GERD and LPR: Similar, But Different Reflux Conditions

Amber J. Tresca
·9 min read

Medically reviewed by Robert Burakoff, MDMedically reviewed by Robert Burakoff, MD

Gastroesophageal reflux disease (GERD) and laryngopharyngeal reflux (LPR) both affect the esophagus (food tube) but in different ways. GERD affects the lower sphincter (muscular ring) in the esophagus, and LPR affects the upper esophageal sphincter.

LPR is considered a subtype of GERD. Its symptoms are felt further up in the throat, while GERD symptoms may be felt lower in the chest. Both conditions can lead to symptoms that affect the throat and other organs.

This article will address the differences between these conditions, how they affect the body, and what treatments might be used.

Understanding GERD and LPR

LPR is an inflammatory condition that affects the upper esophagus. It occurs when acid flows up from the stomach, into the esophagus, and through the ring of muscles in the upper throat.

LPR is a challenging condition to manage, and there are no standards for diagnosis or treatment. It is sometimes called "silent reflux" because the symptoms differ from heartburn or GERD.

GERD is when the muscles of the lower esophageal sphincter are weakened, causing the stomach's contents to back up into the lower esophagus. It is common and often treated with lifestyle changes and medication. However, almost half of the people diagnosed with GERD don't find relief with commonly used medications.

Can You Have Both?

LPR and GERD are considered to be different conditions. However, they can be related because to have LPR, both the lower and the upper esophageal sphincter must be affected. In GERD, only the lower sphincter is weakened.

People with LPR may have symptoms only of that condition, or they may also have symptoms of GERD. To have LPR, stomach acids must travel up through the lower and upper esophageal sphincters. LPR is sometimes considered an "extraesophageal" (outside of the esophagus) complication of GERD.

LPR may affect the voice box and sinuses, but there could also be no symptoms. GERD may cause heartburn, regurgitation, or chest pain.

Is One Worse?

LPR and GERD are related conditions, and they both cause symptoms that can significantly affect quality of life. People with either condition may need to make changes to their diet and lifestyle and take medications, some of which are costly, to prevent or stop symptoms.

Whether one condition is worse than the other may depend on the person's personal experience and outlook. LPR, however, is less recognized and has fewer options for diagnosis and treatment than GERD.

Both conditions have the potential for complications, but LPR may go unrecognized for longer, especially if the symptoms are not bad enough to seek diagnosis or treatment.

GERD vs. LPR Symptoms: How to Tell

It may be challenging to differentiate between GERD and LPR based on symptoms alone. However, there are a few differences in how these conditions affect the throat, esophagus, and other organs.

Symptoms of GERD can include:

  • Chest pain

  • Cough

  • Globus (feeling like something is stuck in the throat)

  • Heartburn (pain and/or burning in the chest)

  • Hoarseness (dysphonia)

  • Nausea

  • Pain or difficulty swallowing

  • Regurgitation (the contents of the stomach coming up and into the throat or mouth)

  • Sore throat

Symptoms of LPR can include:

  • Cough

  • Feeling the need to "clear" the throat

  • Globus

  • Hoarseness

  • Laryngitis

  • Mucus or phlegm in the throat

  • Pain or difficulty swallowing

  • Postnasal drip

  • Recurrent upper respiratory infections

  • Sore throat (chronic)

  • Wheezing

  • A new diagnosis of asthma or a worsening of asthma symptoms

LPR and GERD are often diagnosed with the help of healthcare providers with different specialties. A primary care or family healthcare provider may be the first to assess symptoms. They may need to refer the person to a specialist, such as an otolaryngologist (an ear, nose, and throat doctor or ENT) or a gastroenterologist (a digestive specialist).

After reviewing the symptoms, tests could include an upper endoscopy to look inside the throat and pH testing to monitor the acid level of the esophagus. Sometimes, the healthcare provider may decide to start treatment immediately because if the symptoms improve, more testing may not be needed.

Identifying GERD and LPR Triggers

Certain foods or the timing of eating may set off (trigger) symptoms. Making changes to meals could help avoid some symptoms. People usually need trial and error to figure out what may help.

Some of the lifestyle changes for LPR and GERD are similar. They can include:

  • Avoiding eating or drinking for 2 to 3 hours before going to bed at night

  • Avoiding fried foods and fatty chicken, fish, and meat

  • Avoiding medications such as aspirin, progesterone, corticosteroids, and nonsteroidal anti-inflammatory drugs (NSAIDs) such as Advil (ibuprofen) and Aleve (naproxen)

  • Avoiding talking while eating

  • Chewing gum to increase saliva

  • Eating slowly

  • Elevating the head while sleeping

  • Managing blood pressure

  • Standing as upright as possible for 30 minutes after eating

  • Stopping smoking

  • Wearing loose clothing

For GERD, some of the recommended changes to diet may also include avoiding the following:

  • Acidic foods (citrus fruits, tomatoes, and tomato products)

  • Alcoholic drinks

  • Caffeine

  • Chocolate

  • Coffee

  • Fatty foods

  • Mint

  • Spicy foods

How to Treat GERD and LPR Symptoms

Aside from changing your diet and making lifestyle adjustments such as quitting smoking, medications may help in reducing or preventing symptoms of LPR and/or GERD.

