Heartburn In The Throat : Causes, Symptoms, Diagnosis & Treatment

• Causes Of Heartburn In The Throat
• Laryngopharyngeal Reflux (Lpr)
• Violations Of The Acid-Producing Function Of The Stomach
• Other Diseases Of The Digestive System
• Neurological Diseases
• Itsenko-Cushing's Disease
• Viral Infections
• Survey
• Symptomatic Therapy

Heartburn in the throat is a subjectively unpleasant sensation in the pharynx, which manifests itself in the form of burning and discomfort, provoked by the ingestion of aggressive gastric contents. Episodic heartburn is caused by dietary errors or bad habits. The combination of a symptom with belching, abdominal pain, stool disorders indicates a pathology of the gastrointestinal tract. To identify the cause of burning, endoscopic and radiological methods, examination of the ENT organs are used. To reduce the severity of the symptom, antacids, prokinetics, antisecretory drugs are used.

Causes of heartburn in the throat

Burning and discomfort in the throat can be observed in absolutely healthy people. The most common cause of such symptoms are errors in the diet: abuse of spicy or salty foods, caffeinated drinks that cause an increase in the production of hydrochloric acid, throwing it into the throat. Heartburn can also be caused by smoking and drinking too much alcohol. Burning is often observed in pregnant women, especially in the second and third trimesters, which is associated with an increase in intra-abdominal pressure and reflex opening of the cardiac sphincter.

Laryngopharyngeal reflux (LPR)

The back reflux of the aggressive contents of the stomach into the cavity of the pharynx and larynx is the main cause of the development of heartburn in the throat. The mechanism of the disease is associated with inconsistent work of the upper and lower esophageal sphincters with constant relaxation of the laryngopharyngeal sphincters. As a result of regurgitation (reverse reflux) of liquid contents with a pH below 4, the mucous membrane of the throat is irritated. An important role in the progression of laryngopharyngeal reflux is played by a violation of the reflex reactions of the larynx to an irritant.

The clinical picture of LPR is characterized by a combination of heartburn and nonspecific respiratory complaints: episodic dry cough, mucous discharge from the oropharynx, increased saliva production. Sometimes the sensations are described by patients as a squeezing "lump in the throat". An important sign of the disorder is the aggravation of unpleasant symptoms in a horizontal position, due to the ingestion of more gastric juice into the upper respiratory tract.

Violations of the acid-producing function of the stomach

The appearance of heartburn can be caused by increased production of hydrochloric acid by the parietal cells of the body of the stomach, which provokes the opening of the cardiac sphincter and the reflux of chyme (liquid, partially digested food) into the pharynx. Often the symptom is combined with burning and soreness behind the sternum. Discomfort in the throat also develops due to a decrease in acid production and stagnation of chyme. In this case, unpleasant sensations are potentiated by organic acids, which are produced in large quantities during the decomposition of food in the stomach. Usually lead to burning in the throat:

• Gastritis . At the initial stages of mucosal inflammation caused by exposure to bacterial flora, the production of hydrochloric acid increases significantly. A decrease in the pH of the gastric juice in combination with uncoordinated contractions of the sphincters leads to the reflux of the contents into the overlying sections of the gastrointestinal tract with a sensation of heartburn in the throat. The disease is also manifested by sour belching, constipation and pain in the epigastrium.
• Ulcer disease . The formation of an ulcerative defect in the mucosa, caused by an increase in aggression factors and a decrease in protection factors, always proceeds with severe dyspeptic disorders. With a stomach ulcer, heartburn is caused by impaired motility and gaping of the cardiac sphincter. With duodenal ulcers, duodeno-gastric reflux is observed, against which the mucous throat is irritated by duodenal contents.
• Gastrinoma . A gastrin-producing tumor located in the pancreas or antrum of the stomach provokes an uncontrolled increase in the secretion of hydrochloric acid, which does not depend on food intake. At the same time, sour belching, heartburn in the throat and burning behind the sternum, severe pain in the epigastric region are determined. The condition is aggravated by the addition of steatorrhea, which develops with malabsorption of food.
• Pyloric stenosis . The transition between the stomach and the duodenum often narrows during the cicatricial processes of the pylorus, which is accompanied by inhibition of the production of hydrochloric acid, causing prolonged stagnation of partially digested food masses. As a result, macromolecules decompose with the formation of organic acids. Stretching of the gastric wall triggers reverse peristalsis and promotes acid reflux into the pharynx.
• atrophic gastritis . The disease is of an autoimmune nature or occurs in the later stages of bacterial gastritis, when there has been a hollow destruction of the lining cells of the mucosa. Heartburn is associated with increased formation of lactic and pyruvic acids due to the decomposition and putrefaction of undigested food. Burning associated with rotten belching, vomiting of food eaten, alternating constipation and diarrhea.

