TL;DR: Throat erosion is most commonly caused by acid reflux (GERD or LPR). Symptoms include chronic hoarseness, coughing, a lump-in-the-throat sensation and a burning sore throat. Treatment for throat erosion consists of medication (proton pump inhibitors), lifestyle changes and, if necessary, a specialist examination. Without treatment, serious complications, such as Barrett’s oesophagus, may develop.
A persistent sore throat, hoarseness or a burning sensation in the chest – these symptoms are familiar to many of us. We tend to put these complaints down to a cold or tiredness, and wait for them to go away on their own. However, if the symptoms keep coming back week after week, it is worth considering that there might be something else underlying them.
The treatment of throat irritation is one of the most frequently searched-for topics in gastroenterology – and not without reason. This is because recurrent throat irritation is very often caused by acid reflux, which can lead to serious complications if not treated in good time.
This article summarises exactly what throat erosion is, what symptoms it causes, how it is diagnosed, and what treatment options are available – including when and why it is advisable to consult a gastroenterologist.
What is a sore throat, and what causes it?
„Sore throat” is not a disease in its own right, but a set of symptoms that is almost always caused by gastro-oesophageal reflux disease (GERD) or its lesser-known variant, the laryngopharyngeal reflux (LPR) available.
In both cases, stomach acid – and, in some instances, bile from the duodenum – flows back into the oesophagus and then reaches the throat. This acidic and corrosive fluid irritates and inflames the sensitive mucous membrane of the pharynx, and over time can even erode it.
The main cause of reflux is that the ring of muscle at the top of the stomach – the lower oesophageal sphincter (LES) – does not close properly. As a result, stomach contents are able to flow back to where they should not be.
What are the most common causes?
- Being overweight or obese (increases intra-abdominal pressure)
- Regular consumption of fatty, spicy and acidic foods
- Coffee, alcohol and fizzy drinks
- Smoking
- Lying down after a meal
- Stress and irregular eating habits
- Diaphragmatic hernia (hiatus hernia)
- Certain medicines, e.g. non-steroidal anti-inflammatory drugs (NSAIDs)
- Pregnancy (due to increased intra-abdominal pressure)
What are the symptoms of a sore throat?
At first glance, the symptoms of throat erosion can easily be mistaken for a simple cold or a respiratory infection. This is why some patients do not receive an accurate diagnosis for years – mainly because, in cases of „silent reflux”, the classic symptoms of heartburn may be completely absent.
The most common symptoms are:
- Chronic hoarseness, change in voice quality (particularly in the morning)
- A persistent dry cough that is not caused by an infection
- A lump in the throat (globus sensation)
- A burning, scratchy sensation in the throat and behind the breastbone
- A sour or bitter taste in the mouth, particularly upon waking
- Bad breath (halitosis)
- Difficulty or pain when swallowing (dysphagia, odynophagia)
- Pain radiating to the ear
If these symptoms occur at least two or three times a week and have persisted for several weeks, this is a sign of reflux disease, which should definitely be investigated.
What complications might arise if left untreated?
This is where many people underestimate the seriousness of reflux. Thinking it’s „just heartburn” can be dangerous if the symptoms are ignored for a long time.
Chronic, untreated laryngitis and reflux disease can lead to the following complications:
- Oesophagitis (inflammation of the oesophagus): Recurrent acid irritation causes inflammation of the oesophageal mucosa.
- Cicatricial oesophageal stricture: Prolonged inflammation can lead to the formation of scar tissue, which makes swallowing difficult.
- Oesophageal ulcer: The deeper layers of the mucous membrane may also be damaged.
- Barrett’s oesophagus: The squamous cells are replaced by specialised columnar epithelium – this condition has been shown to increase the oesophageal adenocarcinoma (cancer) the risk of it developing.
- Chronic inflammation of the pharynx and larynx: Recurrent upper respiratory tract symptoms caused not by an infection but by acid.
In the case of Barrett’s oesophagus, the annual risk of cancerous transformation is relatively low (approximately 0.12–0.33%), but without regular gastroenterological check-ups and close monitoring, it cannot be detected in time.
How is a throat ulcer diagnosed?
Without an accurate diagnosis, treatment can only be symptomatic. A consultation with a specialist is essential to rule out any underlying mucosal abnormalities, inflammation and potential complications.
Gastroscopy
with Gastroscopy the primary diagnostic tool for investigating laryngeal erosion and reflux disease. During the examination, the specialist inserts a flexible video endoscope, 6–9 mm in diameter, through the mouth into the oesophagus, stomach and duodenum.
