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?
Assessment is based on your symptoms along with an endoscopic examination in the clinic with a small scope through the nose to examine the throat and larynx directly. The main investigation we use is a scintigraphic reflux study which can show whether there is reflux into the throat and even nose, sinuses, ears and lungs in some people.
How is reflux treated?
Throat symptoms of reflux are more difficult to treat than heart burn and take a longer time to resolve. Treatment is usually with a combination and lifestyle modification but symptoms often take time to improve and we recommend a minimum of 1-2 months of daily treatment initially.
Lifestyle modification
- 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
- 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
- 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)
Medications
- Gaviscon double strength liquid can physically prevent some reflux from occurring. It should be used every night before lying down and can also be used after meals or at other times when reflux is likely to occur – for some people this is at the gym or swimming. Gaviscon double strength is an over the counter medication, a prescription isn’t necessary.
- Larri oral spray is another over the counter medication which can help with symptomatic relief – use 3-4 times a day as needed.
- Nizatidine helps to speed up stomach emptying and reduces acid production and if prescribed, should be taken regularly rather than as needed for throat symptoms.
- Proton pump inhibitors (Pariet, Nexium, Somac, Losec, Zoton and others). These are very effective at reducing the acidity and treating heart burn but often don’t work for throat symptoms and will be prescribed if needed. The best time to take them is 30 minutes before a meal.
Surgery
Surgery may be an option for some people. The procedure is called fundoplication and is performed by an upper GI surgeon (not an ENT surgeon).