Acid reflux swollen throat

Sore throat and acid reflux: What is the link?

Reducing acid reflux reduces the risk of its complications, too. Often, small lifestyle changes can make a difference.

Home remedies

Some people can prevent sore throat caused by acid reflux by avoiding activities and foods that increase the risk of acid reflux and its complications.

Share on PinterestAvoid alcohol, tobacco, sodas, and acidic drinks.

These include:

  • eating small, frequent meals rather than heavy meals
  • not eating within 2 hours before bedtime
  • maintaining a healthy weight
  • not wearing tight clothes
  • not smoking tobacco
  • avoiding acidic, spicy, and fatty foods, including full-fat milk
  • choosing soy or almond milk instead of dairy
  • avoiding carbonated, caffeinated, or alcoholic drinks
  • avoiding citrus and tomato juices, which can irritate the lining of the food pipe
  • avoiding chocolate
  • not eating mint or mint-flavored foods
  • avoiding stress, as far as possible

Medication

Over-the-counter and prescription medicines can neutralize or reduce stomach acids, which relieves the symptoms of sore throat. Various acid reflux medications are available for purchase online.

Other medications may work by strengthening the muscles that separate the food pipe from the stomach. Strengthening these muscles will help prevent acids from travelling back up into the food pipe.

When to see a doctor

Share on PinterestIf you have difficulty swallowing, you should see a doctor.

A person should see a doctor if they have:

  • a sore throat that lasts longer than a week
  • difficulty swallowing, breathing, or opening the mouth
  • joint pain
  • earache
  • a rash
  • a lump in the neck
  • blood in saliva or phlegm
  • a fever higher than 101°F

The discomfort caused by acid reflux is usually manageable, but if the symptoms interfere with daily life, then stronger medications or surgery might be required.

Anyone who feels that they have indigestion but also chest pain, shortness of breath, or pain in the arm or jaw should seek immediate medical attention. These may indicate a heart attack.

Complications of acid reflux

Some people who have acid reflux for a long time may experience complications.

Narrowing of esophagus: Acid can damage the cells in the lower food pipe, resulting in scar tissue that narrows the food pipe, making it difficult to swallow.

Erosion of tissues: The acid can also affect tissues, causing painful ulcers to form. This is known as erosive esophagitis.

Barret’s esophagus: This condition can cause changes in the tissue lining of the lower part of the food pipe. These changes are associated with a higher risk of cancer of the food pipe, esophageal cancer.

Endoscopy exams are routinely used to check for early signs of cancer in patients with Barret’s esophagus.

Throat Services

Need more information? Check out some of the topics below to learn more about specific throat problems many people face.

Sore Throat & Tonsillitis

A sore throat, also called throat infection or pharyngitis, refers to pain, itchiness, or irritation of the throat. You may have difficulty swallowing food and liquids, and the pain may get worse when you try to swallow. Throat pain is the primary symptom of a sore throat. However, other symptoms may include a dry throat, swollen glands in the neck, white patches on the tonsils, and hoarseness. The most common cause of sore throat is bacterial infection or a viruIn cases of infectious pharyngitis that are not viral, the cause is almost always a bacterium, which causes what is commonly called strep throat. Like viral pharyngitis, strep throat can spread quickly and easily within a community, especially during winter and early spring. Unlike most forms of viral pharyngitis, however, untreated strep throat can lead to serious complications, such as glomerulonephritis (a kidney disorder) and rheumatic fever (a potentially life-threatening illness that can damage heart valves). A strep infection also has the potential to spread within the body, causing pockets of pus (abscesses) in the tonsils and in the soft tissue around the throat.

Symptoms:

  • Viral pharyngitis: Sore throat often occurs with the following symptoms: pain when swallowing; redness in the throat; runny nose; stuffy nose; cough; hoarseness; redness of the eyes; and, in children, diarrhea. In some cases, there can be a painful redness around the mouth or small painful sores on the lips and inside the mouth.
  • Strep throat: With strep throat and other forms of bacterial pharyngitis, sore throat can be accompanied by any of the following symptoms: fever; pain when swallowing; a generally sick feeling (malaise); headache; redness and swelling in the throat; a coating on the tonsils or tongue; and swollen, tender lymph nodes (swollen glands) in the front of the neck. Children also can have nausea, vomiting and abdominal pain.

