Updates in the field of non-esophageal gastroesophageal reflux disorder

Ghisa, Matteo; Coletta, Marco; Barbuscio, I.; Marabotto, Elisa; Barberio, Brigida; Frazzoni, Marzio; Bortoli, Nicola de; Zentilin, Patrizia; Tolone, Salvatore; Ottonello, Andrea; Lorenzon, Greta; Savarino, Vincenzo; Savarino, Edoardo

doi:10.1080/17474124.2019.1645593

Cited by 37 publications

(38 citation statements)

References 103 publications

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“…These complaints are non-specific of GERD and LPR, and they can be also caused by allergens, smoke, and various irritant agents [10]. In a large case-control study, patients with esophagitis or esophageal strictures had higher odds ratios (OR) for pharyngitis (OR: 1.60), aphonia (OR: 1.81), and chronic laryngitis (OR: 2.01) compared with controls [12]. Many patients diagnosed with laryngeal reflux do not suffer from the classic symptoms of GERD [19]: heartburn is absent in more than half of the patients with LPR [40].…”

Section: Laryngitismentioning

confidence: 99%

“…A response to the empiric proton pump inhibitor (PPI) therapy (PPI test) would ideally confirm the diagnosis; however, in a meta-analysis, response to PPIs had only sensitivity of 78% and specificity of 54% in the diagnosis of GERD [11]. GERD-related EE manifestations are less responsive to standard therapy with PPIs [12]. Ambulatory 24-h esophageal pH monitoring is indicated in the evaluation of patients' refractory to a PPI test and when the diagnosis of GERD is uncertain.…”

Section: Introductionmentioning

confidence: 99%

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Extra-Esophageal Presentation of Gastroesophageal Reflux Disease: 2020 Update

Durazzo

Lupi

Cicerchia

et al. 2020

JCM

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Gastroesophageal reflux disease (GERD) is defined by the presence of symptoms induced by the reflux of the stomach contents into the esophagus. Although clinical manifestations of GERD typically involve the esophagus, extra-esophageal manifestations are widespread and less known. In this review, we discuss extra-esophageal manifestations of GERD, focusing on clinical presentations, diagnosis, and treatment. Common extra-esophageal manifestations of GERD include chronic cough, asthma, laryngitis, dental erosions, and gingivitis. Extra-esophageal involvement can be present also when classic GERD symptoms are absent, making the diagnosis more challenging. Although available clinical studies are heterogeneous and frequently of low quality, a trial with proton pump inhibitors can be suggested as a first-line diagnostic strategy in case of suspected extra-esophageal manifestations of GERD.

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Section: Laryngitismentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Extra-Esophageal Presentation of Gastroesophageal Reflux Disease: 2020 Update

Durazzo

Lupi

Cicerchia

et al. 2020

JCM

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“…9 As to EE symptoms, the diagnostic accuracy is much lower for both the welldefined gastroesophageal reflux (GER)-related syndromes (eg, cough and laryngitis) and the proposed ones, such as idiopathic pulmonary fibrosis. 10,11 Also, questionnaires present the same limitations of clinical history in terms of poor diagnostic accuracy. Among the various questionnaires available, the gastroesophageal reflux disease questionnaire and the reflux disease questionnaire have been validated in multiple languages and have been shown to provide some diagnostic help.…”

Section: First Approach To Gastroesophageal Reflux Disease Patients: mentioning

confidence: 99%

The Lyon Consensus: Does It Differ From the Previous Ones?

