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Extraoesophageal manifestations of gastro-oesophageal reflux
  1. J Poelmans1,
  2. J Tack2
  1. 1Department of Otorhinolaryngology-Head and Neck Surgery, University Hospitals Leuven, Belgium
  2. 2Department of Medicine, Division of Gastroenterology, University Hospitals Leuven, Belgium
  1. Correspondence to:
    Dr J Tack
    Centre for Gastroenterological Research, Catholic University of Leuven, Herestraat 49, B-3000 Leuven, Belgium; Jan.Tackmed.kuleuven.ac.be

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SUMMARY

A variety of pulmonary and ear, nose, and throat (ENT) symptoms and disorders are considered to be extraoesophageal manifestations of gastro-oesophageal reflux disease (GORD). These extraoesophageal manifestations include asthma, chronic cough, laryngeal disorders, and various ENT symptoms. Recent studies have established that GORD underlies or contributes to chronic sinusitis, chronic otitis media, paroxysmal laryngospasm, excessive throat phlegm, and postnasal drip. Traditionally, management of extraoesophageal GORD manifestations relies on prolonged empiric therapy with high doses of proton pump inhibitors (PPI), followed by pH monitoring under PPI in refractory cases. Recent studies found no benefit of empiric long term high dose PPI therapy. The diagnostic yield of endoscopy in extraoesophageal GORD manifestations seems higher than previously appreciated while pH monitoring under PPI therapy has a low yield. Based on these new findings, a new management algorithm can be proposed that uses short term empiric PPI therapy and GORD investigations off PPI. Well designed controlled studies evaluating the proposed management algorithms and treatment approaches in this area are urgently needed.

CLINICAL MANIFESTATIONS OF EXTRAOESOPHAGEAL REFLUX

Extraoesophageal manifestations of GOR

GORD, defined as the presence of symptoms or lesions that can be attributed to the reflux of gastric contents into the oesophagus, is one of the most common disorders affecting the gastrointestinal tract. When effects of refluxed gastric contents extend beyond the oesophagus itself, this is referred to as extraoesophageal reflux (EOR). These effects may be caused by the direct noxious effects of gastric juice on the mucosal surfaces of the upper airways (pharynx, larynx, middle ear, and nasosinusal complex) and lower airways (tracheobronchopulmonary tree). Unlike the distal oesophagus, the airways are not protected by antireflux clearance mechanisms and intrinsic mucosal properties. It is therefore conceivable that even a single reflux episode extending beyond the oesophagus may be sufficient to cause pharyngeal, laryngeal, and respiratory symptoms and signs. A second mechanism responsible for …

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