Peter Hibberd, M.D., is a doctor whose advice is based on more than 28 years of hospital outpatient and inpatient experience. He is an experienced emergency medicine physician, surgeon, and consultant. Dr. Hibberd is certified by the American Board of Emergency Medicine. He is also a fellow and active member of the American Academy of Family Physicians, an active member of the American College of Emergency Physicians, and a member and fellow of the American Academy of Emergency Medicine. Dr. Hibberd has earned numerous national and international professional certifications, memberships, and awards.

Silent Acid Reflux

Thursday, 17 September 2009 11:48 AM

Question: As far as I know, I have never had any problems with acid reflux, but my doctor said I had "silent acid reflux" and gave me a prescription. How she can diagnose this if I don’t have any symptoms?

Dr. Hibberd's Answer:

I agree with your question. Any time we are given a medication for "silent symptoms" and "silent disease," I want to see the evidence! So-called silent GERD without supporting information is gibberish, and cannot be used as the basis for any treatment. Recommendations should be based on evidence.

The large majority of patients who have reflux symptoms detected by upper GI endoscopy have symptoms or they would not have undergone an endoscopy in the first place.

While unchecked GERD can be associated with esophageal ulceration, stricture, and symptoms, the vast majority of us may experience reflux from time to time and never need reflux medication. Continued severe reflux of stomach contents (or GERD) with its strong acidity, exposes the sensitive tissue of the esophagus to unprotected changes caused by exposure to acid. We try to minimize them by controlling the reflux through diet, elevation of head of bed (much reflux is nocturnal), medication and—less commonly—surgical options.

We do not place patients on medications unless it is symptomatic or unless we feel the patient is at HIGH risk for stricture formation or if we believe pre-malignant changes or Barrett's esophagus is present. Rarely, some patients are found to have severe esophageal disease that relates to longstanding unrecognized GERD, yet when they are properly questioned, it is discovered they have had symptoms of reflux or reflux related-disease (i.e. wheezing).

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