Extraoesophageal symptoms and signs of gastroesophageal reflux disease

  • Bojan Tepeš
Keywords: GERD, atypical symptoms, unexplained chest pain, asthma, hoarseness

Abstract

Background Gastroesophageal reflux disease (GERD) is very common in developed world, with the prevalence of disease is between 6 and 20%. Pathologic reflux can provoke not only typical symptoms (heartburn and regurgitation) but also atypical symptoms and diseases of extraoesophageal organs (pulmonary, ENT, mouth). High prevalence of GERD in patients with unexplained chest pain, asthma, chronic cough, chronic laryngitis, hoarsness and dental erosions is not a proof of causality. GERD can cause these diseases with reflux of acid and pepsin into pharynx, larynx, lungs and mouth (reflux theory) or through vasovagal mechanisms (reflex theory). Conclusions Good therapeutic success with medical or operative treatment in early methodologically not well conducted studies has not been completely proven in double-blind placebo controlled studies. GERD is an ethyological reason for these extraoesophageal symptoms and diseases in an approximately one third of patients. With diagnostic modalities that we have now, we cannot clearly define in which patient is GERD is an ethyologic factor or a contributer, before we start the treatment. In patients suspected of having GERD, there is therapeutic option of a trial with high dose of proton pump inhibitor for 3 to 6 months. In other patients with low clinical suspicion of GERD, 24-hour pH testing should be done first.

Downloads

Download data is not yet available.

References

Dent J, Brun J, Fendrick AM. An evidence-based appraisal of reflux disease management – The Genval Workshop Report. Gut 1999; 44 Suppl 2: S 1–16.

The Gallup Organisation. A Gallup survey on heartburn across America. Princeton NY: The Gallup Organisation Inc.; 1988.

Locke GR, Talley NJ, Fett SH, Zinsmeiter AR, Melton LJ. Prevalence and clinical spectrum of gastroesophageal reflux: a population based study in Olmsted Country, Minnesota. Gastroenterology 1997; 112: 1448–56.

Spechler SJ. Epidemiology and natural history of gastroesophageal reflux disease. Digestion 1992; S1 Suppl 1: 24–9.

Jones RH, Hungin ADS, Philips J. Gastroesophageal reflux disease in primary care in Europe; clinical presentation and endoscopic findings. Eur J Gen Pract 1995; 1: 149–54.

Tepeš B. Gastroezofagealna refluksna bolezen. Med Razgl 2004; 43: 261–77.

Fross R, Offman JJ. Gastroesophageal reflux disease – should we adopt a new conceptual frame work ? Am J Gastroenterol 2002; 97: 1901–9.

Dobman R, Costel DO. Normal and abnormal proximal esophageal acid exposure. Results of ambulatory dual probe pH monitoring. Am J Gastroenterol 1993; 9: 25–9.

Berstad A, Hatlebakk JJ. The predictive value of symptoms in gastrooesophageal reflux disease. Scand J Gastroenterol 1995; 211: 1–4.

Decktor DL, Allen ML, Robinson M. Esophageal motility, heartburn and gastroesophageal reflux. Variations in clinical presentation of esophageal dysphagia. Dysphagia 1990; 5: 211–5.

Geisinger RR. Endoscopic biopsies and cyological brushings of the esophagus are diagnostically complementary. Am J Clin Pathol 1995; 103: 295–9.

Jaspersen D, Kulig M, Labenz J, Leodolter A, Lind T, MeyerSabellek W, et al. Prevalence of extraesophageal manifestations in gastroesophageal reflux disease: an analysis based on Pro GERD Study. Aliment Pharmacol Ther 2003; 17: 1155–20.

Koufman JA. The otolaryngologic manifestations of gastroesophageal reflux disease (GERD). A clinical investigation of 225 patients using ambulatory 24-hour monitoring and an experimental investigation of the role of acid and pepsin in the development of laryngeal injury. Laryngoscope 1991; 101: 1–78.

Sontag SJ, O’Connell S, Khandelwal S. Most asthmatics have gastroesophageal reflux with or without bronchodilatator therapy. Gastroenterology 1990; 99: 613–20.

Irwin RS, Curley FJ, French CL. Difficult to control asthma. Contributing factors and outcome of a systematic management protocol. Chest 1993; 103: 1662–9.

Larrain A, Carasco E, Galleguillos F. Medical and surgical treatment of nonallergic asthma associated with gastroesophageal reflux. Chest 1991; 99: 1330–5.

Sontag SJ, Schnell TG, Miller TQ. Prevalence of esophagitis in asthmatics. Gut 1992; 33: 872–6.

Neverns F, Jonsens J, Piessens J. Prospective study on prevalence of esophageal chest pain in patients refered on a elective basis to a cardiac unit for suspected myocardial ischemia. Dig Dis Sci 1991; 36: 229–35.

Cherian P, Smith LF, Bardhan KD. Esophageal tests in the evaluation of non cardiac chest pain. Dis Esophagus 1995; 8: 129–35.