Because symptoms of viral and bacterial pharyngitis can overlap, it may be difficult for the doctor to distinguish between them based on symptoms alone. Generally, if you have a prominent cough and nasal symptoms you’re more likely to have viral pharyngitis than strep throat.

In addition to viral and bacterial pharyngitis, an infection with fungi (Candida or “yeast”) sometimes can cause throat pain, difficulty swallowing and white patches inside the mouth. This throat infection, commonly called thrush, usually affects infants and people with weakened immune systems. It is relatively rare among healthy older children and adults.

A sore throat that lasts for more than a couple of weeks may be caused by acid reflux from the stomach, breathing through the mouth in a dry environment, postnasal drip or, rarely, a tumor.

Diagnosis:

After reviewing your symptoms, the doctor will ask if you might recently have been exposed to someone with strep throat or any other infection involving the throat, nose or ears.

Your doctor will examine you, paying particular attention to your mouth, throat, nose, ears and the lymph nodes in your neck. If your doctor thinks you have strep throat, he or she may prescribe antibiotics without further testing. If there is some uncertainty, the doctor may want to do a strep test. A rapid strep test is done in your doctor’s office, takes only a few minutes to do and detects 80% to 90% of all cases of strep throat. If this quick test is negative, but your doctor still believes you might have strep, your doctor will take a sample of your throat fluids for more intensive testing in a laboratory. Results will be available in 24 to 48 hours.

Infectious Esophagitis

Esophagitis is swelling and irritation of your esophagus. The esophagus is the tube you use to swallow. It connects the back of your throat to your stomach. The most common cause of swelling and irritation of the esophagus is stomach acid that flows back into your esophagus.

But infections can also cause this swelling and irritation. Fungi, yeast, viruses, and bacteria can all set off the condition, called infectious esophagitis. Anyone can get it, but you are more likely to develop it if your immune system is weakened.

Causes

Infectious esophagitis can be caused by fungi, yeast, viruses, and bacteria.

Symptoms

These are symptoms of infectious esophagitis:

  • Pain when swallowing

  • Difficulty swallowing

  • Mouth pain

  • Chest pain

  • Nausea or vomiting

  • Chills or fever

Risk factors

People with a normal immune system are unlikely to get infectious esophagitis. If you have a medical condition or are undergoing treatment that weakens your immune system, you could be at risk. These conditions put you at risk:

  • HIV/AIDS

  • Cancer treatments, including chemotherapy and radiation treatments

  • Diabetes

  • Bone marrow or stem-cell transplant treatment

  • Medicines that depress the immune system, such as steroids or medicines taken after an organ transplant

  • Long-term antibiotic use

  • Medicines that limit how much stomach acid you produce

  • Alcohol abuse

Advanced age can also make you more likely to get it.

Diagnosis

Your healthcare provider may suspect infectious esophagitis if you have symptoms of esophagitis along with a condition that weakens the immune system.

To make a diagnosis, your healthcare provider may order certain tests:

  • Endoscopy. During this outpatient procedure, the gastroenterologist passes a thin, flexible scope through your mouth to examine your esophagus. He or she might take swabs and scrapings to find the cause of an infection if he or she sees signs, such as white patches, fluid-filled blisters, or sores in your esophagus.

  • Blood work. Your healthcare provider may test your blood for viruses that can cause infectious esophagitis, such as herpes simplex virus.

Treatment

If you have a healthy immune system, your infection may clear on its own without treatment. How infectious esophagitis is treated often depends on the cause:

  • Esophagitis caused by a fungus called Candida. This fungus may be treated with an antifungal medicine called fluconazole or other similar medicines.

  • Viral esophagitis may be treated with antiviral medicines, such as acyclovir.

  • Bacterial esophagitis may be treated with broad-spectrum antibiotics. These are medicines that work against many types of bacteria.

  • Sometimes acid blockers are used along with other treatments.

Complications

Complications are unusual unless you have a condition or disease that weakens your immune system. Complications may include:

  • Infection that spreads to other parts of your body

  • Scar tissue that forms in the esophagus and causes a narrowing

  • Ulcers in the esophagus that lead to bleeding

  • A hole in the esophagus called a perforation or fistula

When to call the healthcare provider

Call your healthcare provider if you have any questions about your medicines or any other aspect of your treatment. Let your healthcare provider know right away if you have:

  • Increased difficulty swallowing

  • Pain with swallowing

  • Symptoms of infection, such as chills or fever

  • Chest pain or difficulty breathing

Living with infectious esophagitis

While you are recovering from infectious esophagitis, work closely with your healthcare provider and keep all your follow-up appointments.

