Silent reflux, also known as laryngopharyngeal reflux (LPR), is a condition in which stomach acid flows back up the esophagus (swallowing tube) into the larynx (voice box) and throat.
In adults, silent reflux can scar the throat and voice box. It can also increase risk for cancer in the area, affect the lungs, and may irritate conditions such as asthma, emphysema, or bronchitis.
In silent reflux, the regurgitation only comes into the oesophagus, throat, or mouth, but does not appear as vomit. In reflux and reflux disease, there is vomiting, which can be projectile.
Proton Pump Inhibitors (PPIs) are the most effective medicines for the treatment of LPR.
Causes of Silent Reflux
If the sphincter does not close properly, acidic stomach contents can flow back into the esophagus, up to the throat and larynx. Risk factors for developing LPR include: Alcohol and/or tobacco use. Certain food choices such as fried or spicy foods.
Typical symptoms of LPR include sensation of post nasal drip, frequent throat clearing, hoarseness, issues with swallowing, a sensation of a lump in the throat, dry cough, and mucous in the throat.
Reflux usually starts before a baby is 8 weeks old and gets better by the time they're 1. Symptoms of reflux in babies include: bringing up milk or being sick during or shortly after feeding. coughing or hiccupping when feeding.
Most patients with LPR require some treatment most of the time and some people need medicine all of the time. Some people recover completely for months or years and then may have a relapse.
Medications which contain alginate (such as Gaviscon Advance) are very helpful. Some patients are asked to take this every night before going to bed. It should be the last thing you swallow before going to bed.
Chronic silent reflux can cause complications, such as breathing problems (asthma or bronchitis), long-term irritation, tissue scarring, ulcers, choking episodes, and noisy breathing. Even worse, though uncommonly, it may increase the risk of cancer of the esophagus, the voice box (larynx), the throat, or the lungs.
Silent reflux can be diagnosed using endoscopy. After you are sedated using anesthetics, your physician will insert a long, thin tube with a small camera attached at the end into your mouth, down your throat, and into the esophagus, stomach, and duodenum (first part of the small intestine).
Although most patients show improvement of symptoms within 3 months, the resolution of symptoms and laryngeal findings generally takes 6 months.
Taking over the counter antacid medications and PPI's such as Omeprazole, Gaviscon, Tums and Rennie's provide immediate relief, but they also block the stomach from producing more stomach acid worsening the problem in the long term.
There is some evidence to suggest that stress and anxiety may provoke acid reflux or make the symptoms worse. For instance, a 2018 study involving more than 19,000 people found that those with anxiety were more likely to experience GERD symptoms.
One of the most important is eating a diet that is low in acid. Research has shown that this type of diet often can reduce laryngopharyngeal reflux symptoms. Examples of low-acid foods are melons, green leafy vegetables, celery and bananas.
However, in laryngopharyngeal reflux the stomach acid refluxes through the esophagus and into the back of the throat. This can cause damage to the larynx, vocal chords and lungs. For this reason, silent reflux damages the upper-aero digestive tract while GERD damages only the esophagus.
LPR doesn't cause any symptoms. The contents of your stomach could reflux up your esophagus, into your throat and voice box, and even into your nasal passages, and you might never know it — until more serious symptoms begin to arise from damage caused by stomach acid.
Testing for Silent Reflux or LPR
The barium swallow is an xray test in which you must swallow chalky material that can be seen on the xrays. This test shows how you swallow and it shows if there is a narrowing or other abnormality of the throat or esophagus.
Gastroenterologists commonly use a procedure like an endoscopy or colonoscopy to diagnose conditions that cause symptoms like abdominal pain, bleeding, acid reflux, nausea, vomiting, and diarrhea.
PPIs like esomeprazole (Nexium), lansoprazole (Prevacid), or H2 blockers (antihistamines like Pepcid AC) are often prescribed for silent reflux to reduce stomach acid.
Carbonated Beverages
Soft drinks not only relax the LES but also increase stomach acid levels. This may be due to the caffeine in popular cola products which can affect the LES and trigger acid reflux.
Conclusions: Gaviscon® Advance alone is effective in treating symptoms of LPR, while co-prescription with a high-dose PPI offers no additional benefit.
When mucus starts to build up or trickle down the back of the throat, this is known as postnasal drip. Causes of postnasal drip include infections, allergies, and acid reflux. As well as feeling the need to clear the throat frequently, a person with postnasal drip may also experience: a sore throat.