Understanding the Difference Between Respiratory Reflux and GERD: Beyond Heartburn

Respiratory reflux and Gastroesophageal Reflux Disease (GERD) are distinct conditions that are often confused. While both involve acid reflux, their symptoms, affected areas, and treatments differ significantly. This comprehensive guide explains the key differences between these conditions.

Key Differences at a Glance

Respiratory Reflux (LPR):

     Primarily affects breathing and throat

     Usually no heartburn symptoms

     Often occurs silently during sleep

     Normal esophagus in 83% of cases

     Poor response to standard GERD treatments, including PPIs

     Symptoms include hoarseness, chronic cough, and breathing difficulties

GERD:

     Primarily affects the esophagus

     Characterized by heartburn and indigestion symptoms

     Symptoms are typically noticeable

    Esophageal involvement

     Usually responds to conventional acid-suppressing treatments

Historical Context and Evolution

The term “gastroesophageal reflux disease” (GERD) emerged in the 1970s when gastroenterologists focused primarily on esophageal symptoms. However, in 1987, I introduced the term “Laryngopharyngeal Reflux” (LPR) to describe a distinct pattern of reflux affecting the throat and airways. By 2017, I felt that we needed a more comprehensive term, respiratory reflux, to better encompass the condition’s full scope.

Current Healthcare Challenges

Medical Training Gap:

Most airway specialists (pulmonologists, otolaryngologists, allergists) lack training in respiratory reflux. Primary care physicians often aren’t equipped to diagnose or treat respiratory reflux. And gastroenterologists focus almost exclusively on heartburn and GERD.

Diagnostic Differences:

Only about 15% of patients show overlap with GERD and respiratory reflux. Traditional gastroenterology GERD tests cannot diagnose respiratory reflux. Different diagnostic approaches and technology are needed for each condition.

Treatment Implications

GERD Patients Typically Benefit From:

          Standard acid-suppressing medications

          Gastrointestinal-focused treatments

          Care from gastroenterologists

Respiratory Reflux Patients Often Require:

     Different treatment approaches focusing on diet and lifestyle

     Specialized care beyond traditional GERD protocols

     Potentially multi-disciplinary (primary care and otolaryngology) management

Call for Healthcare Policy Changes

The Medical Community Needs to Recognize:

(1) Respiratory reflux is distinct from GERD.

(2) The current healthcare structure may not adequately address respiratory reflux.

(3) Medical education should include specific training for respiratory reflux.

(4) Insurance and Medicare policies should reflect the distinctions between respiratory reflux and GERD.

(5) Specifically, Medicare should increase reimbursement for TNE (transnasal esophagoscopy) to make it competitive with sedated endoscopies by gastroenterologists. There should be no facility fees because TNE should be an office-based procedure and the procedure of choice for esophageal screening.

Conclusion

Understanding the difference between respiratory reflux and GERD is crucial for proper diagnosis and treatment. While GERD primarily causes heartburn and digestive symptoms, respiratory reflux affects the airways and throat, often without traditional reflux symptoms. At this time, most patients with acid reflux have respiratory reflux, not GERD. Healthcare policies and medical training need to evolve to better address these respiratory reflux.