Most of us have felt the effects of acid reflex on occasion, especially after a massive meal (hello, heartburn). But sometimes the symptoms of acid reflux, also known as gastroesophageal reflux (GER), are sneakier than the classic uncomfortable burning feeling in your chest.
Like GER, laryngopharyngeal reflux (LPR) happens when stomach acid travels up the esophagus and into the throat. The difference is the symptoms: people with LPR don't usually experience the telltale signs of acid reflux (such as heartburn). That's why this condition is also called silent reflux.
While you won't have to haggle with heartburn, silent reflux produces other problems (more on this later) that can be pretty perturbing.
We spoke with Clark A. Rosen, MD, chief of the division of laryngology at the University of California San Francisco Health and director of the UCSF Voice and Swallowing Center, to learn about LPR, including its symptoms and treatments.
Symptoms of Silent Reflux
Many signs of silent reflux can be attributed to other health-related issues, which is why diagnosing this condition can be tough at times. But if you have several of the following symptoms, you're likely dealing with LPR.
1. Not Sleeping Well
While you're asleep at night, stomach acid can travel back up the esophagus and stimulate the sensors in the lining of the throat, Dr. Rosen says. When this happens, the acid irritates your throat and can cause breathing problems and throat spasms. Not a nice way to wake up.
In fact, acid reflux is particularly problematic when you're lying down. Here's why: Because the stomach and throat are at the same level in this position, acid can easily flow from one to the other, Dr. Rosen says.
Sometimes this occurs when your esophagus sphincter muscle is weak or doesn't close tightly, which may lead to a hiatal hernia (when the upper part of the stomach bulges through an opening in the diaphragm and into the chest cavity), Dr. Rosen says.
Nocturnal reflux can also be the result of eating a large dinner or drinking alcohol, which can loosen the valve that separates the stomach from the throat, Dr. Rosen says.
2. Sore Throat and Hoarseness
When stomach acid scorches the delicate lining of your throat, it's no wonder your pharynx will feel like it's gone up in flames.
In addition to soreness, hoarseness can happen when you have LPR too. The vocal fold becomes swollen or irritated due to the acid exposure, which can make your voice raspy, Dr. Rosen says.
3. Coughing and Wheezing
When acid directly interacts with the throat, you might experience respiratory symptoms such as coughing or wheezing.
But you can still suffer from these symptoms without direct exposure of acid to the throat. Some research shows that acid in the lower part of the esophagus can cause the breathing tubes in your lungs (called bronchioles) to constrict like you're having an asthma attack, Dr. Rosen says.
4. Difficulty Swallowing
Struggling to swallow is another common symptom of silent reflux. When stomach acid contents encounter the throat and esophagus, inflammation and irritation will occur in the lining of the swallowing tube and the throat, Dr. Rosen says.
5. A Lump in the Throat
Similarly, inflammation — caused by acid exposure — can lead to a "lump in the throat" feeling or a foreign body sensation in the area, Dr. Rosen says.
How to Treat Silent Reflux
Luckily, LPR is very manageable in most cases. Here, Dr. Rosen shares the top strategies to soothe and stop silent reflux.
1. Limit Late-Night Eating
Nixing eating late at night will reduce the risk of acid exposure. Ideally, you should wait at least two to three hours after your last meal or snack before bedtime, Dr. Rosen says.
2. Get to a Healthy Weight
Excess weight can put a lot of pressure on the stomach and force its acidic contents up into the esophagus (especially at night), Dr. Rosen says. This can be especially challenging for people with obesity.
Consequently, sometimes losing 10 or 15 pounds can significantly help to reduce and treat reflux, he says.
3. Limit Foods That Trigger Reflux
Reduce or avoid acidic foods (think: tomato-based products) and spicy foods, Dr. Rosen says.
Also, curb your intake of coffee, chocolate and alcohol, which can relax and loosen the lower esophageal sphincter, making it easier for acid to flow from the stomach to the throat, he adds.
4. Stop Smoking
Puffing also promotes reflux, Dr. Rosen says. Just another reason to quit the habit.
5. Take Medication
Amending your diet and daily habits should always be the first step — and sometimes the only one needed — to treat LPR, Dr. Rosen says. But in certain cases, you might turn to a medicine to treat acid reflux. Here are some options:
Antacids: Antacids neutralize the acid in the stomach. This reduces the likelihood that acid will leave the stomach and cause problems up in your throat, Dr. Rosen says.
But you shouldn't rely on antacids as a long-term solution for silent reflux, Dr. Rosen says. Instead, use an antacid if you're having an acute episode (for instance, you had a late-night meal of pasta with tomato sauce and a glass of wine).
Alginate: Alginate is a chemical that comes from seaweed, and, when mixed in the right combination inside your stomach, it forms a barrier — like a raft on top of the fluid in your stomach — which prevents acid from traveling into the esophagus, Dr. Rosen says.
Alginate comes in liquid or gel form, which you ingest after a meal.
Histamine H2-receptor antagonists: Also known as H2-blockers, these over-the-counter medicines (like Pepcid) work by reducing the amount of acid produced by the stomach, Dr. Rosen says.
Proton pump inhibitors: More potent than other therapies, this medicine also decreases acid production in the stomach. "Still, most people won't need something so strong and will do well with OTC Pepcid," Dr. Rosen says.
Also worth noting: Some preliminary research has hinted at serious complications (like development of Alzheimer's disease, heart disease, kidney disease and community-acquired pneumonia) from prolonged use of protein pump inhibitors, Dr. Rosen says. However, more rigorous studies are needed to validate the possible correlation, he adds.