You’ve likely just been scoped (laryngoscopy) and the doctor has told you that it looks like you have some reflux tissue changes from stomach acid. Your first reaction is probably “I don’t have acid reflux. I never feel heartburn!”

What is it? Reflux laryngitis is an irritation in the back of the throat due to acid or other chemicals that come up from your stomach. This usually happens at night when you’re asleep. Other terms for this problem include gastroesophageal reflux disease (GERD), laryngopharyngeal reflux (LPR), acid reflux, and chronic laryngitis. Typical symptoms include hoarseness, a sensation of a lump or excess mucous in your throat, “post-nasal drip,” excessive need to clear your throat, and a non-productive cough. Heartburn is not a necessary symptom to be diagnosed with acid reflux, and about half of all patients that have reflux to the level of the voice box (larynx) do not have heartburn. Some people report waking with an irritating cough, or burning in their throats.

Chyme flies: Acid reflux is fairly common with almost half of Americans having symptoms at some point each year. Lifestyle, eating habits, smoking, alcohol, and stress all have a big effect and can exacerbate reflux enough to cause severe symptoms. Certain medical conditions and medications can also increase reflux or make you more susceptible to its effects. Stomach fluid (chyme) contains hydrochloric acid as well as digestive enzymes, which can make the problem worse.

By the time you recognize severe or frequent symptoms, irritation to the lining of your larynx has already occurred, making it difficult to treat with lifestyle changes alone. Medications to reduce the amount of acid produced in your stomach are usually helpful in improving the initial irritation. About half of all reflux patients requiring medication to reduce acid can successfully wean off the medication after an appropriate amount of time. The other half either have recurrent symptoms at some point in the future, need to stay on the medication for an extended period of time, or require additional treatment to control the reflux. Evaluation by a Gastroenterologist is frequently helpful in those patients with uncontrolled reflux or severe heartburn.

Lifestyle changes can help: Lifestyle changes are important to controlling the problem. Recognize stress and reduce those stressors you can control. Caffeine, alcohol, tobacco (including second-hand smoke) all make reflux worse. Carbonated beverages can increase belching, which also brings up chyme. Spicy and fatty food, as well as mints can make reflux worse. Also, going to bed with a full stomach of food makes nighttime symptoms worse. So it is recommended to wait about 2 hours after eating dinner before you lay down. Often elevating the head of the bed 6 inches can help keep the chyme in its place in the stomach. Pillows won’t do it – put 6” of magazines under both headposts.