Jamie Koufman is a New York City-based physician and researcher who specializes in the diagnosis and treatment of acid reflux and voice disorders.
President Obama reportedly had a mysterious sore throat for weeks, but now the diagnosis is in: acid reflux into the throat, also called airway reflux or LPR (laryngopharyngeal reflux). This puts the president in good company. Since 1975, the occurrence of reflux has increased 400 percent (almost one in five Americans now suffers from airway reflux), and reflux-related esophageal cancer has increased more than 500 percent to become the most rapidly increasing cancer in the United States.
Airway reflux is the backflow of stomach contents (stomach acid, enzymes, etc.) into the esophagus and then up into the throat. As with the president, most people with airway reflux don’t know they have it; the condition is often silent, without digestive symptoms such as heartburn or indigestion. The causes of airway reflux include obesity, overeating, an unhealthy diet, too much acid in the diet, eating too late at night, smoking and stress.
I conducted an online survey asking one question: “Think you might have reflux? Which symptoms do you have?” The almost 50,000 responses offered a revealing, if unscientific, portrait.
In order of frequency, the symptoms people reported were: post-nasal drip (15 percent), chronic throat clearing (14 percent), a “lump in the throat” sensation (14 percent), hoarseness (12 percent), sore throat (11 percent), chronic cough (10 percent), heartburn (10 percent) and choking episodes (7 percent). Although heartburn may be the symptom most commonly associated with reflux, it is often not the most frequent or important one. Indeed, having seen thousands of patients with airway reflux, I can attest to the fact that heartburn is rarely the primary symptom.
Because most people with airway reflux do not have heartburn, their symptoms may be incorrectly diagnosed as sinusitis, an allergy, asthma or some other lung disease. Many doctors are uncertain how to diagnose and treat airway reflux. I recommend examination by an experienced otolaryngologist (an ear, nose and throat doctor), not endoscopy by a gastroenterologist.
It is also important to emphasize that the effective treatment of airway reflux requires changes in diet and lifestyle. Acid-suppressive medications alone are insufficient. The key lifestyle modifications that are necessary are no eating after 8 p.m. and a low-acid diet.
Finally, since long-term, untreated acid reflux, including silent airway reflux, can cause both esophageal and throat cancers, all refluxers, including the president, should have an awake (and not sedated) esophageal examination to exclude serious esophageal disease.
It may not offer him a lot of comfort, but Obama’s acid reflux could have a silver lining because so many Americans are similarly affected and so many of these cases are misdiagnosed. Greater awareness can do much good for many people. Airway reflux is epidemic, but it can be cured by proper treatment and lifestyle changes.
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