Silent Reflux: Meaning, Causes, Risks & Treatment

Many people suffer from sore throats with changes in the weather, but for some, it could be a symptom of something much more serious. They could have what is known as silent reflux.

What is Silent Reflux?

Silent acid reflux is a situation in which acid comes up through a valve into the esophagus from the stomach, creating a lot of irritation in the throat area, but not necessarily in the stomach.

The stomach has a protecting liner but in the oesophagus it is absent, so some irritation may be felt there. It affects one's ability to speak, and then one starts experiencing frequent sore throat, cough, and pain in the sternum, which is the breast bone.

Expert care for silent reflux

Laryngologists (ear, nose, and throat doctors who specialise in larynx issues) have vast experience identifying and treating silent reflux and other oesophagal, throat, and laryngeal disorders. They usually start by recommending medication and lifestyle changes. Next, they may propose sophisticated minimally invasive procedures if nonsurgical treatment fails.

Causes of silent reflux

There are several things that can induce reflux. Most don't realize that silent reflux or laryngeal pharyngeal reflux (LPR) is the cause of their symptoms. When people eat, food goes down the oesophagus into the stomach.

There is a sphincter (elastic-like ring of muscle) at its connection with the stomach that closes to prevent stomach contents from going up the oesophagus. Acidic stomach contents can run back into the oesophagus, up to the neck and larynx if the sphincter does not close properly. This can lead to silent reflux.

Silent reflux symptoms

Silent reflux, as the name implies, causes few symptoms. Compared to silent reflux, gastroesophageal reflux disease (GERD) causes symptoms. Most persons with silent reflux do not have heartburn or chest pain but may experience the following silent reflux symptoms:

1. A feeling of a continual lump in the throat
2. Hoarseness
3. Asthma
4. Postnasal dripping
5. Swallowing Difficulties
6. Reduced vocal stamina
7. Raspy sound
8. Persistent cough
9. Discomfort when singing

Any of these symptoms could be indicative of silent reflux. While these symptoms are common and seemingly minor, they do point to a problem needing to be addressed. If one has continuing silent reflux symptoms it is necessary to see an ENT specialist for a prompt evaluation.

Diagnosis of silent reflux

A primary doctor performs a detailed examination to obtain a diagnosis. This will most likely include obtaining a history of symptoms and information on therapies tried and when symptoms are likely to occur.

A doctor may send a patient to a gastroenterologist if they believe they would benefit from a second check-up. In addition, if one has silent reflux and scarring or damage because of it, the doctor may refer a patient to an otolaryngologist (ENT specialist).

They may perform additional testing if necessary, such as the following.

• Acid reflux test: A test to determine the amount of acid in the fluid inside the oesophagus.
• Endoscopy: A procedure that uses a long, thin tube with a lit camera at its tip to see inside the throat and oesophagus.
• Swallowing study: This test evaluates how food passes from the mouth via the oesophagus using a specific liquid called barium that shows up on X-rays.

How silent reflux is treated

Silent reflux can be treated through lifestyle changes and medicine.

These lifestyle adjustments are intended to help lower the risk factors that contribute to reflux. Among these lifestyle changes are:

1. Refraining from eating and drinking at least three hours before going to sleep.
2. When sleeping, raising the head higher.
3. Identifying trigger foods and limiting or eliminating them. Chocolate, spicy foods, citrus, fried foods, and tomato-based dishes are common examples.
4. Quitting smoking.
5. Learning to manage stress.

Stimulants could be different among individuals. One might require some medical intervention despite efforts to manage the reflux through lifestyle changes. The medication will also help to mitigate any damage caused by silent reflux. However, it will not reverse it.

The following are the most commonly used drugs to treat silent reflux:

• H2 blockers, such as Tagamet, Pepcid, or nizatidine to reduce gastric acid.
• Proton pump inhibitors (PPIs), include Prevacid, Nexium, and Protonix to reduce gastric acid.
• Antacids to neutralize the acid.
• Sucralfate to help protect damaged mucous membranes.

A doctor may also prescribe an over-the-counter antacid such as Mylanta or Gavascon, for when the reflux really flares up, especially straight after meals. Surgery is only rarely required.

Risk factors

Signs of silent reflux can affect people of any age or gender. Common risk factors include:

1. Overweight
2. Height
3. Pregnancy
4. Sustained stress levels
5. Smoking
6. A deformed or malfunctioned oesophagal sphincter

Certain food groups like citrus, tomato, chocolate and spicy foods also contribute to reflux. Beverages such as coffee and alcohol and carbonated drinks all add to the risk.

Left unattended, reflux can have a serious negative impact on the voice. And more importantly, chronic reflux, when not treated and managed, can lead to cancer of the oesophagus, a condition that has an extremely low survival rate.

Those who suspect that they are suffering from silent reflux symptoms are advised to visit a doctor, who is best placed to direct their care.