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How to Soothe a Throat Irritated by Acid Reflux


Acid reflux causes two main throat irritation complaints: soreness, which may feel different at various times, and a sensation of something being stuck in your throat or globus. The two seem to coincide and can be a clue that the throat discomfort is not from an infection or allergy.

Globus is a persistent or intermittent non-painful sensation of a lump or foreign body in the throat. It is associated with an irritated throat, usually is long-lasting, tends to recur, and is associated with acid reflux. It is one of the most common conditions that ear-nose-throat doctors see. Some estimate that up to half of healthy individuals have globus and an associated sore throat at some point in their lives.

Globus is often a result of an irritated throat from acid reflux. It is notoriously difficult to diagnose, difficult to treat, and even challenging to convince a patient that he or she has the problem. Lastly, it is not something else.

Many patients demand an antibiotic for a self-diagnosed “Strep throat” when in reality the antibiotic is the last thing they need.

How long has this type of irritated throat been recognized?

Hippocrates first described “globus pharyngeus” approximately 2,500 years ago. It was not until the 1700s when John Purcell described the condition. Purcell believed the throat irritation was a result of pressure on the Adam’s apple or thyroid cartilage because of its frequent association with menopause or psychological stress, hence the later used term of “globus hystericus.”

Most doctors agree that the root of globus and its associated sore throat appears to be from many causes. The majority consensus is that it is a result of gastroesophageal reflux disease (GERD), abnormalities of the upper esophagus, psychological and psychiatric disorders, and that stress can play a significant role.

Because of the ill-defined nature of both the symptoms and probable causes, it has been difficult to establish standard investigation, diagnosis, management, and treatment strategies.

Can acidity make your throat hurt?

It seems logical that the acid from our stomach would burn. After all, even drinking something acidic like orange or grapefruit juice burns our throats at times, particularly if we already have some soreness in our throat.

Our throat is part of our airway. The lining of our throat is covered by airway epithelium and its job is to inactivate and remove infectious particles from inhaled air or swallowed food or drink in order to prevent infection.

It turns out that we have antimicrobial factors present in the airway surface liquid (ASL). Airway defenses are strongly affected by changes in the pH of ASL. Historically, acidification of the airway surfaces, particularly in the lungs, has been suggested as a measure of airway disease.

There are two proposed mechanisms as to how GERD can cause the soreness in our throat and/or a globus sensation of feeling like there is something stuck:

  • Direct irritation and inflammation of the laryngopharynx (back of the throat and voice box) by retrograde flow (opposite flow of normal) of gastric contents, also known as laryngopharyngeal reflux (LPR).
  • Vasovagal reflex hypertonicity of the upper esophagus triggered by acidification or distention of the distal esophagus. Vasovagal reflex means an automatic response having to do with one of our most important nerves (the vagus nerve) that controls our blood pressure, breathing, and brain.

How long does a sore throat from acid reflux last?

There is no set time period for how long the sore throat from acid reflux can last. It is not only highly variable, but it can be unpredictable, too.

There are many conditions that can cause irritation, inflammation, and soreness to the mouth and back of the throat. These include pharyngitis, tonsillitis, chronic sinusitis with post nasal drip, allergies, and even having recent vomiting or stomach upset.

Psychogenic factors and stress can cause or trigger the soreness or globus sensation in our throat. We have all experienced episodes such as getting anxious before a big exam or a result of our sadness for someone passing at a funeral.

Overall life stress can be a contributing factor as well. Although there are many psychiatric disorders that can increase the prevalence of patients seeking health care for persistent sore throats and globus sensation, the exact etiological significance of these psychological characteristics remains uncertain.

Can acid reflux make you feel like you have strep throat or cold?

Yes, the symptoms can be identical. The work-up to determine the cause can be identical, too.

The difference in the physical examination can be different. The back of the throat may be irritated with some redness, but often the exam is perfectly normal. The appearance of Strep throat, for example, can be far different because there is usually evidence of marked redness, white spots, pus, and significant swelling.

The best way to determine whether the acid reflux is the culprit versus a bacterial or viral infection is to perform a laryngoscopic examination. This involves using a thin flexible fiberoptic endoscope down through the nose after local anesthesia is applied to look down at the voice box.

Although there are many things the doctor will look for on the laryngoscopic examination, one is significant: pseudosulcus vocalis since it is found in over one-third of asymptomatic patients or ones who have occasional or recurrent sore throats.

Pseudosulcus vocalis is a pattern of swelling or edema on the top (ventral) surface of the vocal cords.

Can you treat acid reflux with medicine for a common sore throat?

The principles of medical treatment are important. For the common sore throat, many times the treatment is a lifestyle change or diet. For Strep throat or a bacterial infection, antibiotics may be needed, but if the problem is more from GERD or LPR, the antibiotics can aggravate the situation.

Four categories of drugs are used in treating laryngopharyngeal reflux (LPR): proton pump inhibitors (PPIs), H2-receptor agonists, prokinetic agents, and mucosal cryoprotectants.

All or some of these may be helpful. Consult with your doctor to see which ones may be best for you.

Lifestyle and dietary changes include:

  • Decrease the size of portions at mealtimes.
  • Meals should be eaten two to three hours before lying down.
  • Avoid food and beverages that affect the lower esophagus function (eg, fried or fatty foods, chocolate, peppermint, alcohol, coffee, carbonated beverages, citrus fruits or juices, tomato sauce, ketchup, mustard, vinegar).
  • Eat at a slower pace to reduce aerophagia (swallowing air).
  • Patients with concurrent deglutitive abnormalities (trouble swallowing such as those patients who have had an injury or stroke) benefit from specifically targeted interventions (e.g. swallowing therapy by a speech-language pathologist).

Conclusion

Acid reflux causes two main throat irritation complaints: soreness, and a sensation of something being stuck in your throat. To reduce the irritation, the acid reflux can be treated through a combination of drugs and lifestyle changes. Talk to your healthcare provider if your sore throat is caused by more than a cold or Strep throat.

Key takeaways

Sore throats and GERD may be related and are common.

Medical treatments may vary, but lifestyle and dietary changes are the same.

Resources:

UCLA Health. Globus pharyngeus.

Boston Medical Center. Laryngopharyngeal reflux (LPR).

Temple Health. LPR: The silent version of reflux.

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