I was first diagnosed with “silent reflux” because of a chronic cough and throat clearing. Started treatment with Pepcid, then was put on big doses of PPI's. Cough never went completely, so finally saw pulmonologist and discovered MAC. I never had heartburn until I tried to come off the PPI's. When you stop them, you get a rebound of increased acid production. It took a really long time (months) of extremely gradual tapering to get off them and I don’t think I’ll ever take them again! They shut down the acid, but you still have the reflux. If acid keeps the MAC down, maybe that's even counterproductive! We need more research for sure! Now I manage the reflux with sleeping position, diet, and going to bed with an empty stomach. There’s some new procedure in Europe for reflux that works with a nerve stimulator to increase the tone in the esophageal valves. That would be a great option to have!