November 28, 2023

Acid Reflux: Definition of Terms



  • The terms for acid reflux have changed and evolved over the past fifty years; nevertheless, LPR, laryngopharyngeal reflux and  GERD, gastroesophageal reflux disease remain the most commonly used terms.
  • Other terms such as “atypical” reflux disease, extraesophageal reflux, airway reflux, and silent reflux have been used too; although the first three have become archaic … but silent reflux remains a much-used term.
  • While the relatively new term, respiratory reflux and LPR are currently being used as synonyms; in reality, respiratory reflux is a more accurate and comprehensive term.

Next week, a new term, SNoRR, will be introduced; it helps explain how and why silent reflux may affect so many.

Believe it or not, acid reflux, specifically “peptic ulcer of the esophagus” was discovered in 1934, but it wasn’t till the 1970s that clinicians had a better handle on the symptoms and manifestations of esophageal acid reflux; and the term GERD, gastroesophageal reflux disease, came into common usage. (GERD literally means “reflux from the stomach into the esophagus causing disease.”_ The main symptoms of GERS are heartburn and indigestion.

Reflux Laryngitis

When I began my work on throat reflux, “GERD” was the only term except for reflux laryngitis that had been reported in the medical literature as early as the 1960s by otolaryngologists, Drs. Olsen, Cherry, Margoles, Ward, and Toohill. These pioneering physicians recognized that acid reflux could cause a hoarseness and other voice box and throat problems … but without heartburn. But they had no diagnostic technology to prove that reflux was the cause.

Laryngopharyngeal Reflux

In 1981, I was the first to place 24-hour pH (acid) probes in the pharynx (throat) of my patients to document diseases like reflux laryngitis. And my patients almost never had heartburn or indigestion; they had silent reflux. The most common symptoms of LPR were/are post-nasal drip, ear fullness and tinnitus, facial pressure, sinus pain, hoarseness, difficulty swallowing, sore throat, a sense of a lump in the throat, wheezing, and shortness of breath sinus. And in addition, these patients esophageal examinations were usually (83%) normal. To differentiate the reflux manifestations, symptoms, and patterns in my otolaryngology patients compared to GI patients with GERD, in 1987 I coined LPR, laryngopharyngeal reflux, literally “reflux into the larynx (voice box) and pharynx (throat)

Silent Reflux

Since most LPR patients did not have the primary telltale symptom of GERD, heartburn; they have silent reflux. How the term “silent Reflux” came to be is a fun story. My friend, Dr. Walter Bo, chairman of anatomy department, was a delightful man who always wore a bowtie and smelled slightly formaldehyde. Walter came to see me because of hoarseness, especially in the morning, post-nasal drip, and chronic throat-clearing.

After I examined him, I told him that he had reflux, but Walter said, “No, I don’t have any reflux.” Again, I said, Yes you do,” and again he said, “No I don’t.” Then, I explained that one could have reflux without having heartburn or indigestion. Apparently, he acquainted reflux with heartburn and heartburn with reflux. Since he had no heartburn, he had concluded that he didn’t have reflux. After, my explanation, Walter paused and then thoughtfully announced, “I see; I have the silent kind of reflux.“ “Yes, Walter that’s it; you have silent reflux.”

Archaic GI Terms

As soon as I began publishing my research using the terms LPR and airway reflux, not wanting to use my ENT terms, the GIs came up with other terms for LPR, “atypical” reflux, extraesophageal reflux and supraesophageal reflux. I believe that GIs thought that the term LPR was claiming reflux to be important in the otolaryngology (ear, nose and throat) realm, and they didn’t like that. But their terms atypical reflux, extraesophageal, and supraesophageal reflux are rarely used today.

Respiratory Reflux

As terms go, laryngopharyngeal reflux is difficult to pronounce and it isn’t inclusive enough. LPR literally means “reflux into the voice box and throat”; however, reflux can affect any part of the respiratory tract, that is, the ears, nose, throat, sinuses, larynx, vocal cords, trachea, bronchi, and lungs.  Therefore, I’d like to change-out LPR for an easier-to-pronounce, more intuitive, more inclusive, and more accurate term, Respiratory Reflux (RR) (2015).

Respiratory Reflux (RR) is the better term, but I have no problem with the two terms RR and LPR being used interchangeably, as synonyms for now. However, I believe that Respiratory Reflux is a pinnacle term, and as such, it will eventually replace LPR.

Terms For Acid Reflux (1970 to the Present)

re·flux n [ L re– back + fluxus flow]    1: a flowing back    2: a process of refluxing

Common Terms for Reflux

General Terms

Acid reflux

Gastric reflux

Peptic reflux

Indigestion / Heartburn

Terms for Esophageal Reflux

Gastroesophageal Reflux Disease, GERD

Gastro-Oesophageal Reflux Disease, GORD [U.K.]

Peptic Esophagitis / Esophageal Erosions

Terms for Throat / Airway / Respiratory Reflux

Reflux Laryngitis

Supraesophageal Reflux

“Atypical” Reflux Disease 

Extraesophageal Reflux Disease

Laryngopharyngeal Reflux, LPR

Silent Reflux 

Airway Reflux

Respiratory Reflux, RR

† Terms coined by Dr. Jamie Koufman

Next week a new term, SNoRR, will be introduced, a term that I believe explains how and why reflux may affect millions of unsuspecting Americans.

For more information about diagnosis and treatment of reflux laryngitis, see my two companion books on Amazon: Dropping Acid: The Reflux Diet Cookbook & Cure and Dr. Koufman’s Acid Reflux Diet. And, if you would like to schedule a virtual consultation with me, you can book it online.

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