What is silent reflux?

Silent Reflux or LPR is a condition where the acid in the stomach goes back up the esophagus and into the throat and larynx. The signs of silent reflux include cough, sore throat, hoarseness, and other signs.
Silent Reflux or LPR is a condition where the acid in the stomach goes back up the esophagus and into the throat and larynx. The signs of silent reflux include cough, sore throat, hoarseness, and other signs.

Silent Reflux, also called Laryngopharyngeal reflux (LPR), is a very common medical condition. Silent reflux signs include soreness, irritation, or swelling in the throat or voice box, also called the larynx. Here’s what you need to know about the condition’s signs, causes, diagnosis, and treatment options. 

Silent Reflux or LPR is a condition where the acid in the stomach goes back up the esophagus and into the throat and larynx. It’s called silent reflux because it doesn’t cause any symptoms in the chest like heartburn or indigestion.

Silent reflux signs and symptoms

Silent acid reflux signs are usually in the throat.

  • A need to clear your throat a lot. 
  • Sore throat.
  • Coughing
  • Hoarseness that usually starts in the morning and can get better as the day continues. 
  • Feeling like there is a lump in your throat, also called globus pharyngeus. 
  • Feeling like mucus is stuck in the throat.
  • Red, swollen, or irritated larynx.

What causes silent reflux?

When you eat, food goes down your throat and the esophagus into your stomach. A muscle called the lower esophageal sphincter decides when to open or close the opening between the esophagus and the stomach. In normal cases, the muscle keeps the opening closed unless you're eating.

Sometimes, this muscle doesn’t work properly and doesn’t close when it should. The acid in the stomach then goes up through the esophagus back into the throat, causing silent reflux.

Silent reflux can become more common as adults get older. Some people are more likely to get silent reflux than others, including those:

  • With unhealthy eating habits.
  • Who wear very tight clothing.
  • Who are overweight.
  • With a lot of stress.

How is silent reflux diagnosed?

Your doctor will look for the usual signs and symptoms in the throat. Sometimes, your doctor may need to do additional tests:

Swallowing study

A swallowing study is a type of X-ray test. You will be asked to swallow a liquid called barium which will coat the insides of your stomach and esophagus, so they show up on the X-ray machine. 

Endoscopy

In an endoscopy, the doctor will insert a tube with a camera at the end into your esophagus and down to your stomach to see what’s going on inside.

Esophageal PH test

In this test, your doctor will check the acid level, also called PH, in your stomach. One end of a tube is passed down through the esophagus into your stomach, and the other is connected to a recording unit.

How do you treat silent reflux? 

Most people don’t need medical treatment for silent reflux. Your doctor may ask you to make healthy changes to your lifestyle instead.

  • Quit smoking.
  • Avoid alcohol and caffeine (found in coffee, tea, and soda, for example). 
  • You may also have to avoid citrus juices from citron, lime, grapefruit, lemon or orange fruits, and fizzy drinks. Other acid-producing foods to avoid include tomatoes, cheese, chocolate, peppermint, and garlic. You can eat more low-acid foods like green leafy vegetables, bananas, celery, and melons. Low-acid foods help to reduce silent reflux symptoms.
  • Eat smaller meals more frequently. These should be low-fat, non-spicy, and not fried. It is better to eat your biggest meal of the day in the morning or at lunchtime and chew slowly and mindfully.
  • Lose weight
  • Don't wear clothing that’s too tight, especially around the waist.
  • Avoid lying down soon after eating. You may also be asked to avoid eating for up to 2 hours before your bedtime. 
  • Sleep with your head raised higher than the rest of the body so the stomach acid doesn’t travel up. 
  • Learn how to manage your stress better. 

Your doctor may ask you to take different medications depending on the treatment that’s right for you. Drugs called proton pump inhibitors help reduce the amount of acid created in the stomach.

Sometimes you may be asked to take antacids or medicines called histamine antagonists to reduce stomach acids. Pro-motility drugs which increase stomach and bowel movements may also be prescribed.

Your doctor may sometimes recommend surgery if you have a serious condition of silent reflux. 

Conclusion

Silent reflux is common, and most cases of the condition clear up successfully with lifestyle changes and medical treatment.  Ask your doctor for specific advice.

Prevent silent reflux by maintaining a healthy weight, eating a low-fat and low-acid diet, managing stress, avoiding tight clothing, and eating no less than 2 hours before bedtime. 

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Medically Reviewed on 1/5/2022
References
SOURCES:

Cleveland Clinic: "Laryngopharyngeal Reflux (LPR)."

Doncaster and Bassetlaw Hospitals NHS Foundation Trust: "Silent Reflux."

International Archives of Otorhinolaryngology: "Laryngopharyngeal Reflux: Diagnosis, Treatment, and Latest Research."

Mayo Clinic: "Mayo Clinic Q and A: Lifestyle changes may ease laryngopharyngeal reflux."

UTSouthwestern Medical Center: "Silent Reflux."