Silent Acid Reflux: Throat Discomfort Without Heartburn

Gastroesophageal reflux disease (GERD)

Doctor, is it possible for acid reflux to cause discomfort only in the throat without any burning sensation in the esophagus? Shouldn't the acid pass through the esophagus before reaching the throat? If that's the case, the esophagus should feel something, but I don't experience any burning in the esophagus or chest.
Instead, I only have bloating and throat discomfort.
I have been experiencing bloating for a year, but it's not stomach pain.
My throat often feels dry and itchy, and I feel like there's something in it, requiring me to drink water frequently to alleviate the discomfort.

P.S.
The symptoms persist 24/7 and are more pronounced after meals.
I have undergone an endoscopy, and the first doctor said I have excessive stomach acid causing reflux, the second doctor mentioned a loose lower esophageal sphincter leading to reflux, and the third doctor noted mild gastritis, suggesting possible functional gastrointestinal disorders.
Generally, they prescribed me PPI medications, but after taking them for a month, I didn't feel any effect or relief from my discomfort, so I stopped taking Western medicine out of fear.
I have since turned to traditional Chinese medicine to adjust my body, but the symptoms continue.

A Xun, 20~29 year old female. Ask Date: 2015/10/02

Dr. Lin Minghui reply Gastroenterology and Hepatology

Hello, the typical symptom of gastroesophageal reflux disease (GERD) is a burning sensation in the chest.
However, some individuals may present with atypical symptoms such as throat discomfort, a sensation of a foreign body, coughing, and asthma.
Atypical symptoms tend to respond poorly to proton pump inhibitors (PPIs), and additional medications may be necessary for treatment.
In addition to pharmacological treatment, it is important to improve dietary and lifestyle habits for GERD management, such as avoiding spicy and irritating foods.
If symptoms persist, further investigation for other causes should be conducted.
Sincerely, Dr.
Ming-Hui Lin, Attending Physician, Department of Gastroenterology, Taoyuan General Hospital, Ministry of Health and Welfare.

Reply Date: 2015/10/02

More Info

Silent acid reflux, also known as laryngopharyngeal reflux (LPR), is a condition where stomach acid flows back into the throat and larynx without the typical symptoms of heartburn. This can indeed cause throat discomfort without the accompanying sensation of burning in the esophagus or chest. The mechanism behind this phenomenon is quite interesting and can be explained through the anatomy and physiology of the upper gastrointestinal tract.

When acid reflux occurs, it typically travels from the stomach up through the esophagus. However, in some cases, the acid can reach the throat and larynx without causing significant irritation to the esophagus itself. This can happen for several reasons:
1. Sensitivity Variability: The esophagus and throat have different sensitivities to acid. Some individuals may have a hypersensitive throat that reacts to even small amounts of acid, while the esophagus may not react as strongly. This can lead to symptoms like throat discomfort, dryness, or a sensation of a lump in the throat (globus sensation) without the burning sensation typically associated with heartburn.

2. Esophageal Motility: The esophagus has a series of muscular contractions that help push food down into the stomach. If there is a dysfunction in these contractions, it may allow acid to linger longer in the esophagus or even reach the throat without causing the typical burning sensation.
3. Acid Exposure Duration: The duration of acid exposure can also play a role. If the acid is present in the throat for a prolonged period, it may cause irritation and discomfort even if it does not cause significant damage to the esophagus.

4. Gastroesophageal Junction Dysfunction: The lower esophageal sphincter (LES) is a muscle that acts as a barrier between the stomach and esophagus. If this muscle is weak or relaxes inappropriately (as in the case of a "loose" LES), it can allow acid to escape into the esophagus and throat. This can happen without the person experiencing the typical heartburn sensation.

Your symptoms of throat discomfort, dryness, and the need to drink water frequently to alleviate discomfort are consistent with LPR. The fact that you have experienced these symptoms for an extended period, along with the findings from multiple doctors, suggests that there may be an underlying issue with acid regulation or esophageal motility.

Regarding the treatment, proton pump inhibitors (PPIs) are commonly prescribed to reduce stomach acid production. However, as you noted, they may not always provide immediate relief, and some individuals may experience side effects or feel apprehensive about long-term use. It is not uncommon for patients to feel frustrated when medications do not yield the expected results.
If you have not found relief with PPIs and are considering alternative treatments, it may be beneficial to explore lifestyle modifications that can help manage your symptoms. These include:
- Dietary Changes: Avoiding trigger foods such as spicy foods, citrus, caffeine, and alcohol can help reduce symptoms. Eating smaller, more frequent meals rather than large meals can also be beneficial.

- Posture: Maintaining an upright posture during and after meals can help prevent reflux. Avoid lying down immediately after eating.

- Weight Management: If applicable, losing weight can reduce pressure on the stomach and lower esophageal sphincter, potentially alleviating symptoms.

- Hydration: Staying well-hydrated can help soothe throat discomfort.

- Stress Management: Stress can exacerbate gastrointestinal symptoms, so incorporating relaxation techniques such as yoga, meditation, or deep breathing exercises may be helpful.

Since you have also sought traditional Chinese medicine, it may be worth discussing with your practitioner how their approach can complement your treatment plan.
In conclusion, it is indeed possible to experience throat discomfort from acid reflux without the sensation of heartburn. If your symptoms persist despite lifestyle changes and alternative treatments, it may be worthwhile to consult with a gastroenterologist who specializes in reflux disorders for further evaluation and management options.

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