Silent reflux, also known as laryngopharyngeal reflux (LPR), is a type of acid reflux that does not cause traditional heartburn symptoms. This silent form of reflux can result in a range of uncomfortable symptoms that often go untreated. In this blog post, we’ll discuss the causes, diagnosis, and treatment options for silent reflux.
What Causes Silent Reflux?
Silent reflux occurs when stomach acid flows back up into the throat and mouth area. This happens because the lower esophageal sphincter (LES) muscle—which usually keeps stomach contents in their place—doesn’t close properly or becomes weakened over time. When the LES doesn’t close properly it allows stomach acid, bile and other digestive enzymes to reach places they shouldn’t. If they remain in the lower esophagus, they cause typical symptoms such as heartburn and regurgitation. If these gastric contents travel further up the esophagus going above the upper esophageal sphincter (UES) muscle into the throat and mouth, it is called LPR. The acid and other enzymes such as pepsin and trypsin then irritate these areas and can cause symptoms like a sore throat, hoarseness, coughing fits, chronic sinus issues, globus (knot in the throat sensation), constant clearing of the throat and even regurgitation of food or liquids.
Diagnosing Silent Reflux
Since the symptoms of silent reflux are not always typical of traditional heartburn, many people and their physicians don’t realize they have it. Since these symptoms overlap with other illnesses such as sinusitis, allergies and asthma, it is common for patients to go misdiagnosed for years. During an exam for silent reflux, your doctor may ask you questions about your symptoms and perform a physical examination to check for signs of inflammation in your throat or vocal cords. Your doctor may also order further testing such as an endoscopy or pH monitoring study to confirm a diagnosis of silent reflux.
Over the past 14 years, Dr. Grandhige has become a leader in the diagnosis of LPR having treated hundreds of patients with silent reflux. He utilizes a specialized catheter called a 24 hour ph/impedance catheter that is specifically placed above and below the UES (upper esophageal sphincter). This is the most accurate way of diagnosis. It is just as important to confirm LPR as it is to refute the diagnosis in order to avoid treating patients with medications or procedures.
Treating Silent Reflux
If you’ve been diagnosed with silent reflux there are steps you can take to reduce your discomfort. Some lifestyle modifications can help alleviate symptoms such as eating smaller meals more frequently throughout the day; quitting smoking; reducing alcohol consumption; avoiding eating late at night; sleeping with your head elevated; drinking plenty of water; managing stress levels; exercising regularly; avoiding wearing tight clothing around your midsection; losing weight if necessary; and avoiding activities that require straining such as heavy lifting or strenuous exercise right after eating meals. You may also need to take medications to reduce stomach acid production. Medications are effective at treating typical symptoms of reflux such as heartburn, but are suboptimal at treating the atypical symptoms of LPR.
When medications and lifestyle modification is inadequate, procedures and surgeries to address the strength of the LES are effective or increase LES pressure so that stomach contents stay where they belong – in the stomach! These include repair of hiatal hernias, the LINX procedure, TIF procedure and fundoplications.
Patients with silent reflux should also be evaluated for complications of reflux such as Barrett’s esophagus or esophageal cancer. Given that they do not have typical symptoms of pain and burning, damage can occur and go unnoticed for years.