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Laryngopharyngeal Reflux (Silent Reflux)

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Diagnosis of LPR

Although silent reflux is harder to diagnose than GERD, a doctor can diagnose it through a combination of a medical history, physical exam, and one or more tests. Tests may include:

  • An endoscopic exam, an office procedure that involves viewing the throat and vocal cords with a flexible or rigid viewing instrument
  • pH monitoring, which involves placing a small catheter through the nose and into the throat and esophagus; here, sensors detect acid, and a small computer worn at the waist records findings during a 24-hour period.

 

Treatment of LPR

Silent reflux treatment for infants and children may include:

  • Smaller and more frequent feedings
  • Keeping an infant in a vertical position for at least 30 minutes after feeding
  • Medications such as H2 blockers or proton pump inhibitors, as directed by the pediatrician
  • Surgery for any abnormalities that can't be treated in other ways

Silent reflux treatment for adults may include these lifestyle modifications:

  • Lose weight, if needed.
  • Quit smoking, if you are a smoker.
  • Avoid alcohol.
  • Restrict chocolate, mints, fats, citrus fruits, carbonated beverages, spicy or tomato-based products, red wine, and caffeine.
  • Stop eating at least three hours before going to bed.
  • Elevate the head of the bed about 4 to 6 inches.
  • Avoid wearing tight-fitting clothes around the waist.
  • Try chewing gum to increase saliva and neutralize acid.

You may also need to take one or more types of medicine such as:

  • Proton pump inhibitors such as rabeprazole (Aciphex), dexlansoprazole (Dexilant, Kapidex), esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec), or omeprazole and sodium bicarbonate (Zegerid) to reduce gastric acid.
  • H2 blockers such as nizatidine (Axid), famotidine (Pepcid), cimetidine (Tagamet), or ranitidine (Zantac) to reduce gastric acid.
  • Prokinetic agents to increase the forward movement of the GI tract and increase the pressure of the lower esophageal sphincter. These medications are not as commonly used, because they have been linked to adverse effects on heart rhythm and diarrhea.   
  • Sucralfate to help protect injured mucous membranes.
  • Antacids to help neutralize acid; these are used more commonly for symptoms of heartburn.

Some people respond well to self-care and medical management. However, others need more aggressive and lengthy treatment. If this is not effective or if symptoms recur, your doctor may suggest surgery.

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