We all have experienced it – that unhappy stomach after too much indulgence or after eating a meal that was too spicy, greasy or sweet. I am talking about “Heartburn”. Heartburn is only the symptom of what is technically called “Reflux”-  a condition in which your stomach content comes back into your throat, causing burning in the chest and/or a sour taste in your mouth. 

Did you know that 1 out of 5 people in the United States is diagnosed with Gastroesaphogeal Reflux Disease (GERD)? The causes for reflux are unique to each person and can include lifestyle and diet, low stomach acid, hiatal hernia or even sleep apnea. 

But aside from the obvious symptom producing reflux, there are other types that are silent, yet debilitating and even causing long-term damage to organs. 

So what exactly is the difference between heartburn, GERD and other reflux issues?

1. Silent reflux (the technical term is LPR – laryngopharyngeal reflux) affects mainly the, vocal chords and the back of the throat or sinuses. It does not produce the typical heartburn symptoms and I will get into this in more detail below.

2. Acid reflux is similar to silent refill, but the defining symptom is burning pain in the throat or chest.

3. GERD is a more advanced, chronic condition in which acid-containing contents in your stomach persistently leak back up into your esophagus, potentially causing damage to the throat if left untreated.

How do I know if I have silent reflux?

Symptoms that could point to you having silent reflux include:

• Hoarseness or vocal cord inflammation
• Chronic dry cough or frequent bronchitis
• Sore throat
• The need to clear throat or feeling a tickle
• The feeling of a lump in the back of the throat that affects swallowing
• Postnasal drip, chronic sinus infections
• Sleep disturbance
• Shortness of breath

If you have any of these symptoms repeatedly or over long period of time, you may want to get 

evaluated by a gastroenterologist for silent reflux. Reflux that is not treated can lead to more serious symptoms and conditions such as:

• Chronic vocal injury or scarring of vocal chords
• Barrett’s esophagus (pre-cancerous changes in the esophageal lining)
• Narrowing of the airway just below the vocal cords
• Eosinophilic esophagitis 

While it is important to rule out anything serious, the treatment of reflux depends on the severity and root cause. Pharmaceutical drugs like Proton Pump Inhibitors (Prilosec, etc.) can help in some cases but these drugs were never meant to be taken for a prolonged period of time. In fact, many people take these drugs and don’t even get relief. Even worse, long-term PPI use is associated with an increase in all-cause mortality, cardiovascular problems and GI infections.

Are there other options to treat silent reflux?

The answer is YES! Reflux can respond quite well to some diet and lifestyle changes, removing reflux triggers such as fried, fatty and processed foods as well as refined sugar. Improving your gut microbiota with probiotics seems to also have a positive effect on reflux and in certain cases, a supplement increasing stomach acid can bring relief. 

More specific suggestions I give my patients include:

• Switching to a low-carb diet 
• Avoiding caffeine and alcohol
• Eating smaller meals, avoiding overeating
• Taking the last meal about 3 hours before going to bed
• Sleeping elevated
• Taking 3 mg of melatonin 2 hours before you go to bed (closes the sphincter muscle)
• Taking digestive enzymes to decrease transition time of food through the stomach
• DGL (deglycyrrhizinated licorice) – heals the stomach lining and reduces acid
• Homeopathic remedies and herbs (meadowsweet and marshmallow)
• Acupuncture to treat underlying root causes (stress, anxiety, etc.)

Bottomline

Don’t let your reflux symptoms (whether noticeable or silent) go untreated. As you see, there are many treatment solutions that have little or no side effects. And if you have been on a PPI for a long time – DO NOT stop the medication without taking to a medical practitioner. I see a lot of patients that complain that their reflux got worse after they stopped the medication. This is the result of the body trying to catch up and overproducing acid. 

So, if you think you have silent or any other reflux – make an appointment for a free consolation and find out what treatment options are available to you.