Got GERD?

More Than Heartburn: Understanding GERD, LPR, and Their Impact on Voice and Swallowing

As a medical Speech-Language Pathologist, I work with many patients who experience persistent throat symptoms—chronic cough, voice changes, constant throat clearing—and are often surprised to learn that these can be caused by a reflux condition. But not all reflux is created equal. In fact, two different types: Gastroesophageal Reflux Disease (GERD) and Laryngopharyngeal Reflux (LPR). Both affect the body in unique and often misunderstood ways.

Let’s break it down.

What Is GERD?

GERD occurs when stomach contents escape through the lower esophageal sphincter (LES) and flow backward into the esophagus. It’s most commonly associated with:

• Heartburn

• Chest pain

• A sour taste or regurgitation

This type of reflux tends to affect the mid to upper esophagus, but typically does not reach the throat or voice box.

What Is LPR?

LPR, or Laryngopharyngeal Reflux, is sometimes referred to as “silent reflux”—because it often occurs without the classic heartburn symptoms. In LPR, the refluxed material travels higher, reaching the throat and sometimes the vocal folds. Common symptoms include:

• Chronic throat clearing (especially after meals)

• Persistent cough

• A hoarse or weak voice

• A sensation of something "stuck" in the throat

• Increased risk of aspiration pneumonia (PNA) in severe cases

As a swallowing and voice specialist, these are signs I frequently assess during laryngeal imaging and endoscopic evaluations.

Why Do These Conditions Occur?

Certain medical conditions or anatomical abnormalities can increase your risk of reflux, including:

• Scleroderma

• Myasthenia Gravis

• Achalasia

• Hiatal hernia

• Esophageal diverticulum

• Eosinophilic esophagitis (EoE)

All of these can weaken the body's natural barriers to reflux or disrupt normal esophageal motility, making it easier for stomach acid to travel where it shouldn’t.

How We Evaluate Reflux in the Clinic

During a laryngeal screening with voice evaluation or flexible endoscopy eval of swallowing (FEES), I often look for visual signs of reflux using a tool called the Reflux Finding Score (RFS). This scoring system helps identify inflammation, redness, or other tissue changes consistent with LPR.

When reflux is suspected, I may recommend consultation with an ENT (Ear, Nose, and Throat physician) or a Gastroenterologist (GI specialist). However, access to these specialists can often be delayed or limited—so it's important to have a plan for early symptom management.

What Can You Do About It?

If you're experiencing symptoms of GERD or LPR, here are some proactive steps to take:

1. Talk to Your Primary Care Provider (PCP)

Discuss over-the-counter options like Proton Pump Inhibitors (PPIs) such as Omeprazole. These medications work by reducing the amount of acid produced in the stomach, lowering the risk of reflux irritation.

2. Try a Holistic Supplement

One well-tolerated option is Reflux Gourmet, a natural alginate-based supplement. Alginate creates a gel-like barrier at the top of the stomach that:

• Coats the lining of the esophagus

• Physically prevents stomach contents from rising into the throat creating a gel like boat barrier

This can be especially helpful after meals or before lying down, when reflux is more likely to occur.

Why This Matters for Speech and Swallowing Health

Chronic reflux, especially LPR, can cause long-term damage to the tissues of the throat, alter the voice, and complicate safe swallowing. As SLPs, we are often the first clinicians to identify these signs and help patients take early action.

If you’re experiencing persistent throat discomfort, voice issues, or swallowing changes, you’re not imagining it—and help is available.

Your body is talking to you. Don’t wait until it’s screaming.
Reflux may be silent, but its effects don’t have to be.