Extraoesophageal manifestations of gastro-oesophageal reflux

• Published in: Gut Vol. 54; no. 10; pp. 1492 - 1499
• Main Authors: Poelmans, J, Tack, J
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Society of Gastroenterology 01.10.2005; BMJ; BMJ Publishing Group LTD; Copyright 2005 by Gut
• Subjects: acid suppression; Acids; Algorithms; Asthma; Asthma - etiology; Asthma - therapy; Biological and medical sciences; Bronchitis; Cancer; Chronic Disease; Chronic obstructive pulmonary disease; Chronic obstructive pulmonary disease, asthma; Confidence intervals; Cough - etiology; Cough - therapy; Ear diseases; Endoscopy; Esophagus; extraoesophageal manifestations; gastro-oesophageal reflux; Gastroenterology. Liver. Pancreas. Abdomen; Gastroesophageal reflux; Gastroesophageal Reflux - complications; Humans; Hydrogen-Ion Concentration; Laryngeal Diseases - etiology; Laryngeal Diseases - therapy; Larynx; Lung Diseases - etiology; Lung Diseases - therapy; Medical sciences; oesophagitis; Other diseases. Semiology; Otitis Media - etiology; Otitis Media - therapy; Otorhinolaryngologic Diseases - etiology; Otorhinolaryngologic Diseases - therapy; Pneumology; Pneumonia; Proton Pump Inhibitors; Pulmonary fibrosis; Recent Advances in Clinical Practice; Respiratory system : syndromes and miscellaneous diseases; Studies; Gastroesophageal reflux; Lung disease; Respiratory disease; Middle ear disease; Esophageal disease; Oropharynx; Sinusitis; Cough; Asthma; Chronic; Nose; Digestive diseases; Bronchus disease; ENT disease; Otitis media; Paranasal sinus disease; Larynx; Obstructive pulmonary disease; Endoscopy
• ISSN: 0017-5749; 1468-3288; 1458-3288
• DOI: 10.1136/gut.2004.053025

A variety of pulmonary and ear, nose, and throat (ENT) symptoms and disorders are considered to be extraoesophageal manifestations of gastro-oesophageal reflux disease (GORD). These extraoesophageal manifestations include asthma, chronic cough, laryngeal disorders, and various ENT symptoms. Recent studies have established that GORD underlies or contributes to chronic sinusitis, chronic otitis media, paroxysmal laryngospasm, excessive throat phlegm, and postnasal drip. Traditionally, management of extraoesophageal GORD manifestations relies on prolonged empiric therapy with high doses of proton pump inhibitors (PPI), followed by pH monitoring under PPI in refractory cases. Recent studies found no benefit of empiric long term high dose PPI therapy. The diagnostic yield of endoscopy in extraoesophageal GORD manifestations seems higher than previously appreciated while pH monitoring under PPI therapy has a low yield. Based on these new findings, a new management algorithm can be proposed that uses short term empiric PPI therapy and GORD investigations off PPI. Well designed controlled studies evaluating the proposed management algorithms and treatment approaches in this area are urgently needed.