A recent practice update (MF Vaezi, D Katzka, F Zerbib. Clin Gastroenterol Hepatol 2018; 16: 1018-29) reviews the data and provides up-to-date recommendations for extraesophageal symptoms attributed to gastroesophageal reflux disease (GERD) in adults.
Extraesophageal symptoms attributed to GERD could include cough, asthma, hoarseness, sore throat, sinusitis, dental erosions, and ear pain.
- Non-GI evaluations by ENT, pulmonary and/or allergy are essential and often should be performed initially in most patients.
- “Abnormalities seen on endoscopy have poor predictive value for determination of GERD as the cause of extraesophageal symptoms”
- “Ambulatory pH/impedance monitoring…have limited ability to establish GERD as the cause of an extraesophageal symptom. The main role of testing is to document the absence of GERD.”
- Empiric therapy with ‘aggressive’ acid suppression for 6-8 weeks can help in assessing association between reflux and extraesophageal symptoms.
- Testing for reflux on therapy should be considered mainly in those with high probability of baseline reflux (eg. previous esophagitis, Barrett’s esophagus, or prior abnormal pH study).
- Surgical treatment is discouraged in those with extraesophageal reflux symptoms unresponsive to aggressive PPI therapy
Related blog posts:
- 2018 Pediatric GERD Guidelines
- How Many Kids with Reflux have Reflux?
- Esophageal Diseases Special
- pH Probe Testing: Rumors of My Death are Premature
- Better to do a coin toss than an ENT exam to determine reflux
- PPI Webinar NAPSPGHAN
- Treating reflux does not help asthma | gutsandgrowth
- Salivary Pepsin Doesn’t Pass Muster for Reflux
- Does Reflux Lead to Increased Aspiration Pneumonia? | gutsandgrowth