Do I have "silent reflux"?

Dear readers,

In the following I would like to explain some points on the subject of “silent reflux”.

Many of the questions I get are about so-called "silent reflux". Strangely enough, it has almost become "fashionable" and you get the impression that something special and almost mysterious has finally been discovered in medicine. I briefly explain how it all fits together:

“Silent reflux” is actually about what is known as “respiratory reflux”. The scientifically vague nomenclature of the so-called “silent reflux” was created a long time ago when people didn’t yet know exactly how it all fit together. But what is behind it?

Pepsins play a crucial role in chemical digestion in the stomach. Pepsins are aggressive proteases, i.e. enzymes that can attack and break down proteins. But all of our body cells are also made of proteins. Therefore, the activity of these substances in the stomach is controlled by a fine system of nerve impulses and gastrointestinal hormones.

However, if the closure between the stomach and esophagus does not work, these substances escape from the stomach and rise upwards. Pepsins behave somewhat differently than hydrochloric acids. They rise mainly in gaseous form as aerosols. The esophagus serves as a kind of chimney and channels the pepsins upwards. The rise of bile acids, the so-called DGER, i.e. a reflux of bile acids from the duodenum up to the throat, is also increasingly being discussed. Read the blog "Bile Reflux" about this.

All of these substances from the depths flow up through the larynx, then to the throat, the oral mucosa, the tongue and the paranasal sinuses. They are often sucked into the bronchi and lungs when breathing in, causing asthma-like symptoms. They can also reach the middle ear via the so-called "Eustachian tube" or the eyes via the tear ducts. Red eyes, skin irritations on the face and repeated middle ear infections are actually caused by this. Basically, wherever air flows with our breathing, these enzymes can spread and attack our own cells. Therefore, the term "respiratory reflux" describes this complex clinical picture most accurately and has nothing to do with "silent". But the term "silent reflux" has remained in colloquial use from the history of medicine.

The consequences are varied. Each organ affected reacts in its own way: coughing, shortness of breath and asthma-like suffocation attacks are triggered via the bronchi. Laryngitis causes hoarseness, a need to clear the throat and a weak voice. The paranasal sinuses tend to swell overnight. Patients start to snore, which was not the case before. As a result, repeated ENT operations are even carried out on the paranasal sinuses, which are ultimately completely healthy, because the real cause of the symptoms has not been identified.

A whole range of different symptoms can arise, depending on which areas are primarily affected and how sensitive the respective mucous membranes are. In any case, the immune system and cell regeneration are required day and night to relieve this constant inflammation. This takes strength and substance. This is what one patient wrote to me:

"It all started in 2013 and has been going on for years now. I obviously have a lot of atypical symptoms, which is probably why the diagnosis took so long. I mainly suffer from respiratory and sinus symptoms, thick mucus in the throat (rinse at least twice a day), constant clearing of the throat and constant fatigue. However, the typical symptoms such as constant burping, a bad taste in the mouth in the morning when I wake up, etc. are now causing me more and more trouble.

Everything was checked. Visited many lung specialists, cortisone spray etc.! Mild asthma was diagnosed. ENT doctor says CT and then another lung specialist, another ENT doctor starts allergy treatment. Then he operated on my sinuses (even a total operation). No improvement. He says my sinuses including mucous membranes look perfect, but the symptoms are still the same and are severely limiting my quality of life. Heart, neurology, all without or without major findings. My GP prescribed me acid blockers as a test, also in double doses. But all without resounding success. Not much has happened. He says that at least it can't be caused by reflux. I have the feeling it's getting worse. Why am I so sick, so exhausted? I could tell you a lot more! I'm enclosing the results of a manometry and a pH measurement, as well as a recent gastroscopy. Thank you very much!"

This odyssey lasted for 7 years of his life! Now that you have read this blog, you could have certainly saved him from many wrong turns.

Yours

Dr. med. Eckhard Löhde