The Silent Reflux Epidemic

It’s pernicious!

And you probably have it, because 125 million people do. Half don’t even know they have it, and their doctors don’t know it either. Millions of Americans have undiagnosed and untreated acid reflux, sometimes for years or even life-long. How could this be? Because too-specialized medical specialists can’t see the reflux forest for the trees; because many millions have “silent reflux”; and because the role of one particular food additive, ACID. Indeed, acid in food has been overlooked as a cause of massively widespread and uncontrolled airway reflux. The latter, airway reflux, is a term for stomach juice backflow into the breathing passages, including the ears, nose, throat, and lungs.

Reflux is increasing so rapidly that one wonders if we all will have it soon. Since the 1970’s, prevalence of reflux has increased an average of 4% per year. Reflux is now epidemic, affecting 40% of the American population. Twenty-two percent have GERD (gastroesophageal reflux disease) with heartburn and indigestion, and another 18% have silent reflux, also called LPR or laryngopharyngeal reflux.

A frightening implication of this increase is that millions of Americans may be at risk for the development of reflux-related cancer. That’s right—reflux causes cancer! During this same period of time, the prevalence of esophageal cancer has increased 850% and now is the fastest growing cancer in the U.S. In addition, as many as 10% of people with reflux symptoms have Barrett’s esophagus, a reflux-caused, pre-cancerous condition.

So why do we have a reflux epidemic? ACID! It now seems likely that the primary cause of this reflux/cancer epidemic can be traced to acidification of foods/beverages, which until now has been virtually ignored as a problem. In 1973, following an outbreak of food poisoning, Congress enacted Title 21 and charged the FDA (Food and Drug Administration) with providing “Good Manufacturing Practices” to insure that bottled and canned foods and beverages crossing state lines would not be contaminated by bacteria. Thus, for two generations, almost everything bottled and canned has had acid added to discourage bacterial growth and prolong shelf-life. After all this time, it appears that the most dangerous food additive of all may have been simply overlooked.

Recognizing and understanding “silent reflux” is crucial. The symptoms of reflux are not just digestive—like indigestion and heartburn (chest pain after eating)—they also include hoarseness, chronic cough, post-nasal drip, a lump-in-the-throat sensation, difficulty swallowing, choking episodes, shortness of breath, sinusitis, and asthma. If you have any of those symptoms, you probably have silent reflux. The term “silent” is derived from the observation that the reflux (backflow from the stomach) can easily be overlooked if it occurs at night while people are asleep or during the day in small amounts with no heartburn. It just may go unnoticed.

Remember, if you have unexplained or mysterious throat, breathing, airway, or digestive symptoms, think of silent reflux. The dots are now connected: The reflux and esophageal cancer epidemics are related to too much acid in our foods and beverages. BTW, the average 12-29-year-old in the United States consumed 160 gallons of soft drinks last year; that’s almost a half-gallon a day! We must have a national dialog about not only reflux and unhealthy eating but about food additives, especially ACID, and also about how we preserve food.

If you have reflux, you personally must become active, because this must be a grass roots movement. It is the role of government to protect its people; and we the people have gotten reflux and cancer from the unintended consequences of acid in our food. I believe that the end game is clear. If we insist on having FDA-mandated acidity (pH) on all food and beverage labels, the American people will solve the reflux/cancer problem for themselves.

Nov. 8, 2011 New York Times Articles by Tara Parker-Pope: Tired of the Burn? Low-Acid Diet May Help and A Heartburn-Free Thanksgiving

The figure at the top of this post is a biopsy of Barrett’s esophagus, the reflux-related, precancer. This specimen is stained in a special way, using IHC (immunohistochemistry) for human pepsin. This photo shows that pepsin is produced in Barrett’s. The implications of this have a bearing on the potential importance of long-term low-acid diet in people with Barrett’s.  In other words, dietary acid can activate the pepsin. Indeed, although only anecdotal at this point, the author has seen the regression of Barrett’s in some of her patients on a long-term low-acid diet. This is an exciting new conceptual breakthrough!

3 comments to The Silent Reflux Epidemic

  • Hello Dr Koufman.My name is Muraya ,I live in Kenya(Africa). Its a testament to the genius of the internet that I was able to read of your great research far away from the US. I would like to know your opinion on fundoplication as a tool to deal with gerd and lpr.Especially where a patient is young and faces a lifetime of ppi’s and all sorts of antiacids, and the effects,longterm of ppi use.

  • Jamie A. Koufman, M.D., F.A.C.S.

    Fundoplication is an excellent treatment. I had one in the 1990s by Dr. John Hunter. It has held up well ever since. The fundoplication surgery should be a complete 360-degree wrap for people with LPR (airway reflux), and contraray to the GI literature, it is most indicated when the antireflux meds don’t work, particularly in chronic cough and those patients with severe lung disease. Reflux has been shown to be the most common cause of failutre after lung transplatation (not organ rejection).

    Here at the Voice Institute of New York, we get reflux testing–ambulatory, 24-hour, double-probe (simultaneous pharyngeal and esophageal) pH monitoring (looking at several pH thresholds)–with the patient on medication to evaluatte drug efficasy before we recommend antireflux surgery. Unfortunately, GI docs have no test for airway reflux; and thus, have no way of knowing when a patient is failing medical treatment. Those are the ones who need surgery most. BTW, I recommend surgery to about 10% of my patients.

  • Carole

    I have been sick for about a year now and have seen several doctors including some in the emergency room. My symptoms are always shortness of breath, mucus, constricted airway, cough. I have had numerous tests, scans, and x-rays. I had surgery in December for a deviated septum and sinusitis. I had hoped that was the cure but last week my symptoms came back. I saw my ENT who perscribed Asmanex, Nasonex, and Atrovent. I them went to my Pulmonary doctor who said it was bronchitis and he said to stay on meds perscribed by ENT except for Atrovent and to use my Albuterol Nebulizer only when necessary as a rescue. I have been doing my own research the last few days and am convinced that what I have is Silent Reflux. Now I wonder if some of these meds are worsening my condition. I plan to visit my ENT with this query asap and in the meantime am watching what I eat and taking an over the counter acid reducer. BTY, my back is killing me from coughing. Thanks for your info.