#refluxdisease may exist as either a purely esophageal type or GERD, a purely respiratory type known as
LPR, or a mixture of the two. The #esophageal
type of #reflux
is usually characterized by either burning or
pain in the chest and/or upper abdomen and other symptoms such as difficulty swallowing, regurgitation
or pressure in the chest. The respiratory type is more known for symptoms that include sore throat,
increased mucus production, hoarseness, vocal pain or fatigue, sinus drainage, chronic cough, asthma,
bronchitis, ear pain, and even sleep apnea.
The symptoms of all types of reflux have been shown to be caused by too many relaxations of the LES.
These relaxations are known as transient lower esophageal relaxations or TLESR's. Normally, these
relaxations occur only 2-3 times per hour. In patients with reflux, the transient relaxations may occur
dozens of times in an hour, allowing the stomach contents to vent up into the esophagus or throat.
The reflux associated with esophageal reflux is mostly a disease of the reflux of liquid acid, bile or
digestive enzymes. The respiratory form of reflux is caused principally by aerosolized Pepsin (a digestive
enzyme of the stomach) that adheres to the tissues and is reactivated by acid food or beverages in the diet.
As such it is more difficult to control because it requires more LES pressure to hold back gas vs. a liquid.
In the past it was felt that the abnormal number of TLESR's and therefore reflux, was due to excessive
nerve impulses to the #LES
muscle, causing it to relax too often or lack of adequate contraction of the
sphincter muscle. We now know that these increased relaxations are primarily due to weakening of theLES due to progressive degeneration over time, to the point that LES is too weak to hold back the normal
pressure of the stomach contents. This is why medications are largely ineffective and only help to control
symptoms while the reflux continues and the LES degeneration continues to worsen over time until even
the medications are ineffective