What is GERD?
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, 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”–the esophagus.
When stomach acid touches the sensitive tissue lining the esophagus and throat, it causes a reaction similar to squirting lemon juice in your eye. This is why GERD is often characterized by the burning sensation known as heartburn.
In some cases, reflux can be silent, with no heartburn or other symptoms until a problem arises. Almost all individuals have experienced reflux (GER), but the disease (GERD) occurs when reflux happens often over a long period of time.
What is LPR?
During gastroesophageal reflux, the contents of the stomach and upper digestive tract may reflux all the way up the esophagus, beyond the upper esophageal sphincter (a ring of muscle at the top of the esophagus), and into the back of the throat and possibly the back of the nasal airway. This is known as laryngopharyngeal reflux (LPR), which can affect anyone. Adults with LPR often complain that the back of their throat has a bitter taste, a sensation of burning or something is “stuck”. Some patients have hoarseness, difficulty swallowing, the need for 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. Many patients with LPR do not experience heartburn.
In infants and children, LPR may cause breathing problems such as cough, hoarseness, stridor (noisy breathing), croup, asthma, sleep-disordered breathing, feeding difficulty (spitting up), turning blue (cyanosis), pauses in breathing (apnea) and even a severe deficiency in growth. Proper treatment by the physicians at OOA for childhood LPR is critical.
What are the symptoms of GERD and LPR?
The symptoms of GERD may include persistent heartburn, acid regurgitation, nausea, hoarseness in the morning, or trouble swallowing. Some people have GERD without heartburn. Instead, they experience pain in the chest that can be severe enough to mimic the pain of a heart attack. GERD can also cause a dry cough and bad breath.
While GERD and LPR may occur together, patients can also have GERD alone, without LPR or LPR alone, without GERD. If you experience any symptoms on a regular basis (twice a week or more), then you may have GERD or LPR. For proper diagnosis and treatment, you should be evaluated by your primary care doctor or the physicians at OOA.
Who gets GERD or LPR?
Women, men, infants and children can all have GERD or LPR. These disorders may result from physical causes or lifestyle factors. Physical causes can include a malfunctioning or abnormal lower esophageal sphincter muscle (LES), hiatal hernia, abnormal esophageal contractions and slow emptying of the stomach. Lifestyle factors include diet which includes chocolate, citrus, fatty foods and certain spices, destructive habits such as overeating and alcohol and tobacco abuse. Young children experience GERD and LPR due to the developmental immaturity of both the upper and lower esophageal sphincters. It should also be noted that some patients are just more susceptible to injury from reflux than others. The same amount of refluxed material in one patient may cause very different symptoms in other patients.
Unfortunately, GERD and LPR are often overlooked in infants and children, leading to repeated vomiting, coughing in GERD and airway and respiratory problems in LPR, such as sore throat and ear infections. Most infants grow out of GERD or LPR by the end of their first year, but the problems that resulted from the GERD or LPR may persist.
What role does an ear, nose, and throat specialist have in treating GERD and LPR?
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. These problems require an otolaryngologist—head and neck surgeon, who has extensive experience with the tools that diagnose GERD and LPR. The physicians at OOA treat many of the complications of GERD and LPR, including: sinus and ear infections, throat and laryngeal inflammation and lesions, as well as a change in the esophageal lining called Barrett’s esophagus, a serious complication that can lead to cancer.
How are GERD and LPR diagnosed and treated?
GERD and LPR can be diagnosed or evaluated by a physical examination and the patient’s response to a trial of treatments with medication. Other tests that may be needed include an endoscopic examination (a long tube with a camera inserted into the nose, throat, windpipe, or esophagus), biopsy, x-ray, examination of the esophagus, 24 hour pH probe with or without impedance testing, esophageal motility testing (manometry), and emptying studies of the stomach. Endoscopic examination, biopsy, and x-ray may be performed as an outpatient or in a hospital setting. Endoscopic examinations can often be performed in your ENT’s office, or may require some form of sedation and occasionally anesthesia.
Adult lifestyle changes to prevent GERD and LPR
• Avoid eating and drinking within two to three hours prior to bedtime
• Do not drink alcohol
• Eat small meals and slowly
• Limit problem foods such as Caffeine – Carbonated drinks – Chocolate –Peppermint – Tomato – Citrus fruits – Fatty and fried foods
• Lose weight
• Quit smoking
• Wear loose clothing