“Silent Reflux” — What is It and What Can Be Done about It?

This medical article is part of our continuing series on the Heartburn & Reflux Center at Florida Hospital Altamonte Springs.

A medical condition known as “silent reflux” or laryngopharyngeal reflux (LPR) affects many people. Like GERD, LPR results when stomach content back up, causing reflux. But unlike GERD, classic reflux symptoms such as heartburn may not be present, which is the reason LPR is called “silent” reflux—classic symptoms don’t present, so it’s harder to know it’s there.

LPR happens when the openings at each end of the esophagus don’t work properly. These openings, also called sphincters, are responsible for keeping stomach contents in the stomach and not letting it back up into the larynx, throat, or sometimes even up the nasal passages. When they don’t work properly, areas not protected from gastric or stomach acid can get inflamed and irritated. Children and infants often suffer from LPR because their organs, including the esophagus, are not as developed as adults, and also they lie down very often. Infant and child esophagi are also shorter than that of adults. Adults also get LPR, but the cause in adults in currently unknown.

Symptoms in children include chronic or barking cough, hoarseness, asthma, noisy or partial breathing (also known as apnea), difficulty in feeding or swallowing (which can in turn lead to difficulty gaining weight, a danger for babies and young children), and spitting up. Adults with LPR experience heartburn, but other symptoms are a persistent cough, constant throat clearing, trouble swallowing or breathing, hoarseness and sore throat, post-nasal drip or feeling like there is post-nasal drip, and excess throat mucus.

LPR can cause serious, long term damage if left untreated, including an increased risk of cancer.

While LPR is more difficult to diagnose than standard GERD, it can be detected with medical exams and tests. Endoscopy can detect it, as well as monitoring pH via a small catheter inserted into the esophagus via the nose. The presence of acid is monitored for 24 hours and the results are looked at to confirm an LPR diagnosis.

Treatment differs, depending on the age of the affected person. Infants and children may do better with smaller, more frequent feedings as well as keeping the child upright after feeding for at least 30 minutes. Some pediatricians will prescribe medications that have been approved for use in children. In extreme cases, surgery can also correct the problem.

For adults with LPR, lifestyle changes can help, such as quitting smoking (good advice for all); weight loss; the restriction of certain food and drink such as alcoholic beverages, chocolate, spicy and acidic foods; and a better schedule of eating that includes not eating at least three hours before going to bed. Medication for adults also includes proton pump inhibitors (such as Prilosec, and Nexium) and H2 blockers, as well as more common over-the-counter medications like antacids. Other medications may be used as well, at the advice of your doctor. If more aggressive treatment is needed, surgery is an option.

To learn more about LPR or if you think you might have LPR, contact the Heartburn & Reflux Center at Florida Hospital Altamonte Springs.