Reflux is a common condition that many adults and infants experience in their lifetime and is often treatable with changes to diet and lifestyle.
However, in more severe cases of reflux, individuals can experience discomfort, reporting frequent heartburn and indigestion.
In these cases, you may be referred to a specialist for further acid stomach tests to achieve the correct diagnosis, resulting in the most appropriate treatment plan.
However, there is also a type of reflux known as silent reflux (laryngopharyngeal reflux (LPR)), where the symptoms are less obvious, so it is not as easy to diagnose and prescribe the right course of treatment.
In this post, we look at what silent reflux is, some of the symptoms associated with the condition, and why it is often misdiagnosed.
Silent Reflux Diagnosis
Silent reflux occurs when stomach acid travels back, through, and past the oesophagus and up into the throat or nasal cavity, even passing back into a patient’s lungs.
This happens when the sphincters (valves) at the bottom of the oesophagus and entrance to the stomach aren’t working correctly, so stomach acid is able to flow back into the back of your throat, causing inflammation which can be painful.
Due to the acid bypassing the oesophagus, you won’t feel or show the more obvious symptoms of reflux, making it incredibly difficult to diagnose and a condition that can, therefore, often be overlooked.
Symptoms of Silent Reflux
- A feeling that something is stuck at the back of your throat
- A hoarse or croaky voice
- Frequent coughing to clear the throat
- Breathing difficulties
- Difficulty swallowing
- Bitter taste at the back of your throat
- Burning sensation at the back of your throat
- Sore or dry throat
- Throat mucus
- Excessive burping.
Due to the lack of a specific symptom, it is challenging to rule out LPR, which can result in silent reflux misdiagnoses and a potential delay in receiving the most appropriate treatment.
Misdiagnose Silent Reflux
When first presented with symptoms from the patient, such as a sore throat, coughing, or a croaky voice, silent reflux can be misdiagnosed as a problem with the throat related to colds, allergies, and even overuse of the vocal cords.
However, if these symptoms continue, get worse, or you develop further symptoms mentioned above, which continue over a period of six weeks, your GP may refer you to a specialist, such as the team at the Functional Gut Clinic, for further investigation and to rule out more serious conditions.
There is also a need for more awareness of the clinical differences between GORD (gastro-oesophageal disease) and silent reflux, with many GPs still unaware of the complexities and symptoms of laryngopharyngeal reflux.
It is only by carrying out specific examinations to test acid reflux that silent reflux can be diagnosed correctly.
LPR Diagnosis
It is always good to receive a diagnosis for silent reflux as soon as possible so you can receive targeted and effective treatment.
Tests that may be carried out to confirm LPR include:
- 24-hour reflux test
- pH monitoring
- Oesophageal manometry
If further tests are required upon reviewing your medical history and carrying out an initial examination, you may be asked to attend a barium swallow test or an endoscopy.
These testing procedures are excellent at diagnosing reflux and its severity in patients.
However, for those experiencing possibly silent reflux, there is a less invasive test known as the Peptest.
An excellent diagnostic tool in detecting silent reflux, the Peptest uses lateral flow technology to measure the volume of pepsin (gastric acid) present in your saliva, affecting your throat and nasal passages.
This fast and reliable test can help to diagnose laryngopharyngeal reflux effectively.
Treatment
Treatment of silent reflux can include:
- Changes to lifestyle and diet
- Losing weight (is appropriate)
- Quitting smoking
- Limiting alcohol intake
- Restricting fatty and acidic foods and drinks
- Avoiding eating 3 hours before bed
- Avoiding tight clothing around the waist
- Chewing gum, which helps increase saliva and neutralise the acid.
You may also be prescribed certain medications, including:
- Proton pump inhibitors
- H2 blockers
- Antacids
Note: Surgery will be considered for those more serious cases and will be discussed with your consultant.
If silent reflux is left untreated, it can lead to scarring on the throat and voice box, irritating certain conditions such as asthma or bronchitis, and it can affect the lungs.
Functional Gut Clinic
LPR is an inflammatory condition relating to reflux, and it is hard to diagnose due to symptoms being non-specific.
All of our team are specialists in the diagnosis and treatment of gut issues, which include silent reflux.
By collecting a comprehensive medical history and carrying out the right tests using the best diagnostic tools, we provide our patients with accurate diagnoses, leading to more effective treatment.
Please contact us if you would like an appointment, or you can request a referral to us from your GP.
Disclaimer: The information is general and does not take into account your personal situation. This information is intended to provide general guidance and should not be used for self-diagnosis or to self-treat any medical condition. If pain persists, consult your doctor.