Silent Reflux

Silent Reflux

A Confusing Condition That Has A Lot to Say

The acidic environment of the stomach is necessary for digestion. Whenever we eat food, this activates the stomach to produce acid and digestive enzymes to break the food up into pieces that can be digested so that nutrients can be absorbed.  Even thinking about eating can activate this mechanism. 

When stomach acid, however, which was designed to specifically stay in one part of the body, leaves that area and moves to locations that aren’t equipped to handle exposure to acid and digestive enzymes, this can produce problems.  Specifically, when this acid moves backwards from the stomach along the digestive tract into the esophagus, the “swallowing tube” which connects the throat to the stomach, one may experience a condition called acid reflux or gastro-esophageal reflux disease (GERD). 

Most people associate acid reflux with the following symptoms:

  • Heartburn
  • Indigestion
  • Bloating
  • Belching
  • Chest pain often under the breastbone (sternum)

Sometimes patients with acid reflux disease don’t complain of digestive problems at all.  This type of acid reflux is referred to as “atypical” or “silent” reflux.  But the term “silent” can be misleading, because these patients do have symptoms—just not digestive ones.  They may complain of:

  • Hoarseness
  • Cough
  • Throat clearing
  • Post-nasal drip, thick mucus
  • Sensation of something being stuck in throat
  • Bad breath (halitosis)

In so called “silent” reflux, or what we call laryngopharyngeal reflux (LPR) a small amount of acid leaves the stomach and works its way to the top of the esophagus near the throat.  Digestive symptoms such as heartburn may not be triggered, however, other symptoms occur that suggests problems such as a cold or even sinusitis. 

Although this is primarily a gastrointestinal system problem, symptoms often direct these patients to end up under the care of an Ears, Nose and Throat (ENT) doctor. 

The good news is that treatment is often the same or very similar for both the lower esophageal (GERD) and upper esophageal (LPR) reflux symptoms.  They can be managed with behavioral changes, prescription and over-the-counter medications, but sometimes require more extensive evaluation and surgery.