Understanding Silent Reflux: Symptoms, Causes, and Treatments

What is silent reflux?

Silent reflux is the laryngopharyngeal reflux in which the contents of stomach with acid travels up the oesophagus and reaches the throat and voice box. This is called silent reflux because many of the patients wont be having the symptom of heartburn as in Gastro oesophageal reflux disease and that’s why it can be difficult to diagnose.

What causes Silent Reflux?

When we swallow, food passes down the throat and through the esophagus to   stomach . A muscle called the lower esophageal sphincter controls the opening between the esophagus and the stomach.
The muscle remains tightly closed except when we swallow food. When this muscle fails to close, the
acid-containing contents of the stomach can travel back up into the esophagus and can reach the
throat, voice box or the back of the nasal cavity.It can cause inflammation in areas that are not protected against gastric acid exposure.

What are the symptoms and signs of Silent Reflux?

  • Sore throat
  • A sensation of a lump in the throat
  • The feeling of mucus sticking in the throat and airways
  • Red, swollen, or irritated larynx (voice box)
  • Excessive throat clearing & persistent cough
  • Hoarseness & pain while speaking
  • Excessive belching
  • Trouble breathing or Asthma-Like Symptoms
  • Nausea
  • A feeling of postnasal drip or excessive throat mucus
  • Difficulty swallowing (Dysphagia)

What are the tests for diagnosis and evaluation of Silent Reflux?

  • Pharyngo-laryngo-oesophagoscopy
  • Esophageal pH (acid) Evaluation
  • Swallowing study- Xray Barium swallow/Flexible endoscopic evaluation of swallowing

What are the complications of Silent Reflux?

  • Increased risk of cancer in the esophagus, throat, voice box, and lungs
  • Acid erosion and scaring in the throat and larynx
  • Ulcers
  • Formation of a stricture
  • Choking
  • Aspiration which may lead to pneumonia
  • Problems with the lungs including asthma, emphysema, and bronchitis

What are the available treatment options for Silent reflux?

  • Acid reflux medications (Antiacids, H2 blockers, Proton pump inhibitors, Prokinetics etc)
  • If medications fail, surgical options exist for correcting the stomach valve and preventing acid reflux.
  • surgery to repair structural abnormalities if any exist.

What are the Lifestyle modifications to be made for prevention and treatment of Silent reflux?

  • Taking meals at regular timings
  • Eating smaller meals 4-5 times a day is better that 2-3 larger meals.
  • Avoiding  heartburn trigger foods
  • Avoiding tight clothing around the abdomen/waist
  • Stopping use of  nicotine products
  • Avoiding alcohol
  • Losing weight if  overweight
  • Fasting 2-3 hours before  bedtime
  • Raising the head of the bed 6-8 inches
  • Adopting a low-fat, high-fiber diet
  • Avoiding processed foods

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