Extraesophageal and atypical manifestations of GERD |
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Authors: | WAI-MAN WONG† RONNIE FASS |
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Institution: | The Neuro-Enteric Clinical Research Group, Section of Gastroenterology, Department of Medicine, Southern Arizona Veterans Health Care System and University of Arizona Health Sciences Center, Tucson, Arizona, USA.; Current affiliation: Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China |
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Abstract: | Abstract Extraesophageal manifestations of gastroesophageal reflux disease (GERD) are essentially complications of GERD that primarily involve organs that are in proximity to the esophagus. Non-cardiac chest pain (NCCP) is an atypical manifestation of GERD, because symptoms originate in essence from the esophagus. In both atypical and extraesophageal manifestation of GERD frequent heartburn is uncommon and lack of GERD symptoms is not unusual. Esophageal mucosal injury is rarely present making upper endoscopy a low-yield procedure in both conditions. While association with GERD has been commonly reported, the extent of causality remains unknown. In NCCP, the usefulness of the proton pump inhibitor (PPI) test in diagnosing GERD-related NCCP has been established. Similar value in extraesophageal manifestations of GERD has been proposed, but rarely studied. While treatment of extraesophageal manifestations of GERD remains a challenge, PPIs in at least double the standard dose, should be considered for the initial therapy. Properly designed therapeutic studies are still lacking as well as the exact role of antireflux surgery in this patient population. |
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Keywords: | PPI atypical manifestations of GERD extraesophageal manifestations of GERD NCCP |
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