Extraesophageal manifestations associated with gastroesophageal reflux

RESUMO

Approximately 25 per cent of the patients with gastroesophageal reflux disease (GERD) present only extraesophageal manifestations. GERD may be defined as clinical manifestations and tissue lesions associed to gastroesophageal reflux. GERD results from excessive exposure of the mucosa to aggressors, prominently acid and pepsin, associated with diminished esophageal defense mechanisms. This review aims to characterize extraesophageal GERD symptoms. Most patients with reflux-related otolaryngologic symptoms present relatively preserved motor function and esophageal clearance, but exhibit poor upper esophageal sphincter function, which leads to a "high" (pharyngeal) symptom. Acidification in the distal esophagus is likely to activate vagovagal reflexes. These reflexes. These reflexes also induce respiratory symptoms and bronchoconstriction. Nonspecific laryngitis, granuloma, posterior comissure hypertrophy, cricoarytenoid arthritis and come cases of globus pharyngeus have been attributed to larynx and pharynx irritations produced by repeated GER episodes. Otolaryngologic patients with reflux respond better to treatment than those patients whose symptoms are typically gastrointestinal.