Gastroesophageal reflux is the passage of gastric contents into the esophagus. When this reflux of contents causes symptoms or damage to the lining of the esophagus, this is known as GERD. Various factors work together to cause GERD, including the condition of the muscle sphincter at the lower esophagus, presence of a hiatal hernia, the ability of acidic contents to pass through the esophagus, and decreased flow of saliva. GERD can result in typical symptoms, including heartburn or regurgitation (i.e. the reflux of gastric contents into the mouth). However, GERD can cause less common, unusual symptoms that are not typically associated with reflux.
Typically, the reflux of stomach contents into the esophagus causes a burning sensation up the chest known as heartburn. This sensation can occasionally become severe and long lasting, mimicking the chest pain associated with a heart attack. It is important that if you experience severe chest pain that you contact your doctor to be sure that the pain is from your reflux and not other medical conditions.
Reflux of acid contents into the throat while sleeping can cause choking and ultimately retching fits with attempts at clearing the throat. This can lead to severe burning in the throat, which can last for hours. It is best to avoid late-night meals or going to bed right after eating in order to prevent choking from occurring.
Sore Throat and Chronic Cough
Reflux that occurs during sleep can reach the throat without any knowledge or realization that this is occurring. The acidic contents can irritate the throat, resulting in inflammation and soreness. Sore throat can also occur during the day, typically after meals if it is due to reflux. This reflux of contents into the throat can also result in the constant need to “clear the throat,” or a globus sensation in the back of the throat, leading to a chronic cough.
Reflux can travel upwards to the upper esophageal sphincter and pass over the vocal cords in the larynx. When this happens, the larynx can become inflamed, which is called acid laryngitis. This inflammation then can lead to cracking and other changes in the voice, or hoarseness.
Wheezing can worsen reflux due to pressure changes in the abdominal and chest cavities. Moreover, when acidic content refluxes into the larynx, it is thought that the airways then constrict. This has been difficult to prove, however. But when reflux medications are taken, it has been found that both wheezing and reflux symptoms improve.
Excessive Salivation (Water brash)
Refluxed gastric contents are an irritant to the esophagus. As a result, a neurological reflex, similar to that which occurs prior to vomiting, causes excessive production of saliva.
Persistent exposure of the lining of the esophagus to acidic gastric contents can result in inflammation and damage to the lining. After a prolonged period of time of inflammation, the lining begins to scar, forming rings of scar tissue or strictures. This can cause difficulty with passage of food through the esophagus or a sensation of food getting stuck in the esophagus. This is known as dysphagia. It is important to discuss these types of symptoms with your physician because constant damage to the lining of the esophagus can also lead to precancerous changes called Barrett’s esophagus.
It is imperative that you discuss any symptoms you are experiencing with your physician and undergo proper testing to see if these symptoms are only GERD, or something even more serious.
Constance Pietrzak, M.S., M.D., is a gastroenterologist with Advocate Medical Group in Chicago. Through her work with HealthCentral, she strives to expand knowledge on gastroesophageal reflux disease (GERD) and inflammatory bowel disease (IBD). Follow Constance on Facebook and Twitter for timely updates on IBD, and more.