What is Silent Reflux Disease?

Silent Reflux Disease is also known as laryngopharyngeal reflux or LPR. This condition is a form of acid reflux that does not exhibit the classic reflux or GERD symptom of heartburn. LPR is common in infants and children because of their shorter esophagus and underdeveloped esophageal sphincter, but adults can be diagnosed as well. This condition can be managed through lifestyle changes, medication, and more severe cases can be remedied with surgery.

What causes Silent Reflux?

All types of reflux are caused by the stomach acid backing up into the gastrointestinal tract. This happens because the sphincter at the end of the esophagus, the valve that separates the esophagus from the stomach can malfunction. If the valve does not close properly this can cause the stomach acid to travel up the esophagus and reach the back of the throat and the voice box. This is where the name laryngopharyngeal reflux stems from, with the larynx being the voice box and the pharynx being the back of the throat. These tissues experience inflammation due to being exposed to stomach acid, which causes the main symptoms of Silent Reflux.

What are signs and symptoms of Silent Reflux?

Silent Reflux or LPR is more common in children because of their developing GI tract.

The most common signs of this condition in children are:

  • Hoarseness
  • Noisy breathing
  • Trouble feeding
  • Spitting up

While these symptoms may seem vague, if paired with trouble gaining weight or pauses in breathing that may suggest sleep apnea, Silent Reflux must be considered.

In adults, Silent Reflux is less common but can be the root of the symptoms, especially if the symptoms seem vague and not clearly related to reflux.

The most common signs in adults are:

  • Bitter taste in the back of the throat
  • Burning sensation in the back of the throat
  • Hoarseness
  • Persistent cough

Adults may have heartburn, but this is more likely in cases of GERD than of LPR. Those experiencing Silent Reflux may also feel a lump in their throat, have post nasal drip, or have a sore throat. These symptoms seem vague and unrelated to having reflux, but if multiple symptoms are present LPR must be considered.

How is Silent Reflux Different from GERD?

Gastroesophageal reflux disease, most commonly known as GERD is a common form a reflux usually characterized by consistent heartburn. Other symptoms include:

  • Acid taste in mouth
  • Chronic dry cough at night
  • Asthma
  • Bad breath

GERD differs from Silent Reflux or LPR by its painful symptoms instead of more silent and vague symptoms. It can be more difficult to diagnose Silent Reflux because of the absence of heartburn and the misleading throat conditions, while GERD symptoms more directly affect the GI tract and indicate acid reflux more clearly.

Silent Reflux Diagnosis

Silent Reflux can be difficult to diagnose because of the misleading symptoms compared to GERD. The most common methods of diagnosis beyond a physical exam are an endoscopic exam and pH monitoring.

An endoscopic exam involves a laparoscopic camera used to view the throat and vocal cords for evidence of inflammation and deterioration. Alternatively pH monitoring occurs with a small catheter passed through the nose down to the esophagus, where acid can be detected. The results are sent to a computer the patient wears and returns to have the results analyzed.

Silent Reflux Treatment

The treatment for Silent Reflux varies from lifestyle changes to medication and in more severe cases surgery to repair the malfunctioning sphincter. Each patient affected by this condition may find success with a mixture of lifestyle changes and medication, per the treatment plan discussed with their physician.

Lifestyle changes

For children with Silent Reflux the first step is to make some changes to their daily life to help remedy and reduce their symptoms. Since infants and small children are more affected by this condition some simple lifestyle changes can help them through their symptoms, and the condition may be resolved as the child grows and the GI tract matures.

Lifestyle changes for children include:

  • Smaller and more frequent feedings
  • Keeping the child upright for 30 minutes after feedings

These simple changes will help the sphincter separating the esophagus and stomach stay closed and allow the stomach to process the contents without backing up into the throat.

Adults are less commonly affected by Silent Reflux but some lifestyle changes can help reduce the uncomfortable symptoms. One way to reduce symptoms is to eat smaller meals and stop eating two hours before bed. It can also help to sleep with the head of the bed elevated to help keep the sphincter closed and reduce the stomach acid backing up into the esophagus. Losing weight can reduce symptoms, as well as trying over the counter antacids.

A change in diet can also reduce symptoms. Those experiencing symptoms should try to avoid the following foods:

  • Spicy foods
  • Fatty foods
  • Alcohol
  • Tobacco
  • Caffeine
  • Mint
  • Chocolate
Medications

The most common medications prescribed to treat Silent Reflux are H2 blockers and proton pump inhibitors, both of which can be used to treat adults and children. Over the counter antacids are a good first step if lifestyle changes do not reduce symptoms, but consult a doctor to establish the best treatment plan.

Surgery

In more severe cases of Silent Reflux, surgery may be indicated to correct the malfunctioning esophageal sphincter. A fundoplication may be necessary to strengthen the valve. This procedure takes part of the stomach and wraps it around the esophagus to help reinforce the malfunctioning valve. An alternative surgery is to replace the faulty valve with an artificial one, or add an artificial reinforcement to support the valve.

Silent Reflux Natural Remedies

There are a few natural or herbal remedies that can reduce Silent Reflux symptoms, usually in the form of teas or supplements. Natural remedies include:

  • Deglycyrrhizinated licorice (DHL): can soothe the mucous lining of the esophagus
  • Marshmallow Root: improves digestion and reduces stomach acid
  • Chamomile: can soothe esophagus and aid in digestion
  • Catnip: helps relax the muscles of the digestive tract, reduces stomach acid, acts as a buffer in the esophagus protecting against stomach acid