A review of the atypical manifestations of gastroesophageal reflux disease

Abstract

Manifestations of atypical gastroesophageal reflux disease (GORD) are varied, and the presentation of atypical symptoms may occur in the absence of typical symptoms. The most sensitive and specific investigation for GORD is pH monitoring, and its application in atypical disease is utilized throughout this paper as a basis for correlating disease and pathogenesis. The less well-known areas of laryngeal manifestations, particularly chronic hoarseness and globus, are discussed in addition to recent work on orodental manifestations. Well-known areas of cardiac and respiratory manifestations, which include chronic cough and asthma, are also reviewed. Evidence from clinical trials indicates that aggressive anti-reflux therapy in patients with atypical symptoms can be effective. Where appropriate, medical therapy may involve long-term proton pump inhibitor, although further research outlining the roles of other therapies such as surgery is awaited.

Intrinsic Causes of Erosion

“…The manifestations of GERD are many and can be categorised into oesophageal (typical) and extra-oesophageal (atypical). The oesophageal symptoms include heartburn, regurgitation, belching, bloating, globus and dysphagia [29,30]. Heartburn and regurgitation are the two most common symptoms and have been defined as 'characteristic symptoms of the typical reflux syndrome' by 44 members of the global consensus group which achieved 95% agreement [27] (table 1).…”

“…Examples include oedema with erythema, laryngeal stenosis [46,47] and vocal cord ulcers [30,48]. The presence of refluxed gastric contents above the UOS is believed to cause the inflammation.…”

Gastroesophageal Reflux Disease and Tooth Erosion

“…pH monitoring is considered to have the highest sensitivity (ability to detect true cases as positive) and specificity (ability to diagnose false cases as negative) in diagnosing GERD [44]. pH-monitoring systems include a 24-hour catheter-based pH-monitoring system and a 48-hour wireless pH-monitoring system.…”

Non-erosive reflux disease rather than cervical inlet patch involves globus

“…Reflux of gastric contents into the laryngopharynx superior to the level of the UES is referred to as laryngopharyngeal reflux, which is implicated in the pathogenesis of several otolaryngological disorders, including globus [9]. The sensation of globus is presumed to be generated by this reflux, which is regarded as one of the atypical or extra-esophageal manifestations of gastroesophageal reflux disease (GERD) [2][3][4]9].…”