If you have ongoing symptoms of painful or difficult swallowing, your healthcare provider may suggest that you take these steps:

  • Stop smoking.

  • Avoid alcohol and caffeine.

  • Avoid over-the-counter medicines that may irritate your esophagus, such as aspirin or ibuprofen.

  • Avoid foods or beverages that give you heartburn.

  • Lose weight if you are overweight.

  • Eat smaller meals more often.

  • Avoid eating for 3 hours before you go to bed.

  • Avoid sleeping in a flat position. Elevate the head of your bed several inches.

Could You Be at Risk for Esophagitis?

Heartburn, gastroesophageal reflux disease (GERD), and esophagitis can have a complicated, intertwined relationship.

“Esophagitis simply means inflammation of the esophagus,” says Stella Y. Chow, MD, the director of gastroenterology at the Lahey Clinic North Shore in Burlington, Massachusetts.

Your esophagus is the tube that connects your throat to your stomach. When your esophagus becomes irritated or swollen, it causes esophagitis symptoms. Heartburn, a common symptom of esophagitis, affects almost 40 percent of Americans at least twice a month, but having occasional heartburn does not necessarily mean you have esophagitis.

GERD, which affects approximately 20 percent of people in the United States, is a more serious form of regular and frequent heartburn that is more likely to lead to esophagitis. GERD occurs when stomach acid spills out of your stomach and moves upward into your esophagus, a condition called reflux. Since the lining of your esophagus is not designed to tolerate stomach acid, the acid causes irritation and swelling inside your esophagus.

Common Causes of Esophagitis

It’s not always clear why some people have a lot of acid reflux, but it may be due to a weakness of the muscles that keep acid inside the stomach, called a hiatal hernia.

“Esophagitis from acid reflux may be mild or it may be quite serious. Over time, acid reflux may cause swelling or scarring of the esophagus that interferes with swallowing,” says Dr. Chow.

“GERD is the most common cause of esophagitis, but other conditions can also cause esophagitis,” Chow explains. These include:

  • Pill esophagitis “This condition may occur from swallowing pills that irritate your esophagus. Common examples include the antibiotic doxycycline and potassium pills,” says Chow. Pill esophagitis may also occur when you swallow pills without drinking enough water.
  • Esophageal infection Yeast infections, fungal infections, bacterial infections, and some viral infections can all cause esophagitis.
  • Eosinophilic esophagitis. An estimated 56.7 out of 100,000 people are diagnosed with eosinophilic esophagitis in the United States, according to a study published in April 2014 in Clinical Gastroenterology and Hepatology. “This is a rare type of allergic reaction that causes inflammation of the esophagus,” says Chow. Foods such as milk, eggs, wheat, soy, peanuts, beans, rye, and beef may trigger this form of esophagitis, according to the Mayo Clinic.
  • Other causes These include irritation from excessive vomiting due to illness or bulimia, alcohol, caffeine, cigarette smoking, or heartburn-causing medications like aspirin or anti-inflammatories.

Heartburn and Other Esophagitis Symptoms

Heartburn or acid indigestion may be the most common symptom of esophagitis. Heartburn may occur after meals, especially when when you’re lying down, and may cause burning in your chest or throat and a bitter taste in your mouth.

Other esophagitis symptoms may include:

  • Difficult or painful swallowing
  • Chest pain
  • Cough
  • Food impaction
  • Acid regurgitation
  • Chronic hoarseness
  • Sore throat

All these symptoms can also be caused by other conditions, so you should see your doctor to determine their cause. Do not assume they are all due to esophagitis. In children and infants, feeding difficulties and failure to thrive may be signs of esophagitis, according to the Mayo Clinic.

How Esophagitis Is Diagnosed

Diagnosis of esophagitis starts with a history and physical exam, Chow explains. “If your doctor thinks you might have esophagitis, you will probably need a special type of imaging study. You may also need a special examination to look inside your esophagus, called an endoscopy.”

Diagnostic tests include:

  • Esophageal manometry A thin, pressure-sensitive tube is passed through your nose, into the esophagus to measure the pressures and the pattern of muscle contractions in your esophagus.
  • Barium swallow This imaging study takes an X-ray picture of your esophagus after you drink a barium solution. Barium coats the inside of the esophagus to reveal any narrowing from esophagitis.
  • Endoscopy During this procedure, a doctor investigates your esophagus through a flexible lighted tube. The tube is inserted through your mouth and requires light anesthesia.
  • Biopsy During an endoscopic procedure, doctors frequently remove a piece of esophageal tissue to be looked at under a microscope for signs of inflammation.

