Silent Reflux 101

Approximately half of the patients who have silent reflux have symptoms like heartburn, which almost everyone with acid reflux experiences.

You are probably thinking, “What is silent reflux?” Most people do not realize that there are actually two types of reflux: traditional acid reflux, which is also called gastroesophageal reflux disease (GERD), and less commonly known laryngopharyngeal reflux (LPR), or “silent reflux.” While both occur in the same way, they present with different symptoms.

Voice, swallowing and breathing specialist Matthew R. Naunheim, MD, MBA treats LPR at Massachusetts Eye and Ear. Below, he shares helpful information on causes and symptoms, as well as tips for treatment.

What is silent reflux?

Silent reflux occurs when gastric contents from the stomach move up the airway digestive tract and head into the esophagus. The esophageal sphincter, which acts as a valve at the upper part of the stomach, can lose muscle tone and allow stomach contents to travel back into the esophagus and throat. “Generally, it should be a one-way system,” said Dr. Naunheim. “The lining of the throat is easily irritated by the acid and enzymes found in the stomach.”

How does it differ from acid reflux?

Silent reflux causes damage to the upper aerodigestive tract, while acid reflux harms only the esophagus. LPR is referred to as silent reflux because the symptoms that patients experience often do not feel like traditional acid reflux. That is, changes to the voice, the sensation of something being stuck in the throat, excessive dry cough or chronic throat clearing.

What should you do if you suspect you have silent reflux?

Before trying any at-home remedies, make an appointment with your primary care physician (PCP). Most of the time, your PCP will be able to manage your reflux symptoms. If what you are experiencing is out of the ordinary, where it does not go away with treatment or your voice does not return to normal, your PCP may refer you to a gastroenterologist (for esophageal symptoms) or an ear, nose and throat specialist (for throat symptoms).

How can it be treated?

If your doctor confirms you have silent reflux, there are several lifestyle changes you can make to reduce symptoms:

• Maintain a healthy diet; limit intake of carbonated beverages, caffeine, peppermint and spicy foods
• Eat smaller meals so the stomach is less full
• Avoid lying down after eating
• Try not to eat within three hours of going to sleep
• Consider a nutrition and weight loss program

“For my patients, tomato sauce and coffee are the most common culprits in causing silent reflux to flare up,” noted Dr. Naunheim.

Are there other ways to manage silent reflux?

If dietary and lifestyle changes do not work, over-the-counter and prescription medications can be taken to treat silent reflux. The type of medicine recommended is based on the severity of the symptoms. Typically, it is something that is taken once or twice a day, 30 minutes before or after a meal, to help reduce the amount of acid in the stomach. You should always consult a doctor before taking any medications and schedule any follow-up as needed.

“I am realistic with my patients, who are adults and can make their own choices,” said Dr. Naunheim. “To prevent silent reflux from acting up, you do not need to completely cut out certain foods, but rather make modifications to your diet and habits.”

About our expert

Dr. Matthew Naunheim is a voice, swallowing and breathing specialist at Massachusetts Eye and Ear. His research focuses on observing patient preferences in order to make the best decisions for them in the clinic and operating room. He sees patients at Mass. Eye and Ear’s main campus.