Hewson EG, Sinclair JW, Dalton CB. Twenty-four hour esophageal pH monitoring: The most useful test for evaluation noncaridac chest pain. Am J Med 1991; 90: 576–83.

Lantinga LJ, Sprofkin RP, McCroskery JH. One year psychological follow up of patients with chest pain and angiographically normal coronary arteries. Am J Cardiol 1988; 62: 209–13.

Harding SM, Sontag SJ. Asthma and gastroesophageal reflux. Am J Gastroenterol 2000; 95 Suppl: 523–32.

Harding SM, Guzzo MR, Richter JE. The prevalence of gastroesophageal reflux in asthma patients without reflux symptoms. Am J Respir Crit Care Med 2000; 34–9.

Shan CA, Harding SM, Haile JM. Gastroesophageal reflux-induced bronchoconstriction: an intra esophageal acid infusion study using state of the art technology. Chest 1994; 106: 731–7.

Tuchman DN, Boyle JT, Pack AJ. Comparison of airway responses following tracheal or esophageal acidification in the cat. Gastroenterology 1984; 87: 872–81.

Richter JE. Gastroesophageal reflux disease and asthma: the two are directly related. Am J Med 2000; 108 Suppl 4A: S153–8.

Herve P, Denjcon A, Jian R. Intraesophageal perfusion of acid increases the bronchomotor response to metacholine and to isocapnic hyperventilation in asthmatic subjects. Am Rew Resp Dis 1986; 134: 986–9.

Field SK, Sutherland LR. Does medical antireflux treatment improve asthma in asthmatics with gastroesophageal reflux: a critical review of the literature. Chest 1998, 87: 872–81.

Gibson PG, Henry RL, Coughlan JL. Gastroesophageal reflux treatment for asthma in adults and children. The Cochrane Database of Systematic Reviews 2003; 1.

Irwin RS, Richter JE. Gastroesophageal reflux and chronic cough. Am J Gastroenterol 2000; 95 Suppl 8: 58–64.

Ours TM, Kavuru MS, Schilz RJ, Richter JE. A prospective evaluation of esophageal testing and a double-blind, randomised study of omeprazole in a diagnostic and therapeutic algorithm for chronic cough. Am J Gastroenterol 1999; 94: 3131–8.

May EE, Dubois JJ, Hamilton GB. Pulmonary fibrosis associated with tracheobronchial aspiration. Chest 1976; 69: 512–5.

Johnson DA, Drane WE, Curran J. Pulmonary disease in progressive systemic sclerosis. Arch Intern Med 1989; 149: 583–93.

Gayner EB. Otolaryngologic manifestations of gastroesophageal reflux. Am J Gastroenterol 1991; 86: 801–5.

Champion GL, Richter JE. Atypical presentations of gastroesophageal reflux disease: chest pain, pulmonary and ear, nose, throat manifestations. Gastroenterologist 1993; 1: 18–33.

Richter JE. Extraesophageal presentations of gastroesophageal reflux disease. Semin Gastrointest Dis 1997; 8: 75–89.

Ohlman L, Olofsson J, Tibbling L. Esophageal dysfunction in patients with contact ulcer of the larynx. Ann Otol Rhinol Laryngol 1983; 92: 228–30.

Oelschlager BK, Eubanks TR, Maronian N, Hilbel A, Oleynikov D, Pope CE, Pellegrini CA. Laryngoscopy and pharyngeal pH are complementary in the diagnosis of gastroesophageal-laryngeal reflux. J Gastrointest Surg 2002; 6: 183–94.

Wong RKH, Hanson DG, Waring PJ, Shaw G. ENT manifestations of gastroesophageal reflux. Am J Gastroenetrol 2000; 95 Suppl 8: S 15–22.

Noordzij JP, Khidr A, Evans BA, Desper E, Mittal RK, Reibel JF, Levine PA. Evaluation of omeprazole in the treatment of reflux laryngitis: a prospective, placebo-controlled, randomised, double-blind study. Laryngoscope 2001; 111: 2147–51.

Eherer AJ, Hobermann W, Hammer HF, Kiesler K, Friedrich G, Krejs GJ. Effect of pantoprazole on the course of reflux-associated laryngitis: a placebo-controlled double blind crossover study. Scand J Gastroenterol 2003; 38: 462–7.

Gregory.Head BL, Curtis DA, Kim L, Cello J. Evaluation of dental erosion in patients with gastroesophageal reflux disease. J Prosthet Dent 2000; 83; 675–80.

Lazarchik DA, Filler SJ. Dental erosion: predominant oral lession in gastroesophageal disease. Am J Gastroenterol 2000; 95 Suppl 8: S 33–8.

Richter JE. Ear, nose and throat and respiratory manifestations of gastro-esophageal reflux disease: an increasing conundrum. Eur J Gastroenterol Hepatol 2004; 16: 837–45.

How to Cite
1.
Tepeš B. Extraoesophageal symptoms and signs of gastroesophageal reflux disease. ZdravVestn [Internet]. 1 [cited 15Nov.2019];75(4). Available from: https://vestnik.szd.si/index.php/ZdravVest/article/view/2005
Section
Review article

Most read articles by the same author(s)