Quiet reflux

Silent reflux is reflux that you do not feel or feel very little, i. H. Reflux without the acid-associated symptom of heartburn. Quiet reflux is often an incidental finding. It is not uncommon for the ear, nose and throat doctor to see traces of reflux during the larynx examination.

However, all the symptoms of classic reflux are more common, with the exception of acid-associated symptoms such as heartburn. The medical relevance and also the causes are identical to "normal" reflux: Due to a diaphragmatic hernia (= hiatal hernia) and due to a poorly or non-functioning occlusion device between the stomach and esophagus, stomach contents return into the esophagus (= reflux). But why does the heartburn symptom fail? There are a number of different reasons for this:

  • It is about alkaline or gall reflux or mixed reflux
  • What flows back is not so acidic or quantitatively so minimal that the symptom of heartburn is not perceived
  • Due to years of exposure and damage from reflux, the mucous membrane is no longer able to feel the acid.
  • It is not a real reflux from the stomach, but merely a fluid floating in the esophagus, which naturally is not acidic, but causes reflux-like symptoms, but without heartburn, caused by a voiding disorder and /or movement disorder of the esophagus.

The symptoms are similar to those of classic reflux disease:

  • Hoarseness and sore throat
  • Laryngitis
  • Cough
  • Difficulty swallowing
  • Throat clearing
  • Nausea < /li>
  • frequent respiratory infections
  • non-allergic asthma
  • Barrett

The diagnosis is the same as for a classic reflux disease

  • Gastroscopy to clarify a diaphragmatic hernia (= hiatal hernia), GERD, eosinophilic esophagitis, stenoses, Schatzkiring, achalasia
  • Impedance measurement for quantitative determination of reflux and, even more important, for symptom correlation: ie, is the felt and bothersome symptom related or not to reflux. Both statements are essential and decide on further diagnostics and the treatment strategy
  • Manometry to clarify motility disorders (= movement disorders) or emptying disorders of the esophagus to assess the lower esophageal sphincter (LES), i.e. the lower occlusive apparatus between the stomach and esophagus
  • Video cinematography is a functional examination of the esophagus, reveals movement disorders, can depict reflux, shows the position of the LES in relation to the diaphragm and shows possible sliding of the LES

The therapy is also similar to that of classic reflux disease, except that all drugs that inhibit gastric acid production are subjectively of little help, as these are no acid-associated symptoms. As is well known, the reflux itself cannot be stopped or treated with medication, just like with the classic reflux disease. If the examinations carried out are actually a relevant reflux with corresponding inflammation (= GERD), an inhibition of gastric acid production is still useful, especially if it turns out that the reflux is acidic, but is only felt but not felt and /or a there is a clear inflammatory component ..

Life style changes are also in the foreground here. A summary of the recommendations can be downloaded here (PDF) .

Should the lifestyle changes and any drug treatments not lead to the desired goal, in the case of a relevant diaphragmatic hernia, surgical closure of the hernia can effectively and sustainably treat the reflux and prevent or reduce possible secondary diseases associated with reflux Control to be brought. The operation not only treats reflux-associated symptoms effectively and sustainably, but also, in contrast to drug therapy, the reflux itself. The operation is the best prevention of Barrett's, esophageal cancer and diseases that do not affect the esophagus (extra-esophageal manifestation), such as COPD and Oral, nose and throat disorders associated with reflux.