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 – causes, symptoms and treatment

Laryngopharyngeal reflux is not an independent disease, but one of the most common manifestations of gastroesophageal disease (GERD), a pathology of the digestive system, in which the contents of the stomach or duodenum are regularly thrown into the esophagus and cause inflammation of its walls .

Laryngopharyngeal reflux is estimated to occur in about 10% of people diagnosed with gastroesophageal reflux (GERD). Most often, reflux affects people of young and middle age: 20-60 years.

Mechanism of development of laryngopharyngeal reflux

The esophagus is a hollow muscular tube that connects the pharynx to the stomach. Wave-like contraction of the esophagus allows you to push the chewed food into the stomach.

In the upper and lower parts of the esophagus there are special valves – sphincters

Sphincters are located in the upper and lower parts of the esophagus – special valves that allow liquid and food to pass only down into the stomach. Outside of eating, these valves are normally closed and prevent gastric contents (undigested food and gastric juice) from entering the esophagus.

Gastric juice contains hydrochloric acid, which helps digest food. Acid does not harm the stomach, but it acts destructively on other organs.

In laryngopharyngeal reflux, the upper esophageal sphincter does not close completely. As a result, the contents of the stomach are thrown into the esophagus, and from there into the upper respiratory tract and larynx and damage their mucous membranes.

Causes of laryngopharyngeal reflux

There are a number of factors that can trigger the development of laryngopharyngeal reflux.

Main causes of LPR:

• eating large amounts of salty, fatty foods, chocolate, coffee, carbonated drinks, alcohol;
• peptic ulcer of the stomach and duodenum;
• chronic gastroduodenitis – simultaneous damage to the mucous membrane of the stomach and duodenum;
• hiatal hernia – a hernial protrusion that appears when the lower esophagus, upper stomach and intestinal loops are displaced into the chest cavity;
• cholelithiasis – the formation of stones in the gallbladder;
• increased intra-abdominal pressure with flatulence, large neoplasms of internal organs or retroperitoneal space, severe obesity, as well as during pregnancy;
• taking certain drugs from the nitrate group, calcium channel blockers, antidepressants;
• irregular meals, habit of overeating before going to bed;
• Working in a bent or stooped position or taking such postures immediately after eating.

One of the causes of laryngopharyngeal reflux is eating a lot of fatty and fried foods

Symptoms of laryngopharyngeal reflux

The main symptoms of laryngopharyngeal reflux are an unproductive cough and sore throat that worsens after eating. Without timely treatment, there is a risk of developing dysphonia: the voice becomes hoarse or may completely disappear. In this case, it is only possible to speak in a whisper. Unpleasant sensations may appear in the ear area – congestion, pops.

Complications of laryngopharyngeal reflux

In LPR, the mucous membranes of the mouth and upper respiratory tract are constantly injured by the acidic contents of the stomach. Over time, this can provoke sluggish inflammatory processes.

The most common complications of laryngopharyngeal reflux – LPR:

• chronic tonsillitis – inflammation of the palatine tonsils;
• laryngitis – inflammation of the mucous membrane of the larynx;
• adenoiditis – acute or chronic inflammation of the pharyngeal tonsil;
• chronic tracheobronchitis – inflammation of the mucous membrane of the bronchi, trachea and bronchioles (terminal branches of the bronchial tree).

Diagnosis of laryngopharyngeal reflux

Diagnosis of “laryngopharyngeal reflux” is made on the basis of patient complaints, examination data and instrumental and laboratory studies.

Inspection

At the appointment, the doctor conducts a survey: he studies the patient’s diet, eating habits, be sure to pay attention to comorbidities and factors that may contribute to an increase in intra-abdominal pressure.

The Reflux Symptom Index (RSI) scale is sometimes used for preliminary diagnosis of LPR. The assessment is carried out on a five-point scale, where 0 – the symptom is absent, 5 – the symptom is pronounced.

If the RSI is 10 or more, the patient may be suspected of having laryngopharyngeal reflux.

Next, the specialist examines the patient’s pharynx and larynx using special lighting and mirrors. On the back and side walls of the pharynx with LPR, enlarged lymphoid follicles are usually found – they look like grains on the mucous membrane. Mucus is visible between the palatine arches, there may be plugs in the tonsils. At the same time, the mucous membrane of the pharynx is swollen and cyanotic.

When examining the larynx, the doctor may find ulceration in the vocal folds and laryngeal cartilages.

