GERD, Silent reflux, Hiatal hernia, LPR – what’s the difference?

There is so much confusion about GERD, Silent Reflux, Hiatal hernia, LPR and other related conditions. In fact, one of them isn’t a sickness in itself at all. Read here about their similarities and differences, and the common problem that underlies them all.

We hear questions like this all the time. There is a lack of good explanations of how all these conditions are linked. People say that they have LPR but not Hiatal hernia; or are prescribed PPI medication but do not have reflux. Here, experts cast a light on the subject and why these people are wrongly advised.

Differences and similarities

Let’s start by looking at the symptoms and differences between some common conditions

The differences in how the symptoms present are listed below, but you won’t miss the similarities between all of these conditions either. In all cases the experts say, “This condition is caused when stomach acids leak up into the esophagus and attack the soft tissues there”. Later we will look at this common denominator in all the conditions, what causes it, and how it can be treated.

Another thing that you might notice is that Hiatal hernia is not mentioned at all. That’s because Hiatal hernia is not a disease in itself, it is a condition that allows LPR, GERD, Silent Reflux, IED, Esophagitis and other diseases to occur.

GERD (or GORD)

GERD stands for Gastro Esophageal Disease, if you prefer to spell Oesophagus with an “O”, then you’d call it GORD.

This condition is caused when stomach acids leak up into the esophagus and attack the soft tissues there. The symptoms usually include heartburn, a feeling of something stuck in the throat, pain behind the breastbone, difficulties in swallowing some foods, thick phlegm or frothy saliva, and regurgitation. In addition, there is often a persistent non-productive cough as the Upper Esophageal Sphincter (UES) fails to open properly.

LPR

LPR is an abbreviation for Laryngopharyngeal Reflux. This condition is caused when stomach acids leak up into the esophagus and attack the soft tissues there. The symptoms usually include heartburn, sore throat, irritation in the larynx and vocal cords and hoarseness.

LPR differs from GERD (see above) in that discomfort is not usually experienced in the chest cavity, only in the throat region.

Silent reflux

This condition is caused when stomach acids leak up into the esophagus and attack the soft tissues there. The symptoms are the same as for LPR (see above) except that heartburn is not usually present.

Heartburn

This condition is caused when stomach acids leak up into the esophagus and attack the soft tissues there. The symptoms are a nagging pain in the chest or throat.

Barrett’s esophagus

This condition is caused when stomach acids leak up into the esophagus and attack the soft tissues there. Untreated for a period of time this can cause the cells in the lining of the esophagus to change character. This worries doctors because it could be a sign that they are turning pre-cancerous.

Hiatal hernia

If Hiatal hernia is the root of all these conditions, it would be good to know more about it. You will see that the condition is quite simple to understand, sometimes difficult to diagnose by examination, and capable of being treated.

Anatomical description

The diaphragm is the thin but powerful muscle below the ribs that divides the chest cavity (heart and lungs) from the stomach cavity. It is attached to the base of the sternum (breastbone) and follows the base of the ribcage and ends at the spine.

The esophagus runs from your throat down to your stomach, the point where it passes through the diaphragm is called the Hiatus canal. Here the diaphragm muscle grips around the esophagus and ensures that mouth of the stomach cannot normally intrude through into the chest cavity except when we burp or vomit.

The valve at the top or mouth of the stomach is called the LES (Lower Esophageal Sphincter), its job is to remain tightly closed except when swallowing and admitting food and drink into the stomach. An exception to this is when we need to burp, or when we are ill and need to vomit. In these cases, the neck of the stomach must slide up through the diaphragm to allow the LES to open upwards to discharge gases or liquids. In its natural position below the diaphragm it cannot do this, it is only able to flex open in a downward direction and permit one-way traffic into the stomach.

When the stomach intrudes at other times, in an uncontrolled and undesired way, stomach acids can be refluxed into the esophagus. This causes the symptoms of reflux.

The cause of this uncontrolled intrusion of the neck of the stomach is that the muscle gripping the esophagus in the Hiatus canal is weakened or ruptured. In Latin, such a rupture is called a Hernia. The condition is thus known as a Hiatus hernia and is the underlying cause of all persistent reflux problems. 

Hiatal hernia is not a disease

A Hiatal hernia is not a disease, it is a condition that allows LPR, GERD, Silent Reflux, IED, Esophagitis and other diseases to occur. These conditions are sometimes known by their full names: Laryngopharyngeal Reflux, Gastroesophageal Reflux Disease, Intermittent Esophageal Dysphagia.

Why is Hiatal hernia not always confirmed?

Hiatus hernia can be confirmed by an internal examination called a gastroscopy or by X-ray, but this can be difficult. 

Hiatus hernia is difficult to diagnose with certainty, a sliding Hiatus hernia (90% of all cases) is by its nature intermittent and does not always exhibit at the time of examination. The main reason for a gastroscopy is often to rule out other serious conditions, not to confirm a Hiatus hernia.

Our scientific studies always distinguish between those patients with the symptoms of a Hiatus hernia and a confirmed diagnosis; and those with the symptoms but no confirmation. In these studies, these two groups have the same symptoms, treatment and positive results. In reality there is no difference between the two groups.

In a customer study (June 2020) directed at IQoro users in Sweden and UK we asked how many people believed they had a Hiatus hernia. They had the symptoms and were training with IQoro, but we asked if they had a confirmed diagnosis.

More than 2 900 responded: 37% had a confirmation and 37% suspected a Hiatal hernia or didn’t know. The respondents were almost all in Sweden and the UK, and to add to this uncertainty people were 1.8 times more likely to have had confirmed diagnosis in one country than the other. Getting certainty is a postcode lottery!

Hiatus hernia is the root of all these conditions: and thus they can be treated.

Hiatus hernia is not a sickness or a disease in itself: rather it is a muscular weakness that causes other conditions. It can be successfully treated with IQoro.

If you suffer from the symptoms described, and you are doing no more than taking medication, it is unlikely that the underlying problem will improve. The drugs are important to prevent the reflux causing more serious damage to your vulnerable internal tissues; but they won’t ever cure the underlying problem: drugs can’t make muscles stronger

IQoro is a suitable treatment for Hiatus hernia, it treats and strengthens the weak muscle that underlies reflux conditions. Visit the rest of our site to learn more.

You should not stop your medication unless your doctor agrees. Seek medical advice if you are concerned about your condition.