Sore throat and acid reflux: Causes and treatment

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Acid reflux happens when stomach acid travels up into the esophagus, irritating its lining. This irritation can lead to a sore throat, a dry cough, and wheezing.

It can also cause heartburn, a bitter taste in the mouth, regurgitation, indigestion, and difficulty swallowing.

Acid reflux is a common condition. A person may notice the symptoms when they are lying down or bending over, or after eating a big meal or spicy food.

Read on to learn about:

• what acid reflux is
• if it can cause a sore throat
• acid reflux in children
• treatments and self-care strategies
• other causes of a sore throat

Acid reflux is another name for gastroesophageal reflux. It occurs when stomach acid and other stomach contents rise up into the esophagus.

Acid reflux is a common condition and often does not cause symptoms. When it does, a person may have indigestion or heartburn.

Some people develop chronic reflux, and doctors call this gastroesophageal reflux disease (GERD). It causes more severe and lasting symptoms. About 20% of people in the United States have GERD.

In addition to indigestion and heartburn, acid reflux can cause:

• a sore throat
• regurgitation
• nausea
• pain or difficulty with swallowing

Having weakened or irregular muscles at the base of the esophagus can cause GERD. Other possible causes include:

• eating fatty, acidic, or spicy foods
• having unusual esophageal spasms
• pregnancy
• a hiatal hernia
• slow stomach emptying

Learn more about acid reflux, including how doctors diagnose it, here.

Yes. Acid reflux can cause a sore throat, though heartburn is the most common symptom.

When a sore throat stems from acid reflux, a person may also feel as if they have a lump in their throat.

Head and neck symptoms related to acid reflux can be misleading. Doctors sometimes misdiagnose a persistent sore throat from acid reflux as recurrent or chronic tonsillitis.

Complications of acid reflux

Some people who have acid reflux for a long time may experience:

• Narrowing of the esophagus: The rising stomach acid can damage cells in the lower esophagus, resulting in scar tissue that narrows the organ. This can make swallowing difficult.
• Erosion of tissues: The acid can also cause ulcers, which can be painful. This is known as erosive esophagitis.
• Barret’s esophagus: This condition can cause changes in the tissue that lines the lower esophagus. These changes are associated with a higher risk of esophageal cancer. Routine endoscopy exams can detect early signs of this cancer in people with Barret’s esophagus.

Laryngeal pharyngeal reflux

When stomach, or gastric, acid reaches the vocal cords, it can cause significant inflammation.

If this occurs repeatedly, it can cause in hoarseness, frequent throat clearing, coughing, and a feeling that something is stuck in the throat. The name for this issue is laryngeal pharyngeal reflux.

It often seems to begin as an upper respiratory illness. The symptoms may linger, as a result of damage to the vocal cords that can stem from even small levels of acid reflux.

Treating acid reflux effectively reduces the risk of its complications. Often, small changes to routines can make a difference.

Diet and other self-care strategies

Some people can prevent the sore throat from acid reflux by avoiding activities and foods that increase the risk of acid reflux and its complications.

In otherwise healthy people, these measures may be enough to manage acid reflux, without the need for meds:

• eating small meals 3 to 4 times a day
• elevating the head more during sleep
• not eating 2–3 hours before bed
• avoiding citrus juices, tomato juice, and other acidic drinks, which can irritate the lining of the esophagus
• avoiding acidic, spicy, and fatty foods, including full-fat cow’s milk
• avoiding carbonated, caffeinated, and alcoholic drinks
• not eating mint or mint-flavored foods
• avoiding chocolate
• maintaining a moderate weight
• not wearing tight clothes
• not smoking

Medication

OTC and prescription medicines can neutralize or reduce stomach acids, relieving the symptoms of acid reflux, including a sore throat.

Two helpful types of medication are histamine-2 blockers (h3 blockers) and antacids. h3 blockers help reduce the amount of acid in the stomach, while antacids can help with mild symptoms of acid reflux or GERD.

Other medications work by strengthening the muscles that separate the esophagus from the stomach, to prevent stomach acid from traveling upward.

Various acid reflux medications are available for purchase online.

When to see a doctor

A person should see a doctor if they have any bothersome or concerning symptoms, especially those that might indicate an underlying health issue.

It is also a good idea to contact a doctor if existing reflux symptoms worsen. Particularly if the symptoms are interfering with daily life, a doctor may recommend stronger medications or surgery.

Anyone who has indigestion with chest pain, shortness of breath, or pain in the arm or jaw should receive emergency medical care. These symptoms may indicate a heart attack.

Learn about the signs of a heart attack in females here.

Acid reflux can affect children and infants, as well as adolescents and adults.

Infants with acid reflux may refuse to eat or be unable to gain weight. They may have breathing difficulties or pain after eating.

The cause may be spending long periods lying down or an underdeveloped esophagus.

