Extra‐esophageal manifestations of gastroesophageal reflux

Abstract

Gastroesophageal reflux disease (GERD) is a common medical condition affecting approximately 35–40% of the adult population in the western world. The role of GERD in causing extra‐esophageal symptoms including laryngitis, asthma, cough, chest pain, and dental erosions is increasingly recognized with renewed interest among gastroenterologists and other specialists. Direct injury by mucosal contact, and vagally mediated reflex from distal esophageal acid exposure are the two possible mechanisms by which reflux‐related extra‐esophageal tissue injuries may occur. Several investigational techniques may be used to diagnose gastroesophageal reflux; however, because of the poor sensitivity of endoscopy and pH monitoring, and the poor specificity of laryngoscopy, empiric therapy with proton‐pump inhibitors (PPI) is now considered the initial diagnostic step in patients suspected of having GERD‐related symptoms. In those who improve with such therapy, it is likely that GERD may be the cause of the extra‐esophageal presentation. In those who are unresponsive to such therapy, other diagnostic testing such as impedance/pH monitoring may be reasonable in order to exclude continued acid or weakly acid reflux. However, PPI‐unresponsive patients usually have causes other than GERD for the extra‐esophageal symptoms and signs.

Dental erosion, an extraesophageal manifestation of gastroesophageal reflux disease: the experience of a center for digestive physiology in Southeastern Mexico

“…It has been reported that the prevalence of dental erosion in patients with GERD varies from 5.00 % to 58.41 % (8,24-34), which we corroborated in our series of patients, were a prevalence of 78.9 % was found, higher than the prevalence reported by other authors (8,28,30,31). This is directly related to the severity and duration of the disease; in our cohort, the average time of evolution was 50.09 ± 32.26 months, and the presence of acid reflux was demonstrated in 70.0 % of cases by ph-metry (8,(19)(20)(21)(22)24,34). By comparing the degree of dental erosion with the severity of esophagitis, we found that 75.0 % of the patients with grade N0 and N1 had normal mucosa or grade A esophagitis, whereas patients with N2 and N3 DE were associated with greater frequency to esophagitis stages C and D; the difference was statistically significant (p = 0.021).…”

Laryngopharyngeal reflux in patients with reflux esophagitis

“…In the past, Koufman described posterior laryngitis in 74% and laryngeal edema with erythema in 60% of all patients with GERD [16] . Tauber et al also reported 85% of GERD-positive patients had posterior laryngitis and 69% had laryngitis with an interarytenoid erythema and edema [22] .…”

“…Currently, there is no "gold-standard" for the diagnosis of LPR. Ambulatory 24-h dual or triple probe pH-metry was once considered the best method for reflux testing [16] but the position of the probes makes the measurement not easy to interpret, and there is no consensus about the pathological reflux at the level of laryngopharynx [6] . Moreover, extra-esophageal reflux is also intermittent.…”

“…A negative pH study does not rule out extra-esophageal reflux [17] . The empiric therapy with aggressive acid suppression, usually BID dosing of protonpump inhibitors (PPIs), is currently recommended as the most practical and cost effective approach for the patients suspected with extra-esophageal presentations of GERD [16] . Nevertheless, this therapeutic trial for the diagnosis of LPR could not provide direct evidence of pathologic imaging changes of patients, about which most clinicians want to learn.…”

Dental approach to erosive tooth wear in gastroesophageal reflux disease

“…16 Patients can take antacids immediately after heartburn or a sensation of acid reflux into the oral cavity. 36 Patients with erosion should be educated to rinse the mouth with water, sodium bicarbonate, and a fluoride mouthwash immediately after a significant acid challenge. 16 The water will eliminate most of the acid, the sodium bicarbonate will neutralize the remaining acid, and the fluoride mouthwash will help remineralize the etched tooth structure.…”