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Gastroesophageal reflux disease (GERD) and upper respiratory symptoms (ENT)

Gastroesophageal reflux disease (GERD) and upper respiratory symptoms (ENT)

The notion that chronic or recurrent ENT disorders may be related to a digestive disorder like GERD has been known for only a few years. However, the relation between GERD and the chronic inflammation of the lower respiratory tracts has been known for more than a century.

The analogy with the inflammation of the upper respiratory tract is strong and finally prevailed. Considered for a long time "atypical" manifestations of reflux, these ENT and bronchial pathologies are now recognised by gastroenterologists as an integral part of the disease.

What is laryngopharyngeal reflux?

Your saliva and food normally transit through the oesophagus towards the stomach on a one-way basis. GERD is the abnormal backflow of part of the gastric contents in the opposite direction, that is to say in the oesophagus, then in the pharynx and in the larynx: this phenomenon is called laryngopharyngeal reflux (LPR).

LPR is very common in the adult Western population: about 60% of asthmatics also have LPR, whilst 50% of people with chronic cough and up to 80% of people having a sensation of a lump in the throat (also called globus) suffer from LPR. However, the majority of patients with LPR suffers from minor and intermittent symptoms and do not consult an ENT specialist. LPR is often a chronic disorder.

The cause of LPR is complex but corresponds to a failure of the anatomical barrier (valve) located at the junction between the oesophagus and stomach.

What are the symptoms and signs of LPR?

Many of the symptoms of patients suffering from LPR are similar to those of gastroesophageal reflux or stomach ulcer. The backflow of acid gastric juices is the main cause of the burning of tissues. Heartburn is sometimes accompanied by a sensation of acid reflux in the throat or a bitter taste in the mouth. This is called acid regurgitation. Sometimes this sensation of reflux is not felt consciously.

In addition to the local pain caused by tissue irritation and the sensation of a foreign body or a lump in the throat, LPR may cause hoarseness or voice fatigue (called dysphonia) due to the irritation of the larynx. Other revealing symptoms of LPR include hypersalivation, difficulty in swallowing (or dysphagia), and several frequent respiratory symptoms (hoarseness, cough, asthma) that sometimes disrupt sleep.

An otorhinolaryngological examination (consisting of a flexible camera inserted through the nose) often can identify LPR when the throat (pharynx or larynx) presents some symptoms.

Persistent LPR without treatment may cause, after many years, oesophageal stenosis and even cancer.

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