Also, some experts believe that the length of the esophagus, the condition of the muscles in the lower esophagus, and pinching of the fibers in the diaphragm may influence the development of this condition in children.

Children may also be sensitive to certain foods that affect the valve-like mechanism between the esophagus and the stomach.

When children have acid reflux, doctors may may recommend:

• not lying down immediately after a meal
• having the head raised more during sleep
• the same changes to eating habits described in the self-care section above

For older children, depending on the severity of the symptoms, doctors may prescribe or recommend:

• antacids
• h3 blockers, such as famotidine (Pepcid)
• proton pump inhibitors, such as esomeprazole (Nexium), omeprazole (Prilosec), and lansoprazole (Prevacid)

Several environmental and behavioral factors can cause a sore throat. It may be more likely that a viral or bacterial infection is responsible, such as:

• A cold or the flu: These viral illnesses are the most common cause of a sore throat.
• Strep throat: Group A Streptococcus bacteria cause the inflammation known as strep throat. Symptoms include a sore throat that starts suddenly, red and swollen tonsils, pain when swallowing, and a fever.
• Diphtheria: This potentially serious illness can also cause a fever, weakness, and swollen lymph nodes, sometimes called swollen glands.
• Whooping cough: This bacterial illness causes a sore throat by affecting the respiratory mucous membrane.

Some other illnesses that can cause a sore throat include:

• mononucleosis, also known as glandular fever
• measles
• chickenpox
• croup

In rare cases, a sore throat is sign of HIV or throat cancer.

Anyone with a weakened immune system, such as from HIV, may be prone to oral thrush and cytomegalovirus infection, both of which can affect the throat.

Allergies

Anyone with an allergy to mold, pet dander, or pollen may have a sore throat when they encounter these allergens. The allergic reaction causes mucus to accumulate in the throat, which results in pain and inflammation.

Dry air can also make some people’s throats feel raw and scratchy.

Smoke, tobacco, and alcohol

People who smoke or are regularly exposed to secondhand smoke have an increased risk of a sore throat.

Chewing tobacco or drinking alcohol can also irritate the throat.

Shouting and speaking

Talking for long periods without rest, speaking loudly, or shouting can strain the muscles in the throat, causing soreness.

Acid reflux can cause several symptoms, including a sore throat. Anyone can develop this condition, including infants. The treatment may involve self-care strategies and, for older children and adults, medications.

Speak with a doctor if the symptoms do not improve with treatment or worsen. Also, contact a doctor if asset reflux symptoms occur with any symptoms that are concerning.

If indigestion accompanies chest pain, shortness of breath, or pain in the arm or jaw, contact emergency medical services. These symptoms can indicate a heart attack.

Could Your Sore Throat Be Caused by ‘Silent Reflux’?

Despite its name, silent reflux, also known as Laryngopharyngeal Reflux (LPR), is anything but quiet. The condition, which causes throat irritation and pain, is referred to as silent reflux because it often lacks the hallmark symptom of GERD and typical acid reflux – heartburn.

Despite the absence of heartburn, many people with LPR report a wide variety of symptoms due to the damage the acid causes to their voice box, respiratory system, teeth, and throat.

“Reflux can be what we call extra-esophageal,” notes Michael Vaezi, MD, PhD, clinical director of the division of gastroenterology and hepatology and director of the Center for Esophageal Motility Disorders at Vanderbilt University in Nashville, Tenn. “These patients may not have heartburn sensation in the chest. It’s not really silent, [but it is] presenting atypically.”

Not So Silent Symptoms

If you have LPR you may experience:

• Hoarseness. As stomach acid comes up onto your voice box, or larynx, you may find your voice sounds more hoarse or harsh than usual. This symptom may be particularly noticeable in the mornings, since acid is often more likely to move up the throat when you are lying down.
• Throat problems. Acid reflux into the pharynx, or back of the throat, can also cause atypical symptoms. You may feel as if you constantly have sore throat, or always need to clear your throat. Additionally, it may feel as if there is a lump in the back of your throat that won’t go away. Other symptoms include frequent hiccups, trouble swallowing, or a nagging cough.
• Respiratory problems. People with silent reflux can experience wheezing or difficulty catching their breath as a result of airway irritation due to acid reflux. LPR can often exacerbate underlying asthma and make it more difficult to treat.
• Tooth decay. Stomach acid that backs up into the mouth can erode or eat away at the protective enamel of the teeth, causing teeth to become fragile and discolored.

