Managing Throat Discomfort from Acid Reflux: A Patient's Journey

Q: Managing Throat Discomfort from Acid Reflux: A Patient's Journey

Hello： 1. <br>If the discomfort in the throat is more pronounced in the morning, it may be due to gastroesophageal reflux disease (GERD). <br>You should pay attention to your sleeping position, trying to avoid lying completely flat, refrain from eating late-night snacks, and moni

The sensation of a foreign body in the throat caused by acid reflux?

Since I have been studying abroad, I started experiencing throat discomfort around January 2017.
I delayed seeking treatment until July when I returned to Taiwan and consulted an otolaryngologist.
He diagnosed me with laryngitis caused by gastroesophageal reflux disease (GERD) and prescribed esomeprazole, stating that I might need to take the medication for three to six months to see improvement.
I brought a six-month supply of the medication back with me, but after taking it for three months, I still felt discomfort in my throat.
I then returned to Taiwan to see a gastroenterologist, who performed an endoscopy.
At that time, the doctor said my stomach was generally fine and that there was no evidence of GERD, suggesting I should follow up with the otolaryngologist.
I did not retrieve the endoscopy report, but the gastroenterologist mentioned I had mild gastritis, which he said was quite normal and common.
I continued taking the medication until January 2018, completing six months, but I was concerned about the long-term effects on my health.
Without a doctor's guidance abroad, I was hesitant to continue taking the medication.
During the medication period, I sometimes felt quite comfortable, while at other times, the discomfort recurred.
I have been managing my lifestyle and diet.
Now, my questions are:
1.
The otolaryngologist said my laryngitis was due to GERD, while the gastroenterologist found no significant issues with my stomach or esophagus, only mild gastritis, which he deemed normal.
(Since I did not go back for the report, I wonder if I misunderstood something.) If I return to Taiwan in July, should I see an otolaryngologist or a gastroenterologist? My only symptom is the sensation of a foreign body in my throat; I do not feel any discomfort in my stomach and am not aware of any acid reflux symptoms (perhaps I experience it at night while asleep).
However, I do wake up every morning with a particularly dry throat and yellow phlegm, which gradually improves after waking, but the discomfort persists.
Both otolaryngologists I consulted attributed it to GERD.

2.
I have been taking esomeprazole for six consecutive months.
I stopped for two months between January and March, fearing I was taking too much medication.
Now, in March, my throat discomfort has slightly returned.
Should I continue taking esomeprazole? Is this medication safe for long-term use without side effects? If there are potential side effects, would it still be advisable to continue taking it in my current situation?
3.
I am unsure of what to do now.
I have adjusted my lifestyle and diet, but I still wake up every day with throat discomfort.
Although I have been on medication for six months and it may have been effective, the symptoms recur after stopping the medication.
The symptoms are not severe, and the sensation of a foreign body is tolerable.
However, I worry that if surgery is required, it may be an overreaction, yet I am also concerned about the potential for serious complications if I do not pursue surgery.

Mr. Hsu, 20~29 year old female. Ask Date: 2018/03/11

Dr. Cai Anshun reply Gastroenterology and Hepatology

Hello: 1.
If the discomfort in the throat is more pronounced in the morning, it may be due to gastroesophageal reflux disease (GERD).
You should pay attention to your sleeping position, trying to avoid lying completely flat, refrain from eating late-night snacks, and monitor your weight (both overweight and underweight are not advisable).
2.
Generally, using medication continuously for three months cannot be considered long-term use.
If symptoms persist, it is still acceptable to use it; however, if it is used continuously for over a year, be cautious of potential side effects such as calcium malabsorption.
Additionally, there is a risk of bacterial overgrowth in the intestines due to insufficient stomach acid, and a few reports suggest a possible increased risk of gastric lymphoma.
3.
If the symptoms are not severe and are tolerable, medication may not be necessary.
If you are concerned about complications, regular endoscopic examinations should suffice.
Changhua Hospital cares about your health.
Dr.
Tsai An-shun.

Reply Date: 2018/03/11

More Info

Managing throat discomfort from acid reflux can be a complex journey, especially when symptoms persist despite treatment. Your experience highlights the challenges many patients face when navigating between different specialties and the sometimes conflicting advice they receive. Here’s a comprehensive approach to your situation based on your questions and the medical knowledge surrounding acid reflux and its management.

1. Understanding Your Diagnosis
You mentioned that an ENT specialist diagnosed you with laryngitis due to acid reflux, while a gastroenterologist found no significant issues with your stomach or esophagus, aside from mild gastritis. This discrepancy can be confusing. It’s important to note that gastroesophageal reflux disease (GERD) can sometimes present with atypical symptoms, such as throat discomfort, without the classic symptoms of heartburn or regurgitation.
The throat discomfort you experience, particularly the sensation of a lump in your throat (often referred to as globus sensation), can indeed be linked to acid reflux. The fact that you have a dry throat and yellow phlegm upon waking could suggest that acid is irritating your throat during the night, even if you are not consciously aware of it.

2. Follow-Up Care
When you return to Taiwan, it may be beneficial to see both an ENT and a gastroenterologist again, but perhaps with a more focused approach. You could consider asking the ENT for further evaluation of your throat symptoms, possibly including a laryngoscopy to assess any inflammation or damage. Simultaneously, a gastroenterologist might perform a pH monitoring test to evaluate acid exposure in your esophagus, which could provide more clarity on whether GERD is indeed a contributing factor.

3. Medication Management
Regarding your use of esomeprazole, it is a proton pump inhibitor (PPI) that is generally considered safe for long-term use, but like any medication, it can have side effects. Common side effects include headaches, gastrointestinal disturbances, and, with prolonged use, potential risks such as vitamin B12 deficiency, bone fractures, and kidney disease. If you have been on it for six months and are experiencing a recurrence of symptoms after stopping, it may be reasonable to resume the medication, but this should ideally be done under the guidance of a healthcare provider.

If you decide to continue with esomeprazole, it’s crucial to monitor your symptoms and discuss any concerns with your doctor. They may suggest a step-down approach, where you gradually reduce the dose, or consider switching to an H2 blocker, which can also help manage acid levels with potentially fewer long-term side effects.

4. Lifestyle Modifications
You mentioned that you have made adjustments to your lifestyle and diet, which is excellent. Continued adherence to lifestyle modifications can significantly impact your symptoms. Here are some additional tips:
- Dietary Changes: Avoid trigger foods such as spicy dishes, citrus fruits, chocolate, caffeine, and carbonated beverages. Eating smaller, more frequent meals can also help.

- Weight Management: If applicable, maintaining a healthy weight can reduce pressure on the stomach and lower the risk of reflux.

- Sleep Position: Elevating the head of your bed can help prevent nighttime reflux.

- Hydration: Staying well-hydrated can help alleviate throat dryness.

5. Psychological Factors
It’s also worth considering the psychological aspect of chronic symptoms. Anxiety and stress can exacerbate physical symptoms, including throat discomfort. If you find that your symptoms are affecting your quality of life, discussing these feelings with a mental health professional may provide additional coping strategies.

Conclusion
In summary, your journey with throat discomfort from acid reflux is multifaceted, involving both physical and possibly psychological components. It’s essential to continue working closely with your healthcare providers to find a management plan that works for you. Regular follow-ups, medication management, lifestyle modifications, and addressing any psychological factors will be crucial in your path to relief. Remember, you are not alone in this, and many patients experience similar challenges.

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