Silent Reflux is Not So Silent

Many people are familiar with GERD (gastroesophageal reflux disease), but far fewer people are familiar with its cousin laryngopharyngeal reflux, or silent reflux.

Laryngopharyngeal reflux (LPR) certainly has some similarities with GERD. In normal digestion, food travels to the end of the esophagus, where a circular muscle known as a sphincter relaxes, allowing the food to pass through into the stomach. Once the food has passed through the sphincter, it usually tightens back up, preventing stomach acids and food from flowing back up the esophagus (refluxing). With GERD and LPR, however, this sphincter does not contract adequately, and acids and stomach contents are able to return to the esophagus, causing irritation. LPR, however, causes different symptoms than GERD. GERD primarily affects the esophagus, causing chronic heartburn and irritation to the upper digestive tract. With LPR, acids and stomach contents tend to rise higher than with GERD, irritating the pharynx (back of the throat), the larynx (the voice box), and even the back of the nasal passages. LPR patients may experience heartburn, but may also experience a number of additional symptoms, including:

  • Frequent throat clearing

  • Persistent or chronic cough

  • Hoarseness

  • Sensation of a lump in the throat that does not clear with swallowing

  • Feeling of postnasal drip

  • Difficulty swallowing

  • Difficulty breathing

  • Frequent sore throat

LPR may affect individuals of all ages, genders, and races. It is common in infants, as their esophageal sphincters may not have fully developed, their esophaguses are shorter, and they spend much time lying on their backs, which may cause reflux at any age. The pooling of stomach acid in the unprotected throat tissues may cause long-term damage in children, such as contact ulcers, frequent ear infections, and lasting buildup of fluid in the middle ear. Adults with LPR may also experience long-term effects, including scarring in the pharynx and larynx. The exposure to acid and chronic irritation of the areas may also increase a patient’s risk of developing a number of forms of cancer. LPR patients who are also afflicted with bronchitis, asthma, or emphysema may experience further complications of their respiratory conditions.

Only a doctor can diagnose LPR. Once diagnosed, it may be recommended that a patient undergo certain lifestyle changes, including identifying and avoiding triggering foods, abstaining from eating at least three hours prior to bed, and elevating the head of one’s bed. In infants, smaller and less frequent feedings may be recommended, as well as keeping the infant in a vertical position for at least 30 minutes following feedings. Medications may be prescribed to help alleviate symptoms that persist despite lifestyle changes, and severe cases may call for surgery. If you suspect you or your child has LPR, your doctor will work with you to determine the best course of action for your individual case.


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