Health Conditions

Toss the Allegra – Could the Problem Be In Your Belly? Silent Reflux Posing as Allergies

The cough that shows up after you eat, the incessant throat clearing, the random hoarseness in your voice. You’ve been to your allergist and she’s prescribed anti-histamines, decongestants – maybe even steroids. And yet, the cough persists. Your mucus production is on hyper drive and there’s an unsettling sensation of fullness in your throat that you just can’t clear.

Laryngopharyngeal Reflux (LPR) – also known in the medical community as ‘silent reflux’ — is actually just as common as her counterpart – though maybe not as well known. It is generally more difficult to pin down with a diagnosis, and can also be trickier to treat.

And the drugs aren’t working.

You are at your wit’s end.

Time to take a step back from your bronchial concerns and turn your focus toward your gut.

You’ve got reflux.

But, no! Reflux means heartburn, indigestion, chest pain and belching acid! Everyone knows that!

Indeed those are symptoms of Gastroesophageal Reflux (GERD) and they are quite common. Difficult to ignore but usually easy to diagnose and treat.

However, GERD has an evil twin sister, and she’s the silent type.

Laryngopharyngeal Reflux (LPR) – also known in the medical community as ‘silent reflux’ — is actually just as common as her counterpart – though maybe not as well known. It is generally more difficult to pin down with a diagnosis, and can also be trickier to treat.

What is ‘Silent’ Reflux?

Laryngopharyngeal Reflux is when acid produced in the stomach backs up, or refluxes, into the back of your throat (pharynx) and your ‘voice box’ (larynx). It is different from Gastroesophageal Reflux in which stomach acid regurgitates only to the level of the esophagus. In LPR the acid produced in the stomach routinely washes up much higher in the digestive tract and pools there – possibly even making it up into the back of your nasal airways.

The persistent presence of stomach acid pooling in tissues that are not equipped to handle repeated exposure to gastric acid can lead to inflammation. The inflammation creates conditions ripe for throat irritation that many try to relieve by coughing or throat clearing, and generally signal the body to increase production of mucus to help soothe and protect inflamed tissues.

What’s going on?

Under ideal conditions you have two sphincters which control the flow of stomach acid, one at either end of your esophagus. The lower esophageal sphincter (LES) is supposed to close off after letting food that has just been swallowed pass into the stomach. In people with GERD, the LES malfunctions, allowing gastric acid to back up into the esophagus creating the type of experience you might equate with squirting lemon juice into your eye. This unpleasant burning sensation is at the root of the word ‘heartburn’. Many people experience gastroesophageal reflux (GER) from time to time and there are many food triggers; caffeine, chocolate, citrus, tomatoes and mint to name a few. It is when individuals experience repeated episodes of GER that they receive the diagnosis of GERD (gastroesophageal reflux disease).

It is different from Gastroesophageal Reflux in which stomach acid regurgitates only to the level of the esophagus. In LPR the acid produced in the stomach routinely washes up much higher in the digestive tract and pools there – possibly even making it up into the back of your nasal airways.

It is during GER that the upper esophageal sphincter may also malfunction, allowing the gastric juices to travel further up the esophagus into the pharynx, larynx and nasal passages. People who suffer from this type of sphincter malfunction may never have the typical symptoms of heartburn at all. Instead they may complain of a sour taste in the back of the mouth, or the feeling that there is something stuck in their throat. They may see their doctor due to a persistent cough or an excess of mucus and an inability to clear it.

This is where things can get confusing.

 

 

Allergies or reflux?

Many people who go to their doctor with complaints of cough, postnasal drainage or drip and sore throat fall easily into the diagnosis of ‘allergies’. And indeed, your body is reacting to a foreign substance, in this case gastric acid. However, in the case of LPR it is the Inflammation in the back of your throat and nasal passages that signals the production of excess mucus rather than an environmental allergen. Other common allergic reactive symptoms such as itchy or watery eyes, itchy throat and sneezing will often not be present in cases of LPR alone.

And though many people will initially be prescribed medicines to combat allergens, most will not see complete relief, if any, from their LPR symptoms with the usual treatment course for allergies.

Toss the Allegra – Could the Problem Be In Your Belly? Silent Reflux Posing as Allergies

Antacids to the rescue!

Not so fast. You’ve made it this far and narrowed your problem down to the presence of stomach acid where it doesn’t belong. You don’t want to make the situation worse!

Other common allergic reactive symptoms such as itchy or watery eyes, itchy throat and sneezing will often not be present in cases of LPR alone.

