Gastroesophogeal Reflux Laryngitis / Pharyngitis

Stomach contents are generally prevented from regurgitating back up the esophagus (feeding tube) into the throat by a muscular ring at the entrance to the stomach. Many drugs and foods cause this muscle to relax which allows the acid to reflux from the stomach. During the day, gravity helps to keep acid from flowing upwards towards the throat. When lying down to sleep at night, especially if the muscular ring is relaxed and the stomach is full, stomach acid can freely flow through the esophagus into the throat. This leads to the symptoms associated with GER laryngitis/pharyngitis.

TREATMENT

THINGS TO AVOID:

1. Caffeine and decaffeinated products B this includes, but is not limited to, coffee, tea, iced tea, chocolate, and all cola drinks. Non-caffeinated beverages are okay such as water, Sprite, Ginger Ale, 7-Up, Gatorade, Fresca, and herbal (chamomile) teas.
2. Avoid citrus juices especially orange juice, cranberry juice, and lemonade. Apple and grape juice are fine, especially if consumed in moderation.
3. Avoid alcoholic beverages.
4. Avoid eating or drinking, other than water, for 3 hours prior to going to sleep. This is important to avoid bathing the throat in the acidic contents of the stomach throughout the night.
5. Avoid tight fitting clothing like back braces and girdles. The increased pressure on the abdomen causes food to regurgitate from the stomach.
6. Spicy food, including tomato sauce and pizza.
7. Avoid eating fatty foods including nuts, whole milk, and fried foods. Fatty foods stay in the stomach longer, increasing the chance for reflux.
8. Cigarette/cigar smoking.
9. Mints
10. Eat more frequent, smaller meals throughout the day to avoid overfilling the stomach.

THINGS TO DO:

1. Drink water, clear sodas, non-citrus juices, non-caffeinated herbal teas.
2. Raise the head of your bed by placing 1 brick below each of the upper bedposts or by placing a foam wedge under the mattress. This will ensure that your head will be elevated above your stomach, lessening the chance for acid to reflux into the throat.
3. If you have not been prescribed a medication you can:
   1. Take 1 tablespoon of Mylanta or Maalox one hour after each meal and at bedtime. If this causes loose bowel movements, then alternate 1 tablespoon Amphojel and 1 tablespoon Mylanta or Maalox.
   2. Zantac 75 mg. (over-the-counter), 1-2 tablets, two times per day.
   3. Take Prilosec-OTC (over-the-counter), 1-2 tablets two times per day.

Although this may seem difficult, we need to eliminate the GERD completely to allow the acid burn in your throat to heal. It may take 1-2 weeks of strict adherence to these guidelines to begin to notice an improvement in your symptoms. It may take 3-4 more months for the burn to heal completely. At that point, you will then be able to once again eat and drink normally but you will need to avoid overindulgence of these types of foods. Overindulgence will typically lead to mild symptoms that will then signal you to modify your diet once again temporarily.

Chronic uncontrolled GERD increases your risk of cancer of the esophagus and larynx. It is, therefore, important to schedule an appointment with a gastroenterologist if your GERD is recurring frequently, so that he/she can look at your esophagus and perform a biopsy, if necessary.

It is also important to see us every 3-4 months if your symptoms recur frequently, so that we can examine your larynx. If you overuse your voice regularly (teachers, vocalists, etc.) treatment of GERD will lead to much less frequent hoarseness and a tremendous improvement in the quality and power of your voice.

We enjoy teaching our patients about their medical problems and the treatment plan that we have recommended. We believe that with this education, our patients are more likely to get better and to stay better.

These information sheets are intended for use by our patients in conjunction with regular care from Drs. Siegel and Bosworth. Use of these sheets by others can lead to a delay in diagnosis with potential worsening of health. If you are not one of our patients, please schedule an appointment so that we can help you to feel better as soon as possible.