Unexplained Hoarseness: One Clue to an Eating Disorder

The culprit may be acid reflux.

Unexplained hoarseness may be a symptom of an underlying eating disorder, according to Drs. Randy and Lori Sansone. Such hoarseness may be the result of acid reflux, or entry of acidic gastric material into the laryngoesophageal tract (Innov Clin Neuroscience. 2012; 9:37).

Acid reflux, or exposure to acidic gastric contents to the upper portion of the gastrointestinal tract, causes a well-known syndrome, gastroesophageal reflux, or GERD. Symptoms found in GERD include heartburn, chest pain, regurgitation, an acidic taste, belching, difficulty swallowing, and bad breath. GERD affects about 20% of the general population.

A recent article by Dr. Phillip Mehler raises the topic of esophageal complications related to regurgitation of acidic gastric contents (Int J Eat Disord. 2011; 44:95). Patients who induce vomiting, such as those with anorexia nervosa, binge eating-purging type or those with purging-type bulimia nervosa are at risk for acid reflux. Thus, hoarseness in a young normal-weight or underweight woman or man may be a clue to self-induced vomiting. Persons with laryngoesophageal reflux may complain of feeling “a lump in my throat,” “burning in my throat,” or a dry cough, coughing that awakens the person from sleep, excessive postnasal drip, chronic throat-clearing, chest pain, or wheezing. Upper GI tests will show abnormal esophageal findings, such as the absence of a high pressure zone above the lower esophageal sphincter with relatively low resting pressure. Patients with BN frequently complain of heartburn and acid-reflux symptoms.

In one report, after conventional therapy, such as psychotropic drugs and psychotherapy failed, a patient with AN was helped by antireflux surgery (Isr J Psychiatry Relat Sci. 2009; 46:231). These authors recommend that patients with unexplained symptoms of AN may have serious esophagogastric complications that can affect their response to psychiatric treatment. Alternatively, some patients with primary esophageal disorders may present with symptoms of eating disorders.

The Sansones also note that it is somewhat ironic that while there are few articles on this topic in the general medical literature, it is a popular topic on the Internet. For example, one recent posting was titled “Are You having Acid Reflux Symptoms from Being Bulimic?”