Acid reflux is a common problem. It happens when the acid your stomach makes to digest food travels back up into your esophagus where it doesn’t belong. When you think of acid reflux, you generally think of heartburn symptoms like chest pain or a burning feeling in your throat. When you have these symptoms often it might be a chronic condition called gastroesophageal reflux disease (GERD).
However, acid reflux doesn’t always cause heartburn symptoms. Sometimes, it can cause symptoms like chronic cough or sore throat. This is known as “silent reflux” or laryngopharyngeal reflux (LPR). Despite having very different symptoms, LPR and GERD are similar conditions that are managed with many of the same treatments.
LPR and GERD are both types of reflux, but the symptoms are very different. GERD causes many of the symptoms that likely come to mind when you think of heartburn. By contrast, you can have LPR without having symptoms at all.
When LPR symptoms occur, they often resemble that of a cold or allergies.
It’s common to get heartburn, especially after a large meal. People with GERD have heartburn that comes back repeatedly. Heartburn symptoms include:
- burning feeling in your chest that can last several hours
- burning feeling in your throat
- chest pain when you lie down or bend over
- bad taste in your mouth and the back of your throat
- trouble swallowing
Symptoms that mean your heartburn could be GERD:
- happen twice a week or more
- seem to be getting worse
- wake you up at night
- cause pain or discomfort that interferes with your day
- are those you’ve had on and off for several years
LPR symptoms might not feel like acid reflux at all. You won’t have heartburn or chest pains. Symptoms include:
- chronic cough
- sore throat
- postnasal drip or the feeling of mucus in the back of your throat
- vocal hoarseness
- red, swollen, or sore voice box
- trouble swallowing
In some cases, you might only have one or two of these symptoms. Many people who have symptoms assume they’re having a respiratory problem and acid reflux. This can make LRP hard to diagnose.
|GERD Symptoms||LPR Symptoms|
|Difficulty swallowing||Difficulty swallowing|
|Burning feeling in the chest||Chronic cough|
|Pain in your chest when you lie down||Vocal hoarseness|
|Burning feeling in your throat||Sore throat|
|Bad taste in the back of your throat||Postnasal drip or mucus at the back of your throat|
|Pain that occurs at night and wakes you up||Red, swollen, or sore voice box|
|Symptoms that occur twice a week or more|
Children and infants have different symptoms than adults because the muscles in their stomachs and esophagus are not strong and developed and yet. In children and infants, symptoms might include:
- breathing problems
- pauses in breath while sleeping
- noisy breathing or asthma
- trouble gaining weight
- trouble eating
- spitting up
- turning blue
- episodes of distress that include arching the back
If your child’s skin color begins to turn blue, call 911 or go to the nearest emergency room immediately.
GERD is very common. Research indicates that around 20 percent of Americans have the condition. LPR is less common among adults, but still affects millions of Americans. In infants, LPR is more common due to undeveloped esophagus muscles and large amounts of time infants spend lying down.
When you digest food, rings around the top and bottom of the esophagus, called sphincters, shrink to prevent the contents of your stomach from going up into your esophagus. When you have acid reflux, this mechanism doesn’t work as it should. Your sphincter might not close properly.
This can lead to both GERD and LPR.
In GERD, some of your stomach contents travel up to your esophagus, causing the burning sensations associated with the condition. In LPR, stomach content travels all the way up to the back of your throat, causing a cough and sore throat.
Anyone can develop either LPR or GERD. They’re both common conditions that may affect otherwise healthy people. However, there are some known risk factors. The conditions share many similar risk factors including:
GERD can also be caused by some medications.
You can have both GERD and LPR at the same time. Some doctors and researchers think LPR is a symptom of GERD. Conversely, some suggest that these conditions might be easier to manage if they’re treated as two separate problems.
The conditions don’t always occur together. Some people have GERD with no LPR symptoms at all. Similarly, it’s possible to have LPR without ever experiencing traditional heartburn. Technically, LPR does involve the reflux of gastric acid into and then past the esophagus into the larynx. For many people, these two conditions and their symptoms occur together.
A primary care doctor can often diagnose you with LPR or GERD. You’ll have an exam where you will tell a doctor about your symptoms, any home remedies you’ve tried, and when symptoms most often occur. The doctor will review your medical history and medications to make sure your symptoms aren’t being caused by something else.
You don’t typically need tests to diagnose LPR and GERD, but a doctor might order them in some cases. Testing is normally done to see if your acid reflux has caused scarring or damage to your esophagus or throat. To check for damage, you’ll have a test called an endoscopy. During this test, a lighted tube with a camera will be inserted into your throat. The camera will take images the doctor can use in your diagnosis and treatment.
Another test you might have is called an ambulatory acid (pH) probe test. For this test, a monitor will be placed in your esophagus and attached to a computer you’ll wear. The monitor measures:
- how often acid comes up into your esophagus
- how much acid is there
- how long it stays there
The monitor for this test can be placed in your throat during your endoscopy.
You might also need to see a specialist, especially if you do have damage to your throat or esophagus, or if your symptoms are hard to control. You might be referred to a gastroenterologist for GERD. For LPR, you might be referred to an otolaryngologist, commonly known as an ear, nose, and throat doctor.
LPR and GERD are very similar conditions. Because they are both caused by acid traveling up the esophagus, they can both be treated in the same way. Your doctor will likely first recommend that you make some lifestyle changes. They’ll talk to you about what you eat and what time of day to eat. This might include limiting spicy foods, foods high in fat, and foods high in acid. They might also suggest you lose weight and avoid caffeine, alcohol, and smoking.
Other treatments include over-the-counter medications like:
- Antacids can provide quick relief when you’re having heartburn. However, their relief is typically temporary and will not prevent future heartburn or heal significant damage done by acid in your esophagus or larynx.
- H2 receptor blockers cause your stomach to make less acid and may provide relief. However, they don’t provide immediate relief to the heartburn you’re already having.
- Proton pump inhibitors are often more effective than H2 receptor blockers. Like H2 blockers, they also reduce the amount of acid your stomach makes but in a different way. They can also help heal any damage done by acid reflux.
If OTC medications don’t improve your symptoms, your doctor might prescribe stronger versions. They might also prescribe a medication to help strengthen your esophageal sphincter.
When medications don’t help, surgeries might be an option. Surgeries for GERD and LPR can strengthen your esophageal sphincter to help prevent acid reflux.
Occasionally, heartburn can be managed at home. GERD and LPR are more serious and should be checked out by a doctor. Not only will they help you get the treatment you need, but they will also see if there is any damage to your esophagus or throat.
A medical professional can help you prevent further damage. So, it’s a good idea to see a doctor if you’ve been experiencing any symptoms of GERD or LPR for several weeks.
GERD and LPR are both caused by acid reflux. When you have LPR, the acid travels all the way up to your esophagus and into your throat, causing symptoms that are very different from GERD. LPR is more common in infants, but it frequently occurs in adults as well. Treatment for both conditions is similar and involves lifestyle changes and medications that block acid production.