Silent Reflux - When Reflux Is Not Noticeable

In short: Silent reflux is reflux (GERD) without the characteristic burning behind the breastbone — so many people don't realise they have it. The acid still reaches the oesophagus and throat and can cause inflammation and damage, which is why unusual symptoms like a persistent cough or hoarseness are worth checking with a doctor.

Silent reflux: what is it?

Reflux itself is easy to explain: it is the return flow of food pulp together with aggressive gastric acid from the stomach into the oesophagus. How can this happen?

If the production of gastric acid exceeds its normal level, or if the sphincter between the oesophagus and the stomach is weakened, the mechanism that seals the stomach upwards can fail. The contents of the stomach then enter the oesophagus — in the opposite direction to where they should go.

The problem is that the mucous membrane of the oesophagus is not protected from the stomach acid; pain and inflammation are the result.

Silent reflux, on the other hand, is not recognisable by classic heartburn. Although the problem is the same and the usual inflammations and damage also develop, the person affected does not feel any pain behind the breastbone.

In many cases, this phenomenon occurs together with so-called laryngo-pharyngeal reflux (LPR), in which the stomach acid penetrates into the larynx and throat area. LPR mainly occurs at night when the patient is lying down. Both the position and sleep favour silent reflux.

Symptoms & risks of silent reflux

Heartburn that you don't really notice? This may not sound so bad at first, but on closer inspection it quickly becomes clear: if you don't feel your reflux, you don't do anything about it.

Without the right treatment and regular check-ups by a doctor, secondary diseases are easy to develop — and if at all, they are only detected at a very late stage. Possible complications include:

• inflammation of the oesophagus
• ulcers or bleeding
• scarring and narrowing of the oesophagus
• difficulty swallowing
• oesophageal cancer

This is why it is particularly important to keep your eyes open — especially if you have had heartburn problems before, or if there is a family history of reflux.

Silent reflux does not pass by the body without leaving a trace. Some complaints can give a decisive indication of the disease if they recur frequently or even become chronic. These include:

• hoarseness
• sore throat
• difficulty swallowing
• coughing
• frequent throat clearing
• asthma and frequent respiratory infections
• nausea
• laryngitis

If you notice these symptoms more often than usual — for example if they get worse at night or in the morning — it is advisable to consult a doctor. He or she can determine whether you are suffering from silent reflux or whether there are other causes behind the symptoms.

Diagnosis and treatment

The difficulty in diagnosing silent reflux is establishing the connection between the comparatively unusual symptoms and the reflux disease.

Affected people do not present with typical reflux symptoms — they come to the doctor because they suffer, for example, from a persistent cough or frequently recurring respiratory infections. The doctor should definitely keep the possible diagnosis of "silent reflux" in mind: in conversation with the patient, a few points can provide decisive clues.

Problems with heartburn in the past, a family history of reflux, obesity, a poor diet, eating too late in the evening, or taking medications that promote reflux all increase the likelihood of an unnoticed reflux of the stomach contents.

Awareness of the consequences of gastric-acid reflux on the respiratory tract is growing: more and more studies show that reflux is the cause of chronic bronchitis or asthma in many cases. Experts therefore recommend that, once a chronic respiratory disease has been diagnosed, it should always be checked for existing reflux.

Often, silent reflux is only unmasked when the doctor performs a gastroscopy as part of preventive care, or if another disease of the digestive tract is suspected. In this procedure, a tube-like device equipped with a tiny camera is inserted through the patient's mouth. This gives an insight into the oesophagus and stomach and shows directly whether there is any damage caused by the stomach acid.

Once silent reflux is detected, treatment is the same as for "ordinary" reflux. Appropriate medication can control the formation and/or effect of stomach acid, an adapted diet reduces excess weight and heartburn as well as other reflux effects, and identifying personal risk factors significantly supports prevention. In severe cases, doctor and patient can also consider surgery, which can put a permanent end to reflux.

Diagnosis & treatment at a glance

FAQ: silent reflux