Abstract
Gastroesophageal reflux disease (GERD) is defined by the presence of symptoms induced by the reflux of the stomach contents into the esophagus. Although clinical manifestations of GERD typically involve the esophagus, extra-esophageal manifestations are widespread and less known. In this review, we discuss extra-esophageal manifestations of GERD, focusing on clinical presentations, diagnosis, and treatment. Common extra-esophageal manifestations of GERD include chronic cough, asthma, laryngitis, dental erosions, and gingivitis. Extra-esophageal involvement can be present also when classic GERD symptoms are absent, making the diagnosis more challenging. Although available clinical studies are heterogeneous and frequently of low quality, a trial with proton pump inhibitors can be suggested as a first-line diagnostic strategy in case of suspected extra-esophageal manifestations of GERD.
Highlights
Gastroesophageal reflux disease (GERD) is a common gastrointestinal (GI) condition with a worldwide diffusion and high prevalence in Western countries
An empirical trial of double-dose pump inhibitor (PPI) is recommended as first-line therapy in patients with suspected Laryngo-pharyngeal reflux (LPR) to aggressively suppress the hypopharyngeal acid reflux [48]
In the suspect of GERD-related non-cardiac chest pain (NCCP), a PPI trial could be used by primary care physicians as the initial diagnostic tool after the exclusion of non-esophageal causes: rabeprazole 20 mg twice daily for two weeks has shown a sensitivity of 81% and specificity of 62% in diagnosing GERD-related NCCP [76]
Summary
Gastroesophageal reflux disease (GERD) is a common gastrointestinal (GI) condition with a worldwide diffusion and high prevalence in Western countries. Ambulatory 24-h esophageal pH monitoring is indicated in the evaluation of patients’ refractory to a PPI test and when the diagnosis of GERD is uncertain. This diagnostic test is the only capable of assessing the association between refluxates and reflux symptoms, being useful in detecting GERD-related EE manifestations [5]. Upper gastrointestinal endoscopy is recommended when alarm signs are present (e.g., anemia, undesired loss of weight), in cases of no response to PPI treatment (no decrease of GERD symptoms after short PPI treatment, recurrence of EE symptoms besides 3 months of PPI treatment), dysphagia, suspicious of other causes of heartburn (e.g., eosinophilic esophagitis), long-lasting EE symptoms, the presence of GERD complications, the presence of Barrett esophagus, and fundoplication (before and after)
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