Everything you didn’t know about silent reflux
Reflux is an increasingly recognised term that many people associate with heartburn and indigestion. As many as 20 to 40 % of the UK population are affected by repeated episodes of gastric contents coming up from the stomach and into the oesophagus, causing immediate discomfort that sufferers are acutely aware of. However, in some people, gastric contents don’t settle in the oesophagus but travel up into the throat or nasal cavity and can even pass down into the lungs. This type of reflux is called laryngopharyngeal reflux (LPR), or ‘silent’ reflux – silent because the gastric contents swiftly bypass the oesophagus, and don’t cause obvious symptoms like indigestion. Instead, LPR causes a whole gamut of non-specific problems that are not immediately associated with ‘traditional’ reflux. Though not acute, the symptoms of LPR are still debilitating, and so awareness and accurate diagnosis are vital for effective management and treatment.
So, how much do you know about LPR?
- Symptoms
Exposure to even small amounts of refluxate damages the delicate mucosal linings of the larynx and pharynx, leading to a variety of unpleasant symptoms. The most common are:
- a sensation of food or phlegm sticking, or a feeling of a lump in the throat (globus)
- a hoarse, tight or croaky voice
- frequent throat clearing
- difficulty swallowing (especially tablets)
- a sore or dry throat
- sudden coughing spasms at night
- excessive burping, particularly during the day
- Why can silent reflux be overlooked by sufferers and GPs?
Silent reflux is frequently misread as a problem of the throat, something related to coughs, colds, allergies or over-using the voice, and it’s in this context that symptoms are often relayed to GPs. If this clinical picture persists for six weeks or more, the patient will commonly have an urgent referral to a specialist for further investigation and to rule out more serious causes, like cancer. Fortunately, fewer than 5 % of patients referred on to ENT departments on the two-week pathway are diagnosed with cancer. In contrast, up to 40 % of them are estimated to be suffering with silent reflux.
- Challenges of existing diagnostic tests for LPR
For most cases, the physiological test of choice to confirm reflux disease is 24-hour dual-channel pH monitoring and oesophageal manometry. This is an invasive test, involving two nasal catheters inserted into the stomach and staying in place for 24-48 hours. Patients sometimes have to travel considerable distances to large teaching hospitals for access to this test. Other investigations, like barium swallows or endoscopy, are also invasive. While these used to be the ‘gold standard’ methods for diagnosing reflux, there is now a growing recognition that they can be subject to reliability issues, depending on the operator or the equipment used.
- A non-invasive physiological test for silent reflux
Early studies have demonstrated that Peptest – simple lateral flow technology like a pregnancy test, which measures the presence or absence of the gastric enzyme pepsin in a saliva sample – is a fast, cost-effective and reliable diagnostic test for reflux disease that is more comfortable and convenient for the patient, and less open to operator variability. A recent multi-centre study across five ENT departments in the UK looked at how Peptest performed in a standard voice clinic patient cohort. Read the whole report here, and find out how powerful this test could be in diagnosing LPR.
