Certain foods should be avoided including spicy, fried, and “heaty” foods such as chocolates, peanuts, sugary foods and carbonated drinks. Caffeine, nicotine and alcohol are also best avoided.
Your doctor may recommend medication to reduce acid production (e.g. omeprazole), protect the lining of the oesophagus, or promote stomach emptying. Sometimes these medications are taken for several months or more. Surgery to reduce reflux can also help, but is rarely required. |
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