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aciphexo
Regular Member


Date Joined Apr 2011
Total Posts : 377
   Posted 12/3/2011 1:39 PM (GMT -6)   
I am not quite sure how one can diagnose LPR from GERD accurately when the symptoms overlap each other so much.

With LPR there is more 'upright day reflux' - and with GERD there is more 'supine noctural reflux - and I've read that having 'atypical' GERD symptoms can be interpreted to mean that one has LPR - where atypical includes things like cough/asthma/repiratory/throat-globus/mouth-sores etc.

However, it seems to me that often times one can have GERD/heartburn with symptoms in the throat/mouth- similarly, one can have LPR with heartburn symptoms as well.

My symptoms were more atypical (throat/vocal area inflammed) earlier this year (no cough/respiratory though) - but lately have become more heartburn/GERD-like (still occasional bitterness in the mouth). So, I am not sure if I have GERD or LPR - or may be a bit of both?

bcfromfl
Regular Member


Date Joined Nov 2011
Total Posts : 417
   Posted 12/3/2011 3:03 PM (GMT -6)   
I have seen a reference or two on the web trying to categorize one or the other into prone and supine, but that's simply not true. Both categories can have symptoms either day or night, depending upon the individual.  LPR symptoms tend to get worse at night, however, because in most people who have this condition, the subconscious relaxation of the upper esophagus allows reflux and reflux vapor into the throat.
 
The term, GERD, as a general reference of the condition, can refer to both types. When one is using "GERD" or "NERD" or "LPR" as a means to describe symptoms, however, it's pretty cut-and-dried. In this respect, GERD includes heartburn, and any other esophageal symptoms/conditions caused by reflux.  LPR, which is a special complication of GERD brought on by a weak pharyngeal sphincter (in addition to a weakened LES), includes a whole host of atypical symptoms, including hoarseness/laryngitis, faux-asthmatic conditions, headaches, cricopharyngeal spasm, etc.
 
It's common for those who experience LPR not to have heartburn, and there are probably a couple of good reasons for this.  However, the symptom of heartburn is usually what's used by the individual, or doctor, to diagnose reflux.  So, LPR symptoms can appear without a precedent, making it a bit mysterious.
 
Usually the means to diagnose, and treat, LPR symptoms is more empirical.  Does the patient respond to diet and behavior modifications typical of GERD?  Do antacids, H2 blockers, or PPIs reduce symptoms? etc...
 
Whenever someone (as you described yourself) notes reflux symptoms in the throat, that is LPR.  LPR is GERD, too, so both descriptions are correct.
 
-Bruce

belljar1995
Regular Member


Date Joined Dec 2011
Total Posts : 93
   Posted 12/3/2011 7:15 PM (GMT -6)   
Hi, I too am confused about the diagnosis. It also seems that people can have GERD/LRP without really any painful symptoms. The ENT told me that LRP can lead to asthma and more chronic type coughing and hoarse voice. It seems though that one could sometimes reflux into the throat and sometimes not....

I tend to have a feeling of fluid rushing up in my throat when I get up in the AM....but it doesn't hurt...it's just noticeable.

dencha
Forum Moderator


Date Joined Feb 2009
Total Posts : 7181
   Posted 12/3/2011 7:42 PM (GMT -6)   
Hi PPI,
I know that some doctors put a lot of emphasis on the term LPR and often use it as an excuse not to do the Nissen surgery, since the results are less clear cut than the patient with straightforward food and acid reflux into the mouth, or esophagitis and Barretts.
 
I was never diagnosed as an LPR patient, however I fit the LPR standard.  I had real asthma before my GERD started getting worse, and that asthma got uncontrollable because of the refluxing that was occuring.  I never had a large amount of acid refluxing, but because it was hitting my lungs, that small amount of acid was doing a tremendous amount of damage.
 
I also think that those of us who have a lot of "silent reflux" are in the LPR category.  Straight GERD seems to be just those people with many, many reflux episodes, and acid and food regurge into the mouth.  Or, those people who have obvious damage to the esophagus.
 
Those of us who have endoscopies only to find healthy esophageal tissue (even when we're on PPIs, which one would think GIs would take into account) are often relegated to a status that seems to carry the label "unimportant". 
 
GI docs are really mostly focused on those patients with large amounts of acid that has the potential of creating pre-cancerous and cancerous conditions.  The rest of us have to stand in the background, seeing our ENTs and our asthma doctors, and arguing that our seemingly non-existant (in the eyes of GI docs) reflux is affecting our quality of life.  Unfortunately we are often speaking to deaf ears.
 