If, based on the results of the interview and examination, the doctor suspects LPR – laryngopharyngeal reflux, he may prescribe instrumental examinations to the patient to confirm the diagnosis.

Instrumental diagnostics

One of the main ways to confirm or exclude laryngopharyngeal reflux is laryngoscopy (examination of the larynx using a special mirror). The procedure allows you to assess in detail the condition of the mucous membrane of the mouth and larynx, to identify violations in the work of the vocal cords.

Also, for diagnostics, FGDS can be prescribed – fibrogastroduodenoscopy . During the procedure, a thin tube is inserted through the patient’s mouth into the esophagus, at the end of which there is a camera and a special flashlight. The procedure is not too pleasant, but does not last long.

According to the results of EGD, the doctor can assess the condition of the mucous membrane of the esophagus and sphincters – valves that are located in its upper and lower parts

Intragastric pH is a method that measures the acidity of the gastric juice and evaluates how damaging the stomach contents are to the esophagus. During the study, a flexible probe is inserted into the corresponding section of the gastrointestinal tract. The results obtained from the probe are processed by a computer.

Esophageal impedancemetry is a study that allows you to detect the movement of gastric contents into the esophagus and evaluate how often and for how long this happens, how the process is affected by the position of the person’s body, the amount of food and the type of medications that he takes. During the procedure, a thin probe equipped with special sensors is inserted into the esophagus and left for 24 hours.

To determine the causes of LPR, the doctor may refer the patient to laboratory tests.

Laboratory diagnostics

So, if chronic gastroduodenitis is suspected, it is useful to take an analysis for Helicobacter in feces by PCR. The bacterium Helicobacter pylori is one of the main causative agents of inflammatory diseases of the stomach and duodenum, including gastroduodenitis.

Helicobacter, DNA (Helicobacter pylori, PCR) feces, quality.

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LPR can also provoke cholelithiasis. A general and biochemical blood test helps to suspect it. The CBC will show non-specific signs of inflammation – an increase in ESR and the concentration of leukocytes. The results of a biochemical study can confirm hypercholesterolemia (increased blood levels of cholesterol), hyperbilirubinemia (high levels of bilirubin) and an increase in alkaline phosphatase activity.

Complete blood count extended with leukocyte formula and reticulocytes (only venous blood)

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Biochemistry 13 indicators

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Treatment of laryngopharyngeal reflux

Treatment of LPR is carried out simultaneously with GERD therapy and includes two main areas: lifestyle changes and the use of proton pump inhibitors (PPIs).

Basic recommendations related to the patient’s lifestyle:

• stop smoking and drinking alcohol;
• monitor body weight;
• to sleep with the head of the bed raised by 15 cm;
• do not wear tight belts, corsets, bandages;
• adjust the diet: do not overeat at night, avoid fatty and fried foods, citrus fruits, coffee, chocolate;
• do not lie down immediately after eating;
• do not take uncontrolled drugs that provoke reflux (reflux of stomach contents into the esophagus): nitrates and calcium channel blockers (they are prescribed for heart disease), as well as antidepressants.

Proton pump inhibitors are medicines that permanently reduce stomach acid production. Usually they are prescribed in standard doses, then the dosage is reduced and gradually switched to maintenance therapy for a period of 6 months to 1 year. The dosage regimen is prescribed by the attending physician.

In difficult cases, surgical treatment may be required – Nissen fundoplication: the fundus of the stomach is wrapped around the esophagus, thus creating a cuff that prevents gastric juice from flowing back into the esophagus.

Which doctor to contact for laryngopharyngeal reflux

Laryngopharyngeal reflux is treated by an otolaryngologist (ENT) – a specialist in diseases of the larynx, pharynx, nose, and ears. He often works with a gastroenterologist.

Prognosis and prevention

With timely treatment and compliance with all doctor’s recommendations, the prognosis is favorable.

Neglected cases and self-treatment can lead to complications: chronic tonsillitis, pharyngitis and other diseases, including pneumonia – pneumonia.

To prevent relapses, patients need to adhere to a balanced diet: do not overeat at night, refuse fatty and fried foods, citrus fruits, coffee, and alcoholic beverages. Sleep with the head of the bed raised by 15 cm. Do not lift weights, watch your weight and do not tighten your chest and stomach with tight corsets and bandages.

And most importantly: when the first symptoms of laryngopharyngeal reflux appear, consult a general practitioner or otolaryngologist (ENT) so as not to start the disease and avoid its complications.

