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Acid Reflux

Silent Reflux or LPR: A Hard-To-Diagnose Cousin Of Acid Reflux

Jun 29, 2017

Silent reflux or Laryngopharyngeal reflux (LPR) is a condition in which the acidic contents of the stomach travel as far as the larynx (voice box) and the back of the throat. They inflame the sensitive larynx and may cause damage to it.

Silent reflux is similar to GERD, wherein there is backflow of stomach contents into the esophagus or food pipe. However, this condition might not present itself with the typical symptoms of GERD, like heartburn. That is why it is tough to diagnose and is called “silent reflux.” LPR is quite common in infants and young children due to their undeveloped esophageal sphincters. Esophageal sphincters are muscular valves that guard the upper and lower ends of the esophagus. While the upper esophageal sphincter guards the openings of the food and wind pipe, allowing only food to enter the esophagus, the lower esophageal sphincter (LES) allows swallowed food to enter the stomach. The LES keeps the acidic contents of the stomach within the stomach. If the LES is undeveloped (as in the case of infants and young children), it can open backwards allowing stomach contents to slosh back up the esophagus. This is called acid reflux. LPR can also occur in adults, usually with a risk of more damaging complications.

Symptoms of Silent Reflux

When this condition occurs in children, symptoms include:

  • Hoarseness
  • Chronic cough (that usually does not get resolved with common cough medication)
  • Noisy breathing (there might also be pauses in breathing)
  • Trouble feeding, vomiting food while feeding

Symptoms of silent reflux in adults could include:

  • Persistent cough
  • Hoarseness
  • A feeling of a lump in the throat that doesn’t go away even after repeated swallowing
  • Excess throat mucus
  • Trouble swallowing
  • Sore throat
  • Trouble breathing
  • A bitter taste at the back of the throat

Causes of Silent Reflux

Causes of Silent Reflux

Causes of Silent Reflux

Acid reflux (backflow of acidic contents of the stomach into the esophagus, or food pipe) occurs when the lower esophageal sphincter (LES) is weakened due to one (or more) of many reasons. The LES is a muscular valve that guards the junction between the esophagus and the stomach. While it allows food that is swallowed to enter the stomach, it does not, usually, open upwards to allow backflow of stomach contents.

In GERD, the backflow causes heartburn in the chest as the refluxate (stomach contents) burns and irritates the sensitive lining of the esophagus. In silent reflux, however, there is rarely any heartburn.

In infants and young children, reflux can occur because their esophageal sphincters aren’t fully developed and may not be able to hold the acidic contents within the stomach. When their stomachs are full, infants usually spit up food. A full stomach exerts pressure on the sphincter, which opens upwards causing backflow of food.

Certain physical characteristic may put you at risk of silent reflux:

  • A hiatal hernia
  • A stomach that empties slowly (This condition, also called “gastroparesis” may be caused due to damage to nerves that control the muscular movements of the stomach. Food remains inside the stomach for a long time and does not move efficiently into the small intestine. The food exerts pressure on the LES and causes acid reflux)
  • Problems with esophageal contractions (Esophageal contractions are normally occurring rhythmic muscular movements that help move the swallowed food forward and into the stomach. However, in certain cases these contractions are irregular and uncoordinated leading to spasmodic, severe pain. This condition can put you at risk of acid reflux.)
  • Weakened LES

Individuals who use their voices a lot (singers, teachers) are also at risk of this condition. A common finding is that individuals often suffer from a cold or a flu before they develop silent reflux. These conditions make the larynx more sensitive to the acidic stomach contents.

Complications of Silent Reflux: Why You Should Not Allow Your GERD To Cause It

Silent Reflux, if left untreated, can damage the vocal cords (larynx), often permanently. The larynx is a sensitive organ and can easily be damaged by constant exposure to acidic contents of the stomach.

In children, silent reflux can cause infections of the ear as well as that of the sinus (sinusitis). It can also cause narrowing of the area below the vocal cords. This may change their voice permanently.

In adults, apart from vocal cord damage, silent reflux can also increase the risks of cancer in the area. An existing asthma, bronchitis or emphysema can worsen. Lungs may be affected and cause a host of different lung-related health complications.

Treatment of Silent Reflux

silent reflux

Treatment of Silent Reflux

Based on your symptoms, your doctor may suspect silent reflux and may prescribe you conventional anti-reflux medication that includes proton pump inhibitors, H2 blockers and acid neutralizers. However, these medicines have their own side effects and may do more harm than good in the long run.

You may also need to make certain lifestyle modifications so as not to aggravate your condition. These will include quitting smoking and drastically limiting (or stopping) alcohol consumption and identifying and eliminating trigger foods (usually, spicy foods, chocolates, tomato-based foods, etc).

Sometimes your doctor may advise a surgery to strengthen your esophageal sphincter if it has become very weak.

At Sepalika, we believe in the Functional Medicine approach, where doctors look at the body as a complex machine with multiple of inter-dependent organ systems. Chronic health conditions are caused when there is an imbalance in the bodily functions that the body is unable to correct on its own. This is where intervention is required. This intervention looks to correct the imbalance through a combination of diet, lifestyle changes, correcting nutritional deficiencies through dietary supplements and managing everyday stress.

Silent reflux is no different and it has to be treated at its root. If we understand the real reasons for acid reflux and treat the underlying condition, we can surely treat silent reflux too.


Silent reflux, or LPR, is a difficult-to-diagnose variant of acid reflux. It can cause damaging health complications that include permanent damage to the vocal cords and cancer, among others. Heartburn is rarely present and this is what makes it challenging to identify. And yet there are certain tell-tale signs that may be used to arrive at a conclusion and treat the problem at its root, through a holistic approach.

Jitendra Rathod
Jitendra is a microbiologist and a passionate student of the human body. He is a firm believer in the power of alternative and holistic medicine. He believes nature holds the key to restore us back to health and balance.