Heartburn: The story of reflux

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Most of us have experienced the sharp pain in the chest we commonly refer to as heartburn. This condition, usually associated with having eaten something that "hasn’t gone down well," is caused by stomach contents backing up into the esophagus and is called gastro-esophageal reflux (GER). Reflux is prevented by the pressure of a valve-like connection between the esophagus and the stomach called the lower esophageal sphincter (LES). There is evidence that reflux into the esophagus and even into the throat may occur insidiously even in the absence of heartburn and may cause chronic sore throats and voice disorders in otherwise healthy individuals.

Since the acidic contents of the stomach are corrosive to the esophagus and the throat, chronic reflux can lead to esophagitis, an inflammation of the lower esophagus. Laryngeal inflammation, on the other hand, attacks the back of the vocal chords, which causes a lowering of pitch and the constant need to clear one’s throat. In extreme cases, pre-malignant changes may occur.

Reflux can be caused by certain foods, medications, and lifestyle habits such as smoking, chewing gum, and eating late at night, all of which can decrease LES pressure. Fatty meals remain in the stomach longer and can cause reflux. Singing can cause reflux if the frequent expansion of the lungs presses down on the diaphragm and the stomach. Most singers do not eat before a performance and are advised to eat frequent but small meals on the day of performance. They should also avoid late post-performance meals since going to bed on a full stomach may provoke reflux resulting in an irritated, froggy throat the next morning.

While popular antacid medications such as ranitidine or omeprazole are helpful, the management of GER requires nutritional and lifestyle changes. Voice professionals pressed for time should avoid the temptation of fast food if they want to keep their throats healthy.

To avoid reflux:

· Increase protein intake (lean meats, low-fat cheese, legumes), decrease fatty meals, avoid sauces

· Avoid peppermint, coffee, strong tea, chocolate, citrus and tomato juices (a vitamin C supplement is recommended)

· Eat small frequent meals and don’t eat late at night

· Limit alcohol intake and watch your weight

· Drink between meals rather than with meals

· Elevate the head of your bed 30 degrees

Lisa Jane Callow is a clinical nutritionist at the Montreal General Hospital.

Françoise P. Chagnon is the Director of the Voice Lab at the Montréal General Hospital

The Throat Doctor

Submit your questions about voice or vocal ailments to Doctor Françoise Chagnon c/o La Scena Musicale, 5411 Waverly, Montreal, Quebec, H2T 2X8.