February 5, 2024

Can Respiratory Reflux Cause Death?



  • Pneumonia is the leading cause of death (40%) among elderly nursing home residents; and of those 30% have no pathogen found … all fingers point to aspiration pneumonia from respiratory reflux.
  • Chronic Obstructive Lung Disease is usually attributed to smoking, however, with or without smoking, silent respiratory reflux can cause and/or accelerate COPD.
  • Most cases of sleep apnea are caused by silent respiratory reflux (usually over decades); it can be diagnosed by examination of the throat, and it is potentially reversible.
  • ALL cases of laryngeal cancer in my practice have had severe pH-documented respiratory reflux, and that includes nonsmokers as well as smokers.
  • Lung cancer in life-time nonsmokers? All of my patients had respiratory reflux and respiratory reflux was the likely cause of the cancer.

Note: Respiratory Reflux (RR) and Laryngopharyngeal Reflux (LPR) are synonyms and the terms can be used interchangeably. Going forward, I prefer the term RR and so should you; it is easier to pronounce, more intuitive, more comprehensive, and implies that RR can affect any and all parts of the respiratory system, which it does.

Over the course of my career spanning almost fifty years, I have seen over 100,000 patients with respiratory reflux and respiratory tract diseases. And since 1987, I have had the world’s best, 100%-accurate respiratory reflux-testing system — ambulatory 24-hour double probe (simultaneous pharyngeal and esophageal) ISFET pH-monitoring — that accurately measures reflux (acid) in the throat. (The ISFET chip is the best pH-chip which is used in expensive laboratory pH meters; and I had my ISFET pH-catheters custom made.) 

I know that this post will be controversial, but I want my perspective to be “on the record,” in the blogosphere. Most physicians will disagree with my conclusions, however, no one else has data like that which I have collected over decades. 

My detractors have nothing to confirm or deny the assertions offered here. There are several reasons for this: (1) overspecialization and fragmentation of the aerodigestive tract; (2) the go-to doctor for reflux, the gastroenterologist (GI), knows absolutely nothing about respiratory reflux and has no tests for it; (3) allergists, otolaryngologists, and pulmonologists are equally clueless as GIs, as there is nothing in their curricula about respiratory reflux; and (4) Medicare reimbursement for quality reflux diagnostics is so low that most providers are no longer doing reflux-testing because they don’t want to lose money. See my previous posts, Reflux Testing Is a Waste of Time and TNE.   

Aspiration Pneumonia

Pneumonia accounts for 40% of hospitalizations in nursing home residents, and its mortality is roughly 33%. Of those pneumonia patients, 30% have Community-Acquired Pneumonia (CAP); and that has a 50% mortality rate. By the way, CAP implies that no pathologic organism (bacteria) was identified, and the likely cause is reflux aspiration. 

So, why do so many elderly people in nursing homes die of CAP? Here’s what I think: Give an elderly refluxer a bedtime snack of chocolate pudding and ginger ale, for instance – and that’s what ends up in their lungs at two o’clock in the morning — they end up dying of chocolate-pudding-ginger-ale pneumonia.

It came as an unpleasant surprise to me that there is a law requiring nursing home residents be asked if they want a bedtime snack … Really? … Bad idea! … Let’s change that law.

FYI: Respiratory reflux can cause Recurrent Aspiration Pneumonia in young, otherwise-healthy people. Indeed, I have seen patients with recurrent pneumonia, as many as four times a year. Assuming that those patients have no congenital or structural flaw in the laryngopharynx and are not immunocompromised, then the most likely diagnosis is Silent Nocturnal Respiratory Reflux, with aspiration. In every such case that I can recall, all tested positive for reflux … and most important: long-term antireflux treatment stopped all bouts of pneumonia. 

COPD (Chronic Obstructive Lung Disease) 

Approximately 16 million people in the U.S. have COPD, and about 30% of those cases are life-time non-smokers. In my practice, I have seen about 50 patients with serious COPD, and all but two had severe respiratory reflux. Especially long-time (e.g., 25 years) ex-smokers with progressive COPD … respiratory reflux is the cause of progression of the COPD; it has nothing to do with past smoking. And, COPD cannot occur in a relatively young non-smokes. While there are occasionally other causes, 95% of the time the underlying cause/diagnosis for the COPD is respiratory reflux.

Paradigm Shift: With an effective antireflux program, the progression of COPD can be halted, even reversed; see my previous post on COPD, and also have a look at Chronic Bronchitis.   

Sleep Apnea

Almost 34 million (7%) Americans have sleep apnea, and it causes death mostly from heart attack and stroke. If you are diagnosed with sleep apnea before the age of 50, your life expectancy is 8-18 years. Obesity is also linked to sleep apnea. It is generally believed that there is no cure for sleep apnea, but there is … long-term healthy diet and lifestyle choices.  

In my experience, sleep apnea is caused by years/decades of Supine Nocturnal Respiratory Reflux (SNoRR), and it usually can be diagnosed by examination of the throat. It can be reversed but treatment must be tight for a minimum of 6-12 months. However, the Big Uvula associated with SNoRR can shrink back to normal size within a few weeks. (Don’t have surgery for this!)

Laryngeal and Lung Cancer

Up to 25% of patients with laryngeal cancer are nonsmokers; that from a paper entitled, The rising rate of nonsmokers among laryngeal carcinoma patients: Are we facing a new disease? A new disease, really? Nope. It isn’t a new disease, but it is a disease … Respiratory Reflux … that the authors of the paper don’t understand or even recognize.  

Illustrative Case: Early in my career, a 44-year-old business man, a non-drinker, lifetime nonsmoker, came to see me with a small right vocal cord cancer. I removed it with the laser, but it took months to heal. Over the course of the next six years, he came back with three more vocal cord cancers, two on the other side, all of which I removed. Finally, a lightbulb went on in my head, and I diagnosed and treated his respiratory reflux. In those days, I knew less about treatment. Although his diet and lifestyle was relatively clean, he underwent antireflux surgery … and never again developed a vocal cord cancer.    

In semi-retirement, I do not have the resources to mine my clinical data so that they can be reported in the medical literature. That said, my memory and ability to retrieve cases remains intact. So? How could one ever forget something like this? —  In all my years, 100% of patients (~90 cases) with laryngeal cancer had pH-documented respiratory reflux … and at least twenty were lifetime nonsmokers. 

In addition, in my basic science laboratory, we demonstrated by biopsy that laryngeal cancers contain pepsin; and in addition, in laryngeal tissue culture, it has been shown that the main stomach enzyme, pepsin can upregulate known laryngeal cancer markers

Esophageal cancer is not covered in this post, but esophageal reflux (GERD) causes it; see my post on Barrett’s Esophagus

For more information about diagnosis and treatment of respiratory reflux, see my two companion books on Amazon: Dropping Acid: The Reflux Diet Cookbook & Cure and Dr. Koufman’s Acid Reflux Diet. And, if you would like to schedule a 30-minute, virtual consultation with me, you can Book Online.

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