Patient Handout for Throat Problems and Gastro-esophageal Reflux

Stomach contents are normally acidic and are generally kept in the stomach by a valve at the lower end of the esophagus. Reflux is the term used when stomach acids come back up into the esophagus or throat. Symptoms result from direct acid irritation, or reflex tightening of throat muscles.

The sense of a lump in the throat, called globus, may result from chronic reflux laryngitis or from increased tension in the upper esophageal opening behind the voice box. The resulting increase in secretions in the throat leads to habitual throat clearing. These increased secretions may be mistaken as postnasal drip or "phlegm". A person with nighttime reflux will frequently waken with a sore, irritated throat and a gravely voice. Muscle tension in the larynx may lead to vocal difficulty, trouble swallowing, and, in severe cases, to choking spells and airway obstruction. Heartburn, the typical symptom of reflux, may not be present when the throat is affected.

Treatment is directed at keeping the stomach contents where they belong and neutralizing it when reflux is likely to occur. The following are suggested lifestyle changes that may reduce reflux.

• Obesity promotes reflux. Try to achieve an optimal weight.
• Avoid tight clothing around the midsection of the body or stooping after meals.
• Use abdominal breathing. Let your abdomen expand with each breath in.
• Elevate the head of your bed on blocks, 4 to 6 inches. Extra pillows are not as effective. Do not eat for 3 hours before lying down.

Antacids may be used to neutralize stomach acids and should be taken half an hour after each meal and at bedtime. Examples include TUMS, Maalox, Mylanta, Gaviscon. Acid production can be blocked by medications, some of which can be purchased over the counter without a prescription (eg, Pepcid AC). Prescribed drugs such as H2 blockers (eg, cimetidine or ranitidine) are taken twice daily with meals, and proton pump inhibitors (eg, Losec, Prevacid or Pantoloc) are usually taken once a day in the morning.

Additional factors that may improve symptoms of reflux:

• Eat small meals, up to 6 times each day.
• Caffeine and nicotine increase reflux. Stopping the use of these addictive chemicals will help to relieve the reflux symptoms.
• Avoid foods that cause heartburn such as tomatoes, spicy foods, and citrus fruits. Some fruit juices are irritating as well as acid producing.
• Include protein with each meal and reduce your fat intake. (See the section on diet that follows)
• Although throat lozenges may temporarily reduce symptoms, they cause more reflux. Avoid chewing gum, cough drops, and mouthwashes.