Everything You Need to Know About Silent Reflux (LPR)

Most people have heard of or experienced GERD. If you’re familiar with GERD (gastroesophageal reflux) and acid reflux then you’re probably just as familiar with the burning sensation of heartburn and other painful symptoms associated with it. But there is another form of acid reflux called laryngopharyngeal reflux. This type often presents without heartburn. It isn’t quite as well known and often left untreated as a result.

We’re going to talk about :

• what LPR is.
• what symptoms to watch out for.
• how you can treat it so that you can get back to living your life pain-free.

What is Silent Reflux (LPR)?

LPR is very similar to GERD in its mechanism and causal factors. Both issues are triggered by acid reflux escaping through the lower esophageal sphincter (LES) muscle. A common misconception is that this is a result of excessive stomach acid. However, it is actually a result of low stomach acid. Your LES gets the signal to close after you eat from the correct levels of acid in your stomach. When there isn’t enough acid present, the LES doesn’t close, allowing acid to travel up into your esophagus, causing reflux.

The difference with LPR is that the acid travels all the way up into the throat area, causing different symptoms compared to regular GERD. The reflux causes damage as it moves upwards, including inflammation and irritation to the airway, with issues arising in the nose, sinuses, throat, voice box, and even the lungs.

The LPR patient generally doesn’t experience the symptoms of heartburn and chest pain that are closely correlated with GERD. This is why it’s referred to as “silent”. However it can cause significant discomfort so it is most definitely not “silent” for the majority of people. MIsdiagnosis due to lack of common GERD symptoms means that many people aren’t aware that they have the condition until the later stages (if ever). This is quite dangerous as it can lead to serious illness such as laryngeal cancer.

Symptoms of LPR 

Although it doesn’t usually present with heartburn, LPR does present with a number of symptoms, such as:

• Hoarseness: When stomach acid goes up into the larynx, it can cause inflammation, resulting in hoarseness or cracking of the voice, especially in the mornings. (Tip: Try lying on your left side at night to reduce this symptom.)
• Throat issues: Irritation to mucous membranes leads to extra mucus production, causing a chronic cough, a constant sore throat, a feeling of a "lump" in the throat (referred to as "Globus syndrome"), and trouble swallowing (dysphagia).
• Difficulty breathing/wheezing: Silent reflux can often make it difficult for sufferers to “catch their breath” due to the acid reflux irritation in the airway. As a result, existing respiratory conditions such as asthma can make LPR more difficult to treat (but not impossible).
• Dental decay: When stomach acid gets into the mouth it can cause tooth erosion and discoloration.
• Sinus problems: LPR can cause inflammation of the sinuses and increase the production of mucus. This mucus will commonly start to drip down the back of the throat resulting in what’s known as a post-nasal drip.

Treating Silent Reflux/LPR

Adapting your diet to include "reflux-friendly" foods can help manage LPR symptoms. Keeping a food diary to identify these trigger foods - often high-fat, sugary, or acidic - can be beneficial. It doesn’t resolve the underlying problem, and symptoms will likely come back when you start eating trigger foods again, but anything that helps is obviously a bonus.

You’re probably wondering why you need to “avoid” acidic foods if the problem is low stomach acid, right? The answer to this comes down to the very reason why adapting your diet treats the symptoms but doesn’t actually resolve your acid reflux. When you adapt your diet to make it less acidic, you’re sticking a band-aid on the problem. There’s less acid in your stomach to get through your open LES, so that’s a win. BUT you’re not treating the main problem. Which is that your LES shouldn’t be open after you eat in the first place. If your LES was performing optimally, it wouldn’t matter what you ate.

Addressing the Root Cause

In the long-term, silent reflux is best treated by addressing the root cause, which is most commonly the exact same thing that causes GERD: low stomach acid. By adding supplements to your diet to increase acid production, you can get your lower esophageal sphincter muscle working properly again so that you don’t experience reflux at all anymore. This is what we do with our Reflux Inhibitor in combination with the Acid Relief in our Heartburn Relief Kit to heal any irritation and inflammation. 

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