Atypical symptoms of gastric reflux

In addition to the classic symptoms concerning the digestive system, acid reflux can also occur with disorders of a non-gastroenterological nature. Here they are.

The characteristic disorders of gastroesophageal reflux concern the digestive system, but there are also discomforts that go beyond the boundaries of the stomach and esophagus and can be a symptom of this problem

Gastric reflux: what we are talking about

It is known, gastroesophageal reflux is due to the ascent in the stomach of gastric contents. It is not surprising, therefore, that the typical symptoms of this disorder concern the digestive system.

But, next to the regurgitation and burning sensation in the mouth of the stomach, other disorders of a non-gastroenterological nature may appear and which, for this reason, are called “atypical symptoms” of reflux.

Indeed, sometimes the typical symptoms are missing and the disorder can only be diagnosed based on this sort of side effects.

The atypical symptoms mostly concern the respiratory system, but there are also discomforts pertaining to ENT.

Sometimes, then, the burning sensation in the chest caused by reflux is so intense that it is confused with angina pectoris and is classified by doctors as “non-cardiac chest pain”.

A reflux not only esophageal

The most common atypical symptoms of reflux therefore include ENT (ear, nose or throat), lung or heart problems.

Precisely because often the gastric contents also invade body districts other than the esophagus, we can speak of gastro-pharyngeal reflux (with the involvement of the throat) and gastro-pharyngo-laryngeal (in which the vocal cords are also involved).

Symptoms may be:

  • pharyngitis (sore throat)
  • nasopharyngitis
  • snoring
  • Laryngitis
  • hoarseness
  • gingivitis
  • abundant salivation
  • halitosis and caries
  • non-cardiac chest pain.

Sometimes it is also possible that reflux is associated with:

  • dysphagia (difficulty swallowing)
  • Odinophagia (pain when swallowing)

Reflux: respiratory symptoms

asthma … …

But the most easily detectable signs are those affecting the respiratory tract, such as bronchial asthma, which can be a symptom of reflux especially if there is no production of phlegm.

Currently, the mechanism of asthmatic crises has not yet been clarified. There are two theories about it:

“Reflux” Theory Asthmatic crises are due to the passage of gastric contents into the bronchi
“Reflex” theory Asthmatic attacks are caused by a reflex triggered by acidic material in the lower part of the esophagus

It is probable that both mechanisms contribute to the generation of asthma.

… and other respiratory symptoms

Reflux can also cause:

  • Laryngospasm and aspiration pneumonia, so called because they are due to actual aspiration of gastric contents into the lungs.
  • increased production of phlegm
  • (which can even cause blood to spit out)
  • sensation of lump in the throat (so-called hypopharyngeal bolus)
  • sinusitis
  • recurrent bronchitis and bronchopneumonia.

Atypical symptoms during pregnancy

The atypical symptoms of gastroesophageal reflux are also very common during pregnancy.

In general, women who find themselves suffering from it during pregnancy manifested the same problems even before becoming pregnant, and usually during the first trimester the atypical symptoms are associated with the presence of typical symptoms of reflux, such as heartburn .

Problems that increase in pregnancy include non-cardiac chest pain, difficulty swallowing, a feeling of a lump in the throat, a scratchy cough, belching, and hiccups.

Both the hormonal changes typical of pregnancy and the pressure exerted by the baby on the stomach can be at the root of acid reflux.

Beware of long-term damage

In some cases, gastroesophageal reflux can cause erosions, ulcers or a narrowing of the inner diameter of the esophagus (stenosis).

Just as stomach contents moving up into the esophagus can cause serious long-term injury, their passage to other organs can also have serious consequences.

A typical example is what can happen to the vocal cords: repeated episodes of reflux can damage them and predispose them to the formation of granulomas, non-tumor masses of inflammatory origin. Other consequences can be chronic laryngitis, polyps and carcinomas.

A diagnosis at three hundred and sixty degrees

The immediate consequence of such a varied symptomatology means that the diagnosis of reflux may require the opinion of various specialists, in order to implement the most suitable therapy for solving the problem.

On the other hand, specialists such as cardiologists, pulmonologists and allergists must be ready to consider a diagnosis of gastroesophageal reflux when they have ruled out the presence of the pathologies of their competence associated with the atypical symptoms found in the patient.

To arrive at the diagnosis of reflux it may be necessary to combine the observation of clinical symptoms with other analyzes.

