Does this sound familiar? You go to the doctor with a chronic sore throat, severe post-nasal drip, or the feeling of a lump in your throat. You’re surprised when the doctor diagnoses you with acid reflux because you rarely (or never) suffer from heartburn.
A story like that is very common with patients who have silent acid reflux, which isn’t typically accompanied by heartburn or chest pain. Now that you have a diagnosis, you may be wondering the best ways to manage your condition.
This article explains the causes and symptoms of silent acid reflux and treatment options to help patients find relief.
What is silent acid reflux?
Acid reflux is when stomach acid travels up into the esophagus and larynx (voice box) and causes discomfort. When acid reflux isn’t accompanied by heartburn or chest pain, it’s called silent acid reflux or atypical reflux.
Symptoms of Silent Acid Reflux
Some common symptoms include:
- The feeling of having a “lump” or something stuck in the throat (globus sensation)
- Pain or discomfort when swallowing
- Post-nasal drip (feeling lots of phlegm in the back of the throat)
- Sore throat
- Constant coughing or clearing the throat
- A sour taste in the back of the mouth
- Bad breath
- Hoarseness
- Asthma (because reflux can make asthma worse)
Causes of Silent Acid Reflux
At the end of your esophagus, there’s a ring of muscle that keeps food and stomach acid from coming back up. In patients with silent reflux, this ring of muscle is weakened and inflamed. When the muscle is weak, it can’t keep acid out of the esophagus, which causes discomfort.
There are many different causes of this muscle weakening, including:
- Genetics. Your family history plays an important part in your risk of experiencing reflux.
- Eating habits. Certain foods (including alcohol and spicy or high-fat foods) can trigger reflux or make symptoms worse, especially if you lay down after eating.
- Hiatal hernias. Hiatal hernias, which occur when part of your stomach pushes through into your chest cavity, can cause reflux. Some hiatal hernias require surgery, but many can be treated through lifestyle changes and medication.
- Sleep apnea. While scientists are still studying the relationship between sleep apnea and reflux, we do know that treating sleep apnea can reduce reflux symptoms in some patients.
- Bacterial infections. H. pylori is a bacteria that can live in the stomach and cause reflux symptoms in some patients. Your doctor can perform tests to check for H. pylori and recommend treatment from there.
- Using tobacco. Smoking or chewing tobacco weakens your esophagus, which leads to reflux. Quitting can help improve your symptoms.
- Pregnancy. Pregnancy can often cause silent reflux symptoms because of hormonal changes and the pressure the baby places on the stomach. These symptoms typically get better after giving birth, but your doctor can recommend short-term treatment options in the meantime.
Treatment Options
It’s possible to successfully manage silent acid reflux and reduce symptoms, though patients often have to try a few different methods to find relief.
Your doctor may recommend a combination of three things: medication, dietary changes, and at-home remedies. If you can’t control symptoms with medication and lifestyle changes, you may be a candidate for surgery.
1. Medication
Reflux medications can help reduce acid production, which then reduces inflammation in your esophagus and voice box.
Depending on your condition, health history, and what other medications you take, your doctor may recommend over-the-counter (OTC) medicine or prescription drugs.
- Proton-pump inhibitors (PPIs). PPIs are a class of drugs that work by blocking acid production in the stomach. They’re the most effective kind of medication for reflux, but they should only be taken under the direction of a doctor. Some common brands of PPI include Prilosec®, Nexium®, and Prevacid®.
- H2 blockers. Like PPIs, H2 blockers are drugs that stop acid production. They provide immediate relief from some mild symptoms and are sometimes recommended instead of taking PPIs long-term. Talk to your doctor before taking H2 blockers.
- Antacids. OTC antacids (like TUMS® or Gaviscon®) can help with immediate relief from heartburn, but they aren’t a solution for frequent discomfort. Don’t take antacids more often than the label recommends.
- Antibiotics. If your reflux is caused by H. pylori bacteria, antibiotics can help. Doctors often prescribe a course of antibiotics in combination with another medication.
Both PPIs and H2 blockers can interfere with other medications because of how they reduce acid production. Talk to your doctor before you stop or start any medication.
2. Dietary Changes
The foods we eat can have a major impact on acid production, which can then trigger symptoms. To combat this, Dr. Cody says gastroenterologists often recommended that patients avoid foods that are very acidic or high in fat, such as:
- Spicy foods
- Tomatoes and tomato sauces
- Citrus fruits (lemons, oranges, pineapples, etc.)
- Caffeine
- Chocolate and mints
- Fried foods
- Full-fat dairy
- Fatty meats (bacon, sausages, etc.)
- Alcohol
For some patients, adjusting what they eat is all it takes to eliminate symptoms. Others may find that they can safely eat foods on this list without experiencing discomfort.
However, if your symptoms don’t go away despite diet changes, talk to your doctor about other options.
3. At-home Lifestyle Changes
There are a few adjustments you can make to your daily and nightly routines to help.
- Eat smaller meals. Eating smaller meals throughout the day (instead of three big meals) can help reduce symptoms.
- Avoid tight-fitting clothes. Tight belts and pants can put too much pressure on your stomach. Wear looser clothing when possible.
- Don’t eat before bedtime. Your last meal should be about 2 hours before you go to bed—and skip the midnight snack, too.
- Don’t exercise after eating. Exercise, especially high-impact activities like running, can aggravate symptoms if you’re working out on a full stomach. Schedule your workouts either before a meal or at least 2 hours after eating.
- Sleep propped up. When you lay down, acid can flow into your esophagus because gravity isn’t keeping it in your stomach. You can try sleeping on a recliner, using a wedge to prop up your head and shoulders, or elevating the head of your bed with blocks or boards.
- Stop smoking. Because tobacco can lead to reflux, stopping smoking can improve your symptoms. If you’re having trouble quitting on your own, talk to your doctor for help.
4. Surgery
Surgery is a last-resort option for patients whose symptoms don’t get better with other treatments. There are a few different surgical options, but the most common is a procedure called Nissen fundoplication, which strengthens the esophagus.
Your GI doctor can help determine if surgery is right for you.
When to See a Doctor About Silent Acid Reflux
If you’ve tried a few at-home solutions (like adjusting your diet and sleeping propped up) and haven’t seen any improvements in your symptoms, it’s time to speak with a gastroenterologist.
You should also talk to a doctor if the discomfort interrupts your sleep or keeps you from doing daily activities.
Additionally, you should seek immediate medical attention if:
- Swallowing is difficult or impossible
- Your heartburn leads to nausea or vomiting
- You’re losing weight unintentionally
- You have chest pain or shortness of breath
