Many patients know of GERD (gastro-oesophageal reflux disease), where acidic stomach contents are returned back up the oesophagus, often with a burning sensation in the chest (heartburn). However, reflux may occur without alerting symptoms of heartburn. This is known as laryngopharyngeal reflux (LPR) - the ‘silent reflux’.
Because most people do not realise that reflux can occur without heartburn, LPR is often under-diagnosed or misdiagnosed as other conditions with similar characteristics.
In LPR cases, the acidic stomach contents are returned beyond the oesophagus, reaching the throat and back of the nose, causing various problems in these areas.
The pharynx and larynx serve as a passageway for air to reach the lungs and for food to reach the stomach via the oesophagus. At each end of the oesophagus is a muscular ring (sphincter), which prevent regurgitation of the contents of the stomach. When these sphincters are incompetent, acidic stomach contents can regurgitate back into the oesophagus, sometimes reaching the throat and back of the nose. This commonly occurs when an LPR patient lies horizontally, such as while sleeping.
The regurgitated contents include stomach acids that irritate and burn the sensitive larynx. Saliva is alkaline and the lining of the oral cavity and throat are resistant to alkaline media, but not to acidic media. LPR patients usually do not experience heartburn because the oesophagus is more resistant to acid than the larynx.
LPR is common in infants and children because their oesophageal sphincters are underdeveloped, they have shorter oesophagus, and they are often lying horizontally.
Snoring and obstructive sleep apnea can predispose a patient to LPR.