reflux diagram

Simply put, Reflux is the contents of the stomach (Acid, Pepsin & Bile) escaping through a valve at the top of the stomach and up into the oesophagus and even into the airways causing a variety of symptoms.

There are many causes including poor diet, too much alcohol, use of certain pain killing drugs, stress and general lifestyle.

Gastroesophageal Reflux Disease (GORD)

Gastroesophageal reflux disease is one of the most prevalent chronic diseases in the world with an estimated 4 million people in the UK suffering from daily reflux episodes. It is characterised by the symptoms of heartburn and regurgitation.

Cause of LPR

The cause of LPR is poorly understood. It is thought that an abnormality of the upper or laryngeal sphincter (UOS) of the oesophagus malfunctions, allowing a small amount of stomach secretions to touch the larynx and pharynx. The reflux has devastating effects because the larynx and pharynx have no defence mechanisms to these substances. It is known that refluxing as little as two times per week can have significant effects on the voice. The long-term consequences of LPR include severe degradation of the voice, and even larynx cancer.

GORD is caused by reflux of the gastric contents into the oesophagus. In most sufferers this is due to a relaxation of the lower oesophageal sphincter (LOS) that opens to allow food and liquids to pass into the stomach, and closes to prevent food and stomach acid from flowing back into the oesophagus. This relaxation of the LOS happens a few times each day in people without GORD. It’s not known why it happens more frequently in GORD sufferers. The oesophagus lining isn’t the same as that of the stomach and isn’t able to cope with pepsin, acid and other stomach enzymes and hence it is easily injured. It is this reflux of pepsin and acid into the oesophagus that produces the symptoms and potential damage to the oesophagus.

LaryngoPharyngeal Reflux LPR (Airway Reflux)

During gastroesophageal reflux, the contents of the stomach may reflux all the way up the oesophagus, beyond the upper oesophageal sphincter (a ring of muscle at the top of the oesophagus), and into the back of the throat and possibly the back of the nasal airway. This is known as laryngopharyngeal reflux (LPR), contact of delicate laryngeal and respiratory tissues with corrosive gastric juice produces symptoms such as hoarseness, voice disorders, chronic coughing and throat clearing. Around 35% of the US population exhibit LPR symptoms while 50% of all voice disorder or chronic cough patients will be diagnosed with LPR.

What are the symptoms?

Gastroesophageal Reflux Disease or GORD is known for causing heartburn but when it reaches the throat and beyond (Airway Reflux or Laryngopharyngeal Reflux (LPR) it can cause a variety of symptoms.

Common Symptoms of Reflux



Persistent Heartburn Store Throat
Oesophagitis Chronic Cough
Nausea A feeling of a lump in the throat
Hoarseness in the moming Post Nasal Drip
Trouble swalowing (Oesphageal stricture) Persistent Throat clearing
Regurgitation Voice Changes
Difficulity swallowing (dysphagia)
Hoarseness (disphonia)
Astma – reflux is the cause of 40% of adult onset asthma
Tooth decay

Supine and Upright reflux

Based upon pH-monitoring data, most patients with airway reflux (LPR) are upright (daytime) refluxers; however when an LPR patient has supine (nocturnal) reflux, tissue damage tends to be more severe. When it comes to initiation, nighttime reflux is far more injurious than daytime reflux. For many LPR patients, regardless of dose of acid-suppressive medications, late-night eating must be curtailed before effective treatment can begin.

How dangerous is Reflux?

Without early diagnosis and treatment reflux can in time lead to damage to the oesophagus (erosive oesophagitis) and to a pre-cancerous condition called Barrett’s Oesophagus. In certain cases it may also be linked to cancer of the Larynx.

Lower quality of life

In addition to the health risks, GORD symptoms can impact a person’s health and happiness.

A majority of GORD patients report that their quality of life has been compromised because of problems with food, drink, and sleep, as well as social and physical limitations. Quality of life for GORD patients is similar to heart-attack patients, and in some cases, even lower than those for cancer and diabetes.