Acid reflux occurs when acidic stomach contents leak up into the esophagus, and it is most commonly associated with symptoms like heartburn. If stomach acid irritates the throat or goes into the lungs, it can cause problems like excessive mucus production and wheezing. Like other reflux symptoms, these can be worse after eating. If you suffer from acid reflux and frequently wheeze or cough up mucus when eating, it’s important to recognize these symptoms so you can seek medical attention.
Acid Reflux and Mucus
Mucus accumulation in the throat is a common symptom of acid reflux. Acid reflux after eating can occur with large meals. It can also happen with spicy food and caffeine, which allow the band of muscle separating the stomach and esophagus to relax and open. Once acidic digestive juices move upward, they can cause swelling in the throat, forming a "shelf" on which mucus accumulates. Along with the accumulation of mucus can come other throat symptoms such as hoarseness, throat clearing and chronic cough, sore throat, sensation of having something stuck in the throat and trouble swallowing. Acid reflux can also cause a post-nasal drip, which may be related to sinusitis or inflammation of the sinuses.
Acid Reflux and Wheezing
Acid reflux can cause or contribute to a variety of breathing symptoms when eating, from coughing to wheezing. Wheezing with eating can happen when stomach acid refluxes from the esophagus and into the windpipe or even the lungs. This is called aspiration. When the acid irritates the breathing tubes, it makes them swell and tighten, so air cannot get through. The body's immune system produces mucus as part of its defense against the acid, further worsening symptoms. People with acid reflux may have what is called "micro-"aspiration and not know about it, especially as a cause of nighttime coughing and wheezing. If untreated, chronic aspiration can damage the lungs by causing inflammation, infection and scarring. Nighttime aspiration can be reduced by sleeping with the head of the bed at an incline of several inches, to prevent stomach contents from traveling up into the esophagus. It is also best to avoid late-night meals.
Acid Reflux and Asthma
Wheezing with acid reflux after eating can be due to asthma -- a chronic lung disease with symptoms like wheezing, coughing or shortness of breath. According to the 2009 "Annals of Thoracic Medicine," 30 to 80 percent of people with asthma have the chronic form of acid reflux. The relationship between asthma and acid reflux is complicated, and for a given person it may be difficult to tell whether acid reflux has caused the asthma or if it has made existing asthma symptoms worse. Acid reflux is thought to trigger wheezing in two ways -- by the irritating effect of acid on the breathing tubes and on a nerve in the lower esophagus, both of which make the airways tighten up. A sign that acid reflux may be contributing to asthma is if asthma symptoms get worse after eating a large meal. Another clue that acid reflux may be involved is attacks of heartburn or other reflux symptoms that occur before asthma symptoms ever begin.
Precautions and Next Steps
Acid reflux that causes any respiratory symptoms, including wheezing, excessive mucus or chronic cough, should always be evaluated by a healthcare provider.
Certain people with respiratory problems related to acid reflux will benefit from treatment with drugs called proton pump inhibitors, or PPIs. These drugs, such as omeprazole (Prilosec) and lansoprazole (Prevacid), prevent the stomach from making acid. Losing extra weight has been shown to be one of the best ways to reduce or eliminate acid reflux symptoms. For acid reflux that occurs with eating, avoiding large volume meals and keeping track of foods that may trigger symptoms can also help.
If you experience shortness of breath, choking or are unable to swallow, or if you notice blood or what looks like coffee grounds in your vomit, or bloody or black tarry stools, seek emergency medical attention.
Medical advisor: Jonathan E. Aviv, M.D., FA