title: Extra-esophageal gastroesophageal reflux disease and asthma: understanding this interplay.
abstract: Gastroesophageal reflux disease (GERD) is a condition that develops when there is reflux of stomach contents, which typically manifests as heartburn and regurgitation. These esophageal symptoms are well recognized; however, there are extra-esophageal manifestations of GERD, which include asthma, chronic cough, laryngitis and sinusitis. With the rising incidence of asthma, there is increasing interest in identifying how GERD impacts asthma development and therapy. Due to the poor sensitivity of endoscopy and pH monitoring, empiric therapy with proton pump inhibitors (PPIs) is now considered the initial diagnostic step in patients suspected of having GERD-related symptoms. If unresponsive, diagnostic testing with pH monitoring off therapy and/or impedance/pH monitoring on therapy, may be reasonable in order to assess for baseline presence of reflux with the former and exclude continued acid or weakly acid reflux with the latter tests. PPI-unresponsive asthmatics, without overt regurgitation, usually have either no reflux or causes other than GERD. In this group, PPI therapy should be discontinued. In those with GERD as a contributing factor acid suppressive therapy should be continued as well as optimally treating other etiologies requiring concomitant treatment. Surgical fundoplication is rarely needed but in those with a large hiatal hernia, moderate-to-severe reflux by pH monitoring surgery might be helpful in eliminating the need for high-dose acid suppressive therapy.
authors.affiliation: Division of Gastroenterology, Hepatology, and Nutrition, Center for Swallowing and Esophageal Disorders, Digestive Disease Center, Vanderbilt University Medical Center, 1660 TVC, Nashville, TN 37232-5280, USA.
authors.forename: Rishi D
authors.initials: RD
authors.lastname: Naik
authors.forename: Michael F
authors.initials: MF
authors.lastname: Vaezi
mesh_terms: D001249:Asthma / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D003371:Cough / Q000209:etiology; D050782:Esophageal pH Monitoring; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology / Q000601:surgery; D006635:Histamine H2 Antagonists / Q000627:therapeutic use; D006801:Humans; D007827:Laryngitis / Q000209:etiology; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D012852:Sinusitis / Q000209:etiology
chemical_list: D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors
keywords: asthma; extra-esophageal reflux; fundoplication; pH monitoring; proton-pump inhibitor