Clash of LPR and GERD: What Sets Them Apart and What They Share
Gastroesophageal Reflux Disease (GERD) and Laryngopharyngeal Reflux (LPR) are both forms of acid reflux, a condition where the stomach's contents flow back into the oesophagus or upper airways. While they share some similarities, these conditions have distinct differences in symptoms, anatomical involvement, and treatment approaches.
Symptoms
GERD primarily causes heartburn, acid regurgitation, and sometimes nausea, which reflect irritation in the lower oesophagus. On the other hand, LPR typically presents with extra-oesophageal symptoms such as chronic throat clearing, hoarseness, sore throat, cough, and the sensation of a lump in the throat (globus sensation), often without heartburn.
Anatomical Involvement
GERD involves reflux of stomach acid into the lower oesophagus, causing irritation primarily in the oesophageal lining. In contrast, LPR involves reflux reaching higher than GERD, affecting the larynx, pharynx, and upper airway structures, which is why symptoms are more related to the throat and voice box.
Treatment Options
Treatment for GERD includes lifestyle changes, medications, and sometimes surgical interventions. Lifestyle changes may include weight loss, avoiding late meals, reducing spicy/fatty foods, and quitting smoking. Medications like antacids, H2 blockers, and proton pump inhibitors (PPIs) are often prescribed to reduce gastric acid production. In severe cases or for those who do not respond adequately to medication, surgery such as Nissen fundoplication or endoscopic procedures like radiofrequency ablation may be an option.
LPR treatment also often involves PPIs and lifestyle modifications, but management focuses more on protecting the upper airway and vocal cords. Treatment effectiveness can be variable due to the less obvious symptoms and sometimes subtle mucosal damage in the laryngopharynx. Behavioral changes, like elevating the head of the bed while sleeping and avoiding eating close to bedtime, can help minimize nighttime reflux episodes for LPR.
Seeking prompt medical attention is essential for individuals experiencing symptoms of LPR or GERD. Lifestyle modifications, such as quitting smoking and limiting alcohol consumption, are essential in reducing LPR symptoms. LPR is sometimes referred to as "silent reflux" due to its lack of typical symptoms.
Both conditions can cause discomfort, inflammation, and tissue damage in their respective affected areas. Adopting healthier eating patterns, weight management, and avoiding triggers such as spicy foods, caffeine, and alcohol may benefit both conditions.
In GERD, the lower oesophageal sphincter weakens, leading to the backflow of gastric acid and enzymes into the oesophagus. LPR occurs when the upper oesophageal sphincter fails to function adequately, allowing stomach contents to reach the upper airways and larynx.
Common symptoms of GERD include a burning sensation in the chest or throat, regurgitation of stomach contents, an acidic taste in the mouth, difficulty swallowing, and nausea. LPR may not cause chest discomfort or heartburn like GERD does.
In summary, GERD mainly affects the oesophagus with classic reflux symptoms, whereas LPR affects the throat and voice box with more varied, atypical symptoms. Both can be managed with acid suppression and lifestyle changes, but LPR may require a more specialized approach due to the involvement of upper airway structures.
