Silent Reflux: A Hidden Epidemic

Jamie Koufman, MD, F.A.C.S. Founder & Director, Koufman Reflux Director, Voice Institute of New York

Posted on | By Jamie Koufman, MD, F.A.C.S. | Comments ()

To find out if you may have silent reflux, take this simple quiz. Just circle the number for each symptom and add up the numbers.  

The quiz is actually known as the Reflux Symptom Index (RSI), and it is a great first test to see if you have reflux. If your RSI is 15 or more (and you have a zero or one for heartburn), you may have silent reflux; you should see a specialist trained in detecting reflux by examination of both the throat and esophagus. Doctors who only scope the esophagus are missing the boat. Get your printable version of the Reflux Symptom Index. 

Why Is Reflux Sometimes Silent?

What makes silent reflux different than heartburn is that the silent reflux sufferer may be unaware of having it, and his or her doctor may not suspect the diagnosis. A lot of reflux is needed to damage the esophagus, but very little reflux can severely damage the more sensitive throat, sinuses and lungs. Many people with silent reflux have never even once experienced classic heartburn. 

How the term “silent reflux” came to be is instructive. In 1987, Walter Bo, a medical school colleague, was my patient. As a result of nighttime reflux, he had terrible morning hoarseness. This was because he had a habit of eating dinner very late and then falling asleep on the sofa. Hence, he would reflux into his throat all night.

I tried explaining the problem, but Walter repeatedly denied having reflux. As it turned out, Walter affirmed that he thought that heartburn and reflux were the same. When I was able to explain that one could have reflux without heartburn – as in this example, when it occurred during sleep – Walter rolled his eyes and said, “I see. I have the silent kind of reflux.” I declared, “Yes, Walter, that’s it! You have silent reflux!”


Why Doesn’t My Doctor Know About This?

Unfortunately, people with silent reflux symptoms, even if they ask their doctor, are usually incorrectly told they do not have reflux. The medical specialties are broken down by parts of the body, and doctors are experts in, and only test for, those parts of the body in which they specialize. The problem is that reflux does not care where your doctor trained and how it might affect the different medical specialties – the esophagus treated by gastroenterologists, the throat and sinuses treated by ear, nose and throat specialists (otolaryngologists), and the trachea and lungs treated by lung specialists (pulmonologists). 

Jamie Koufman, MD, F.A.C.S.

Article written by Jamie Koufman, MD, F.A.C.S.
Founder & Director, Koufman Reflux Director, Voice Institute of New York