Gastroesophageal reflux disease (GERD) and laryngopharyngeal reflux disease (LPRD) make up the last branch of chronic airway-digestive inflammatory disease (CAID). When we swallow, food and liquids travel through the esophagus and land in the stomach, where stomach acids help the digestive process. Within the esophagus are two constricting muscles: the lower esophageal sphincter and the upper esophageal sphincter. During normal swallowing, these rings of muscle open and close at the precise moment that food passes through the esophagus. When the lower esophageal sphincter is not functioning properly, there is a backflow of stomach acid into the esophagus. This acid flow irritates the esophagus causing heartburn, a painful, burning sensation in the chest. If this happens, it can be a sign of GERD. Additionally, recent research reveals that the stomach enzyme pepsin causes damage to the airway - digestive membranes when it refluxes.
Those of us who experience GERD have a clear picture of how it feels. Typically, the profile of a GERD patient is someone who is sedentary; is slightly overweight; and has a history of burping, heartburn, and stomach pain, usually associated with meals. GERD sufferers
often regurgitate their food, particularly at night, which can cause chronic coughing. This symptom is usually a clue that the GERD complications are reaching beyond the esophagus. When the upper esophageal sphincter doesn’t function correctly, acid that has already flowed back into the esophagus enters the throat and voice box. When this happens, acidic material contacts the sensitive tissue at the back of the throat and even the back of the nasal airway - causing heartburn, sore throat, phlegm, postnasal drip, cough, choking, hoarseness, and/or CAID. This is known as LPRD. GERD and LPRD can occur separately or together.
Other symptoms of LPRD include a bitter taste in the back of the throat, which commonly occurs in the morning upon awakening, and the sensation of a lump or something stuck in the throat, which does not go away despite multiple swallowing attempts. Some adults may also experience a burning sensation in the throat. Others may find themselves with ear pain caused by inflammation of the throat; laryngitis caused by the inflammation of the voice box from the reflux; gingivitis, which is irritation and inflammation of the gums as a result of the acids burning the membranes around the teeth; nasal obstruction caused by the inflammation of the nasal membranes, resulting in nasal swelling; noisy breathing (stridor) caused by the inflammation and swelling around the airway; or bad breath (halitosis).
More than half of LPRD sufferers do not experience heartburn: The stomach acid does not stay in the esophagus long enough to irritate the esophagus and cause these symptoms. In LPRD, most of the damage to the esophagus and/or the throat caused by reflux that happens without you ever knowing it. The frequency and the contact time of the acid with mucous membranes in the pharynx is much greater than the contact with the esophagus. Compared to the esophagus, the mucous membranes in the voice box and the back of the throat are significantly more sensitive to the affects of stomach acids. Acid that passes quickly through the food pipe does not have a chance to irritate the area for too long. However, acid that pools in the throat and voice box will cause prolonged irritation, resulting in the symptoms of LPRD. For this
reason, LPRD is often referred to as “silent GERD,” and can be very difficult to diagnose.
Irritation in the voice box can lead to a laryngospasm, which means that the voice box contracts. This can be a very scary: It feels as if you were going to choke or suffocate. Some doctors believe that laryngospasm, GERD, and panic attacks are related. Worst of all, acids can enter the trachea and the lungs, where they can be even more damaging. These tissues will become irritated, leading to bronchitis and asthma. In patients who have bad asthma, this irritation can set off status asthmaticus, in which the lungs tighten up and you cannot get air. Status asthmaticus is rarely caused by reflux; but if it occurs, it can be life threatening.
Finally, 10-15 percent of patients who have chronic GERD can end up with histologic changes of the esophageal lining. This occurs in the lower esophagus. This disease is called Barrett’s esophagus: In rare instances, the acids cause the normal lining of the esophagus to be replaced by the type of lining that is found in the stomach or intestine. When this membrane is continuously subjected to refluxing acid, esophageal cancer can develop. A gastroenterologist can make this diagnosis with an outpatient endoscopy and biopsy of the esophagus. For people found to have these changes, close monitoring of the esophagus is necessary. Furthermore, the refluxing acids can potentially cause ulcers in the esophagus. Although this is also rare, these ulcers can hemorrhage and perforate. For all of these reasons, it is very important to control severe reflux (4).