# Is this "silent reflux"? (And what is "silent reflux"?)



## Peter123 (May 29, 2006)

Hi. The basic question is: does it seem like I might have â€œsilent refluxâ€? Secondarily, do I need an upper endoscopy as the next diagnostic test? Oh, and is there really such a thing as a â€œsilent reflux,â€ in the sense that on this discussion board we see serious GERD with serious symptoms, but no silent reflux (maybe itâ€™s rare?).For eight weeks until 2 weeks ago I was suffering what I will call an Irritable Bowel Syndrome flare-up. (I have had mild IBS for probably 30 years, and am now 50 years of age.)During this time, one of the symptoms I noticed was a moderately raw and foul throat and mouth, worst in the morning. Often it would continue in varying milder degrees all day, and once I recall it got strong again late afternoon. After I wake up I want to go rinse out my mouth with water, because of the raw feeling. At this moment as I write at noon there is just a very small bitter residue in my throat and mouth, though my throat was quite sore this morning and mouth was quite foul this morning.I asked my wife to smell my breath when it was feeling quite foul, and she said it smelled awful. I asked also did it smell acidic, alkaline or bacterial, and she guessed bacterial. There definitely is no food odour.The IBS has calmed down considerably (though not entirely disappeared), I thought the throat and mouth was calming down too but it is definitely still there, and was back to quite raw and foul again this morning.However, I never have heartburn pain.My general practitioner looked at my throat during the IBS flare-up and said it looked a bit irritated, consistent with "silent reflux". He suggested I have an upper endoscopy, since they are putting me asleep anyway on June 9 for my first colonoscopy. When I went back to him recently, he said my throat looked okay this time, but I should still have the upper endoscopy. He doesnâ€™t believe seeing an Ear, Nose, and Throat specialist is worthwhile, for perhaps throat scoping to have a close look at the throat, because he says patients often come back saying the ENT specialist could not say anything except that it might be reflux. When I look at medical books for reflux, I never see upper endoscopy as the first diagnostic step. Also, I wonder that, if my throat is feeling better by the time of the upper endoscopy, there will be nothing to see and it will be a wasted upper endoscopy.Relatedly, is there any need for the upper endoscopy to try to have a peek into my duodenum by passing through that duodenal sphincter, or is a look at the esophogeal sphincter above the stomach enough? (Is peering at the stomach itself also useful in this case?)But mainly, have you heard of "silent reflux" and does this seem like to you?Thanks!!!Peter


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## Guest (May 29, 2006)

Endoscopy is such a easy and comfortable diagnostic, you might as well have it done. It would be the answer to all your questions.Silent reflux is not that silent, if your throat is sore in the morning along with breath and taste issues. I have not had those symptoms to the degree you have mentioned. Char


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## Peter123 (May 29, 2006)

Thanks Char!Also, this morning during a burp after a meal I felt a bit of acid come into my throat (though did not feel it as heartburn at all). This suggested to me that my problem is not acid, cause now I know the sharp feeling of acid on my throat.Can one have reflux that is not acid?On the other hand, the rawness in the throat seems more than simple halitosis, and I don't have frequent runny nose to suggest postnasal drip.Isn't human health a fascinating and challenging subject!


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## Kathleen M. (Nov 16, 1999)

You mean articles like this? http://www.medscape.com/viewarticle/450231Yep sometimes they do the diagnosis just by symptoms alone and do certain drugs make it go away. It can be cheaper to do that.If it has been going on for some time they often do want to check to see if there is any damage down there and be able to monitor the damage to the esophagus (is it better after treatment than before, is it getting worse..that sort of thing). Damage left unchecked can eventually cause serious problems, so they often like to know where you are at in the disease process.K.


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## Peter123 (May 29, 2006)

Kathleen, thanks.The article you recommended is spot on, and basically suggests an upper endoscopy should not be a routine procedure to check for reflux except when alarming symptoms or other special situations (which are not my case, except in my case the physician says "as long as you will be asleep anyway for the colonoscopy, might as well do the upper endoscopy," so it isn't easy to go against their recommendation).I still don't understand how there can be a reflux problem without acid, and except for the occasional burp with acid I don't otherwise feel the sharpness of acid.Also, I read your story of beating IBS, thanks for posting that. I have a sleep problem in the last 8 weeks coincidental with the IBS flare up of waking during the night, whereas before I slept solidly through the night. I don't wake up due to any pain -- I don't know why I wake up early. Was waking during the night your sleep disorder? I understand that early wakening is usually associated with anxiety or depression, which may also be related to IBS.Peter


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## Kathleen M. (Nov 16, 1999)

I wasn't breathing right when I slept so I'd wake up very briefly to get breathing again then fall right back to sleep. I usually didn't wake up enough to know I had awakened. I'd do that all night long (anytime I'd try to drop into REM sleep), not just the typical wake up at 3 or 4 am and can't get back to sleep for an hour or three depression/anxiety thing.


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## Bluelake (Apr 10, 2003)

Hi all,I was diagnosed with LPR reflux in Feb. and it seems a lot like silent reflux - no heartburn either!I was put on Nexium at 40mg 2 x's a day (along with Zelnorm and Miralax for my IBS-C) and it helped some, but now I have to get some more tests done. Has anyone had the "cookie swallow" esophagram test or the Video Flouroscopy test? Don't know if this is all related to IBS since it is mainly difficulty swallowing. Any help/advice would be appreicted - I am 27 and do not want to remain on on all of this medication as I just added another for TMJ! Help!!


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## 15758 (Feb 27, 2006)

Ugh. I have so-called "LPR" reflux too, and I take Protonix 40mg 2Xday PLUS Zantac 150 twice a day. I think mine is actually related to my esophageal spasm, which is chronic 24 hours a day, and I suspect allows tiny bits of stomach juices to creep their way up into the back of my throat. I had sleep apnea, sore throats, horarseness, nasal polyps...all the tell-tale signs of this "silent" reflux. I've never had heartburn either, and it took me forever to find out what I had. Even on all that medication, I still get sore throats, bad breath, and swellings in my neck just under the jawbone. I think even though I'm suppressing all the acid, I can't stop the spasm, so I still get tummy juices coming up into my throat. Ugh. I hate it.


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