Gastroesophageal Reflux Disease & Laryngopharygeal Reflux Disease
WHAT IS GASTRO-OESOPHAGEAL REFLUX DISEASE?
- Gastro-oesophageal reflux disease (GORD) occurs when acid from the stomach travels back up the oesophagus. Normally food travels from the mouth, down through the oesophagus and into the stomach. A ring of muscle at the bottom of the oesophagus, known as the lower oesophageal sphincter, contracts to keep the acidic contents of the stomach from refluxing into the oesophagus.
- In patients with GORD, the lower oesophageal sphincter does not close properly. This allows acid and other contents of the digestive tract to move up and reflux into the oesophagus.
- When stomach acid touches the lining of the oesophagus it can cause a burning sensation known as heartburn.
WHAT IS LARYNGOPHARYGEAL REFLUX DISEASE?
- Laryngopharyngeal reflux disease (LPRD) occurs when stomach acid refluxes beyond the oesophageal sphincter, into the back of the throat and possibly the back of the nasal airway.
- Adults with LPRD often do not complain of typical heartburn symptoms, which is why it is often known as “silent reflux”. Instead, they may complain of a dry cough, a hoarse voice, or a feeling of a lump in the back of their throat. Sometimes, they may complain of discomfort in their throat or a bitter taste.
- Rarely breathing difficulties can occur if the voice box is affected.
WHAT ARE THE SYMPTOMS OF REFLUX DISEASE?
Symptoms of GORD include: Heartburn and acid regurgitation, Nausea & Occasional difficulty swallowing
Symptoms of LPRD include: Hoarseness, Sensation of a lump in the throat, Dry cough, Sore throat, Bad breath and Difficulty swallowing.
How are Gastro-oesophageal Reflux Disease and Laryngopharygeal Reflux Disease diagnosed?
Gastro-oesophageal Reflux Disease and Laryngopharygeal Reflux Disease can be diagnosed on history, examination and by the patient’s response to treatment with medication. Additional tests may be undertaken such as a nasal endoscopic examination, though the findings on examination can often be due to non-reflux related causes, and so, are non-specific.
- Increasingly these days, patients may undergo objective testing such as:
- 24 hours Oesophageal +/- Pharyngeal pH & impedance probe testing – which tests for the reflux of liquids up the oesophagus and into the pharynx, and measures the acidity (pH), of those liquids. This test is considered the ‘gold standard’ test for the diagnosis of GORD and LPRD
- Oral salivary pepsin testing – which tests a patient’s saliva for the presence of pepsin, an enzyme only produced and secreted in the stomach. This test can be considered a useful screening test in patients where a diagnosis of LPRD is considered. If the test is positive, the patient is highly likely to have LPRD. If the test is negative, there is a chance it is falsely negative, and if symptoms and suspicion of LPRD persist, referral for the gold standard pH impedance testing
WHAT ARE THE TREATMENT OPTIONS FOR GORD AND LPRD?
- Dietary and lifestyle changes are the mainstay of treatment. Medications are also often used
WHAT DIETARY AND LIFESTYLE CHANGES CAN BE MADE TO IMPROVE GORD AND LPRD?
- Lifestyle Measures:
i.Avoid eating or drinking within 2-3 hours of bedtime
ii.Have your main meal at lunch, instead of dinner
iii.Eat small meals, and eat slowly
iv.Lose weight
v.Wear loose clothing
vi.Stop smoking – if you smoke
vii.Elevate the head of your bed by 10-15 cm – esp. if experiencing heartburn symptoms
2. Dietary Measures:
- Favour Foods
i.Increase the tone of the upper & lower oesophageal sphincter, moderate the secretion of acid & pepsin, and decrease digestion time
i. alkaline foods – e.g. Alkaline water, Apple/Pear/Banana Juice, chamomile tea
ii. proteins – lean meats, fresh fish, egg whites
iii. low-acid – e.g. asparagus, broccoli, mushrooms, cauliflower, green beans, turnip, parsley, tofu.
iv. low-fat – e.g. low-fat cheese, skim milk
v. Steamed or cooked vegetables.
- Limit foods which relax the upper & lower oesophageal sphincter, increase the secretion of acid & pepsin, and increase digestion time and thus potentially increase reflux. Some of them are:
i. Caffeine – e.g. coffee, black tea, energy drinks
ii. Carbonated Drinks
iii. Chocolate
iv. Peppermint
v. Tomato
vi. Fatty and fried foods – e.g. preserved meats, pork & lamb chops,
vii. Alcohol
viii. Raw greens, uncooked vegetables – as these tend to prolong gastric digestion.
ix. Spicy foods
x. Citrus Fruits
xi. Acidic foods.
CONCERNS OR QUESTIONS?
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