What Is Silent Reflux and What Can I Do About It?

Silent reflux often goes undetected. Like acid reflux, silent reflux can cause regurgitation, difficulty swallowing, hoarseness, and a sore throat. But unlike acid reflux, it does not usually present with heartburn, and the only symptoms may relate to the throat. 

Without this very obvious symptom of burning pain, silent reflux symptoms can go unnoticed and become normalized. But silent reflux should be addressed to improve your quality of life and prevent worsening digestive conditions later on.

In this article, we’ll review the symptoms, diagnosis, causes, and treatment of silent reflux and discuss how you can address silent reflux naturally.

silent reflux: woman touching her throat

The Differences Between Silent Reflux, Acid Reflux, GERD, and LPR

Let’s start with defining “reflux” by itself. Reflux occurs when the contents of the stomach come back up into your esophagus, and sometimes all the way up to your throat. For many people (but not everyone), this causes heartburn. From there we get two different types of reflux:

  • Silent reflux: This affects the voice box/larynx and the throat/pharynx. You might feel this as a sore throat, burping, hoarse voice, etc. The reflux is “silent” because it doesn’t cause the burning pain of heartburn and so may go unnoticed for some time. 
  • Acid reflux: This affects the esophagus, which connects the throat and the stomach. The primary symptom is heartburn or burning pain.

Then, we have LPR and GERD, two conditions involving chronic reflux:

  • LPR (laryngopharyngeal reflux): You can think of LPR as the chronic presentation of silent reflux. The two terms are often used interchangeably. “Laryngo” means something that affects the larynx or voice box, and “pharyngeal” means something that affects the area at the back of the throat, called the pharynx. So together, this is reflux affecting the larynx and the pharynx. 
  • GERD (gastroesophageal reflux disease): GERD is a condition involving chronic acid reflux. This condition often overlaps with LPR. 

Silent Reflux Symptoms

silent reflux: infographic about reflux symptoms

Symptoms of silent reflux may affect the throat, larynx or voice box, and even the sinuses. If you are experiencing any of the symptoms below, you may want to see a healthcare professional for evaluation [1]. 

  • Sore throat
  • Hoarseness or vocal cord inflammation
  • Regurgitation
  • Throat clearing or tickling in the throat
  • Difficulty swallowing (dysphagia)
  • Chronic cough or frequent bronchitis
  • The feeling of a lump in the back of the throat
  • Postnasal drip
  • Sleep disturbance
  • Trouble breathing
  • Heartburn or burning sensation 

When silent reflux goes untreated, it can eventually lead to more serious symptoms, including: 

  • Narrowing of the airway just below the vocal cords [2]
  • Chronic vocal injury or scarring of the vocal folds 
  • Barrett’s esophagus (changes in the skin lining your esophagus), which can lead to a rare esophageal cancer [3]
  • Eosinophilic esophagitis [4]
man suffering from silent reflux

Diagnosing Silent Reflux

Typically you would see an ear, nose, and throat doctor (otolaryngologist) or a gastroenterologist to diagnose silent reflux. 

Doctors will look at your medical history, symptoms, and possibly test with an endoscopy to inspect your throat and stomach for inflammation, ulcers, or scarring. Unfortunately, an X-ray cannot be used to diagnose silent reflux. 

Having symptoms like trouble swallowing, frequent vomiting, and feeling a lump in your throat can in some cases be signs of a different underlying medical condition, and should be evaluated by your doctor to rule out more serious causes. 

Silent Reflux Causes

Like many digestive problems and disorders, there is no one universal cause for silent reflux. But some possible causes include: 

  • Slow transit time through the gut (low gut motility or constipation) [1]
  • Low stomach acid, low digestive enzymes, or low bile, all of which serve to digest food and kill any pathogens that enter your body with your food and drink
  • Low sphincter function: Sphincters are muscles throughout your digestive tract that allow contents to pass through and then are supposed to keep them from coming back up. In the case of silent reflux, a weak esophageal sphincter can allow stomach contents and digestive juices back into the esophagus and throat, causing symptoms [1].

Some conditions may make you more likely to develop silent reflux. These include: 

  • Hiatal hernia: This occurs when the upper part of your stomach bulges through your diaphragm. Hiatal hernia is associated with reflux for about 53% of patients [1].
  • Sleep apnea: A systematic review found that 45% of people with sleep apnea also had LPR [1].
  • Low stomach acid: Producing less stomach acid often comes with age [5], some autoimmune diseases, or long-term PPI use [6].
different high protein foods

How to Treat Silent Reflux

It’s important to begin treatment as soon as possible once you suspect you have silent reflux. This can prevent long-lasting damage to the throat and esophagus. Treatment tends to take one of two routes.

A conventional approach usually involves proton pump inhibitors, also called PPIs, like Prilosec. However, for many people, these medications may at best only be partially effective.  At least one systematic review found there was no statistical difference for patients between PPIs and a placebo [1]. Using these medications for a long period of time can also result in worse side effects, like cardiovascular complications, kidney damage, bone fracture, GI distress [7], and even an increase in all-cause mortality [1].

Surgical treatment is also possible using a procedure called fundoplication, which wraps part of the stomach around the esophagus to prevent reflux. This procedure has been found to be effective for improving LPR symptoms like cough, throat clearing, and overall quality of life, and most patients were then able to discontinue PPI use after surgery [8]. But ideally, a natural approach to healing silent reflux would make this procedure unnecessary. 

