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"I Have NEVER Had Heartburn!"

Posted Sep 22 2008 5:37pm
"I can eat ANYTHING and never have heartburn. How could my problems possibly be caused by reflux of digestive (stomach) contents back into my esophagus? Surely I'd feel some type of digestive complaint (heartburn/indigestion/belching) if I had GERD." I often hear this from a person with extraesophageal reflux (EER). Ten to 15% of ear, nose and throat complaints caused by GERD will never have had indigestion, heartburn or sour acid taste in the mouth. How can this be? Contrary to popular belief, acid reflux occurs routinely (after ordinary meals of our Western style diet) whenever our stomach is full. This happens to MILLIONS of fellow citizens every day with out heartburn. Hence MOST reflux episodes occur without our conscious knowledge. You may still be skeptical, I know I was. Study the literature and the research and you will see that I'm speaking truth and facts. The disagreements come in the details of intrepretation of the events. It is confusing to mistake the occurence of the acid in the esophagus after eating event to be "normal" based on anothers arbitrary definition. For instance, while asleep, if strong night time stomach acid lingers in the esophagus OVER 60 minutes it is considered "abnormal". However if that same event, the dwell time of the strongest acid lasted 55 minutes it is considered "physiologic". Do you begin to get a feeling for the problems we face when we say normal/abnormal? Back to the case at hand; IT IS A FACT THAT ACID/DIGESTIVE JUICE commonly enters the esophagus and the owner of that esophagus never knows it. So much for the idea that you will/must feel GERD. I believe heartburn is the "worst of the worst". The body perhaps only feels the GERD when the acid outstrips the ability to contain the "escaped" acid. This may be why EER presents with little or no gastric issues. The complaints are extremely variable. My experience is that sucessful treatment for the cause of the reflux makes problems remote to the digestive tract resolve. If the GERD is calling for mucus production to protect the esophagus and the mucus producing tissues of the sinuses hear the call, they make copious amounts of mucus just as the esophagus does, in a "preemptive" manner even if the acid hasn't reached them. The Vagus nerve is the conduit of information form the esophagus to the mucus producing tissues. The signal from the esophagus is very intense. Any mucus producing tissues in the distribution of this nerve can (mistakenly) make maximal mucus based on the intensity of the alarm. And you end up with mucus for no apparent reason. The ONLY way to sucessfully normalize the mucus production is remove the stimilus that was causing the situation. In the case of EER or laryngopharyngeal reflux (LPR) treating the esophageal reflux, even though no heartburn is present, can bring very gratifing results.
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