It's a lot more difficult to get noticed, so we have to be a lot more persistent.  My GI docs dragged his feet and kept me from pursuing a surgical cure for probably 5 or 6 years, with the last 4 years being unbearable.  My PCP and asthma docs were very frustrated, as they couldn't get my lungs cleared up due to the reflux.  On one occasion I was in the hospital for a week because of a gastritis induced reflux episode that required high doses of IV steroids to keep me breathing.  I'm not sure that most GI docs (at least the ones I've come in contact with) truly understand the impact of LPR style GERD.
 
I know you face frustration constantly. 
I wish you luck in your quest for answers!
Denise

Post Edited (dencha) : 12/3/2011 6:45:27 PM (GMT-7)


bcfromfl
Regular Member


Date Joined Nov 2011
Total Posts : 417
   Posted 12/3/2011 10:02 PM (GMT -6)   
I shouted out loud at the TV tonight when I saw this commercial for Nexium: http://www.youtube.com/watch?v=5m_ocIvUI24  "...you wouldn't want your doctor doing your job, so why are you doing his?"  We have to do HIS job because it seems most doctors out there are CLUELESS about GERD, save for writing prescriptions and getting as many patients through their door as possible!!!  I hate having to do so much reading and research on the web, but it's only because I've been from doctor to doctor with very little help or information.  I'm sure many of the members of this messageboard feel the same way...
 
Sorry, had to get that off my chest.  I really appreciate your posts, Denise.  Thank you!
 
-Bruce

cdgnirose
Regular Member


Date Joined Nov 2011
Total Posts : 20
   Posted 12/4/2011 4:51 AM (GMT -6)   
Yes.. they don't understand.  I hate having to start all over  whenever we change countries.  I would love to deal with only one specialist and not jump hoops each time when the people don't understand the problem.

stkitt
Forum Moderator


Date Joined Apr 2007
Total Posts : 32602
   Posted 12/4/2011 10:06 AM (GMT -6)   
"...you wouldn't want your doctor doing your job, so why are you doing his?" 
 
My reaction to this, "when it comes to your health, you are your own best advocate. You must take control and be proactive."
 
Amen.
 
Kitt :-)
~~Kitt~~
Moderator: Anxiety, Osteoarthritis,
GERD/Heartburn and Heart/Cardiovascular Disease.

www.healingwell.com

"only as high as I reach can I grow, only as far as I seek can I go, only as deep as I look can I see, only as much as I dream can I be"

aciphexo
Regular Member


Date Joined Apr 2011
Total Posts : 377
   Posted 12/4/2011 10:48 AM (GMT -6)   
I agree. In my experience, if you fall out of the bell curve (are an outlier), then it gets exponentially hard to treat and manage your medical condition. Most doctors only know how to handle patients who are standard GERD cases, not the atypical ones.

dencha
Forum Moderator


Date Joined Feb 2009
Total Posts : 7181
   Posted 12/4/2011 11:39 AM (GMT -6)   
100% agreement there!

mock turtle
Regular Member


Date Joined Mar 2011
Total Posts : 467
   Posted 12/4/2011 12:20 PM (GMT -6)   
i agree with what bcfromfl said... that a significant element of LPR is the upper esophageal sphincter dysfunction (Pharyngoesophageal sphincter)

i too have noticed that feeling in the morning that i have been breathing fumes...that feeling when i take a deep breath that my airway has been attacked by vapor rather than a liquid burn...its hard to prove or explain, but its a different feeling then when i aspirate reflux

seems to me LPR is GERD.... plus....... a malfunctioning UES and really since "normal" people reflux to some moderate degree, the issue for LPR may be better described (guessing here) as mild or borderline gerd with a UES thats really a problem!

PPI-LESS , unlike your situation i feel like i do more damage at night than in the day, when things are bad (eating trigger foods, eating too much, and or, anxiety etc)

i have been diagnosed as having LPR...but as you indicated top of thread these things are difficult to know. maybe the "acid" test (pun intended) is simply the presence of absence damage to the pharynx, larynx, bronchi and lungs

and is it just me or does winter make this all so much worse (holidaze?)

hang in there
mt

LocalGuy23
Veteran Member


Date Joined Sep 2011
Total Posts : 620
   Posted 12/4/2011 12:32 PM (GMT -6)   
Guys someone from the US got the linx procedure done.....does this give is hope in traveling somewhere else to get it done?
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