Gastro-esophago-pharyngeal reflux.

Reflux of gastric contents into the esophagus, pharynx, and larynx does occur. This phenomenon can produce hoarseness, globus, dysphagia, otalgia and laryngospasm. It may be responsible for the appearance of contact granulomata, esophageal webs, and pachyderma. The key to reflux is the lower esophageal sphincter and the nature of the stomach contents. Multiple factors may be influential including those conditions causing aerophagia. The diagnosis of reflux depends on a high index of suspicion. Physical findings may reveal only subtle changes of arytenoid erythema. Thyrohyoid tenderness is not an infrequent sign. Treatment is usually simple, involving first elimination of those factors which increase intragastric pressure or lower the lower esophageal sphincter pressure. Elevation of the head of the bed and antacids will often prevent further gastric insult to the pharynx and larynx and thus eliminate the patient's discomfort.