In my 24 years as a practicing ear, nose, and throat specialist, I have treated thousands of patients with acid reflux disease.
Acid reflux occurs when stomach acid flows backwards up into the esophagus. The esophagus is the structure that connects the throat to the stomach.
Among my patients with acid reflux many are surprised to learn that you can have acid reflux without the traditional complaint of heartburn.
Here are seven other facts those with acid reflux are often surprised to learn:
1. Acid reflux affects approximately 60 million Americans. Classically, acid reflux disease was thought to be a disease affecting white males over 50. However, that no longer holds true. Acid reflux affects every race, gender and adult age group.
2. There are two types of acid reflux disease: “Heartburn reflux,” in which the main complaint is heartburn, and “throatburn reflux,” in which the main complaints are chronic cough, frequent throat-clearing, hoarseness and/or a lump-like sensation in your throat. Throatburn reflux is acid reflux without any heartburn complaints. The medical term for heartburn reflux is GERD (gastro-esophageal reflux disease) and the medical term for throatburn reflux is LPR (laryngopharyngeal reflux)
3. Acid reflux can lead to more serious problems. Let untreated, or insufficiently treated, acid reflux disease can lead to severe inflammation in the esophagus, stomach, lungs, vocal cords, and throat. In some cases, untreated or insufficiently treated acid reflux can even progress to esophageal cancer – the fastest growing cancer in America and Europe since the mid 1970s.
4. You should avoid acidic foods if you have acid reflux disease, because they loosen the muscle between the stomach and the esophagus. In addition to the “classic” acidic foods – such as caffeine, chocolate, alcohol, mint, tomato, onion, and garlic – “healthy” foods such as honey, blackberries, strawberries, raspberries, and blueberries are very acidic too.
5. Healthy acidic foods such as honey and berries can have their acidity neutralized by buffering them with more alkaline (less acidic) foods. For example, berries become safer for people with acid reflux if you add unsweetened almond milk.
6. A low acid, high-fiber diet that contains a balance of all three macronutrients (proteins, fats, carbs) reduces inflammation from acid reflux and helps with sustainable weight loss as well, in my clinical experience.
7. Acid reflux can be diagnosed without having to sedate the patient. In other words, we now have the ability to examine the esophagus for damage from acid reflux with the patient wide awake. This technique, which I helped pioneer in 1998 in the United States, is called TNE (transnasal esophagoscopy).
The traditional way to examine the esophagus had been to place a large camera in the mouth and guide it past the throat into the esophagus. Because the camera went through to the back of the mouth, where the powerful gag reflex was always stimulated, we needed to give patients intravenous sedation to negate the effects of the gag reflex. With TNE, an ultra-thin camera the size and softness of a cooked piece of spaghetti, is placed via the nose into the throat area, then into the esophagus. By going through the nose, the doctor bypasses the back of the mouth, so the gag reflex isn’t stimulated.
Because you don’t have to worry about the gag reflex with TNE, patients don’t need IV sedation. Because the patient is awake, the procedure is much safer, there’s also no need for expensive monitoring , and the patient can go back to work or to play right after the procedure.
TNE is less expensive and more convenient than traditional sedated upper endoscopy. And numerous studies have shown that TNE is as safe as traditional sedation upper endoscopy, as well-tolerated by the patient, and as good as detecting potentially precancerous tissue. Most people have never heard of TNE, but in the past 10 years, more doctors are using this technique and residency training programs are teaching it.
Jonathan E. Aviv MD, FACS, is the clinical director and founder of the Voice and Swallowing Center of ENT and Allergy Associates in New York City. He is the author of Killing Me Softly From Inside: The Mysteries and Dangers of Acid Reflux and Its Connection to America’s Fastest Growing Cancer with a Diet That May Save Your Life. You can reach him on Facebook, and YouTube.