Home Remedies

Some foods may help avoid or prevent symptoms. In general, these foods are higher in fiber, have a high water content, or have a high pH and can counteract high acid content. Some of the foods a healthcare provider might recommend be added to the diet include:

  • Broth-based soups

  • Fruits such as bananas and melons (including watermelon)

  • Herbal teas (without caffeine)

  • High-fiber foods such as asparagus, beets, broccoli, brown rice, carrots, cous cous, green beans, oatmeal, and sweet potatoes

  • Vegetables such as cauliflower, celery, cucumber, fennel, and lettuce

  • Nuts

Other home remedies, which have varying levels of evidence, can include:

  • Apple cider vinegar (only diluted in water and taken with meals)

  • Baking soda (sodium bicarbonate)

  • Drinking milk (nonfat only)

  • Eating yogurt (low fat only)

  • Ginger

  • Lemon water with honey

Medications

Antacid and anti-acid reflux medications are available over-the-counter (OTC) for mild symptoms. For more severe or frequent symptoms, talk to a healthcare provider about which medications can best address your problems.

Antacids

Antacids neutralize stomach acid and can be taken to relieve symptoms. They are available OTC. These medications come with various combinations of active ingredients. People may want to try various forms to see which works best and can avoid adverse effects, such as constipation,

Common antacids and their active ingredients include:

  • Chooz, Tums (calcium carbonate)

  • Gaviscon (alginic acid, sodium bicarbonate, aluminum hydroxide, magnesium carbonate)

  • Rolaids (calcium carbonate and magnesium hydroxide)

Antacids should not be used more than occasionally. If you need them daily, talk to a healthcare provider.

PPIs and H2 Blockers

Two main types of medications reduce stomach acid: histamine-2 receptor antagonists (H2 blockers) and proton pump inhibitors (PPIs). These medications help with symptoms by lowering the amount of acid produced by the stomach. They are available both OTC and as prescription medications.

If you use OTC medications more than twice a week, see a healthcare provider for recommendations on which treatments are most appropriate.

H2 blockers can relieve unexpected heartburn and other acid-related symptoms. They include:

  • Tagamet HB (cimetidine)

  • Pepcid AC (famotidine)

  • Axid AR (nizatidine)

PPIs are more often chosen for treating LPR and GERD because they tend to be more effective. They should be taken daily to provide ongoing symptom relief. When a healthcare provider prescribes them, the dosage may be higher than the over-the-counter versions. In addition, the dosage prescribed for LPR may be higher than that for GERD.

Common PPIs include:

Short and Long-Term Risks of GERD and LPR

GERD and LPR may be associated with a risk of other health conditions. Acid in the throat and inflammation could cause other problems in the long term.

LPR may be associated with other conditions, such as:

GERD may also be associated with long-term risks. These can include:

  • Asthma

  • Barrett's esophagus (tissue in the esophagus being replaced by tissue that's more similar to that of the intestine)

  • Chronic cough

  • Esophagitis (inflammation in the throat)

  • Esophageal stricture (narrowing in a section of the throat)

  • Hoarseness

  • Laryngitis

  • Loss of tooth enamel (from exposure to stomach acid)

GERD has been associated with a lower quality of life, especially when nighttime heartburn leads to a lack of sleep, daytime fatigue, and loss of productivity. LPR could lead to a lack of sleep, anxiety and depression, stress, pain, and fatigue.

These negative impacts show how important a diagnosis and effective treatment is to reducing and preventing symptoms that can negatively affect the quality of life.



The Effect of LPR on Mental Health

LPR is associated with more quality-of-life issues than GERD. The social, physical, emotional, and functional burden of LPR is shown to be significant. Rates of depression and anxiety are also higher.

People with LPR take more sick time than those with GERD, and the condition impacts their work life. In addition, those with LPR are less satisfied with their treatment options.



How to Manage GERD and LPR Flares

After a diagnosis of GERD or LPR, a healthcare provider will advise on long-term management strategies, including lifestyle changes and medications. Often, lifestyle changes are for the long term and are meant to prevent flare-ups.

In the short term, if symptoms crop up, the first step might be to note any foods that might have triggered symptoms so that they can be avoided in the future. Elevating the head of the bed while sleeping and avoiding eating before lying down might also be helpful. Some people invest in pillows or other devices to prop up the head of the bed.

After changing the diet, over-the-counter antacids may be the next step in managing a flare-up of GERD or LPR. Many options are available, so it can help to talk with a healthcare provider to find out which one might be the best fit.

What's important is to talk with a healthcare provider when symptoms occur more than a few times a week, or they don't respond to OTC treatments.

Summary

LPR and GERD are related but have different symptoms. LPR tends to be more challenging to diagnose and treat, while GERD is more common, and there are guidelines for treatment. Symptoms can overlap, which is why a diagnosis from a healthcare provider is important.

Diet and lifestyle changes may be effective in some cases, but prescription medication might be necessary to treat the symptoms in others.

Read the original article on Verywell Health.