What is Silent Reflux?
Silent reflux, also known as Laryngopharyngeal Reflux Disease (LPR), is an extra oesophageal disorder of gastroesophageal reflux (GERD) with symptoms relating to sensations in the throat.
These symptoms were previously thought to constitute part of the spectrum of GERD, however silent reflux is now thought to be a distinct entity and should be managed differently.
In a large study, throat clearing was observed in 87% of patients with silent reflux versus only 3% of patients with GERD. Similarly whilst 20% of patients with silent reflux also report heartburn, a significantly higher proportion with GERD, at 83% report heartburn.
Globus sensation, chronic throat clearing and gravelly voice are the three most common presenting symptoms of silent reflux. Chronic throat pain, the sensation of choking as well as chronic cough, may also be frequently experienced.
The prevalence of silent reflux is rapidly increasing and are diagnosed and treated primarily by ENT surgeons. If you think you are at risk, contact your GP who can refer you to an ENT surgeon.
Once diagnosed; silent reflux can be treated by a combination of medications as well as behaviour and dietary changes. This article will focus on the behavioural and dietary modifications to treat silent reflux as these have been found to be essential to the treatment of silent reflux, in addition to medical therapy. In fact, recent studies suggest that anti-reflux medication will have little effect if the diet is not carefully controlled.
Many foods and drinks can make symptoms worse, and it is important that these be reduce. In particular, caffeinated or carbonated beverages, dairy products, acidic foods such as tomatoes, all citrus fruits and their juices etc. should be reduced.
Changes in behaviour and habits include weight loss, quitting smoking, avoiding alcohol and not eating immediately before bedtime are all factors that aims to reduce reflux disease. It is now that nicotine and alcohol relax the sphincters of the oesophagus, allowing acid to reflux more easily.
Untreated silent reflux can lead to other laryngeal pathologies (vocal cord ulcer and granulomas) and worsening of coexisting asthma and COPD. Untreated silent reflux may also place a role in exacerbating chronic sinusitis and contribute to the development of laryngeal cancer. For more information on silent reflux or if you think you are at risk, please speak to your doctor or a medical professional who can refer you to an ENT Consultant.
This information is intended solely for the general information of the reader and is not a substitute for medical care provided by a licensed and qualified health professional. Please consult your GP/health care provider for a formal diagnosis.
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Evaluation and Management of Laryngopharyngeal Reflux. The Journal of the American Medical Association. March 9, 2012.
Laryngopharyngeal Reflux. American Academy of Otolaryngology – Head and Neck Surgery. March 9, 2012.
Laryngopharyngeal Reflux: Diagnosis, Treatment, and Latest Research: Andrea Maria Campagnolo, Jacqueline Priston, Rebecca Heidrich Thoen, Tatiana Medeiros, and Aida Regina Assuncao Int Arch Otorhinolaryngol. Nov 5, 2013.