What Is Silent Acid Reflux?

Silent acid reflux, or laryngopharyngeal reflux (LPR), is a condition where stomach acid flows back into the throat without causing typical heartburn symptoms. This can lead to throat irritation, voice changes, and discomfort. If you suspect you have LPR, it's essential to understand its causes, symptoms, and treatment options. In the UK, managing silent acid reflux typically involves lifestyle changes, dietary adjustments, and, in some cases, medications. Knowing when to consult a GP or a specialist is crucial for effective management. Here, we provide informative answers to common questions about silent acid reflux and how to manage LPR.

Key Takeaways

What Is Silent Acid Reflux?

Silent acid reflux, also known as LPR, happens when stomach acid flows into your throat without causing heartburn. It can lead to throat irritation, hoarseness, or a feeling like there's a lump in your throat. Unlike regular acid reflux, it’s harder to notice, so recognising these symptoms is key.

How to Manage It

LPR can often be controlled through lifestyle changes:

• Eat smaller, low-fat meals and avoid spicy or acidic foods.

• Wait 2–3 hours after eating before lying down.

• Over-the-counter medications like antacids or alginate products (e.g., Gaviscon) can provide relief.

When to See a Doctor

Consult a GP if:

• Symptoms persist for weeks or worsen over time.

• Over-the-counter remedies don’t help.

• You experience severe symptoms like difficulty swallowing or a hoarse voice that doesn’t go away.

For unresolved cases, your GP may refer you to a specialist for advanced tests and tailored treatment.

What is silent acid reflux?

Silent acid reflux, also known as laryngopharyngeal reflux (LPR), is a condition where stomach acid flows back into the throat and larynx (voice box) without causing the typical symptoms of heartburn or indigestion (Cengiz et al, 2009). This can lead to irritation and damage to the throat and vocal cords. If you suspect you have silent acid reflux, it's essential to consult a healthcare professional for diagnosis and treatment options.

What are the symptoms of silent acid reflux?

Silent acid reflux, or laryngopharyngeal reflux (LPR), often presents with subtle symptoms, such as:

• Throat Clearing: Frequent clearing of the throat, sometimes accompanied by a dry cough.

• Hoarseness: Changes in your voice, making it sound hoarse or raspy.

• Throat Discomfort: Feeling like there's a lump in your throat or experiencing a sore, irritated throat.

• Difficulty Swallowing: Sensation of difficulty or discomfort when swallowing.

• Postnasal Drip: Excessive mucus or a feeling of mucus dripping down the back of your throat.

• Chronic Sore Throat: Ongoing throat discomfort or soreness.

These symptoms can vary in intensity but often persist. If you suspect silent acid reflux, it's important to consult a healthcare professional for an accurate diagnosis and appropriate treatment.

What are the causes of silent acid reflux?

Silent acid reflux, like traditional acid reflux (GERD), occurs when stomach acid flows back into the throat. The causes of silent acid reflux can include:

• Weak Lower Esophageal Sphincter (LES): A weakened LES can allow stomach acid to flow back into the throat.

• Dietary Factors: Consuming acidic or spicy foods, caffeine, alcohol, or large meals before bedtime can trigger reflux (Brown & Shermetaro, 2023).

• Obesity: Excess weight can put pressure on the stomach, pushing acid into the throat (Suyu et al, 2018).

• Hiatal Hernia: This condition can weaken the LES and contribute to reflux.

• Smoking: Smoking can relax the LES and worsen symptoms (Wang et al, 2012).

• Certain Medications: Some medications, like certain asthma drugs or calcium channel blockers, can relax the LES (Lee et al, 2012).

• Pregnancy: Hormonal changes during pregnancy can relax the LES, leading to reflux (Healthline, 2016).

• Stress: High-stress levels can exacerbate reflux symptoms (Kirti,Y., 2018).

Identifying and addressing these factors, along with medical guidance, can help manage and reduce silent acid reflux. If you suspect you have LPR, it's advisable to consult a healthcare professional for a proper evaluation and treatment plan.

How does someone know they have silent acid reflux?

Recognizing silent acid reflux can be challenging because it doesn't typically produce the typical heartburn symptoms. However, you may have silent acid reflux if you experience:

• Persistent throat clearing or coughing.

• Hoarseness or a change in voice.

