Recognize gastroesophageal reflux

Sore throat and cough: nothing strange, especially in autumn. But sometimes, behind this seemingly trivial symptom, there may be something else.

Sore throat and cough : nothing strange, especially in autumn. But sometimes, behind this seemingly trivial symptom, there may be something else.

Sore throat and cough that arise suddenly and tend to persist, perhaps without being too serious, but creating a significant annoyance. Nothing strange, especially if autumn has arrived and if you breathe the polluted air of the cities or you can’t give up your habit of smoking. But sometimes, behind these seemingly trivial respiratory symptoms, there may be something else that, in itself, has little to do with actual airway disease.

At the origin of a  dry and  irritable cough that does not want to go away, often accompanied by pharyngitis and hoarseness or voice alterations, there may in fact be an inflammatory process triggered not by cold air, smog, tobacco, viruses or bacteria , but from the gastric acids that the stomach is unable to retain and which can go back, albeit in small quantities, along the esophagus and reach the pharynx and throat.

In these cases, respiratory tract disorders depend on the presence of gastroesophageal reflux disease .

However, understanding it can be difficult if there are no other characteristic symptoms such as a burning sensation in the mouth of the stomach or in the center of the chest, hiccups, swallowing and digestive difficulties with clear perception of acid reflux or regurgitation after eating ( particularly in the case of large meals), both during the day and during sleep at night.

In practice, it works like this: when the acidic material that has risen from the stomach towards the esophagus reaches very high up, until it reaches the pharynx, the larynx, and perhaps even the initial part of the trachea, the irritation of the mucous membranes that results in these locations stimulates a “defensive” reflex that induces coughing.

In fact, the mucous membranes of the upper respiratory tract are not used to withstanding an acid environment and, to prevent worse damage, they become inflamed and react in an attempt to remove the harmful agent.

In reality, this occurrence does not often occur, so much so that the cough is considered an “atypical” symptom of gastroesophageal reflux, even if it is sometimes the first to appear and the last to go away, only after the acid reflux has been been completely eliminated through appropriate and effective therapies, which fortunately exist.

The probability of experiencing respiratory tract disorders following gastric reflux does not increase in direct proportion to the severity of the latter and this can considerably complicate the diagnostic procedure. However, if sore throat, cough, increased mucus production and trouble breathing are present along with a feeling of bloating and heartburn ( heartburn ) and difficult digestion (especially after consuming a large meal or one rich in heavy fatty foods from digest) and are not justified by the presence of a cold , flu , bronchitis or an allergyrespiratory system, it is advisable to carry out some targeted gastroenterological investigations.

Hard to recognize

Given the varied and very subjective nature of its typical symptoms (pain in the pit of the stomach and heartburn in the center of the chest, increased production of saliva, gastric heaviness sometimes associated with some nausea , but rarely with vomiting, etc.), and atypical (sometimes similar to those of a respiratory disease such as bronchial asthma or other affections of the bronchi and throat) the diagnosis of gastroesophageal reflux disease is not always easy and often requires a certain number of in-depth tests to rule out you have other health problems affecting your digestive system or respiratory tract.

In general, to characterize the disorder more quickly, when there is a suspected cough or a sore throat that struggles to go away after the usual five or six days, it is advisable to contact your doctor explaining:

  • how long the breathing discomfort and any other associated symptoms have been present
  • the moments of the day when they get worse
  • one’s own lifestyle habits (professional activity and sport, diet, smoking, alcohol consumption, etc.).

The doctor, evaluating the clinical picture as a whole, may decide to prescribe a specialist visit and targeted diagnostic investigations.

Exams to do

In people who have a chronic form of acid reflux or have repeated vomiting for a long time, hydrochloric acid and bile that travel up the esophagus to the mouth can cause inflammation (esophagitis), changes in structure, and damage to the esophageal epithelium (Barrett’s esophagus), with formation, in the most severe cases, of erosions and ulcers.

The analyzes to highlight these phenomena are a bit invasive and, in general, not much loved by those who have to perform them, but they are essential to confirm the diagnosis of reflux.

The most used technique for this purpose is digestive endoscopy (gastroscopy): it involves inserting a small tube through the mouth with a video camera mounted on the end, capable of scanning the esophageal and gastric mucosa and recording the images, allowing the specialist to identify any signs of inflammation or structural alteration (such as a partial obstruction of the esophagus, called stricture) and possibly to carry out a biopsy of the gastric mucosa.

Another important analysis is esophageal pH-metry, which measures the level of acidity present in the various sections of the esophagus. If a person has reflux, the acidity in their esophagus changes throughout the day because the material coming up from the stomach is acidic, and with each episode of reflux the pH drops. If a very acidic pH is also recorded in the upper portions of the esophagus, it is very probable that the respiratory symptoms depend precisely on gastric reflux.

pH-metry also allows you to know how many episodes of reflux happen to a person during a day. To perform it, the doctor inserts a small tube with a pH sensor into the esophagus, passing through the nose, which he leaves in place for 24 hours, during which he can go home and carry out his usual activities, including drinking and eating.

