Silent Reflux (LPR): Symptoms, Causes & Treatment

The reflux that skips the heartburn: why LPR causes cough, hoarseness and throat-clearing, how it differs from GORD, and what actually treats it.

Part of the Complete Acid Reflux Guide.

What silent reflux is — and why “silent”

Silent reflux — medically, laryngopharyngeal reflux (LPR) — is reflux of stomach contents all the way up to the throat (pharynx) and voice box (larynx). The “silent” is not about noise: it means the reflux happens without heartburn. The oesophagus can tolerate brief splashes of acid without complaint, so the journey upwards goes unnoticed. The larynx cannot — it has almost no defence against acid and pepsin (a stomach enzyme), so even small, brief exposures inflame it.

The result is a person with a chronically irritated throat and voice box, no chest symptoms, and often months of treatments for the wrong conditions before anyone says the word “reflux”.

Symptom checklist

LPR rarely announces itself with one symptom; it is usually a cluster of the following:

• Chronic cough — dry, tickly, often worse after meals or on lying down
• Hoarseness — a rough or weak voice, typically worst in the morning
• Constant throat-clearing — the single most characteristic LPR habit
• Globus — the sensation of a lump in the throat that swallowing doesn’t clear
• Post-nasal-drip feeling — mucus seeming to run down the back of the throat
• Sore or burning throat without infection
• Trouble swallowing or a feeling food catches high in the throat
• Voice fatigue — the voice wearing out over the day, especially in speakers and singers

LPR vs GORD: the key differences

The two overlap — plenty of people have both. For the classic condition, see our guide to GORD explained.

Why it’s so often misdiagnosed

Every LPR symptom has a more famous cause. Chronic cough gets treated as asthma; the post-nasal-drip feeling as allergies or sinusitis; the sore throat as recurrent infection; hoarseness as overuse. Antihistamines, nasal sprays and inhalers follow — and do nothing, because the problem is coming from below, not above. The pattern that should raise suspicion: throat symptoms that persist for weeks, worse after meals or in the morning, in someone whose allergy and asthma treatments are not working. If that is you, reflux belongs on the list even though your chest has never burned.

How LPR is diagnosed in the UK

There is no single simple test. Diagnosis usually rests on the symptom pattern (structured questionnaires such as the Reflux Symptom Index), sometimes supported by examination of the voice box — a quick nasendoscopy performed in an ENT clinic, which can show redness and swelling behind the vocal cords. In persistent or unclear cases, 24-hour pH monitoring can measure reflux reaching the upper oesophagus. In practice, many UK clinicians make a working diagnosis from the story and confirm it with a proper trial of treatment — which is reasonable, provided red-flag symptoms have been excluded first.

Treatment: what works for LPR

LPR responds to the same tools as ordinary reflux — used harder and for longer.

PPIs: higher intensity, longer course

Where GORD often settles with 4 weeks of a once-daily PPI, LPR typically needs 8–12 weeks, often twice daily, before judging the result — the inflamed larynx simply heals slowly. A common error is abandoning treatment at three or four weeks as “not working”.

Alginates: a particular role in LPR

Alginates such as Gaviscon Advance have a special place in silent reflux: the raft they form blocks not just acid but pepsin, the enzyme thought to do much of the laryngeal damage — and pepsin is not switched off by PPIs. Many specialists prescribe an alginate after meals and at bedtime alongside the PPI.

Diet and habits

The overlap with standard reflux advice is large: smaller evening meals, a 3-hour gap before bed, less alcohol, caffeine and fatty food — see the full list in foods to avoid. Two LPR-specific additions: fizzy drinks are a notable culprit (each belch carries pepsin upwards), and voice care matters — constant throat-clearing itself inflames the larynx, so swallow or sip water instead when the urge strikes. Night symptoms respond to the same fixes as ordinary night-time reflux: left-side sleeping and a raised bed-head.

When to see an ENT specialist

Referral makes sense when symptoms persist despite 8–12 weeks of proper treatment, when the diagnosis is in doubt, when voice problems are significant (especially for professional voice users), or when any red-flag feature appears. ENT can examine the larynx directly, exclude other causes, and arrange pH testing where needed.

Treatment from Access Doctor

Access Doctor’s pharmacist independent prescribers can prescribe the PPI course that silent reflux needs following a short online consultation, with discreet delivery across the UK.