Silent Reflux (LPR)

Laryngopharyngeal reflux disease, often known as “silent reflux” or LPR, is a disorder in which stomach acid refluxes into the back of the throat, irritating the vocal cords and lungs. LPR is a subtype of gastroesophageal reflux disease (GERD). Despite the fact that classic GERD and LPR are both caused by reflux of stomach contents, the symptoms experienced by patients are drastically different. It is much more difficult to diagnose silent reflux than classic acid reflux.

LPR is frequently referred to as silent reflux because, in many individuals, it is not accompanied by classic acid reflux symptoms such as heartburn, but some patients have both silent reflux and acid reflux symptoms. In contrast, the majority of people with LPR exhibit symptoms such as a sore throat, chronic cough, or globus sensation, which have significant overlap with other diseases like allergies, sinusitis and asthma. As a result, LPR is under diagnosed by some practitioners and over diagnosed by others.

Silent Reflux

Symptoms of Silent Reflux

LPR is common among GERD patients and can manifest with or without other usual GERD symptoms. Most patients with LPR suffer from the following symptoms rather than heartburn:

  • Chronic Cough

  • Clearing of the throat

  • Hoarseness
  • Asthma like shortness of breath
  • Recurrent sinusitis
  • Post nasal drip
  • Globus or lump in the throat sensation
  • Sore throat

How to diagnose LPR

Typically, LPR is suspected when a patient’s vocal cords or airway are irritated during an assessment for throat or lung-related symptoms by an ENT or Pulmonary physician.

At Tampa Bay Reflux Institute, Dr. Grandhige has pioneered a technique for definitively diagnosing those patients with LPR that may benefit from anti-reflux surgery. Using acid and bile testing of the larynx and pharynx, he can specifically assess if there is enough reflux occurring to accurately make the diagnosis of Laryngopharyngeal Reflux. Without this type of pH/acid and bile testing, many patients are diagnosed with LPR and placed on life-long antacid medications. Only if an accurate diagnosis can be made, procedures and surgeries are offered.

In order to comprehensively evaluate patients the following tests may be considered:

  • 24 hour pH/impedance testing
  • 48 hour Bravo pH monitoring
  • Restech Pharyngeal pH testing
  • ENT evaluation and laryngoscopy
  • Allergy evaluation

Treatment Options for Silent Reflux

Since LPR is caused by chronic reflux, LPR treatments are comparable to those used for GERD. Depending on the specifics of each situation after appropriate testing, treatment regimens may involve one or more of the following options:

• Changes in lifestyle to minimize reflux

• Drugs that lower stomach acid

• Surgical treatment to decrease reflux

When testing does not confirm the diagnosis of LPR, medications and alternative therapies such as behavioral modification, hypnosis and acupuncture are discussed to address the undiagnosed symptom. Considerable success is seen with these modalities if no significant reflux is detected.

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