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Can I Have Acid Reflux Without Heartburn

Controlling Reflux Without A Ppi:

Can You Have Reflux Without Heartburn? | Dr. Kevin Ghassemi

For other strategies to ease indigestion and control heartburn we are sending you our Guide to Digestive Disorders. DGL is a natural compound derived from licorice that can be helpful against heartburn. Other natural favorites for easing heartburn or reflux include ginger-persimmon tea or apple cider vinegar. Over-the-counter approaches include antacids such as Tums or Maalox, or a half-teaspoon of baking soda in a glass of water.

Other Natural Remedies For Silent Reflux

Once the previous three steps have been implemented, there are a few other options to try if your silent reflux symptoms dont completely resolve.

  • Melatonin may be a surprisingly effective treatment for GERD and LPR. The hormone produced by your body to stimulate sleep may also protect the esophagus from gastric acid and improve strength in the lower esophageal sphincter or LES . Some studies even suggest melatonin may be as effective as a PPI for improving GERD .
  • Sodium Alginate, a supplement derived from brown kelp, acts as a physical barrier between the esophagus and stomach. A systematic review found alginate therapy highly effective for mild GERD .
  • Prokinetic or promotility herbs like the RKT, Iberogast, or STW 5 formulations can help improve colon transit time, allowing your digestion to flow in the correct direction. These herbs may help with heartburn, reflux, and LES function .

Change Your Sleeping Position

Even if you didnt eat for a few hours before you laid down to sleep, you could start feeling heartburn once you lay down immediately.

Why does this happen if your body has already had ample time to digest?

Simply put, the position that you are in when you lay on your back puts extra pressure on the sphincter at the bottom of your esophagus.

This sphincter is the LES, the muscle separating your stomach from your esophagus and is the root of acid reflux disorders.

When the LES is pressed on when you lie down flat, it can cause reflux to occur.

To avoid this, make sure you are elevating your head and shoulders when you sleep and not simply laying flat.

This can easily be done by putting a few pillows behind you.

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Quite Often I Hear My Patients Say That They Dont Understand How I Can Tell Them They Have Acid Reflux Disease Because They Don’t Have A Complaint Of Heartburn In Fact Many Of My Patients Initially Simply Do Not Believe They Have Acid Reflux Disease At All The Symptoms They Do Have When They Come In To See Me Are Some Combination Of Cough Hoarseness Frequent Throat Clearing Excess Phlegm In Their Throat Post Nasal Drip And/or Difficulty Swallowing In Other Words Their Symptoms Are Not About Heartburn Rather They Are About Throat Burn

Quite often I hear my patients say that they dont understand how I can tell them they have acid reflux disease because they don’t have a complaint of heartburn. In fact, many of my patients initially simply do not believe they have acid reflux disease at all. The symptoms they do have when they come in to see me are some combination of cough , hoarseness , frequent throat clearing , excess phlegm in their throat , post nasal drip and/or difficulty swallowing . In other words, their symptoms are not about heartburn, rather they are about “throat burn.”

What is even more confusing to my patients is that these throat symptoms are usually treated with antacid medications that are the same as traditional heartburn medications like Nexium, Prilosec, Prevacid, Aciphex, Protonix, Kapidex or Zegerid. Or another class of antacid medications such as Zantac or Pepcid.

So what’s going on here? Whats going on is that there are 2 related diseases taking place here, GastroEsophageal Reflux Disease and LaryngoPharyngeal Reflux Disease . In both diseases, acid from the stomach is refluxing back up into either the esophagus, attached to the stomach from above, or all the way back into the throat, which sits on top of the esophagus.

How do we treat this acid induced swelling of the throat? The treatment consists of being careful with the intake of 4 of your favorite food groups: caffeine, chocolate, alcohol and mint. In addition, antacid medications are often used as well.

