Sore throat from acid reflux
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Sore Throat from Acid Reflux: Understanding the Connection
Introduction to Acid Reflux and Sore Throat
Acid reflux, also known as gastroesophageal reflux disease (GERD), is a condition where stomach acid frequently flows back into the esophagus, causing irritation. When this acid reaches the upper airways, it can lead to laryngopharyngeal reflux (LPR), which is often associated with symptoms such as a sore throat, chronic cough, and hoarseness2 4.
Symptoms and Diagnosis of Laryngopharyngeal Reflux (LPR)
Common Symptoms
LPR can manifest through various symptoms, including a persistent sore throat, chronic cough, hoarseness, excess throat mucus, and a sensation of a lump in the throat (globus)2 4 5. These symptoms are often more pronounced during the daytime when the individual is upright, unlike GERD, which typically worsens at night2.
Diagnostic Tools
The gold standard for diagnosing LPR is ambulatory 24-hour double pH-probe monitoring, which measures acid exposure in both the esophagus and the pharynx2. Laryngoscopic evaluation is also commonly used to identify signs of reflux in the throat, such as irritation and inflammation of the larynx1 6.
Treatment Approaches
Proton Pump Inhibitors (PPIs)
PPIs are the mainstay of treatment for LPR, as they reduce stomach acid production. Studies have shown that PPI therapy can significantly improve symptoms such as postnasal drip, sore throat, and chronic cough in patients with LPR3 5. However, some patients may not respond to PPI therapy, indicating the need for further diagnostic evaluation and alternative treatments1.
Lifestyle and Dietary Modifications
Lifestyle changes, including dietary adjustments, are crucial in managing acid reflux. Patients are often advised to avoid foods and beverages that trigger reflux, eat smaller meals, and avoid lying down immediately after eating8. These modifications can help reduce the frequency and severity of reflux episodes.
Surgical Interventions
In cases where medical therapy fails, surgical options such as fundoplication may be considered. This procedure involves wrapping the top of the stomach around the lower esophagus to strengthen the lower esophageal sphincter, thereby preventing acid reflux1 8.
Emerging Treatments
Argon Plasma Coagulation (APC)
A pilot study has explored the use of argon plasma coagulation (APC) to ablate gastric inlet patches in the cervical esophagus, which can alleviate symptoms like globus sensation and sore throat. This treatment showed promising results, with significant symptom reduction observed in patients7.
Conclusion
Sore throat caused by acid reflux, particularly LPR, is a common but often overlooked condition. Accurate diagnosis through pH monitoring and laryngoscopy, combined with effective treatment strategies such as PPIs, lifestyle changes, and potentially surgical interventions, can significantly improve patient outcomes. Emerging treatments like APC also offer new hope for those with persistent symptoms. Understanding and addressing the underlying causes of LPR is essential for effective management and relief of sore throat symptoms.
Sources and full results
Most relevant research papers on this topic
Sore throat and a red hypopharynx: is it reflux?
Laryngoscopic evaluation is not sensitive enough for GERD diagnosis, and the patient may benefit from ndoscopy, pH, or impedance monitoring.
Case ReportLaryngopharyngeal reflux and Helicobacter pylori.
Laryngopharyngeal reflux (LPR) is associated with Helicobacter pylori, causing symptoms such as hoarseness, sore throat, and coughing, and can be effectively treated with proton pump inhibitors.
Literature Review
Rigorous JournalEffects of a Proton-Pump Inhibitor on Postnasal Drip Symptoms in Patients With Laryngopharyngeal Reflux
Proton-pump inhibitor treatment for 8 weeks may effectively improve postnasal drip symptoms in patients with laryngopharyngeal reflux.
RCTOtolaryngologic manifestations of gastroesophageal reflux.
Gastroesophageal reflux (GER) can cause various head and neck symptoms, and its diagnosis and treatment are crucial for otolaryngologists.
Highly CitedAcid reflux management: ENT perspective.
Voice change, sore throat, globus, and cough choking are the most reliable symptoms of laryngopharyngeal reflux, and flexible oesophago-gastroscopy is a reliable diagnostic tool.
Observational StudyProximal esophageal pH-metry in patients with 'reflux laryngitis'.
Patients with laryngeal symptoms in gastroesophageal reflux disease have significantly more proximal esophageal acid exposure and often have laryngoscopic findings of posterior laryngitis compared to control patients.
Observational StudyHighly CitedArgon plasma ablation of gastric inlet patches in the cervical esophagus may alleviate globus sensation: a pilot trial.
Ablation of gastric inlet patches with argon plasma coagulation can alleviate chronic globus sensation or sore throat, without affecting acid reflux or its treatment.
Non-RCTReflux and cough.
Reflux contributes to cough by direct irritation and increasing sensitivities to other noxious agents, and treatment focuses on dietary changes, lifestyle changes, and medication.
Laryngeal manifestations of gastroesophageal reflux disease
Reflux laryngitis (LPR) is a common symptom of GERD, and treating it with proton pump inhibitors and surgical fundoplication is effective for most patients.
Are persistent throat symptoms atypical features of gastric reflux and should they be treated with proton pump inhibitors?
Persistent throat symptoms may not be atypical features of gastric reflux and may not benefit from proton pump inhibitor treatment.
Systematic Review
Very Rigorous Journal