When you talk about reflux, most people automatically associate the word with traditional acid reflux, which presents with common symptoms like heartburn, regurgitation, bloating, etc. What many patients don't know is that there are actually two different types of reflux: acid reflux and the less commonly known Laryngopharyngeal Reflux, i.e. "silent reflux". Although both can be associated with Gastroesophageal Reflux Disease (or GERD), they do differ in a number of ways, particularly when it comes to symptoms.
Acid reflux is a condition commonly associated with gastroesophageal reflux disease (GERD). Symptoms of acid reflux, the most common of which is heartburn, can be very uncomfortable. Acid reflux happens when acid from the stomach flows back up into the esophagus and causes irritation and a burning sensation in the chest.
Acid reflux typically occurs when a patient’s lower esophageal sphincter fails to close properly, therefore not forming a sealed barrier in between the esophagus and the stomach. The corrosive acid of the stomach is meant to break down food, however when it escapes into the esophagus it damages the tissue. The stomach has a natural defense against the acid’s erosive properties, but the esophagus does not. Acid reflux symptoms can include: heartburn, chest pain, regurgitation, bloating, asthma, cough, hoarseness, tooth enamel decay, and sleep disruption.
Silent reflux, or laryngopharyngeal reflux (LPR), is similar to gastroesophageal reflux in the sense that it is also the result of stomach acid escaping past the lower esophageal sphincter. However, in laryngopharyngeal reflux the stomach acid refluxes through the esophagus and into the back of the throat. This can cause damage to the larynx, vocal chords and lungs. For this reason, silent reflux damages the upper-aero digestive tract while GERD damages only the esophagus.
Laryngopharyngeal reflux is referred to as silent reflux because the symptoms that patients display are atypical for reflux problems. For instance, almost everyone who has GERD experiences heartburn, but only about half of the patients who have silent reflux have symptoms like heartburn. This is because the stomach acid does not stay in the esophagus for very long. In other words, it does not have enough time to cause damage to the esophagus.
Other symptoms of laryngopharyngeal reflux include hoarseness, throat irritation, continual throat clearing, chronic cough, shortness of breath, and sinus infections. Silent reflux is diagnosed much the same way as GERD. Common diagnostic tests are the esophageal manometry, barium swallow, and pH testing.
Treating Acid Reflux & Silent Reflux
The treatment for both conditions is similar. Lifestyle and diet changes are often recommended for less severe cases. There are no blanket rules for what foods are acceptable and which are not, however some specific foods can cause individual patients to experience symptoms. Common examples of problem foods and beverages are coffee, spicy foods, citrus fruit, greasy food, and tomato sauce. Problem foods are determined on a case-by-case basis.
Another common treatment method for temporary symptom alleviation is medication. Physicians will often recommend proton pump inhibitors (PPIs) or chewable calcium supplements to quell the symptoms of reflux. Proton pump inhibitors “turn off acid producing cells in the stomach, to put it in layman’s terms.” This can have some damaging side effects, though. Decreased stomach acid can cause mineral malabsorption, B12 deficiency, and anemia. Medication can also be expensive, and since it treats symptoms rather than causes it can be a lifelong expense.
The third treatment option for both GERD and LPR, and the only one that treats the root cause and is effective at long-term alleviation of symptoms, is anti-reflux surgery. This is the most lasting treatment method, as it addresses the structural issues that cause reflux diseases rather than just the effects of the diseases. Three common anti-reflux surgeries are the LINX procedure, the TIF/EsophyX procedure, and Nissen Fundoplication procedure. These surgeries seek to strengthen the weak esophageal sphincter that is allowing stomach acid to reflux in the first place, relieving the symptoms and addressing the issue.
Living with reflux of any kind can be difficult, but it's important to remember that chronic reflux isn't a life sentence. If you're interested in taking control of your life back, in finding a long-term solution to your reflux issues, then take some time to sit down with our reflux specialists. They'll walk you through every step of the process including diagnosis, treatment options tailored to suit your unique needs, and how to manage life after reflux.