title: Approach to the patient with presumed extraoesophageal GERD.
abstract: Reflux related cough, asthma and laryngitis are frequently encountered and are considered part of extraoesophageal syndromes. The diagnosis of extraoesophageal reflux is difficult due to the lack of gold standard diagnostic criteria. Esophagogastroduodenoscopy and esophageal pH monitoring are inadequate diagnostic tools for due to poor sensitivity and specificity. For this reason, empirical PPI therapy is recommended as an initial approach to diagnose and treat the potential underlying cause of these symptoms in patients without alarm symptoms. Diagnostic testing with esophageal pH and/or impedance monitoring and esophageal motility testing is usually reserved for those who continue to be symptomatic despite a trial of therapy with PPIs. Recent developments have increased our understanding of this difficult to treat group of patients but more research into reflux related extraoesophageal symptoms are needed to better diagnose and treat this group.
authors.affiliation: Division of Gastroenterology, Hepatology, and Nutrition, Center for Swallowing and Esophageal Disorders, Vanderbilt University Medical Center, C2104-MCN Nashville, TN, USA.
authors.forename: Fehmi
authors.initials: F
authors.lastname: Ates
authors.forename: Michael F
authors.initials: MF
authors.lastname: Vaezi
mesh_terms: D001249:Asthma / Q000175:diagnosis*; D003371:Cough / Q000175:diagnosis*; D016145:Endoscopy, Digestive System; D050782:Esophageal pH Monitoring / Q000009:adverse effects; D004947:Esophagus; D005764:Gastroesophageal Reflux / Q000175:diagnosis* / Q000188:drug therapy; D006801:Humans; D007827:Laryngitis / Q000175:diagnosis*; D054328:Proton Pump Inhibitors / Q000627:therapeutic use
chemical_list: D054328:Proton Pump Inhibitors
keywords: Asthma; Chronic cough; Chronic laryngitis; Extraoesophageal reflux syndrome; Reflux