Signs of acid reflux: Is it only heartburn?

By  Dr. Ali Lankarani - Gastroenterologist, Internist, Esophagologist, pancreatologist, Advanced Endoscopist, consultant,


"I was given a few of the Paleo blend to try and I absolutely love this coffee. A great cup of coffee without the acidity. Normally I do not drink a lot of coffee due to getting heartburn, but Doctors’ Choice Coffee does not give me heartburn at all. Try it and see for yourself!" - Jill F. St. Paul, MN

Acid reflux is the most common chronic disorder affecting adults. Heartburn is considered the hallmark of the disease and if a patient is not experiencing heartburn, GERD is usually not considered. In contrast to this general belief, there are several signs and symptoms associated with GERD that could manifest in the absence of heartburn. Each individual can experience a different set of problems as the result of GERD depending on the end organ most damaged by GERD and the amount of reflux.

“Silent GERD” is a term used to describe GERD in individuals who are not complaining of typical heartburn.

In cases where the esophagus is damaged the most, heartburn, belching, regurgitation, chest pain, difficulty or pain with swallowing and sensation of food sticking in the esophagus can be seen. These symptoms are referred to as “esophageal complications of GERD.” Individuals who are encountering problems due to damage of organs other than esophagus are considered to have “extra-esophageal manifestations of GERD.”

In individuals whose throats and sinuses are damaged the most, hoarseness or loss of the voice, sensation of lump or phlegm in throat, need for constant clearing of the throat, chronic sore throat, chronic cough, chronic ear pain, bad breath, post-nasal drip and chronic sinus infection can be seen. In instances where the stomach acid reaches the mouth, inflammation of the gums, dental enamel erosions, cavities and dental decay can be observed. Frequently, severe GERD can affect lungs causing shortness of breath, aspiration, recurrent pneumonias, worsening of asthma, COPED and sleep apnea.

In most instances, individuals affected by GERD suffer from multiple difficulties listed above. Diagnosis of silent GERD requires high index of suspicion and close attention to all of the signs and symptoms mentioned above. Patients with extra-esophageal manifestations of GERD may suffer from their symptoms for many years before getting accurately diagnosed.

The task of the physician is not to treat each of these symptoms separately. An astute physician has to put these pieces together, much like pieces of a puzzle, to unveil GERD as the underlying problem and treat GERD.

If you are suffering from any or combination of problems mentioned above, you need to be evaluated for silent GERD. In the upcoming article, I will discuss how to accurately diagnose GERD. Meanwhile, please continue reach out to me or leave comments on my posts about the topics that you would like to be discussed.


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