One of the biggest myths about acid reflux medications is that they help with acid reflux. In fact, they do nothing to prevent reflux of acid into your esophagus or throat. What they really do is to lower acid secretion in your stomach so that whatever comes up doesn’t cause as much irritation.
The problem is that whatever comes up, although less acidic, still have small amounts of bile, digestive enzymes, and stomach bacteria that can continue to irritate the throat. In fact, studies have found pepsin (a digestive enzyme) and H. pylori (a common stomach bacteria) in ear, sinus and lung washings. This is why aggressive long-term acid reflux therapy only works sometimes. One you stop it, it usually comes back. Ultimately, dietary and lifestyle changes are what keeps the symptoms away for good.
Laryngopharyngeal reflux disease (LPRD) is one of the most common conditions seen in a typical ENT practice. Symptoms include chronic cough, post-nasal drip, hoarseness, lump sensation, throat pain burning, with or without any stomach symptoms. Published studies in our field recommend long-term (2-3 months) of twice daily treatment with one of the PPIs (proton pump inhibitors such as Prilosec, Nexium, Protonix, Aciphex, etc.). A recent study showed that these medications can have a significant rate of rebound acid secretion after stopping, so people may need to continue for a long time.
So why do so many people continue to have acid coming up into the throat? This is where my sleep-breathing paradigm can explain this all-too-common problem. Most modern humans, by definition, stop breathing once in a while when sleeping. This is due to a combination of our smaller jaws, and a predisposition to inflammation and swelling of the already narrowed airways. When in deep sleep, due to our muscles relaxing to various degrees, the smaller your jaw size, the more likely you’ll stop breathing and wake up partially or completely. During this process, a vacuum effect is created, actively suctioning up small amounts of your stomach juices into your lower esophagus or your throat.
This is why I’ve cut back my recommendation for PPI therapy dramatically to only 1-2 week short bursts, while emphasizing dietary and lifestyle modifications. Many people with chronic acid reflux issues will have an underlying sleep-breathing problem, and further testing usually confirms this.