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Extra-esophageal gastroesophageal reflux disease and asthma: understanding this interplay.
Expert Rev Gastroenterol Hepatol. 2015 Jul; 9(7):969-82.ER

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+Show Affiliations

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.No affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

26067887

Citation

Naik, Rishi D., and Michael F. Vaezi. "Extra-esophageal Gastroesophageal Reflux Disease and Asthma: Understanding This Interplay." Expert Review of Gastroenterology & Hepatology, vol. 9, no. 7, 2015, pp. 969-82.
Naik RD, Vaezi MF. Extra-esophageal gastroesophageal reflux disease and asthma: understanding this interplay. Expert Rev Gastroenterol Hepatol. 2015;9(7):969-82.
Naik, R. D., & Vaezi, M. F. (2015). Extra-esophageal gastroesophageal reflux disease and asthma: understanding this interplay. Expert Review of Gastroenterology & Hepatology, 9(7), 969-82. https://doi.org/10.1586/17474124.2015.1042861
Naik RD, Vaezi MF. Extra-esophageal Gastroesophageal Reflux Disease and Asthma: Understanding This Interplay. Expert Rev Gastroenterol Hepatol. 2015;9(7):969-82. PubMed PMID: 26067887.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Extra-esophageal gastroesophageal reflux disease and asthma: understanding this interplay. AU - Naik,Rishi D, AU - Vaezi,Michael F, Y1 - 2015/06/11/ PY - 2015/6/13/entrez PY - 2015/6/13/pubmed PY - 2016/3/24/medline KW - asthma KW - extra-esophageal reflux KW - fundoplication KW - pH monitoring KW - proton-pump inhibitor SP - 969 EP - 82 JF - Expert review of gastroenterology & hepatology JO - Expert Rev Gastroenterol Hepatol VL - 9 IS - 7 N2 - 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. SN - 1747-4132 UR - https://www.unboundmedicine.com/medline/citation/26067887/Extra_esophageal_gastroesophageal_reflux_disease_and_asthma:_understanding_this_interplay_ L2 - http://www.tandfonline.com/doi/full/10.1586/17474124.2015.1042861 DB - PRIME DP - Unbound Medicine ER -