Extraesophageal symptoms: What role for the proton pump inhibitors?

Publication date: 6 September 2004 Source:The American Journal of Medicine Supplements, Volume 117, Issue 5, Supplement 1 Author(s): H.Juergen Nord The esophageal complications of gastroesophageal reflux disease (GERD) are well described and include erosive esophagitis, stricture, Barrett esophagus, and adenocarcinoma. Primary care physicians often encounter patients with “extraesophageal” manifestations of GERD in the absence of heartburn. Patients may present with symptoms involving the pulmonary system, noncardiac chest pain, and ear, nose, and throat disorders. The diagnosis of reflux disease in these individuals may be challenging because, in addition to the absence of heartburn, endoscopy is often negative. Laryngoscopy and 24-hour dual-channel intraesophageal pH-metry may have greater diagnostic yields, but they are costly, invasive, and time-consuming. A trial of proton pump inhibitor (PPI) therapy is increasingly being considered a first-line diagnostic test in those with suspected reflux-related extraesophageal symptoms. The duration as well as dose of PPI should be based on the presenting symptoms, with patients having pulmonary manifestations often requiring twice-daily therapy for 2 to 3 months. In contrast, symptoms of reflux-related noncardiac chest pain may be relieved with a 1-week, standard-dose treatment trial. Patients who fail to experience symptom resolution or improvement should undergo further diagnostic evaluations including 24-hour esophagea...
Source: The American Journal of Medicine Supplements - Category: Drugs & Pharmacology Source Type: research