Do you have a persistent cough that refuses to leave no matter what treatments you try? Is this accompanied by a bit of hoarseness in your voice? Though these symptoms could be due to a variety of reasons, one major one is silent reflux.
What is Silent Reflux?
Silent reflux, also known as laryngopharyngeal reflux (LPR) is difficult to diagnose because it does not have all the typical symptoms of acid reflux. Yet it is a type of acid reflux that can affect anyone from babies to adults.
Silent reflux vs normal reflux
You have likely heard of acid reflux, a condition that afflicts millions of Americans. Most people are aware that they have acid reflux due to one of its most identifiable symptoms -heartburn. In silent reflux patients, heartburn or acid indigestion is not a common symptom. As a result, patients are often surprised when they are diagnosed with silent reflux.
Acid reflux occurs when gastric acid (stomach juices) flow back up into your esophagus (food pipe). This causes a burning sensation in your chest known as heartburn. Persistent acid reflux might result in gastroesophageal reflux known as GERD.
Silent reflux like GERD is a chronic and more severe form of acid reflux. LPR is similar to GERD but without the typical symptoms. Gerd irritates the esophagus, whereas LPR irritates the throat, nose and larynx (voice box).
In LPR, the stomach juices flow up the esophagus, past the esophageal sphincter and into the throat or the nasal passages. This causes an irritation in your throat leading to excessive throat clearing. If left untreated for too long, gastric acid causes sufficient inflammation to damage your vocal cords, resulting in a croaky voice.
Gerd and LPR can occur together or on their own. In other words, you can have GERD without LPR or LPR without GERD. The latter is more difficult to diagnose.
What Are the Symptoms of Silent Reflux?
There are a few symptoms associated with LPR, but most people do not relate them to acid reflux. This is why it is known as “silent” reflux. Here are some of the more well-known symptoms:
• A persistent dry cough
• Constant throat-clearing due to excess mucus
• A postnasal drip
• Difficulty or pain in the throat when swallowing
• A bitter taste at the back of your throat
• A burning sensation in your throat
• Chronic sore throat
• Feeling like there is a lump in your throat.
• Hoarseness resulting from damage to your vocal cords
What Causes Silent Reflux?
Factors for developing LPR include:
• Acidic foods such as tomatoes and spicy foods irritate the lining of the throat
• Fried or oily foods like French fries
• Foods that are high in fat, like full-cream dairy products and chocolate
• Caffeinated beverages increase the acidity of gastric juices
• Carbonated beverages
• Alcohol and tobacco
• Eating large meals and lying down soon after a meal
• Being overweight
In some cases, silent reflux is a result of a hiatal hernia. This is caused by the lower esophageal sphincter (LES) muscle and upper part of your stomach moving above your diaphragm which then allows acid to move into your esophagus.
Silent reflux in babies
Reflux disease is a common occurrence in babies and young children. This is because their digestive tracts are still figuring out how things should work. As their esophageal sphincter muscles mature, babies tend to outgrow reflux conditions.
As with adults, LPR is difficult to recognize in babies. Common symptoms include:
• Wheezing
• Difficulty breathing
• Nasal congestion
• Gagging
• Chronic coughing
• Ear infections
• Choking
• Trouble sleeping
• Failure to thrive
• Refusing to eat
If you observe any of these symptoms in your baby, take the following steps regarding feedings:
• Keep baby upright during and after feedings
• Stick to small but frequent feedings
• Burp baby during and after each feeding
If symptoms persist or get worse, please consult your doctor.
Diagnosis and Tests
How do you know if you have silent reflux?
It is relatively easy to tell if you have acid reflux – often the symptoms begin with heartburn and is treated with over-the-counter meds such as ant-acids. Silent reflux, however, is often misdiagnosed or difficult to diagnose.
Your doctor will refer you to an otolaryngologist (ENT specialist) for an evaluation and/or tests. An ENT (Ear, Nose & Throat specialist) diagnoses and treats LPR patients.
What tests are used to diagnose laryngopharyngeal reflux disease?
Often a diagnosis can be made without tests. If tests are needed, they might include:
• Acid reflux test to measure the amount of acid in your esophagus
• Endoscopy – a small camera attached to the end of a long, thin tube is inserted into the esophagus through the nose or mouth to check the lining of the esophagus and stomach.
• Barium swallow radiograph – an x-ray procedure to check for damage to your esophagus.
• Biopsy – in more persistent cases, a biopsy of the esophageal lining is carried out to check for underlying complications such as esophageal cancer.
• Other less common tests include pH monitoring and Esophageal Impedance Monitoring.
Treatments and Remedies
Prescribed medications that are known to help alleviate silent reflux symptoms:
• Over-the-counter (OTC) antacids such as Gaviscon Advanced helps to reduce excess stomach acid.
• H2 receptor blockers, such as Pepcid and Tagamet decrease the amount of acid produced in the stomach. They are available over the counter or by prescription.
• Medicines that directly block acid production are prescribed for more severe cases. These are known as PPIs (Proton Pump Inhibitors). Some brands such as Nexium are available over-the-counter and others such as Dexilant, Protonix, and Aciphex are available on prescription from your ENT.
PPIs work over a longer period than antacids or H2 Blockers, giving your laryngeal tissues time to heal. They have been proven to be very effective as a treatment for LPR and GERD, but the concern nowadays is that PPIs can increase the risk of contracting Covid-19. For more information on this read our article here.
Natural treatments:
• Natural supplements that support digestive health can ease some of the symptoms of acid reflux
• Drink plenty of water – this aids digestion
• Eat more foods that neutralize stomach acids such as veggies and healthy fats
• Switch from caffeinated drinks to herbal teas
• Include ginger in your diet – it has natural anti-inflammatory properties
Lifestyle Changes
One of the most recommended ways to alleviate and manage the symptoms of LPR is a change in diet and lifestyle. Here are some tips of what you can do:
• Avoid eating at least two hours before bedtime
• Try not to lie down straight after a meal
• Eat smaller meals more frequently throughout the day
• Follow a bland diet to lower acid levels
• Stick to lean meats like chicken breasts with the fat trimmed off
• Avoid spicy foods, especially those high in fat
• Avoid foods that trigger acid reflux such as cheese, tomatoes, processed foods and coffee
• Limit alcohol consumption
• Try to lose any excess weight
• Exercise frequently
• Avoid clearing your throat
What happens if LPR is left untreated?
Untreated silent reflux can lead to chronic coughing and even more serious complications such as esophageal cancer. So be sure to consult your doctor if your acid reflux symptoms persist and are not relieved by meds, home remedies or lifestyle changes.