Laryngitis Gastrica: Causes, Symptoms & Treatment

Laryngitis gastrica is an inflammation of the larynx caused by reflux of stomach acid. Therefore, the condition usually occurs as a symptom of reflux disease. Dietary measures and drug proton pump inhibitors are used for treatment.

What is laryngitis gastrica?

Laryngitis is an inflammation in the mucous membranes of the larynx. This inflammation can be acute or chronic. Both children and adults can get it. As a rule, laryngitis is either bacterial or viral. In the special form of laryngitis gastrica, however, neither bacteria nor viruses are the triggers of the inflammation. Chemical stimuli or vocal stress are also not responsible for the inflamed mucous membranes at the larynx in laryngitis gastrica. Instead, the larynx is attacked by refluxing gastric juice in this condition. This phenomenon is a symptom of reflux disease, so that laryngitis gastrica usually occurs as an accompanying symptom in the context of this disease. Reflux disease is a relatively common condition because of dietary habits in an affluent society. Approximately 20 percent of Americans are affected by reflux to the throat. Nearly half of them already had a history of laryngitis gastrica.

Causes

There are sphincters in the esophagus that keep the stomach contents from rising back up into the throat by what is called resting pressure. Only during swallowing is the lower sphincter of the esophagus relaxed. If this sphincter is damaged, reflux occurs. If, in addition, peristalsis is disturbed, there is excessive contact between mucous membranes and gastric acid. This can cause inflammation in the area of the larynx. The causes can be of various kinds. For example, the patient’s eating and drinking habits play a role. Spicy foods, fatty foods and coffee are judged to be risk factors for reflux disease. Similarly, a hiatal hernia can result in slackening of the esophageal sphincter and disorders of esophageal peristalsis. Diseases involving excessive gastric acid production are also possible causes, such as Zollinger-Ellison syndrome. Equally conceivable causes are general muscle weaknesses, medications or stress.

Symptoms, complaints, and signs

The main symptom of laryngitis gastrica is voice disturbance. Hoarseness is one of the most important changes, but impure, busy or even toneless voice sound can also occur. As a rule, laryngitis causes pain. This pain ranges from a general sore feeling in the throat to an unbearable scratching. There is usually a persistent urge to cough, with patients reporting mainly a dry cough. Sometimes, fever also sets in. In extreme cases, the mucous membrane of the larynx swells severely, pressing on the trachea and causing shortness of breath. A bitter taste spreads in the mouth due to the stomach acid and heartburn develops. Some patients additionally complain of a globus sensation, which manifests itself in dysphagia during eating and drinking. These dysphagia do not have to be actual, but can also be due to the subjective feeling of the affected person. Especially at night, the reflux symptoms present themselves.

Diagnosis and course of the disease

To make the diagnosis of laryngitis gastrica, 24h-pH-metry is usually performed in addition to endoscopy and gastroscopy. The probes used for this purpose have a measurement point in the hypopharynx that detects reflux in the affected region. In a loupe laryngoscopic image, this type of laryngitis manifests as hyperplasia of the posterior laryngeal mucosa. The coloration of the inflamed areas is relatively bright and the structure is pleated. Gastric juice decreases the resistance of the mucosa barrier. Pollutants thus penetrate more easily into deep cell layers. Also changes mucosal immune system adjust after some time. Chronic laryngitis gastrica can therefore promote laryngeal cancer, for example.

Complications

Due to laryngitis gastrica, those affected primarily suffer from hoarseness. This is not associated with flu or a cold and usually remains permanent.Furthermore, the patient’s voice may also change, and it is not uncommon for them to suffer from pain as well. This pain can also spread to other regions of the body. A cough also usually occurs and continues to reduce the quality of life of the affected person. Due to the inflammation, patients also continue to suffer from fever and, in the worst case, shortness of breath. Not infrequently, the shortness of breath can lead to a loss of consciousness, during which the affected person can also injure themselves. As a rule, laryngitis gastrica also leads to heartburn and further also to difficulty in swallowing. A normal intake of liquids and food is no longer possible for the affected person, so that in many cases there are deficiency symptoms or malnutrition. Laryngitis gastrica can be treated with the help of medication. As a rule, however, treatment of the underlying disease is also necessary to prevent the symptoms from recurring. There are usually no complications with treatment. However, patients are also dependent on a strict diet.

When should one go to the doctor?

If laryngitis is suspected, a doctor should be consulted in any case. Anyone who suddenly notices hoarseness or pain in the throat should at best confer directly with the family doctor. If laryngitis gastrica is treated early, the symptoms usually subside quickly. Medical advice must be sought at the latest if the voice disorders and pain are accompanied by fever. Severe heartburn, shortness of breath and dysphagia are further warning signs that need to be clarified. People who eat an unhealthy diet or suffer from a disease associated with excessive stomach acid production are particularly at risk. If the complaints occur in connection with taking medication, it is best to inform the doctor in charge. If stress is suspected as the cause, a therapist should also be consulted. Other points of contact for people with laryngitis gastrica are the gastroenterologist or an ear, nose and throat specialist. Children should first be referred to a pediatrician if they experience hoarseness and pain when swallowing. Laryngitis must be monitored carefully during recovery.

