Despite the absence of heartburn, many people with LPR report a wide variety of symptoms due to the damage the acid causes to their voice box, respiratory system, teeth, and throat. “Reflux can be what we call extra-esophageal,” notes Michael Vaezi, MD, PhD, clinical director of the division of gastroenterology and hepatology and director of the Center for Esophageal Motility Disorders at Vanderbilt University in Nashville, Tenn. “These patients may not have heartburn sensation in the chest. It’s not really silent, [but it is] presenting atypically.”
Not So Silent Symptoms
If you have LPR you may experience:
Hoarseness. As stomach acid comes up onto your voice box, or larynx, you may find your voice sounds more hoarse or harsh than usual. This symptom may be particularly noticeable in the mornings, since acid is often more likely to move up the throat when you are lying down.Throat problems. Acid reflux into the pharynx, or back of the throat, can also cause atypical symptoms. You may feel as if you constantly have sore throat, or always need to clear your throat. Additionally, it may feel as if there is a lump in the back of your throat that won’t go away. Other symptoms include frequent hiccups, trouble swallowing, or a nagging cough.Respiratory problems. People with silent reflux can experience wheezing or difficulty catching their breath as a result of airway irritation due to acid reflux. LPR can often exacerbate underlying asthma and make it more difficult to treat.Tooth decay. Stomach acid that backs up into the mouth can erode or eat away at the protective enamel of the teeth, causing teeth to become fragile and discolored.
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Treating Silent Reflux
If your doctor suspects LPR they may order some tests to confirm their diagnosis and determine which treatment option is best for you. These tests include:
Barium swallow. This test involves a series of X-rays of the upper gastrointestinal system, or digestive tract, performed after a patient drinks a special barium solution. The contrast solution allows doctors to evaluate the digestive tract for structural problems that may be associated with LPR.Endoscopy. Doctors insert a lighted tube attached to a small camera into the throat. The tube is used to examine the larynx, pharynx, and esophagus for signs of damage consistent with acid reflux. Tissue samples are usually taken to test in the laboratory for any evidence of chronic irritation, inflammation, infection, or abnormal cells.pH monitoring. A thin tube is inserted through the patient’s nose and down into the esophagus. A device at the end of the tube measures the acidity, or pH, of the inside of the esophagus over a period of one to two days. Alternatively, a capsule is attached to the wall of the esophagus to monitor pH levels. The capsule then detaches and is passed through the patient’s digestive system. Abnormally high levels of acidity are suggestive of LPR.Proton pump inhibitor test. Your doctor may try to diagnose your problem by treating you with a trial of proton pump inhibitors, which reduce the amount of acid secreted by the stomach. If your symptoms improve or disappear with medication then you most likely have LPR.
Silent reflux is most often treated with proton pump inhibitors such as Nexium (esomeprazole), Protonix (pantoprazole), Prevacid (lansoprazole), Aciphex (rabeprazole), or Prilosec (omeprazole). Lifestyle changes can also help reduce LPR symptoms. Your doctor may recommend:
Quitting smokingAvoiding alcoholEliminating caffeineLosing weightDitching meals three hours prior to bedtimeElevating the head of your bed four to six inchesAvoiding restrictive clothingDietary changes (Foods that are fatty, fried, spicy, or include mint or chocolate should be avoided)
In some cases, LPR symptoms may persist despite lifestyle changes and medications. In these instances, surgery may be recommended to tighten the lower esophageal sphincter. Although LPR is an uncomfortable and potentially serious condition, with the right diagnosis it is possible to keep symptoms under control and avoid complications.
