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Silent Reflux (LPR) – Causes, Symptoms & Treatment

Silent reflux (LPR) is a form of reflux where stomach acid rises into the throat without causing typical heartburn symptoms.

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Things worth knowing about "Silent reflux"

Silent reflux (LPR) is a form of reflux where stomach acid rises into the throat without causing typical heartburn symptoms.

What is silent reflux?

Silent reflux, medically known as laryngopharyngeal reflux (LPR), is a condition in which stomach acid and stomach contents flow back up through the esophagus into the throat and larynx. Unlike classic gastroesophageal reflux disease (GERD), silent reflux often occurs without the typical symptom of heartburn, which is why it frequently goes undiagnosed for a long time.

Causes

Silent reflux develops when the lower and/or upper esophageal sphincters fail to function properly and cannot prevent stomach contents from flowing back upward. Common contributing factors include:

Weakness of the lower esophageal sphincter
Increased stomach pressure (e.g., due to obesity or pregnancy)
A diet high in fatty, spicy, or acidic foods
Alcohol and caffeine consumption
Smoking
Stress and certain medications
Hiatal hernia

Symptoms

Since heartburn is often absent in silent reflux, the symptoms are non-specific and frequently attributed to other conditions. Common symptoms include:

Chronic cough, especially at night or in the morning
Hoarseness or voice changes
Frequent throat clearing
Globus sensation (feeling of a lump in the throat)
Difficulty swallowing
Burning or scratching sensation in the throat
Excess mucus in the throat (postnasal drip)
Asthma-like symptoms

Diagnosis

Diagnosing silent reflux can be challenging due to its non-specific symptoms. The following diagnostic methods are commonly used:

Laryngoscopy: Visual examination of the larynx to assess irritation and inflammation
pH monitoring: Measurement of acid levels in the esophagus over 24 hours
Impedance-pH monitoring: Detection of both acidic and non-acidic reflux events
Gastroscopy: Endoscopic examination of the esophagus and stomach lining
Review of medical history and symptoms

Treatment

Lifestyle Modifications

Lifestyle changes form the foundation of treatment for silent reflux:

Avoiding trigger foods such as coffee, alcohol, chocolate, citrus fruits, and fatty meals
Eating smaller, more frequent meals
Avoiding eating close to bedtime
Elevating the head of the bed during sleep
Weight loss if overweight
Quitting smoking and reducing alcohol consumption

Medication

The following medications are commonly used in treatment:

Proton pump inhibitors (PPIs): Reduce stomach acid production (e.g., omeprazole, pantoprazole)
H2 blockers: Also reduce acid production
Antacids: Provide short-term neutralization of stomach acid
Alginate preparations: Form a protective barrier over stomach contents

Surgical Treatment

In severe or treatment-resistant cases, a surgical procedure such as fundoplication may be considered, in which the stomach is wrapped around the lower esophagus to prevent reflux.

References

Koufman, J. A. (2002). Laryngopharyngeal reflux is different from classic gastroesophageal reflux disease. Ear, Nose & Throat Journal, 81(9 Suppl 2), 7–9.
Lechien, J. R. et al. (2019). Laryngopharyngeal reflux: a state of the art review. Otolaryngology – Head and Neck Surgery, 160(5), 762–782. PubMed PMID: 30741580.
Vakil, N. et al. (2006). The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. American Journal of Gastroenterology, 101(8), 1900–1920.

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