Tips to Avoid Esophagitis

“Some things you can do to prevent esophagitis symptoms caused by GERD include taking over-the-counter antacids, avoiding meals close to bedtime, losing weight, not wearing tight-fitting clothing, not smoking, and cutting back on alcohol, spicy foods, and caffeine,” suggests Chow.

Untreated esophagitis can lead to serious complications, including changes to the structure of the esophagus and tearing of the esophagus lining tissue, and can even increase your risk of developing esophageal cancer, according to the Mayo Clinic. You can lower your risks of these complications by staying away from identified triggers. Healthy people usually recover within three to five days, but those with a weakened immune system may take longer to heal from an episode of GERD with esophagitis.

If you have esophagitis symptoms that occur more than twice a week, they don’t seem to be responding to over-the-counter antacid medications, the symptoms are so severe that it is difficult to eat, or if the symptoms are accompanied by headache, fever, and muscle aches, you should visit your doctor. Esophagitis symptoms such as food getting stuck in your throat, pain when swallowing, and weight loss should be further investigated.

Additional reporting by Erica Tricarico.

Understanding the oesophagus and stomach

When we eat, food passes down the gullet (oesophagus) into the stomach. Cells in the lining of the stomach make acid and other chemicals which help to digest food. Stomach cells also make mucus which protects them from damage from the acid. The cells lining the oesophagus are different and have little protection from acid.

There is a circular band of muscle (a sphincter) at the junction between the oesophagus and stomach. This relaxes to allow food down but then normally tightens up and stops food and acid leaking up (refluxing) into the oesophagus. In effect, the sphincter acts like a valve.

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What are reflux and oesophagitis?

What is acid reflux?

Dr Sarah Jarvis MBE

  • Acid reflux means that some acid leaks up (refluxes) into the gullet (oesophagus).
  • Oesophagitis means inflammation of the lining of the oesophagus. Most cases of oesophagitis are due to reflux of stomach acid which irritates the inside lining of the oesophagus.

The lining of the oesophagus can cope with a certain amount of acid. However, it is more sensitive to acid in some people. Therefore, some people develop symptoms with only a small amount of reflux. However, some people have a lot of reflux without developing oesophagitis or symptoms.

Gastro-oesophageal reflux disease (GORD)

This is a general term which describes the range of situations – acid reflux, with or without oesophagitis and symptoms.

What are the symptoms of acid reflux and oesophagitis?

  • Heartburn: this is the main symptom. This is a burning feeling which rises from the upper tummy (abdomen) or lower chest up towards the neck. (It is confusing, as it has nothing to do with the heart!)
  • Other common symptoms: these include pain in the upper abdomen and chest, feeling sick, an acid taste in the mouth, bloating, belching, indigestion (dyspepsia) and a burning pain when you swallow hot drinks. Like heartburn, these symptoms tend to come and go and tend to be worse after a meal.
  • Some uncommon symptoms: these may occur and if they do, can make the diagnosis difficult, as these symptoms can mimic other conditions. For example:
    • A persistent cough, particularly at night, sometimes occurs. This is due to the refluxed acid irritating the windpipe (trachea). Asthma symptoms of cough and wheeze can sometimes be due to acid leaking up (reflux).
    • Other mouth and throat symptoms sometimes occur, such as gum problems, bad breath, sore throat, hoarseness and a feeling of a lump in the throat.
    • Severe chest pain develops in some cases (and may be mistaken for a heart attack).

What causes acid reflux and whom does it affect?

The circular band of muscle (sphincter) at the bottom of the gullet (oesophagus) normally prevents acid leaking up (reflux). Problems occur if the sphincter does not work very well. This is common but in most cases it is not known why it does not work so well. In some cases the pressure in the stomach rises higher than the sphincter can withstand – for example, during pregnancy, after a large meal, or when bending forward. If you have a hiatus hernia (a condition where part of the stomach protrudes into the chest through the diaphragm), you have an increased chance of developing reflux. See separate leaflet called Hiatus Hernia for more details.

