The pH of NAR episodes may affect the biological activity of the
refluxate content.
Laryngopharyngeal reflux (LPR) and lung aspiration of
refluxate are dangerous complications that often occur in the absence of oesophagitis or its primary symptom, heartburn (5).
This suggests that gastric
refluxate can enter the middle ear and thus contribute to the development of OME.
Vagal innervation is also the underlying mechanism for cardiac arrhythmia and ischemia being triggered by esophageal irritation with acidic
refluxate, as well as esophageal spasm being triggered by cardiac ischemia (4,5).
The role of an alginate suspension on pepsin and bile acids - key aggressors in the gastric
refluxate. Does this have implications for the treatment of gastro-oesophageal reflux disease?
In addition, decreasing transient lower esophageal sphincter relaxations (TLESRs) can reduce distal acid exposure and weakly acidic
refluxate [6].
There were also no correlations found between pH levels and RSI 7 "Troublesome or annoying cough" or RSI 2 "Clearing your throat." Cough can not only be triggered by direct contact of the laryngeal mucosa with
refluxate, as is the case with LPR, but GERD could cause indirect irritation to the larynx due to esophageal irritation caused by a vagal reflex [44].
"Aspiration of even a small amount of a neutral-pH
refluxate causes cough," Koufman explains.
(2) LPR is linked to globus by two main mechanisms: (1) vagal reflux stimulation in the esophagus by acidic reflux and (2) mucosal injury in the larynx from direct contact with
refluxate that contains gastric acid and pepsin.
(18) This transition usually occurs in the context of chronic gastrooesophageal reflux disease, which causes exposure of the epithelium to
refluxate. Gastro-oesophageal reflux disease is a major contributory factor and 5% of people with reflux disease develop Barrett's oesophagus.
While many people experience some degree of normal reflux of gastric acid contents, such episodes are generally considered "physiologic," as they are asymptomatic and the
refluxate rapidly clears.
PPI therapy exclusively targets gastric acid production, but acid is not the only potentially harmful agent in the
refluxate. An effective Stretta stops the reflux of all noxious refluxed material, including the potentially carcinogenic bile acids, while it obviates the potential side effects of PPIs.