RELATED: 7 Surprising Facts About GERD and Acid Reflux

Treating Silent Reflux

If your doctor suspects LPR they may order some tests to confirm their diagnosis and determine which treatment option is best for you. These tests include:

• Barium swallow. This test involves a series of X-rays of the upper gastrointestinal system, or digestive tract, performed after a patient drinks a special barium solution. The contrast solution allows doctors to evaluate the digestive tract for structural problems that may be associated with LPR.
• Endoscopy. Doctors insert a lighted tube attached to a small camera into the throat. The tube is used to examine the larynx, pharynx, and esophagus for signs of damage consistent with acid reflux. Tissue samples are usually taken to test in the laboratory for any evidence of chronic irritation, inflammation, infection, or abnormal cells.
• pH monitoring. A thin tube is inserted through the patient’s nose and down into the esophagus. A device at the end of the tube measures the acidity, or pH, of the inside of the esophagus over a period of one to two days. Alternatively, a capsule is attached to the wall of the esophagus to monitor pH levels. The capsule then detaches and is passed through the patient’s digestive system. Abnormally high levels of acidity are suggestive of LPR.
• Proton pump inhibitor test. Your doctor may try to diagnose your problem by treating you with a trial of proton pump inhibitors, which reduce the amount of acid secreted by the stomach. If your symptoms improve or disappear with medication then you most likely have LPR.

Silent reflux is most often treated with proton pump inhibitors such as Nexium (esomeprazole), Protonix (pantoprazole), Prevacid (lansoprazole), Aciphex (rabeprazole), or Prilosec (omeprazole).

Lifestyle changes can also help reduce LPR symptoms. Your doctor may recommend:

• Quitting smoking
• Avoiding alcohol
• Eliminating caffeine
• Losing weight
• Ditching meals three hours prior to bedtime
• Elevating the head of your bed four to six inches
• Avoiding restrictive clothing
• Dietary changes (Foods that are fatty, fried, spicy, or include mint or chocolate should be avoided)

In some cases, LPR symptoms may persist despite lifestyle changes and medications. In these instances, surgery may be recommended to tighten the lower esophageal sphincter.

Although LPR is an uncomfortable and potentially serious condition, with the right diagnosis it is possible to keep symptoms under control and avoid complications.

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Laryngopharyngeal reflux symptoms and treatment

Treatment of the disease laryngopharyngeal reflux is engaged in
otorhinolaryngologist,

gastroenterologist

Laryngopharyngeal reflux (LPR) is the reflux of stomach contents (acid and enzymes such as pepsin) into the larynx, resulting in hoarseness, a sensation of a lump in the throat, difficulty swallowing, coughing, and a feeling of mucus in the hypopharynx.

Reflux as the cause of the above symptoms without gastroesophageal reflux disease (GERD) is constantly questioned. Guidelines issued by specialized societies in the field of laryngology and gastroenterology represent different points of view. Both groups acknowledge that the interpretation of existing studies is difficult due to the uncertain diagnostic criteria for LPR, varying response rates to treatment, and the significant placebo effect of the current treatment.

Relatively limited data are available on the prevalence of LPR: approximately 30% of healthy individuals may have episodes of reflux on 24-hour pH measurements or characteristic changes in the larynx.

LPR may directly or indirectly cause laryngeal symptoms. The direct mechanism includes irritation of the mucous membrane of the larynx with caustic substances – refluxes (acid, pepsin). An indirect mechanism involves irritation of the esophagus, leading to laryngeal reflexes and symptoms.

Helicobacter pylori infection may also contribute. The prevalence of H. pylori among patients with LPR is about 44%.

Laryngofangeal reflux and GERD

Although gastric acid is common to both LPR and GERD, there are many differences that make LPR a distinct clinical entity.

• A prerequisite for GERD is heartburn, which is reliably observed only in 40% of patients with LPR.
• Most patients with GERD have evidence of esophagitis on biopsy, while patients with LPR only in 25% of cases.
• GERD is thought to be a lower esophageal sphincter problem and occurs primarily in the supine position. In contrast, LPR is seen primarily as an upper esophageal sphincter problem, and occurs primarily in the upright position during exercise.
• LPR requires much less acid exposure than GERD.

There are significant differences between the mucous membrane of the esophagus and the larynx.

• The upper limit of normal for acid reflux into the esophagus is up to 50 episodes per day, while 4 episodes of reflux into the larynx is no longer a normal option.
• In the larynx, unlike the esophagus, which eliminates acid during peristalsis, reflux remains much longer, causing additional irritation.
• The epithelium of the larynx is thin and poorly adapted to combat caustic chemical damage from the same pepsin and acid.

Symptoms of laryngopharyngeal reflux

• Dysphonia or hoarseness;
• cough;
• lump in throat;
• discomfort and feeling of mucus in the throat;
• dysphagia (swallowing disorder).

Some researchers believe that chronic irritation of the larynx may lead to the development of carcinoma in patients who do not drink alcohol or smoke, although there is no evidence to support this.

