Diagnosis and Treatment of the Extraesophageal Manifestations of Gastroesophageal Reflux Disease
- 1 January 2017
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Annals of Surgery
- Vol. 265 (1), 63-67
- https://doi.org/10.1097/sla.0000000000001907
Abstract
OBJECTIVE To review the clinical presentation, diagnosis, and treatment options available for management of extraesophageal manifestations of gastroesophageal reflux disease (GERD) and to compare the most recent technological advances to the existing guidelines. SUMMARY BACKGROUND DATA Extraesophageal manifestations of GERD include cough, laryngopharyngeal reflux (LPR), and asthma. Recent advances in diagnostic modalities may have outpaced the existing diagnostic and therapeutic clinical guidelines. METHODS We searched the MEDLINE, Cochrane, and Embase databases for articles pertaining to the presentation, diagnosis, and treatment of extraesophageal manifestations of reflux, specifically cough due to reflux, LPR, and asthma due to reflux. Search terms applied to 3 thematic topics: diagnosis, medical treatment, and surgical treatment. We had searched the bibliographies of included studies, yielding a total of 271 articles for full review. We graded the level of evidence and classified recommendations by size of treatment effect, according to the guidelines from the American Heart Association Task Force on Practice Guidelines. RESULTS One hundred twenty-eight articles met criteria for analysis. Our findings show that the diagnosis of cough, LPR, or asthma due to gastroesophageal reflux is difficult, as no criterion standard test exits. Also, patients often present without heartburn or regurgitation typical of GERD. Combined multichannel intraluminal impedance, the pH (MII-pH) monitoring system, and the symptom association probability (SAP) test might distinguish extraesophageal manifestations of reflux from idiopathic chronic cough, laryngitis due to other causes, and atopic asthma. In addition, extraesophageal manifestations of reflux are most effectively diagnosed with a stepwise approach incorporating empiric treatment and antisecretory therapy, combined MII-pH monitoring, and surgical intervention in few selected cases. CONCLUSIONS Recent studies demonstrate the potential diagnostic role of MII-pH monitoring. Surgical intervention provides resolution of extraesophageal symptoms less reliably than typical symptoms when the patient has GERD.Keywords
This publication has 56 references indexed in Scilit:
- Management of patients with chronic cough using a clinical protocol: a prospective observational studyCough, 2013
- A Preliminary Investigation of Laparoscopic Fundoplication Treatment on Gastroesophageal Reflux Disease-related Respiratory SymptomsSurgical Laparoscopy, Endoscopy & Percutaneous Techniques, 2012
- Effectiveness of Laparoscopic Total and Partial Fundoplication on Extraesophageal Manifestations of Gastroesophageal Reflux DiseaseSurgical Laparoscopy, Endoscopy & Percutaneous Techniques, 2012
- Clinical outcomes of atypical extra-esophageal reflux symptoms following laparoscopic antireflux surgerySurgical Endoscopy, 2011
- Randomised clinical trial: high-dose acid suppression for chronic cough - a double-blind, placebo-controlled studyAlimentary Pharmacology & Therapeutics, 2010
- Efficacy of Esomeprazole for Treatment of Poorly Controlled AsthmaThe New England Journal of Medicine, 2009
- The Role of Gastroesophageal Reflux in Exercise-Triggered Asthma: A Randomized Controlled TrialDigestive Diseases and Sciences, 2008
- Long-term outcomes of laparoscopic antireflux surgery for gastroesophageal reflux disease (GERD)-related airway disorderSurgical Endoscopy, 2006
- Treatment of Chronic Posterior Laryngitis With EsomeprazoleThe Laryngoscope, 2006
- Pharyngeal and laryngeal symptoms and signs related to extraesophageal reflux in patients with heartburn in gastroenterology practice: a prospective studyClinical Otolaryngology, 2005