This method allows for the direct examination of:
- The condition of the mucous membrane and the extent of erosion
- The severity of oesophagitis according to the Los Angeles classification (grades A–D)
- Presence of Barrett’s metaplasia
- Any narrowings, ulcers or tumours
If necessary, a tissue sample (biopsy) may also be taken to establish an accurate histological diagnosis. The test is mandatory in the case of so-called. warning signs The following symptoms may occur: unintentional weight loss, bleeding, severe difficulty swallowing.
Supplementary examination methods
- 24-hour pH monitoring: It directly measures the number of acid episodes and their correlation with symptoms.
- Impedance measurement: Both acidic and non-acidic reflux episodes can be detected.
- Oesophageal manometry (HRM): It is used to rule out motility disorders (e.g. achalasia) and prior to planned surgery.
- Empirical PPI test: Administration of a proton pump inhibitor for diagnostic purposes – improvement in symptoms confirms the diagnosis of reflux.
If there are also symptoms affecting the lower part of the digestive system (e.g. iron deficiency, changes in bowel habits, unexplained weight loss), the gastroscopy and colonoscopy It is possible to carry out the tasks together on a single occasion.
Treatment of throat ulcers: medication options
Treatment for throat erosion almost always begins with medication, which the doctor prescribes depending on the severity of the symptoms and the diagnosis.
Proton pump inhibitors (PPIs)
PPIs are the „gold standard” of acid-reducing treatment. They inhibit the activity of acid-producing cells in the stomach, thereby reducing the amount of refluxed acid and its corrosive effect.
Important to note: In cases of extra-oesophageal reflux and laryngeal erosion, treatment that is longer and more intensive than standard GERD therapy is required. According to the clinical protocol, it is recommended to take 1 PPI twice daily in such cases, for 12 weeks. The first dose should be taken 30–60 minutes before breakfast, and the second 30–60 minutes before dinner.
The most commonly used active ingredients are: omeprazole (20–40 mg), esomeprazole (20–40 mg), pantoprazole (40 mg), rabeprazole (20 mg) and lansoprazole (30 mg).
H2-receptor antagonists (H2RAs)
They can be used for moderate or milder symptoms (e.g. famotidine, cimetidine). They are less effective than PPIs, but may provide faster relief of symptoms.
Antacids and alginates
Antacids, which provide rapid, temporary relief from mild symptoms. Gaviscon-type alginates form a physical barrier between the acid and the mucous membrane.
Mucosal protectants
Sucralfate forms a protective layer on the damaged mucous membrane, helping the erosions to heal. It is particularly useful for GERD during pregnancy.
Agents that enhance motility (prokinetics)
If delayed gastric emptying is a contributing factor to the reflux, the doctor may prescribe a prokinetic (e.g. itopride, domperidone, metoclopramide). These help stomach contents to move downwards more quickly, reducing the likelihood of reflux.
Surgical solution
If drug treatment proves persistently ineffective, laparoscopic anti-reflux surgery (e.g. Nissen, Toupet or Dor fundoplication) may be considered, which mechanically strengthens the lower oesophageal sphincter.
Lifestyle and dietary changes
Alongside medication, lifestyle changes are essential for long-term improvement. Without them, symptoms may return even with the best medication.
Etrend:
- Avoid fatty, spicy and acidic foods (citrus fruits, tomatoes, chocolate, peppermint)
- Cut down on your intake of coffee, alcohol and fizzy drinks
- Eat more often, but in smaller portions – a full stomach increases reflux
Eating habits:
- Finish eating at least 2–3 hours before going to bed
- Don’t lie down straight after a meal – without gravity, acid is more likely to flow back up
Sleeping position:
- Raise the head of the bed by about 15 centimetres – this physically makes it harder for acid to flow back up at night
Body weight:
- If you are overweight, losing even a few kilograms can noticeably reduce abdominal pressure and symptoms of reflux
Smoking and alcohol:
- Giving up smoking is crucial: nicotine relaxes the lower oesophageal sphincter, directly worsening the symptoms of reflux
When should you see a gastroenterologist?
Not every sore throat requires immediate medical attention. However, if you experience any of the following symptoms, do not delay seeking medical advice:
- The symptoms 2–3 times a week or occur more frequently
- The complaints for several weeks they are suffering from, and self-treatment at home is not helping
- Difficulty swallowing or painful swallowing appear
- Unintentional weight loss, anaemia, bloody vomit or bloody stools may occur
- Over the age of 40 the symptoms first appear
These are known as ‘alarm’ (warning) symptoms, in the presence of which a gastroscopy is medically mandatory in order to rule out more serious causes.
