Extraesophageal reflux disease (EERD) refers to retrograde flow of gastric contents to the upper aerodigestive tract that causes a variety of symptoms such as cough, hoarseness, and asthma, among others.

Contents 1 Background 2 Clinical Manifestations 3 Diagnosis 4 Treatment 5 References 6 See also

[edit] Background

Gastroesophageal Reflux Disease (GERD) was recognized as a clinical entity in the mid 1930s and now is the most prevalent upper gastrointestinal (GI) disorder in clinical practice. Around the same time, in 1934, Bray suggested a link between gut symptoms and airway disease. Acid-related laryngeal ulcerations and granulomas were first reported by Chery in 1968^[1]. Subsequent studies suggested that acid reflux might be a contributory factor in other laryngeal and respiratory conditions and in 1979 Pellegrini and DeMeester were the first who documented the link between these airway symptoms and reflux of gastric contents, they also proved that treatment of reflux disease results in elimination of these airway symptoms^[2].

[edit] Clinical Manifestations

Extraesophageal symptoms are the result of exposure of the upper aerodigestive tract to the gastric juice that causes variety of symptoms including wheezing, chronic cough, dysphonia, globus pharyngeus and chronic throat clearing. However there are multiple potential etiologies for these respiratory and laryngeal symptoms and establishing reflux as the cause based on symptoms alone is unreliable.

[edit] Diagnosis

Diagnosis of EERD purely based on symptoms is unreliable; this is mainly due to nonspecific nature of these symptoms, that present in variety of diseases. Further laryngoscopic findings such as erythema, edema, laryngeal granulumas and interarytenoid hypertrophy have been used to establish the diagnosis but, these symptoms are first, very nonspecific and second, have been described in the majority of asymptomatic subjects undergoing laryngoscopy^[3] . Response to acid suppression therapy has been suggested as a diagnostic tool for confirming diagnosis of the EERD but studies have shown that the response to empiric trials of acid-suppressive therapy i.e PPI in these patients is often disappointing^[4]. Measurement of pharyngeal acid exposure is the best diagnostic technique to establish GERD as the cause of respiratory and laryngeal symptoms. Usage of pH probe that has been used in esophageal pH monitoring to monitor pharyngeal pH is of limited value. This is because the conventional sensors are getting dry as they expose to air and get covered by mucosa. Some investigators are working on a new pH sensor with the ability to function in pharyngeal environment^[5]. The initial results are promising but widespread clinical usage of it requires more investigations.

[edit] Treatment

Patients with extraesophageal reflux disease remain a difficult subgroup of the GERD spectrum to manage. Several studies have emphasised on importance of measuring proximal esophageal or ideally pharyngeal acid exposure in patients with clinical suspicious of EERD to document reflux as the cause of the symptoms. Once these patients are identified, Nissen fundoplication should be offered to the patients in the early phase of disease as medical treatments often don’t provide any benefit and a delay in referring patients for surgical treatment is associated with poor outcome.

[edit] References

[edit] See also

• Gastroesophageal Reflux Disease
• Esophageal pH monitoring