Key takeaways

  • Silent reflux does not always cause heartburn but can irritate the throat and vocal cords, leading to symptoms like hoarseness and frequent throat clearing.
  • In infants, silent reflux can manifest as coughing, vomiting, or feeding difficulties, and a doctor should investigate any breathing or feeding problems.
  • Lifestyle changes like avoiding tobacco and maintaining a moderate weight, along with dietary changes such as avoiding acidic foods, can help relieve symptoms of silent reflux.

Silent reflux, also known as laryngopharyngeal reflux (LPR), does not always cause heartburn, but it can cause damage to the throat and vocal cords.

In LPR, stomach acid flows back into the esophagus. When these acids contact the food pipe and vocal cords, irritation, discomfort, and burning can occur.

LPR can develop in infants and adults, and it is treatable.

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LPR is also called “silent reflux” because it does not necessarily cause the same symptoms as gastroesophageal reflux disease (GERD). Many people do not experience heartburn or indigestion.

Almost all people with LPR experience hoarseness, which is the main symptomatic difference between LPR and GERD. Other potential symptoms include:

Symptoms in children and infants

The symptoms of silent reflux in infants and children may include:

It is common for infants to spit up, but problems with breathing and feeding could indicate a more serious health problem. A doctor should investigate these symptoms. Children with silent reflux will not always vomit or regurgitate.

Some symptoms, such as projectile vomiting or blood in vomit, could also indicate other health problems. Visit a healthcare professional if these symptoms appear.

Researchers are currently exploring possible links between silent reflux in children and recurrent ear infections and sinusitis.

LPR symptoms occur because stomach acid regurgitates into the throat.

In infants, the muscular valves at the end of the food pipe are still developing. These valves keep the contents of the stomach from flowing back into the food pipe. This is why infants spit up so often, especially with a full stomach.

Certain factors may increase the risk of developing LPR, including:

  • a diet with lots of acidic or fatty foods
  • caffeine and alcohol
  • eating large portions just before sleeping
  • obesity
  • smoking

To diagnose LPR, a doctor will ask about symptoms and medical history. They will also carry out a physical examination and possibly some laboratory tests.

Additional tests for LPR might include a barium X-ray and an examination of the stomach and food pipe, which involves passing through the mouth a thin, flexible tube with a camera on the end.

Diagnosis of LPR in children and infants is challenging, and there are no standardized diagnostic criteria. However, a healthcare professional may request an endoscopy of the gut if concerning symptoms are present, such as:

  • a failure to thrive without visible vomiting
  • swallowing difficulties
  • a dislike of feeding
  • unexplained distress

People can often manage LPR symptoms by adjusting their eating habits and making lifestyle changes. However, a doctor may recommend the following medications for some people:

Reflux is common in children up to the age of 1 year, and only those who have difficulty feeding or breathing require treatment. A doctor may recommend changing the infant’s feeding habits and using age-appropriate medication.

In severe cases, or when another treatment has not been effective, tube feeding and surgery may be necessary.

The following lifestyle changes may relieve symptoms of silent reflux:

  • avoid tobacco
  • chew gum that contains sodium bicarbonate
  • achieve or maintain a moderate weight
  • elevate the head when sleeping
  • sit upright while eating
  • avoid lying down immediately after eating
  • wear loose clothing
  • bend the knees when picking objects up to reduce pressure on the stomach

Tips for children

Most infants outgrow silent reflux by their first birthday. Some, however, might need treatment.

Lifestyle changes that may help include:

  • feed the infant smaller, more regular meals
  • keep the infant in an upright position for around 30 minutes after feeding
  • closely monitor for signs of breathing or feeding trouble
  • avoid exposure to secondhand smoke

If breathing or feeding problems develop, seek medical help.

Dietary changes that may relieve symptoms include:

  • drinking plenty of fluids, including water and herbal teas
  • avoiding fried and fatty foods, chocolate, alcohol, and caffeine
  • avoid foods that increase acidity, such as tomatoes, citrus fruits, and sodas
  • eating smaller meals more often
  • eating slowly and chewing well
  • avoiding exercise or lying down immediately after eating

In adults, damage to the vocal cords can occur if a person does not receive treatment for LPR. In the long term, it can lead to:

It may also increase the risk of cancer of the larynx.

Adults with persistent throat problems may benefit from speaking with a doctor, especially if they feel something is stuck in their throat. The doctor may refer them to an ear, nose, and throat (ENT) specialist.

Children with LPR symptoms that appear alongside breathing and feeding problems need to see a doctor as soon as possible. Silent reflux can have serious health consequences.

Silent reflux, or laryngopharyngeal reflux (LPR), occurs when a person regurgitates stomach acid. The acid passes up through the food pipe into the throat and can affect the vocal cords.

Most people with silent reflux have a hoarse voice. Other potential symptoms may include coughing, a sore throat, and vomiting. Some people may experience heartburn, although this is more common in GERD.

Lifestyle and dietary changes may help a person manage symptoms of LPR. If these changes do not offer relief, people may benefit from speaking with a doctor about other treatment options.