<aside> 📘 AGA Clinical Practice Update on the Diagnosis and Management of Extraesophageal Gastroesophageal Reflux Disease: Expert Review, 2023

ACG Clinical Guideline: Guidelines for the Diagnosis and Management of Gastroesophageal Reflux Disease, 2022

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Definition

• GERD (Gastroesophageal reflux disease) is a condition which develops when the reflux of stomach contents causes troublesome symptoms and/or complications.

Symptoms

Typical symptoms

• Heartburn
• Acid-regurgitation
• Esophageal chest pain

Atypical symptoms - Extraesophageal reflux(EER)

• Reflux Pathway: EER can exacerbate inflammatory conditions through acid or non-acid mechanisms, including micro-aspiration of digestive fluids, which may not improve with acid suppression.
• Reflex Pathway: EER may increase laryngeal or airway inflammation via neurologic mechanisms, contributing to supra-esophageal complaints.
• Symptoms include
  • Laryngeal hoarseness
  • Dysphonia
  • Pulmonary fibrosis
  • Asthma
  • Dental erosions/caries
  • Sinus disease
  • Ear disease
  • Post-nasal drip
  • Throat clearing

Diagnosis of GERD

Algorithm

AGA Clinical Practice Update on the Diagnosis and Management of Extraesophageal Gastroesophageal Reflux Disease: Expert Review, 2023

PPI trial

• Patients with classic GERD symptoms (heartburn, regurgitation) without alarm symptoms should undergo PPI trial.
• 8-weeks PPI QD or BID before a meal. A positive response was defined as at least 50% improvement in heartburn.

Endoscopy