From the Guidelines
LPR (Laryngopharyngeal Reflux) and GERD (Gastroesophageal Reflux Disease) are distinct conditions with different symptom profiles and affected areas, despite being related. GERD primarily affects the esophagus, causing symptoms like heartburn, regurgitation, and chest pain when stomach acid flows back up the esophagus 1. In contrast, LPR, also known as "silent reflux," affects the throat and voice box, leading to symptoms such as chronic cough, hoarseness, throat clearing, post-nasal drip, and difficulty swallowing, often without heartburn 1.
Key Differences and Similarities
- GERD symptoms are typically esophageal, including heartburn and regurgitation, whereas LPR symptoms are extraesophageal, involving the throat and voice box 1.
- Both conditions can be managed with lifestyle modifications, such as avoiding trigger foods, eating smaller meals, not eating before bedtime, elevating the head during sleep, and weight loss if needed 1.
- Medications for both conditions include proton pump inhibitors (like omeprazole 20-40mg daily or pantoprazole 40mg daily) and H2 blockers (like famotidine 20mg twice daily) 1.
- LPR may require longer treatment (2-6 months) than GERD and might respond less quickly to medication due to the higher sensitivity of the throat to acid damage 1.
Diagnostic Challenges
- The relationship between reflux and cough is complex, with variable responses to proton pump inhibitor (PPI) therapy and difficulties in confirming a causal association between reflux and extraesophageal symptoms 1.
- Diagnostic algorithms for extraesophageal reflux are challenging due to the heterogeneous manifestations and overlap with other conditions 1.
- A personalized approach to the evaluation and management of GERD symptoms is recommended, considering the individual patient's symptoms, pathophysiology, and response to treatment 1.
Treatment Approach
- A personalized treatment plan should be developed for each patient, taking into account their specific symptoms, medical history, and response to treatment.
- Lifestyle modifications and medications should be tailored to the individual patient's needs, with regular follow-up and adjustment of the treatment plan as necessary 1.
- Antireflux medications should be used judiciously, considering the potential benefits and risks, and avoiding unnecessary therapy 1.
From the Research
Difference between LPR and GERD
- Laryngopharyngeal reflux (LPR) is an inflammatory reaction of the mucosa of pharynx, larynx, and other associated upper respiratory organs, caused by a reflux of stomach contents outside the oesophagus 2.
- Gastroesophageal reflux (GER) is a common disease usually limited to the oesophagus 2.
- LPR is considered an extraesophageal manifestation of the gastroesophageal reflux disease (GERD) 2.
- The symptoms of LPR include hoarseness, cough, sore throat, a feeling of throat obstruction, excessive throat mucus 3, whereas GERD is characterized by recurrent and troublesome heartburn and regurgitation 4.
Pathophysiology and Treatment
- LPR and GERD have different pathophysiology, with LPR involving both reflux and reflex mechanisms 3.
- The treatment options for LPR and GERD include lifestyle modifications, proton pump inhibitors, and endoscopic surgery 3, 5.
- However, the diagnosis of LPR is more challenging than GERD due to its non-specific symptoms/signs 6.
Diagnosis and Association
- There is no standardized diagnosis or treatment protocol for LPR 3.
- The diagnosis of LPR is based on physiological diagnostic testing, including hypopharyngeal multichannel intraluminal impedance-pH catheters 6.
- LPR is associated with GERD, but the two conditions have distinct characteristics and treatment approaches 2, 4.