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.
Interested in more discussions like this? Go to the Lung Health Support Group.
Hi @dtrinkle54 and welcome to Mayo Clinic Connect. Chronic cough can be so incredibly uncomfortable, not to mention the stigma coughing now comes with because of COVID. You are dealing with an issue that many of our members have talked about. For that reason, I moved your comment to a discussion that is centered around "silent acid reflux".
Here is where I moved your post: https://connect.mayoclinic.org/discussion/breathing-problem-silent-reflux-a-hidden-epidemic/
These are also for your reference: https://connect.mayoclinic.org/discussion/self-diagnosed-laryngopharangeal-reflux/
Also: Mayo Clinic Q and A: Lifestyle changes may ease laryngopharyngeal reflux: https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-q-and-a-lifestyle-changes-may-ease-laryngopharyngeal-reflux/
I would definitely suggest a GI physician if you indeed are having the acid reflux. Sometimes a different perspective can mean the world. What are you currently taking to combat these symptoms?
As you probably know, medications, you should review the options, are only one aspect of treatment.
Another is raising the head of your bed 6 to 8 degrees.
Also your diet is a key to avoiding the symptoms.
Unfortunately, it is not likely that you can "fix" the cause, a weak lower esophageal sphincter, allowing the "back flow" of bile and acid into the food pipe/your throat.
Did this diet help you by not not coughing, clearing your throat, breath better? I am overweight too. Did it help loose the weight?
I have neck pain and headaches alot. I will try to do 6-8 inches with the pillow to see if it will help in the mornings.
The pillow in not good enough; you are raising from the waist up.
@dtrinkle54– Would also like to welcome you to Mayo Clinic Connect. I also have COPD and GERD. So you are dealing with two different things that might be resulting in the same thing = coughing and are acting synergistically. COPD can cause your lungs to produce excess mucus, leading to frequent coughing. Not all coughs are effective in clearing excess mucus from the lungs. I assume that you have a Pulmonologist. What has he said about helping to rid yourself of your mucus? Both excess mucus from COPD and GERD together most likely cause a lot of irritation so you cough more.
Below there is a link to a video to help rid yourself of some of your mucus more effectively.
Amanda has given you some great sites to look at. Have you seen a GI doctor?
I thank you so much for the info. Yes I am seeing a pulmonary doctor. I change insurance so I had to find a new one. He says I may have sleep apnea also. He ordered a test for me. I have not heard from anyone yet. I have had this along time. Sometimes I choke up, throw up, and I heat up and get red in the face. Everytime I get up start to do anything I cough. I stay home all the time and no friends and family comes to see me, nor do I go see them. This cough controls me. I have a sad life.
Sorry that you have been dealt such a difficult hand.
I have a couple of suggestions:
1. Have a complete physical to rule out any issues, and to prioritize your actions and those of your PCP. Your initial goal should be to control both your cough, and the surrounding impact. Sleep apnea is difficult, but controllable.
You have the choice to move forward, as difficult as it will be, or to maintain the miserable existence that you describe.
2. Ask to be connected to a psychiatric social worker in order to help you sort out your life from here on.
No one should be alone; if possible you should find a way to reconnect with the world, and your family and friends.
Best of luck.
@dtrinkle54– At this time, with so much going on in your life it's normal to feel sad and depressed. I agree with @spudmato that you should seek out counseling to help you through this and maybe reunite with your family. Stress can also increase coughing. Right now you might think that things are out of control. But you can begin to reverse this, no one else can. It has to be you.
Good day to everybody. I am in advance sorry for any mistakes in writing, English is my third language.
I suffer from Esophagitis Reflux, silent one.
Started as light burning in stomach but i never had problem with it.
Burning went away and every time after overeating i felt pain left side of my neck, pain was radiating under collar bone. Strange was that while i was eating pain was building up, culminating when i finish eating. But i could also burp very hard right away and pain would be right away gone.
October 2019 i had endoscopy, started PPI and i felt better.
I still had bit of pain after eating to much trough year, but barely any and i had no need to burp anymore.
October 2021 i tried to kick off PPI's for several weeks. For first time i felt acid burns and i still went trough with it. Burning stopped but after 5 weeks without PPI's i started having. pain under left rib cage. Pain was dull and only when i am rotating my body or leaning on left or right side. Never pain while resting and no difference if with full or empty stomach.
I started Omeprazole right away and i stopped sleeping on my left side because i thought that could also be the reason. I sleep with my head raised 8 inch from my foot so i did sleep on my left rib cage for months.
I got better, now i am 10 weeks into PPI's and pain is almost gone, not sure if is from PPI's or from not sleeping on my left side anymore.
But last few days i do have pain in neck again, now for first time even without eating and while resting. It is very light pain, and it come for half second and go away but it is constant trough the day.
Did anyone had something similar?
Thing that worry me is same neck pain that i have now even without full stomach, and partially pain under rib cage that is not completely gone but gone some 90% in last 10 weeks..
I am 43, healthy male, never alcohol, never drugs, not smoker. Been on diets for most part of my life eating healthy but i did overeat a lot especially on bulk periods because i was bodybuilding.
Thank you for any input and opinion.