Silent Reflux - Laryngopharyngeal Reflux (LPR)

Silent reflux is also known as laryngopharyngeal reflux (LPR), and is not a very common type of reflux. The esophagus features two sphincters  which are meant to keep the content and acidity of the stomach where they belong. These rings of muscles are located on the bottom and top of the esophagus. The one located on the bottom is known as the lower esophageal sphincter (LES) and is the most popular as it comes up frequently in any literature related to reflux, gerd or heartburn. There is also an upper sphincter which is found on the upper part of the esophagus as it joins along the upper portion of the throat, directly rear of the voice box (larynx).

The word "reflux" derives out of a Greek language and it literally means "backflow." The laryngopharyngeal reflux describes the backflow of the stomach contents through the LES and the upper sphincter into the voice box. The tricky part about this is that most people with "LPR" do not have any of the symptoms such as indigestion or heartburn and this is one of the main reasons that this condition is labeled "silent reflux." The lack of noticeable symptoms also make this illness very hard to diagnose, virtually impossible without the proper medical testing.

Symptoms of Silent Reflux:

• Post Nasal Drip 
• Long lasting Bouts of Chronic Cough 
• Difficulty Swallowing 
• A "lump" or "feeling of stuck food" in the throat 
• Hoarseness, Sore Throat or Voice Loss 

Why no Heartburn?

The reason that many individuals that have LPR do not feel heartburn is that the contents do not stay within the esophagus long enough to cause heartburn. However, since the voice box is even more sensitive than the esophagus, many other serious problems can occur and this includes complete voice loss, in growths or even cancer. In some of the more sever cases, the LPR can affect the sufferer's ability to breathe.

Do I have LPR?

As I mentioned before, since the symptoms such as heartburn do not appear it is quite hard to associate what is happening with reflux. One of the additional problems is that many of the symptoms also correlate with other illnesses such as allergies or  asthma.

This doesn't mean that you cannot figure out what is happening. If you feel a lot of mucus constantly within your throat this could be the body's defense against the acid. Saliva features a property that can neutralize acid and is one of the reasons that the body will produce large amounts of it in order to protect your throat and voice box. If you also possess a chronic hoarseness, clear your throat a lot, cough often, have a dificulty swallowing or simply feel as if there is food stuck in your throat then this could be a direct correlation to LPR.

What Doctor Should I See?

The specialist who will be able to test and and perform treatments is called the Ear, Nose and Throat Physician (Otolaryngologist ). There are a couple text that can be performed, with the most common one being the throat exam. In this one, the doctor will place a tiny camera in your throat through one of your nostrils. They will be numbed first so you shouldn't feel anything, no worries there... had one done and barely felt it, although the gag reflex may be triggered a bit in some people. There are also other tests (ph-metry, barium swallow) that can be done and requested by the doctor, but this one will allow to examine the voice box and any damage that might have been done to it.

When receiving this test, do take notes and find out the options that you have in the treatment. They could range from simple lifestyle, diet changes,  medications all the way down to a surgery.

Barium Swallow

This is an x-ray test in which the patient swallows a chalky type of material and this can be later observed on the x-ray machine. The test is able to evaluate and show the swallowing mechanism as well as any abnormality or  narrowing of the esophagus  /  throat.

pH-Metry

An overnight test that is used to measure the ph levels / acidity within the throat and esophagus. The test is called "annoying" by many, but not painful. There is a soft, small, flexible tub installed through the nose and left over 24 hours. The test is not usually performed in the hospital, so you will have to leave and come back after it is completed. The probe will measure the ph levels and through a connection to a small computer (placed around the waist) note down the results which will be looked over by the doctor.

Medication

Often,  non-prescription antacids  are recommended. These may include Mylanta , Gelucil, Maalox or other such as Alka-Seltzer . In numerous people, simple changes in lifestyle are not enough to keep the symptoms at bay and stronger drugs  might be required in order to control or neutralize the acid production.

Since reflux is one of those conditions that need continuous maintenance it is hard to actually treat it. There might be a person that feels well and thinks that they have beat it, but a few bad decisions later they have a relapse.

Is LPR dangerous?

When left untreated for a long period of time, LPR can become very dangerous. The person might suffer from choking, noisy breathing and might even develop bronchitis or b. The cancer of the voice box, throat or esophagus is not common but can also happen as a result of silent reflux.