Most of us have heard of gastroesophageal reflux disease, frequently referred to as GERD. GERD is one of the most commonly diagnosed digestive disorders in the U.S. According to the American College of Gastroenterology, more than 60 million Americans experience heartburn at least once a month. “GERD is a common and oftentimes a complex, chronic condition that manifests in various ways other than with the typical ‘heartburn’ symptoms. It can be difficult to diagnose and manage, but with the proper dietary, behavioral and medical therapy, a patient can return to a normal healthy life,” says Chris Lascarides, MD, gastroenterologist at Mather Gastroenterology. If you have GERD, you may have experienced heartburn or indigestion. But is it possible to suffer from reflux and not know it?
Laryngopharyngeal reflux (LPR) or “silent reflux” is a condition in which acid from the stomach travels up the esophagus and gets to the throat. This type of acid reflux typically does not produce heartburn or indigestion like GERD. Because these hallmark GERD symptoms are absent, or “silent,” many people don’t realize they’re suffering from reflux.
What’s the difference between silent reflux & GERD?
At either end of your esophagus is a ring of muscle called a sphincter. Normally sphincters keep the contents of your stomach where it should be – in your stomach. With GERD, the lower sphincter does not work properly. This allows stomach acid to back up into the chest, causing the tell-tale symptom of heartburn. With silent reflux, the upper sphincter doesn’t work correctly and the backflow of stomach acid and digestive enzymes (pepsin) can wreak havoc on the esophagus causing inflammation in sensitive areas that are not protected against gastric acid exposure.
Someone with silent reflux may not have classic GERD symptoms, particularly heartburn, making it more difficult to diagnose, and leaving the sufferer unaware that they have it. The most common symptoms of silent reflux include:
- Mild difficulty swallowing
- Non-productive throat clearing (with feeling of a lump in the throat)
Unfortunately, because symptoms of silent reflux, such as a cough and sore throat can be attributed to many other illnesses, diagnosis can be difficult. The pooling of stomach acid in throat caused by LPR can create long-term irritation and damage, and without treatment it can lead to serious problems, such as scarring the throat and voice box and increasing risk for cancer. This is why proper diagnosis and treatment is so important.
Treating silent reflux
Most cases of silent reflux can be managed with lifestyle changes, such as:
- Losing weight, if necessary
- Quitting smoking
- Avoiding alcohol, chocolate, mints, fatty foods, citrus fruits, carbonated beverages, spicy or tomato-based products, red wine and caffeine
- Stopping eating at least two to three hours before bed
- Making sure your head/upper portion of your body is propped up in bed to help keep stomach acid from backing up into your throat
- Avoiding wearing tight-fitting clothes around the waist
- Taking medication such as antacids to help neutralize acids, or other prescription medications at your doctor’s direction
Most people respond well to self-managed care; however, in some cases silent reflux symptoms may persist despite lifestyle changes and medications. In these instances, surgery may be recommended to tighten the esophageal sphincter. Although silent reflux is an uncomfortable and potentially serious condition, with the right diagnosis and treatment it is possible to keep symptoms under control and avoid complications.