[Gastroesophageal reflux disease--extraesophageal manifestations]

Gastroesophageal reflux is often associated with symptoms of the respiratory tract. Chronic cough of unknown origin, laryngeal complaints and even non allergic asthma, resistant to steroid therapy, are suspicious of being reflux related. These extraesophageal manifestations can occur without typical reflux complaints, such as heartburn, and even without evident esophagitis. Therefore, prolonged pH-monitoring is essential to confirm the diagnosis. In some cases it will be adequate to start a therapeutic trial with proton pump inhibitors (PPI) to prove the causal connection between reflux and symptoms. The treatment of the extraesophageal manifestations of gastroesophageal reflux disease is identical with the management of reflux esophagitis. PPI are the treatment of choice. Sometimes higher doses of PPI are required. Fundoplication may be appropriate for selected patients.