Traditionally the medical community has told reflux sufferers that the problem is a result of too much stomach acid. Why else would the stuff be backing up into your esophagus? The standard drug treatment course would be three-fold; antacids (Maalox, Mylanta, Rolaids or Tums) to neutralize stomach acid, H-2 receptor blockers to reduce acid production (Tagamet, Pepcid, Zantac) and in more severe cases proton pump inhibitors (PPIs) to completely block acid production (Prevacid or Prilosec).

Increasingly, however, research supports the idea that rather than an excess of stomach acid being the problem, in fact – the opposite is true. And though you certainly don’t want stomach acid in your esophagus – you most certainly do want it in your stomach.

Hydrochloric acid, also known as stomach acid, is an extremely important part of the digestive process and serves three main functions:

  • Breaking down proteins into the essential nutrients your body needs to do its job
  • Signaling the pancreas and small intestine to begin producing bile and digestive enzymes without which digestion doesn’t happen properly
  • Aiding the immune system by killing bacteria that are present in the food you eat

When there isn’t enough stomach acid present for digestion, not only do the above three vital functions suffer, but undigested food hangs around in the stomach far longer than it should. Just like food left out on the counter that food begins to rot producing methane gas. You know how a balloon works, right? The same effect takes place in your stomach when undigested food sits around producing gas. Extra gas contributes to increased intra-abdominal pressure, which in turn causes stomach bloating which pushes the contents of the stomach – including the acid – through the LES and into the esophagus.

Taking the traditionally recommended course of drugs – drugs that Americans spend more than 14 billion dollars on annually – only exacerbates the problem over time by blocking the production of much needed stomach acid.

Healing naturally

Whether you are experiencing symptoms of GERD or LPR – it’s worth a try to tweak your diet and lifestyle choices to see if you can have a positive impact on symptoms by improving digestion and encouraging the production of more – not less – stomach acid.

In the case of both types of reflux the most effective treatments revolve around prevention. Here are some home remedies that can have a positive effect on digestion:

  • Apple cider vinegar – two teaspoons diluted in water daily before meals can improve digestion.
  • Digestive bitters – available in many health food stores – have many digestive benefits, including stimulation of all digestive secretions; saliva, bile, enzymes, hormones, etc.

In addition, there are many lifestyle choices you can make to help as well:

  • Elevate the head of your bed by six inches
  • Remain upright for 2-3 hours after eating
  • Eat small meals – large meals overtax your system by rapidly increasing the production of stomach acid and crowding out valuable digestive space
  • Wear loose fitting clothes around the waist to alleviate pressure and squeezing on the stomach
  • Keep a food diary, notice triggers and eliminate them (common triggers include those listed earlier in the article along with carbonated beverages, certain spices, high fat and fried foods, as well as alcohol)
  • If you are overweight, losing even 10% of your body mass can help.
  • Stop smoking – the massive list of benefits to kicking the nicotine habit definitively includes a reduction in reflux.
  • Get 30 minutes of moderate exercise on most days – stick to low impact exercises like walking, swimming or flat-road biking at first to avoid jarring motions that could stir up stomach acid. Exercise can aid in weight loss as well as lower stress levels – both of which can improve digestion.

The Beast In Your Belly

While LPR has recently become more widely known in the medical community, it can still be tricky to get your doctor to see your symptoms as anything but the more obvious diagnosis of ‘allergies’. It’s always a good idea to keep abreast of the current medical research and diagnostic trends in order to function more as a partner and less as a patient in all of your healthcare choices. And if you find yourself wondering why your allergy medicine isn’t working, coughing and hacking and clearing your throat of excess mucus – or experiencing traditional symptoms of reflux; burning, belching, flatulence and bloating – it might be time to consider the possibility that the problem is rooted in your digestion and what you need is more – not less – stomach acid.

Sources:

Sella GC, Tamashiro E, Anselmo-lima WT, Valera FC. Relation between chronic rhinosinusitis and gastroesophageal reflux in adults: systematic review. Braz J Otorhinolaryngol. 2016;

Ali Mel-S. Laryngopharyngeal reflux: diagnosis and treatment of a controversial disease. Curr Opin Allergy Clin Immunol. 2008;8(1):28-33.

Jozkow P, Wasko-czopnik D, Medras M, Paradowski L. Gastroesophageal reflux disease and physical activity. Sports Med. 2006;36(5):385-91.

Pontes P, Tiago R. Diagnosis and management of laryngopharyngeal reflux disease. Curr Opin Otolaryngol Head Neck Surg. 2006;14(3):138-42.

Peters JH, Demeester TR, Crookes P, et al. The treatment of gastroesophageal reflux disease with laparoscopic Nissen fundoplication: prospective evaluation of 100 patients with “typical” symptoms. Ann Surg. 1998;228(1):40-50.

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Holly Tellander

Holly Tellander

Author Holly Tellander is a guest contributor to Womenshealth.com.

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