State of the art: extraesophageal manifestations of gastroesophageal reflux disease.

Although heartburn and regurgitation are the most common symptoms of gastroesophageal disease (GERD), several laryngeal, pharyngeal, and pulmonary symptoms, collectively known as laryngopharyngeal reflux, have also been associated with this disease. However, the case that GERD is the cause of these symptoms is difficult to make because neither endoscopy nor prolonged reflux monitoring has shown consistent evidence of either esophageal injury or abnormal reflux frequency. To date, there have been few controlled trials of antireflux therapy, and the data that are available are conflicting. Nevertheless, gastroenterologists are often confronted with difficult-to-manage patients with extraesophageal symptoms that are considered to be the result of GERD. This article reviews the current literature on this topic and discusses the author's approach to treating these patients.