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Facts and Fantasies on Extraesophageal Reflux: A Gastroenterologist Perspective

Zerbib, Frank MD, PhD; Dulery, Charlotte MD

Journal of Clinical Gastroenterology: October 2017 - Volume 51 - Issue 9 - p 769–776
doi: 10.1097/MCG.0000000000000918
Clinical Reviews

Gastroesophageal reflux disease encompasses a wide spectrum of disorders related to the reflux of gastric contents into the esophagus. Extraesophageal reflux (EER) may be suspected in patients with unexplained chronic cough, pharyngolaryngeal symptoms, and asthma. For physicians, suspected EER is challenging as there is currently no tool that can reliably make a definitive diagnosis. Endoscopic signs are not specific, pharyngeal and proximal reflux monitoring are not reliable, and if distal pH or pH-impedance monitoring can identify patients with abnormal reflux, they cannot predict the response to therapy. Controlled randomized trials have failed to reliably demonstrate any benefit of high-dose proton-pump inhibitors over placebo in patients with laryngeal symptoms, chronic cough, and asthma. Overall, the role of gastroesophageal reflux has been largely overestimated in patients with suspected EER. Especially when proton-pump inhibitors failed to improve symptoms, other diagnosis should be considered, such as functional laryngeal disorders which are probably much more prevalent in these patients than pathologic gastroesophageal reflux.

Univ. Bordeaux, CHU Bordeaux, Gastroenterology, Hepatology and Digestive Oncology Department, Magellan Medical and Surgical Center, Haut Lévêque Hospital, Bordeaux, France

F.Z .was supported by Allergan speaker’s fee, advisory board, Reckitt-Benckiser speaker’s fee, advisory board, Takeda speaker’s fee, Coloplast Speaker’s fee, Vifor pharma Speaker’s fee, Mayoli Spindler speaker’s fee, Medtronic research support, Sandhill Scientific research support. The other author has nothing to disclose.

Address correspondence to: Frank Zerbib, MD, PhD, Gastroenterology, Hepatology and Digestive Oncology Department, Magellan Medical and Surgical Center, Haut Lévêque Hospital, Avenue Magellan, F-33604 Pessac, France (e-mail: frank.zerbib@chu-bordeaux.fr).

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