Treatment and therapy

Treatment of laryngitis gastrica depends on the causes and severity of the condition. A change in diet may make sense under certain circumstances. Abstaining from nicotine may also be worthwhile, as nicotine stimulates gastric juice production. That being said, patients are often advised to eat several small meals throughout the day. Hard-to-digest meals just before bedtime are eliminated from the diet. Overweight patients are also advised to reduce their excess weight. If voice disorders are present, voice therapy is additionally advised after improvement of the mucosal pattern. As a drug treatment, therapy with proton pump inhibitors is considered the treatment of choice. These drugs are intended to inhibit the formation of gastric acid. Often, the medication is administered on a trial basis and without further diagnostics based on the patient’s medical history. However, this approach is now strongly criticized. In the case of alarm signals, for example, no drug therapy should take place. The most important alarm signals include anemia and growths in the esophagus. Only in rare cases is surgical intervention proposed as the primary treatment for laryngitis gastrica. This procedure is also known as fundoplicatio and corresponds to a minimally invasive procedure to restore the closing function in the esophagus.

Outlook and prognosis

Normally, inflammation of the larynx has a favorable prognosis. The disease is treated with medication. Under optimal conditions, freedom from symptoms takes place within a few weeks. Particularly in the case of acute laryngitis gastrica, medical care should be sought so that an improvement in health can be achieved as quickly as possible. In addition, a chronic course of the disease may occur. This is usually the case if the affected person is also overweight or if there are disturbances in food intake. In these cases, therapies should be used that work towards a targeted improvement in lifestyle habits.The patient is informed about the cause of the symptoms and is also given training that he or she can implement independently outside the therapy period. Even with these courses of the disease, the prognosis is favorable, as freedom from symptoms can be achieved through the patient’s cooperation. If growths are noticed in the esophagus, surgical intervention is necessary for the improvement of general health. The tissue changes must be removed for freedom from symptoms to occur. The surgery is associated with risks and side effects. Nevertheless, in a large number of cases it is a routine operation that proceeds without further complications. In most cases, the patient is discharged from treatment as recovered after the wound has healed.

Prevention

Laryngitis gastrica can be prevented by eating an appropriate diet and abstaining from alcohol and nicotine. Reducing obesity can also be interpreted as a preventive measure.

Follow-up

Because layryngitis gastrica is caused by the reflux of gastric acid into the laryngeal area, the main focus of aftercare is to prevent this in the best possible way. This requires a change in diet by the patient and thus his active cooperation. In this context, the portions at meals should be smaller. It is better to eat small meals more often during the day than a few large ones, is the motto, which also serves the digestive tract. In addition, sour, sweet and spicy foods have a tendency to stimulate gastric acid production and should therefore also be reduced. Alcohol and nicotine can also promote reflux and are to be significantly reduced or completely avoided in the sense of a targeted reduction of acid production. In addition, nicotine should be avoided anyway for the stressed larynx area in the aftercare of laryngitis gastrica. The regeneration can be optimized in such a way clearly. The sleep attitude comes with the Reflux also with it also with the Laryngitis gastrica a special meaning. In order to avoid a reflux of gastric acid into the sensitive areas of larynx and pharynx, an elevated sleeping position of the upper body is recommended. In addition, sumptuous meals before bedtime are unfavorable and should therefore be avoided at all costs. Stress can also promote reflux and should be consistently reduced.

What you can do yourself

If laryngitis gastrica has been diagnosed, the patient should first and foremost change his or her diet. It is recommended to eat several small meals and to eliminate foods that are difficult to digest from the diet. Regular fluid intake is also important so that the mucous membranes are always well moistened and the viruses can be flushed out quickly. In addition, stimulants such as nicotine, alcohol and caffeine must be avoided, as these further irritate the stomach and throat and stimulate gastric juice production. Overweight individuals must reduce their weight in the long term. In principle, the voice should be spared during laryngitis. Warm drinks relieve pain and promote blood circulation. Throat compresses have a similar effect and can be combined with eucalyptus ointment, essential oils and other natural remedies. Also helpful is inhaling with salt solutions and remedies such as sage or marshmallow. A room humidifier regulates the air and thus supports the recovery process. After the acute phase of the disease, the immune system must be strengthened, whether through exercise in the fresh air, a vitamin-rich diet or plenty of sleep and bed rest. If the symptoms of laryngitis gastrica do not subside, an otolaryngologist should be consulted.