The contents of the stomach include stomach acids. When these acids make contact with the food pipe and vocal chords, irritation, discomfort, and burning can occur.
This is caused by a reflux action, meaning a backward or return flow. In silent reflux, stomach acid flows back into the esophagus and irritates the throat.
It is called "silent," because it does not necessarily involve the symptoms normally associated with acid reflux, such as heartburn. However, it can lead to hoarseness, frequent throat clearing, and coughing.
Silent reflux can develop in infants and adults. It is treatable.
When acid reflux leads to persistent heartburn, occurring maybe twice a week for 3 weeks or more, this is known as gastroesophageal reflux disease, or GERD. Silent reflux, or laryngeal-pharyngeal reflux (LPR) is similar, but without the heartburn and indigestion.
Silent reflux can cause discomfort in the throat.
Silent reflux, or laryngeal-pharyngeal reflux (LPR), develops when the stomach acid travels back through the food pipe and reaches the back of the throat.
The most common symptoms in adults include:
- feeling like something is stuck in the throat
- frequent throat clearing
- a bitter taste at back of throat
- difficulty swallowing
- swelling and irritation of vocal cords
- sensation of post-nasal drip
- difficulty in breathing
In children and infants
The symptoms of silent reflux in infants and children include:
Cough can be a sign of silent reflux in children.
- failure to grow and gain weight
- sore throat
- noisy breathing
- ear infections
- difficulty feeding
- turning blue
- aspiration, or inhaling food and other particles into the lungs
It is common for infants to spit up, but problems with breathing and feeding could be signs of something more serious. These should be investigated by a doctor.
In addition, children with silent reflux will not always vomit or regurgitate.
Researchers are currently exploring possible links between LPR in children and recurrent ear infections and sinusitis.
Some symptoms, such as projectile vomiting or bile, or bloodstained vomit, could be indications of other health problems. These should be reviewed by a doctor.
Many adults manage to control symptoms by adjusting their eating habits and making lifestyle changes.
Medications to treat LPR, such as antacids, are available over the counter (OTC). These can help prevent the acid from returning to the esophagus.
H2-blockers, a form of anti-histamine, may help, especially if the person is bothered by a cough at night.
If antacids do not work, a doctor may prescribe a proton pump inhibitor (PPI), such as omeprazole, to reduce stomach acidity. This will be used for between 4 weeks and 6 months.
Reflux is common in children up to the age of 1 year, and only those who have difficulty feeding or breathing will need treatment.
Changing the infant's feeding habits and using age-appropriate medication may help.
In severe cases, or when other treatment has not been effective, tube feeding and surgery may be necessary.
In infants, the muscular valves at the end of the food pipe are not fully developed. These valves keep the contents of the stomach from flowing back into, and through, the food pipe.
This explains why it is common for infants to spit up, especially after they have been fed and their stomachs are full.
Adults often have a cold or the flu before they develop LPR. These conditions may make the vocal cords more sensitive to stomach acid.
Certain physical characteristics may make some individuals more likely to develop LPR, including those who have:
- problems with the lower food pipe valve
- a low-emptying stomach
- a hiatal hernia
- problems with food pipe contractions
Lifestyle risk factors include:
- frequently consuming alcohol, spicy and fatty food, and sodas
- being overweight
Individuals who use their voices a lot, such as teachers and singers, may also be more at risk from the condition. It can also develop during pregnancy.
Damage to the vocal cords can result if LPR is not treated in adults.
In the long term, it can lead to:
- lung and breathing disorders
- recurrent pneumonia
- chronic cough
- persistent or repeated laryngitis
- oral cavity disorders
It may also increase the risk of cancer of the larynx.
A doctor will ask about symptoms and medical history and carry out a physical examination. There may be some tests.
An adult with persistent throat problems should see a doctor, especially if it feels as if something is stuck in the throat. They may be referred to an ear, nose, and throat specialist.
Additional tests for LPR may include a barium X-ray and an examination of the stomach and food pipe, which involves passing a scope, or camera, through the mouth.
Children with symptoms of LPR, and especially breathing and feeding problems, need to see a doctor as soon as possible, as the results can be serious.
Contrast studies of the gut are not recommended for infants, children, and young people.
An endoscopy of the gut may be called for if certain concerning symptoms are present, such as a failure to thrive without visible vomiting, trouble swallowing, a dislike of feeding, or unexplained distress.
Feeding a child small amounts and keeping them upright after eating can reduce symptoms.
For adults with silent reflux, some lifestyle changes can keep the throat from becoming dry and irritated.
- avoiding tobacco
- chewing gum that contains sodium bicarbonate
- losing weight, if appropriate
- raise the head of the bed so that gravity helps prevent reflux
- wearing loose clothing
- bend the knees when picking things up, to reduce pressure on the stomach
Throat clearing can make symptoms worse. Other ways of clearing the throat that may be less harmful are:
- breathing out forcefully instead of coughing
- gently tapping the vocal cords together
- taking a sip of water
Shouting, whispering, extensive speaking, and clearing the throat can put stress on the throat, so these should be avoided where possible.
Tips for children
Most infants outgrow their silent reflux by their first birthday, but some will need treatment.
Tips that can help include:
- feeding the infant smaller, more regular meals
- keeping the infant in an upright position for at least 30 minutes when feeding
- closely monitoring for signs of breathing or feeding trouble
If breathing or feeding problems develop, medical help should be sought.
Dietary recommendations include:
- drinking plenty of fluids, including water and herbal teas
- avoiding fried and fatty foods, chocolate, alcohol, and caffeine
- avoid foods that increase acidity such as tomatoes, citrus fruits, and sodas
- eating smaller meals more often, and chewing well
- not eating within 2 hours of going to bed
Ways to prevent acid reflux from irritating the throat include:
- eating smaller amounts, more frequently
- avoiding bending, singing, or exercising for at least 2 hours after eating
- waiting at least 3 hours to lie down after eating