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Reflux Questions: Answered by a Board-Certified Swallowing Specialist

George Barnes, MS, CCC-SLP, BCS-S, is a board-certified speech-language pathologist with specialized expertise in swallowing and voice disorders. Known for his ability to break down complex clinical concepts in a clear and compassionate way, George brings a unique perspective to reflux—especially how it impacts the upper airway, voice, and swallowing.

In this post, George answers some of the most common questions about reflux through the lens of a swallowing specialist. From “silent reflux” to pepsin damage and globus sensation, he offers evidence-based insight into what’s really going on when reflux symptoms go beyond the burn—and how speech-language pathologists (SLPs) play a key role in helping patients find relief. 

Whether you’re a clinician or someone navigating Laryngopharyngeal Reflux (LPR) yourself, this is a must-read.

Q: What is Laryngopharyngeal Reflux (LPR), and how is it different from GERD?

Answer: LPR is when stomach contents reflux into the larynx and pharynx, whereas GERD is reflux that only occurs up to the level of the esophagus. Unlike GERD, LPR often doesn't cause heartburn, giving it the spooky nickname you could easily mistake for a horror film, "The Silent Reflux." Common symptoms include hoarseness, throat clearing, globus sensation, and cough. As an SLP, these are the very patient symptoms doctors often come to us with.


The esophagus has some protection that the larynx lacks, making the acidic contents of the stomach more harmful when they pass the cricopharyngeal segment (AKA upper esophageal sphincter) and into the sensitive mucosal tissue of the upper airway. One of these protections is a water-based layer that protects tissue by forming an alkaline buffer against acid. It's like handling a hot sheet pan with thick oven mitts. Those mitts come off when the acid enters the laryngopharynx, which is the area that would need this protection the most.

Q: How does reflux affect my voice?

Answer: Reflux, especially pepsin, can irritate and damage the vocal folds. This damage can lead to:

Remember that most standard reflux pharmaceuticals (I.e., Proton pump inhibitors) do not target reflux but the acidic environment of the stomach so that the reflux that does occur is not as damaging to the sensitive tissue above the level of the lower esophageal sphincter. While an important management component, especially in patients with severe reflux, this approach does not address the core issue. 

Further, even non-acidic reflux can damage the upper airway's sensitive tissues, which are responsible for maintaining a healthy voice. For example, trypsin and pepsin are enzymes responsible for breaking down proteins and are present in gastric secretions no matter the stomach's pH level. You can think of them as tiny little starving critters that eat up whatever comes their way. When these enzymes make their way to the tissue of the upper airway where there isn't any food, they break down this sensitive tissue like they'd break down food. Ouch!

Q: Can reflux cause swallowing problems?

Answer: Yes! Reflux can contribute to dysphagia (difficulty swallowing). It can cause:

Further, in some cases of LPR, the damage done to the mucosal membrane of the upper airway can be so severe that it causes significant levels of swelling and edema, which disrupts the ability to safely and effectively push food and liquid through the pharynx and into the esophagus. Swallowing requires high levels of sensation and coordination to manipulate the bolus through the upper airway. Doing this with a swollen laryngopharynx is like trying to play the guitar with boxing gloves on. It doesn't get the job done in the same way.

Q: How is reflux diagnosed?

Answer: Diagnosis often involves a combination of:

Q: How can an SLP help with reflux-related voice and swallowing issues?

Answer: SLPs play a crucial role in managing these issues through:

Q: What lifestyle changes can help manage reflux?

Answer: Key modifications include:

Q: What medications are used to treat reflux?

Answer: Common medications include:

Q: Is surgery an option for reflux?

Answer: In some cases, surgery (like fundoplication) may be considered if other forms of medical management fail. However, it's important to weigh each patient's risks and benefits before moving forward with surgical options.

Reflux can significantly impact voice and swallowing, but proper diagnosis and management can provide relief. If you're experiencing these issues, consult your attending physician to see if you'd benefit from further assessment by a speech pathologist, ENT, and/or gastroenterologist.

About the Author

George Barnes, MS, CCC-SLP, BCS-S is a board-certified speech-language pathologist specializing in dysphagia management, with expertise in diagnostics for medically complex patients. As the co-founder of FEESible Swallow Solutions LLC and The Dysphagia Expert LLC, he is dedicated to improving patient access to high-quality dysphagia services. George is also an educator, mentor, and researcher committed to advancing the field of medical speech-language pathology.

For more from George, tap here.

Disclaimer

This article is for informational purposes only and does not replace professional medical advice. Always consult a qualified healthcare provider for individualized guidance on managing acid reflux or any other medical concerns.