Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.
Almost everyone has some acidic reflux, but the amount of reflux is small
and rarely causes inflammation of the esophagus (esophagitis). As the
amount of acid reflux increases above the normal range, so does the
probability of developing esophagitis and its symptoms. In patients
with symptoms that suggest acid reflux, a diagnosis of reflux can be
made by demonstrating an acid pH in the esophagus for a greater than
normal amount of time.
A common alternative method to diagnose
reflux is to treat patients with medications that reduce reflux. If
the patient's symptoms stop, then the symptoms are likely to be due to acid
reflux. Another way of diagnosing acid reflux as the cause of
symptoms is to demonstrate that episodes of acid reflux recorded by
esophageal pH monitoring occur at exactly the same time as
esophageal pain.
Esophageal pH monitoring also can be used to determine why
treatment for reflux is not working. For example, a patient treated for acidic
reflux may continue to have symptoms. If so, then the question must
be asked as to why the symptoms are continuing. Is it because the
medication is not adequate or is it because the symptoms are not due
to reflux and, therefore, are not responding to treatment for
reflux? If the pH monitoring study performed while the patient takes
his or her medication for reflux shows abnormal amounts of reflux,
then treatment is inadequate and needs to be changed. If the amount
of acid reflux is within the normal range, then it is likely that the
symptoms are not being caused by acid reflux, and other potential
problems need to be considered as the cause of the symptoms.
What are the limitations of esophageal pH monitoring?
The demonstration of abnormal amounts of acid reflux does not mean
that symptoms are being caused by the reflux. Only treatment with
medications that treat reflux coupled with a marked reduction of
symptoms can be used to substantiate reflux as the cause of the
symptoms. Nevertheless, it is important to remember that treatment
is associated with a placebo response. For instance, 10% to 20% of
patients without acid reflux report an improvement in symptoms with
anti-reflux medications. Therefore, even a good response to
treatment does not definitely prove that reflux is the cause of
symptoms.
Some of the strongest evidence that episodic chest pain is being caused by
acid reflux is provided by demonstrating that the painful episodes coincides with
an episode of acid reflux. If there are very frequent episodes of
reflux, however, it may not be possible to separate a true
association between a symptom and reflux from a chance association
due to the great frequency of episodes of reflux. Conversely, if a
symptom occurs infrequently, for example, once every few days, it is
unlikely that the symptom will occur during a routine 24 hour
monitoring session, and therefore, a correlation will not be
possible. One attempt to get around the latter problem is to extend
the monitoring to several days, but this extended monitoring is done
infrequently.
GERD (gastroesophageal reflux disease) is a condition in which the acidified liquid
contents of the stomach backs up into the esophagus. The symptoms of uncomplicated GERD are heartburn,
regurgitation, and nausea. Effective treatment is available for most patients with GERD.
Chronic cough is a cough that does not go away and is generally a symptom of another disorder such as asthma, allergic rhinitis, sinus infection, cigarette smoking, GERD, postnasal drip, bronchitis, pneumonia, medications, and less frequently tumors or other lung disease. Treatment of chronic cough is dependant upon the cause.
Esophagitis is caused by an infection or irritation of the esophagus. Infections that cause esophagitis include candida yeast infection of the esophagus as well as herpes.
Hoarseness (abnormal deep, harsh, raspy voice) is caused by a variety of conditions in which the larynx (voice box and vocal chords) are irritated or injured. Examples of causes of hoarseness include: laryngitis, straining the vocal cords by yelling or screaming, infections, GERD, allergies, and more. Treatment of hoarseness depends on the cause.
Digestion is the complex process of turning food you eat into the energy you need to survive. The digestive process also involves creating waste to be eliminated, and is made of a series of muscles that coordinate the movement of food.
Acid backing up into the larynx (voice box), it causes reflux laryngitis. Irritation of the lining of the esophagus, larynx, and throat can lead to esophagitis, sinusitis, strictures, hoarseness, throat clearing, swallowing problems, asthma, chronic cough, and more. Typical symptoms of reflux laryngitis include heartburn, hoarseness, or a sensation of a foreign body in the throat. Reflux laryngitis can be treated with OTC medication, prescription medication, and lifestyle changes.
Digestion RSS
Healthy Living Tips
This site complies with the