Endomedix Gastroenterology and safe examinations under anaesthesia
From Endomedix Gastroenterology Centres Its highly qualified specialists, working as an experienced team, carry out the full range of diagnostic and therapeutic procedures for the treatment of reflux and throat erosion.
Many people are apprehensive about endoscopic examinations – the gagging, the discomfort, the stress. Endomedix therefore pays particular attention to patients’ comfort and safety. Endoscopic examinations are carried out at Endomedix clinics not under light sedation, but under professional general anaesthesia is carried out under the supervision of a specialist anaesthetist throughout.
This protocol ensures:
- with complete freedom from pain and a stress-free life
- The complete suppression of unpleasant reflexes (gagging)
- For the specialist, the maximum precision for the purpose of making a diagnosis and taking samples
- The patient the highest level of clinical safety
Choose the examination that best suits your symptoms and book an appointment:
- For general enquiries or an initial consultation: Gastroenterology consultation
- In the event of upper gastrointestinal symptoms: GASTROSCOPY UNDER ANAESTHESIA
- In the case of gastrointestinal complaints, if an examination of the lower section is also warranted: GASTRIC AND COLONOSCOPY UNDER ANAESTHESIA
Summary: Don’t ignore persistent throat symptoms
Treating a sore throat does not end with simply taking medication and avoiding coffee. Lasting improvement requires an accurate diagnosis, targeted treatment and regular medical check-ups.
Early detection and consistent treatment protect the mucous membrane from serious damage and can prevent the development of Barrett’s oesophagus or adenocarcinoma. If you have been experiencing recurring throat irritation, a burning sensation or hoarseness for weeks, the first step is to consultation with a specialist in gastroenterology – where, with the help of experts, it may become clear what is actually behind the complaints.
Frequently asked questions (FAQ)
How can you tell the difference between a sore throat caused by erosion and a normal sore throat?
A sore throat caused by an infection is usually accompanied by a fever, swollen lymph nodes and a short duration, and clears up within a few days. In contrast, throat erosion causes persistent, recurring symptoms – such as chronic hoarseness, a burning sensation in the morning and a lump-in-the-throat sensation – which may not be accompanied by symptoms of infection. If throat symptoms persist for several weeks and do not respond to antibiotic treatment, it is advisable to consult a gastroenterologist.
Can a gastroscopy be carried out without anaesthesia?
Yes, it can also be carried out using local anaesthesia of the pharynx (with lidocaine spray). However, at Endomedix clinics, for professional and safety reasons, the examinations under general anaesthesia is carried out – not under light sedation. General anaesthesia guarantees complete freedom from pain, eliminates unpleasant reflexes and ensures maximum precision for diagnostic purposes.
How long should proton pump inhibitors be taken for throat erosion?
Recommended duration of treatment for oesophageal erosion and extra-oesophageal reflux 12 weeks, taken twice daily. This is a longer course of treatment than the protocol used for simple GERD. The specific medication, dosage and duration of treatment are determined in each case by a specialist, based on the individual’s symptoms and diagnostic findings.
What should I do if my symptoms don’t improve even though I’m taking medication?
If treatment with a proton pump inhibitor fails to bring about any improvement after 4–8 weeks, the cause must be investigated further. The next step is usually to Gastroscopy This procedure allows the condition of the mucous membrane to be accurately assessed. In severe cases that cannot be treated with medication, anti-reflux surgery (fundoplication) may also be considered.
Which foods should you definitely avoid if you suffer from acid reflux and throat irritation?
Fatty and spicy foods, chocolate, peppermint, citrus fruits and tomatoes should be avoided. Alcohol (particularly wine and beer), coffee, tea and fizzy drinks can also make reflux worse. The size and timing of your meals are just as important: do not eat anything 2–3 hours before going to bed, and opt for smaller, more frequent meals.
When is a colonoscopy also recommended alongside a gastroscopy?
with combined gastroscopy and colonoscopy This test is recommended if there are also symptoms affecting the lower digestive tract: e.g. iron-deficiency anaemia, unexplained weight loss, changes in bowel habits, or to comply with screening recommendations for those aged 45–50 and over. Both examinations can be carried out at the same time, under a single anaesthetic.
