Extra-Esophageal Manifestations of Gastroesophageal Reflux Disease: Diagnosis and Treatment

Gastroesophageal reflux disease (GERD) is a common disease that is often diagnosed based on typical symptoms of heartburn and regurgitation. In addition to these more classic manifestations, GERD is increasingly associated with extra-esophageal symptoms, including chronic cough, asthma, laryngitis,...

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Bibliographic Details
Published in:Drugs (New York, N.Y.) N.Y.), 2013-08, Vol.73 (12), p.1281-1295
Main Authors: Hom, Christopher, Vaezi, Michael F.
Format: Article
Language:English
Subjects:
Acids
Asthma
Asthma - diagnosis
Asthma - drug therapy
Biological and medical sciences
Cough - diagnosis
Cough - drug therapy
Diagnosis, Differential
Endoscopy
Esophagus
Gastroenterology. Liver. Pancreas. Abdomen
Gastroesophageal reflux
Gastroesophageal Reflux - diagnosis
Gastroesophageal Reflux - drug therapy
Humans
Hydrogen-Ion Concentration
Inflammation
Internal Medicine
Laryngitis - diagnosis
Laryngitis - drug therapy
Larynx
Medical sciences
Medicine
Medicine & Public Health
Other diseases. Semiology
Pathophysiology
Pharmacology/Toxicology
Pharmacotherapy
Proton Pump Inhibitors - therapeutic use
Review Article
Severity of Illness Index
Tooth Erosion - diagnosis
Tooth Erosion - drug therapy
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Summary:Gastroesophageal reflux disease (GERD) is a common disease that is often diagnosed based on typical symptoms of heartburn and regurgitation. In addition to these more classic manifestations, GERD is increasingly associated with extra-esophageal symptoms, including chronic cough, asthma, laryngitis, and dental erosions. Due to the poor sensitivity of endoscopy and pH monitoring, and the poor specificity of laryngoscopy, empiric therapy with proton pump inhibitors (PPIs) is now considered the initial diagnostic step in patients suspected of having GERD-related symptoms. For those who improve with PPIs, GERD is the presumed etiology, but for those who remain unresponsive to such therapy, further diagnostic testing with impedance/pH monitoring may be necessary in order to exclude refractory acid or weakly acid reflux. In those with normal test results despite PPI therapy and continued symptoms, causes other than GERD may be pursued. Recent data suggest that in patients with extra-esophageal symptoms, objective findings of moderate-sized hiatal hernia and moderate reflux on pH testing may predict response to acid suppressive therapy. PPI-unresponsive patients usually have causes other than GERD for their extra-esophageal symptoms and continued PPI therapy in this group is not recommended.
ISSN:0012-6667
1179-1950
DOI:10.1007/s40265-013-0101-8