Do you often have dry throat, sore throat and hoarse voice, accompanied by chest pain or heartburn? Could it be that you have pharyngitis? not necessarily! It may also be a disease that otolaryngologists have paid more attention to in recent years – laryngopharyngeal reflux syndrome. Especially people at high risk of this disease should pay more attention to adjusting their diet and lifestyle to avoid triggering “reflux”.
This disease often “masquerades” as strep throat
Laryngopharyngeal reflux syndrome refers to a series of symptoms, signs and diseases caused by abnormal reflux of gastric contents into the throat above the upper esophageal sphincter. The prevalence rate is 10% to 35%.
In addition to pepsin and gastric acid, gastric contents also include bile acids and pancreatic enzymes. The gastric contents mentioned above can irritate and damage the pharyngeal and laryngeal mucosa after being refluxed through the esophagus, causing mucosal inflammation, epithelial thickening, and sticky secretions, thereby causing a foreign body sensation in the pharynx, excessive phlegm in the throat, chronic throat clearing, fatigue in pronunciation, and hoarseness. symptom.
It is worth mentioning that the vast majority of patients with laryngopharyngeal reflux syndrome will have hoarseness, so most of them go to otolaryngology clinics for treatment. However, due to the special cause of the disease, it is often misdiagnosed as ordinary pharyngitis. As a result, antibiotics and Chinese patent medicines for clearing away heat and dispelling fire were often taken, but they were not symptomatic. As a result, patients could not be cured for a long time after taking the medicine, which had a great impact on their lives and psychology.
As otolaryngologists have deepened their understanding of laryngopharyngeal reflux syndrome in recent years, they have found that this disease is relatively common in clinical practice, and more than 50% of voice disorders are related to it.
Bad work and rest habits can also cause reflux
From a medical point of view, the problem of throat lesions caused by the reflux of gastric contents is caused by a variety of factors.
Disease factors are a major cause of reflux. For example, obstructive sleep apnea-hypopnea syndrome can easily induce reflux and harm throat health. From the perspective of life and mental factors, poor eating and resting habits, depression and stress, etc. Mental distress can also easily cause reflux.
In addition, from an anatomical point of view, the throat is relatively fragile and has poor acid resistance. When gastric contents reflux into the throat, it will naturally cause irritation and damage to the throat mucosa. Correspondingly, refluxed substances stimulate the esophageal vagus nerve, causing coughing and serious damage to the vocal cord mucosa. At the same time, they cause the relaxation reflex of the upper esophageal sphincter, causing more gastric contents to reflux into the throat.
It is currently believed that laryngopharyngeal reflux syndrome is related to the following diseases, including chronic pharyngitis, chronic laryngitis, laryngeal contact granuloma, subglottic stenosis, paroxysmal laryngospasm, vocal cord leukoplakia, asthma and other diseases. Especially recently, the disease has also been suspected to be a risk factor for laryngeal cancer in patients without a history of exposure to tobacco and alcohol.
High-risk groups should seek medical attention if they have symptoms
High-risk groups for laryngopharyngeal reflux syndrome include long-term smokers and drinkers, patients with gastroesophageal reflux disease, hiatal hernia, obesity, habitual vomiting, and those who eat high-sugar, high-fat, and spicy foods. When disease-related symptoms appear and persist, you should go to the otolaryngology clinic as soon as possible for specialist evaluation and examination.
The diagnosis of laryngopharyngeal reflux syndrome relies on patient questioning and endoscopy. The microscopic manifestations most closely related to laryngopharyngeal reflux syndrome include: fissures, erythema, edema and hyperplasia in the posterior commissure area, and extensive edema of the vocal cords and tracheal mucosa.
Currently, the academic community has developed a reflux symptom index scale and a reflux examination score scale based on patient symptoms and laryngoscopy severity. When the reflux symptom index scale is greater than 13 points and the reflux examination score scale is greater than 7 points, it is considered abnormal.
Laryngopharyngeal reflux syndrome is a disease involving multiple manifestations in otolaryngology, respiratory, and gastroenterology. At present, the treatment of this disease is highly controversial, and there is no unified and effective treatment plan. The currently recommended treatment plan is anti-reflux treatment, including behavioral therapy and medication.
The purpose of drug treatment is to inhibit gastric acid secretion and promote gastrointestinal emptying. Drugs include proton pump inhibitors (omeprazole, pandoprazole, etc.), H2 receptor blockers (cimetidine, famotidine) and intestinal motility drugs (mosapride). Proton pump inhibitors and intestinal motility drugs should be taken half an hour before meals, while H2 blockers are often taken before bed. Drug treatment should be given for more than 3 months, and it usually takes 2 to 4 weeks to be effective.
Four habits you need to change to stop reflux
Behavioral therapy focuses on changing eating and sleeping habits related to reflux, including:
change eating habits
Stop smoking and drinking, and reduce the intake of excessive high-sugar and high-fat foods, acidic fruits, strong tea, coffee and other irritating foods. The above foods can stimulate gastric acid secretion and increase intragastric pressure, leading to reflux of gastric contents.
Adjust the way you eat
Eat small and frequent meals, strictly fast 2 to 3 hours before going to bed, and elevate your head 5 to 8 centimeters appropriately. Lying down can easily increase the chance of gastric acid reflux. Taking the above measures can effectively reduce gastric acid secretion and gastric content reflux during sleep.
Avoid belts that are too tight
A belt that is too tight can easily increase intragastric pressure and promote reflux of gastric contents.
Increase exercise to avoid obesity. Obesity can cause upper airway stenosis, and negative pressure in the throat during inhalation during sleep can lead to reflux of gastric contents. Text/Li Pu (Xuanwu Hospital, Capital Medical University)