Question

Clearly differentiate between:
Laryngopharyngeal reflux and gastro-esophageal reflux.

Hint:

LPR primarily affects the throat and larynx, while GERD primarily causes symptoms related to the esophagus. Treatment is similar, but LPR requires additional attention to the upper airway.

Answer 1

Step 1: Laryngopharyngeal Reflux (LPR):
Laryngopharyngeal reflux is a condition where stomach contents, including acid, travel up the esophagus and reach the larynx and pharynx, causing inflammation. It is more likely to present with symptoms affecting the upper airway. Key characteristics include:
1. Symptoms: Chronic cough, hoarseness, throat clearing, globus sensation (feeling of a lump in the throat), and dysphagia.
2. Mechanism: LPR typically occurs due to dysfunction of the upper esophageal sphincter (UES), allowing acidic gastric contents to reach the larynx.
3. Diagnosis: Diagnosis is often clinical, with supportive tests such as pH monitoring or laryngoscopy to visualize the effects of acid on the larynx.
4. Treatment: Treatment involves proton pump inhibitors (PPIs), lifestyle modifications (such as diet and posture), and voice therapy.

Step 2: Gastro-esophageal Reflux (GERD):
Gastro-esophageal reflux disease (GERD) is a condition where stomach acid and digestive juices flow backward into the esophagus, causing symptoms such as heartburn and regurgitation. It primarily affects the lower esophagus. Key characteristics include:
1. Symptoms: Heartburn, regurgitation, chest pain, and dysphagia.
2. Mechanism: GERD occurs due to the dysfunction of the lower esophageal sphincter (LES), allowing stomach acid to reflux into the esophagus.
3. Diagnosis: Diagnosis is typically based on symptoms, endoscopy, and pH monitoring to assess acid exposure in the esophagus.
4. Treatment: Treatment includes PPIs, antacids, prokinetic agents, and lifestyle changes (such as avoiding spicy foods, caffeine, and lying down after meals).

Step 3: Key Differences Between LPR and GERD:
1. Location of Symptoms: LPR affects the upper airway (larynx, pharynx), while GERD affects the lower esophagus.
2. Symptoms: LPR primarily causes hoarseness, chronic cough, and throat clearing, while GERD primarily causes heartburn and regurgitation.
3. Treatment: Both conditions are treated with PPIs, but LPR may also involve lifestyle changes such as elevating the head during sleep and voice therapy.