If you’ve ever dealt with acid reflux, you might assume all symptoms come from the same condition. Not so. While gastroesophageal reflux disease (GERD) is the most common cause of heartburn and indigestion, laryngopharyngeal reflux (LPR) — often called silent reflux — often goes ignored or unnoticed. 

Unlike GERD, LPR leads to hoarseness, throat clearing, or a chronic cough. But, otherwise, it’s often asymptomatic, making it extremely hard to diagnose. Let’s learn more about GERD and LPR symptoms.  

What’s the Difference Between GERD and LPR? 

Both GERD and LPR have the same underlying mechanism. 

Usually, when you digest food, the lower oesophageal sphincter forms a barrier between the oesophagus and stomach, preventing backflow. However, if the sphincter doesn’t function, acid can move into the oesophagus (GERD). If it continues in the voice box and throat, it becomes LPR. 

People with GERD often have difficulty swallowing (dysphagia) and severe heartburn in the centre of their chest. Strangely, despite also passing via the oesophagus, the acid in LPR is less symptomatic. Aside from a cough, hoarseness, or shortness of breath, there are often no specific symptoms. In fact, LPR is frequently confused with asthma or a respiratory infection.   

To put it simply: 

• GERD primarily involves digestive symptoms

• LPR usually involves respiratory or throat symptoms (or no symptoms at all)

Do GERD and LPR Ever Overlap? 

Yes. Given that acid must travel through the oesophagus on the way to the throat, in some sense, all cases of LPR also involve GERD. Therefore, everyone with LPR has GERD. 

It’s estimated that around 20% of people have GERD, and a further 5-30% may have LPR (although there is some overlap between the two conditions). Indeed, a 2018 study of 80 people found that 57% of people with GERD displayed evidence of LPR.  

One of the conditions may precede the other. Due to the similarities in symptoms and causes, LPR is often misdiagnosed as GERD (and vice versa). That’s why it’s crucial to get an accurate diagnosis by a specialist. 

Diagnosis and Treatment Differences 

Diagnosing LPR and GERD 

Most cases of mild LPR and GERD are diagnosed based on your medical history and symptoms. If the case is severe or persistent, your doctor may recommend an endoscopy. A thin tube with a camera at the end is threaded into your throat, voice box, and oesophagus to look for signs of acid damage.  

If only LPR is suspected, your doctor may perform a laryngoscopy, which only visualises the voice box and throat.  

Alternatively, 24-hour pH monitoring is another option. It measures acid levels in your oesophagus to confirm if reflux is occurring and how high up your oesophagus it’s going.  

Treating LPR and GERD 

Treatment for silent reflux and GERD is similar. Options include medications and or lifestyle changes. 

Lifestyle changes involve avoiding potential triggers. These include: 

• Foods: Fatty, spicy, citrus, tomato, chocolate, peppermint

• Drinks: Caffeine, alcohol, fizzy drinks

• Habits: Smoking, large meals, eating late, lying down right after eating

Medications aim to reduce acid production. H2 receptor blockers (e.g., ranitidine) and proton pump inhibitors (PPIs) (e.g., omeprazole) are quite effective. In rare cases, the reflux symptoms persist, requiring surgery.  

When to See a Doctor 

Most people with acid reflux start with over-the-counter (OTC) medications such as antacids. These neutralise the acid during an attack. However, they won’t solve the problem in the long term. 

Don’t ignore symptoms just because they don’t include heartburn. 

Aside from LPR, a chronic, persistent cough is a sign of several potentially harmful conditions. Speaking to a doctor as soon as possible reduces the risk of complications. 

You should see a doctor if you notice: 

• A chronic cough that won’t go away

• Frequent throat clearing or a sensation of something stuck in your throat

• Hoarseness, especially in the morning

• Trouble swallowing or feeling like food gets stuck

• Persistent sore throat with no clear cause

• A bitter or sour taste in your mouth, especially after meals

• Chest discomfort or heartburn that keeps returning

• Symptoms that seem like asthma but don’t improve with inhalers

Discover the Cause of Your Symptoms 

 Dealing with acid reflux? If you can’t tell whether it’s GERD versus silent reflux, we can help.  

The Functional Gut Clinic provides high-level diagnostic testing for acid reflux, including pH and impedance monitoring, oesophageal manometry, and gastric emptying studies. We’ll get to the bottom of your symptoms. This is also important for diagnosing and treating reflux in babies, which can present as both GERD and LPR. 

Learn more about GERD acid reflux, and how we can help.