Causes of Silent Reflux

The esophagus has a muscle ring on both ends which generally help in keeping down the stomach contents. However, due to silent reflux, the sphincters fail to function properly causing stomach acids in backing up all way to the pharynx (backside of throat) or larynx (voice box) or also reaching backside of the nasal air way. It could lead to unshielded regions exposed to gastric acid getting inflamed.

Silent reflux is prevalent among babies due to underdeveloped sphincters, having a smaller esophagus and their supine position at most occasions. The reason for silent reflux among adults might be unknown.

Symptoms of Silent Reflux

Symptoms among babies and kids might comprise of:

• Gruffness.
• Unceasing coughing or ‘barking’.
• Asthma.
• Noises audible during respiration or hiatus during breaths or apnea.
• Difficulties felt when the child is fed, spits up or inhales food.
• Difficulty trying to gain weight.

With silent reflux, adults might sense tart taste or burning feeling in the backside of the throat (heartburn). However, adults have lesser likelihood of having the typical GERD symptoms. Quite frequently, adults experience signs which are indistinct and could be mistaken for other conditions. The most prevalent symptoms comprise of:

• Excessively trying to clear throat.
• Unrelenting coughing.
• Croakiness.
• Lumpiness felt in the throat which fails to subside despite repetitive ingestion.
• A feeling of post-nasal drip or excessive mucus in the throat.
• Difficulty to swallow or/and breathe.
• Throat soreness.

Complications of Silent Reflux

Pooling up of stomach acid into the laryngeal and throat region could lead to long-standing irritation and harm and if not treated could be grave.

Among babies and kids, silent reflux could lead to:

• Constriction of the region beneath the vocal cords.
• Contact ulcer formations.
• Recurring ear infection that develop due to Eustachian tube functioning issues.
• Enduring accruement of mid-ear fluid.

Among adults, silent reflux could cause scarring in the larynx and throat and additionally increasing chances of cancer developing in those regions, affecting lungs and might aggravate conditions like bronchitis, asthma or emphysema.

Diagnosis of Silent Reflux

Though silent reflux is tricky in diagnosing as compared to GERD, a physician could detect it via a merger of medical past, physical examination and a single or more testing. Tests might comprise of:

• During an endoscopic examination, a pliable or firm observational device is used for peering into the vocal cords and throat.
• During pH monitoring procedure, a tiny catheter is introduced via the nostril inside the throat and esophageal area. The multiple sensors spot acid and a mini-comp donned on the waistline would record readings in a twenty-four time period.

The degree of severity of GERD is dependent on the LES disorder along with sort and quantity of fluid being refluxed into the esophagus and the defusing outcome of saliva.

Gastroesophageal Reflux Disease Causes:

• Certain doctors think that hiatal hernia- a condition wherein the stomach bulges into the chest cavity, tends to weaken the LES muscle and lead to gastroesophageal reflux. When one coughs, vomits, strains or any such kind of abrupt physical stress and exertion could raise the pressure in the abdomen leading to hiatal hernia.
• Overweight, pregnancy, stress.
• Consuming oversized quantities of foods and particularly onion, garlic, pepper, chocolate, tomato or tomato-derived foods, citrusy fruits, fatty or highly spiced food items, peppermint.
• Having particular drinks derived from citrus fruits, aerated drinks, caffeine or caffeine based drinks, alcohol, and smoking.
• Having meals just prior to bedtime and when one lies down or bends over particularly following a meal.
• Those who wear restricting clothes or belts.
• Those on particular medications, certain antibiotics, aspirin, NSADs like Aleve, Advil among others.

Gastroesophageal Reflux Disease Symptoms:

• Sensation of heartburn, known also as acid indigestion that normally seems like a strong pain in the chest area commencing at the backside of the breastbone, radiating up to the throat, quite often leaving an insipid after-taste in the mouth.
• The burning  sensation, pressure or discomfort lasting up to two hours, mostly worsening subsequent to a meal, most often mistaken for heart ailment or stroke.
• Children affected by GERD may persistently vomit, cough and have other respiratory distresses.
• Coughing, feeling of hoarseness or soreness in the throat. Swelling or Inflammation in the larynx and throat region.

Exams & Tests:

• A detailed physical exam of the throat and the larnyx is conducted by the doctor.
• X-rays are taken after the patient has been advised to ingest barium. This aids in detecting ulcer formations and presence of strictures.
• In certain cases of chronic esophageal reflux or with symptoms not curable by most treatments, a comprehensive and detailed diagnosis is crucial that involves employing testing methods like upper GI series, Upper Endoscopy test, Bernstein test, Esophageal manometric testing, Esophageal motility testing, Esophageal Acid Testing and Esophageal pH testing techniques.

Gastroesophageal Reflux Disease Treatment:

Treatment for GERD is aimed at reducing the quantity of reflux or minimising the harm done to the esophageal lining due to the recurrent reflux.

• Altering one’s way of life and diet.
• Keeping away from food items and drinks that tend to slacken the LES or might cause irritation of the esophageal lining.
• Restricting portion sizes during meals, keeping a gap of nearly three hours between meals and going to bed.
• Maintaining ideal weight and quitting smoking.
• Raising the headrest portion of the bedding on six inch slabs or alternatively using a specifically made wedge to sleep on that works on the principle of gravity to reduce reflux into the esophagus, thus lowering heartburn.
• Avoiding cushions for supporting oneself up, that mainly exerts strain on the stomach.
• Certain non-prescription antacids help in alleviating the undesirable symptoms by having a neutralizing effect, though for momentary periods of time. An antacid-alginic acid combo provide relief for many as it is forms a foam casing atop the stomach averting acid refluxing to take place.
• Protracted antacid consumption could lead to adverse side effects such as diarrhoea, an alteration in calcium metabolism in the body and magnesium accumulation in the body. Excessive magnesium accumulation in individuals with kidney ailments is known to be detrimental. If antacid consumption is needed for longer than three weeks, then prompt medical advice must be taken.
• To treat severe reflux and burning sensation in the heart, reflux-reducing medicines like H2 blockers including cimetidine (Tagamet), famotidine (Pepcid), nizatidine (Axid) and ranitidine (Zantac).
• A different form of drug known as the acid or proton pump inhibitor like esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec), pantoprazole (Protonix), and rabeprazole (Aciphex).
• Therapy that include the administration of motility medicines like cisapride, bethanecol, metoclopramide that improve LES muscle strength, hasten the stomach’s emptying process and target the gastrointestinal tract.
• The Stretta procedure is a widely popular, least invasive way to effectively treat GERD. This non-surgical option is undertaken by using a fine tubular structure, Stretta device that is lowered down till the esophagus, releasing high-intensity radio emissions used to tighten the LES.  Another minimally invasive choice that needs no medicines is endoscopic stitches.

Possible Complications:

• At certain occasions GERD is known to cause detrimental complications like Esophagitis due to excessive stomach acids being refluxed into the esophagus leading to esophageal blood loss or ulcer formations.
• Severe scarring could cause a tapering or constriction of the esophagus. In certain individuals there is considerable wounding of the esophageal lining leading to a condition called the Barrett’s esophagus, considered by many experts to be a harbinger of esophageal cancer.
• A minor population of individuals ailing from GERD need surgical intervention procedures like Fundoplication when most of the treatment options seem futile.

Prevention:

• Keeping away from food items and drinks that have an undue effect on the LES muscle or cause irritation in the esophageal lining.
• Reducing weight if obese, cessation of smoking.
• Raising headrest of the bed to nearly six inches.
• Trying not to lie down for two to three hours following a meal.
• Taking antacids if necessary.