Silent Acid Reflux: Symptoms, Causes, and Natural Treatment Options

What is Silent Acid Reflux?

Let’s start by understanding GERD (gastroesophageal reflux disease). 

GERD is the frequent or persistent reflux or backflow of acidic stomach contents into the oesophagus (food pipe), leading to damage to the oesophageal lining. It may potentially lead to complications if left untreated.

Silent acid reflux is a form of GERD, which also involves the backflow of gastric contents into the oesophagus but affects your throat (pharynx), voice box (larynx), and the sinuses, apart from the oesophagus.

Unlike typical acid reflux, silent acid reflux or laryngopharyngeal reflux (LPR) causes unusual and subtle symptoms which are harder to identify and often leave those affected to suffer for years without an accurate diagnosis.

Symptoms of Silent Acid Reflux

Silent acid reflux does not cause the symptoms you usually expect from acid reflux, such as heartburn or sour belching. Instead, silent acid reflux causes a variety of other symptoms, many of which affect the throat and respiratory system. 

1. Hoarseness or Voice Changes

Stomach acids can irritate your throat and vocal cords, leading to irritation and inflammation of the affected parts. This results in voice changes, especially when you wake up in the morning.

What to Look For:

• A raspy, weak, or hoarse voice.
• A sensation of a lump in the throat.
• Inability to maintain a steady voice for long.
• A need to clear the throat frequently.

2. Chronic Cough

Have you ever swallowed water the wrong way and had an instant urge to cough? That’s your body’s way of protecting your airways. Similarly, in silent acid reflux, the acidic stomach contents repeatedly rise into your throat and irritate the tissues lining your vocal cords and throat. This persistent irritation triggers cough as a protective mechanism. Over time, this cough becomes chronic. 

What to Look For:

• A cough that is dry and continuous. 
• A cough that is triggered by talking or eating. 
• Cough that is aggravated when lying flat or after eating. 
• Your cough syrup and allergy medications do not help much.

3. Sore Throat

The constant exposure of the delicate tissues of your throat and voice box to the strong stomach acids results in irritation, inflammation, and injury to the lining, causing a sore throat.

What to Look For:

• Frequent throat irritation.
• A raw or burning sensation in the throat.
• Dryness and scratchiness of the throat.
• Difficulty in swallowing.

4. Post-Nasal Drip

When the stomach acids irritate your throat and upper airways, it results in a sensation of mucus dripping down the back of your throat. 

What to Look For:

• A feeling of mucus dripping down the back of your throat.
• You need to clear your throat constantly.
• The feeling of something stuck at the back of your throat.

5. Chronic Respiratory Issues

Silent acid reflux can also affect your lungs, cause breathing difficulties, and even result in asthma-like symptoms, like shortness of breath, coughing, and wheezing.

What to Look For:

• Chronic cough and wheezing, especially at night.
• Symptoms of asthma that do not improve with typical asthma medications.

6. Bad Breath (Halitosis)

With silent acid reflux, stomach acids and undigested food particles can travel back into the throat and mouth, which creates a suitable environment for bacteria to multiply in an oxygen-rich environment. 

What to Look For: 

• Sour taste and persistent bad breath. 
• A metallic taste, especially after meals.

Read more - From Heartburn to Halitosis: Understanding and Treating Acid Reflux and Bad Breath.

Causes of Silent Acid Reflux

What prevents the contents of a water bottle from spilling out when you squeeze it? The tight cap, right? But what if the cap were damaged or loose? You’d definitely expect some leakage.

This is similar to what happens in silent acid reflux. The LES is a ring of muscle located at the lower part of the oesophagus, just above the stomach, that prevents the backflow of stomach contents. However, some factors lead to impairment in this muscle, causing it to weaken or relax at inappropriate times.

As a result, stomach acid travels upwards into your oesophagus, throat, and airways. What causes this? Let us find out.

1. Weak Lower Oesophagal Sphincter (LES)

The lower oesophageal sphincter (LES) relaxes while swallowing food so that it can go into the stomach. If the LES is weak or relaxes at the wrong time, this can allow the stomach contents to flow back into the oesophagus, throat, and airway. 

2. Obesity 

Extra body weight places extra pressure on the stomach and the lower oesophageal sphincter, which may increase the chances of GERD and silent acid reflux.

3. Pregnancy

The hormonal fluctuations associated with pregnancy, in conjunction with the enlarging uterus, will raise intra-abdominal pressure and may cause abnormal relaxation of the LES, thereby producing symptoms of silent acid reflux. 

4. Diet and Lifestyle 

Certain foods and beverages, such as fatty and fried foods, chocolate, citrus fruits, spicy foods, alcohol and caffeine, will all lead to the relaxation of the LES and can thus promote silent acid reflux. Eating too much food at one meal or lying down after eating can exacerbate silent acid reflux.

5. Smoking

Smoking leads to diminished LES pressure, making it weak, increases stomach acid production, and causes cough, which further contributes to silent acid reflux by raising the intra-abdominal pressure.