Identifying Gluten And Other Food Sensitivities


While it is possible to test for Celiac disease with a biopsy during an endoscopy, youll need to specifically ask for this test because it is not done automatically. Plus, the biopsy result will not be able to identify gluten sensitivity which is much more common than Celiac disease.

Celiac disease is an autoimmune condition and is much rarer than gluten sensitivity . The treatment for both Celiac disease and gluten sensitivity is to avoid gluten.

If you are wondering whether gluten is an issue for you whether it is an underlying cause of heartburn, bloating, and other digestive symptoms then you can find out in one of two ways:

  • Go on an elimination diet: Avoid gluten for 3 weeks, then add gluten and the other foods back in one by one and note any symptoms that increase as you do so.
  • Do a food sensitivity panel that checks for IgA and IgG antibodies to gluten, gluten-containing grains, and other common food allergens, such as dairy products , and eggs.
  • It is important to know that your standard doctor or allergist will not run an IgA and IgG panel. They only check of IgE reactions, which are immediate responses to foods. While it is important to know whether you have a classic food allergy, that wont tell you whether you also have a delayed food sensitivity.

    There are many food sensitivity panels available, however, I want to make sure you know about the best IgA and IgG panels based on my 20 years of experience.

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    Are There Any Complications From Oesophagitis

    • Scarring and narrowing . If you have severe and long-standing inflammation it can cause a stricture of the lower gullet . This is uncommon.
    • Barretts oesophagus. In this condition the cells that line the lower oesophagus become changed. The changed cells are more prone than usual to becoming cancerous.
    • Cancer. Your risk of developing cancer of the oesophagus is slightly increased compared to the normal risk if you have long-term acid reflux.

    It has to be stressed that most people with reflux do not develop any of these complications. Tell your doctor if you have pain or difficulty when you swallow, which may be the first symptom of a complication.

    What Medications Do I Take To Manage The Symptoms Of Gerd

    Many over-the-counter and prescription medications relieve GERD. Most of OTC drugs come in prescription strength too. Your provider will give you a prescription for these stronger drugs if youre not getting relief from the OTC formulas.

    The most common GERD medications:

    • Antacids include Tums®, Rolaids®, Mylanta®, Riopan® and Maalox®.
    • H-2 receptor blockers include Tagamet®, Pepcid AC®, Axid AR® and Zantac®.
    • Proton pump inhibitors include Prevacid®, Prilosec®, Zegerid®, Nexium®, Protonix®, AcipHex® and Dexilant®.
    • Baclofen is a prescription drug used to reduce the relaxation of the lower esophageal sphincter which allows acid backwash.

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    Behavioral And Other Factors

    As mentioned above, body weight is a significant factor in promoting reflux of stomach acid, and weight reduction is helpful.

    Pregnancy will markedly increase symptoms of heartburn and sometimes throat symptoms as well. This is partly due to the space taken up by the growing infant. One should avoid clothing that fits tightly across the midsection of the body. It is helpful to practice abdominal or diaphragmatic breathing. This means you should concentrate on pushing out the stomach with each breath instead of expanding the chest. Avoid slumping when sitting down. Avoid bending or stooping as much as you can.

    For many people, reflux occurs most often at night and sets up the irritation that continues to bother during the daytime. One of the most important things you can do is to elevate the head of your bed. To do this, use blocks, books or bricks underneath the legs at the head of the bed. The elevation should be 4-6 inches or so, but not high enough that you will slide down when sleeping. Professional singers with acid reflux should consider traveling with blocks in their suitcase for use in hotel rooms.

    The use of multiple pillows to get the head up is not effective because it causes the body to curl unless the pillows are maintained under the shoulders in addition to the head. Wedge-shaped pillows can be helpful in this regard.

    How Gut Health Affects Silent Reflux

    How to fix acid reflux( heartburn) without medication??

    Research shows that your gut health, specifically your microbiome health, may relate to reflux symptoms. One systematic review showed that probiotics seemed to improve the symptoms of GERD, including heartburn, regurgitation, abdominal pain, and gas .

