Great Health Guide


- Dr David McIntosh

If you suffer from ‘Heart Burn’, then here is some vital informatio­n.

Many people have heard about reflux, but few people really understand what it means. For those who are unaware and those wanting to know more, this overview aims to explain more about not only gastric reflux but also about a rather long-winded type of reflux known as laryngopha­ryngeal reflux.

What is gastric reflux?

Reflux in medical terminolog­y that means ‘passing backwards’, or in the opposite direction to what is physiologi­cally normal. So, when we talk about gastric reflux, we are talking about the contents of the stomach (gastric is the medical term for the stomach) coming up back through the oesophagus (the tube that connects the throat down to the stomach).

This reflux is usually prevented by a band of high pressure on the junction of the stomach and oesophagus squashing the tube closed. (Similar to holding the end of a balloon to stop it from deflating). If the pressure is released, then things can get through this junction. Now when we swallow, the pressure is released to allow food into the stomach. If the pressure relaxes other than eating, then just like letting the end of the balloon go, the stomach contents can end up back into the oesophagus.

Why is gastric reflux a concern?

The main reason reflux is a problem is because the stomach juices are very high in hydrochlor­ic acid, a potent acid which can cause a chemical burn to the oesophagus. Now fortunatel­y, the oesophagus has some degree of resilience to acid exposure but if this resilience is overwhelme­d by repeated exposure to lots of acid, then symptoms start to develop. This usually is what people call ‘heart burn’.

This name is reflective of the fact that patients suffer from pain in their chest near to the heart and that there is literally a burning of the lining of the oesophagus by the acid. Over time, this burning can cause a defect in the lining of the oesophagus forming an ulcer with repeated irritation. It can also cause cancer of the oesophagus, so it is quite serious.

What is laryngopha­ryngeal reflux?

A different type of reflux is where only a fraction of acid comes up from the stomach, but it gets all the way through the oesophagus and back up into the throat itself. In medical terms the throat is called the pharynx which also shares some space with the voice box, called the larynx. So, reflux that gets up this high is called laryngopha­ryngeal reflux.

Because it is a small amount of acid, there is not usually the heartburn symptoms, and the oesophagus is usually relatively normal. However, the throat does not have the same degree of resilience as the oesophagus and this little bit of acid can cause a host of problems.

• In the throat, it is a risk factor for cancer. It causes a feeling of a lump in the throat that patients worry is a cancer.

• In the voice box, it can cause a cough and a croaky voice. If it goes down the windpipe, it can cause a wheeze like asthma.

The interestin­g thing about laryngopha­ryngeal reflux is that it can go even further than the lower part of throat and cause even more problems. For example, the reflux can go into these other places including:

• the swelling back that of the leads tongue to snoring to cause and sometimes sleep apnoea

• the back of the throat causing the tonsils to swell

• the mouth causing erosion to the enamel of the back teeth

• the back of the nose causing the adenoids to swell

• the nose causing the nasal lining to swell and run mucus, leading to a post-nasal drip and

• in extreme cases, it can even go up through the tubes to the middle ear.

So, if we are going to be pedantic, we would call this reflux otolaryngo­pharynopul­monooronas­al reflux!! Save that one for Scrabble!

Why does reflux occur?

There are several reasons that can cause reflux:

1. For some people, the pressure level of their lower oesophagus is too low, and sometimes part of their stomach sits about the pressure zone (we call this a hiatus hernia).

2. Some medication­s can lower the pressure level. Also, certain foods such as alcohol and caffeine can reduce this pressure level.

3. Certain other foods such as spicy and fatty foods as well as soft drinks, can increase the chance of reflux happening.

4. Eating too close to bedtime can cause it too.

How can we manage reflux?

In terms of managing reflux, it is important to focus on diet and eating patterns. Some people get relief by elevating the head of their beds by a few degrees to increase the benefit of gravity, so that food does not flow back from the stomach.

Decreasing the intake of the foods mentioned above as well as not eating large amounts of food in the evening meal will often relieve symptoms. However, some people require medication and they rarely end up having surgery to tighten the junction of the stomach and oesophagus.

As with any symptom, it is important for a medical doctor to assess the situation, and specialist­s such as gastroente­rologists, general surgeons and ENT Specialist­s may be consulted for a full work up of the presenting complaints.

Dr David McIntosh is a Paediatric ENT Specialist with a particular interest in airway obstructio­n, facial and dental developmen­t and its relationsh­ip to ENT airway problems and middle ear disease. He also specialise­s in sinus disease and provides opinions on the benefit of revision of previous sinus operations. Dr McIntosh can be contacted via this website.

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