Atypical presentation of gastroesophageal reflux disease: chest pain, pulmonary, and ear, nose, throat manifestations.

Over the past 2 decades, we have learned a great deal about the atypical presentations of gastroesophageal reflux disease (GERD). Both distal and proximal reflux of gastric contents are associated with a variety of extraesophageal manifestations, including angina-like chest pain, pulmonary, or otolaryngological problems. Whereas the esophagus is usually the first target of injury in GERD, any contiguous structure can be affected either by direct contact of gastric contents or via a reflex-mediated mechanism. The expanding use of ambulatory esophageal pH studies, especially with dual pH probe monitoring, should provide a clearer understanding of the pathophysiology of these disorders and allow more successful treatment in the future.