Gastroscopy is often not helpful; in fact, only in a few cases are the atypical symptoms associated with the anomalies typically found in the case of esophagitis (inflammation of the esophagus, which in addition to infections can also be caused by excessive exposure to gastric juices).

Not only that, even in the case of typical symptoms, such as difficulty swallowing, alterations of the esophagus are present only in a minority of cases.

For this reason, the diagnostic procedure generally does not include the execution of a gastroscopy; instead, the use of this investigation is more frequent when one wants to analyze the appearance of complications or for the so-called differential diagnosis, i.e. to distinguish gastroesophageal reflux from pathologies that have symptoms that partially overlap with those of reflux.

Among other tests that may be useful in diagnosing gastroesophageal reflux, measuring the pH of the esophagus can help confirm the presence of reflux if atypical symptoms persist.

Furthermore, in the presence of atypical symptoms, the analysis of the levels of the hormone gastrin 17 (G-17), or gastrinemia, also seems particularly promising.

Gastrin 17 is involved in the control of gastric acid secretion, which is stimulated by its action; in turn, Gastric Acidity Inhibits Gastrin Production.

Gastrin values below 1.9 pmol/L could be an indication of gastroesophageal reflux.

Anti-reflux remedies: only after diagnosis

In the presence of typical symptoms, the disappearance of discomfort with the use of remedies that counteract stomach acidity is an indication of their association with gastroesophageal reflux.
In the case of atypical symptoms, on the other hand, it is not advisable to start a treatment directed against a hypothetical gastroesophageal reflux without first having ascertained the diagnosis. It is also important to remember that reflux is treated first of all with an adequate lifestyle.
For tobacco users it is essential to stop smoking, because smoking promotes the ascent of gastric contents through the lower esophageal sphincter (the valve that separates the esophagus from the stomach and which is normally located at the same height as the diaphragm). In smokers the efficiency of this valve is itself reduced; moreover, every time a cigarette is lit, the frequency of acid reflux episodes increases.
Most of these episodes are associated with coughing or deep inspirations which, by increasing intra-abdominal pressure, overload an already weak sphincter.
Some drugs (such as nonsteroidal anti-inflammatories, progestins, bisphosphonates, blood pressure or heart drugs, and drugs that reduce saliva production, such as antihistamines) Can also weaken the lower esophageal sphincter; their intake can therefore be included among the risk factors for reflux.
Proper sleep hygiene can be helpful in preventing this problem from turning into a cause of insomnia. Anyone who has to deal with the typical symptoms of reflux knows this well: heartburn, for example, can significantly increase when you go to bed.
Other less typical complaints, such as a chronic cough, can also increase while sleeping or trying to fall asleep. If when you are lying down the food in the stomach goes up into the digestive tract only as far as the esophagus, the symptom you will have to deal with will be burning in the abdomen, but if the acidic material goes back up into the throat you will wake up coughing and feeling of being choked on vomit or acid regurgitation.
To minimize the problem, it may be useful to avoid going to bed immediately after eating (better to wait 3-4 hours) and to raise the part of the bed on which the head rests, for example by using extra pillows.
Finally, it is important to avoid being overweight (which can be associated with a lower seal of the lower esophageal sphincter) and to follow some dietary precautions.
Some foods can relax the lower esophageal sphincter; their list includes:
For this reason it is advisable to avoid them, just as it is advisable to limit the consumption of acidic foods (such as citrus fruits and tomatoes) which, in the event of gastric contents rising, can aggravate the irritation of the esophageal mucosa and of the other tissues reached.
Among drinks it is better to avoid alcohol, which weakens the lower esophageal sphincter, and carbonated drinks, because by promoting belching they force the opening of the sphincter and therefore facilitate reflux.

Surgery: a solution for complicated cases

In most cases, reflux can be kept under control thanks to an appropriate lifestyle and, if necessary, the intake of medicines (for example proton pump inhibitors).
However, there are progressive forms that can lead to even serious complications, such as the so-called Barrett’s esophagus. In these cases, as well as in the presence of a hiatal hernia, surgical treatment may be indicated.
An accurate diagnosis will allow to identify the most suitable strategy for the single case.
Joycelyn Elders, MD

Joycelyn Elders is the author and creator of EmpowerEssence, a health and wellness blog. Elders is a respected public health advocate and pediatrician dedicated to promoting general health and well-being.

The blog covers a wide range of topics related to health and wellness, with articles organized into several categories.

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