    A meta-analysis also found that H. pylori, a bacterium that can infect the stomach and cause ulcers, is present in about half of LPR patients . However, some research shows that H. pylori can actually protect against developing acid reflux or esophageal cancer .

    We can tentatively suggest that working to reduce H. pylori and any other gut pathogens as well as supporting the beneficial bacteria in the microbiome with probiotic therapy may help improve LPR or silent reflux symptoms.

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    Gerd Symptoms And Risks

    There are several symptoms that could indicate the presence of GERD:

    • Aspiration, when food rises through the esophagus and returns down the trachea
    • Chronic hoarseness or cough
    • Difficulty swallowing
    • Frequent heartburn
    • Live with a connective tissue disorder

    Women who are pregnant can also experience GERD during their pregnancy.

    Lifestyle choices are another risk factor in developing GERD:

    • Eating large meals late at night
    • Excessive drinking of alcohol or coffee
    • Smoking

    Many people with GERD find that certain foods trigger their GERD symptoms, such as fried, fatty or spicy foods. If acid reflux is mild and flares up only in response to specific foods, simple dietary changes may be enough to control your GERD symptoms.

    Diagnosing Lpr And Gerd

    A primary care doctor can often diagnose you with LPR or GERD. Youll have an exam where you will tell a doctor about your symptoms, any home remedies youve tried, and when symptoms most often occur. The doctor will review your medical history and medications to make sure your symptoms arent being caused by something else.

    You dont typically need tests to diagnose LPR and GERD, but a doctor might order them in some cases. Testing is normally done to see if your acid reflux has caused scarring or damage to your esophagus or throat. To check for damage, youll have a test called an endoscopy. During this test, a lighted tube with a camera will be inserted into your throat. The camera will take images the doctor can use in your diagnosis and treatment.

    Another test you might have is called an ambulatory acid probe test. For this test, a monitor will be placed in your esophagus and attached to a computer youll wear. The monitor measures:

    • how often acid comes up into your esophagus
    • how much acid is there
    • how long it stays there

    The monitor for this test can be placed in your throat during your endoscopy.

    You might also need to see a specialist, especially if you do have damage to your throat or esophagus, or if your symptoms are hard to control. You might be referred to a gastroenterologist for GERD. For LPR, you might be referred to an otolaryngologist, commonly known as an ear, nose, and throat doctor.

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    Why Do I Get Heartburn When I Dont Eat

    Sometimes its assumed that you get heartburn is because you have too much acid in your stomach but thats not always the case.

    There are quite a few ways heartburn can happen in the first place. One of the more common ones is when the lower esophageal sphincter or LES for short opens when it shouldnt. If you didnt know the LES is the valve directly above the stomach designed to open when food and liquid is coming down and stay closed otherwise.

    If the LES is open this can sometimes lead to heartburn. The important thing to note here is often when people get heartburn its when they have eaten or drank something that made it worse but sometimes this effect can linger on and continue to give you symptoms even when you havent eaten.

    How Common Is Gerd

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    GERD is very common. The condition and its symptoms touch a huge number of people: 20% of the U.S. population.

    Anyone of any age can develop GERD, but some may be more at risk for it. For example, the chances youll have some form of GERD increase after age 40.

    Youre also more likely to have it if youre:

    • Overweight or obese.
    • Smoking or are regularly exposed to second-hand smoke.
    • Taking certain medications that may cause acid reflux.

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    Treating Lpr And Gerd

    LPR and GERD are very similar conditions. Because they are both caused by acid traveling up the esophagus, they can both be treated in the same way. Your doctor will likely first recommend that you make some lifestyle changes. Theyll talk to you about what you eat and what time of day to eat. This might include limiting spicy foods, foods high in fat, and foods high in acid. They might also suggest you lose weight and avoid caffeine, alcohol, and smoking.

