Extraesophageal GERD

The majority of data regarding healing and symptom relief of GERD have been generated from clinical trials of patients with heartburn and erosive esophagitis. There are very few well-designed trials of medical therapy for patients with extraesophageal GERD-related disease (asthma, cough, noncardiac chest pain, laryngitis). A few uncontrolled trials have demonstrated superiority of PPIs for reducing respiratory symptoms thought related to GERD in patients with GERD-related symptoms but these data also indicate that there has been a need for higher doses and more prolonged therapy with PPIs to achieve adequate symptom relief.38 Medical therapies for reflux-related asthma have also shown improvement in asthma symptom scores, medication use, and quality-of-life measures, but not improvement in pulmonary function testing.39 Interestingly, a meta-analysis of the surgical anti-reflux trial data has demonstrated the same lack of improvement of this GERD therapy on pulmonary function results.40

Consensus opinion suggests that patients with GERD-related extraesophageal disease should be treated with a twice-daily PPI for 8-16 weeks as an initial course of therapy. This is based on the goal of eliminating even minor amounts of esophageal acid exposure, because even modest amounts of acid may be enough to precipitate symptoms or mucosal injury. Many authors would suggest that even longer treatment intervals are needed to ensure an optimal response, particularly in patients with reflux laryngitis. Although data are lacking, some authorities recommend a 3- to 6-month response time for some difficult-to-treat patients with reflux-related otolaryngological disease. Overall, the response of the extrae-sophageal disease manifestations of GERD to medical therapy has been variable and less predictable than the healing data. This is likely attributable to the fact that extraesophageal disease manifestations of GERD are often the result of multiple factors—acid reflux being only one of these. Elimination of esophageal acid exposure may not resolve the presenting symptom, e.g., hoarseness, if there are persistent contributing factors such as voice strain, repetitive throat clearing, or postnasal drip. Surgical anti-reflux therapy has also demonstrated variable results in improving the outcomes of extraesophageal GERD. The best predictor of the success of anti-reflux surgery for these extraesophageal symptoms has been a previous response to medical therapy with a PPI.41

MEDICAL MANAGEMENT OF GERD: ALGORITHMS AND OUTCOMES

Herbal Remedies For Acid Reflux

Herbal Remedies For Acid Reflux

Gastroesophageal reflux disease is the medical term for what we know as acid reflux. Acid reflux occurs when the stomach releases its liquid back into the esophagus, causing inflammation and damage to the esophageal lining. The regurgitated acid most often consists of a few compoundsbr acid, bile, and pepsin.

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