New developments in extraesophageal reflux disease

Abstract

Gastroesophageal reflux disease (GERD) can present with a wide variety of extraesophageal symptoms that are usually difficult to diagnose because of the absence of typical GERD symptoms (ie, regurgitation or heartburn). The diagnostic process is further complicated by the lack of a definitive test for identifying GERD as the cause of extraesophageal reflux symptoms. Due to the low predictive value of upper endoscopy and pH testing-as well as the lack of reliability of the symptom index and symptom association probability-extraesophageal reflux disease is still an area of investigation. This paper discusses recent developments in this field, with special emphasis on new diagnostic modalities and treatment options.

Keywords: Extraesophageal reflux disease; asthma; chronic cough; chronic laryngitis.

Figures

Figure 1

The Montreal definition of constituent syndromes of extraesophageal reflux.

Figure 2

Gastroesophageal reflux disease (GERD) is the third most common cause of chronic cough (after postnasal drip syndrome [PNDS] and asthma). These 3 causes account for 86% of all cases of chronic cough, and there are often multiple causes for each case.

Figure 3

It has been proposed that asthma and gastroesophageal reflux disease (GERD) may exacerbate each other, as GERD may induce bronchospasm, and asthma may induce GERD. Treating both conditions may break this cycle and improve patients’ symptoms.

Figure 4

A Dx-pH probe (Respiratory Technology Corp.) and light-emitting diode in a patient’s oropharynx.

Figure 5

A lateral flow device showing a positive pepsin test result relative to the control band from a gastric juice sample.

Figure 6

A Forest plot depicting the risk ratios of studies assessing the efficacy of proton pump inhibitors (PPIs) in patients with reflux laryngitis. The combined risk ratio is calculated via the random effects method.