Extraesophageal manifestations of gastroesophageal reflux disease – pathophysiology, diagnosis and management
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Gastroesophageal reflux disease (GERD) is defined as a condition in which the reflux of stomach contents causes troublesome symptoms and/or complications. This common disease may also present with atypical, extraesophageal symptoms. Laryngopharyngeal reflux (LPR) is the reflux of gastric contents into the throat and larynx, which causes symptoms such as globus, throat clearing, hoarseness and chronic cough. GERD and LPR may be related to many dis-eases, including laryngitis, asthma, COPD, chronic rhinosinusitis, otitis media, dental erosions, and even laryngeal cancer or life-threatening events. The diagnosis of LPR is based on clinical symptoms (measured by RSI), laryngoscop-ic signs (evaluated in RFS), an empiric trial of proton pomp inhibitor (PPI) therapy, 24-hour pH monitoring, impedance monitoring, esophageal manometry and endoscopic examination. The most common management is double-dose PPI therapy for at least six months. When this treatment is ineffective, the surgery should be considered. However, di-agnosis and treatment of LPR is still controversial. Further studies are necessary to establish an optimal algorithm for the management of LPR.
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