Choking often occurs with night time acid reflux, but silent acid reflux can also cause choking, coughing, and other throat related issues.  Although commonly referred to as silent reflux, the actual term for this particular form of acid reflux is Laryngopahryngeal reflux (LPR).

What is LPR?  Laryngopharyngeal reflux is similar to gastroesophageal reflux disease (GERD) in that it occurs when the lower esophageal sphincter (LES) weakens and opens, allowing acid to reflux into the esophagus.  However, the main difference is that the primary symptom of GERD is heartburn, while the primary symptoms of LPR typically occur in the throat.

Most people are aware that acid reflux usually occurs when the LES, the lower sphincter in the esophagus located between the esophagus and stomach, malfunctions.  However, what is not as commonly known is the esophagus actually has another sphincter called the upper esophageal sphincter (UES).  The UES is located where the esophagus meets the throat.  When both the LES and UES fail, silent acid reflux is the result.  

What is the difference between LPR and GERD?  As was previously mentioned, LPR results when stomach acid makes it past both of your sphincters and pools in your throat, or reaches your mouth or the back of your nose.  GERD is when acid makes it past the LES and remains in the chest and does not pass through the UES.

The most common symptom of GERD is heartburn, which occurs after a person has experienced repeat episodes of reflux, and the acid has burned away the protective lining that coats the esophagus.    Although some LPR sufferers experience heartburn, this isn’t a common symptom, because the refluxed digestive juices do not remain in the esophagus long enough to cause damage.  This is often why LPR is referred to as silent acid reflux, because most people don’t associate the symptoms they experience from laryngopharyngeal reflux with acid reflux.

What are the symptoms of LPR?  Symptoms almost always occur in the throat and are usually felt because, unlike the esophagus, there is no protective lining in the throat.

Common symptoms that may be experienced include:
• Chronic cough
• Asthma-like symptoms
• Regurgitation
• Sour or bitter flavor in the mouth
• Frequent need to clear the throat
• Consistent mucous in the throat
• Burning sensation or pain in the throat
• Sore throat
• Hoarseness and possible loss of voice
• Difficulty swallowing
• Post-nasal drip
• Pain in the ear and/or consistent ear infections
• Nausea
• Heartburn

A silent acid reflux sufferer may experience some or all of these symptoms.

What should I do if I think I have LPR?  If you think you may be suffering from laryngopharyngeal reflux, you should visit your doctor for an examination and diagnoses.   Your general practitioner (GP) may send you to an otorhinolaryngologist (a medical professional who specializes in diagnosing and treating ear, nose and throat disorders, also known as an ENT specialist).

You can expect to have different tests done, such as a fiberoptic endoscopy, a special test that is designed to visualize the full length of your throat, and is often used to diagnose LPR.  Other tests you may experience for further diagnosis include barium swallow or dual pH probe studies.  It is imperative that you have LPR diagnosed and treated, because it can cause just as serious damage as untreated GERD. 

How is LPR treated?  Silent acid reflux is primarily treated with the same methods as GERD.  The reason is because the goal is to reduce acid to treat symptoms and prevent acid reflux from occurring.  Thus, treatment typically involves lifestyle changes (I.E. eliminating foods and beverages that trigger acid reflux, quitting smoking, losing excess weight, not eating before bed, etc.), and may include antacid medication or surgery depending on the severity of LPR and the frequency of acid reflux attacks.

Remember that you should always consult your doctor first before starting any method of treatment.  Do not self-diagnose silent acid reflux, because the symptoms you are experiencing may be related to another condition altogether.  Always seek a professional diagnosis.

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