Pharyngeal reflux: what are the symptoms and how to treat it

By Cristiano Antonino On Jun 24, 2022

Reflux is often referred to as either gastro-oesophageal or pharyngolaryngeal reflux. Gastro-oesophageal reflux and pharyngolaryngeal reflux have in common that gastric material rises through the oesophagus, but they are not the same thing

In gastro-oesophageal reflux, acidic material rises from the stomach due to a dysfunction of the cardia (the orifice from which the oesophagus flows into the stomach), whereas in pharyngolaryngeal reflux, chewed food tends to rise due to a malfunction of the muscles of the upper oesophageal sphincter, i.e. the valve that closes the upper part of the oesophagus to the passage of food to prevent it from rising in the upper airway.

Pharyngolaryngeal reflux: symptoms

Pharyngolaryngeal reflux manifests itself with some non-specific symptoms generally considered atypical in gastro-oesophageal reflux.

Often the patient reports the presence of burning or retrosternal pain, which is not identified as heartburn, sometimes associated with a dry, hacking cough especially after meals.

In many cases dysphonia may be present, with lowering of the voice, symptoms referred to the throat such as sore throat, burning or sensation of a pharyngeal foreign body and production of thick and abundant mucus.

With less frequency, ear infections, rhinitis and laryngospasm may also appear.

Since we are dealing with a non-specific symptomatology, with symptoms common not only to inflammatory diseases but sometimes also to tumour diseases, it is a good idea to consult an ENT specialist in the presence of these complaints.

The specialist, after an accurate anamnesis, will perform an objective examination with fibrolaryngoscopy, a diagnostic test that, by means of a small fibre optic camera, will make it possible to visualise all the upper aerodigestive tracts and possibly observe signs of reflux, excluding the presence of any other pathologies.

The symptoms are often associated with oedema (swelling), reddening of the mucous membranes of the hypopharynx and larynx and sometimes the presence of laryngeal granulomas.

Moreover, as the symptoms may be partly common to those of gastro-oesophageal reflux and the two pathologies may coexist, diagnosis and treatment sometimes require a multidisciplinary approach with a gastroenterologist specialist.

How to treat pharyngolaryngeal reflux

Pharyngeal reflux involves pharmacological treatment, either with drugs that reduce gastric acidity by reducing the irritant agent in the larynx, or with medical devices designed to protect and reconstitute damaged mucous membranes.

Along with drug therapy, however, it is important to act on lifestyle and change certain habits.

For example, it is good to

stop smoking;
reduce consumption of fatty cheese, fried and fatty foods, red meat, chocolate and mint;
limit consumption of alcohol, fizzy drinks and coffee;
reduce body weight;
wait at least 2 hours before lying down on the bed or sofa after a meal to allow the stomach to empty;
in the most severe cases, it is recommended to sleep by placing elevators at the top of the bed, to keep the trunk slightly inclined, thus preventing gastric material from rising.

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