ANTI-REFLUX PROTOCOL     


Reflux esophagitis and laryngitis are caused by leakage of stomach juices out of the stomach and into the esophagus and throat. The juice from the stomach is highly acidic and contains digestive enzymes. These have the same effect on delicate throat linings as they do on the food we eat. Irritation, a bitter taste, coughing, soreness, throat clearing, and excessive mucus are all symptoms associated with this disorder. A sensation of a lump in the throat due to spasm of the muscle at the top of the esophagus is also a common symptom.

The following instructions are intended to help decrease the acidity of the stomach juices, reduce the production of acid, and prevent leakage of the stomach juices out of the stomach. When the symptoms are severe, strict attention must be paid to the following instructions. When symptoms are less severe, you may use your judgment as to which suggestions should be followed. It is common for resolution of symptoms to require two to four weeks for significant improvement to be noted. Refer back to this page if symptoms recur in the future.

1) Take an antacid in liquid form (Maalox, Mylanta, or other antacid of your choice) 30 minutes after meals and at bedtime. The usual dose is 30 ccs. A double dose at bedtime is frequently helpful. If symptoms are not improved within one week, please contact us. You will probably require a medication, such as Zantac or Propulsid.

2) If you are overweight, you should begin a weight loss program.

3) Diet restrictions help control symptoms. A bland diet divided into multiple small feedings is recommended. What is bland for one person may be too spicy for another. Use common sense and restrict obviously irritating foods. Five or six snacks per day are desirable rather than three full meals. Food should be properly chewed and should not be too hot or too cold. Take your time while eating.

4) Alcohol, tobacco, caffeine and chocolate are agents which dilate the lower esophageal sphincter and allow leakage from the stomach into the esophagus. These are to be strictly avoided during times when symptoms are present. Alcohol and caffeine also stimulate stomach acid secretion. Candy, lozenges, gum and breath fresheners taken between meals are to be avoided. The stomach can be fooled into thinking that a meal is about to be presented and will ready stomach acid in preparation for receiving food. Between-meal snacks are preferable.

5) Do not eat for four hours before retiring to bed. Go to bed on a completely empty stomach, except for liquid antacid and evening medications.

6) The head of your bed should be elevated such that the throat is higher than the stomach. Most of the damage done by reflux of stomach acid occurs at night. If you have a regular bed, put the legs of the head of the bed on eight inch blocks and sleep on three pillows, such that you are flexed at the waist. If you have another type of bed, multiple pillows will be necessary to achieve desired height. If your symptoms are quite severe, sleeping in a reclining lounge chair is often necessary.

7) Clothing that fits tightly across the mid-section of the body should be avoided. Women should not wear constricting garments such as girdles. Men should wear suspenders rather than a belt. Braces that constrict the stomach should be avoided during the treatment for reflux esophagitis.

8) Practice abdominal breathing during the time you are symptomatic. Concentrate on pushing out the stomach with each breath, instead of expanding the chest. Allow your stomach to be relaxed. A tense abdominal wall increases intra-abdominal pressure and increases the likelihood that stomach acid will be pushed out of the stomach and upwards into the esophagus.

9) Do not bend or stoop anymore than is absolutely necessary. Gardening or chores on the hands and knees should be avoided. Exercises requiring lifting or bending should also be avoided during the treatment period.

10) Stress stimulates secretion of stomach acid. If your life is stressful, and our treatment is initially not successful, it may be necessary to enter treatment for stress reduction and/or for uncontrolled anxiety. Please contact us if this is a problem that needs attention.

If at any time your symptoms are getting worse or new symptoms that do not fit this pattern appear, you should let us know about it. Although reflux esophagitis and laryngitis are common symptoms, they are by no means the only reason for a sore throat or a feeling of a lump in the throat.



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