Of all the forms of acid reflux, silent reflux is the most mysterious. The proper, medical name for silent reflux is “Laryngopharyngeal Reflux” (LPR). As with Gastroesophageal Reflux Disease (GERD), LPR involves the backing up (refluxing) of acid from the stomach into the esophagus.
The symptoms of silent reflux, however, are usually quite different than those of GERD. Frequently there is no burning in the chest. This is why it is called “silent reflux”. It is not because GERD is noisy, but it is because it is possible to suffer silent reflux and not even know it.
The esophagus has two sphincters (rings of muscle) at either end. The purpose of these rings is to ensure that food passes only one direction through the esophagus on its way to the stomach. With LPR these sphincters don’t work right. Stomach acid may back up all the way into the throat or larynx, or even into the nasal passages.
Laryngopharyngeal Reflux is Common in Infants
Newborn babies are often born with underdeveloped, or “floppy”, sphincters. Usually this problem will correct itself after a few years, but in some cases the condition may continue into adult life.
Silent Reflux Symptoms
The symptoms, diagnosis and treatment are different for infants than for adults. The most prevalent symptoms found in infants and children include:
- Chronic coughing
- Noisy breathing
- Difficulty in feeding
- Trouble gaining weight
Sometimes LPR reflux expresses itself in infants through apnea, a pause in breathing. In severe cases a baby may need to sleep with an apnea monitor that detects when breathing stops so the parents can wake them up.
For adults, the symptoms are usually vague, difficult to diagnose and are easily confused with other problems. They may include:
- Excessive throat clearing
- A persistent cough
- A lump in the throat that won’t go away
- A sensation of postnasal drip or excess throat mucus
- Trouble swallowing
- Trouble breathing
- Sore throat
Because of the similarity of these symptoms to other minor conditions LPR may go undiagnosed for many years.
Silent Reflux Complications
Children may experience certain complications if their reflux goes untreated, such as:
- Narrowing of their throat below the vocal cords
- Contact ulcers
- Frequent ear infections
- A buildup of middle ear fluid
In adults, silent reflux can scar the throat and voice box; increase the risk of cancer; affect the lungs; and irritate asthma, emphysema or bronchitis.
Diagnosis - What to Expect
LPR is more difficult to diagnose than GERD, but a doctor can make an accurate diagnosis using several different methods:
- A look at your medical history. This is the vaguest method, but there are hints in a person’s medical history that can point your doctor in the right direction.
- Physical exam. A standard physical can indicate the possibility of LR.
- Endoscopic exam – Using a special instrument your doctor can view the throat and vocal cords to look for signs of laryngopharyngeal reflux.
- pH Monitoring – This is a common test used with both infants and adults to not only diagnose LPR reflux, but also to determine the frequency of reflux episodes. A small catheter is inserted through nose and into the throat and esophagus. The catheter connects to a monitor, usually strapped to the wrist of the adult or to the crib of the child. The monitor measures acid levels during a 24-hour period. Usually you are required to accurately record all food consumption and you may be restricted to only certain foods or fluids during the twenty four hour period. For example. While performing the test on an infant it is common to be allowed to feed your infant only apple juice, and you would need to record the exact minutes of the day when the apple juice is being consumed. This allows the doctor to line up reflux episodes with food consumption to make the best diagnosis.
Silent Reflux Treatments
For infants and children treatments may include some or all of the following:
- Smaller more frequent feedings. In more severe cases a feeding tube may be used to administer small amounts of milk or formula throughout the day or night.
- Keeping the infant in a vertical position for at least 30 minutes after feeding.
- Sleep on wedge. A more drastic slant on the previous treatment, sleeping on an incline wedge keeps the child’s body in a partially vertical position while sleeping.
- Medications. These may include medications to reduce acid as well as medicines that help to strengthen the sphincters.
- Apnea monitor – If apnea is a danger an apnea monitor may be used at night to signal if the child stops breathing while sleeping.
- Surgery – As a last resort surgery may be required to try to strengthen the sphincters.
For adults the treatments are very similar to those for GERD or chronic heartburn:
- lose weight
- quit smoking
- avoid alcohol
- restrict chocolate, mints, fats, citrus, carbonation, spicy or tomato-based foods
- Limit caffeine;
- Eat smaller meals, take smaller bites.
- chewing gum;
For more information about treatments for adults suffering from silent reflux see this article about heartburn and its treatments.