Martinucci Irene, Albano Eleonora, Marchi Santino, Blandizzi Corrado
Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy -
Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.
Minerva Gastroenterol Dietol. 2017 Sep;63(3):221-234. doi: 10.23736/S1121-421X.17.02393-5. Epub 2017 Mar 3.
Associations of gastroesophageal reflux disease (GERD) with extraesophageal manifestations, such as chronic cough, asthma, and laryngitis, are reported frequently, and there is a strong evidence of biological plausibility in support of this relationship. On the other hand, extraesophageal reflux disease (EERD) is usually multifactorial in nature with reflux being just one of the several potential contributing cofactors. Moreover, the accuracy of currently available diagnostic tests for EERD is suboptimal, and therefore the causal relationship between GERD and EERD remains far from being conclusively proven. In addition, there is a general paucity of data supporting a beneficial effect of anti-reflux treatments on symptoms of patients with suspected EERD. Therefore, diagnostic as well as therapeutic management of EERD remains largely empirical. Current guidelines suggest an initial empiric trial of proton pump inhibitors in patients without alarm features, who present also typical GERD symptoms. For those patients who improve with PPIs, GERD is presumed to be the etiology. In patients with refractory reflux, combined impedance/pH monitoring might provide the single best strategy for evaluating reflux symptoms. In this context, as symptoms ascribable to GERD may depend on other causes, investigations that excludes GERD can help to redirect the diagnostic and treatment efforts to other pathological conditions. The present review intends to discuss the current state of knowledge regarding the challenging diagnostic and therapeutic management of patients with suspected EERD, emphasizing the points of strengths and limitations of currently available diagnostic options, and to provide an update on major diagnostic innovations in this area.
胃食管反流病（GERD）与诸如慢性咳嗽、哮喘和喉炎等食管外表现之间的关联屡有报道，并且有强有力的生物学合理性证据支持这种关系。另一方面，食管外反流病（EERD）本质上通常是多因素的，反流只是几个潜在的促成因素之一。此外，目前用于EERD的诊断测试准确性欠佳，因此GERD与EERD之间的因果关系仍远未得到确凿证明。此外，普遍缺乏数据支持抗反流治疗对疑似EERD患者症状有有益效果。因此，EERD的诊断和治疗管理在很大程度上仍然是经验性的。当前指南建议，对于没有警示特征且同时出现典型GERD症状的患者，初始进行质子泵抑制剂的经验性试验。对于使用质子泵抑制剂后症状改善的患者，推测GERD是病因。对于难治性反流患者，联合阻抗/pH监测可能是评估反流症状的最佳单一策略。在这种情况下，由于可归因于GERD的症状可能取决于其他原因，排除GERD的检查有助于将诊断和治疗工作转向其他病理状况。本综述旨在讨论关于疑似EERD患者具有挑战性的诊断和治疗管理的当前知识状态，强调当前可用诊断选项的优势和局限性，并提供该领域主要诊断创新的最新情况。
