Laryngopharyngeal reflux: the silent killer

Have you ever experienced hoarseness, post nasal drip, chronic throat clearing, frequent sore throats, regurgitation of sour material, having the sensation there is a lump in your throat (also known as globus sensation), frequent belching, and/or heartburn? If you have, you most likely either had an episode or suffer from acid reflux.

Laryngopharyngeal reflux (LPR) is similar to gastroesophageal reflux (GERD). Both result from gastric juices that come into the esophagus and throat. The difference between LPR and GERD are the symptoms. With GERD, you may experience typical signs of reflux mentioned previously, but in LPR, the symptoms are silent which is why LPR is commonly known as "silent reflux."

At the end of your esophagus is the cardiac sphincter which normally keeps your contents in your stomach, where they belong. In LPR (and GERD), the cardiac sphincter does not close tight enough allowing the highly acidic gastric juices to enter into your pharynx or larynx. This acidic juice can cause edema of the vocal cords (arytenoids and interarytenoids) leading to hoarseness and the ever so wonderful, post nasal drip and chronic throat clearing.

What becomes an issue is the way we are told to treat reflux. We are told if we have signs of reflux to take proton pump inhibitors (PPIs) such as Omeprazole to reduce the suppression of acid. The stomach contains a gastric acid pump which produces stomach acid to aid in the digestion of food. PPIs work by binding to and blocking the pump decreasing the amount of acid produced by the stomach (Simpson 2008). While the medication works to suppress the acid, it is only putting a band-aid on the anatomical and underlying problem. The issue is not just production of acid, the issue is the inadequacy of the cardiac sphincter to properly do its job--keep stomach contents where they belong.

LPR has been called the silent killer. Reflux can lead to a condition called Barrett's esophagus which is where acid causes the stratified squamous epithelia of the esophagus to be replaced by simple columnar epithelia containing goblet cells (this makes me cringe). Barrett's esophagus is a premalignant condition and if left untreated, could lead to malignant esophageal adenocarcinoma with an 85% mortality rate (ASGE 2013).

What many physicians propose are lifestyle recommendations to reduce the amount of acid that comes into your esophagus. These recommendations include not eating or drinking 3 hours before bedtime, sleeping with your head elevated 4-6 inches, limiting the amount of fatty and spicy foods in your diet, if you're over weight, lose weight, avoid alcohol, caffeine and mints, and take your antacid prescribed by your physician 30 minutes before breakfast or 30 minutes before bedtime (Simpson 2008).

Research has shown that elevating your head while sleeping actually improves the function of your cardiac sphincter therefor reducing the amount of acid coming into your esophagus (Hoppo et al 2012).

Coming from someone who was diagnosed with moderate acid reflux, I never though this was something to be too concerned with, but after this blog, I think I will start regularly taking my prescribed antacid.  

References:
Hoppo T, Komatsu Y, Nieponice A, Schrenker J, Jobe BA. Jul 2012. Toward an improved understanding of isolated upright reflux: positional effects on the lower esophageal sphincter in patients with symptoms of gastroesophageal reflux. Division of Thoracic and Foregut Surgery. 36(7):1623-31

GERD, Barrett's Esophagus and the Risk for Esophageal Cancer. 2013. American Society for Gastrointestinal Endoscopy (ASEG). Available at: http://www.asge.org/patients/patients.aspx?id=402 

Simpson CB. 2008. Laryngopharyngeal Reflux Disease (LPR). UT Health Science Center. Otolaryngology Head and Neck Surgery. Available at: http://www.uthscsa.edu/oto/lpr.asp