What Is Silent Reflux?

The feeling of a lump in the throat or a bad taste in your mouth when you wake in the morning can also signal LPR.

Problem is, these warning signs mimic symptoms associated with other conditions (including allergies and the common cold) and lifestyle habits (such as overeating, eating late, lying down right after a meal).  

“Diagnosis of LPR is sometimes difficult because the symptoms are very nonspecific,” says Lee Akst, M.D., associate professor of otolaryngology — head and neck surgery, at Johns Hopkins Medicine and director of the Johns Hopkins Voice Center. They can also be caused by other nonreflux issues, he says, including dryness, subtle vocal cord lesions or vocal cord nerve weakness. “These can all cause the same complaints of LPR,” Akst says.

When to see a doctor

If you’re experiencing symptoms and an internet search leads you to believe it may be LPR, you should schedule an appointment with your primary care doctor.

“Given the nonspecific nature of LPR symptoms, it’s a good idea to see your doctor in a timely manner,” Zeiger says. “Although LPR rarely represents an urgent medical condition, there are other conditions that cause similar symptoms and may require more prompt evaluation and management. Your doctor will help guide you through what can be a tricky diagnosis.”

If left untreated, LPR can cause complications, including frequent infections (the stomach acid interferes with the mucus’s ability to clear infections from your throat and sinuses) and irritation that can interfere with your ability to speak and swallow. 

Treatment of LPR usually begins with lifestyle changes. “Diet and behavioral changes are fundamental to the treatment of LPR,” Zeiger says. Those include:

• Maintaining a healthy weight
• Quitting smoking
• Limiting caffeine, alcohol and carbonated drinks
• Avoiding chocolate, peppermint, tomatoes, citrus fruits and foods that are fatty, fried and spicy

“Eating meals late at night can also worsen LPR,” Zeiger adds. “Many physicians recommend waiting several hours after eating before lying down so that stomach contents are less likely to reflux up to the throat.”

If symptoms persist, your doctor may recommend what’s known as acid suppression therapy using one of a variety of medications that include proton pump inhibitors (PPIs) such as omeprazole (Prilosec) or lansoprazole (Prevacid) and histamine-2 (H2) blockers. Not to be confused with antacids, which work by neutralizing stomach acid, PPIs and H2 blockers reduce the amount of acid the stomach makes.

“It's difficult to know what part of the throat complaints are related to LPR and what relates to something different,” Akst says. “That’s why the most appropriate path forward is often to treat for possible reflux and see if the patient gets better, while acknowledging that it might not be reflux, and keeping all of the other possibilities in mind.

“All too often,” he adds, “I see patients fixate on reflux and get higher and higher doses of antacids without paying attention to the other issues that might be causing their complaints.”

If lifestyle changes and medication don’t alleviate symptoms, your doctor will likely recommend seeing an otolaryngologist (a.k.a. ear, nose and throat specialist, or ENT).

ENTs often use laryngoscopy (a process in which a thin tube with a camera is inserted through the nose or mouth to look at the larynx or voice box), mainly to rule out polyps, vocal fold paralysis and cancer.

“Cancers of the aerodigestive tract can [have] similar symptoms to LPR,” Zeiger explains. Other symptoms — such as severe voice change, trouble breathing and a lump in the neck — are associated with head and neck cancer, he adds.

If symptoms worsen, your doctor may recommend a surgical procedure known as laparoscopic Nissen fundoplication. During the procedure, the area connecting the stomach and esophagus is tightened to prevent reflux.