John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.
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.
Foods and drinks can cause heartburn and acid reflux or GERD, for example: 1) alcohol, because it relaxes the lower esophageal sphincter, 2) caffeine, 2) chocolate, 3) peppermint, 4) garlic, raw onions, black pepper, and spicy foods, 5) tomatoes, and 6) citrus fruits and juices.
Reflux is caused by weakness in the muscle at the junction of the esophagus with the stomach. Normally, this muscular valve, or sphincter, functions to keep food and stomach acid from moving upward from the stomach to the esophagus and larynx. This valve opens to allow food into the stomach and closes to keep the stomach's contents from coming back up. The backward movement of stomach contents (gastric contents) up into the esophagus is called gastroesophageal reflux. Moreover, any increase in abdominal pressure (such as obesity or tight clothing, which can push acid back from the stomach up the esophagus) or a person with a hiatal hernia will have an increased risk for reflux. When it causes symptoms or esophageal inflammation it is referred to as gastroesophageal reflux disease (or GERD). When the acid backs up into the voice box (larynx), the condition is referred to as reflux laryngitis.
Stomach acid can cause irritation of the lining of the esophagus, larynx, and throat. This can lead to
Rarely, reflux can lead to cancers of the esophagus or larynx.
Heartburn is the most common symptom associated with reflux. The American College of Gastroenterology estimates that more than 60 million Americans experience heartburn at least once a month and some studies suggest that more than 15 million people experience heartburn symptoms each day. The incidence of GERD is on the rise, and the rise in obesity is believed to be a contributing factor. In addition to heartburn, reflux severe enough to cause laryngitis can cause chronic hoarseness, asthma, or a foreign body sensation in the throat (globus phenomenon). Considering the high prevalence of GERD, reflux laryngitis and its symptoms are uncommon.
In most patients, the presumptive diagnosis of reflux laryngitis is based on the typical history of heartburn and hoarseness. Testing usually is reserved for those patients who do not respond to conservative therapy (as explained below) or drug therapy. Diagnostic tests includes an:
Diet, home remedies, medications, and lifestyle changes to treat acid reflux, heartburn, and reflux laryngitis.
There are several different types of medications available over the counter (OTC) or by prescription.
Antacids neutralize stomach acid and give immediate relief. Popular choices include sodium bicarbonate (Alka Seltzer), calcium carbonate (Tums, Rolaids, Alka-Mints), and aluminum and magnesium antacids (Maalox, Mylanta, Riopan, Gaviscon). Use antacids 30 to 60 minutes after each meal and at bedtime because they are more effective at these times.
People on a low sodium diet should avoid sodium bicarbonate. Calcium and aluminum can cause constipation, while magnesium antacids can cause diarrhea. Patents with kidney disease should avoid magnesium and aluminum antacids. Check with your pharmacist or doctor for any interactions with other medications you are taking.
Drugs such as nonsteroidal anti-inflammatory drugs (NSAIDS), theophylline (Theo-Dur, Respbid, Slo-Bid, Theo-24, Theolair, Uniphyl, Slo-Phyllin), anticholinergics, and calcium channel blockers should be avoided if feasible, but discuss discontinuing any medication with a doctor first.
The acid-blocking drugs (famotidine [Pepcid], cimetidine [Tagamet], nizatidine [Axid], ranitidine [Zantac]) are known as H2-blockers. These are available without a prescription. However, their strength may be inadequate.
Other valuable medications include metoclopramide (Reglan), which helps to empty the stomach more rapidly; or proton pump inhibitors, such as omeprazole (Prilosec) and lansoprazole (Prevacid).
If conservative therapy and medical therapy fail, surgery may be necessary. Traditionally, fundoplication, a procedure that serves to strengthen or recreate the muscular valve (lower esophageal sphincter), requires significant surgical work and hospital stay. Surgery or fundoplication also has been able to be done with an endoscope, which shortens the hospital stay and recovery.
In some patients it appears clear that the laryngeal symptoms - hoarseness, cough, sore throat - are due to reflux, for example, in patients with marked heartburn and regurgitation of acid.
In most patients with laryngeal symptoms - those with milder heartburn and no regurgitation who comprise the majority of patients in whom reflux laryngitis is considered - it is not as clear. Examination of the larynx may reveal redness and swelling, but many diseases of the larynx as well as reflux can cause these signs.
There are difficulties with using symptoms to diagnose reflux. For example, cough may occur when there is reflux into the esophagus. Refluxed liquid does not need to reach the larynx.
Finally, it is unclear whether refluxed liquid from the stomach that is not acid can cause reflux laryngitis, and there is no way of testing whether or not non-acid liquid is reaching the larynx. Many physicians use a trial of potent acid-suppression with PPIs to try to prove that acid reflux is the cause of the laryngeal symptoms. The problem with a trial of PPIs is that some symptoms such as cough and throat clearing can be caused by habit, and the PPIs may have a placebo effect. Thus, a response to PPIs may not be proof that reflux is the cause of symptoms.
Endoscopy is a broad term used to described examining the inside of the body using an lighted, flexible instrument called an endoscope. Endoscopy procedure is performed on a patient to examine the esophagus, stomach, and duodenum; and look for causes of symptoms such as abdominal pain, nausea, vomiting, difficulty swallowing, or intestinal bleeding.
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. Signs and symptoms of esophagitis include cough, mouth sores, chest pain, bad breath, sore throat, heartburn, and difficulty swallowing.
Treatment of esophagitis includes diet, lifestyle changes, and medication depending upon the cause.
Coughing is a reflex that helps a person clear their airways of irritants. There are many causes of an excessive or severe cough including irritants like cigarette and secondhand smoke, pollution, air fresheners, medications like beta blockers and ACE inhibitors, the common cold, GERD, lung cancer, and heart disease.
Natural and home remedies to help cure and soothe a cough include stay hydrated, gargle saltwater, use cough drops or lozenges, use herbs and supplements like ginger, mint, licorice, and slippery elm, and don't smoke.
Over-the-counter products (OTC)to cure and soothe a cough include cough suppressants and expectorants, and anti-reflux drugs.
Prescription drugs that help cure a cough include narcotic medications, antibiotics, inhaled steroids, and anti-reflux drugs like proton pump inhibitors or PPIs, for example, omeprazole (Prilosec), rabeprazole (Aciphex), and pantoprazole (Protonix).
Laryngitis is an inflammation of the voice box (vocal cords). The most common cause of acute laryngitis is infection, which inflames the vocal cords. Symptoms may vary from degree of laryngitis and age of the person (laryngitis in infants and children is more commonly caused by croup). Common symptoms include
Chronic laryngitis generally lasts more than three weeks. Causes other than infection include smoking, excess coughing, GERD, and more. Treatment depends on the cause of laryngitis.
Signs and symptoms of pregnancy vary by stage (trimester). The earliest pregnancy symptom is typically a missed period, but others include breast swelling and tenderness, nausea and sometimes vomiting, fatigue, and bloating.
Second trimester symptoms include backache, weight gain, itching, and possible stretch marks.
Third trimester symptoms are additional weight gain, heartburn, hemorrhoids, swelling of the ankles, fingers, and face, breast tenderness, and trouble sleeping.
Eating a healthy diet, getting a moderate amount of exercise, also are recommended for a healthy pregnancy. Information about the week by week growth of your baby in the womb are provided.
Sinus infection (sinusitis) is caused by allergies, infection, and chemicals or other irritants of sinuses. Signs and symptoms are headache, fever, and facial tenderness, pressure, or pain. Treatments of sinus infections are generally with antibiotics and at times, home remedies.
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