Understanding the Difference Between Acidic and Non-Acid Reflux (LPR)

Throat burning, chest pain, heartburn…: These are the tell-tale signs one thinks of when asked about Gastroesophageal Reflux Disease (GERD). But did you know not all reflux is acidic?

A lesser-known, yet increasingly recognized condition is Laryngopharyngeal Reflux (LPR), often referred to as "silent reflux." In this blog, the FLORA team aims to educate our readers about the condition to raise awareness and foster conversation to make this condition more widely understood and addressed.

What is Non Acid Reflux or Laryngopharyngeal Reflux (LPR)?

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Laryngopharyngeal Reflux (LPR) involves the backflow of stomach contents into the larynx (voice box) and pharynx (throat), which drives symtpoms from irritation to the sensitive tissues of the larynx and pharynx. Unlike GERD, LPR may not produce heartburn or regurgitation because the refluxed material can be less acidic. LPR is thus harder to recognize and diagnose, and a formal diagnosis may include a combination of symptom assessment, laryngoscopy (to visualize the larynx and pharynx), and pH monitoring/impedance-pH monitoring.

Symptoms of LPR

LPR shares many of the same symptomology of acidic reflux but is not accompanied by heartburn, regurgitation of acid or sour-tasting fluid, or chest pain as seen with GERD. LPR symptoms include:

• Chronic cough

• Hoarseness or voice changes

• Throat clearing

• The sensation of a lump in the throat (globus sensation)

• Postnasal drip

• Breathing difficulties

As for many GI Dysfunctional Disorders, symptoms may be constantly present or exacerbated with specific triggers (such as stress, food intolerances, etc.), depending on the root cause.

Causes of LPR

• Dysfunction of the upper esophageal sphincter (UES)

• Dietary factors

• Stress and anxiety

• Respiratory conditions

• Post-viral (COVID-19). Although more research is needed to more clearly understand this link, we have had a large increase in clients suffering from LPR post-COVID

Acidic and Non-Acidic Reflux: So, What’s the Difference?

While acidic and non-acidic reflux diseases involve the dysfunction of thoracic sphincters, the experiences of the different reflux disorders create a profoundly different experience. If you are interested in learning more about Acidic Reflux (GERD) check out Understanding Acid Reflux: A Comprehensive Guide to Managing and Stopping Symptoms.

Quick Guide to LPR v GERD

Symptoms

• Acidic Reflux (GERD): Predominantly heartburn, regurgitation, and chest pain. (One may also have the symptoms of LPR. Note: one may have both GERD & LPR, they may not be mutually exclusive.)

• Non-Acid Reflux (LPR): Often presents with throat symptoms like chronic cough, hoarseness, throat pain, throat discomfort, and throat clearing.

Acidity

• Acidic Reflux: Typically involves reflux containing stomach acid.

• Non-Acid Reflux: Can involve non-acidic stomach contents, such as bile or pepsin.

Affected Areas

• Acidic Reflux: Primarily affects the esophagus and stomach lining, but my also impact the throat / sinuses if reflux is left untreated.

• Non-Acid Reflux: Affects the throat, esophagus, larynx, and pharynx, and can impact respiratory pathways.

Diagnosis

• Acidic Reflux: Diagnosed through symptoms, pH monitoring (pH impedance test), and endoscopy.

• Non-Acid Reflux: Can be diagnosed via pH monitoring (pH impedance test) or symptomatology. May require laryngoscopy and guidance from an ENT.

Treatment Modalities

Lifestyle and Dietary Changes:

• Avoid Trigger Foods: Spicy, fatty, and acidic foods, as well as caffeine and alcohol, can exacerbate symptoms.

• Eat Smaller, More Frequent Meals every ~3 hours: Large meals can increase pressure on the LES and UES.

• Elevate Head During Sleep: Helps prevent nighttime reflux.

• Maintain a Healthy Weight: Reduces pressure on the stomach and LES.

• Consider your relationship with stress and stress management, including stress-relieving activities like movement, grounding, journaling, etc.

Alginate Therapy:

• For Both Acidic and Non-Acid Reflux: Alginate-based formulations (e.g., RefluxRaft) can help provide a barrier to block reflux and prevent symptoms. Try RefluxRaft here.

Other Therapies:

• Voice Therapy with a Speech Language Pathologist: Beneficial for individuals with LPR to reduce throat irritation.

Understanding the differences between acidic and non-acid reflux is vital for effective treatment. While GERD and its typical symptoms of heartburn are more well-known, LPR presents a unique set of challenges due to its non-acidic nature and atypical symptoms. Proper diagnosis and tailored treatment strategies can significantly improve the quality of life for individuals suffering from either form of reflux.

For personalized dietary and lifestyle advice, FLORA Nutrition can help you find relief from both acidic and non-acidic reflux! Our 8-week, self-paced course teaches you the FLORA Method for healing from all types of reflux, in addition to lifetime access to the FLORA app, and community support.

To learn more, check out 8 Weeks to Reflux Relief Masterclass.

Written by Molly Pelletier, MS, RD, LDN | Molly Pelletier is a Registered Dietitian specializing in acid reflux/GERD/LPR/IBS and a leading voice in nutrition for acid reflux. Molly's background in nutrition science and her personal health journey with GERD culminated in the curation of FLORA Nutrition, where she shares evidence-based tools and strategies to help others recover from reflux and optimize their overall well-being. Follow Molly on Social Media @mollypelletier.rd on all platforms | YouTube | Instagram | TikTok | Pinterest | 

Blog co-created with FLORA Team Member & MS Nutrition, Jacqueline Gilpin