What is “silent” reflux?

Reflux in general refers to acid content in our stomach that is then pushed back in reverse into the upper digestive tract.  Depends what the reflux is doing, and in which ways you are being affected, there are various names for reflux issues.

Let’s review some basic physiology first.  As we swallow food, that food is initially chewed and broken down into small particles in the mouth.  Once it is chewed thoroughly, the food is then pushed back into the throat and down towards the food pipe, the esophagus.  There is a small sphincter between the throat and esophagus, called the upper esophageal sphincter.  As food nears this area, the sphincter momentarily relaxes and the food can make it past the sphincter.  In this esophagus, the food is usually pushed down by peristalsis, otherwise known as swallowing waves.  Towards the end of the esophagus, approaching the stomach, there is the lower esophageal sphincter.  This in turn also relaxes and allows the food to get emptied into the stomach.  Once the food is in the stomach, it will be digested by the acidic juices as well as periodic contraction of the stomach.

Occasionally, various different conditions can cause some amount of acid to go back in reverse into the esophagus and even further up into the throat area.  One condition is called hiatal hernia, in which actually part of this stomach has herniated into the chest area.  This allows for much easier access of the acidic secretions into the esophagus.  Spicy foods, overdistension of stomach by overheating, or stressful conditions have also been implicated in causing reflux issues.

Generally, reflux of acid into the lower portion of the esophagus is called gastroesophageal reflux, commonly known as GERD.  This portion of the esophagus actually has quite a bit of protective mechanisms against the regular flow of acid.  It is believed that most patients could experience up to 50 episodes of acid reflux in this area before they eventually become symptomatic of heartburn or other digestive issues.

Laryngopharyngeal reflux (LPR) refers to reflux of acid issues all the way through the lower esophageal sphincter, the esophagus, through the upper esophageal sphincter, and into the throat.  Typically, this lands in the area of the voice box.  Some people experience hoarseness and others experience problems with swallowing or a sensation of fullness in the throat (globus).  This area of the body does not have as many protective mechanisms and patients become symptomatic much sooner.

The term silent reflux specifically refers to patients who do not feel symptoms of heartburn or acidic taste in the throat or other associated issues, but rather feel the secondary effects such as bloating or a sensation of ball being stuck in the throat (globus sensation).  Often times, when patients with silent reflux are told about their actual diagnosis, they are surprised that some acid issues have been going on for quite some time without their being cognizant of it.

The treatment of all kinds of reflux issues involves both behavioral changes as well as diet modifications and possibly medical therapy.  All of these remedies have been discussed in other portions of this website.

The diagnosis of reflux can be made by your physician, sometimes by history and physical alone and sometimes by additional testing with endoscopy.  An appointment with your primary doctor or specialist can be very helpful for this.


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Posted in: Throat, Voice

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