Respiratory reflux

Airway Reflux = Respiratory Diseases = Respiratory Reflux

I was trained as an ENT doctor, but I have evolved to practice Integrated Aerodigestive Medicine (IAM). As an IAM doctor, I am part ENT (ear, nose, and throat) doctor, but I know about the parts of ENT that ENT doctors don’t know about. I am part gastroenterologist, i.e., gastrointestinal (GI) doctor, but I know about the parts of GI that GI doctors don’t know about. And I am part pulmonologist (PUL) (lung and chest physician), but I know about the parts of PUL that pulmonary doctors don’t know about.

I don’t completely over lap with those specialties; however, unlike most specialists, I do take care of whole patients. The focus of my research and medical practice is acid reflux, especially reflux that affects the airway—ears, nose, sinuses, throat, voice box, trachea, bronchial tubes, and lungs. There are many terms for the reflux (backflow) of stomach contents into the esophagus and airway.

Common Terms for Reflux

General Terms
Acid reflux
Gastric reflux

Terms for Esophageal Reflux
Gastroesophageal reflux disease (GERD)
Gastro-oesophageal reflux disease (GORD) [U.K.]
Peptic esophagitis / Esophageal erosions
Esophageal Reflux

Terms for Throat Reflux
Laryngopharyngeal reflux* (LPR)
Extraesophageal reflux disease
Supraesophageal reflux disease
Atypical reflux disease
Reflux laryngitis
Silent reflux*
Airway Reflux*
Respiratory Reflux*

The asterisks (*) mark the terms, which I personally coined. The last one, Respiratory Reflux, is brand new and it is the topic of this post.

First, let me offer a disclaimer: I have almost given up taking to medical colleagues. They don’t listen; and furthermore, I believe that they don’t care a whit for new ideas that challenge the prevailing medical models. The “heartburn business model,” for example, proffered by GI doctors, has cost America $1.5 trillion in the past 40 years and perhaps as many as 55,00 deaths. During that time, reflux, especially respiratory reflux, has become the great public health epidemic of our time, affecting and estimated 125 million Americans, about half with esophageal reflux and half with respiratory (aka airway) reflux. My book, The Chronic Cough Enigma, was written because I couldn’t get the work published in a medical journal. (Yes, the paper was a first-rate piece of scientific research; and yes, there is politics and ugly egotism in the peer-review process.)

So, I am writing this for the lay public and for the medical profession. The truth is that I believe that the term Respiratory Reflux will catch on simply because it is both accurate and intuitive. I came up with LPR specifically to differentiate the problems of my patients from those of GIs with GERD. It was LPR vs. GERD for about 20 years.

Second, I for the past few years, I have been trying to get medical colleagues to abandon the terms LPR and GERD because they are cumbersome and hard to pronounce. Indeed, they are not even accurate terms. I suggested new terms, esophageal reflux and airway reflux (for LPR and GERD respectively) as being more encompassing, precise and intuitive.

Finally, the new term will call attention to the fact that reflux is the great masquerader of our time, that many respiratory diseases are caused by or complicated by acid reflux.

Why Respiratory Reflux Is A Good Term

The most common misdiagnoses in America are allergy, sinusitis, and asthma. These conditions are usually due to “airway reflux”; therefore, it makes great sense to call acid reflux that mimics allergies—post-nasal drip is the single most common symptom of airway (LPR)  reflux—respiratory reflux. As it turns out sinus disease is also often caused by reflux; I see many patients who have had unsuccessful sinus surgery, whose symptoms disappear after the reflux is fixed. Finally, there is asthma. We waste $1 billion per week on inappropriate asthma treatment (that is actually respiratory reflux). These also are respiratory conditions caused by reflux. Therefore, the term respiratory reflux is recommended for all respiratory tract disorders caused by airway reflux. Furthermore, the term itself will call attention to the question of misdiagnosis. See my IN or OUT post for more about the costly problem of misdiagnosed asthma.

Symptoms and Manifestations of Respiratory Reflux

Chronic cough
Difficulty swallowing
Dental caries and erosions
Shortness of breath
Choking episodes
Sleep apnea
Reflux laryngitis
Vocal fatigue
Larynx (laryngeal) cancer
Voice breaks
Endotracheal intubation injury
Chronic throat clearing
Contact ulcers and granulomas
Excessive throat mucus
Posterior glottis stenosis
Post-nasal drip
Arytenoid fixation
Paroxysmal laryngospasm
Globus pharyngeus
Difficulty swallowing
Throat cancer
Difficulty breathing
Shortness of breath
Vocal cord dysfunction
Choking episodes
Paradoxical vocal fold movement
Vocal nodules and polyps
Food getting stuck
Pachydermia laryngis
A sensation of a lump in the throat
Recurrent leukoplakia
Intermittent airway obstruction
Polypoid degeneration
Chronic airway obstruction
COPD (Chronic obstructive pulmonary disease)
Sudden Infant Death Syndrome

In conclusion, the term Respiratory Reflux is recommended for acid reflux that rises up out of the esophagus (swallowing tube that connects the throat and stomach) into the airway. Such reflux causes and mimics many respiratory symptoms and diseases.

Airway reflux = Respiratory Diseases = Respiratory Reflux








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