Breathing problem: Silent Reflux a hidden epidemic

[ssgaurav2000]

Often overlooked and misdiagnosed, silent reflux affects over 50 million Americans. The backflow of stomach acid and digestive enzymes (pepsin) can wreak havoc on your esophagus (the food passage that goes from your throat to your stomach), as well as your ears, nose, throat, vocal cords, sinuses, mouth, and lungs. Pepsin, in the presence of acid, digests protein and damages tissue. Outside the protected stomach, pepsin, bathed in acid, digests you! And when pepsin attacks your sensitive airway and esophageal tissues, you can suffer all kinds of problems.

The most common silent reflux symptoms are hoarseness, chronic cough, throat-clearing, post-nasal drip, sinusitis, sore or burning throat, difficulty swallowing, shortness of breath, snoring, sleep apnea, bad breath, tooth decay, asthma, and COPD. Unfortunately, your doctor is probably unaware that these symptoms may be caused by silent reflux and that it could be controlled with the proper diagnosis and treatment.

Did you know that asthma is one of the most common misdiagnoses, because silent reflux mimics asthma? Here’s a big tipoff: When you have trouble breathing, do you have more difficulty getting air IN or OUT? People with reflux have trouble getting air IN during inspiration (not out during expiration). People with asthma have difficulty getting air OUT of the lungs. In truth, many people with “asthma” may not actually have it, and, consequently, asthma medication doesn’t really help much if at all. The fact is that once the correct diagnosis is made, effective anti-reflux treatment can permanently cure this asthma-like breathing problem.

How Do I Know If I Have Silent Reflux?

One of the characteristics of silent reflux is that most people who have it have several different symptoms all at the same time, but often heartburn isn’t one of them.

To find out if you may have silent reflux, take this simple quiz. Just circle the number for each symptom and add up the numbers. The quiz is actually known as the Reflux Symptom Index (RSI), and it is a great first test to see if you have reflux. If your RSI is 15 or more (and you have a zero or one for heartburn), you may have silent reflux; you should see a specialist trained in detecting reflux by examination of both the throat and esophagus. Doctors who only scope the esophagus are missing the boat. Get your printable version of the Reflux Symptom Index.

Why Is Reflux Sometimes Silent?

What makes silent reflux different than heartburn is that the silent reflux sufferer may be unaware of having it, and his or her doctor may not suspect the diagnosis. A lot of reflux is needed to damage the esophagus, but very little reflux can severely damage the more sensitive throat, sinuses and lungs. Many people with silent reflux have never even once experienced classic heartburn.

How the term “silent reflux” came to be is instructive. In 1987, Walter Bo, a medical school colleague, was my patient. As a result of nighttime reflux, he had terrible morning hoarseness. This was because he had a habit of eating dinner very late and then falling asleep on the sofa. Hence, he would reflux into his throat all night.

I tried explaining the problem, but Walter repeatedly denied having reflux. As it turned out, Walter affirmed that he thought that heartburn and reflux were the same. When I was able to explain that one could have reflux without heartburn – as in this example, when it occurred during sleep – Walter rolled his eyes and said, “I see. I have the silent kind of reflux.” I declared, “Yes, Walter, that’s it! You have silent reflux!”

Why Doesn’t My Doctor Know About This?

Unfortunately, people with silent reflux symptoms, even if they ask their doctor, are usually incorrectly told they do not have reflux. The medical specialties are broken down by parts of the body, and doctors are experts in, and only test for, those parts of the body in which they specialize. The problem is that reflux does not care where your doctor trained and how it might affect the different medical specialties – the esophagus treated by gastroenterologists, the throat and sinuses treated by ear, nose and throat specialists (otolaryngologists), and the trachea and lungs treated by lung specialists (pulmonologists).

The Solution: Integrated Aerodigestive Medicine

Only a trained reflux specialist who knows what to look for in all affected areas and who has the right diagnostic tests is equipped to make an accurate diagnosis. Otherwise, a doctor may guess wrong and treat you for an illness that you don’t have. Some of the symptoms of silent reflux can sometimes be caused by other diseases, which doctors try to treat unsuccessfully, leaving you miserable, frustrated, and having wasted money on useless tests and drugs.

Instead of focusing on the patient’s diet and lifestyle – the root cause of almost all reflux disease – doctors often employ pills, usually the wrong pills, that rarely correct the problem. In truth, reflux medications are grossly misused and over-used today.

[mikeadams51]

Very good post. I have severe COPD and suffer acid reflux both silent and normal. Most of the symptoms highlighted in the chart I have to a level 3 to 5 on a daily basis. Some specialists are suggesting acid reflux could be the cause of lung problems. Thank you for a cracking good post

[Hidden]

Great post i have all them symptoms and now what they are all from

[tigersocksy]

Excellent post and I scored a 34! I am due for a endoscopy on the 13th and to see a ENT after that. Hoping I will get some answers. Thank you again for this most informative post.

