What is silent reflux?
Silent acid reflux is the backward flow of the acidic stomach contents up into the esophagus where it results in a number of complications. Acute acid reflux or gastroesophageal reflux disease (GERD) in chronic cases do not always present with the typical symptoms associated with these disorders. Heartburn (burning chest pain), nausea, regurgitation, and other less common symptoms may be totally absent despite the condition being present. It often goes by unnoticed for weeks or months until the complications of acid reflux becomes evident, particularly in the upper respiratory tract.
The most common symptom in this case is a chronic sore throat, which tends to be worse in the mornings and ease slightly or entirely during the course of the day as described under morning sore throat. Over time, other signs and symptoms associated with reflux pharyngitis and/or laryngitis (combined : laryngopharyngeal reflux) or even aspiration pneumonia becomes evident.
Causes of Silent Acid Reflux
The backward flow of the acidic stomach contents into the esophagus may occur for a number of reasons. It occasionally occurs throughout life but in certain cases, it becomes chronic.
Acute causes may include :
- alcohol consumption
- lying prone (face down) after a large meal
- exercise after eating
- hanging upside down after eating
Chronic causes of reflux (gastroesophageal reflux disease, GERD) may be due to :
- LES (lower esophageal sphincter) dysfunction
- hiatal hernia
- impaired esophageal motility
- delayed gastric emptying
- increased intra-abdominal pressure – pregnancy, obesity
Signs and Symptoms of Silent Acid Reflux
As the name infers, silent acid reflux is asymptomatic and can remain so for long periods of time. It is often once the clinical features of chronic reflux becomes evident that treatment is sought.
This may include :
- Chronic sore throat and morning sore throat
- Persistent cough
- Difficulty swallowing (dysphagia)
- Swollen uvula
- Hoarse voice
- Lump in the throat feeling
- Bad taste in the mouth (cacogeusia)
- Difficulty breathing (dyspnea)
- Itchy throat
- Sleep apnea
- Tooth cavity
The other signs and symptoms of acid reflux may gradually become evident.
Treatment of Silent Acid Reflux
The treatment of silent acid reflux is the same as that discussed under stomach reflux. It involves the use of :
- Antacids to neutralize the stomach acid.
- Proton pump inhibitors (PPIs) and H2-blockers to reduce gastric acid secretion.
- Prokinetic drugs to speed up gastric emptying.
- Sucralfates line the alimentary tract and protect it against the stomach acid.
These medications are discussed further under Stomach Acid Medication. Anti-reflux surgery is rarely considered unless a patient is non-responsive to the drugs mentioned above.
Other medication may also be necessary to treat the complications related to silent acid reflux. However, some of these drugs may have to be used with caution as it could exacerbate the reflux.