Symptoms characteristic of LPR may also be due to the following conditions:

• postnasal syndrome;
• allergic rhinitis;
• vasomotor rhinitis;
• upper respiratory infections;
• habitual cough;
• use of tobacco or alcohol;
• excessive use of the voice;
• change in temperature or climate;
• emotional problems;
• environmental irritants;
• vagus neuropathy.

Diagnosis

There is considerable controversy regarding the appropriate method for diagnosing LPR.

Most patients are diagnosed clinically based on symptoms associated with LPR.

During laryngoscopy (examination of the larynx), swelling and hyperemia (redness) of varying degrees are noted. However, the relatively weak correlation between symptoms and endoscopic findings is an argument against the use of endoscopic diagnostic methods.

The Reflux Signs Score and the Reflux Symptoms Index are well suited for both diagnosis and monitoring of response to therapy.

Daily Ph-metry with a dual sensor probe, despite excellent sensitivity and specificity, is questioned because the results of this diagnostic method often do not correlate with the severity of symptoms.

Another diagnostic option may be empiric PPI therapy.

Treatment of laryngopharyngeal reflux

Lifestyle modification and diet are the main approach in the treatment of LPR and GERD. The role of drug therapy is more controversial. Whether asymptomatic patients with incidental signs of LPR require treatment is unknown. There are theoretical concerns that LPR may increase the risk of malignancy, but this has not yet been proven. In any case, patients with asymptomatic LPR are advised to follow a diet.

Patients are advised to stop smoking, alcohol, foods and drinks containing caffeine, chocolate, mint. Prohibited foods also include most fruits (especially citrus fruits), tomatoes, jams and jellies, barbecue sauces and most salad dressings, and spicy foods. Small meals are recommended.

Exercise should be avoided for at least two hours after meals, and food and drink should be avoided three hours before bedtime.

Drug therapy usually includes proton pump inhibitors (PPIs), h3 blockers, and antacids. PPIs are recommended for six months for most LPR patients. This figure is based on the results of endoscopic studies (this is the time needed to reduce laryngeal edema), as well as a high percentage of relapse in the case of a three-month course of therapy. Termination of therapy should be carried out gradually.

If PPIs and H2 blockers have failed, treatment with tricyclic antidepressants, gabapentin, and pregabalin should be considered, as laryngeal hypersensitivity is one possible mechanism for reflux.

How is laryngopharyngeal reflux treated at Rassvet Clinic?

All patients with complaints of hoarseness, feeling of a lump in the throat, difficulty swallowing, coughing, feeling of mucus in the laryngopharynx are examined by an otorhinolaryngologist and a gastroenterologist.

An endoscopic examination of the nasal cavity, nasopharynx, and larynx is performed to exclude other diseases that, in addition to LPR, can provoke these symptoms. The gastroenterologist also prescribes the entire range of necessary examinations, including the elimination of H. Pylori infection.

The key to successful therapy is the joint management of the patient by an otorhinolaryngologist, a gastroenterologist, in some cases a psychiatrist and a psychotherapist.

Author:

Chekaldina Elena Vladimirovna
otorhinolaryngologist, Ph.D.

Publication date: February 5, 2021

Update date: August 9, 2022

Treatment of gastroesophageal reflux disease – symptoms and stages

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Contents

• What is gastroesophageal reflux disease?

• How is gastroesophageal reflux disease treated?

You have been treated by an otorhinolaryngologist , but the prescribed treatment did not help? You cannot understand why you are referred to gastroenterologist if you have a sore throat, a hoarse voice and even its loss or a persistent cough that is not amenable to standard therapy?

Often the cause of these complaints can be diseases of the gastrointestinal tract, namely gastroesophageal reflux disease , or abbreviated GERD .

What is gastroesophageal reflux disease?

In this disease there is a reflux of gastric or gastrointestinal contents into the esophagus and even into the larynx, due to the fact that the epithelium of the pharynx and larynx is more sensitive to the damaging effect of gastric secretions, and the above complaints appear.

The presence of such extraesophageal manifestations can cause difficulties in both diagnosis and treatment errors. What to do? First of all, it is necessary to analyze the time and causes of the onset of symptoms of the disease. If these symptoms are associated with GERD, they occur and intensify when bending over, in a horizontal position, physical exertion, after drinking alcohol and some eating errors (fatty foods, alcohol, carbonated drinks), when taking certain medications that reduce tone smooth muscles, are often accompanied by heartburn, sour belching and even chest pain.

Of the instrumental diagnostic methods that make it possible to diagnose GERD, daily pH-metry with the simultaneous use of two probes (pharyngeal and esophageal) and esophageal impedancemetry are , allowing to estimate the number of refluxes of gastric contents, their duration, to assess the composition of the refluxed contents.

How is gastroesophageal reflux disease treated?

Treatment of GERD should begin with lifestyle changes: first of all, it is necessary to reduce body weight, if it is excessive, and stop smoking.