Chronic coughs, rhinitis, postnasal drip or even asthma? Have you ruled out silent reflux? Aka laryngopharyngeal reflux. Patients experiencing silent reflux don’t present with heartburn or any typical GORD features but ultimately suffer from a similar failure of the lower oesophageal sphincter (LOS) – with their complications manifesting higher up, into the upper digestive and respiratory systems. An overlooked and under-recognised condition, medical opinion has fluctuated about its name, prevalence, significance, management…you name it…however there is now a strong body of evidence that says this condition should be diagnosed and investigated as a cause of many of these otherwise unexplained chronic symptom pictures.
Take this case from group mentoring last month:
63yo female in the context of chronic constipation describes an uncanny comorbid relationship between her ‘bad stomach’ (sense of stagnation, delayed emptying likened to gastroparesis) and profound sinus congestion. She reports never having one without the other. The sinus congestion is non-infectious, there is ‘nothing’ when she blows her nose yet there is a marked sense of congestion & irritation. She reports no heartburn, reflux etc.
But could it be silent reflux?
Most commonly, I stumble across this condition in middle aged women with unexplained chronic irritating coughs, the constant ‘tickle in their throat’ or even difficulty with speaking loudly or for long periods without coughing or discomfort. This presentation often leaves many health practitioners lost. No infection. No thyroid enlargement. No CHF. But this is one I’m on the lookout for. Getting confirmation of the diagnosis is not easy or straight forward but I would recommend referral particularly for those older individuals who have suffered this presentation long-term (e.g. years) in order to exclude erosive oesophagitis or worse-still metaplastic changes in the form of Barrett’s oesophagus, though this is unlikely.
This month’s UU30 helps you to better recognise the myriad presentations of silent reflux, understand the latest about why this condition occurs and is increasing & wraps up with my top, somewhat unusual, interventions which have proved highly successful in my own clinic…. and there’s no slippery elm in site LOL…no offence slippery elm 😉
Chronic dry coughs, rhinitis, postnasal drip, the sensation of ‘a lump in their throat’ or even asthma? Have you ruled out silent reflux aka laryngopharyngeal reflux? Download the latest UU30 to get up to speed with this prevalent condition or become a subscriber today and get this installment and another one every month for the year!