GERD (GastroEsophageal Reflux Disease) symptoms are typically different than LPR (LaryngoPharyngeal Reflux) symptoms, but patients can have symptoms generally associated with either GERD or LPR.

Classic GERD symptoms are: Heartburn; regurgitation.

LPR Symptoms are: Hoarseness; frequent throat clearing; increased phlegm; post-nasal drip; chronic cough; difficulty swallowing (dysphagia); lump-like sensation in throat; choking sensation.

Laryngo-Pharyngeal Reflux (LPR) is DIFFERENT from Gastro-Esophageal Reflux Disease (GERD) . The "CLASSIC" Symptoms of GERD in a typical ESOPHAGITIS patient are HEARTBURN - 83%, COUGH - 47%, DYSPHAGIA - 40%, REGURGITATION - 23% (1). On the contrary, the typical symptoms of LPR in the typical ENT patient are HOARSENESS - 71%, CHRONIC COUGH - 51%, DYSPHAGIA - 51% GLOBUS - 47%, THROAT CLEARING - 42%, HEARTBURN and/or REGURGITATION - 10%-33% (2, 3, 4).

The reflux pattern in the typical GERD patient is a supine, nocturnal reflux (patient
refluxing while lying flat at night) while the LPR patient generally refluxes while upright
during the day (2, 3).

Esophageal function in the GERD patient generally demonstrates esophageal dysmotility with significantly prolonged esophageal acid clearance times and Lower Esophageal Sphincter dysfunction. In contrast, the LPR patient has good esophageal function with near normal esophageal acid clearance. Generally, LPR patients have Upper Esophageal Sphincter dysfunction (5, 6). In addition, the larynx is far more susceptible to acid injury than esophagus because in the larynx there are no acid clearing mechanisms (peristalsis; salivary bicarbonate) and the laryngeal tissues are thin, fragile and poorly adapted to protect against reflux. One normally refluxes about 50 times a day from the stomach into the esophagus. If as few as 2 of those normal reflux events contact the laryngeal tissues, it is abnormal, and changes in the laryngeal tissues can result (3, 7). Therefore, it is LARYNGEAL EDEMA, or swelling, not ERYTHEMA, or redness, that is the clinical hallmark of LPR (4).

DIAGNOSIS of LPR
There are a variety of tests that can assist in making the diagnosis of LPR, including
Double probe pH monitoring - 24 hour or 48 hour testing; Sensory Testing; Flexible
Endoscopic Evaluation of Swallowing with Sensory Testing (FEESST); Barium
esophagography - normal in 77%; Esophagoscopy - normal in 80%; Bernstein acid
perfusion - normal in 70% and the Reflux Symptom Index (RSI) and the Reflux Finding
Score (RFS).
The Reflux symptom index is a questionnaire completed by the patient at each visit and attempts to quantify the patients symptoms. The Reflux Symptom Index is the following:
Reflux Symptom Index (RSI) (8)
Within the last MONTH, how did the following problems affect you?
(0=no problem;5=severe problem)
Hoarseness or problem with voice
Clearing your throat
Excess throat mucous or postnasal drip
Difficulty swallowing food, liquids or pills
Coughing after you ate or after lying down
Breathing difficulties or choking episodes