Sam Cansfield was sitting at her desk drinking coffee when she suddenly felt a crushing pressure build in her chest.
The feeling surprised fit and healthy Sam, 54, but as the effect was ‘fairly short-lived’ she thought nothing more about it.
But mysteriously it happened again and again over the next two weeks – and Sam developed a tingling sensation in her throat as well as a runny nose, even though she didn’t have a cold.
“It was such a strange feeling and I didn’t know what caused it,” Sam remembers.
She also occasionally felt as if she had a lump in her throat and sometimes even as if she were choking.
After three weeks, Sam, who works in property and lives near Hertford, saw her GP, who sent her for an electrocardiogram as he suspected it was a problem with her heart rhythm.
Sam Cansfield, a fit and healthy 54-year-old, developed a tingling sensation in her throat and also a runny nose, although she did not have a cold
When this became clear, the GP no longer offered tests.
“I was really worried at the time because no one seemed to know what the problem was,” says Sam.
‘But the chest pressure, runny nose and strange crawling feeling in my throat kept getting worse.
‘The symptoms got worse after I ate anything, every time I drank coffee. But it was always there, in some form or another.’
Worried that something was seriously wrong, Sam made an appointment online in November 2020 with a private doctor who identified the problem as a form of reflux, which surprised Sam, “as I didn’t have any typical reflux symptoms,” she says.
There was a reason for that: she didn’t have typical reflux.
Reflux normally occurs when acidic stomach contents leak into the esophagus, typically causing heartburn (a burning sensation in the chest) and nausea – but Sam had what’s known as silent reflux.
It is also called laryngopharyngeal reflux (LPR) and causes symptoms that focus on the throat, nose and chest, such as coughing, sore throat, the need to constantly clear the throat or a feeling of a lump in the throat.
Silent reflux begins – like all reflux – when the valve between the stomach and the bottom of the esophagus (esophagus) weakens, allowing forcible escape of acid and other stomach contents.
Risk factors include being overweight, as this can put pressure on the stomach valve, smoking, having a hernia (where part of the stomach pushes up into the chest) and suffering from stress and anxiety.
Diet can also contribute to reflux because certain foods and drinks, such as coffee, tomatoes, alcohol, chocolate, and fatty or spicy foods, can cause the production of excess stomach acid and relax the valve.
But there may be no obvious reason why it is developing, the NHS said.
It is not entirely clear why some patients experience silent symptoms, while others have a more classic feeling of heartburn.
One theory is that irritants escape from the stomach in a spray, rather than the rush of liquid acid that usually causes heartburn, says Nick Boyle, a consultant upper gastrointestinal surgeon and medical director of the Reflux UK, a specialist private clinic with centers throughout Great Britain.
This spray can travel down the esophagus and reach the throat, larynx, the back of the mouth – and even as far as the sinuses behind the nose, causing a wide range of symptoms, says Mr Boyle.
Some patients develop a hoarse or weak voice because the acid irritates their larynx, or some experience sinus problems, a runny nose, and a bad taste in their mouth.
Because the gastric spray can be inhaled into the lungs, the condition can lead to persistent respiratory infections in some cases.
‘It’s called silent reflux because it isn’t accompanied by heartburn, but I’ve always thought it’s not a good name,’ says Mr Boyle.
‘Many people have these symptoms and it is not silent, they suffer a lot.’
Although one in four people in Britain have some form of reflux, silent reflux is not recorded separately from other forms, according to the charity Gut UK.
However, a British study of almost 380 randomly selected people published in the European Archives of Oto-Rhino-Laryngology in 2012 found that one in three had symptoms of silent reflux.
The problem is that many people with silent reflux, in the absence of heartburn, struggle for years without a diagnosis, says Mr Boyle.
Dr. Rehan Haidry, a gastroenterologist at the private Cleveland Clinic in London, says that about 10 percent of his reflux patients have the silent form and that some of them have been wrongly told they had asthma.
But a prompt diagnosis is important because any form of reflux increases the risk of Barrett’s esophagus, in which the cells lining the lining of the esophagus undergo changes due to constant acid exposure.
And according to Cancer Research UK, up to 13 percent of those with Barrett’s esophagus will develop oesophageal cancer. Therefore, people who have it are monitored for signs of cancer.
