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Acid Reflux / GERD Message Board
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Old 05-24-2011, 08:30 PM   #1
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sgibson1967 HB User
Gerd or lpr?

Hey everyone... so, the last couple weeks I have had some pretty intense issues with acid reflux. Now I've had a history of what was diagnosed as GERD in high school, about 8 years ago. I was prescribed Prilosec in the AM and Zantac before bed, and it cleared up in a month or so. However, it seems like it's reared its ugly head again... I have these awful chest pains near my breastbone, and feel short of breath at times with a lump in my throat that won't go away for hours at a time. Drinking water or clearing my throat (which I have to do quite often) does nothing. I am a singer in a band, and I've been singing 4 hours a night once-twice a week for about two years. This condition obviously has made it near impossible to perform, sometimes I can't even get through a half hour. I fear I could do some permanent damage to my vocal cords from the over exertion necessary to perform. Does this sound more like LPR (laryngopharyngeal reflux) than GERD? I have basically no issues with heartburn, but often find what I'd just eaten coming back up my esophagus with a bitter taste. It's awful. I am taking the medication I took back in high school, but I've only been doing it for three days... Prilosec OTC 20mg in the morning and Zantac 150mg at night. I have no insurance currently, so seeing the same ENT specialist would cost anywhere between $100 - $350... I just don't have it right now. Any help would be greatly appreciated... thank you!

 
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Old 05-25-2011, 07:32 AM   #2
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Re: Gerd or lpr?

hi,what exactly is LPR? I think i have smething other than just GERD,my main problms are severe pressure in chest andjust under breastbone,horrible SOB ,lump in throat,food,pills getting stuck adn this is intensified,weird as it sounds by bending forward or talking much? also have hoarseness. havent had any formal testing..I go for an endoscopy on 6/15....the doctor gave me some samples of something called dexilant60mg. which I looked up because the rude ********* badword didnt even spend 2 minutes with me,much less explain what the meds were for,but anyway it said its for severe GERD if 60mg. I have taken it for only 2 days now and it is alreaDY HELPING SOME! thank God! sorry for getting this topic all on myself,just new and curious about all this! thanx for listening and I sure hope u feel better REAL soon!

Last edited by spastic44f; 05-25-2011 at 07:34 AM. Reason: spelling

 
Old 05-25-2011, 07:50 AM   #3
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miketx HB Usermiketx HB User
Re: Gerd or lpr?

Hey sgibson, some people swear that LPR and GERD are distinct medical conditions. Some posters on this site even claim that LPR isn't necessarily acid-related. For me, however, LPR symptoms and GERD symptoms are almost certainly caused by the same underlying problem. I experience symptoms ranging from a bitter taste in my mouth, to hoarseness, to excessive mucus, to heartburn. Some of these symptoms are "GERD symptoms," while others are "LPR symptoms." My understanding is that for most treatment purposes, there is little point to distinguishing LPR from GERD because the treatment will be basically the same -- PPIs. The only thing that will differ is the dosage. I've read that surgery may be more likely to help with heartburn than with LPR symptoms, but I haven't seen any non-anecdotal evidence to support that claim.

 
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sgibson1967 (05-25-2011)
Old 05-26-2011, 05:09 AM   #4
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Re: Gerd or lpr?

GERD can have many of the symptoms with LPR, but also heartburn, which actually is rarely experienced by LPR patient like myself. In fact, I have never had heartburn. Also, you can have both GERD and LPR - they are absolutely distinct diseases - even if acid is a common denominator. One arguement is that LPR is more related to Pepsin activity than GERD - basically Pepsin destroys your throat when activated by acid - and there is no protein for it to breakdown.

My symptoms: breathing difficulty (as if I have asthma which I dont); restricted or tight throat - mine is more restriction feeling that globus like I am being choked; vocal issues like fatigue, hoarseness and sometimes pain; some dry coughing; burps that happen many times a day. This can all happen at once, or sometimes I just get the thrill of one or two at a time. Most LPR suffers are day time upright refluxers (but it is possible to have issues at night).

