Extraesophageal Reflux Disease – Interdisciplinary Consensus
Authors:
J. Vydrová 6; Karol Zeleník 7; P. Brandtl 1; K. Lukáš 2; J. Turzíková 3; J. Chlumsk 4; V. Sedlák 5; J. Vojtíšková 8; B. Seifert 8
Authors‘ workplace:
Gastroenterologická ambulance, Praha
1; IV. interní klinika 1. LF UK a VFN, Praha
2; Dětská pneumologická ambulance FN Bulovka, Praha
3; Pneumologická klinika 1. LF UK a FTNsP, Praha
4; Plicní klinika LF UK a FN, Hradec Králové
5; Hlasové a sluchové centrum Medical Healthcom s. r. o., Praha
6; Otorinolaryngologická klinika FN Ostrava
7; Ústav všeobecného lékařství 1. LF UK, Praha
8
Published in:
Otorinolaryngol Foniatr, 60, 2011, No. 2, pp. 63-70.
Category:
Original Article
Overview
In view of the increasing incidence and prevalence of the esophageal reflux disease (ERD) there is also an increasing incidence and prevalence of the extraextraesophageal reflux disease (EERD). There is a pressing need for determination of the approach to the patients at the interdisciplinary level. The material is based on the already elaborated and updated standards for ERD (1). Extraesophageal reflux (EER) is a condition when there is the penetration of the duodenal/gastric content above the level of upper esophageal sphincter (UES). Extraesophageal reflux disease (EERD) is a condition when the reflux causes complaints and/or complications in the larynx, pharynx, respiratory tract and oral cavity. In case of the heart rate disorders and in some cases of bronchial asthma and cough the reflux content does not reach above the level of upper esophageal sphincter. The case is the irritation of a nervus vagus branch and there are therefore extraesophageal manifestations of ERD. The precise prevalence of EERD is not known; the group of patients is not homogeneous and the severity of symptoms varies. The signs and symptoms of EERD have been encountered in 4 % - 10 % of U.S. patients attending the ORL out-patient department (2). Etiopathogenesis of EERD does not significantly differ from ERD. The degree of damage depends of prevailing aggressive factors over defensive ones. The insufficiency of upper esophageal sphincter is considered to be the most important cause. The chemical composition of the reflux content is the important pathogenetic factor as well as the duration of exposure on the mucosa of individual organs. The sleep reflux may play a role as well (3, 4).
In more distant regions (middle ear, paranasal cavities, lungs), the role reflux aerosols is presumed. Typical symptoms of esophageal reflux disease include heartburn and regurgitation, but these are encountered only in a part of patients with extraesophageal reflux disease (in 6 to 43% of patients with ORL complaints, in 40 to 60% of patients with asthma and in 25 to 57% of patients with cough. The establishment of diagnosis of extraesophageal reflux disease is not simple and there is no specific diagnostic method available. The therapy must be complex in nature and consists of regimen and diet measures. The medication treatment applies antacids, prokinetics, proton pump inhibitors and in some cases bile acid adsorbents. Laparoscopic fundoplication is indicated in specific cases only after the conservative therapy has failed.
Key words:
esophageal reflux disease, medicament treatment, laparoscopic fundoplication.
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Audiology Paediatric ENT ENT (Otorhinolaryngology)Article was published in
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