The Not So Common Forms of Reflux

Most people think of gastroesophageal reflux disease or GERD as the classic symptoms of heartburn or regurgitation.  Heartburn is often reported as a burning sensation below the breast bone and regurgitation is the effortless repeating or return of food material back up the esophagus (or food tube).  It is important not to mistake a chest pain complaint that may be cardiac in origin for reflux.  See your doctor if you have a new chest pain complaint, especially if you have cardiac disease risk factors such as a family history of heart disease, high cholesterol, obesity, or if you smoke.  Now, back to reflux troubles.

GERD can be much more than classic reflux.  In fact,  there are the atypical symptoms of reflux that include sore throat, hoarseness, vocal cord disturbances, cough, throat clearing, noncardiac chest pain, asthma, and, even, sinusitis.  The entity of laryngo-pharyngeal reflux or LPR represents those afflictions of the throat and voice box caused by reflux.  LPR is usually first diagnosed by the ear, nose & throat doctor (otolaryngologst).  These unusual forms of reflux are somewhat difficult to treat and, often, do not respond to acid lowering drugs that are most successful in the treatment of classic GERD.

A definitive way of diagnosing difficult to understand reflux is to perform combined impedance and pH reflux monitoring.  In postings  to come, we will cover these methods of diagnosis in more detail.

Once  the diagnosis is made, therapy can be instituted with acid lowering drugs, and if they do not work, one can consider procedural therapies such as transoral incisionless fundoplication, known as TIF or the Stretta procedure.  These procedures attempt to augment the lower esophageal sphincter and gastroesophageal flap valve to prevent the backwash of the stomach contents into the esophagus. The procedures are performed in an outpatient setting, and require no cutting whatsoever.