Sources

1. Plotnikova E.Yu., Krasnova M.V., Krasnov K.A., Baranova E.N. Laryngopharyngeal reflux in gastroenterological practice // Attending physician, 2014. No. 2. P. 61–66.
2. Plotnikova E.Yu. “Masks” of gastroesophageal reflux disease. Laryngopharyngeal reflux // IDoctor, 2014. No. 6(25). C. 28–31/
3. Kosyakov S. Ya., Loranskaya I. D., Angotoeva I. B., Muldasheva A. A. Laryngopharyngeal reflux: yesterday, today, tomorrow // Medical Council, 2016. #6. pp. 78–80.

Sore throat and voice treatment for reflux symptoms

Sore throat and its treatment with symptoms of reflux requires a mandatory consultation with a gastroenterologist, an otolaryngologist and the appointment of complex therapy.

A hoarse throat, a lost voice, a feeling of itching, coughing, hoarseness, frequent heartburn are all symptoms of reflux esophagitis. It occurs when inflammation of the mucous membranes of the lower segment of the esophagus due to the frequent reverse reflux of contents from the stomach.

Sore throat and its treatment with symptoms of reflux requires a mandatory consultation with a gastroenterologist, an otolaryngologist and the appointment of complex therapy.

Effect of reflux on the voice

With a long and protracted disease of the digestive tract, diseases of the throat and larynx often occur. The backflow of contents from the esophagus into the throat that occurs with reflux leads to a burning sensation and sensation of a lump in the throat, and sometimes causes swelling of the vocal cords. Such an impact on the speech apparatus is often accompanied by changes in the voice.

Typical symptoms of reflux, indicating a disease of the throat and ligaments, are:

• frequent nocturnal cough;
• morning hoarseness, passing during the day;
• pain when swallowing;
• dry mouth;
• foreign body sensation in throat;
• difficult breathing at night;
• involuntary spasms of the muscles of the larynx;
• heartburn.

With reflux, the throat hurts most often after eating and in the morning after waking up, a characteristic plaque is noticeable on the tongue and a bitter taste appears in the mouth.

How reflux can affect the condition of the larynx

The surfaces of the pharynx and larynx are very sensitive to the effects of gastric secretions. The epithelial layer of these organs is not as protected as the epithelium of the esophagus, therefore, it reacts more intensively to negative influences. This leads to the fact that as a result of reflux disease, conditions such as:

• redness or swelling of the ligaments;
• contact ulcers of the larynx;
• granulomas on the vocal folds;
• narrowing of the glottis.

With prolonged inflammation, in advanced cases, when the necessary treatment is not carried out, tumors may form in the throat and larynx.

How to treat a throat with reflux

For effective treatment of throat with reflux, proper nutrition is required:

• frequent small meals;
• getting rid of excess weight and bad habits, in particular, smoking;
• elimination of meals just before bedtime;
• removal of foods with a high level of acidity from the diet.

To eliminate hoarseness and get rid of hoarseness, you can also use the complex preparation Homeovox. It will help to quickly restore ligaments, cope with voice disorders and protect it from overvoltage.

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• frequent nocturnal cough;
• morning hoarseness, passing during the day;
• pain when swallowing;
• dry mouth;
• foreign body sensation in throat;
• difficult breathing at night;
• involuntary spasms of the muscles of the larynx;
• heartburn.

With reflux, the throat hurts most often after eating and in the morning after waking up, a characteristic coating is noticeable on the tongue and a bitter taste appears in the mouth.

How reflux can affect the condition of the larynx

The surfaces of the pharynx and larynx are very sensitive to the effects of gastric secretions. The epithelial layer of these organs is not as protected as the epithelium of the esophagus, therefore, it reacts more intensively to negative influences. This leads to the fact that as a result of reflux disease, conditions such as:

• redness or swelling of the ligaments;
• contact ulcers of the larynx;
• granulomas on the vocal folds;
• narrowing of the glottis.

With prolonged inflammation, in advanced cases, when the necessary treatment is not carried out, tumors may form in the throat and larynx.

How to treat a throat with reflux

For effective treatment of throat with reflux, proper nutrition is required:

• frequent small meals;
• getting rid of excess weight and bad habits, in particular, smoking;
• elimination of meals just before bedtime;
• removal of foods with a high level of acidity from the diet.

To eliminate hoarseness and get rid of hoarseness, you can also use the complex preparation Homeovox. It will help to quickly restore ligaments, cope with voice disorders and protect it from overvoltage.