Laryngopharyngeal and oesophageal sensitivity

This is a condition which presents with symptoms that include globus, heartburn, cough, acid or water brash and a sensation of discomfort when swallowing. It may arise as a result of several factors including gastro-oesophageal reflux which may then provoke a sensitivity which persists even when the reflux has improved. Patients have an increased perception of oesophageal stimuli than normal individuals. In general patients with oesophageal symptoms are expected to have normal oesophageal pH studies.It reflects a dysfunction of the interactions between oesophageal nerves, which control sensation and motility in the gullet and the central nervous system which receives messages from the oesophagus and throat and sends messages to it. Abnormalities may include oesophageal nerves which fire in response to less stimulus than would normally be expected (nerves firing at a lower threshold) abnormal processing of oesophageal sensation at the level of the spinal cord or within the brain. These processes are also significantly influenced by emotional context. The threshold at which messages from the oesophagus  are allowed to travel up to the brain changes depending on the emotional context in which the sensation arises. Once sensitvity is triggered it is often difficult to “reset” the oesophageal nervous system.

Depending on the triggers a number of interventions may be used to alleviate oesophageal sensitvity including, acid suppression, and drugs which modulate pain perception either within the gut or at the level of the central nervous system. These include amitriptyline and  gabapentin, or drugs which may have a role in reducing peripheral inflammation such as montelukast (unlicesed).