• Feeling like there's a lump in your throat.

• Throat irritation or soreness.

• Difficulty swallowing.

• Postnasal drip or a constant need to clear your throat.

If you experience these symptoms regularly, it's advisable to consult a healthcare professional for evaluation and diagnosis. They can recommend appropriate treatments to manage silent acid reflux and prevent further complications, following an examination of your throat and voice box via a fibre-optic telescope camera that is passed through your nose.

How is silent acid reflux diagnosed?

Diagnosing silent acid reflux, or laryngopharyngeal reflux (LPR), typically involves a combination of medical assessment and diagnostic tests (Campagnolo et al, 2014 & Vaezi, M., 2016). Here's how it's usually done:

• Medical History: Your healthcare provider will discuss your symptoms and medical history, paying close attention to any throat or voice-related issues.

• Physical Examination: A physical examination may be performed to check for signs of LPR, such as throat irritation or hoarseness.

• Laryngoscopy: This involves using a special instrument called a laryngoscope to examine the throat, vocal cords, and larynx for signs of irritation or damage caused by reflux.

• pH Monitoring: In some cases, pH monitoring may be recommended. This test measures the level of acid in your throat and helps confirm the presence of LPR.

• Barium Swallow: This imaging test involves drinking a contrast solution and having X-rays taken to visualise the oesophagus and rule out other conditions.

• Esophageal Manometry: This test assesses the function of the oesophagus and lower esophageal sphincter (LES) to identify any issues contributing to reflux (Baldwin & Puckett, 2022).

Once the diagnosis is confirmed, your healthcare provider will work with you to develop a treatment plan, which may include lifestyle changes, dietary modifications, medications, and other therapies to manage silent acid reflux effectively. It's essential to consult a healthcare professional for a proper evaluation and diagnosis.

How is silent acid reflux treated?

The treatment and management of silent acid reflux, or laryngopharyngeal reflux (LPR), typically involves a combination of lifestyle changes, dietary modifications, medications, and sometimes, supportive therapies. Here's an overview of treatment options:

• Lifestyle Changes (Brown & Shermetaro, 2022): 

• Elevate your head: Sleeping with your head elevated can help prevent acid from flowing into your throat during the night.

• Avoid lying down after meals: Wait at least two to three hours before lying down after eating.

• Weight management: If you're overweight, losing weight can reduce pressure on your stomach and decrease reflux.

• Dietary Modifications (Lechien et al, 2021):

• Identify trigger foods: Avoid foods and beverages that can trigger reflux, such as acidic or spicy foods, caffeine, alcohol, and fatty meals.

• Eat smaller, more frequent meals: This can help reduce the likelihood of reflux.

• Medications:

• Proton Pump Inhibitors (PPIs) (Reimer & Bytzer, 2008): These medications reduce stomach acid production and can be prescribed to manage LPR symptoms.

• H2 Blockers (Nugent et al, 2022): Histamine-2 receptor blockers can also reduce stomach acid and are sometimes used.

• Antacids (Martinucci et al, 2013): Over-the-counter antacids can provide temporary relief from reflux symptoms.

• Supportive Therapies:

• Speech therapy (Vashani et al, 2010): In some cases, speech therapy can help improve voice and swallowing issues caused by LPR.

• Behavioural and dietary guidance: A healthcare professional may provide guidance on lifestyle and dietary changes to minimise symptoms.

• Management of Underlying Causes: 

• If there's an underlying cause contributing to LPR, such as a hiatal hernia, addressing that condition may be necessary.

It's important to work closely with a healthcare provider to develop an individualised treatment plan tailored to your specific symptoms and needs for managing silent acid reflux and improving your quality of life. LPR can be managed effectively with the right approach, but ongoing monitoring and adjustments to your treatment plan may be necessary for long-term relief. Remember that management may require some trial and error to find the most effective combination of strategies for your specific case. 

What over the counter medication is available for silent acid reflux?

In the UK, there are over-the-counter (OTC) medications and prescription medications available for managing silent acid reflux or laryngopharyngeal reflux (LPR). These medications can provide relief from mild symptoms, but it's essential to consult with a pharmacist or healthcare professional before using them. Common OTC options include:

• Antacids: Antacids like Gaviscon, Rennie, or Maalox can help neutralise stomach acid and provide temporary relief from heartburn and reflux symptoms.