Most people have heartburn at some time, perhaps after a large meal. However, about 1 adult in 3 has some heartburn every few days, and nearly 1 adult in 10 has heartburn at least once a day. In many cases it is mild and soon passes. However, it is quite common for symptoms to be frequent or severe enough to affect quality of life. Regular heartburn is more common in smokers, pregnant women, heavy drinkers, those who are overweight and those aged between 35 and 64 years.

What tests might be done?

Tests are not usually necessary if you have typical symptoms. Many people experiencing acid leaking up (refluxing) into the gullet (oesophagus) are diagnosed with ‘presumed acid reflux’. In this situation they have typical symptoms and the symptoms are eased by treatment. Tests may be advised if symptoms are severe, or do not improve with treatment, or are not typical of GORD.

  • Gastroscopy (endoscopy) is the common test. A thin, flexible telescope is passed down the oesophagus into the stomach. This allows a doctor or nurse to look inside. With inflammation of the lining of the oesophagus (oesophagitis), the lower part of the oesophagus looks red and inflamed. However, if it looks normal it does not rule out acid reflux. Some people are very sensitive to small amounts of acid and can have symptoms with little or no inflammation to see. Two terms that are often used after an endoscopy are:
    • Oesophagitis. This term is used when the oesophagus can be seen to be inflamed.
    • Endoscopy-negative reflux disease. This term is used when someone has typical symptoms of reflux but endoscopy is normal.
  • A test to check the acidity inside the oesophagus may be done if the diagnosis is not clear.
  • Other tests such as heart tracings, chest X-ray, etc, may be done to rule out other conditions if the symptoms are not typical.

What can I do to help with symptoms?

The following are commonly advised. However, there has been little research to prove how well these lifestyle changes help to ease reflux:

  • Smoking. The chemicals from cigarettes relax the circular band of muscle (sphincter) at the bottom of the gullet (oesophagus) and make acid leaking up (refluxing) more likely. Symptoms may ease if you are a smoker and stop smoking.
  • Some foods and drinks may make reflux worse in some people. It is thought that some foods may relax the sphincter and allow more acid to reflux. It is difficult to be certain how much foods contribute. Let common sense be your guide. If it seems that a food is causing symptoms then try avoiding it for a while to see if symptoms improve. Foods and drinks that have been suspected of making symptoms worse in some people include peppermint, tomatoes, chocolate, spicy foods, hot drinks, coffee and alcoholic drinks. Also, avoiding large-volume meals may help. See the separate leaflet called Oesophageal reflux diet sheet for more details.
  • Some medicines may make symptoms worse. They may irritate the oesophagus or relax the sphincter muscle and make acid reflux more likely. The most common culprits are anti-inflammatory painkillers (such as ibuprofen or aspirin). Others include diazepam, theophylline, calcium-channel blockers (such as nifedipine) and nitrates. But this is not a complete (exhaustive) list. Tell a doctor if you suspect that a medicine is causing the symptoms, or making symptoms worse.
  • Weight. If you are overweight it puts extra pressure on the stomach and encourages acid reflux. Losing some weight may ease the symptoms.
  • Posture. Lying down or bending forward a lot during the day encourages reflux. Sitting hunched or wearing tight belts may put extra pressure on the stomach, which may make any reflux worse.
  • Bedtime. If symptoms recur most nights, the following may help:
    • Go to bed with an empty, dry stomach. To do this, don’t eat in the last three hours before bedtime and don’t drink in the last two hours before bedtime.
    • If you are able, try raising the head of the bed by 10-20 cm (for example, with books or bricks under the bed’s legs). This helps gravity to keep acid from refluxing into the oesophagus. If you do this, do not use additional pillows, because this may increase tummy (abdominal) pressure.

What are the treatments for acid reflux and oesophagitis?

Antacids

Antacids are alkaline liquids or tablets that reduce the amount of acid. A dose usually gives quick relief. There are many brands which you can buy. You can also obtain some on prescription. You can use antacids ‘as required’ for mild or infrequent bouts of heartburn.

Acid-suppressing medicines

If you have symptoms frequently then see a doctor. An acid-suppressing medicine will usually be advised. Two groups of acid-suppressing medicines are available – proton pump inhibitors (PPIs) and histamine receptor blockers (H2 blockers). They work in different ways but both reduce (suppress) the amount of acid that the stomach makes. PPIs include omeprazole, lansoprazole, pantoprazole, rabeprazole and esomeprazole. H2 blockers include cimetidine, famotidine, nizatidine and ranitidine.

