– Genita, Delaware First of all, you have taken the most important step in evaluating a chronically sore throat by visiting an ear/nose/throat specialist. His diagnosis of gastroesophageal reflux disease (GERD) sounds probable since that is a common cause of chronic sore throat, especially on only one side. What happens is the lower esophageal sphincter (the valve between your stomach and esophagus) weakens, which allows stomach contents (acid, bile, and semi-digested food) to leak into the esophagus, often causing heartburn, chest pain, and esophagitis. The acid can sometimes reach the throat, leading to laryngitis, hoarseness, dry cough, and the persistent mostly one-sided sore throat you mention. Another possible culprit is a chronic postnasal drip. Typically, over-the-counter medications that contain both an antihistamine and a decongestant are useful, which is why the Benadryl may be helping. Keep in mind that there are many causes of postnasal drip, including allergies, dryness, pollution, and other irritants — especially tobacco smoke. Also remember that it is not uncommon to have more than one cause of the soreness, such as a reflux and postnasal-drip combo. What can you do? Besides taking medication (which you should always review with your doctor) try the following strategies and see if they help:
Put a humidifier in your bedroom.Avoid late night eating and drinking.Control your weight.Eat smaller meals.Raise the head of your bed.Don’t smoke.
Q2. Every time I swallow I feel like there is something stuck in my throat. My doctor says I have silent reflux. I have been on Protonix since February. I was feeling better, but now it’s beginning to feel worse. What more can I do? — Mir, New York Protonix (pantoprazole) is a proton pump inhibitor, one of a class of medications that blocks acid secretion from the stomach. Acid-decreasing drugs should have markedly improved your swallowing difficulties by now, if the problem were related to GERD or acid reflux. At this point, I would suggest that you see a gastroenterologist to determine the cause of this sensation. Q3. My acid reflux is so bad when I lie down at night that it keeps me tossing and turning. What can I do for reflux when I am sleeping? — Tony, Arizona Gastroesophageal reflux disease (GERD) is caused by the reflux of stomach contents into the esophagus. When you are sitting or standing, the force of gravity reduces reflux, whereas lying down worsens reflux and its associated symptoms. One way to improve GERD during sleep is to elevate the head of your bed at least six inches above the feet with a surgical wedge or wooden boards. Other measures that can improve GERD when you are sleeping are:
Avoid eating less than two hours before bedtime. Food stimulates acid secretion, which can damage the lining of the esophagus and increase the volume of the refluxed contents.Avoid alcohol, smoking, peppermint, caffeine, and high-fat foods. These substances cause relaxation of the lower esophageal sphincter, which normally helps keep stomach contents from refluxing into the esophagus.Weight loss also lowers the amount of pressure on the abdomen, which can help decrease reflux.Finally, over-the-counter medications that neutralize acid (such as Gaviscon, Mylanta, Maalox, or Tums) or block stomach production of acid (such as Zantac, Pepcid, Tagamet, or Prilosec) can improve reflux.
Q4. My heartburn seems to get worse when I exercise. I’ve tried waiting for an hour after eating or exercising on an empty stomach, but there is no difference. Taking an antacid while I’m exercising does help somewhat. Do you have any advice? — Patricia, California Heartburn, the most common symptom of gastroesophageal reflux disease (also known as GERD), can be exacerbated during exercise. The type of exercise you do can certainly affect the amount of acid that backs up into the esophagus. Physical activity like weight lifting, for example, can increase the pressure on your abdomen. When abdominal pressure is increased, your stomach contents are more likely to kick back into your esophagus. An empty stomach will not help, because acid is still being produced in your stomach and it can still be pushed up into the esophagus. I would suggest taking antacids before exercise, or trying an over-the-counter acid blocker such as Prilosec or a histamine-2 blocker like Zantac, Tagamet, or Pepcid. If your symptoms persist, you should consult your primary doctor or a gastroenterologist. Q5. Is it possible to have bad breath as a result of a digestive problem? I’m currently on pantoprazole for upper abdominal pain, bloating, and heaviness in my stomach. Though gastroesophageal reflux disease (GERD) has been cited as a cause of halitosis (bad breath), the evidence is not yet conclusive that it truly is. Severe acid reflux can result in stomach contents refluxing into the mouth (usually when a patient is reclining or lying flat), which can cause both a bad, acidic taste and halitosis. However, no clear evidence exists that blocking acid with a proton pump inhibitor or other agent improves bad breath. Other causes of halitosis are more common, including the growth of certain mouth bacteria, gingivitis (infection in the gums), and sinusitis (infection in the sinus cavities). You might consider seeing your dentist for an evaluation to determine whether you have any oral problems that might be contributing to your halitosis. Q6. Are there any contraindications to the long-term use of medications like Prevacid, Nexium, or Prilosec? I take one in the morning and one in the evening and am perfectly comfortable but just a little concerned about the long-term effects. — Marian, Arizona Proton-pump inhibitors, including Prevacid, Nexium, and Prilosec, are widely prescribed medications used to treat GERD and block stomach-acid secretion. While this class of drugs is generally considered safe, there are some concerns with long-term treatment. These medications work by blocking acid secretion from the parietal cells of the stomach, but these cells also make a substance called intrinsic factor, which is critical for vitamin B12 absorption. Because proton-pump inhibitors also reduce intrinsic factor secretion, long-term use can lead to a vitamin B12 deficiency. You should have your vitamin B12 levels checked and replaced if they are low. More recently, bone loss and osteoporosis have been noted in patients using proton-pump inhibitors over the long term. Make sure you periodically discuss your usage with your doctor, so he or she can check for any of these side effects. Learn more in the Everyday Health GERD Center.
