Lots of people know about gastroesophageal reflux disease (GERD) and its common symptoms, like acid reflux, heartburn and stomach acid in the throat or mouth (regurgitation). Silent reflux, also known as laryngopharyngeal reflux (LPR), is similar. But with LPR, symptoms aren’t as noticeable as they are with GERD.
With both LPR and GERD, stomach acid flows back into the esophagus and reaches the throat and voice box (larynx). GERD mainly affects the lower esophagus while LPR affects the upper part.
“LPR is when GERD causes symptoms that affect the throat, vocal cords or airway,” said Emil Graf, MD, a bariatric surgeon and GERD specialist with Banner Health. “People typically complain more of chronic hoarseness or voice fatigue. They may complain of asthma, coughing after meals, chronic throat clearing or the feeling of something stuck in their throat that they can’t clear with swallowing.”
With LPR, stomach acid also irritates the tissues of the throat and larynx (voice box). Other symptoms may include chronic cough, voice fatigue or changes, post-nasal drip or a persistent sore throat.
Because heartburn isn’t usually a symptom of silent reflux, it can be hard to diagnose. “LPR can be silent and is frequently misdiagnosed as a respiratory disorder such as asthma or post-nasal drip. Symptoms can seem unrelated to reflux,” Dr. Graf said.
Symptoms of silent reflux
“Most patients are aware of acid reflux and believe reflux symptoms only cause heartburn or acid regurgitation,” Dr. Graf said. But LPR mainly affects the voice box. It can cause:
- A cough that doesn't go away, or frequent throat clearing, because stomach acid irritates and inflames the throat and triggers the body's reflex to clear the airways.
- Changes in voice quality, making your voice sound hoarse, rough or strained because the acid irritates the vocal cords and causes inflammation, so they don’t vibrate normally.
- Throat discomfort that can range from mild irritation to soreness, as well as the feeling that something is stuck in the throat (globus sensation).
- Other symptoms such as difficulty swallowing (dysphagia), dental erosion or decay from acid exposure and in some cases, asthma or pneumonia.
If you have symptoms of LPR, it’s important to seek medical care. Long-term exposure to stomach acid can lead to severe throat irritation, persistent soreness and a higher risk of vocal cord nodules or polyps. Over time, the acid may also wear away tooth enamel.
What can you do to reduce symptoms of LPR?
Lifestyle habits and diet choices can impact your silent reflux symptoms. “First-line treatment centers on lifestyle modifications,” Dr. Graf said.
- Quit smoking and limit alcohol. “Tobacco and alcohol make the problem worse,” he said.
- Some foods can relax the muscle where your stomach and esophagus connect (lower esophageal sphincter), so stomach acid can reach the throat. Avoid spicy foods and acidic fruits like citrus, tomatoes, chocolate and caffeine. Keeping a food diary can help you find out which foods trigger your symptoms.
- Avoid acidic drinks like citrus juices and carbonated beverages, which can make your stomach produce more acid. Drink non-acidic beverages such as water and herbal tea instead.
- Eating large meals can put pressure on your stomach and make reflux more likely. Choosing smaller, more frequent meals can help.
- Tight-fitting clothing puts pressure on your stomach, so choose looser options.
- If you have obesity, losing weight can lower the pressure on your stomach.
- Eating close to bedtime or lying down after a meal can make your symptoms worse. It's best to avoid eating for a few hours before bedtime so acid doesn't creep up into the esophagus when you're lying down. “Eating earlier and taking a walk after a meal will help to ensure that your stomach is empty when you lie down,” Dr. Graf said.
- Elevate your head and upper body in bed to help keep stomach acid from entering the throat. Use extra pillows or a wedge pillow.
- Try stress reduction techniques such as deep breathing exercises, yoga, meditation or mindfulness since stress can make LPR worse.
When it’s time to see an expert
Sometimes, it’s not enough to treat LPR on your own. “If lifestyle modifications fail to improve or resolve your symptoms, you should seek medical care,” Dr. Graf said.
A health care provider can review your symptoms, take your medical history and perform a physical exam. They may also recommend diagnostic tests like examining the throat with a flexible scope (laryngoscopy) or measuring acid levels in the esophagus and throat (pH monitoring).
“LPR can be more difficult to diagnose than classic GERD since it doesn’t have the classic symptoms of heartburn and acid regurgitation,” Dr. Graf said.
Based on your diagnosis, your provider will recommend treatment options. “Medications can suppress acid production and reduce or resolve symptoms,” Dr. Graf said.
You’ll want to see your provider for follow-up appointments to check how your treatment is working and make any changes. “LPR is more difficult to treat with acid suppression medications compared to classic GERD,” Dr. Graf said. So you may need to try different options to get relief.
The bottom line
LPR, also called silent reflux, is a type of acid reflux that affects your throat and upper respiratory tract without causing heartburn. It may also cause chronic cough, hoarseness, throat irritation and the feeling of a lump in the throat.
Changes like avoiding certain foods, eating smaller meals and staying upright after eating can help reduce symptoms. If those changes don’t bring relief, talk to your health care provider or an expert at Banner Health.
To learn more about your symptoms and risk for acid reflux and GERD, take our free acid reflux assessment.