• Alginate-Based Products: Some OTC products, like Gaviscon Advance, contain alginate, which forms a protective barrier in the stomach to reduce reflux.

• H2 Blockers: e.g. Ranitidine (requires a prescription)

• Proton Pump Inhibitors (PPIs): While PPIs are generally prescription medications in the UK, you may find low-dose OTC versions, such as Nexium Control (esomeprazole), which can be used for short-term relief of heartburn. Omeprazole, Lansoprazole and Pantoprazole are prescription options.. 

Remember that OTC medications are suitable for occasional or mild symptoms. If you experience persistent or severe symptoms of LPR, or if you need long-term management, it's crucial to consult a healthcare professional for a proper evaluation and to discuss appropriate treatment options (including prescription medications). They can guide you on the best course of action for your specific situation.

At what point should someone consult a GP about silent acid reflux?

Consulting a GP (General Practitioner) about silent acid reflux, or laryngopharyngeal reflux (LPR), is advisable under the following circumstances:

• Persistent Symptoms: If you experience persistent symptoms such as chronic throat clearing, hoarseness, throat irritation, or difficulty swallowing that last for more than a few weeks, it's essential to seek medical advice.

• Severe Symptoms: If your LPR symptoms are severe, causing significant discomfort or interfering with your daily life, it's important to consult a GP promptly.

• Worsening Symptoms: If your symptoms worsen over time or if you notice any concerning changes in your voice or throat health, it's a sign that you should seek medical attention.

• Complications: LPR can lead to complications, such as damage to the throat and vocal cords. If you suspect or have been diagnosed with complications related to LPR, it's crucial to consult a healthcare professional.

• No Improvement with OTC Medications: If over-the-counter medications for acid reflux don't provide relief or if your symptoms persist despite their use, it's time to see a GP for further evaluation and potentially prescription medications.

• Concerns or Questions: If you have concerns or questions about your symptoms, their possible causes, or the best course of action for managing LPR, don't hesitate to consult a healthcare professional for guidance.

Your GP can assess your condition, recommend appropriate diagnostic tests if needed, and provide a tailored treatment plan to manage silent acid reflux effectively. Early intervention can prevent complications and improve your quality of life, which is why it’s important to contact a healthcare professional as soon as you think you might be suffering from the health condition.

When is someone referred to a specialist for silent acid reflux?

A referral to a specialist for silent acid reflux or laryngopharyngeal reflux (LPR) may be considered in the following situations:

• Persistent or Severe Symptoms: If your LPR symptoms are persistent, severe, or do not respond to initial treatments prescribed by your GP, your GP may refer you to a specialist for further evaluation and management.

• Complications: If you have developed complications related to LPR, such as vocal cord damage or Barrett's oesophagus, a specialist, such as an ear, nose, and throat (ENT) doctor or a gastroenterologist, may be needed to address these specific issues.

• Diagnostic Uncertainty: In cases where the diagnosis of LPR is uncertain or if there are other underlying conditions that need to be ruled out, a specialist can provide expertise in diagnosing and managing reflux-related problems.

• Need for Specialised Testing: Specialists may have access to specialised tests, such as advanced laryngoscopy or esophageal pH monitoring, to further evaluate and confirm the presence and severity of LPR.

• Complex Cases: Complex cases that require a multidisciplinary approach involving different specialists, such as speech therapists or nutritionists, may necessitate a referral to coordinate comprehensive care.

Your GP will assess your individual situation and symptoms to determine if a referral to a specialist is appropriate. Specialists can provide more specialised care and expertise in managing silent acid reflux and its associated complications.

Medically Reviewed by:
Dr. Alexis Missick MBChB. MRCGP
GMC reference no: 7151419
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Sources

• UHCW NHS - Laryngopharyngeal Reflux Information

• DBTH NHS - Silent Reflux Update

• WSH NHS - Silent Reflux Patient Leaflet

• Torbay and South Devon NHS - Laryngopharyngeal Reflux Information

• SFH NHS - Laryngopharyngeal Reflux Patient Information

• NHSTayside Scotland - Laryngopharyngeal Reflux Information

• WebMD - Laryngopharyngeal Reflux (Silent Reflux)

• NICE - Gastrooesophageal Reflux Disease in Children and Young People