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Breathing problem: Silent Reflux a hidden epidemic
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.
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Hi. I have been diagnosed with silent reflux, but not sure if i hsve the correct diagnosis. According to what it states here, peoplw with silent reflux have trouble breathing in, but I have trouble breathing out all the way. I can exhale, but my exhale is cut short right at the end of my exhale. It's like my lungs close before i finish my exhale. I also get a little winded during more strenuous exercise. I dont think it is asthma as asthma meds don't work. My PFT numbers are still somewhat in the normal range, but my breathing does seem to worsen though time. My ct scan does show bilateral atalectasis or scarring at the base of my lung, but my doctor said its common to see that in many patients. It usually just means i was not taking a full breath. I dont thing its correct. I do think that there is scarring and not just atalectasis or not full breath. Can anyone shed some light and tell my what they think I have? My breathing seems to be worsening and I'm not going to see My pulmonologist until May. Can anyone help me figure this out? It has been a year and half with symptoms and still no answers.
@rkomenaka Have you had an ongoing cough? Do you cough up sputum ever?
You may want to read about Bronchiectasis, if you do. This is simply a suggestion to explore further. I mention this because you say Asthma is not the problem.
Bronchiectasis causes damage to your airways and makes it very difficult to rid the mucus / phlegm from deep within the smaller airways of your lungs. Many people use airway clearing techniques or devices when diagnosed with this condition. It is a rare disease so likely not the issue.
All of this is simply a suggestion to look further and ask more questions of your pulmonologist. A CT scan of the lungs - which you had - is said to be the gold standard for diagnosis of certain lung conditions, so it should have revealed issues to your pulmonologist. Perhaps you need a second opinion?
I would recommend that you advocate for yourself.
If you have silent reflex, you could elevate your head during sleep on a wedge pillow or raise the head of your bed, also avoid certain trigger foods, and don’t eat 2-3 hours before bedtime. Hope this helps.
One other technique that helps some people is the pursed lips technique for breathing. Inhale for a count of 2-3 and then exhale through pursed lips, as if you were going to whistle. Some sites say exhale to the count of 5 and others recommend exhaling longer, if you can. Repeat a few times daily. It is also calming. There are websites that give you options for deep breathing exercises. Check with your physician or pulmonologist, but there is benefit for most people according to the research.
Hi Jnmy,
Thank you so much! Your information and advice is very helpful. I will certainly check on Bronchiectasis. It sounds possible. I do have phlem that I cough up while I am taking a shower. I was couging for over a year, but my doctor was able to relieve my couging with Carafate. I'm no longer coughing, thank goodness! Thank you for the advice about he silent reflux too and the breathing exercise! I will try it! I'm sure it will help! Can't hurt to try it. I really appreciate your response. I am hoping to get more answers soon! Thank you once again!
You’re very welcome. There is more information about silent reflux (or LPR) on reliable websites. It would be worth a read.
If you have phlegm that is thicker in consistency you might want to request a sputum test sooner than later. Sometimes the colour is an indication of issues, such as bacteria.
This may not apply to
You, but I have read some research that suggests that sinus infections can lead to lower respiratory issues and n some cases asthma is sometimes initially thought to be the issue. Do ask questions and advocate for yourself. If you don’t have a copy, you can ask to have your CT scan results. Good luck!
@cmshirey17 and @tarinmo, I encourage you to submit a request to speak to a Mayo Clinic appointment cooridinator to learn about Mayo experts specializing in aerodigestive disorders. Click this link to arrange a phone call http://mayocl.in/1mtmR63
I have been diagnosed with idiopathy pulmonary fibrosis and I have been suffering from acid reflux since I990 but it got worse in 2018 the digestive doctor is telling me that it is only a theory not a medical fact I am concerned and confused please give me a real answer for this please thanks
I had an upper GI and was diagnosed with some mild acid reflux. Over a year later, I had a 24 hr PH test done (gold standard for diagnosis of reflux) and that specialist said they could not diagnose me with acid reflux. Many people have episodes of acid reflux from time to time. GERD seems to cause bloating, pressure, pain etc in the stomach area and silent reflux or LPR might not have those symptoms, but the individual may have a hoarse voice, stinging in the throat or even nose area. The acid moves up beyond the sphincter of the stomach to the throat.
Avoid certain trigger foods (super spicy, chocolate, acidic ..) and certain drinks, elevate your head during sleep and best not to eat 2-3 hours before bedtime.
I was told people can take Gaviscon or Tums or another products as needed, or even a PPI before a meal that you know will likely trigger symptoms. Check with your primary care physician. Hope that is helpful.