Gastroesophageal reflux disease is one of the most common disorders in the Western world. Roughly 40 percent of American adults have heartburn or acid regurgitation, the hallmark symptoms of GERD, at least once monthly. These symptoms, which doctors call "esophageal manifestations" of GERD, are familiar to most people. However, GERD can also present with extra-esophageal symptoms, such as chronic cough, recurrent sinus or ear infections, hoarseness or persistent sore throat. It is even possible to experience extra-esophageal symptoms of GERD without having heartburn or reflux, which can delay diagnosis.
1. High Reflux
Your stomach contents are normally kept in place by a complex muscular mechanism called the lower esophageal sphincter. If your LES is compromised by age, obesity, overeating, medications, smoking, alcohol or other factors, your stomach contents can regurgitate up into your esophagus. The symptoms caused by reflux are largely dependent on the volume of refluxed material and how high it rises into your esophagus. According to a 2012 review in "Gastroenterology and Hepatology," high esophageal reflux – a condition called laryngopharyngeal reflux – can cause sore throat, painful swallowing or the sensation of a lump in your throat. Diagnosis of laryngopharyngeal reflux may require laryngoscopy, which allows your doctor to visualize your throat through a narrow scope, or other special tests.
2. Inhaled Irritants
Your digestive system and respiratory tract are connected at your larynx, or voice box. When you swallow, messages traveling between your brain and throat close your epiglottis – a leaf-shaped structure at the top of your larynx – creating an effective seal over your airway. Similarly, if your stomach contents rise into your esophagus, nerve reflexes clamp your epiglottis over the top of your larynx and prevent you from inhaling potentially caustic substances. However, if you have frequent bouts of high reflux, you could inadvertently inhale small amounts of stomach acid. This could generate a cough, hoarseness, constant throat clearing, excess mucus production or breathing difficulties.
3. Throat Cancer
Doctors have known for many years that GERD causes throat problems for some patients. However, researchers are still trying to decide whether acid reflux increases the risk of laryngeal cancer. Other irritating substances – namely cigarette smoke and alcohol – have been solidly linked to laryngeal cancer. But the connection between GERD and laryngeal cancer is less clear. A 2005 review in "Current Opinion in Otolaryngology & Head and Neck Surgery" reported there was no convincing evidence linking GERD to laryngeal cancer. Conversely, a study published in the September 2006 issue of "The American Journal of Medicine" stated that GERD is a significant risk factor for laryngeal cancer. If you have throat symptoms due to GERD, ask your physician if you need to be screened for throat cancer.
People who have throat problems due to GERD are typically advised to make lifestyle changes to reduce acid reflux, such as quitting smoking, limiting alcohol consumption, losing weight and eating small, low-fat meals. Acid-suppressing medications such as omeprazole (Prilosec) or lansoprazole (Prevacid) may also be part of your treatment plan. However, it is not unusual for people who are taking maximum doses of acid-suppressing drugs to still have symptoms, possibly because other substances are rising from your stomach – pepsin, for example – that can irritate your throat, but that are not addressed by these medications. Therefore, if you don't respond to medications and lifestyle changes, your doctor may recommend surgery.
- ISRN Gastroenterology: Current Trends in the Management of Gastroesophageal Reflux Disease: A Review
- American Family Physician: Atypical Presentations of Gastroesophageal Reflux Disease
- Gastroenterology & Hepatology: New Developments in Extraesophageal Reflux Disease
- Current Opinion in Otolaryngology & Head and Neck Surgery: What Is the Evidence that Gastroesophageal Reflux Is Involved in the Etiology of Laryngeal Cancer? (abstract)
- The American Journal of Medicine: Laryngeal Cancer and Gastroesophageal Reflux Disease: A Case Control Study
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