title: Long-term clinical course of extra-oesophageal manifestations in patients with gastro-oesophageal reflux disease. A prospective follow-up analysis based on the ProGERD study.
abstract: BACKGROUND
  Gastro-oesophageal reflux disease can be associated with extra-oesophageal reflux disease such as chronic cough or laryngeal symptoms. The aim of this study was to analyse the clinical course of extra-oesophageal reflux disease in a large population with gastro-oesophageal reflux disease and extra-oesophageal reflux disease under routine clinical care.
  
  
  METHODS
  ProGERD is a prospective multicentre cohort study of 6215 outpatients with gastro-oesophageal reflux disease. At baseline all patients underwent endoscopies and were interviewed for extra-oesophageal reflux disease. Initial standardised treatment was esomeprazole for up to 8 weeks. After 2 years of follow-up, reflux symptoms and the prevalence of extra-oesophageal reflux disease were assessed. A multivariate analysis was performed with resolved versus persistent symptoms for chronic cough and laryngeal symptoms as dependent predictors. Independent variables were gender, age, body mass index (BMI), alcohol consumption, cigarette smoking, gastro-oesophageal reflux disease classification, history of gastro-oesophageal reflux disease in the family, duration of gastro-oesophageal reflux disease and proton pump inhibitors medication.
  
  
  RESULTS
  Four thousand four hundred and four patients (71%) were available for analysis at 2 years, including 570 and 454 patients who had chronic cough and laryngeal disorders at baseline, respectively. In 63% and 74% of the patients, chronic cough and laryngeal disorders had resolved. Patients with persistent respiratory symptoms in year 2 had significantly more reflux symptoms. Further clinically relevant associations were smoking and non-steroidal anti-inflammatory drugs use. According to the multivariate analysis, classification of gastro-oesophageal reflux disease, proton pump inhibitors medication or duration of gastro-oesophageal reflux disease were not associated with the resolution of cough or laryngeal symptoms.
  
  
  CONCLUSIONS
  In most patients with gastro-oesophageal reflux disease and extra-oesophageal reflux disease, respiratory symptoms resolve during long-term routine care. A high reflux symptom load was associated with the persistence of respiratory disorders.
authors.affiliation: Klinikum Fulda gAG, Germany. d.jaspersen.medII@klinikum-fulda.de
authors.forename: D
authors.initials: D
authors.lastname: Jaspersen
authors.forename: J
authors.initials: J
authors.lastname: Labenz
authors.forename: S N
authors.initials: SN
authors.lastname: Willich
authors.forename: M
authors.initials: M
authors.lastname: Kulig
authors.forename: M
authors.initials: M
authors.lastname: Nocon
authors.forename: A
authors.initials: A
authors.lastname: Leodolter
authors.forename: T
authors.initials: T
authors.lastname: Lind
authors.forename: W
authors.initials: W
authors.lastname: Meyer-Sabellek
authors.forename: M
authors.initials: M
authors.lastname: Vieth
authors.forename: M
authors.initials: M
authors.lastname: Stolte
authors.forename: P
authors.initials: P
authors.lastname: Malfertheiner
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects; D002908:Chronic Disease; D003371:Cough / Q000453:epidemiology* / Q000209:etiology; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000453:epidemiology*; D006801:Humans; D007818:Laryngeal Diseases / Q000453:epidemiology* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D054328:Proton Pump Inhibitors; D020127:Recovery of Function; D012720:Severity of Illness Index; D012907:Smoking / Q000009:adverse effects
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D054328:Proton Pump Inhibitors