However, a natural approach using diet, lifestyle changes, and strategic supplementation can often resolve symptoms without medication or surgery. This means fewer risks and side effects. Let’s examine these methods for treating silent reflux and LPR. 

Step-by-Step Treatment Plan for Silent Reflux

To treat silent reflux through diet and lifestyle changes, follow these steps:

  1. Modify your diet and lifestyle to eliminate triggering foods and reduce stressors.
  2. Support the gut microbiome with probiotic therapy and treat pathogens in the gut (if needed).
  3. Increase stomach acid using betaine HCl if necessary. 
  4. If these first three steps don’t provide symptom relief, add additional therapeutic supplements like melatonin or prokinetic herbs. 
infographic for the natural strategy for silent reflux and LPR

Diet and Lifestyle Changes for Silent Reflux

Treating silent reflux or LPR starts with modifying your diet and lifestyle. 

If you have silent reflux or symptoms of LPR, you probably already know that eating certain foods or overeating can trigger symptoms. If you haven’t identified your food triggers yet, a simple elimination diet can help. It will also remove other inflammatory foods from your diet. 

Common triggering foods include: 

  • Oily, acidic, fried, or spicy foods
  • High histamine foods 
  • Caffeine (chocolate, coffee)
  • Alcohol [1, 9]

Beyond this, some specific diets can help improve silent reflux and LPR symptoms: 

Which diet should you start with? It’s usually best to start with a Paleo diet for 2-3 weeks, monitoring your symptoms. The Paleo diet is a simple, anti-inflammatory option that is not overly restrictive and provides relief for many people.

If symptoms don’t improve, you can move on to a more specialized diet like low FODMAP or low histamine. Give any new dietary changes a few weeks before reevaluating your symptoms. Some people experience relief right away, but others need time to adjust to the new dietary pattern. 

However, if the new diet is helping, continue it while you address other underlying issues, including imbalances in the gut. Once underlying imbalances have been improved, you can begin to gradually reintroduce healthy foods that have been eliminated, monitoring your symptoms to see what your body tolerates and what seems to trigger symptoms. 

Other eating and lifestyle habits may also help to control silent reflux: 

  • Eat three meals per day, appropriately spaced with 3-4 hours between meals
  • Avoid lying down for one hour after meals
  • Wait at least two hours before going to sleep after dinner
  • Sip water throughout the day
  • Practice vocal rest by not speaking or singing for short periods of time (an evening or a full day)
  • Elevate the head and shoulders when lying down [9]

How Gut Health Affects Silent Reflux

common gut pathogens

Research shows that your gut health, specifically your microbiome health, may relate to reflux symptoms. One systematic review showed that probiotics seemed to improve the symptoms of GERD, including heartburn, regurgitation, abdominal pain, and gas [13].

A meta-analysis also found that H. pylori, a bacterium that can infect the stomach and cause ulcers, is present in about half of LPR patients [1]. However, some research shows that H. pylori can actually protect against developing acid reflux or esophageal cancer [14]. 

We can tentatively suggest that working to reduce H. pylori and any other gut pathogens as well as supporting the beneficial bacteria in the microbiome with probiotic therapy may help improve LPR or silent reflux symptoms. 

Improve Stomach Acid Levels

infographic on risk factors for low stomach acid

Conventional treatment for LPR and silent reflux often involves suppressing stomach acid with PPIs like omeprazole, esomeprazole (Nexium), lansoprazole (Prevacid), or H2 blockers (antihistamines like Pepcid AC). The thinking goes that if stomach acid is backing up into the esophagus, there must be too much of it.

However, the opposite is often true: There’s actually not enough stomach acid present for proper digestion to take place. You may be at risk for low stomach acid if you: 

  • Are over 65
  • Have anemia or autoimmune disease
  • Frequently use painkillers or consume lots of coffee
  • Have been diagnosed with H. pylori
  • Have chronically used antacids or proton pump inhibitors (PPIs).

You can try improving your stomach acid levels by supplementing with betaine HCl with meals. Not everyone needs to do this, but many of our patients have found huge symptom relief with this extra support. If you find it doesn’t help your symptoms or makes things worse, simply discontinue. 

Other Natural Remedies for Silent Reflux

Once the previous three steps have been implemented, there are a few other options to try if your silent reflux symptoms don’t completely resolve. 

  • Melatonin may be a surprisingly effective treatment for GERD and LPR. The hormone produced by your body to stimulate sleep may also protect the esophagus from gastric acid and improve strength in the lower esophageal sphincter or LES [15]. Some studies even suggest melatonin may be as effective as a PPI for improving GERD [16, 17].
  • Sodium Alginate, a supplement derived from brown kelp, acts as a physical barrier between the esophagus and stomach. A systematic review found alginate therapy highly effective for mild GERD [18].
  • Prokinetic or promotility herbs like the RKT, Iberogast, or STW 5 formulations can help improve colon transit time, allowing your digestion to flow in the correct direction. These herbs may help with heartburn, reflux, and LES function [18, 19, 20].
doctor talking to her patient

How We Can Help With Silent Reflux

At our functional medicine center, our practitioners have years of experience treating reflux conditions, including LPR, silent reflux, and GERD. If you’re dealing with silent reflux symptoms, it’s important to begin healing now to avoid more serious complications to the voice box, throat, and esophagus down the road. 

Get in touch with us today to schedule an appointment, either virtually or in person!

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