“Silent Reflux” – What It Really Means

The term “silent reflux” is used very frequently today—almost like a trend. However, it often appears more mysterious than it actually is.

In reality, it refers to what is better described as respiratory reflux.

What happens in this condition?

In the stomach, pepsins play a central role. These enzymes are highly active and capable of breaking down proteins — including the body’s own tissues.

If the closure between the stomach and the esophagus does not function properly, these substances can escape and move upward.Unlike gastric acid, pepsins often rise in gaseous form as aerosols.

The esophagus acts like a “chimney,” allowing these substances to pass upward.

They are then carried along with the airflow and distributed wherever air reaches. This is why the term respiratory reflux more accurately describes the condition than “silent reflux.”

Which organs are affected?

• larynx and throat

• oral cavity and tongue

• paranasal sinuses

• bronchi and lungs

In some cases also:

• the middle ear (via the Eustachian tube)

• the eyes (via the tear ducts)

• the skin of the face

Like a thin film, these substances spread over the mucous membranes and trigger inflammatory reactions— around the clock, every day. This continuous strain on the immune system and ongoing cellular repair can lead to chronic fatigue.

The consequences

Depending on the organs involved, symptoms may include:

• chronic cough, shortness of breath, asthma-like symptoms

• hoarseness, frequent throat clearing, voice problems

• blocked sinuses, snoring

• mucus in the throat, unpleasant taste in the mouth

• recurrent inflammation (ENT, bronchi)

• pronounced fatigue

These symptoms are often treated individually—without recognizing the underlying cause.

Patients frequently report years of medical consultations, repeated sinus surgeries, allergy treatments, antibiotic therapies, asthma diagnoses, corticosteroid use, and acid-suppressing medications — usually without lasting success.

What does this mean?

Many symptoms of so-called “silent reflux” are not recognized as reflux. The result is long diagnostic journeys and unnecessary treatments.

In some cases, this process can take many years—until targeted treatment finally resolves the problem.

Conclusion

“Silent reflux” is not silent, but a complex condition with widespread effects.The underlying cause lies in a dysfunctional closure mechanism between the stomach and the esophagus—and this is where treatment must begin.

Yours

Priv.-Doz. Dr. med. Eckhard Löhde