Gerd Silent Reflux | Silent Reflux

Everything you Need to Know …and More

Essential Information about…Laryngopharyngeal

What is Laryngopharyngeal?

Laryngopharyngeal (LPR) is where the contents of your stomach up flow back up into your oesophagus (food pipe) and all the way to the throat and/or the voice box. Stomach juices are made up of strong digestive acids, containing enzymes which break down our food. The stomach lining is designed to cope with these juices, but the voice box or throat is not and so the stomach juices cause irritation in your throat.

Laryngopharyngeal Symptoms

LPR is often referred to as ‘silent reflux’ as many people do not experience heartburn or indigestion.

If you do experience symptoms then these may include:

A hoarse voice
A sore throat
Excessive throat clearing
Chronic dry cough
Mucous/phlegm (particularly in the morning) in the throat
A sour taste in the mouth
Difficulty in swallowing
Heartburn, acid reflux or indigestion
A feeling of a lump or tightness in the throat
A burning/dry throat
Occasional difficulty in breathing/exacerbation of asthma
Choking or coughing episodes, especially at night
Excessive burping/belching, particularly during the day

Sometimes these symptoms may be caused by other medications you are taking (such as anti-inflammatory drugs – known as NSAIDs) and therefore you will be prescribed extra medication to take alongside in the form of proton pump inhibitors (PPIs).

Diagnosing Laryngopharyngeal

Diagnosis will be based on the description of your symptoms and the length of time you have been experiencing them.

Silent reflux is usually diagnosed by examination of your throat and voice box by an ENT doctor using a small camera on a thin flexible fibre-optic telescope passed through the nose.

If your symptoms are severe, your doctor may send you for further tests to measure the acid level in your throat and oesophagus, and if, necessary, refer you to a gastroenterologist (a doctor specialising in stomach and digestive problems).

You may be referred for medical tests, such as:

An Endoscopy
A Barium Swallow
An Oesophageal Manomentry
A Capsule Sponge Test

Laryngopharyngeal Treatment

Treatment may include:

Medications

Antacids: Non-prescription ‘over the counter’ liquid antacids/alginate preparations, such as Gaviscon
Proton pump inhibitors (PPI’s): Prescribed by your GP, these acid blocking tablets reduce stomach acid, for example: Rabeprazole (Pariet), Pantoprazole (Protium), Lansoprazole (Zoton), Omeprazole (Losec) or Esomeprazole (Nexium)
Other medications: Such as ranitidine (Zantac) or cimetidine (Tagamet) are used especially for patients who cannot tolerate PPi’s

Lifestyle Changes

Do	Don’t
Take your reflux medication regularly as prescribed – missing even 1 day can cause further damage to your voice box Sit upright when eating Squat to pick up objects – bend at the knees when you pick things up Try to reduce your weight if you are overweight Elevate the head of the bed Lie on your left side rather than your right Stop smoking Minimise stress in your life	Wear tight clothing around the waist Bend over from the waist Eat ‘on the run’ Lie down, bend over or slump just after eating Eat 3 hours before going to bed Use multiple pillows under your head – this can increase the pressure in your stomach Strain, such as lifting heavy objects

Diet

Do	Don’t
Eat smaller meals more regularly Eat slowly, chewing each mouthful fully Drink water, decaffeinated coffee/tea, and diluted squash Limit alcohol intake Eat a low-fat diet After meals try chewing gum containing bicarbonate of soda (“tooth whitening gum”), or drinking bottled, alkaline mineral water	Eat too much spicy or fatty/greasy/fried food, chips, dairy products Eat and drink at the same time – instead, have a drink before/after meals Drink too much tea, coffee, or fizzy drinks Eat acidic foods such as tomatoes (including on pizza and spaghetti) and citrus fruits/juices, such as pineapple and oranges Exercise immediately after a meal

Surgery

In severe cases where medications have not been effective, Laparoscopic Anti-reflux Surgery (LARS) to tighten the valve between the stomach and the oesophagus may be required.

Laryngopharyngeal