Many LPR folks don't even know they have the condition until all of a sudden it explodes - hence the notion of LPR being "silent reflux." Basically, GERD relfects acid that crawls past the LES irritating the esoph. LPR is a condition whereby acid travels past the LES and UES (the area right below your Adams Apples but above the chest cavity) - thus the throat is damaged. Strange enough - but acid can travel past the UES without irritating the esoph. The throat does not have the protection that the esoph. has and can be damaged much more easily and with much less exposure. Hence the treatment plan must be much more aggressive for LPR. Most ENTs (those that specialize in LPR) will tell you to take a double does daily of a PPI, plus 300 mg of Zantac at night. 2x daily PPI treament is typically over 6 months, versus 1-3 months with GERD. Further, diet must be initially PH > 5; with maintence diet of PH 4-5 with moderation on trigger foods and drink. Same BS in terms of raised bed, exercise, stress reduction, etc. for both LPR and GERD.

Testing used to determine LPR is slightly different than GERD - PH Testing and scopes that view the throat and esoph. are used - but the PH test must be dual probe in order to test acid issues both UES and LES. Also, an esoph. manhometry can measure if the UES and LES are funcitoning correctly - resting pressure and whether it works right when you swallow. An ENT is the best place to go for this - I think. Many GIs discount the idea of LPR. Also, I would note that many with LPR have medical issues that seem to "play friendly in the sandbox" with LPR - like PVVN (vagal neuropothy of the throat), vocal cord paresis, chronic cough, etc. Thus, for LPR you might see treatment that includes both PPI, H2 blockers and GABA-drugs that work on nerves, like Neurontin, Elavil, Klonopin, and so on.

Good luck - I am working to get things better on my end... have better days now and then which is promising.

 
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Old 05-26-2011, 07:09 AM   #5
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sgibson1967 HB User
Re: Gerd or lpr?

Thank you, very informative... I seem to have nearly all the signs of LPR. I had GERD in high school, but that was nearly a decade ago and this is a different situation. Called the ENT, he is an excellent doctor and worth the wait... but I can't get in until July 14th. They told me to take 40mg prilosec in the AM and 150mg Zantac in the PM... which doesn't feel like a treatment aggressive enough for what I think I have (it's what I took for GERD when I had it). Hopefully it will begin to heal before then. Feel better, everyone!

 
Old 05-26-2011, 04:08 PM   #6
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Re: Gerd or lpr?

Unfortunately it sounds like you do have LPR. LPR and GERD are similiar and brought about by some of the same issues, but are seperate diseases in themselves. GERD causes stomach problems that can be very intense and that can travel into the chest area, the back, and even the jaw bone region. Some people have intense burning wherever the acid irritation develops. Heartburn is more common with GERD than LPR, but that is not to say there is still not a good amount of acid coming up into areas where it should not. LPR symptoms are much different: excessive mucus build up which puts pressure on the eustachian tubes in the ears creating ear pain, popping or clicking in the ear, constant clearing of the throat with little relief, a lump feeling in one side of the throat, swollen adenoid glands, salivary glands, and even tonsils, sore throat, hoarseness, SOB, the noteably feeling of acid that even reaches into the oral cavity and nasal cavity. Another distinct symptom, though less common is either the clicking in one or both ears or even in one side of the throat, which I have it in one or the other location at times.

Everyone is different so the same PPI's are not going to work for everyone of us. Gama blockers and priobiotics are sometimes necessary to help stabilize everything, as is a better management of dietary needs. The cure is not going to happen overnight as it did not take place in one night either. Try not to be anxious and stressed as these don't help, I know :-( Also, something like an antidepressant can help relieve your own anxiety but also help with the tension in your throat area, hopefully alleviating some symptoms. Good luck to you, it is an uphill battle and I hope you feel better very soon :-)

 
Old 05-27-2011, 05:19 AM   #7
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miketx HB Usermiketx HB User
Re: Gerd or lpr?

What do people mean when they say that GERD and LPR are "separate diseases?" Just that the symptoms are different? My problem is that the contents of my stomach move upward, out of my stomach. Sometimes they irritate my esophagus. Other times they irritate my throat and mouth. You're telling me that I have two different diseases?

Perhaps I really have four diseases, then. Sometimes I get heartburn. Other times I lose my voice. Other times my mouth burns. Other times I get a bad taste in my mouth. If you're counting, that's (at least) four different sets of symptoms.

 
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