Romanian Guidelines for the Diagnosis and Treatment of GERD-induced Respiratory Manifestations

Abstract

Background and Aims: Gastroesophageal reflux disease (GERD) is a common condition present in daily practice with a wide range of clinical phenotypes. In this line, respiratory conditions may be associated with GERD. The Romanian Societies of Gastroenterology and Neurogastroenterology, in association with the Romanian Society of Pneumology, aimed to create a guideline regarding the epidemiology, diagnosis and treatment of respiratory conditions associated with GERD.Methods: Delphi methodology was used and eleven common working groups of experts were created. The experts reviewed the literature according to GRADE criteria and formulated 34 statements and recommendations. Consensus (>80% agreement) was reached for some of the statements after all participants voted.Results: All the statements and the literature review are presented in the paper, together with their correspondent grade of evidence and the voting results. Based on >80% voting agreement, a number of 22 recommendations were postulated regarding the diagnosis and treatment of GERD-induced respiratory symptoms. The experts considered that GERD may cause bronchial asthma and chronic cough in an important number of patients through micro-aspiration and vagal-mediated tracheobronchial reflex. GERD should be suspected in patients with asthma with suboptimal controlled or after exclusion of other causes, also in nocturnal refractory cough which needs gastroenterological investigations to confirm the diagnosis. Therapeutic test with double dose proton pump inhibitors (PPI) for 3 months is also useful. GERD induced respiratory conditions are difficult to treat; however,proton pump inhibitors and laparoscopic Nissen fundoplication are endorsed for therapy.Conclusions: This guideline could be useful for the multidisciplinary management of GERD with respiratory symptoms in current practice.

Exposure to Proton Pump Inhibitors and the Risk of Incident Asthma in Patients with Coronary Artery Diseases: A Population-Based Cohort Study

“…In the previous clinical observation study, the use of PPI to treat GERD was not associated with incident asthma [ 7 , 20 , 21 ]. Ruigómez et al used data from the UK General practice research database and showed that patients treated for GERD with PPI had no significant increased risk of developing asthma (RR: 1.2, 95% CI: 0.9–1.6) [ 20 ].…”

Upper Respiratory Tract Diseases as Extra Esophageal Manifestations of Gastroesophageal Reflux Disease: Current State of the Problem

“…Отчасти они рассмотрены в рекомендациях по ведению пациентов с хроническим кашлем [6]. В 2022 г. опубликованы Румынские рекомендации по диагностике и лечению больных с пульмонологическими проявлениями ГЭРБ [7].…”