Silent Reflux

Many people are surprised to learn that there is such as thing as silent reflux. By this, I mean reflux that occurs without symptoms or at least without the usual symptoms.

Acid reflux most commonly causes the symptom of heartburn. In fact, you often hear the terms acid reflux and heartburn used interchangeably, as if they're one and the same thing. They aren't.

Acid reflux is the physical problem. The term means that acid is refluxing, backing up, from the stomach into the lower esophagus.

Heartburn is a symptom. It refers to a burning sensation typically in the lower chest or upper abdomen. Acid reflux is probably the most common cause of heartburn, but is not the only cause.

On the other hand, it is entirely possible to have acid reflux without experiencing the symptom of heartburn. Admittedly, most of the time acid reflux does indeed cause the typical burning pain we refer to as heartburn. In a way this is unfortunate because when this symptom is absent people, including physicians, often realized that reflux is present.

Sometimes there are other symptoms that may suggest what's going on. For example, on other pages on this site we discussed how acid reflux can cause a sore throat. It's not too hard to imagine how acid in the back of the throat might lead to your occasion.

This sore throat can occur either with or without accompanying heartburn. Obviously, it's easier to recognize that it's coming from acid reflux if the person is having heartburn at the same time. However, a persistent sore throat that doesn't seem to be due to infection and doesn't respond to the usual treatments and watchful waiting may well mean that silent reflux is present.

Another symptom that people don't often associate with reflux is hoarseness. Again, it's not hard to imagine that if you splash acid on your vocal cords regularly you might get a little hoarse. It's very similar to the way acid reflux can cause a sore throat, only now the acid is leaking into the larynx causing irritation of the vocal cords.

If a person sees an ear nose and throat physician with this problem they're likely to use a scope to examine the vocal cords. What they see is evidence of irritation and inflammation. Lots of things can cause such irritation, things like smoking, persistent shouting, viral infections and so forth. Typically this will respond to the avoidance of the triggering cause and the passage of time. If it doesn't, the shrewd ENT physician will consider the possibility of silent reflux.

The most extreme case of silent reflux that I've heard of is a situation where a man developed chronic progressive severe scarring and fibrosis of his lungs with no obvious cause. Ultimately, it is physicians determined that he was refluxing acid into his lungs with no other symptoms. He had no sore throat, no hoarseness, no heartburn - nothing to show for it except damage to his lungs.

I hope this clarifies the concept of silent reflux. The best way to recognize it is to first consider it as a possibility if you have any symptoms of your throat, airway or G.I. tract that don't have a clear cut cause and don't respond to standard treatment. If the diagnosis is considered, then appropriate testing can be done to see what actually is going on.