Silent Reflux: Symptoms, Causes, Risks, Complications, Diagnosis, Treatment, Outlook and Prevention

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Women who suffer from silent reflux

1Overview

Silent reflux or also known as Laryngeal reflux is a condition where the gastric acid leaks into the esophagus and causes irritation. Although the silent reflux is similar to Gastroesophageal reflux disease, the symptoms of silent reflux differ from other reflux disorders. A person who has silent reflux disease is not aware that he or she has this condition due to the symptoms that are not noticeable.

2Symptoms

Infant and children may have this condition and symptoms includes:

  • Chronic coughing due to the irritation in the throat and also in the lungs
  • Asthma
  • Apnea or pauses in the breathing pattern
  • Hoarseness of voice due to the inflammation of the larynx and the voice box
  • Low weight gain
  • Low appetite
  • Sore throat
  • Globus syndrome. A feeling of a lump in the throat causes frequent swallowing of the person. The tissues located in the throat are inflamed causing discomfort and pain in the throat.

In adults, the symptoms are similar to Gastroesophageal reflux disease like the hoarseness of the voice, bitter taste in the mouth, difficulty in swallowing, frequent clearing of the throat and sometimes asthma. Unlike Silent reflux, Gastroesophageal reflux disease symptoms are more severe and noticeable like nausea and vomiting, dry and painful cough, episodes of chest pain and heartburn.

3Causes

The sphincter which is found in the stomach and the esophagus is not constricting enough that the gastric acid is leaking into the esophagus. In babies and children, the muscles that are involved in the sphincter is not well developed causing slight vomiting after eating or feeding.

Adults who have silent reflux has several factors that can contribute to having this condition, the weakening of the sphincter will allow the stomach acid to go to the esophagus and causes severe damage like ulcerations to the lining of the throat.

4Risk Factors

There is no specific age group that is affected by the silent reflux even infants can have this condition due to underdevelopment of the sphincter. While in adults, the lifestyle factors like types of food they eat and a sedentary lifestyle can increase the chances of having this type of reflux. Others are:

Smoking

Aside from respiratory diseases, smoking can also be a cause of reflux diseases. Chemicals in the smoke can harm the throat and can even spread to the stomach and the digestive system.

Alcohol

Drinking excessive alcohol can lead to increase acid in the stomach and this can lead to hyperacidity that can damage the lining of the stomach and eventually to the sphincters.

Physical deformity

The esophageal sphincter is not functioning well that it is allowing stomach acid to go through the esophagus.

Slow emptying

Slow emptying of the stomach can also be a factor that can lead to silent reflux. When the food stays in the stomach, acids are produced to enhance the digestion the longer the time the food stays inside the stomach more acids are being produced and that can allow some of the acids to go through the esophageal sphincter.

Overweight or obese

Being overweight or obese can open up many doors that lead to many different types of disease. Central obesity, where the fats are concentrated on the abdomen, can increase the pressure in the stomach and that can force the sphincters to open that will allow the fluids to regurgitate back into the esophagus.

Pregnant

Pregnant women are at risk for having reflux disease due to the baby growing inside her. The uterus pushes up the other abdominal organs to make way for the fetus, increase pressure will be present and thus putting the mother at risk for having episodes of reflux.

5Complications

Silent reflux can cause damage to the linings of the esophagus and can also lead up to the throat and nasal passage. Damaged mucosa can expose the inner layer of the esophagus and that can lead to more serious complications like:

Respiratory problems

Gastric acid can go to the lungs and cause problems like difficulty in breathing due to the accumulation of fluid in the bronchioles thus limiting the amount of air entering the lungs.

Emphysema

This condition is a chronic disease where the air sacks in the lungs are blocked due to excessive scarring. When the air sacks are being blocked, the air exchange will be compromised and that can lead to COPD or Chronic Obstructive Disease which is one of the leading cause of death in the world especially in the United States.

Bronchitis

Bronchitis may occur because of an ongoing infection in the lungs. Damaged by the acid, the mucosal lining of the lungs will not be able to protect the other layers of the lungs thus it is prone to infections.

Cancer         

Due to the excessive damage to the mucosa, there is a risk of developing abnormal cells that can turn into cancer.

Malnutrition

The person will not be able to eat properly because of the pain felt in the throat.

Difficulty in breathing

Due to the scarring in the throat, there will be narrowing of the space and that can lead to labored breathing.

In children having the reflux will cause ulcers in the throat and stomach, ear infections and narrowing or scarring of the lining of the throat and esophagus.

6Diagnosis

Due to the name Silent reflux, it is difficult to diagnose because of the unnoticeable symptoms. The doctors may perform a series of tests in combination with a thorough physical examination. After the assessment, the physician will order tests to verify what kind of condition does the patient has.

Endoscopic exam

A tube will be introduced into the mouth down to the throat to see if there are any signs of scarring on the linings of the esophagus and also to visualize the esophageal sphincter.

Monitoring of pH

This test will record the data through a small device that is worn by the patient. It will detect the pH on the mouth or nose by using a small catheter, this can help the doctor see if there are any presence of acid in these areas.

Barium X-ray

The patient is required to swallow a chalk-like substance, it will allow the doctor to see if there are any narrowing or blockages in the throat using the x-ray.

7Treatment

In adults, there are several ways to treat silent reflux by adjusting the diet by eating nutritious foods and avoid eating chocolates, citrus foods, mints, spicy foods, drinking caffeinated products and carbonated drinks. Others may do these also:

Lose weight

If the person is obese, it is better to lose weight to promote a better life. Exercise daily and have a balanced diet.

Quit smoking and drinking alcohol

Avoiding these habits will lower your risks of having reflux disease and other life-threatening diseases.

Medications

Take prescribed medications by the doctor after having a detailed assessment and tests, medications like H2 blockers and proton pump inhibitors will be prescribed to reduce acid production. Sucralfate is for the injury sustained by the acids, antacids are for neutralizing the acidity in the stomach and also the prokinetic agents is for increasing the movement of the lower gastrointestinal tract but this is not commonly used because of the adverse effect of this drug.

Surgery

Surgery is done to fix or tighten the esophageal sphincter. Fundoplication is an invasive procedure that requires the consent of the patient to perform the surgery. The upper portion of the stomach is then wrapped on the lower section of the esophagus to create a stronger sphincter, this, in turn, will prevent the acids from leaking or going into the esophagus and the airway passages. The procedure is done laparoscopically or by making an incision in the abdomen.

8Outlook

Although silent reflux is hard to diagnose, the treatment is easy and can be done without any pain.  Patients who have been diagnosed with this condition will just have to take the prescribed medication and modify their lifestyle. The condition can be treated and there is a chance of it not coming back. In children and infants, careful monitoring and modify the activities and diet is a must. In infants, the child must have a regular check-up to monitor the condition of the throat and airway passages.

9Prevention

To prevent reflux, lifestyle changes must be made in dietary and activities of daily living of the person.

  • Eat foods that do not aggravate more acid production and avoid eating citrus fruits, chocolates, mints and caffeinated products.
  • Smoking cessation is a must and that also includes drinking alcohol.
  • Maintain an active lifestyle, avoid strenuous activities that require a lot of effort.
  • Lose weight when the person is overweight. The pressure from the abdominal cavity will decrease if the mass build-up around it will also be lessened.
  • Proper body mechanics when lifting heavy objects is also advised by the physician to prevent unnecessary pressure build-up in the body.
  • At bedtime, avoid eating 3 hours before going to sleep to prevent acid production that may leak back up into your esophagus when lying down.
  • Slightly elevate the head of the bed to prevent regurgitation of the acids into the esophagus.