Silent (Extraesophageal) Reflux (EER)

Most individuals have heard of heartburn or GERD (gastroesophageal reflux), but most are unaware of EER (extraesophageal reflux). EER is essentially the direct injury to areas of the body, in addition to the esophagus, by continued acid and pepsin exposure. This is not unlike GERD, however, patients with EER may not suffer from symptoms of heartburn or regurgitation. Therefore, EER is often called Silent Reflux.

What are the symptoms of Silent Reflux?
Some of the most common symptoms of Silent Reflux are:

Chronic cough
Excessive throat clearing
Chest pain
Hoarseness
Insomnia
Sore throat

Or patients may experience:

Pharyngitis or Sinusitis
Recurrent bronchitis
Chronic asthma
Laryngitis
Noncardiac chest pain

If you have any of the listed symptoms, you may have Silent Reflux. Seeking the help of your health care provider is the first step. They have the tools to properly diagnose reflux and heartburn. Once diagnosed, a treatment plan can be recommended.

When told that they have Silent Reflux, many patients claim, “I didn’t think I had that.” Many providers find that their Silent Reflux patients are amazed that they have reflux because their symptoms are not indicative of gastroesophageal reflux. Most individuals associate reflux with heartburn/GERD. What many people don’t realize is that one can have reflux without having heartburn. Individuals with Silent Reflux may lack the classic GERD symptoms of heartburn, regurgitation or a foul taste in the mouth. Because of the lack of traditional heartburn symptoms, Silent Reflux can be misdiagnosed.

How is Silent Reflux diagnosed?
If Silent Reflux is suspected, your health care provider may prescribe a treatment plan and avoid invasive diagnostic testing. This is commonly referred to as empiric therapy. Empiric therapy involves receiving treatment to see if the symptoms subside. It is an attractive diagnostic strategy for patients because it is inexpensive, simple and does not involve testing.

If testing is needed, the most typical test performed to diagnose Silent Reflux is pH Monitoring, a diagnostic tool that measures the acid level in the esophagus. This test is minimally invasive and requires little to no down time.

During this endoscopic procedure and while under sedation, a small capsule is inserted onto the lining of the esophagus. The capsule contains an acid-sensing probe, a miniature battery and a transmitter. Information from the esophagus is transmitted and gathered for two days. The capsule does not need to be removed because it naturally detaches and passes easily through the digestive tract.

During the test, patients are encouraged to eat and live normally; therefore, the probe can effectively measure the acid levels in the esophagus – this will determine the amount of reflux in the esophagus.

How is Silent Reflux treated?
Following diagnosis, a proper treatment plan can be recommended. Most treatment plans include minimizing symptoms through diet and other lifestyle modifications such as:

Smoking cessation
Avoiding:
Caffeine
Eating before bedtime
Eating large meals
Alcohol and tobacco
Tight fitting clothing
Losing weight if you are overweight

In addition, your physician may suggest medication and/or surgery.

Is Silent Reflux life-threatening?
It is important to diagnose and treat Silent Reflux. Studies have found an increased incidence of asthma in people suffering from Silent Reflux. In addition, those suffering from untreated reflux can develop a condition called Barrett’s esophagus – possibly leading to esophageal cancer.

The symptoms of Silent Reflux can often be disguised – diagnosis is the first step, but effective treatment options exist for people suffering from Silent Reflux.