What is reflux?
Reflux occurs when the contents of the stomach travel into the oesophagus (gastro-oesophageal reflux, GORD / GERD) or into the throat (laryngopharyngeal reflux, LPR).
What is silent reflux?
The oesophagus is fairly resistant to acid reflux – it takes a lot to get heart burn. However, the throat and vocal cords are much more sensitive, and are affected not only by stomach acid but by other stomach contents such as pepsin (an enzyme involved in digestion). This is why it is common to have reflux affecting the throat without causing heart burn, which is sometimes called silent reflux. It is also why treatment of acid alone often doesn’t help the throat symptoms of reflux.
What symptoms does it cause?
The main symptoms are:
- A sensation of postnasal drip, mucus in the throat and throat clearing
- Chronic cough
- Sensation of a lump in the throat or constriction when swallowing
- Hoarse voice which often comes and goes
- Chronic sore throat
- Choking episodes
All of these symptoms can sometimes be due to more serious problems and if there is any doubt you will be referred to an ENT surgeon for assessment.
How do we assess reflux?
The diagnosis is mostly based on your symptoms, and by ruling out other causes such as sinusitis or serious problems such as laryngeal cancer. This involves an endoscopic examination in the clinic to examine the throat and voice box directly, and may include other investigations such as CT scans. To confirm reflux into the throat or even the nose and sinuses, scintigraphic reflux studies are now available.
How is reflux treated?
Throat symptoms of reflux are more difficult to treat than heart burn and take a longer time to resolve. The primary treatment is dietary and lifestyle modification and should be continued for at least a month's trial.
- Alkaline water (pH>8.8) can deactivate pepsin in the throat which is thought to be one of the causes of throat symptoms – try drinking it in place of plain water and other beverages
- Eat a light dinner, avoid eating or drinking 3 hours before bed and stay upright after dinner rather than lying down in a recliner.
- Avoid eating for 1-2 hours prior to exercise
- Avoid tight clothing
- Elevate the head of the bed 15-20cm (6-8 inches). Just using pillows often doesn’t work as you need to get your throat higher than your stomach, not just your head.
- Avoid soft drinks - drink alkaline water instead
- Avoid foods and drinks which reduce tone in the oesophageal sphincters - alcohol, caffeine, chocolate, peppermint, fatty and high carb foods
- Avoid acidic and spicy foods.
- A plant based Mediterranean diet may be effective (not necessarily vegetarian)
- Barrier medications – Gaviscon dual action liquid is used to provide a protective barrier and may physically prevent some reflux from occurring. It can be used before meals and we particularly recommend taking it before lying down at night. Gaviscon dual action is an over the counter medication, a prescription isn’t necessary.
- Proton pump inhibitors (Pariet, Nexium, Somac, Losec, Zoton and others). These are very effective at reducing the acidity and treating heart burn but less effective for throat symptoms and will be prescribed if necessary. The best time to take them is 30 minutes before a meal.