Heartburn, indigestion and acid reflux – tips for helping clients
Do you have clients who are regularly experiencing one or more of the following symptoms?
- burning sensation or pain in their stomach, chest or throat
- nausea or vomiting
- a sour or bitter taste in their mouth
- chronic cough, throat clearing or hiccups
- difficulty swallowing or feeling like there is a lump in their throat or that something is stuck in their throat
- food refusal or behavioural issues at mealtimes
If so, they may have acid reflux. But did you know there are actually two types of acid reflux — gastroesophageal reflux and laryngopharyngeal reflux? More importantly, did you know the causes and treatments for each type of reflux are different?
What is reflux?
When everything is functioning as it should, there are two rings of muscles in your throat (called the upper and lower oesophageal sphincters) which act as one-way valves to allow swallowed food and fluid to travel into the stomach. These sphincters are also designed to stop stomach acid from backing up and damaging the delicate tissues of the oesophagus and voice box. If one or both of these sphincters are not functioning properly (and this can happen for a variety of different reasons), then a person will experience acid reflux.
In this condition, it is only the lower oesophageal sphincter (just above your stomach) which isn’t functioning properly. This causes stomach contents to back up into the lower oesophagus, usually causing heartburn, inflamed tissue in the oesophagus and/or the sensation of acid backing up.1 People suffering with gastroesophageal reflux are most likely to experience their symptoms when they are lying down.1
In the European population, acid reflux is quite common, affecting 8.8 – 25.9% of the general public.2 I was unable to find any statistics for rates of gastroesophageal reflux after a brain injury, but 77% of children with cerebral palsy3 and 22-27% of people with a spinal cord injury are thought to experience gastroesophageal reflux.4,5
Treatment generally includes a combination of medication (eg. Gaviscon Advance, Omeprazole, Lansoprazole, Ranitidine) and/or lifestyle changes such as losing weight; reducing intakes of caffeine, alcohol, spicy food, and fatty foods; eating smaller amounts; not eating close to bedtime; and stopping smoking.2 Sometimes other foods need to be restricted as well.
I was so interested to learn about this type of reflux from a Speech and Language Therapy colleague a few months ago (thank you Tracey Dailly!) These clients have very different symptoms to those with gastroesophageal reflux.
With laryngopharyngeal reflux, there is a problem with both the upper and lower oesophageal sphincter muscles and so stomach acid is backing up much higher and damaging the extremely delicate tissue between the nasal cavity and the voice box.7 This damage can happen with a very small amount of acid — much less acid than is needed to produce heartburn or to damage the slightly heartier tissues in the oesophagus.1 This makes it very difficult to spot because these people often do NOT experience heartburn, the sensation of acid in their throat or inflamed tissue in the oesophagus.1 Instead, you must look for much more subtle clues such as hoarseness, a chronic cough, throat clearing, difficulty swallowing and/or feeling like there is a lump in their throat.1,7 Unlike gastroesophageal reflux, these symptoms are most likely to be present during the day and tend to be worse when the person is upright.1,7
Medication and lifestyle changes (as outlined above) are also used to treat this condition, but the medication element must be much more aggressive than when treating someone for gastroesophageal reflux.1 Laryngopharyngeal reflux often requires at least DOUBLE the usual dose of proton pump inhibitors (split into two doses) for several months before people notice any relief.1,6 I’ve made the mistake of assuming that just because someone is already being treated for reflux that all of their symptoms are being managed. This isn’t always the case and when I’ve been in touch with a few GP’s recently and asked for clients to be treated for laryngopharyngeal reflux — the results have been nothing short of miraculous.
For support with dietary and lifestyle advice to help improve a client’s symptoms of reflux, please get in touch with Sheri Taylor, Specialist Rehab Dietitian at firstname.lastname@example.org or 0121 384 7087. To receive articles like this one straight to your inbox each month, don’t forget to sign up for my monthly newsletter below.