[Lyd12]

I went to the docs with silent burping. SHe gave me some medicine that I couldn't tolerate so never got it sorted.

[ssgaurav2000 in reply to Lyd12]

You should get further tests done if its bothering you

[Lyd12 in reply to ssgaurav2000]

Not much faith in doctors these days - use gaviscon sometimes, thanks for r replying.

[Kiiam]

Superb post : certainly the reflux has been aggravating my asthma, and making it s lot more severe , awaiting Endo , but changing the basics has helped a little, and yes I’m hoping for further improvements to come xx😊

[ssgaurav2000 in reply to Kiiam]

Thanks wish you good luck

[Jollj]

Great post, I was diagnosed mild COPD four years ago and given a spiriva inhaler,regressed to moderate 12 months later but after changing my lifestyle considerably am now back in mild bracket,I suffered from some of the symptoms in the table but not as bad as I do now since prescribed the inhaler,are there any know links,I am just under the 15 score.

[Brenda102]

Thanks for posting this. I do believe this is very underdiagnosed. When I finally got diagnosed with bronchiectasis, I had the worst episode of reflux in my life. People need to realize you don't even have to have a significant feeling of heartburn to have this. There is a further subdivision laryngopharyngeal reflux (LPR) where the symptoms are mainly in the throat area.

[GMYog in reply to Brenda102]

Thank you so much for your post.....after suffering for months with a horrible feeling of throat tightness, the feeling of something stuck in my throat, dry cough, sore throat, chest heaviness and pain between my shoulder blades....most of which are much worse when I go to bed at night.....this is the first time I've heard of LPR and I'm sure it is what I've got. I never get heartburn and when my doctor told me he thinks I have reflux I was doubtful but nevertheless have been taking Lansoprazole for the last 10 days. No change as of yet but I understand it can take weeks or even months to work. After I read your post I immediately went onto the nhs website and read up on LPR. I'm going out this morning to get some Gaviscon Advance.....apparently PPIs do not stop the production of pepsin...the key factor in LPR. Gaviscon Advance does. I'm surprised my doctor never told me about LPR, I have said numerous times that the main discomfort is in my throat. I scored 26 on the above chart. I feel more hopeful now that I may be able to get my symptoms under control and it is thanks to you Brenda so bless you x

[DMD5 in reply to GMYog]

Same problems for me - you should try acti ph alkaline water ph 9.0 + . Helps by deactivating pepsin enzyme. It s not curing the LPR but it helps a lot . You could try Acid Watcher diet by Dr Aviv.

Good luck!

[Bevash]

Thank you for posting such an informative article. My score on your chart is 32. Four years ago my asthma started getting worse after being very mild for 44yrs. (I am 73yrs old and live In NZ) . For 44yrs I used one ventolin inhaler a year & only when I had a chest infection. For the past three years I have tried many different preventers which had no effect and are now on Spiriva for (COPD) Symibicort, Loratadine & Nasal spray (for allergies to cat dander, mould, dust mites) I am under the respiratory clinic and are presently being reviewed every 3 months. I have always had a constant cough, no chest tightness and my wheezing is in my throat. (to be told by the clinic this is normal with asthma) After my third hospital admission a Dr passed comment that it was no good giving me normal asthma medications as I don't respond to them. I would have thought this would indicate something else was causing the problem. My Dr has always suspected that there is something else causing my severe breathing problems. I have had bad reflux, a reasonably big gallstone (removed last March) When my asthma gets really bad and my peak flow drops to 70 I have a 5 day course of 40mg prednisone. I am normally having this once a month. I have recently been diagnosed with cataracts in both eyes and glaucoma in one eye. Possibly caused by the long term prednisone. I have just had one cataract removed (going private) as I was only just legal for driving and hope to get the other one done on NHS. Through this forum I came across the Acid reflux diet, read up about Pepsin and have now been referred to an ENT specialist on 17th Sept, Your article certainly points in the direction of silent reflux. When I have mentioned this to the respiratory clinic in the past it has just been ignored. My concern is: how much damage has been done to my throat in the past 4 years using drugs that may not be right for my condition. Once again thank you so very much for your article.

[Bunny_Ears]

Thanks for posting this (though I just came across this post). I think this is what I've got. Been having some breathing difficulties since summer time (was half-way down the 2-week doxy course due to a bug found in sputum), going to A&E twice, and eventually having been told it's stress, with no major relief in symptoms. Mentioned the breathlessness to the consultant on my latest appointment, when my lung function test was good and chest sounded fine, too. She asked if I have reflux, to which I said no, as I had only had heartburn a handful of times over the years so nothing chronic or bothersome. But then I came home, thought about it and words "silent reflux" passed through my mind, as I had heard that term somewhere, so decided to google the symptoms.....and so many of the symptoms fit: the hoarseness, throat clearing, bad post-nasal drip for the past two years, sleep-onset apnea episodes and for the past 4 months - shortness of breath.....I also read that some causal factors are stress (check), lower GI issues (check), medication (check)..........Need to get this checked out, I guess.