**11. Conclusion**

Different results of scientific studies make it difficult to establish clear approach to the symptoms and manifestations of LPR and its relation to GERD. The multifactorial pathophysiology of reflux needs to be investigated in more detail [37]. GERD typically manifests as heartburn, regurgitation, and chest pain, while LPR patients usually do not report these symptoms, and they complain about chronic cough, laryngitis, and a lump in the throat. According to some investigations, ≤50% of LPR patients have GERD, while laryngopharyngeal symptoms were present in 32.8% of GERD patients. LPR patients mainly have gaseous, upright, and daytime reflux events, and only 5.5% of laryngopharyngeal reflux events occurred at nighttime, in the supine position.

GERD could be diagnosed using multiple tools, but fewer objective diagnostic tools exist for diagnosing LPR. However, up to 50% of patients with LPR symptoms may not have classic reflux symptoms. The interindividual differences in the esophageal and laryngopharyngeal mucosa sensitivity must be taken into account, too. The esophagoscopy may be normal in more than 44% of cases and may detect esophagitis in 10–30% of LPR patients, while erosive esophagitis is found in almost 50% of GERD patients. Scientific evidence shows that LPR is not an advanced stage of GERD [17].

The independent existence of LPR in the absence of GERD can be understood through several possibilities. First, reflux can originate from the heterotopic gastric mucosa of the cervical esophagus. Second, reflux events detected in the laryngopharynx are secondary to GER, and patients met both of diagnostic criteria. Third, reflux events detected only in the laryngopharynx are secondary to GER and meet the diagnostic criteria for LPR, but do not meet the criteria for GERD. It seems that more studies would make it possible to define the reflux standard for GERD as well as put together the standard differentiation between LPR and GERD [38].

Safe standard diagnostic procedures, which could precisely determine LPR, have still not been established, and taking careful and detailed hetero-anamnestic history is important. In GERD, typical reflux symptoms usually regress with antireflux therapy, but several meta-analyses have demonstrated no diagnostic or therapeutic benefit of PPI to manage patients with LPRD. Therefore, establishing a multidisciplinary collaboration between gastroenterologists, laryngologists, family medicine physicians, pediatricians, pulmonologists, psychiatrists, and speech-language pathologists is necessary to provide a comprehensive approach to develop acceptable diagnostic and treatment modalities for the pathologic reflux.

A generally accepted view today is that, although the relationship between them is not completely understood, it is necessary to consider them as different types of medical entities and treat them in a different way. Anyway, GERD and LPR can coexist with each other and also independently as different subheadings under the main heading reflux disease [17].