6. Certain Medications

Certain medications, such as calcium channel blockers, asthma medications, sedatives, antidepressants, and pain relievers (NSAIDs), can cause the LES to relax and lead to silent acid reflux.

Natural Treatment Options for Silent Acid Reflux

In order to relieve symptoms, avoid long-term medicine use, reduce the chances of complications, and improve their quality of life, many patients prefer alternative medicine to manage silent acid reflux.

Here are some natural options that can help you manage the symptoms of silent acid reflux:

1. Change Your Diet 

• Stay away from foods that are irritating to the stomach, such as fried and oily foods, spicy foods, sugary foods, acidic foods or fruits (like citrus), chocolate, and processed foods, as they can increase stomach inflammation and worsen reflux. 
• Eat smaller meals more frequently. Eating an excessively large meal can put significant pressure on the abdomen, which can cause reflux to become worse. 
• Make sure to eat your last meal of the day 2 to 3 hours before you lie down to go to bed at night. This will allow your stomach some time to digest by the time you lie down, so there isn’t as much content to be pushed upward into the oesophagus.

2. Herbal Remedies

These powerful herbs work wonders in soothing your gut. Here’s how they can help you.

Ginger:

• Ginger possesses natural anti-inflammatory properties, which reduce gut inflammation and soothe irritation associated with acid reflux.

Chamomile:

• Chamomile is a gastroprotective herb that helps soothe your digestive tract and reduce inflammation. Drinking a glass of chamomile tea can give relief from a sore throat.

Slippery Elm:

• This herb is used to treat hyperacidity and ulcerative conditions. This herb contains mucilage and forms a protective layer inside your digestive tract, protecting the oesophagus and throat from the potent stomach acids.

Aloe Vera Juice:

• This is a safe and effective option to reduce inflammation of the oesophagus caused by stomach acid. Some people reported that Aloe vera works as well as antacids like ranitidine and omeprazole in managing acid reflux.

3. Lifestyle Adjustments

Lifestyle changes do not necessarily have to be sudden and drastic. Minor adjustments to your every day habits can benefit gut health and might alleviate silent acid reflux symptoms. 

Raise the head side of your bed slightly, as this will help keep the stomach acid from flowing back to the oesophagus while lying down at night. 

Watch your body weight, as excess body weight, in particular around the abdomen, can contribute to an increase in abnormal abdominal pressure. Maintaining a healthy body weight relieves some of the pressure against the stomach, which prevents acid reflux symptoms. 

Avoid clothes that are tight around the waist, which can add extra pressure on the abdomen. Instead, opt for loose-fitting or adjustable clothing to help avoid discomfort related to acid reflux. 

Stop smoking. Smoking contributes to the dysfunction of the lower oesophageal sphincter, allowing for the reverse flow of stomach contents into the oesophagus. Stopping smoking can help decrease the opportunity for acid reflux.

4. Stress Management

Stress is a known factor that contributes to GERD, including silent acid reflux. So, what should be done? Just like diet, lifestyle, and natural remedies, stress management should also be given importance while managing silent acid reflux.

Managing stress by practising yoga, mindfulness, meditation, and breathing exercises can help manage the symptoms associated with silent acid reflux.

5. Apple Cider Vinegar

Isn’t it strange that something that is very acidic, such as apple cider vinegar, is a remedy for acid reflux, which is often thought to be caused by excess stomach acid? It is an unusual remedy! 

Then why do some people experience relief when they consume small and diluted amounts of apple cider vinegar before meals? 

While acid reflux is commonly thought to be caused by excess acid in the stomach, it can also arise from low acid. If you consume food with low stomach acid, the food might not digest properly and stay undigested for longer, triggering reflux. 

In such conditions, apple cider vinegar intake raises the stomach’s acidity level, which aids in food digestion and reduces the occurrence of reflux.

When to See a Doctor

We have already seen that silent acid reflux or laryngopharyngeal reflux (LPR) is a form of GERD that can lead to serious complications if left untreated. Because of its unusual symptoms, silent acid reflux frequently goes undiagnosed and leads to complications like:

• Chronic inflammation of the throat or larynx (voice box).
• Damage to the vocal cords and hoarseness of voice.
• Growths or lesions on the vocal cords
• Laryngeal or oesophageal cancers (in rare cases).
• Respiratory issues like asthma, pneumonia, and sinusitis.
• Infections of the ears, teeth, and gums.

The Bottom Line

Silent acid reflux is not completely silent – it just doesn’t give you the familiar heartburn sensation. Instead, it presents a completely different set of symptoms that target your throat, vocal cords, and respiratory structures. 

Typically, silent acid reflux is less common and remains undiagnosed due to misleading symptoms, often treated along the lines of respiratory problems or throat infections, which offer little to no relief. 

But if you are aware of the symptoms and the reasons, you can work towards the appropriate steps to manage this situation, understand how to lessen discomfort, and restore digestion.