Gastroesophageal reflux disease (GORD) occurs when acid from the stomach enters the oesophagus, causing discomfort. Heartburn is the most common symptom due to the irritation from the acid. However, in some people, the acid enters into the oesophagus and higher without causing heartburn.  

Without any discomfort, this silent acid reflux can lead to damage to the throat and vocal cords because of prolonged acid exposure. Below, we cover everything you need to know about silent reflux, from the symptoms to diagnosis and treatment.  

In this guide: 

What is Silent Acid Reflux? 

Silent acid reflux, or laryngopharyngeal reflux, occurs when acid rises above the stomach without causing any heartburn. Usually, heartburn, chest pain, and nausea are characteristic of nausea. However, without these symptoms, diagnosing reflux is much harder. 

Repeated exposure to acid can damage the oesophagus and other structures. The throat, voice box, and even the nasal passage are at particular risk. Long-term, if left untreated, the irritation can lead to scarring, ulcers, and increased risk of cancers.  

Silent reflux is common in infants as their lower oesophageal sphincters (which block acid from rising higher) are undeveloped.  

Causes of Silent Reflux 

Laryngopharyngeal reflux has a similar underlying cause as regular reflux disease. The lower oesophageal sphincter (LOS), which usually blocks acid from exiting out of the stomach, doesn’t work or is too weak. As a result, stomach acid can enter into the oesophagus and other upper GI structures, e.g., voice box, throat, and nose.  

Risk factors for silent reflux include: 

• Pregnancy

• Obesity or being overweight

• Smoking, alcohol, or caffeine consumption

• Consuming trigger foods (e.g., spicy, fatty, or acidic foods)

• High-stress levels

• Hiatus hernia

• Certain medications (e.g., antihistamines, sedatives, or blood pressure drugs)

Silent Reflux Symptoms 

Given its name, silent reflux usually doesn’t present with any immediate symptoms. The acid itself does not cause any discomfort. It’s only when the acid begins to affect other structures that you may notice an issue. 

Potential silent acid reflux symptoms include: 

• Chronic throat clearing

• Persistent cough not related to illness

• Hoarseness or voice changes

• Sensation of a lump in the throat

• Post-nasal drip or excess throat mucus

• Difficulty swallowing (dysphagia)

• Sour taste in the mouth without heartburn

Infants and children often cannot complain about what they feel. Instead, you have to notice the consequences of silent reflux. Look for: 

• Frequent coughing or choking, especially during feeding

• Hoarseness or raspy voice

• Difficulty feeding or refusal to eat

• Persistent hiccups

• Breathing difficulties, such as wheezing

• Irritability or crying after eating

• Poor weight gain or failure to thrive 

Complications of Silent Reflux 

A single episode of silent reflux is unlikely to cause any lasting damage. But, because silent reflux doesn’t trigger any discomfort, repeated episodes of reflux are more likely. Over time, the acid begins to irritate and damage structures in your throat. 

In infants and children, it can cause: 

• Contact ulcers

• Recurrent ear infections

• Narrowing of the region below the vocal cords

In adults, acid damages the oesophagus, leading to permanent cellular changes. Sometimes, these changes can become cancerous. It may also worsen conditions such as asthma or COPD. 

Diagnosing Silent Acid Reflux

Silent reflux is, by its nature, hard to diagnose. Patients must continuously look out for the telltale signs of each episode. If you notice a repeated sour taste, experience voice loss, or have a cough that persists for several days or weeks, speak to your doctor. 

Often, it might not be anything to worry about. However, several of these symptoms are indicative of laryngopharyngeal reflux. If your doctor suspects there is a problem, they will perform a physical examination. Tests for acid reflux disease may include: 

• Endoscopy. A camera is inserted into your throat to visualise the throat and vocal cords. The doctor can observe the region and even pass it down into the oesophagus to determine the underlying cause.

• Gastric Reflux Test. A catheter is inserted via the nose into your throat and oesophagus. For 24 hours, the monitor detects any changes in pH, monitoring for any signs of acid reflux. If the test is positive, an endoscopy may be necessary.

• LPR Reflux Test. Similar to the gastric reflux test but using a different catheter to assess for reflux particularly in the throat region.  

During testing, your doctor may observe changes to your oesophagus. Routine evaluations may be necessary in the future to monitor for any changes.  

Silent Reflux Treatment

The treatment for silent acid reflux is the same as for GORD. Your doctor will prescribe a medication to reduce acid production in the stomach. Antacids, which neutralise the acid in your stomach, are effective at stopping an acid attack. However, because of the nature of silent reflux, they’re not an effective treatment.  

Common medications include: 

• Proton Pump Inhibitors (PPIs). Reduce stomach acid by blocking the enzyme responsible for acid production, providing long-lasting relief. Examples: Omeprazole, Esomeprazole, Lansoprazole.

• H2 Receptor Antagonists. Decrease stomach acid by blocking histamine receptors in the stomach lining, offering quicker but shorter-term relief. Examples: Ranitidine, Famotidine, Cimetidine. 

In addition to medication, your doctor will recommend several lifestyle changes. Each change will mitigate the risk factor for silent reflux. These include losing weight, eating a healthier diet, and minimising or eliminating smoking and alcohol. You can also prop yourself up in bed when you sleep to reduce the effect of gravity.  

Effective Testing for Acid Reflux Disease

Suspect you might have silent acid reflux? Ordering a gastric reflux test is the simplest solution. It provides a comprehensive evaluation of your symptoms, detecting the presence of acid outside the stomach. It’s perfect for people with silent reflux.