How to Tell If It’s Heartburn, GERD or Silent Reflux

If you’re one of those multiple-coffees-a-day people, well, we feel you. But chances are your beloved hot bean juice has occasionally brought on a case of heartburn since coffee is a common trigger.

If you don’t know what heartburn, aka acid reflux, feels like, consider yourself one of the lucky ones. The sensation is akin to your throat and upper chest being on fire — and when you swallow, you’re never sure if it’s going to go down or come back up. 

Most people will get reflux once in a while. But what if you’re starting to experience reflux more often? And what if you don’t have heartburn but you’re having trouble swallowing or have a cough — could those things be related to reflux?  

Is acid reflux the same thing as GERD? 

Not all refluxes are created equal. Sometimes heartburn is a mild annoyance that requires only some antacids and patience, but other times it can be a serious problem that needs more robust treatment to prevent complications.  

Acid reflux 

Gastroesophageal reflux, aka acid reflux, usually happens when your lower esophageal sphincter connecting your stomach to your esophagus opens more than it should.  

“After you eat a meal, this valve can open too often and for too long of a duration, allowing gastric contents to enter the esophagus,” says Dr. Richard Tobin, a gastroenterologist at UW Medical Center.

Other reflux causes include gastroparesis, poor esophageal motility, hiatal hernia, and gastric or esophageal surgery.  

Heartburn is the most obvious symptom of acid reflux, which feels like a burning pain in the chest or up the throat. You may also have the sensation of a lump in your throat, a bad taste in your mouth, or regurgitation, which is the sensation of food coming back up your throat.  

Eating extra spicy food or a large meal or eating before bed can trigger a case of reflux.  

GERD 

Gastroesophageal reflux disease (GERD) is a chronic form of acid reflux characterized by reflux episodes that occur twice a week or more.  

As Tobin describes it, everyone gets reflux from time to time but not everyone has frequent symptoms that indicate disease.  

Untreated GERD can also lead to someone developing what Tobin refers to as “alarm” symptoms, meaning they are serious and you should see a doctor right away: trouble swallowing, significant chest pain, iron deficiency anemia, unexplained weight loss, recurrent vomiting, or significant breathing or throat issues thought to be related to GERD. 

“If there are alarm symptoms, someone should have further evaluation. The best initial test is an upper endoscopy. However, other tests, including X-rays (such as a barium swallow), esophageal manometry and ambulatory ph/impedance tests, can sometimes be helpful,” Tobin says.

Doctors can check for these things by using an endoscope, a small device that allows them to see into narrow areas like the throat. Severe GERD, if left untreated, can increase the risk for esophageal cancer. 

Laryngopharyngeal or “silent” reflux 

Unlike typical heartburn and GERD, laryngopharyngeal reflux  — LPR for short, because the full name is a mouthful — is caused by leaky esophageal sphincters, both the lower one connecting your esophagus to your stomach (like with GERD) and the upper one connecting your esophagus to your throat. The sphincters don’t work properly and allow acid to travel all the way up to your throat.

Sometimes LPR is called “silent” reflux because people may not have typical GERD symptoms like heartburn and may not realize they’re dealing with reflux.  

“I don’t personally like the term silent reflux. It isn’t silent; people still have symptoms,” Tobin says.  

Those symptoms can include a chronic cough, a hoarse voice, a sore throat or feeling like there’s a lump in your throat, swallowing difficulties, postnasal drip and even breathing issues. 

What triggers reflux? 

Some causes of reflux are things you have a certain amount of control over — and some aren’t. Here are a few common causes:  

• Eating foods that are acidic (like citrus fruits), fried, fatty or spicy 
• Being obese 
• Overeating or eating right before bed 
• Drinking alcohol or caffeine  
• Smoking 
• Using NSAID pain medications like ibuprofen or aspirin  
• Pregnancy 

How is reflux treated? 

Treatment options for reflux, whether it’s simple acid reflux, GERD or LPR, vary from things you can do like making changes in your lifestyle to things a doctor can help you with like medications or a surgical procedure.  

You may or may not be a candidate for some of these treatments — especially the surgical options — depending on your medical situation, such as if you have a hiatal hernia. 

“Most people who have reflux don’t need an evaluation, we just treat them,” Tobin says. “If patients have alarm systems, then I will do testing like an endoscopy or a barium swallow test, plus there are second-line tests available if someone isn’t responding to treatment.”

Lifestyle changes to minimize reflux 

If you have milder reflux symptoms or GERD, making a few key lifestyle changes can make a big difference and possibly reduce or get rid of your need for additional treatment:  

• Raise the head of your bed so your head is elevated during sleep  
• Avoid eating within an hour or two of bedtime 
• Minimize eating foods that are acidic, spicy or fatty  
• Avoid or limit caffeine and alcohol and quit smoking 
• Eat several small meals a day instead of large meals 
• For some people, losing weight may help (talk with your doctor about this) 

Medications to treat reflux symptoms 

Antacids like Tums can treat reflux symptoms but won’t fix the problem. Histamine H2 antagonists, aka H2 blockers like Pepcid AC, will treat symptoms and may help heal your esophagus if it has been damaged slightly by acid. For more severe cases of reflux, you can try a proton pump inhibitor like Prilosec, which can reduce symptoms and help your esophagus heal.  

Note, however, that none of these medications will fix GERD entirely, Tobin says.  

Antacids neutralize stomach acid whereas H2 blockers and proton pump inhibitors reduce how much acid your stomach produces (while still ensuring it produces enough for digestion). 

All of these medications are available over the counter, but there are some prescription medications available too that you can ask your doctor about if the stuff you try isn’t working.  

Surgery to fix reflux issues 

In cases of severe reflux, there are several types of surgical procedures that will help treat and prevent reflux. The most common method involves the surgeon wrapping the top portion of the stomach around the lower esophagus thus bolstering the lower esophageal sphincter, Tobin says.  

Whether you just started experiencing reflux more often or have had it for a while and nothing you try is helping get rid of it, it’s important to talk with your doctor about your symptoms to figure out what treatment to try next. Reflux is no fun — and you don’t have to put up with it.