JW Chen et al. Clin Gastroenterol Hepatol 2023; 21: 1414-1421. Open Access! AGA Clinical Practice Update on the Diagnosis and Management of Extraesophageal Gastroesophageal Reflux Disease: Expert Review

Some the “best practice advice:”

• #3 Currently, there is no single diagnostic tool that can conclusively identify GER as the cause of EER symptoms. Determination of the contribution of GER to EER symptoms should be based on the global clinical impression derived from patients’ symptoms, response to GER therapy, and results of endoscopy and reflux testing.
• #4 Consideration should be given toward diagnostic testing for reflux before initiation of proton pump inhibitor (PPI) therapy in patients with potential extraesophageal manifestations of GERD, but without typical GERD symptoms. Initial single-dose PPI trial, titrating up to twice daily in those with typical GERD symptoms, is reasonable.
• #6 In patients with suspected extraesophageal manifestation of GERD who have failed one trial (up to 12 weeks) of PPI therapy, one should consider objective testing for pathologic GER, because additional trials of different PPIs are low yield.

Related commentary: R Yadlapati, WW Chan. Clin Gastroenterol Hepatol 2023; 21: 1395-1398. Modern Day Approach to Extraesophageal Reflux: Clearing the Murky Lens

This commentary identifies huge gaps in our understanding of extraesophageal reflux (EER):

• Clinical value of upper GI endoscopy
• Diagnostic thresholds of reflux monitoring to use for EER (Is it the same as GERD?)
• Significance of nonacidic or weakly acidic reflux
• Whether focus should remain on distal esophageal reflux or proximal reflux

My take: If a patient has normal amounts of reflux, can they still have extraesophageal reflux symptoms? If so, how does one objectively gauge success?

Related blog posts:

• Airway Impedance to Objectively Assess Airway Mucosal Integrity
• Clinical Practice Update: Extraesophageal Symptoms Attribute to Gastroesophageal Reflux Disease
• NASPGHAN Postgraduate Course 2017 (Part 5): Refractory constipation, Extraesophageal GERD, POTS, Recurrent Abdominal Pain
• Gastroesophageal Reflux Phenotypes and “Where Rome, Lyon, and Montreal Meet”
• Current Thinking with Laryngopharyngeal Reflux Symptoms
• Incredible Review of GERD, BRUE, Aspiration, and Gastroparesis

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