It has been estimated that as many as 30% of people have a hiatal hernia or malfunctioning lower esophageal sphincter (LES). The LES is a muscular “valve” that is supposed to keep highly acidic stomach contents from going backward into the esophagus. Persons wish one of these conditions might note frequent heartburn or acid belching. However not everyone has these obvious symptoms. 

When a person with acid reflux lies down at night, acid may travel up to the level of the throat and even come into contact with parts of the larynx. Because this occurs mainly at night during sleep, the person is often unaware that this is happening.

One or many of the following may symptoms may result: 

  • Chronic sore throat: usually worse in the morning and gets better as the day progresses. 
  • Excessive morning “phlegm” 
  • Chronic, irritative cough 
  • A sensation of needing to continually clear one’s throat 
  • A particularly low or husky voice in the morning requiring prolonged “warm-up” if one is a singer. 

 

TREATMENT MEASURES 

1. Avoid caffeine (soda, coffee, tea, chocolates) alcohol, spicy foods, cigarette smoking, fatty foods, and mints. These substances may increase stomach acidity and may also make the LES function poorly. Use decaffeinated drinks. 

2. Eat the last meal/snack of the day no fewer than 4 hours before going to sleep. In addition, try to eat the heavier meals at noon and lighter ones in the evening. The purpose of these suggestions is to have the stomach relatively empty when one lies down so that there is not a lot of “back pressure” to push the stomach contents up the esophagus and into the throat. 

3. Use 4-6 inch bed blocks under the head posts of the bed. Old books or wooden blocks work well for this purpose. This procedure puts the entire bed on a slight downwards slant from head to foot. You may need a pillow under your knees to keep yourself from sliding down. Gravity assists in keeping the stomach acid where it belongs. 

4. You may be prescribed an acid-reducing medicine such as Prilosec OTC, Prevacid, Nexium, Aciphex, or Protonix. Take these medications one hour before breakfast. Treatment of this problem will usually require a 3 month treatment before the medication can be decreased or discontinued. Make sure to refill your medications and continue the treatment. Use a bedtime dose of a simple antacid such as Gaviscon or Maalox in order to reduce acidity. 

5. Weight loss: It is recommended that a trial of the above measures be continued for a minimum 3-4 weeks and that none of the above treatments are omitted. 

If you have further questions, please do not hesitate to call our office at (407) 846-4000

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