Silent reflux is a condition in which stomach acid causes throat discomfort, especially behind the breastbone in the middle of the trunk.
It does not always cause heartburn, but it can cause damage to the throat and vocal cords.
The condition is always known as laryngopharyngeal reflux (LPR).
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.
A reflux action causes these uncomfortable sensations. Reflux refers to a backward or return flow. In LPR, stomach acid flows back into the esophagus and irritates the throat.
LPR can develop in infants and adults. It is treatable.
LPR has the name "silent reflux" due to not necessarily triggering the usual symptoms of acid reflux, such as heartburn. However, silent reflux can lead to hoarseness, frequent throat-clearing, and coughing.
The condition 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 the back of the throat
- difficulty swallowing
- swelling and irritation of vocal cords
- a sensation of post-nasal drip
- breathing difficulties
Symptoms in children and infants
The symptoms of silent reflux in infants and children include:
- failure to grow and gain weight
- a sore throat
- noisy breathing
- ear infections
- feeding difficulties
- 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 a more serious health problem. A doctor should investigate these symptoms.
Children with silent reflux will not always vomit or regurgitate.
Researchers are currently exploring possible links between silent reflux in children and recurrent ear infections and sinusitis.
Some symptoms, such as projectile vomiting or vomit that contains blood, could be indications of other health problems. Visit a health professional if these symptoms become evident.
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.
Many adults manage to control symptoms by adjusting their eating habits and making lifestyle changes.
Medications to treat silent reflux, such as antacids, are available over the counter (OTC). These can help prevent the acid from returning to the esophagus.
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H2-blockers, a form of anti-histamine, might help, especially if a cough bothers the person at night.
If antacids do not work, a doctor may prescribe a proton pump inhibitor (PPI), such as omeprazole, to reduce stomach acidity. A person with LPR can use these 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 require treatment.
Changing the feeding habits of the infant and using age-appropriate medication might help.
In severe cases, or when another 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 the food pipe.
This explains the frequency with which infants spit up, especially with a full stomach.
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 slow-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 frequently and loudly, such as teachers and singers, also face a high risk of developing the condition. It can also develop during pregnancy.
In adults, damage to the vocal cords can occur if a person does not receive treatment for LPR.
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. They will also carry out a physical examination and possibly some laboratory tests.
An adult with persistent throat problems should see a doctor, especially if it feels as if something is stuck in the throat. The doctor may refer them to an ear, nose, and throat (ENT) specialist.
Additional tests for LPR might include a barium X-ray and an examination of the stomach and food pipe, which involves passing through the mouth a thin, flexible tube with a camera attached.
Children with symptoms of LPR that appear alongside breathing and feeding problems need to see a doctor as soon as possible. Silent reflux can have serious health consequences.
Doctors do not recommend contrast studies of the gut for infants and younger children.
The physician may request an endoscopy of the gut if certain concerning symptoms are present, such as:
- a failure to thrive without visible vomiting
- swallowing difficulties
- a dislike of feeding
- unexplained distress
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
- raising the head of the bed so that gravity helps prevent reflux
- wearing loose clothing
- bending the knees when picking objects up, to reduce pressure on the stomach
It might help to avoid mint and mint-flavored foods.
Clearing the throat can make symptoms worse. Other ways of clearing the throat that might be less harmful include:
- 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 avoid these where possible.
Tips for children
Most infants outgrow silent reflux by their first birthday. Some, however, might 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, seek medical help.
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 exercise for at least 2 hours after eating
- waiting at least 3 hours to lie down after eating
While silent reflux is uncomfortable, it is easily preventable and treatable with the right measures.