AGA: Clinical practice updateExtraesophageal Symptoms and Diseases Attributed to GERD: Where is the Pendulum Swinging Now?
Section snippets
Diagnostic Tests and Challenges Associated in Establishing Causal Link
There are no established diagnostic tests that unequivocally link any suspected extraesophageal symptom to GERD. Diagnostic tests used in evaluation of patients with extraesophageal symptoms (Table 2) suffer from either lack of sensitivity or specificity and have limited associated treatment outcomes. Nevertheless, testing is needed, and often in combination, to support or refute this diagnosis. We do not discuss the use of barium esophagography because of its reduced sensitivity in GERD
Treatment Challenges
The goals of treatment in reflux disease, independent of presenting symptom, are to relieve symptoms, heal esophagitis, and prevent recurrence of symptoms and future complications. The options to achieve these goals include lifestyle modification, medical therapy, endoscopic antireflux procedures, and surgical interventions (Table 3). Endoscopic antireflux procedures are not discussed given limited available data in those with extraesophageal reflux.
Conclusions
Emerging new data in diagnostic tests and treatment outcome suggests that reflux could be causal in a subgroup of patients with extraesophageal reflux, although the degree has been overestimated. Furthermore, the cause of extraesophageal symptoms in many patients is often multifactorial rather than from reflux alone. The role of diagnostic testing in this group is to establish presence and degree of reflux and assess the likelihood that it may be linked to patients’ symptoms. Figure 1 outlines
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Conflicts of interest This author discloses the following: Frank Zerbib received devices for research purpose from Medtronic and Sandhill Scientific. The remaining authors disclose no conflicts. Vanderbilt University and Diversatek Healthcare Inc jointly hold a patent on the mucosal impedance concept and device discussed in this review.