Finally, to confirm that gastroesophageal reflux is the cause of cough and sore throat, the “therapeutic test” can be performed, which involves administering the same anti-reflux drugs for one or two months normally used for the treatment of gastroesophageal reflux. ulcer or esophagitis If at the end of the administration cycle, the extra-oesophageal disorders (in addition to any characteristic digestive disorders) have disappeared or have significantly attenuated, the diagnosis is confirmed.

In some cases, to clarify the diagnosis, it may also be necessary to perform a chest x-ray with contrast medium to verify if, together with the acid reflux oesophagitis , there is also a hiatal hernia, a condition that occurs when a portion of the upper stomach passes from the abdominal to the thoracic cavity due to a weakening of the diaphragm that separates the two spaces.

That’s how he takes care of himself

If acid reflux is an occasional phenomenon or occurs during pregnancy, usually there is no real health problem and you shouldn’t worry too much. In these cases it is in fact treatable by paying attention to what you eat and how. But if the problem recurs often, or even after every meal, it is appropriate to consider a medical visit to understand the extent of the disorder and identify the most appropriate treatment.

The pharmacological therapy of choice to treat gastroesophageal acid reflux is based on the use of antacid drugs , capable of reducing the acidity of the stomach (thus slightly raising the pH of the secretions), and on prokinetic drugs, capable of accelerating the gastric emptying by acting on the muscles of the digestive tract.

Antacids such as proton pump inhibitors (PPIs) or H2 receptor inhibitors (on which the production of gastric acid secretions depends) have been used for years as “basic” anti-reflux drugs, generally successfully and without significant side effects.

The combination of antacids with prokinetics offers an additional advantage because, by limiting the residence time in the stomach of the digested food, the likelihood of regurgitation and acid reflux is greatly reduced, with consequent prevention of irritation of the mucous membranes and the development of pharyngitis, cough,  foreign body sensation or lump in the throat and swallowing disorders in general (such as dysphagia, i.e. difficulty swallowing),  inflammation of the vocal cords and hoarseness.

In some more serious cases, which fail to benefit sufficiently from medical therapy, it is possible to resort to surgery aimed at “strengthening” and narrowing the cardia, i.e. the valve that separates the upper portion of the stomach from the esophagus and which has the specific task of preventing the food ingested and mixed with the gastric juices from rising to the top. The operation is usually carried out laparoscopically and is not particularly demanding or dangerous.

Lifestyles saves esophagus

Obesity and overweight, a diet rich in fats and foods and drinks that stimulate the acid secretion of gastric juices, such as alcohol, coffee, fizzy drinks, chocolate and very salty, hot or spicy foods, as well as as innumerable bad eating habits (such as chewing quickly, skipping midday lunch to make up for a dinner that is too abundant, eating disorderly or going to bed immediately after eating) are all risk factors that should be mitigated, if not eliminated, to reduce the extent and negative effects of gastric reflux.

The main measures to be taken to prevent and reduce the symptoms of gastroesophageal reflux include:

  • follow a light diet, consisting of 4-5 small daily meals, based on easily digestible and subjectively well-tolerated foods;
  • eat slowly, chewing food well to reduce the digestive effort of the stomach and reduce the risk of acid reflux and regurgitation;
  • limit the consumption of fatty foods, sausages, fried foods, white wine, spirits, aged cheeses, cocoa/chocolate, tea, coffee, citrus fruits, carbonated drinks, tomatoes, mint;
  • consume milk only if well tolerated and never in the evening before going to bed, since the initial “buffer effect” on gastric acidity is followed by stomach heaviness and greater propensity to acid reflux;
  • do not sit on sofas or armchairs that are too “low” and soft nor, much less, go to bed immediately after eating, but take a 10-15 minute walk or other standing activities to facilitate the flow of food from the stomach to the intestines;
  • practice physical activity regularly during the day (however avoiding it shortly after eating) and try to reduce stress (which notoriously worsens acidity and digestive disorders in general), also through targeted relaxation techniques;
  • avoid sleeping in a completely horizontal position, lying on your back or stomach, but always keep your head slightly raised during sleep and get used to sleeping on your side (the right is better);
  • if you are a smoker, try to quit smoking or significantly reduce the number of cigarettes smoked;
  • do not wear belts or clothes that are tight at the waist, which hinder the passage of food from the stomach to the intestines;
  • before taking drugs that can increase acidity and gastric reflux, always ask your doctor’s opinion and follow his instructions on the matter

Anti-reflux diet

As far as nutrition in particular is concerned, there are foods that are “friends” and “enemies” of reflux. The first ones engage the stomach little and satiate for a long time, while the second ones promote the production of gastric juices and, in some people, tend to loosen the seal of the cardia (or lower esophageal sphincter), facilitating the ascent of gastric contents. Let’s see what they are.

“friendly” foods “enemy” foods
Pasta Chili
Rice Paprika
Cereals Pepe
“raw” extra virgin olive oil Ginger
Tomato sauce (without garlic , onion and hot spices) Cinnamon
Potatoes Nutmeg

Joycelyn Elders is the author and creator of EmpowerEssence, a health and wellness blog. Elders is a respected public health advocate and pediatrician dedicated to promoting general health and well-being.

The blog covers a wide range of topics related to health and wellness, with articles organized into several categories.

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