President Obama has acid reflux disorder LPR

Last week President Obama had his persistent sore throat examined by doctors (WaPo). No it was not caused by North Korean hackers. It turns out the President has the acid reflux disorder LPR (laryngopharyngeal reflux), which is closely related to gastroesophageal reflux disease (GERD). Acid reflux is quite common with 1 out of 7 adults presenting symptoms related to reflux at least once a week [link]; a typical symptom is "heartburn".

With both LPR and GERD, the cause of the reflux is a faulty valve (lower esophageal sphincter or LES) that guards the entrance to the stomach from the esophagus. After food passes through, the valve should close shut preventing the contents of the stomach which are acidic from leaking back up the esophagus. If the LES doesn't close all the way or if it opens too often, acid produced by your stomach can move up into your esophagus. This gives rise to the burning sensation of heartburn.

The distinction between LPR and GERD is somewhat ambiguous in the sense that LPR can be considered a type of gastroesophageal reflux. However, typically if the reflux goes up to the esophagus but no further (where there is another valve) then it is GERD. If the reflux goes beyond the esophagus into the pharynx to the back of the throat, vocal cords, and even the nasal passages, then it is considered LPR.

"Symptoms for GERD include (WebMD) feeling that food is stuck behind the breastbone, heartburn or a burning pain in the chest, nausea after eating. Less common symptoms include bringing food back up (regurgitation), cough or wheezing, difficulty swallowing, hiccups, hoarseness or change in voice, sore throat.

Symptoms for LPR are related and include excessive throat clearing, persistent cough, hoarseness, a "lump" in the throat that doesn't go away with repeated swallowing. Less common symptoms include a sensation of postnasal drip or excess throat mucus, trouble swallowing, trouble breathing, sore throat."

Note that President Obama presented with a persistent sore throat which is a less common symptom for both.

The diagnosis can be made by an upper gastrointestinal endoscopy, esophageal tests that monitor how often acid gets into the esophagus, and x-rays of the esophagus and stomach. President Obama had an endoscopy and CT scan (x-rays).

The risk factors for LPR and GERD include hiatal hernia, obesity, pregnancy, smoking, and stress.
A hiatal hernia occurs when part of your stomach pushes upward through your diaphragm (Mayo). The chances of hiatal hernia are increased by obesity, age (especially > 50), and increased pressure in the abdomen caused by heavy lifting/bending or frequent/hard coughing.

The primary harm caused by reflux disease is that the acidic backwash can irritate the lining of the esophagus and pharynx causing inflammation. More dangerously, this inflammation can lead to Barrett's esophagus, which is a type of precancer. Over time Barrett's esophagus can evolve into an adenocarcinoma i.e. full-blown cancer; it is estimated that about 30% of esophageal cancers may arise from GERD. Esophogeal cancer is the 8th most common cancer in the World, and its incidence in the U.S. is growing rapidly. Like many cancers, the prognosis is poor if not caught early.

Fortunately, there are effective treatments for GERD or LPR that involve lifestyle changes as well as medication. Prescribed medications include antacids, histamine antagonists, proton pump inhibitors which are effective at suppressing acid production.  Lifestyle changes include quitting smoking, losing weight, avoiding food and drink within two to three hours prior to bedtime, avoiding alcohol, caffeine, and carbonated drinks, and eating small meals.

If you present some symptoms for acid reflux disorder (LPR or GERD), it is important to get it checked out by a doctor just like President Obama (Figure 1) did. The risk for esophageal cancer is something to pay attention to and is the reason why doctors took President Obama's condition seriously.

Figure 1. Stress can contribute to acid reflux disorder, but other important risk factors include hiatal hernia and smoking. It is unclear whether President Obama has hiatal hernia, but he used to smoke for many years.