Heartburn

Updated 05 February 2016

Could you have silent reflux?

Do you suffer from an irritating cough? Morning hoarseness? Have to clear your throat often? You could have silent reflux.

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Many people who suffer from silent reflux don't actually realise that they are suffering from a medical condition.

According to Dr Monique Marais, a qualified gastroenterologist and hepatologist in Cape Town explains that silent reflux patients do not have the typical symptoms of reflux which are heartburn and regurgitation.

Not a new condition

“They present with symptoms affecting the vocal cords, mostly hoarseness, and can also have symptoms such as chronic cough, persistent throat clearing, chest pain, or the sensation of a lump in the throat. It might even be linked to worsening asthma.”

Although not a new condition, it hasn’t gained much recognition until recently as the diagnosis is difficult.

So what exactly is it? Silent reflux, also known as laryngopharyngeal reflux is a medical condition which is caused by the backflow of stomach contents and stomach acid and digestive enzymes, into the airway the American Academy of Otolaryngology explains.

Marais explains that it is “due to increased frequency of the relaxation of the muscle ring (sphincter) between the oesophagus and the stomach. This allows stomach content and stomach acid to move upwards in the oesophagus to reach the voice box (larynx) which can cause inflammation.

In some cases the stomach acid can even reach the mouth and in rare cases irritate the airways, worsening asthma symptoms.”

Occasionally a hiatus hernia is present, which can impair the integrity of the sphincter between the stomach and the oesophagus and this can be the culprit promoting reflux into the oesophagus.  

Read: Symptoms of reflux and IBS overlap

Symptoms of silent reflux

The symptoms of silent reflux include:

- Persistent heartburn

- Acid regurgitation

- Nausea

- Hoarseness in the morning

- Trouble swallowing

- Postnasal drip

Marais says that if you suffer from these symptoms and suspect you might have silent reflux, it is advisable to see your doctor who could refer you for further investigation.

Your doctor will then likely refer you for a gastroscopy to evaluate the oesophagus, as there might be signs of reflux, even in the absence of typical symptoms.

But how serious a condition is this? According to Marais it is generally not perceived as dangerous, although she admits it does often affect one's quality of life, and can be very bothersome.

Read: What is gastroesophageal reflux disease (GORD)?

Treatment of silent reflux

Treating reflux usually consists of drugs to suppress the acid production of the stomach. Although this doesn’t actually stop the reflux, it works to reduce the acid content of the fluid moving up in the oesophagus so it will contain very little or no acid – and acid is the main irritant causing the throat-clearing and coughing.

One major treatment option is dietary changes and avoidance of certain medications as certain foods and medication may worsen reflux. In people who are overweight, weight loss is encouraged, especially in those carrying fat mainly around their belly.  

“Lifestyle changes can prevent silent reflux in some people. Avoid high fat meals, large meals, alcoholic beverages, gassy drinks, very spicy foods and foods that contain peppermint flavouring.

“Avoid eating late at night or lying down soon after a meal, and try to lose weight if you are overweight. Try to stop smoking if you are a smoker. But unfortunately this is not always enough to prevent reflux in everybody. But always consult your doctor if you have any concerns,” advises Marais.

Read more:

Chronic heartburn raises the risk of throat cancer

Losing weight can ease heartburn

Magnetic implant may ease chronic reflux