Other diseases of the digestive system

The feeling of heartburn in the throat often indicates diseases of the underlying parts of the digestive system. Burning and pain in the laryngopharynx are sometimes detected with irritation and erosion of the mucosa against the background of ingestion of small intestinal contents with a large amount of bile acids. Secondary disorders of the motor function of the smooth muscles of the gastrointestinal tract and discoordination of the gastric sphincters exacerbate the symptoms. The main causes of heartburn are:

• Duodenitis . Dyspeptic disorders, along with pain syndrome, are the main signs of inflammation of the duodenum. Burning in the throat occurs due to the irritating effect of hydrochloric acid and bile acids on the mucous membrane of the pharynx. Unpleasant sensations are combined with nausea and vomiting, a tendency to instability of the stool, bitter belching. The cholecystic form of the disorder proceeds according to the type of biliary colic.
• Enzyme deficiency . Heartburn with a decrease in the exocrine function of the pancreas is a sign of exacerbation of chronic pancreatitis and gastrointestinal motility disorders caused by duodeno-gastric reflux. Characteristic signs are steatorrhea and tentorrhea - the release of grayish loose stools with undigested food residues. Malabsorption leads to rapid weight loss.
• Peresplenit . Heartburn with inflammation of the spleen capsule usually has a neuro-reflex character and is caused by impaired gastric motility. The symptom is accompanied by burning pain in the left hypochondrium, which radiates to the scapula, left arm and cardiac region. A typical combination of pain syndrome with fever, signs of general intoxication of the body. Unpleasant manifestations are aggravated by physical exertion, coughing, sneezing.
• Adductor loop syndrome . Frequent episodes of stagnation of digested food in the caecum of the intestine in case of disease of the operated stomach lead to stretching of the intestine and its throwing back into the stomach. The smooth muscles of the gastric wall contract reflexively, then the aggressive chyme enters the esophagus and pharynx. In addition to burning sensations in the throat, vomiting is possible after eating, a feeling of heaviness and fullness in the epigastrium, weight loss.

Neurological diseases

Dyspeptic disorders in the pathology of the central nervous system are often provoked by dysregulation of the autonomic innervation of the abdominal organs. Symptoms such as heartburn, nausea, abdominal pain, usually serve as signs of visceral paroxysms. Unpleasant sensations from the gastrointestinal tract are often combined with other types of vegetative reactions: pallor, excessive sweating, palpitations. A burning sensation in the throat area is caused by:

• Temporal epilepsy . Heartburn and other dyspeptic disorders occur as a result of the involvement in the pathological process of autonomic centers responsible for the innervation of internal organs. These symptoms appear both as separate somatosensory paroxysms and as an "aura" before a typical epileptic seizure. Over time, epilepsy leads to emotional and intellectual impairment.
• Alcoholic encephalopathy . Burning, discomfort in the throat, nausea and vomiting, stool disorders are harbingers of the disease. They are associated with local and general toxic effects of ethanol and its metabolites. The detailed clinical picture of the disease is characterized by visual and auditory hallucinations, alternating periods of chaotic excitation and depression of the central nervous system. In severe cases, brain dysfunction turns into a psychoorganic syndrome and dementia.