In general, a PPI is used first, as these medicines tend to work better than H2 blockers. A common initial plan is to take a full-dose course of a PPI for a month or so. This often settles symptoms down and allows any inflammation in the gullet (oesophagus) to clear. After this, all that you may need is to go back to antacids ‘as required’ or to take a short course of an acid-suppressing medicine ‘as required’.

However, some people need long-term daily acid-suppressing treatment. Without medication, their symptoms return quickly. Long-term treatment with an acid-suppressing medicine is thought to be safe and side-effects are uncommon. The aim is to take a full-dose course for a month or so to settle symptoms. After this, it is common to ‘step down’ the dose to the lowest dose that prevents symptoms. However, the maximum full dose taken each day is needed by some people.

Editor’s note

November 2017 – Dr Hayley Willacy has been reading recent reports concerning long-term use of PPI medicines and an increased risk of gastric (stomach) cancer – see Further reading below. Researchers studied over 60,000 people who took PPIs on a long-term basis. They were twice as likely to be diagnosed with stomach cancer in the 7 to 8 years of follow-up. The study was not designed to tell if PPIs were the cause of the increased cancer risk and it may have been down to other factors. For instance, the people studied were of Asian origin and they are known to have a higher risk of stomach cancer than Western populations. The amount of alcohol or how much these people smoked are also key factors and unfortunately, this was not looked at reliably in the study. It is also important to keep the results in proportion. Long-term use of PPIs was linked to around 4 additional stomach cancers cases per 10,000 people per year. The overall risk is still very low.

Prokinetic medicines

Metoclopramide, a prokinetic medicine, speeds up the passage of food through the stomach. It is not commonly used but can help in some cases, particularly if you have marked bloating or belching symptoms.

An operation can ‘tighten’ the lower oesophagus to prevent acid leaking up from the stomach. It can be done by ‘keyhole’ surgery. In general, the success of surgery is no better than acid-suppressing medication. However, surgery may be an option for some people whose quality of life remains significantly affected by their condition and where treatment with medicines is not working well or not wanted long-term.

Another procedure being used involves placing a small magnetic device around the lower oesophagus. The device allows you to swallow but then tightens to stop acid reflux. Because there is not much research into this procedure, it is not often used in the UK at the moment.

Are there any complications from oesophagitis?

  • Scarring and narrowing (stricture). If you have severe and long-standing inflammation it can cause a stricture of the lower gullet (oesophagus). This is uncommon.
  • Barrett’s oesophagus. In this condition the cells that line the lower oesophagus become changed. The changed cells are more prone than usual to becoming cancerous. (About 1 or 2 people in 100 with Barrett’s oesophagus develop cancer of the oesophagus.)
  • Cancer. Your risk of developing cancer of the oesophagus is slightly increased compared to the normal risk if you have long-term acid reflux.

It has to be stressed that most people with reflux do not develop any of these complications. Tell your doctor if you have pain or difficulty (food ‘sticking’) when you swallow, which may be the first symptom of a complication.

By the way, doctor: What causes acid reflux in the throat?

  • Avoid caffeine, alcohol, chocolate, and peppermint, which weaken both esophageal sphincters. Even decaffeinated teas and coffees contain enough caffeine to cause trouble. Some substances in chocolate and peppermint also stimulate stomach acid production.
  • Avoid highly acidic or spicy foods and beverages such as citrus fruits and juices, tomatoes, salad dressings, and barbecue or hot sauces. These foods irritate the tissues lining the throat and voice box.
  • Don’t drink carbonated beverages: they can cause belching, which promotes reflux of stomach contents.
  • Don’t smoke: nicotine stimulates acid production.
  • Opt for small meals spread throughout the day rather than large meals, which exert pressure on the lower esophageal sphincter.
  • Avoid vigorous exercise, heavy lifting, or bending over immediately after eating.
  • Don’t drink or eat for two or three hours before going to sleep.

If diet and behavior changes don’t help, a medication may be prescribed — usually, treatment starts with a proton-pump inhibitor (PPI). Commonly prescribed PPIs include rabeprazole (Aciphex), esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec), and pantoprazole (Protonix). They all work by reducing the amount of acid made in the stomach.