Reflux is often diagnosed simply by a doctor taking a history of symptoms, but if the diagnosis is in doubt, some may be referred for a gastroscopy, where a small camera is placed down the throat to check the esophagus and stomach.
If silent reflux is suspected, another test may involve inserting a small capsule into the esophagus (through a small tube called a catheter) and leaving it in place for 24 hours to measure pH levels, which it monitors wirelessly. . A low pH can be a sign of acid.
After the surgery, Sam can eat anything she wants again, and even drink coffee, which once made her symptoms worse
Whatever the form of reflux, the treatment is the same.
It starts with lifestyle changes, such as losing weight if necessary and taking antacids, which neutralize stomach acid to prevent it from irritating the esophageal lining.
Another option is alginates, which come in the form of liquids and tablets and form a protective barrier on top of the stomach contents to prevent them from entering the esophagus.
‘We use a lot of Gaviscon Advance fluid, an alginate, and find it works well for many patients,’ says Mr Boyle.
Patients may also be prescribed medications called proton pump inhibitors (PPIs), which help by reducing the production of stomach acid.
However, these tend to be less effective for silent reflux, because in this case it’s not just the stomach acid that causes the problem – a number of different substances found in the stomach (including bile and pepsin, a stomach enzyme) – contribute to it. .
(These substances are also involved in other forms of reflux, but appear to be especially important in LPR, for reasons that are not yet fully understood.)
‘PPIs only work in about 20 per cent of people with silent reflux,’ says Mr Boyle.
‘And there is a misconception among many doctors that if PPIs do not work, there is no reflux.’
If people with silent reflux don’t improve after six weeks on PPIs, they should be stopped, says Mr Boyle.
He adds that patients are often switched to higher doses or other PPIs. However, these are unlikely to work and may even make the problem worse because the drugs suppress the production of acid, which can lead to an overgrowth of bacteria called small intestinal bacteria. overgrowth (SIBO), which can lead to bloating and belching – and even worsening reflux.
Tests showed that Sam also had an excess production of stomach acid due to triggers such as coffee.
During the surgery it was also discovered that Sam had a hernia which weakened the valve at the top of her stomach; her stomach pushed up into her chest.
After Sam’s diagnosis in November 2020, she tried a PPI and another type of drug that reduces acid production called an H2 blocker, but neither worked.
She cut out tea, coffee and foods high in fat and tried not to eat too close to bedtime and slept sitting up, supported by pillows, to stop the reflux while she slept.
‘My symptoms, including chest pressure and runny nose, persisted despite everything I tried, and I lived on a diet of antacids, swallowing bottles and bottles of Gaviscon,’ she says.
“I drank it for almost months, after everything I ate.”
Risk factors include being overweight, as this can put pressure on the stomach valve, smoking, having a hernia (where part of the stomach pushes up into the chest) and suffering from stress and anxiety.
As the symptoms persisted, Sam decided she needed a different approach.
‘It was just a terrible experience and I wanted it to be resolved properly. So even though it felt like a big step, I decided to go ahead with the surgery.”
This is usually reserved for severe cases that do not respond to other measures.
Usually this takes the form of an operation called fundoplication, which uses keyhole surgery to wrap the top of the stomach around the bottom of the esophagus to tighten the valve and prevent stomach contents from escaping.
Sam had a newer procedure performed privately by Dr. Haidry, called a transoral incisionless fundoplication, which is performed with instruments and a camera inserted down the throat, making it less invasive.
The esophagus is pushed into the top of the stomach and sutured into place. Studies show this creates a new, stronger valve between the stomach and esophagus to prevent acid from flowing back, although there is a small risk of side effects such as difficulty burping and swallowing and bloating.
Other newer options for surgery include using a small band of magnets around the base of the esophagus, just above the stomach, to strengthen the valve.
It took Sam a year to fully recover from the summer 2021 surgery, but the effects were transformative.
“I no longer have any symptoms, I can drink coffee and eat whatever I want,” she says.
‘I don’t worry about falling asleep or waking up due to my symptoms, and I can sleep lying down again, rather than propped up on pillows.
‘It changed my life.’