Itsenko-Cushing's disease

Heartburn with hyperproduction of hormones of the adrenal cortex is formed due to increased production of gastrin and hydrochloric acid in the stomach. A decrease in the acidity of gastric juice and impaired motility of the upper parts of the digestive tract cause the flow of acidic contents into the laryngopharynx. In addition to dyspepsia in Itsenko-Cushing's disease, pathognomonic signs of pathology are determined: cushingoid appearance (significant fat deposits in the trunk area, moon-shaped face), purple striae (skin stretch marks) on the thighs and abdomen, cardiovascular pathology.

Viral infections

The combination of dyspeptic disorders with respiratory symptoms is characteristic of measles in young children. Periodic throwing of gastric chyme is associated with functional disorders of gastrointestinal motility due to general intoxication and the specific action of the pathogen. Heartburn in the throat is a secondary nonspecific symptom that occurs against the background of the main manifestations: lacrimation, serous rhinitis, dry cough. The destruction of the epithelial layer under the action of viral particles exacerbates the burning sensation in the laryngopharynx.

Survey

Examination of patients with discomfort and burning in the throat is done by a gastroenterologist. Diagnostic search is primarily aimed at a comprehensive study of the morphological and functional state of the esophagus, stomach, and upper intestines. The diagnostic plan necessarily includes an examination of the respiratory tract to assess the degree of pathological changes. The most valuable for establishing the root causes of heartburn are:

• Endoscopy . EGDS allows you to visualize the mucous membrane, to detect signs of inflammatory or ulcerative processes in the gastrointestinal tract wall. According to the indications, the method is supplemented with a biopsy of suspicious foci of the mucous membrane of the upper digestive tract or manometry of the lower esophageal sphincter.
• The study of gastric secretion . Daily measurement of pH in the stomach is necessary to determine the type of secretory activity of parietal cells. In patients with heartburn, the level of acidity in the lower third of the esophagus should also be measured, since a decrease in pH less than 4 indicates the intake of aggressive gastric juice.
• X-ray methods . Carrying out a series of radiographs at certain intervals after oral contrasting helps to detect ulcerative-destructive defects in the mucosa. Leakage of the contrast agent into the esophagus indicates insufficiency of the cardiac sphincter of the stomach.
• The study of ENT organs . To confirm the presence of inflammatory or erosive changes in the throat, an examination of the upper respiratory tract is performed using special endoscopes or laryngeal mirrors: pharyngoscopy, laryngoscopy. Additionally, a smear is taken from the throat and nose to exclude infectious diseases.

To clarify the diagnosis with complaints of heartburn in the throat, laboratory tests are used: the level of pancreatic amylase and lipase is determined, the concentration of gastrin and pepsinogen in the blood is measured, and specific serological reactions are performed. After exclusion of all organic and functional diseases of the gastrointestinal tract, an examination by a neurologist may be required.

Daily pH-metry of the stomach

Symptomatic therapy

Episodic heartburn in the throat is often associated with nutritional errors, therefore, to stop it, it is important to properly adjust the diet. To reduce discomfort, it is recommended to radically limit the intake of salty and spicy foods, smoked meats, strong tea and coffee. You need to eat 4-5 times a day in small portions, chewing food thoroughly. In many patients, the symptoms completely disappear after quitting smoking and reducing the amount of alcohol consumed.

To reduce the frequency and duration of heartburn episodes, it is advisable to avoid wearing tight belts, corsets, and fanny packs. Sleeping on a high pillow helps reduce the likelihood of nighttime attacks. If a burning sensation in the throat is observed constantly and does not disappear after the correction of food addictions, this indicates a disease of the gastrointestinal tract. Before establishing a clinical diagnosis, antacids, proton pump inhibitors, prokinetics can be used to relieve symptoms.