— Celeste Robb-Nicholson, M.D.
Former Editor in Chief, Harvard Women’s Health Watch

Disclaimer:
As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

Laryngopharyngeal Reflux

In adults and children, irritating acidic juices may back up from the stomach into the esophagus (swallowing passage) and throat. This is frequently called gastroesophageal reflux disease or GERD. This condition may occur at any time, but it happens more often when you are laying down. A common anatomic condition known as a hiatal hernia predisposes people to acid reflux. The most commonly recognized symptom of acid reflux is “heartburn” due to irritation of the lining of the esophagus.

Most people do not know that acid reflux can also cause voice problems or symptoms in the pharynx (back of throat). This can happen to someone even if they are not aware of any heartburn and is sometimes called silent reflux, atypical reflux or laryngopharyngeal reflux.

The following information is intended to help you understand acid reflux and the steps you may take to reduce this problem. It is important to realize, however, that the healing of the irritated vocal folds, throat, or esophagus will take time, and you should not expect immediate results.

Symptoms in Adults

Symptoms of acid reflux may include:

  • Hoarseness
  • Excessive mucous or phlegm
  • Throat clearing
  • A sensation of a lump in the throat
  • Sore throat
  • Choking spells
  • Wheezing
  • A sense of post-nasal drip

Singers will often notice:

  • Increased warm-up time
  • Sluggish voice (particularly early in the day)
  • A sense of a “coating” on the vocal folds

In a small percentage of people, more serious problems result, including:

  • Pneumonia
  • Ulcers or granulomas of the larynx
  • Vocal fold scarring or a pouch (diverticulum) of the upper esophagus

There is also a small chance of developing cancer in the esophagus or throat due to long-term acid reflux.

Symptoms in Children

In children, the symptoms can be a little different and may include:

  • Persistent vomiting
  • Bleeding from the esophagus
  • Respiratory symptoms
  • Choking spells
  • Recurrent pneumonia
  • Asthma
  • Swallowing problems or anemia.
  • In some cases, unexplained fussiness and crying in children is due to acid reflux

Dietary Factors and Foods to Avoid

Dietary factors often contribute to acid reflux. Certain foods are acids or irritants themselves; others will bring out stomach acid in large amounts. Both should be avoided.

The following list of foods is especially known to be troublesome:

  • Coffee, tea, chocolate, carbonated beverages, alcoholic beverages, citrus beverages or highly spiced foods
  • Hard candies, gum, breath fresheners, throat lozenges, cough drops, mouthwashes, gargles, etc., may actually irritate the throat directly (many cough drops and lozenges contain irritants such as menthol and oil of eucalyptus) and will also stimulate the stomach to pour out acid.

Being overweight also contributes to acid reflux; if you are overweight, it would help to lose weight. Large meals at one time are troublesome, and so three or four equal, small feedings are preferable to one or two large meals. One should not eat for 2 or 3 hours before bedtime; it is advisable not to lie down right after eating.

Behavioral and Other Factors

As mentioned above, body weight is a significant factor in promoting reflux of stomach acid, and weight reduction is helpful.

Pregnancy will markedly increase symptoms of heartburn and sometimes throat symptoms as well. This is partly due to the space taken up by the growing infant. One should avoid clothing that fits tightly across the midsection of the body. It is helpful to practice abdominal or diaphragmatic breathing. This means you should concentrate on pushing out the stomach with each breath instead of expanding the chest. Avoid slumping when sitting down. Avoid bending or stooping as much as you can.

For many people, reflux occurs most often at night and sets up the irritation that continues to bother during the daytime. One of the most important things you can do is to elevate the head of your bed. To do this, use blocks, books or bricks underneath the legs at the head of the bed. The elevation should be 4-6 inches or so, but not high enough that you will slide down when sleeping. Professional singers with acid reflux should consider traveling with blocks in their suitcase for use in hotel rooms.

The use of multiple pillows to get the head up is not effective because it causes the body to curl unless the pillows are maintained under the shoulders in addition to the head. Wedge-shaped pillows can be helpful in this regard.

Medications

In addition to dietary and behavioral adjustments, medications are often part of an anti-reflux program. Some are available without a prescription, while others require a prescription. Antacids are commonly used for this problem, and they work by neutralizing stomach acid. Other medications work to decrease stomach acid secretion before it happens and are more effective at controlling symptoms. Medications should be discussed with your physician.

