Useful Information for Patients
Disclaimer The information contained within this brochure is for informative purposes only and does not necessarily reflect the official position of the Kenya Ear Nose and Throat Society on this specific subject, as treatment modalities may differ between specialists.
Once food leaves the mouth it travels via an active squeezing mechanism, (peristalsis), through the oesophagus (throat), to the stomach which lies just below the rib cage. A circle of muscle around the lower oesophagus just before the stomach which is known as the lower oesophageal sphincter, (LOS), keeps the stomach contents, including the acid made there, from squirting, (refluxing), back into the oesophagus. In GORD, the LOS does not close properly. GORD occurs when stomach contents, including the acid, reflux up into the oesophagus. The very young have especially immature LOS. Acid contact with the very sensitive lining of the oesophagus and throat causes burning - just like sunburn and the skin. As in sunburn and skin, reflux can and is most often silent, until a problem arises. Almost everyone has experienced some reflux in their life, but the disease (GORD) occurs when reflux happens on a frequent basis often over a long period of time (2). Reflux may reach the laryngopharynx, (voice box and throat) and is then referred to as Laryngopharyngeal Reflux (LPR).
GORD/LPR Symptoms and You
This is very variable - as stated above it may be silent. Symptoms may include persistent heartburn, acid regurgitation, nausea, hoarseness in the morning, or trouble swallowing (2). Some may experience such severe chest pain as to mimic a heart attack. GORD can also cause a dry cough and bad breath. Some people with LPR may feel as if they have food stuck in their throat, a bitter taste in the mouth on waking, or difficulty breathing although uncommon. In infants & children, LPR may cause breathing problems such as: cough, hoarseness, stridor (noisy breathing), croup, asthma, sleep disorders, feeding difficulty (spitting up), turning blue (cyanosis), aspiration, pauses in breathing (apnoea), apparent life threatening event (ALTE), and even a severe deficiency in growth. Proper treatment of LPR, especially in children, is critical (2). Symptoms twice a week or more mean you may have GORD or LPR. For proper diagnosis and treatment, you should be evaluated by your General Practitioner for GORD or an Otolaryngologist - (ENT Doctor).
GORD / LPR and your ENT Doctor
As stated, there are ear, nose, and throat problems either caused by or associated with GORD and LPR. An otolaryngologist - head and neck surgeon has the tools and expertise to diagnose GORD and LPR. They treat many of the complications of GORD/LPR, including: sinus and ear infections, throat and laryngeal inflammation and lesions. Often a Gastroenterologist is brought in to assist.
GORD / LPR - Diagnosis and Treatment
Often there is very little to find on physical examination but the history and specialised evaluation by your ENT including being able to "scope" the patient immediately is most important. A rigid or flexible "scope" (a telescope that gives a clear view of the larynx) is passed through the nose or mouth with or without local anaesthetic. An empiric trial of treatment with a Proton Pump Inhibitor (PPI) drug (reduces the stomach's acid production) can often clinch the diagnosis. This is not recommended without adequate clinical evaluation.
Tests may be needed; Gastroscopy, biopsy, x-ray, 24 hour pH probe, acid reflux testing, oesophageal motility testing (manometry), emptying studies of the stomach, and oesophageal acid perfusion test. Endoscopic examination, biopsy, and x-ray may be performed as an outpatient or in a hospital setting.
Currently Health Care Funders may insist on specific tests, some perceived as unreliable by ENT surgeons. Most funders do not pay for GORD/LPR medications out of their chronic drug allocation. It is advisable that the patient negotiates directly with your medical aid fund manager. It is imperative to not stop GORD/LPR medications without consulting with your Doctor.
Some of the consequences of GORD/LPR include: bad breath, swallowing disorders, hoarseness, sinusitis, cough, chronic laryngitis, chronic oesophagitis, airway obstruction, nasal obstruction, cancer of the oesophagus and emphysema.
The goal of treatment is to keep stomach acid and other irritating substances out of the oesophagus and throat. Treatment allows healing of the damaged oesophagus and voice box as well as prevents further damage. Most will respond favourably to a combination of lifestyle changes and medication. Proton Pump Inhibitors (PPIs) are the drug treatment of choice in most. Other medications include antacids, histamine antagonists, pro-motility drugs, and foam barrier medications (2). Only occasionally is surgery recommended. The fundoplication operation is the operation of choice - stomach wraparound to tighten the LES, but if done in the wrong patient may cause more problems.
GORD / LPR - lifestyle changes
Avoid eating and drinking within two to three hours prior to bedtime.
Limit alcohol consumption and loose weight if overweight.
Eat slowly -small and more frequent meals,
Limit problem foods: Caffeine, Carbonated drinks, Chocolate, Peppermint, Tomato and citrus foods, Fatty and fried foods
Wear loose clothing
Avoid feeding at night – especially bottles
Avoid bottle feeding – constant “full” stomach
Pilot study of the oral omeprazole test for reflux laryngitis, Otolaryngology-Head and Neck Surgery. January 1997,116 No.1 DAVID C. METZ, MD, MARCIA L. CHILDS, RN, CESAR RUIZ, MA, GREGORY S. WEINSTEIN, MD
1. Otolaryngology Head Neck Surgery 1999;120:208-14. (2)
2. AAO-HNS Website