Diagnosing GERD and LPR can often be difficult, especially if the diagnosing physician does not perform all the necessary tests. However, this RefluxMD member had most of the appropriate tests done by multiple specialists, and they indicated no GERD or LPR. However, his GERD symptoms tell another story. Now what?
I have suffered for years. Took the barium test, no reflux found. Had endoscopy with biopsy. No damage or findings. I suffer twenty-four hours a day. I get the worst taste in my mouth. Burning. Stomach cramps. I’ve seen two specialists. Still no change; what can I do?
- Symptoms: Heartburn and hoarseness
- Endoscopy diagnosis: YES but negative
- GERD stage: Unknown
- BMI: 19 – 24 (healthy)
Thank you for your question. I am sorry for your pain and your doctor’s inability to identify the source of your symptoms. Heartburn, hoarseness, burning in the chest, and a terrible taste in your mouth certainly suggests both traditional GERD and LPR, or silent GERD. However, the tests performed should have diagnosed these conditions, and the only other test we would recommend is a 24-hour pH test.
GERD is often misdiagnosed when it is based upon symptoms, but endoscopy with biopsies along with a barium swallow should have found some signs of a failing lower esophageal sphincter (LES). LPR is much more difficult to diagnose, however the “gold standard” for both conditions today is a 24-hour pH test. The Restech pH test is the newest test used by ENTs to determine if the upper esophageal sphincter is comprised, and recently published research highlights its effectiveness. For GERD, the Bravo pH test is recommended. This small device is attached to the esophagus for 24-hours and records the frequency and severity of acid refluxing past the LES and into the esophagus. While you and your doctors discuss these tests, you should also begin to focus on some other conditions that that may be driving your symptoms.
Other medical conditions that can mirror LPR and GERD symptoms
Those that mirror GERD Symptoms
- Cardiac issues or angina. Symptoms can be identical to GERD; in fact, there are over 600,000 trips to emergency rooms annually for heart attacks that are determined to be heartburn. We recommend the Mayo Clinic article on heartburn or heart attack.
- Stomach ulcers. H pylori bacteria infections can create an inflammation in the stomach, which can then progress to a stomach ulcer. Stomach ulcers will create discomfort in the stomach, and it can cause severe chest pain as well. We recommend a good article by Harvard Health on stomach ulcers.
- Gallstones. Although many with gallstones are asymptomatic, when a gallstone blocks the bile duct, pressure can increase in the gallbladder, resulting in severe pain. We recommend a very good article at the NIH.
- Paraesophageal hernia. Unlike a hiatal hernia where the stomach extends up into the hiatus, a paraesophageal hernia pushes up through the diaphragm next to the esophagus. This type of hernia can cause chest pain and abdominal pain. We recommend an article on paraesophageal hernias at Medscape.
- Gastroparesis. A damaged vagus nerve can result in a delay in stomach emptying. This can result in nausea, bloating, and typical GERD symptoms. You may find the article at WebMD interesting.
Those that mirror LPR Symptoms
- Vocal cord lesions. These lesions are membrane structural defects that cause LPR type symptoms. You can learn more in an article by the Cleveland Clinic.
- Granuloma on the vocal cords. This is a result of chronic inflammation located on the back of the vocal cords. This can cause a noticeable hoarseness of the voice. A good description can be found in the Merck Manual.
- Chronic bronchitis. Bronchitis is basically inflammation of the bronchial tubes. Symptoms are similar to LPR, congestion, wheezing, and a chronic cough. We recommend an article by the Mayo Clinic.
- Pleuritis. This condition is typically caused by an infection that causes an inflammation of the lungs. The symptoms are similar to heartburn. We found a very good article at a website dedicated to pleuritis.
- Asthma and allergies. These two conditions are very common and symptoms can often mimic those of LPR.
This is only a partial list of medical conditions that can create symptoms similar to GERD or LPR. Again, we encourage you to discuss with your doctor other non-GERD or LPR medical conditions that could be the underlying cause of your symptoms. Getting an accurate and definitive diagnosis is critical to developing a treatment plan for relief. If you are convinced that your symptoms are due to GERD and or LPR, then you should get a second opinion from a GERD expert. If you would like us to check our lists to determine if there is a GERD expert near you, please feel free to use our DocMatch online tools.
I hope this helps!