For years Harvey Shiffman, 59, a dentist in Boynton, Florida, had issues with throat clearing, loss of voice in the mornings and congestion. After numerous medical consultations left him with a diagnosis of irritable bowel syndrome (IBS) and lactose intolerance, he finally saw an ENT who discovered his silent reflux.
Silent reflux, also called laryngopharyngeal reflux (LPR), similar to GERD (gastroesophageal reflux disorder), is the result of contents from the stomach backing up into the esophagus. Since it's sneaky, you may not have classic symptoms of GERD like heartburn, which is why it's also tricky to diagnose.
Symptoms are vague, hence silent, like excessive throat clearing, hoarseness, cough or a lump in the throat that never seems to go away.
Why do I have silent reflux?
Sphincters at the top and bottom of the esophagus are supposed to control stomach contents and prevent them from splashing up into the throat. With silent reflux, it may be that the sphincters' don’t have adequate control and the stomach acids are backing up, especially while you are lying down.
"Symptoms without burning are harder to diagnose, and you may even notice noises when you breathe or difficulty swallowing pills or food," says Teri Goetz, LAc, MS, ACC, a Chinese and Integrative Medicine practitioner with practices in New York City and Millbrook.
While silent reflux is harder to diagnose, doctors look at symptoms, medical history and can run several tests such as an endoscopic exam, an in-office procedure to view the throat, as well as a pH monitoring test for which sensors are placed in the throat via catheter to detect acid.
"Silent reflux can present first as a dental problem," says Dr. Frank Farrelly, a dentist in Sydney, Australia. Reflux causes erosion of the upper front teeth in particular. The acid causes the enamel to get worn, leading to sensitivity.
Prescription and home remedies
Treatments are similar to regular reflux: lifestyle changes like losing weight, quitting smoking and skipping alcohol, chocolate, caffeine and spicy foods. You may also need medications like proton pump inhibitors (PPI) and antacids to reduce or control gastric acid.
In Goetz's experience, using herbal remedies to soothe and repair the tissue is more useful than the classic prescription of proton pump inhibitors for two reasons. "One: we need stomach acid. Usually reflux is caused by too little stomach acid and food doesn't get properly digested. When we take a PPI, it actually may alleviate the symptom, but you can make the problem worse. And, two, you're not addressing the root cause of the problem and eventually, you're that person popping TUMS constantly, which, by the way, also makes it worse."
Since acid medications lose efficiency after months, Shiffman's internist recommended he read the book "Wheat Belly" and change his diet. "I completely changed my diet removing wheat/gluten and most grains. My condition has improved 95 percent. I am off all acid medications, blood pressure meds, cholesterol meds and have lost 15 pounds with the same exercise and balance of diet," says Shiffman.
Goetz recommends Throat Coat Tea by Traditional Medicinals or licorice root tea. Throat Coat contains many mucilegenic herbs like licorice root and marshmallow root, which helps heal tissue. But don't take if you have high blood pressure.
If you have high blood pressure, you can chew DGL (the deglycyrrhizinated form of licorice) tablets instead, which remove the part of licorice that raises blood pressure. It's also useful for indigestion, ulcers and canker sores.
Other treatments Goetz recommends include L-glutamine (which heals leaky gut and has a similar effect as the herbs mentioned above), lifestyle changes and a low acid diet until you have tamed your symptoms. Plus, never eat within a few hours of bedtime.
Don't forget about the possibility of erosion. There are many options to help protect the teeth from silent reflux. Most important is getting the reflux under control. "In terms of protecting the teeth, reducing acid intake helps," says Farrelly. Drink plenty of water, particularly after acidic foods. And pick up a special erosion toothpaste for sensitive teeth.