Extraesophageal presentations of gastroesophageal reflux disease

Gastroesophageal reflux disease is increasingly being recognized as a common factor contributing to asthma and many ear, nose, and throat complaints. For example, studies suggest that acid reflux is present in 50% to 80% of asthmatic patients, 10% to 20% of chronic coughers, up to 80% of patients with difficult-to-manage hoarseness, 25% to 50% of patients with globus sensation, and a small but definite group of patients with laryngeal cancer. Clinical suspicion is the key to the diagnosis because many patients do not have classic reflux symptoms of heartburn or acid regurgitation. Prolonged esophageal pH monitoring with pH probes in the distal esophagus and proximal esophagus or hypopharynx and laryngeal examinations are the most helpful diagnostic tests. Prolonged acid suppression, either medically or surgically, will cure or help many of these patients.