Although, heartburn is the most common symptom of
gastroesophageal reflux
(GERD) disease (stomach acid entering the
esophagus,
food tube, in the chest), some patients only experience
a tightness in their lower throat or hoarseness. In these patients, there
is no chest discomfort, only throat tightness. For years the medical
profession called this symptom "Globus" and felt it was due to a
psychological problem. Now it is known that the throat tightness is
usually from spasm of the cricopharyngeous muscle in the lower throat and that
this spasm is usually caused by stomach acid. Chronic spasm of this muscle
along with forceful swallowing can cause dilatation of the lower throat (hypopharynx)
and pocket formation (Zenker's Diverticulum).
It has also been found that
occult reflux disease is the most common cause of hoarseness in a non-smoker and
has been implicated in sinusitis in children.
As
with any symptom, other more serious causes are possible and a full medical
evaluation is advisable.
Patients with recurrent or persistent reflux disease should be evaluated by
endoscopy. Chronic reflux disease can cause scaring and narrowing of the
esophagus
and is one for the predisposing factors to
esophageal
cancer. Newer endoscopes are smaller and can be passed via the nose
down the
esophagus.
This procedure is less expensive and can be performed in the office. Much
like a fiberoptic examination of the larynx (voice box).
View Abstract Examination of the
larynx
(voice box)
my give some indication that reflux is present. The finding of
pachydermia (thick wrinkling mucosa) of the back part of the larynx used to be
thought to be caused by reflux but a Hill et.al. reported that this finding is
unreliable in predicting
gastroesophageal reflux
disease.
View Abstract .
Patient Suggestion: Ask your doctor if a generic or
over the counter medication may be able to treat your
condition at a lower cost. For example:
A discount pharmacy was
consulted on Nov 20, 2007 (prices used in this example
may change and vary).
1) A 30 day supply of 40 mg of Nexium taken once a
day cost 139.99. Instead consider taking prilosec
20 mg twice a day at a cost of $41.99.
2) A new drug Zegerid (40 mg) is a combination of
omeprazole and an antacid. It costs $155 for a
months treatment. However, the same dosage of prilosec
(omeprazole) and
antiacid bought over the counter cost under $50 a month.
Patient Suggestion: If your doctor has
recommended an examination of your
esophagus
and stomach using a fibroptic
scope. Ask him if instead of being sedated in a
surgery center and having a large tube placed down through
your mouth, if you could be evaluated using trans-nasal
esophagoscopy where a small tube is placed down your nose.
This procedure is performed in an office setting is costs
less than the traditional fibro-optic esophagoscopy.
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