Silent reflux or laryngopharyngeal reflux (LPR)

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What is silent reflux?

Silent reflux, also known as laryngopharyngeal reflux disease (LPR), is a condition similar to acid reflux or gastroesophageal reflux disease (GERD).

In the case of acid reflux, stomach acids flow up into the food pipe and irritate the lining of the esophagus. This causes a burning sensation – called heartburn – around the middle of the chest.

However, silent reflux rarely causes this symptom, which makes it difficult to diagnose, hence the name.

What causes silent reflux?

Just like in the case of acid reflux, the lower esophageal sphincter (LES) is not working properly.

This muscle sits between the stomach and the food pipe. When this muscle is closed, nothing from the stomach can seep back into the food pipe. If the LES becomes relaxed, it opens the way for the stomach acids to start flowing up into the esophagus.

However, there is another sphincter, called the upper esophageal sphincter (UES) or the inferior pharyngeal sphincter, which is located at the lower end of the throat.

This muscle is responsible for closing the way between the throat and the food pipe. So that air cannot enter the food pipe when breathing and the contents of the food pipe cannot back up into the throat.

For people with silent reflux, both the lower and upper esophageal sphincters are not working properly, which allows stomach acids to find their way up into the throat.

Acids can enter into the voice box (larynx), or throat (pharynx), that’s why silent reflux is called laryngopharyngeal reflux disease in the medical lingo.

Sometimes acids can even enter the nasal airways, causing inflammation and excessive production of mucus.

Risk factors for developing silent reflux

This study has found the following risk factors for developing LPR:

Smoking and alcohol also seem to be risk factors. However, this research paper found that symptoms should improve significantly after quitting smoking.

Symptoms of silent reflux

Children and adults usually have different LPR symptoms.

Silent reflux symptoms in children

The most common symptoms are:

  • hoarseness: a chronic cough, sometimes called as “barking cough”
  • asthma
  • apnea
  • difficulty eating
  • difficulty gaining weight

Silent reflux symptoms in adults

The most common symptoms are:

  • hoarsness, coughing after eating
  • phlegm in throat, constant clearing of the throat
  • constant feeling of having something stuck in the throat
  • trouble swallowing
  • postnasal drip or too much mucus in the throat
  • sore throat
  • difficulty breathing
  • bitter taste in the back of the throat

The common symptoms of acid reflux, like chest pain, are not typical in patients with LPR.

Silent reflux can have a significant impact in many different areas of life:

LPR had a negative impact on psychological status, social functioning and quality of life. GERD symptoms appeared to be the main contributor to decrease quality of life. GERD-related LPR patients had a significant impact on the mental component of their quality of life.

(source)

Diagnosis of silent reflux

According to the University of Texas Southwestern Medical Center, these are the usual steps of diagnosing LPR:

  • Physical exam
  • Review of personal medical history
  • Discussion of symptoms

Sometimes no further tests are required to diagnose LPR. However, if the diagnosis is inconclusive, further examinations are required:

  • endoscopic examination
  • pH monitoring
  • swallowing study

Treatment of silent reflux

Lifestyle and dietary changes can go a long way in preventing silent reflux. Reducing stress can also be very effective.

Doctors usually suggest these changes:

  • Avoid reflux trigger foods, like sugar, fat, spicy foods, fried foods, chocolate, etc.
  • No heavy physical activity after eating, however, a short walk might help.
  • Do not lie down shortly after eating. Do not eat for 2-3 hours before going to bed.
  • Try to lose some weight.
  • Quit smoking, reduce your alcohol and coffee consumption.
  • Use a wedge pillow to elevate your upper body while sleeping.

If lifestyle and dietary changes don’t help, your doctor will prescribe medications, e.g. antacids. If all else fails, a surgery might be required.