Dr. Robert Bodlaj | Practice for Ears-Nose-Throat Medicine
What is reflux, actually?
When we eat, the food we chew and swallow is transported to the stomach through the oesophagus. So that a back-flow (“reflux”) of the stomach contents back into the oesophagus can be prevented, it is equipped with a complex closing mechanism. This is important since aggressive substances are formed in the stomach for the purpose of digestion, mainly stomach acid. In Reflux disease, this closing mechanism for the oesophagus is disturbed so that some of the digestive juices can flow back into the oesophagus. This can lead, for example, to an inflammation of the oesophagus, which in technical terms is referred to as reflux-oesophagitis. Many people are aware of this feeling as “heartburn”, a burning feeling in their chests, which is caused by acid reflux in the oesophagus. Acid can also travel the entire way up the neck and continue into the upper respiratory passages and the back section of the mouth area. This is referred to as laryngo-pharyngeal reflux (LPR), since it occurs in the area of the vocal chords/larynx and the throat (pharynx). LPR is primarily gaseous and not liquid. It often occurs without heartburn, and for that reason it is often not so easily recognised. “Quiet reflux” is especially harmful, because the tissues in the throat and the lungs cannot withstand much acid. It can continue over a very long time before it is identified as a cause of complaints.
In the following , we would like to share some information about the complex field of reflux diagnostics:
What symptoms can be indicative of a reflux disease?
The complaints can occur alone or in combination with others. The most frequently occurring symptoms that indicate a (silent) reflux are the following:
- hoarse voice, especially in the morning
- repeatedly clearing the throat or coughing,
- feeling of a lump in one’s throat,
- excessive mucous formation and flow of secretions along the back wall of the throat,
- sleep apnoea,
- difficulty swallowing,
- upper abdominal pain
Does reflux in the throat have to be taken seriously?
Basically: All impediments to one’s well-being and complaints are signals from the body that one should take seriously. A small amount of reflux is normal. However, when chronic reflux remains untreated, it can cause serious damage to the mucous membranes in the upper respiratory passages and even in the lungs. Early treatment of reflux is very important. If it remains undiagnosed and untreated, it can lead to severe damage in the throat area. Many people who suffer from LPR do not notice it because the resulting symptoms can also be caused by a number of different factors, such as lifestyle (smoking, alcohol consumption) or deficient vocal habits (shouting a lot, poor control of one’s voice). Untreated reflux complaints can have a very significant negative impact on your quality of life. If severe reflux is left untreated, it can cause inflammation of the oesophagus (oesophagitis) and damage the tissue. This can lead in turn to very serious problems even to so-called Barrett’s Oesophagus and even to potential oesophageal cancer (oesophageal carcinoma) in the future. In the area of the upper respiratory passages, untreated LPR can lead to considerable problems such as vocal cord nodules, sub-glottal stenosis (contraction of the airway), granuloma (formation of knotty tissue) and under some conditions can lead to laryngeal cancer. One should not take even apparently minor complaints of this sort “in stride”!
How is reflux diagnosed and treated?
Dr. Bodlaj will ask you a series of questions about your symptoms or will ask you to fill out a questionnaire. This will allow him to determine if your complaints might be caused by a reflux. This information then helps the doctor to decide if a reflux test is the right method to confirm the diagnosis, as a basis for making the right decision on treatment. You absolutely must tell your doctor about any strain to your voice and any consumption of alcohol or nicotine. If there is suspicion of reflux, and examination of the pharynx is indicated. This examination can be quickly and easily carried out in the practice. Dr. Bodlaj will look for signs of swelling, development of redness or whiteness in the mucous membranes and other possible signs of reflux events such as granulomas and nodes.
The highly modern “Restech Dx-System ©” may be used for this. The system inserts a small probe through the nose into the throat behind the tonsils and places it. The tip of the probe contains a sensitive sensor that not only detects liquids but also detects acids in aerosolised form and can record the readings. The probe is mounted to your face with a transparent bandage. The data are recorded wirelessly by a small device that you wear on your belt or can carry over the shoulder with a strap. The position of the probe will not disturb you when you speak, eat, drink or swallow. During the recording period (16-48 hours) you can eat all of your normal meals, go to work and even play sports. You cannot shower or take a bath during this phase because that could damage the transmitter.
The Dx-system will record pH-values as long as the probe is worn. The interpretation of the recorded readings provides your treating physician with reliable indications of the degree of severity of your reflux events. By cooperating with the input of certain information into the Dx-system (meal times, selected symptoms and time spent lying down), you contribute significantly to the success of this diagnostic procedure. You will help your doctor be able to better assess a connection between your complaints and symptom patterns for reflux. This will not only determine if you suffer from reflux, but will determine whether acid is responsible for your problems at all, or whether the symptoms are caused by a high alkali concentration. Removing the probe is very easy. The evaluation of the readings only takes a few minutes. Based on the results, Dr. Bodlaj will be able to determine the best possible treatment for you. Depending on the severity of your symptoms, the findings of the medical examination and your measured pH-values, a treatment regime that’s right for you will be drafted. Depending on the severity of your reflux, this can range from a slight modification of your everyday habits to prescription medication and in moderate to severe cases even to a surgical intervention.
How can you contribute to your own well-being?
Would you like to feel better for the long term? Changing one’s everyday habits is difficult but the following tips can help you to reduce the risk of a reflux disease or to reduce the symptoms of existing reflux:
- Your last meal of the day should be at the latest 3 hours before you go to bed
- Do not eat any snacks and eat slowly.
- You should either consume the following in small amounts or avoid them completely: fatty and spicy foods, caffeine, carbonated drinks, alcohol, chocolate, drinks containing citrus or tomato.
- It is known that these substances can lead to a worsening of reflux, whereby each person reacts individually and differently to foods and beverages.
- Do not wear any tight-fitting clothing, especially not around your hips
- If you are overweight, try to reduce your weight
- If you smoke, cut down or better still quit smoking completely
- Elevate the head of your bed by 10-15 cm (around 30°)