Misunderstandings Regarding Acid Reflux of the Esophagus: Insights from Science
Understanding Gastro-oesophageal Reflux Disease (GORD) and Laryngopharyngeal Reflux (Throat Reflux)
Gastro-oesophageal reflux disease (GORD) and throat reflux, also known as laryngopharyngeal reflux, are related but distinct conditions that involve stomach acid reflux.
Gastro-oesophageal Reflux Disease (GORD)
GORD is a chronic digestive disorder where stomach acid frequently refluxes into the esophagus, causing classic symptoms such as heartburn and regurgitation, and can damage the esophageal lining [1][3][4]. The typical presence of heartburn is a common and often a hallmark symptom of GORD.
Throat Reflux (Laryngopharyngeal Reflux)
On the other hand, throat reflux is a form of reflux where acid reaches the throat and voice box (laryngopharynx). Unlike GORD, throat reflux often does not cause the classic burning sensation associated with acid reflux. Instead, it can lead to symptoms like hoarseness, persistent feeling of a lump in the throat ('globus' sensation), chronic cough, or frequent throat clearing [2].
Key Differences
| Feature | GORD (GERD) | Throat Reflux (LPR) | |-------------------------------------|-----------------------------------------------------|-------------------------------------------------------------| | Definition | Chronic acid reflux causing stomach acid to flow back into the esophagus | Reflux where acid reaches the throat and voice box (laryngopharynx) | | Symptoms | Heartburn (burning chest), sour taste in mouth, regurgitation, nausea, burping, bloating, chest discomfort | Chronic throat clearing, hoarseness, sore throat, lump sensation in throat (globus), dry cough, voice changes, trouble swallowing | | Typical presence of heartburn | Common and often a hallmark symptom | Often no heartburn (called "silent reflux") | | Affected area | Esophagus | Larynx and pharynx (throat and voice box) | | Complications | Esophagitis, esophageal strictures, Barrett’s esophagus, increased risk of esophageal cancer | Chronic inflammation of throat and voice box; voice disorders; respiratory symptoms | | Cause of discomfort | Acid damages esophageal lining causing burning pain | Acid irritates the sensitive throat tissues not designed to tolerate acid | | Frequency and chronicity | Chronic frequent reflux (heartburn > twice a week) | Can be chronic but symptoms often subtle or atypical |
Diagnosis and Treatment
The current gold standard for diagnosing throat reflux is 24-hour pH monitoring. Treatment for throat reflux often begins with lifestyle changes such as weight loss, dietary modifications, and avoiding meals immediately before sleeping. Laryngoscopy may be more beneficial for detecting inflammatory changes caused by small amounts of stomach acid or pepsin that reach the upper airway.
In extreme cases, surgery such as Nissen fundoplication, which involves wrapping the upper stomach around the lower esophagus, may be considered. However, most cases of throat reflux are managed effectively with lifestyle changes and medication.
Importance of Recognition and Early Treatment
Recognizing the differences between GORD and throat reflux and seeking early medical advice is key to preventing complications and improving quality of life. Untreated throat reflux can lead to serious laryngeal pathologies, including laryngotracheal stenosis, granulomas, vocal cord swelling, and even laryngeal cancer.
In clinical terms, GORD involves acid reflux mainly affecting the esophagus, while throat reflux is the reflux reaching the larynx and pharynx, causing throat symptoms that are often harder to diagnose and may occur silently without chest pain or heartburn [2].
[1] https://www.nhs.uk/conditions/gastro-oesophageal-reflux-disease-gord/ [2] https://www.nhs.uk/conditions/laryngopharyngeal-reflux/ [3] https://www.mayoclinic.org/diseases-conditions/gastroesophageal-reflux-disease/symptoms-causes/syc-20371574 [4] https://www.nhsinform.scot/illnesses-and-conditions/stomach-and-digestive-systems/gastro-oesophageal-reflux-disease-gord
- The chronic digestive disorder Gastro-oesophageal Reflux Disease (GORD) can cause weight loss, as prolonged acid exposure in the esophageal lining may lead to a decrease in appetite and nutrition absorption.
- Throat Reflux (Laryngopharyngeal Reflux) can potentially worsen existing health-and-wellness issues, such as chronic diseases like asthma or chronic obstructive pulmonary disease (COPD), since the acid reflux can irritate and inflame the throat and voice box, exacerbating respiratory symptoms.
- Science plays a crucial role in understanding both GORD and Throat Reflux, as ongoing medical research helps uncover new treatments, medication, and fitness-and-exercise approaches to manage these chronic medical-conditions more effectively.
- It's essential to maintain a healthy lifestyle to combat GORD and throat reflux, especially by practicing fitness-and-exercise to promote weight loss, which can alleviate pressure on the stomach and reduce the frequency of acid reflux.
- The inclusion of health-and-wellness practices like fitness-and-exercise, a balanced diet, and medication — when indicated — into a comprehensive treatment plan can help improve the overall quality of life for individuals dealing with GORD and throat reflux.
