People with typical gastroesophageal reflux disease (GERD) have heartburn—chest pain after eating, particularly after eating fried or greasy foods. Most of the time, a doctor makes the diagnosis ofGERD. The more difficult question is how to know if you have “atypical” or “silent” reflux, also called laryngopharyngeal reflux (LPR).
COMMON SYMPTOMS OF REFLUX:
A lump in the throat
LPR can occur during the day or night, but most people with LPR do not have heartburn. (Hence, “silent reflux.”) The explanation for this is that refluxed material does not stay in the esophagus long enough to irritate that organ; however, if even a little of those stomach juices come up into the throat, symptoms can occur. Compared to the esophagus, the throat and voice box are a hundred times more sensitive to irritation and damage from reflux.
The symptoms of LPR are hoarseness, too much throat mucus, throat clearing, post-nasal drip, chronic cough, a sensation of a lump in the throat, sore throat, choking episodes, shortness of breath, asthma, sinus problems, difficulty swallowing, dental disease, and even halitosis. Some people have intermittent or chronic hoarseness, while others have problems with too much nose and throat drainage, that is, too much mucus or phlegm, causing chronic throat clearing. If you have any of those symptoms, especially if you smoke, you should ask your doctor about LPR.
THE REFLUX SYMPTOM INDEX (RSI):
Circle 0–5 in each of the 9 rows and add up the numbers to get your RSI
The specialists who most often diagnose and treat people with LPR are ENT (ear, nose, and throat) doctors, also called otolaryngologists. The two ENT authors use the Reflux Symptom Index (RSI) as a tool for screening patients. You can figure out your own RSI by answering the questions above.
Generally, the magic number for LPR is 15, but the RSI isn’t a surefire way to know if you have LPR, because some people with LPR have low RSIs. On the other hand, most people who have LPR have more than one symptom. The average RSI score for a patient coming for treatment in Dr. Koufman’s practice is over 20. If you think that you have reflux disease of any kind, go see your doctor.
Red Flags for Reflux:
Here are some warning signs and symptoms of serious reflux (both LPR and GERD). Some of these symptoms might indicate the presence of more dangerous conditions as well.
1. Crushing chest pain after eating that makes you wonder if you’re having a heart attack; obviously, you should go to an emergency room right away, just in case.
2. Waking in the middle of the night from a sound sleep coughing and gulping air like a fish out of water; this is called laryngospasm. You can’t die from it, but it can feel that way.
3. Chronic cough for more than three months with a normal chest x-ray. Reflux is the most common cause of difficult-to-diagnose chronic cough cases.
4. A sensation of a lump in the throat that is there almost all the time, except when you are actually eating; usually LPR.
5. Morning hoarseness, progressive (worsening) hoarseness, and painful swallowing can be symptoms of LPR, or even possibly throat cancer. You should see an ENT doctor.
Reflux and Sleep Disorders:
What you eat, how much you eat, and when during the day you eat can all seriously affect the quality of your sleep—which in turn affects your concentration, mood, work habits, and your overall quality of life.
Avoid overeating and especially overdrinking if you have reflux. Also, you should never lie down within three hours after a meal, and if you suffer from nighttime reflux, your bed should have a wedge or somehow be elevated to support both your head and your chest. Regular pillows won’t help if they only support your head. Elevating the chest makes it more difficult for your dinner to go a-wandering while you sleep; gravity helps.
Alcohol is trouble for a refluxer at bedtime. It loosens the valves of the esophagus, allowing stomach contents to reflux. Also, if you go to sleep without a completely clear head, you are officially drunk and may wake up three to four hours later, perspiring and thinking a million different thoughts at once; that’s the sign of alcohol withdrawal. Never go to sleep without a clear head. Do breathing exercises, stay awake as long as possible, and drink a lot of water.
If you wake up coughing in the middle of the night, there are two likely causes. One is reflux, but the other can be made worse by reflux—and that is sleep apnea, a collapse of your throat, especially during the deeper sleep cycles. Sleep apnea is associated with snoring, but snoring can be caused by reflux as well as other conditions such as being overweight and having chronic congestion of the nasal passages. Sleep apnea is very common and under-diagnosed.
If you want to get a good night’s sleep, eat a light dinner and finish at least three hours before going to bed. Avoid salty foods that could cause you to wake dehydrated, and avoid having more than one glass of wine or the equivalent. And, of course: no caffeinated beverages. To really ease into a good night’s sleep, try a warm bath, soothing music, and chamomile tea. (Not peppermint!)