Silent Reflux: What You Need to Know

When people think of acid reflux, they often picture heartburn or indigestion. But not all reflux is so obvious. Silent reflux, also called laryngopharyngeal reflux (LPR) or extra-oesophageal reflux (EOR), can cause throat irritation and voice problems—often without the classic burning sensation in the chest.

What Is Silent Reflux?

Everyone produces acidic juices in the stomach to help digest food. Normally, a muscular valve at the top of the stomach (the oesophageal sphincter) keeps these juices from travelling back up the food pipe.

When this valve is weak, stomach contents can escape upwards, causing reflux. In some people, the reflux can go even further, reaching the throat and voice box (larynx). This irritates the delicate lining and leads to symptoms that are often mistaken for other conditions. Because there is usually no heartburn, it’s called “silent” reflux.

Silent reflux can happen at any time, but it’s particularly common at night, even when you haven’t eaten recently.

Common Symptoms of Silent Reflux

Silent reflux can affect people in different ways, but the most frequent symptoms include:

• A feeling of food sticking or a lump in the throat

• A hoarse, croaky, or strained voice

• Frequent throat clearing

• Difficulty swallowing (especially solid foods or tablets)

• A sore, dry, or sensitive throat

• A bitter, acid, or “bilious” taste in the mouth

• The sensation of excess mucus or phlegm in the throat

• Sudden coughing or choking attacks, particularly at night

• Persistent cough

• Excessive daytime burping

Some people do also experience heartburn, but many do not.

How Is Silent Reflux Diagnosed?

Diagnosis is usually made by an ENT specialist who will:

• Examine your throat and voice box using a small camera (a flexible nasendoscopy, passed gently through the nose)

• Discuss your symptoms in detail

• Sometimes ask you to complete a symptom questionnaire

If your reflux is severe, further tests may be arranged to measure acid levels in the throat and gullet. In certain cases, you may be referred to a gastroenterologist (a specialist in digestive health).

Treatment for Silent Reflux

Treatment is tailored to each individual, but usually involves a combination of lifestyle changes and medication. Options may include:

Lifestyle and dietary changes:

• Avoid eating late at night

• Reduce spicy, fatty, or acidic foods

• Limit caffeine and alcohol

• Raise the head of your bed to prevent reflux at night

Medications:

• Acid-suppressing medications (such as proton pump inhibitors)

• Alginate-based treatments like Gaviscon Advance, which form a protective “raft” over stomach contents, reducing irritation if reflux occurs. (Typically taken four times daily – 10ml after meals and 20ml before bed.)

Surgery:

• Rarely, surgery may be recommended to strengthen the valve between the stomach and gullet if medications are not effective.

Important: Always check with your doctor before starting over-the-counter reflux treatments, especially if you are already taking other medications.

Living With Silent Reflux

For most people, a mix of simple lifestyle adjustments and the right medication can bring significant relief from silent reflux. If you are struggling with unexplained throat symptoms, frequent throat clearing, or persistent hoarseness, it’s worth seeking advice from an ENT specialist—the sooner it’s addressed, the easier it is to manage.