Pulmonary manifestations of gastroesophageal reflux disease
Colonography, Computed Tomographic
Gastroesophageal reflux disease (GERD) is a spectrum of disease best defined as symptoms and/or signs of esophageal or adjacent organ injury secondary to the reflux of gastric contents (principally acid and pepsin) into the esophagus or beyond into the oral cavity or lung. The most common presentations are heartburn-substernal burning beginning just after meals or on bending over, relieved with antacids or an OTC H 2 receptor antagonist or regurgitation-the spontaneous return of gastric contents into the esophagus. Many so called extraesophageal or atypical symptoms have been associated with GERD including unexplained substernal chest pain without evidence of coronary artery disease (non-cardiac chest pain), laryngitis, hoarseness, chronic posterior pharyngitis, globus sensation, otalgia, apthous ulcers, hiccups, and erosion of dental enamel. Careful study has shown that numerous pulmonary symptoms including asthma, chronic cough, and pulmonary fibrosis amongst others may be due to or exacerbated by GERD. The clinical presentation of these pulmonary and other extraesophageal symptoms and approach to diagnosis and treatment of these patients differs from patients with the typical symptoms of heartburn and regurgitation. This article reviews in detail the pulmonary manifestations of GERD with focus on prevalence, clinical presentation, and approach to diagnosis and therapy of these patients.