Ghisa

Barberio

Savarino

et al. 2020

J Neurogastroenterol Motil

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Gastroesophageal reflux disease (GERD) is a complex disorder with heterogeneous symptoms and a multifaceted pathogenetic basis, which prevent a simple diagnostic algorithm or any categorical classification. Clinical history, questionnaires and response to proton pump inhibitor (PPI) therapy are insufficient tools to make a conclusive diagnosis of GERD and further investigations are frequently required. The Lyon Consensus goes beyond the previous classifications and defines endoscopic and functional parameters able to establish the presence of GERD. Evidences for reflux include high-grade erosive esophagitis, Barrett's esophagus, and peptic strictures at endoscopy as well as esophageal acid exposure time > 6% on pH-metry or combined pH-impedance monitoring. Even if a normal endoscopy does not exclude GERD, its combination with distal acid exposure time < 4% on off-PPI pH-impedance monitoring provides sufficient evidence refuting this diagnosis. Reflux-symptom association on pH-monitoring provides supportive evidence for reflux-triggered symptoms and may predict a better treatment outcome, when present. Also recommendations to perform pH-impedance "on" or "off" PPI are well depicted. When endoscopy and pH-metry or combined pH-impedance monitoring are inconclusive, adjunctive evidence from biopsy findings (eg, microscopic esophagitis), high-resolution manometry (ie, ineffective esophagogastric barrier and esophageal body hypomotility), and novel impedance metrics, such as mean nocturnal baseline impedance and post-reflux swallow-induced peristaltic wave index, can contribute to better identify patients with GERD. Definition of individual patient phenotype, based on the level of refluxate exposure, mechanism of reflux, efficacy of clearance, underlying anatomy of the esophagogastric junction, and clinical presentation, will lead to manage GERD patients with a tailored approach chosen among different types of therapy.

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“…Positive predictive values (PPV) results of 100% in both studied populations confirmed that low levels of G-17 are useful in identifying GERD patients. Several studies have investigated the relationship between laryngopharyngeal reflux (LPR), that has been related to extraesophageal syndromes [22,23], and pepsin secretion. In particular, Sone et al [24] showed higher PGs concentration in elderly patients with LPR compared to controls.…”

Section: Discussionmentioning

confidence: 99%

Low Levels of Gastrin 17 are Related with Endoscopic Findings of Esophagitis and Typical Symptoms of GERD

Mario

Crafa

Franceschi³

et al. 2021

JGLD

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Background and Aims: In clinical practice, most patients with symptoms suggestive of gastroesophageal reflux disease (GERD) undergo esophago-gastro-duodenoscopy (EGD), despite its low sensitivity in detecting reflux stigmata. Gastrin 17 (G-17) has been proposed to be related with GERD, due to the negative feedback between acid secretion and this hormone. We assessed the clinical usefulness of fasting G-17 serum determination for a non-invasive diagnosis of GERD in patients with typical symptoms. Methods: We consecutively enrolled patients complaining of typical GERD symptoms in two different settings: a single referral center and a primary care setting. Control groups consisted of dyspeptic patients. All subjects underwent assessment of serum levels of G-17 and EGD. Results: At the academic hospital, 100 GERD patients (n=89 with erosive esophagitis and 11 with Barrett’s esophagus) had statistically significant low levels of G-17 as compared with 184 dyspeptic patients (1.7±1.2 pg/L vs 8.9±5.7 pg/L p<0.0001). Similarly, in the primary care setting, 163 GERD patients had statistically significant low levels of G-17 as compared with 132 dyspeptic patients (0.5±0.2 pg/L vs. 4.0±2.6 pg/L, p<0.0001). Moreover, in the primary care setting, no statistically significant differences were found for G-17 levels between patients with erosive and non-erosive reflux pattern (0.4±0.2 vs 0.7±0.3; p=0.08). In primary care, the accuracy of G-17 less than 1 pg/L to diagnose non-invasively GERD was 94.3%. Conclusions: Low levels of G-17 were detected in patients with erosive esophagitis and Barrett’s esophagus in a referral center and in patients with typical GERD symptoms in a sample of patients from a primary care setting.

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Updates in the field of non-esophageal gastroesophageal reflux disorder

Cited by 37 publications

References 103 publications

Extra-Esophageal Presentation of Gastroesophageal Reflux Disease: 2020 Update

Extra-Esophageal Presentation of Gastroesophageal Reflux Disease: 2020 Update

The Lyon Consensus: Does It Differ From the Previous Ones?

Low Levels of Gastrin 17 are Related with Endoscopic Findings of Esophagitis and Typical Symptoms of GERD

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