GERD: ‘silent refluxers’
Also, studies have shown that asthma, chronic cough, and pulmonary fibrosis may be aggravated or even caused by GERD. No one knows why people get GERD.
These work by forming a ‘raft’ over the stomach contents so that if anything spills back it is less damaging. This treatment is often very effective as the enzymes and bile contained in the stomach juices may cause more damage for many people than the acid. These should be taken four times each day – 10ml after each meal and 20ml at bedtime. Simple antacids without alginate (e.g. Maalox or Rennies) are much less effective and therefore not recommended to treat LPR. If you are already taking medication for other conditions, please consult your doctor before trying over-the-counter reflux medications.
Those problems can indeed be caused psychologically – but they are also a common symptom of silent reflux. Inflammation causes swelling of your mucus membranes. So when you have silent reflux, you can indeed have something like a lump in your throat – a lump of swollen tissue. The swelling won’t be big and round, but enough to give you that feeling. It is very hard for a doctor to tell if a chronic cough is caused by reflux.
Sometimes, a trial of treatment begins with a PPI and skips the H2 antagonist. If treatment relieves the symptoms completely, no further evaluation may be necessary and the effective drug, the H2 antagonist or PPI, is continued. As discussed previously, however, there are potential problems with this commonly used approach, and some physicians would recommend a further evaluation for almost all patients they see.
There are several ways to approach the evaluation and management of GERD. The approach depends primarily on the frequency and severity of symptoms, the adequacy of the response to treatment, and the presence of complications. Transient LES relaxations appear to be the most common way in which acid reflux occurs. Although there is an available drug that prevents relaxations (baclofen), it has side effects that are too frequent to be generally useful. Much attention is being directed at the development of drugs that prevent these relaxations without accompanying side effects.
Other nerves that are stimulated do not produce pain. Instead, they stimulate yet other nerves that provoke coughing.
Response Otolaryngologists and gastroenterologists differ in their definitions and management of LPR. Otolaryngologists treat LPR as a relatively new clinical entity, whereas gastroenterologists treat LPR as a rare extra-esophageal manifestation of gastroesophageal reflux disease (GERD). Gastroenterologists have questioned whether reflux contributes to LPR-related symptoms in patients with no GERD-associated manifestations.
They are available in prescription strength and over the counter. These drugs provide short-term relief, but over-the-counter H2 blockers should not be used for more than a few weeks at a time.
The more of the symptoms listed above that you have over a long time, the higher the chances are that silent reflux is the reason. That is simply because your throat gets stimulated and can cause a vomit reflex. But it can also come from stomach problems which might be the root cause of your reflux. Some people get the feeling of needing to vomit from silent reflux.
Of note, patients needing more than one type of drug for asthma control had a lower rate of asthma exacerbations. Current guidelines, based on data from older studies with significant limitations, recommend considering treatment for reflux disease, even without the classic symptoms, in patients with uncontrolled asthma.
Inflammation of the esophagus from stomach acid causes bleeding or ulcers. In addition, scars from tissue damage can narrow the esophagus and make swallowing difficult. Some people develop Barretts esophagus, where cells in the esophageal lining take on an abnormal shape and color, which over time can lead to cancer.
Proton pump inhibitors are more effective than H2 blockers and can relieve symptoms in almost everyone who has GERD. Foaming agents, such as Gaviscon, work by covering your stomach contents with foam to prevent reflux. These drugs may help those who have no damage to the esophagus.
Silent reflux, or laryngeal-pharyngeal reflux (LPR), is similar, but without the heartburn and indigestion. LPR has the name “silent reflux” due to not necessarily triggering the usual symptoms of acid reflux, such as heartburn. However, silent reflux can lead to hoarseness, frequent throat-clearing, and coughing. Sometimes, non-prescription antacids/alginate preparations (e.g. Gaviscon Advance) are recommended.
Therefore, some patients with GERD will have normal amounts of acid reflux and some patients without GERD will have abnormal amounts of acid reflux. It requires something other than the pH test to confirm the presence of GERD, for example, typical symptoms, response to treatment, or the presence of complications of GERD. GERD also may be confidently diagnosed when episodes of heartburn correlate with acid reflux as shown by acid testing. The usual way that GERD is by its characteristic symptom, heartburn. Heartburn is most frequently described as a sub-sternal (under the middle of the chest) burning that occurs after meals and often worsens when lying down.
Branski R C, Bhattacharyya N, Shapiro J. The reliability of the assessment of endoscopic laryngeal findings associated with laryngopharyngeal reflux disease. 21. Merati A L, Lim H J, Ulualp S O, Toohill R J. Meta-analysis of upper probe measurements in normal subjects and patients with laryngopharyngeal reflux.