'Silent Reflux': Savannah Guthrie's Diagnosis, Explained

• Today host Savannah Guthrie recently announced she has a condition called laryngopharyngeal reflux (LPR).

• LPR may affect up to 30% of people and includes symptoms like hoarseness, voice changes, a lump sensation in the throat, cough, chronic throat clearing, excessive phlegm or mucus, and sore throat.

• Experts recommend seeing an otolaryngologist if you experience symptoms that affect the throat and don't clear up after a few days.

Savannah Guthrie announced she was diagnosed with laryngopharyngeal reflux (LPR) last week on the Today show.

“I just found out this week I have this very thing,” Guthrie said during a segment on LPR. “My voice has been getting hoarser and hoarser, and I thought it was old age. I didn’t know.”

Experts say the condition is particularly hard to spot because the symptoms, like hoarseness, can be symptomatic of many different conditions.

“The symptoms are pretty non-specific,” Lee Akst, MD, associate professor of otolaryngology at Johns Hopkins Medicine and the director of the Johns Hopkins Voice Center, told Health.

“What’s tricky about presumed [LPR] is that there are a lot of other conditions—[like] allergies, dryness, muscle tension dysphonia, small vocal fold lesions, mild vocal fold weakness—which can cause a lot of the same symptoms,” Akst said.

It’s important to see an otolaryngologist if you’ve been experiencing vague symptoms that can affect the throat, like those associated with LPR, and don’t know what’s causing them.

“You should see a specialist to get an accurate diagnosis,” Kyra Osborne, MD, an otolaryngologist at Cleveland Clinic, told Health.

Here are the warning signs of LPR, dietary adjustments that can help alleviate symptoms, and when it’s time to seek medical attention.

Related: Everything You Need to Know About the Health Complications Associated with GERD

LPR Is an Extension of GERD

LPR is closely related to gastroesophageal reflux disease (GERD), the telltale sign of which is heartburn.

GERD occurs when a muscle at the end of the esophagus won’t close properly. As a result, the contents of the stomach travel back up the esophagus and cause irritation.

People with LPR experience this same sensation, except the stomach contents go even further.

“It is not any different than [GERD]—it’s just that [the contents] go higher,” Akst explained. “They move up through the esophagus and get as high as the voice box.”

This causes symptoms like hoarseness, voice changes, a lump sensation in the throat, cough, chronic throat clearing, excessive phlegm or mucus, and sore throat, Osborne said.

Though LPR is an extension of GERD, not everyone who has the condition experiences heartburn. This is why it’s sometimes referred to as “silent reflux,” according to Akst.

“It’s the same mechanism of reflux leaving the stomach and [going] into the esophagus; it’s just that, for some people, the reflux goes high enough to reach the larynx and pharynx, and not everyone is aware of the heartburn,” he explained.

While LPR is sometimes misdiagnosed as GERD, hoarseness can often help doctors determine the difference, since that specific symptom is more commonly associated with LPR.

LPR is estimated to affect 5-30% of people, while GERD impacts nearly 28% of people.

But experts say these estimates may be inflated.

“We’ve been conditioned to think everybody has reflux,” Akst said. “As a field, we probably ‘guess’ at a reflux diagnosis too much, and don’t always consider these other alternatives enough.”

It’s important to remember, he explained, that many of the symptoms caused by reflux are associated with other health issues, and doctors should always rule those out before diagnosing GERD or LPR.

Related: Why Am I Getting Heartburn All of a Sudden?

How to Avoid Silent Reflux

There are a few ways to treat LPR, many of which don’t require medication.

“You can treat silent reflux with dietary and lifestyle management,” Osborne explained.

Medication-free ways to alleviate the symptoms of LPR include:

• Avoid spicy foods

• Limit alcohol intake

• Eat smaller meals

• Refrain from lying down for three hours after eating

• Eat low-fat foods

• Avoid carbonated beverages

• Avoid caffeinated beverages

• Maintain a healthy weight

• Refrain from tobacco use

If these measures don’t work, you should speak with a doctor about other treatment options, Osborne said.

Medications that can be used to treat the symptoms of LPR include antacids, proton pump inhibitors (PPIs), and H2 blockers, Osborne explained. Antacids work by neutralizing stomach acid, while PPIs and H2 blockers reduce the amount of acid the stomach makes.

But most people with LPR won’t need to take medication to treat the symptoms forever, Osborne clarified. Usually, just a short amount of time to help the tissues heal is all that’s necessary.

In more severe cases, a surgical procedure known as a Nissen fundoplication may be used to treat the symptoms of LPR. During the procedure, the junction between the stomach and esophagus is tightened to prevent reflux.

It’s crucial to treat reflux symptoms when they appear because over time they can cause complications like esophagitis, Barrett’s esophagus, or esophageal stricture.

Other complications can affect the lungs, throat, or mouth, and include asthma, the wearing away of tooth enamel, and laryngitis, which causes inflammation of the voice box.

Pneumonia, oral ulcers, recurrent laryngitis, and, in rare cases, squamous cell carcinoma are also possible recurrent infections that can occur because of LPR.

Osborne stressed that these potential complications are another reason not to put off scheduling an appointment with an otolaryngologist if you’re experiencing symptoms that affect the throat—particularly if you’ve tried to treat the symptoms at home and they haven’t gone away.

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