Manifestações extra-esofágicas da doença do refluxo gastroesofágico

Abstract

Gastroesophageal reflux disease often presents as heartburn and acid reflux, the so-called "typical" symptoms. However, a subgroup of patients presents a collection of signs and symptoms that are not directly related to esophageal damage. These are known collectively as the extraesophageal manifestations of gastroesophageal reflux disease. Principal among such manifestations are bronchospasm, chronic cough and laryngitis, which are classified as atypical symptoms. These manifestations comprise a heterogeneous group. However, some generalizations can be made regarding all of the subgroups. First, although the correlation between gastroesophageal reflux disease and the extraesophageal manifestations has been well established, a cause-and-effect relationship has yet to be definitively elucidated. In addition, the main proposed pathogenic mechanisms of extraesophageal reflux are direct injury of the extraesophageal tissue (caused by contact with gastric acid) and the esophagobronchial reflex, which is mediated by the vagus nerve. Furthermore, gastroesophageal reflux disease might not be considered in the differential diagnosis of patients presenting only the atypical symptoms. In this article, we review the extraesophageal manifestations of gastroesophageal reflux disease, discussing its epidemiology, pathogenesis, diagnosis and treatment. We focus on the most extensively studied and well-established presentations.

Prolonged bedtime bottle feeding and respiratory symptoms in infants

“…In infants, GER and microaspiration produce not only gastrointestinal symptoms such as regurgitation and vomiting, but also respiratory symptoms including nocturnal cough, otitis media, sinusitis, chronic cough, recurrent bronchiolitis and pneumonia [20, 21]. Microaspiration repeatedly irritates the airways resulting in inflammation that causes bronchospasm and airway remodeling.…”

“…Microaspiration repeatedly irritates the airways resulting in inflammation that causes bronchospasm and airway remodeling. Irritation of the vagus nerve due to GER increases the incidence of bronchospasm and hyper-responsiveness [20, 22]. An animal study has also demonstrated that GER and microaspiration are major risk factors in developing respiratory symptoms [23].…”

Study of respiratory disorders in endoscopically negative and positive gastroesophageal reflux disease

“…However, the principal evidence that GERD is the cause of chronic cough is based on the resolution of the symptoms after an efficacious antireflux treatment. [33]…”

Estudo de alterações na cavidade oral em pacientes com doença do refluxo gastroesofágico

“…Considerada afecção digestiva de elevada prevalência e incidência em ascensão, a doença do refluxo gastroesofágico (DRGE) compromete a qualidade de vida dos pacientes, em virtude da gravidade das complicações, intensidade e diversidade dos sintomas (9,16,20,25,26,28,31) . O diagnóstico clínico da DRGE é bastante sensível, pois a maioria dos pacientes apresenta os sintomas clássicos da doença, representados por pirose e regurgitação.…”