Refluxed liquid that passes from the throat (pharynx) and into the larynx can enter the lungs (aspiration). The reflux of liquid into the lungs (called aspiration) often results in coughing and choking. Aspiration, however, also can occur without producing these symptoms. With or without these symptoms, aspiration may lead to infection of the lungs and result in pneumonia. This type of pneumonia is a serious problem requiring immediate treatment.
Further, even among those who show abnormal proximal esophageal pH, there is improvement in respiratory symptoms with control of distal gastroesophageal reflux alone. It is also possible that physiological changes in asthma, including increased lower esophageal pressure, the mechanical influence of a depressed diaphragm caused by hyperinflation, and cough mediated by increased abdominal pressure, may contribute to gastroesophageal reflux to some degree.
Sitting up straight and maintaining good posture will help food and acid pass through the stomach instead of backing up into the oesophagus. Food and drink commonly reported to trigger symptoms includes fizzy drinks, spicy foods, high-fat foods, citrus fruits, peppermint, tomatoes, garlic and onions. Caffeine in coffee, tea and cola and theobromine in chocolate have been reported to worsen symptoms, and alcohol and excessive amounts of vitamin C (from supplements) can also increase acid secretion. Being overweight puts extra pressure on the stomach and this encourages reflux, so losing any excess weight, if this applies to you, may ease the symptoms.
In the larynx, damage can occur at an even higher pH. Pepsin in the area of the larynx is still active at a pH of 6.5 and does not become inactive until the pH is approximately 8. Any pepsin lingering in the larynx can be reactivated within 24 hours if the pH changes. Pepsin in the wrong place for any period of time can become reactivated should the pH drop to less than 8, which occurs in almost everybody given a 24-hour time window. Dr. Michael Lupa, MD is a highly trained, board certified otolaryngologist with additional training in sinus surgery and allergy treatment as well as advanced skull base surgery. He studied Biology at Tufts University and went on to complete medical school at Case Western University School of Medicine in Cleveland, Ohio.
In addition, the opening in the diaphragm through which the esophagus passes is tightened around the esophagus. Finally, the upper part of the stomach next to the opening of the esophagus into the stomach is wrapped around the lower esophagus to make an artificial lower esophageal sphincter.
In addition, patients with GERD may find that other foods aggravate their symptoms. Examples are spicy or acid-containing foods, like citrus juices, carbonated beverages, and tomato juice. These foods should also be avoided if they provoke symptoms.
This means that it is contracting and closing off the passage from the esophagus into the stomach. This closing of the passage prevents reflux. When food or saliva is swallowed, the LES relaxes for a few seconds to allow the food or saliva to pass from the esophagus into the stomach, and then it closes again.
The idea of “silent GERD” causing these symptoms as a “tip of the iceberg” phenomenon is not likely in most patients. Furthermore, we don’t have a validated instrument to define GERD in patients with laryngopharyngeal reflux.
GER may occur in both breastfed and/or formula fed infants. Several studies document that breast fed infants empty their stomach faster than formula fed infants and are thus less likely to experience GER symptoms.
Figure 2 summarizes the current concepts of theories that explain a link between asthma and GERD. The reflux theory suggests that symptoms of asthma are due to reflux of acid into the esophagus followed by aspiration into the proximal airways. Animal studies have proven that once trachea is acidified, there is a demonstrable increase in airway resistance. This is confirmed by scintigraphic demonstration of aspiration of radio-labeled isotope into the airway in some patients with GERD and respiratory symptoms. Another theory suggests that distal esophageal acidification results in vagal stimulation and consequent broncho-constriction, independent of airway micro-aspiration. This theory gains support from the observation that not all patients who develop bronchospasm have demonstrable proximal esophageal acidification.
Learn about treatments, prevention methods, and other causes of chronic coughing. Most infants outgrow silent reflux by their first birthday. Some, however, might need treatment. Children with symptoms of LPR that appear alongside breathing and feeding problems need to see a doctor as soon as possible. Silent reflux can have serious health consequences.
When aspiration is unaccompanied by symptoms, it can result in a slow, progressive scarring of the lungs (pulmonary fibrosis) that can be seen on chest X-rays. Aspiration is more likely to occur at night because that is when the processes (mechanisms) that protect against reflux are not active and the coughing reflex that protects the lungs also is not active. Many nerves are in the lower esophagus.