I have never had heartburn

The June 2007 issue of Chest reports 57% of "advanced" COPD (chronic obstructive pulmonary disease) patients tested positive for GERD. Only 1/4 of this group of 42 patients had symptoms of heartburn or indigestion. "Few" were on GERD therapy when surveyed for this study.
I would hope this could help lead the way for more scientific study into this under-appreciated relationship. This highlights just how dangerous our brain percieves GERD to be. It suggests to me that our body harms itself due to the protective response generated by the reflux of digestive contents. The protective response is intended to shield the esophagus from the acid exposure but the stimulus is so intense it spills over into the lungs. While the esophagus is sucessfully protected by the command "glands make mucus, muscles squeeze down, blood vessels leak and tissues swell" the lungs are overwhelmed by the same response. What is necessary to protective the esophagus destroys the lung tissue. This is a form of "friendly fire". The protective response in the esophagus is so sucessful that the person is oblivious to the true nature of the problem. This is how treating GERD often improves asthma, sinus problems, cough and shortness of breath.

I'm editing this column to add another tragic, unexpected death. A 24 year old, exceptionally fit, professional football player (Damien Nash) "collapsed in his surburban St. Louis home...Nash had four physicals since 2004 and was in good health." He had just completed a charity basketball game at his old high school.
"This week (1/19/2007) my local Battle Creek newspaper reported the collapse and death of a 19 year old football player at University of South Florida "after working out". A "prep football player in New Jersey dies... as he walked toward the bench but collapsed"
(October 12, 2006). Todays newspaper (October 10, 2006) reveals : "TOLEDO PLAYER DIES AFTER COLLAPSING...during (basketball) conditioning practice". Did you notice that on September 26 a college football player in Texas died unexpectedly? He was 19 years old. A teenage college football player died in Pennsylvania before the first game. At least two high school football players died this year; one in Missouri and another in Kentucky during preseason conditioning drills. This seems like an unusually large number of "healthy" youths to die, mostly in non-contact drills. It makes me suspicious. Apparently none had a history of asthma, etc.
Maybe I'm just more aware BUT I don't recall these type events occuring in the 60's and 70's. What's going on?
In personal discussions with the very top authorities in the world, it is apparent that every person in the U.S.A. has hydrochloric acid in the esophagus after an ordinary meal. They unabashedly call this "physiologic, because we all do it". The same world authorities will admit that undeveloped, non-industrialized countries DO NOT experience this phemenon. It is proven that acid in the esophagus results in a "steal" of blood from the heart's coronary circulation. It has also been documented that 78% of a group of "healthy" heart rythm disorder patients responded favorably to GERD therapy.
It is likely that the rigorous routine of football conditioning and the recurrent bending to assume the "football stance" promotes gastric reflux. I fear the consequence(s) of "silent" regurgitation of gastric contents into the esophagus. Could this chain of events be playing a role in these "unexplained" tragic senarios? (I have since heard the Toledo BB player had a "tear" of his aorta , again a very "unusual" occurance even if not a cardic arrthymia).

The following information was published by the University of Virginia School of Medicine* for physician continuing medical education:

-Symptoms related to GERD represent one of the most common and often confusing health problems seen in primary care

-An association with GERD has been noted in up to 50% of patients with noncardiac chest pain, 78% with chronic hoarseness and 82% with asthma.

-The frequency of GERD has increased in recent years...

-Extraesophageal manifestations of GERD can occur without the typical symptom of heartburn. In this situation, symptoms often do not improve with the dose and duration of...therapy typically given for heartburn. Many physicians don't realize that higher doses and longer duration of therapy are needed.

*Decision Points In Managing GERD: A Self-Assement Program: The Clinical Presentations of GERD. 2003

From an educational course produced by the University of Virginia School of Medicine.

-SYMPTOMS of GERD are COMMON and CONFUSING.
-FREQUENCY of GERD has increased in recent years.
-Conditions associated with GERD: chronic cough, bronchitis, recurrent pneumonia, hiccups, pharyngitis (sore throat), sinusitis, otitis media, globus sensation (lump in the throat feeling)
-GERD is ASSOCIATED with: NONCARDIAC CHEST PAIN 50%
CHRONIC HOARSENESS 78%
ASTHMA 82%
-GERD's NEGATIVE EFFECT on QUALITY of LIFE is GREATER than angina, duodenal ulcer or menopause.
-GERD is the most common cause of NONCARDIAC CHEST PAIN.
-SYMPTOM SEVERITY is NOT a good predictor for esophagitis, NOR does a LACK OF EROSION correlate with a mild symptom complex.

"I can eat ANYTHING and never have heartburn. How could my problems possibly be caused by reflux of digestive (stomach) contents back into my esophagus? Surely I'd feel some type of digestive complaint (heartburn/indigestion/belching) if I had GERD." I often hear this from a person with extraesophageal reflux (EER). Ten to 15% of ear, nose and throat complaints caused by GERD will never have had indigestion, heartburn or sour acid taste in the mouth. How can this be? Contrary to popular belief, acid reflux occurs routinely (after ordinary meals of our Western style diet) whenever our stomach is full. This happens to MILLIONS of fellow citizens every day with out heartburn. Hence MOST reflux episodes occur without our conscious knowledge. You may still be skeptical, I know I was. Study the literature and the research and you will see that I'm speaking truth and facts. The disagreements come in the details of intrepretation of the events. It is confusing to mistake the occurence of the acid in the esophagus after eating event to be "normal" based on anothers arbitrary definition. For instance, while asleep, if strong night time stomach acid lingers in the esophagus OVER 60 minutes it is considered "abnormal". However if that same event, the dwell time of the strongest acid lasted 55 minutes it is considered "physiologic". Do you begin to get a feeling for the problems we face when we say normal/abnormal? Back to the case at hand; IT IS A FACT THAT ACID/DIGESTIVE JUICE commonly enters the esophagus and the owner of that esophagus never knows it. So much for the idea that you will/must feel GERD. I believe heartburn is the "worst of the worst". The body perhaps only feels the GERD when the acid outstrips the ability to contain the "escaped" acid. This may be why EER presents with little or no gastric issues. The complaints are extremely variable. My experience is that sucessful treatment for the cause of the reflux makes problems remote to the digestive tract resolve. If the GERD is calling for mucus production to protect the esophagus and the mucus producing tissues of the sinuses hear the call, they make copious amounts of mucus just as the esophagus does, in a "preemptive" manner even if the acid hasn't reached them. The Vagus nerve is the conduit of information form the esophagus to the mucus producing tissues. The signal from the esophagus is very intense. Any mucus producing tissues in the distribution of this nerve can (mistakenly) make maximal mucus based on the intensity of the alarm. And you end up with mucus for no apparent reason. The ONLY way to sucessfully normalize the mucus production is remove the stimilus that was causing the situation. In the case of EER or laryngopharyngeal reflux (LPR) treating the esophageal reflux, even though no heartburn is present, can bring very gratifing results.