This is because heartburn is caused by esophagitis due to esophageal dysmotility and lower esophageal sphincter dysfunction, (3) while most patients with LPRD have normal esophageal motor function and upper esophageal sphincter dysfunction.
When reflux occurs is another thing that distinguishes LPRD and GERD.
Most patients with LPRD seek treatment from their primary care physician, typically reporting symptoms that they don't associate with gastric reflux, such as hoarseness, a chronic cough or sore throat, or the sensation of a lump in the throat (TABLE 1).
Diffuse erythema, edema, and interarytenoid hypertrophy/cobble-stoning are the most useful findings for an LPRD diagnosis.
Clinicians who have used the RFS report that a score higher than 7 identifies LPRD with 95% sensitivity.
Ambulatory dual probe pH monitoring was considered to be the gold standard test for LPRD at one time, but newer studies have raised questions about its validity and usefulness, especially in patients taking proton-pump inhibitors (PPIs).
LPRD is often called a diagnosis of exclusion, because of the nonspecific nature of its signs and symptoms and the importance of considering a range of other etiologies.
The American Gastroenterological Association cautions clinicians not to prescribe acidsuppression therapy for patients with LPRD unless they also have GERD.
Lifestyle and dietary changes (TABLE 2), such as smoking cessation, weight loss, and avoidance of alcohol are an important part of LPRD treatment, and may be used as a first-line therapy before prescribing medication.