Several different medications that you might be taking for other medical problems may actually increase stomach acid. These include:

  • Alpha blockers (Dibenzyline), dopamine or calcium channel blockers (Procardia, Cardizem, Isotin, Calan)
  • Anticholinergics (Donnatol, Scopolamine, Probanthine, Bentil and others)
  • Aspirin or aspirin-containing compounds and other drugs used for pain or arthritis, especially the group called “non-steroidal anti-inflammatory” drugs or NSAID’s, are especially prone to aggravating this problem in some people
  • Beta blockers (Inderal, Tenormin, Corgard)
  • Progesterone (Provera, Ortho Novum, Orval and other birth control pills)
  • Theophyllin (Theodur and other products)
  • Vitamin C is also an acid and can cause stomach symptoms

Surgery

In some patients with severe symptoms or complications of acid reflux, surgery can be performed for treatment. If appropriate, your physician will discuss this option with you.

Make an Appointment

Schedule an appointment by calling us at (734) 936-8051.

Is Your Food Pipe Asking for an Esophageal Stretch?

  • Digestive Health

Women. Wisdom. Wellness. Dec 15, 2017

Stretching is good for our muscles and mobility. But did you know that stretching may also be good for your esophagus? A stretching (or dilation) procedure may be an option if you’re suffering from benign (non-cancerous) esophageal stricture, or narrowing of the esophagus.

Your esophagus is the long tube that transports food and liquids from your mouth to your stomach. The most common cause of stricture is esophageal scarring from acid reflux. Other causes include radiation treatment, ingestion of acidic or corrosive substances, immune system disease and damage from medical procedures.

Benign esophageal stricture typically occurs when stomach acid and other irritants damage the lining of the esophagus over time. This leads to inflammation, or esophagitis, and scar tissue, which causes the esophagus to narrow.

Typical symptoms include:

  • difficult or painful swallowing
  • unintended weight loss
  • regurgitation of food or liquids
  • sensation of something stuck in the chest after you eat
  • frequent burping or hiccups
  • heartburn

Call your health care provider if you have unresolved acid reflux or swallowing problems that do not go away. If left untreated, they could put you at risk for choking, dehydration, malnutrition or aspiration pneumonia, a bacterial infection that can occur when vomit, food or fluid enter your lungs through regurgitation.

Who Can Esophageal Stretching Help?

The most common cause of esophageal damage is acid reflux, also known as GERD (gastroesophageal reflux disease). GERD occurs when the muscle between the esophagus and stomach doesn’t close or tighten properly after you swallow, allowing stomach acid to flow back up into your esophagus. The result is heartburn, a burning sensation behind your breast bone.

The following problems also may be treated with esophageal stretching:

  • Schatzki’s ring. An abnormal ring of tissue that forms where the esophagus meets the stomach.
  • Achalasia. This condition blocks food and liquids from moving into your stomach from the esophagus. It’s caused by a defect in the lower esophageal sphincter (LES), a muscular ring that opens (relaxes) when you swallow.
  • Eosinophilic esophagitis. A chronic allergic/immune system disease that causes redness and inflammation in the esophagus.
  • Narrowing caused by radiation treatment to the chest or neck.

Call your health care provider if you have unresolved acid reflux or swallowing problems that do not go away.

How is Esophageal Stretching Performed?

Esophageal stretching widens a narrowed area of your esophagus. It’s typically performed under sedation along with an upper endoscopy, an incision-free, image-guided procedure that takes about 15 minutes.

Your doctor will use an endoscope, a narrow tube with a tiny light and camera at the end, and insert it through your mouth and into your esophagus. You might experience mild pressure in the back of your throat. The tube does not cause trouble breathing.

Your doctor carefully passes tiny tools through the endoscope and uses them to widen the stricture. Alternatively, your doctor might spray a local anesthetic to the back of your throat and then pass a weighted dilator through your mouth and into your esophagus.

What Results Can I Expect?

Most patients experience no symptoms after the procedure or a mild sore throat for the remainder of the day. You can resume eating the same day or the next day, depending on when the anesthetic no longer causes numbness to your throat. Your health care provider can tell you what to expect for the first several days after treatment.

Possible procedure risks include a tear or hole in the esophageal lining, in addition to infection and anesthesia risks.

You may need to have repeat dilations. This depends on the cause and extent of your narrowing. Repeat procedures can allow the dilation to take place gradually, reducing the risk of complications.

If your stricture was caused by acid reflux, you’ll likely need medication to treat that condition, which can prevent the narrowing from happening again. Follow your doctor’s instructions regarding food and lifestyle choices that can minimize the backup of acid into your esophagus.

Source: American Society for Gastrointestinal Endoscopy; U.S. National Library of Medicine; Healthline

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