No Heartburn? You Could Still Have GERD

Your throat is sore and you've started coughing like a smoker — except, you've never touched a cigarette. Your X-rays rule out bronchitis. Now, even though you've never had a hint of heartburn, your doctor suggests that the root of the problem could be a condition labeled atypical gastroesophageal reflux disease, or GERD

Increasingly, experts are learning that GERD can wreak havoc without the usual telltale heartburn. "All of a sudden doctors are realizing that there are other manifestations of reflux," says Dr. David C. Metz, a professor of medicine in the division of gastroenterology at the University of Pennsylvania Health System in Philadelphia. "Interest in these manifestations has exploded."

Acid refluxing up into the larynx — the upper end of the windpipe that contains the vocal cords — can cause a cough, laryngitis or even cancer of the larynx. "When a patient comes in with cancer of the larynx and the person is a non-smoker, you think of GERD," Metz says.

Acid that squirts up into the bronchial tubes can lead to asthma. Some studies have indicated that as many as 70 percent of adult onset asthma cases can be traced back to reflux, says Dr. Bennett Roth, a professor of medicine and chief of clinical gastroenterology at the David Geffen School of Medicine at the University of California at Los Angeles.

GERD and chest pain
Acid in the esophagus can lead to chest pain that mimics the signs of heart problems.

In fact, each year 400,000 people who go to the doctor for chest pain are told that their symptoms have nothing to do with their hearts, Metz says. As many as two-thirds of these people will ultimately be diagnosed as having pain caused by GERD.

Doctors aren't sure how reflux causes chest pain. It may be that the nerves in the chest are stimulated when the esophagus spasms and this is interpreted by the body as pain, Roth says.

Ultimately, doctors determine whether acid reflux is sparking chest pain by treating the GERD and then waiting to see if the symptoms go away.

"We often do a trial with high doses of a proton pump inhibitor," Roth says. "That way we know if we don't get a good response it's not because we undermedicated the patient."

Roth says he often treats patients with PPIs for as long as four weeks because some have chest pain irregularly. "It can take that long to see if the drugs are making a difference," he adds.

Clearing the throat
When acid spurts up into the larynx, a host of unpleasant symptoms can result, Metz says.

"People tend to be chronically clearing their throats," he adds. "They feel like there's a lump in the back of their throats all the time, even when they're not swallowing something. Hoarseness is the most common presentation."

Some patients complain of a sore throat that just won't clear up, Roth says. These days many are diagnosed as having GERD by an ear, nose and throat specialist.

"For years nobody could figure out what was wrong with these patients," Roth says. "Now we're learning that a significant number have reflux."

As with heart problems, GERD-related laryngeal symptoms are diagnosed by a trial of therapy, Metz says.

One big unanswered question is why people have chest pain or larynx problems and no heartburn.

"We don't know why some patients get heartburn predominantly and others have other symptoms," Metz says. "Interestingly there's very little overlap between the groups."

Republished with permission from MSNBC.com