    Other treatments include over-the-counter medications like:

    • Antacids can provide quick relief when youre having heartburn. However, their relief is typically temporary and will not prevent future heartburn or heal significant damage done by acid in your esophagus or larynx.
    • H2 receptor blockers cause your stomach to make less acid and may provide relief. However, they dont provide immediate relief to the heartburn youre already having.
    • Proton pump inhibitors are often more effective than H2 receptor blockers. Like H2 blockers, they also reduce the amount of acid your stomach makes but in a different way. They can also help heal any damage done by acid reflux.

    If OTC medications dont improve your symptoms, your doctor might prescribe stronger versions. They might also prescribe a medication to help strengthen your esophageal sphincter.

    When medications dont help, surgeries might be an option. Surgeries for GERD and LPR can strengthen your esophageal sphincter to help prevent acid reflux.

    Acid Reflux And Headaches

    While there are no studies showing that gastrointestinal disorders can lead to headaches, there are publications that illustrate how gastric problems, in particular acid reflux, can coincide with headaches.

    A study involving 43,782 patients studies the possible prevalence of headaches in patients with gastrointestinal problems. Compared to diarrhea and constipation, patients with acid reflux symptoms report higher prevalence of headaches.

    Another study involving 1,832 migraine patients were tested for heartburn and GERD symptoms. Of the group, 22% reported GERD diagnosis, 11.6% reported heartburn, and another 15.8% reported previously undiagnosed reflux symptoms.

    These studies show that patients with acid reflux problems also tend to experience headaches, although there are no clear reasons why. Although unclear, doctors confirm that treating gastrointestinal problems also alleviates headache symptoms, which is how acid reflux-related headaches are treated.

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    How Is The Diagnosis Of Reflux Laryngitis Made

    1. Patient History

    • A history of symptoms and how the voice fluctuates in relation to eating patterns is key to diagnosing reflux laryngitis.

    2. Symptom Severity scales

    • The laryngologist may use a questionnaire that asks questions about reflux symptoms in order to determine if the patients symptoms are abnormally high, indicating possible reflux.

    3. pH Probe Monitoring

    • In persistent or severe cases of reflux laryngitis, the patient may be asked to undergo a procedure called a pH probe monitoring. During this procedure, the patient wears a monitoring device that captures the backflow of reflux into the throat area. Treatment Role of Medical Treatment First line of treatment for reflux laryngitis involves using medicines that reduce stomach acid secretion. In addition, lifestyle and behavioral modifications, termed reflux precautions, are recommended.

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    How We Can Help With Silent Reflux


    At our functional medicine center, our practitioners have years of experience treating reflux conditions, including LPR, silent reflux, and GERD. If youre dealing with silent reflux symptoms, its important to begin healing now to avoid more serious complications to the voice box, throat, and esophagus down the road.

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    A Few Lifestyle Changes Are Worth Trying Before Resorting To Drugs For Controlling Gastroesophageal Reflux

    If you are sounding a little hoarse and have a sore throat, you may be bracing for a cold or a bout of the flu. But if you’ve had these symptoms for a while, they might be caused not by a virus but by a valveyour lower esophageal sphincter. That’s the muscle that controls the passage between the esophagus and stomach, and when it doesn’t close completely, stomach acid and food flow back into the esophagus. The medical term for this process is gastroesophageal reflux the backward flow of acid is called acid reflux.

    Acid reflux can cause sore throats and hoarseness and may literally leave a bad taste in your mouth. When acid reflux produces chronic symptoms, it is known as gastroesophageal reflux disorder, or GERD. The most common symptom of GERD is heartburnpain in the upper abdomen and chest.

    Three conditionspoor clearance of food or acid from the esophagus, too much acid in the stomach, and delayed stomach emptyingcontribute to acid reflux, says Dr. Jacqueline Wolf, a gastroenterologist and associate professor of medicine at Harvard Medical School and author of A Woman’s Guide to a Healthy Stomach: Taking Control of Your Digestive Health.


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