Extraesophageal Symptoms of GERD
Extraesophageal GERD syndromes are divided into two entities. The first states that have confirmed association with GERD and reflux are caused by chronic cough, reflux laryngitis and asthma, hypersalivation, and reflux damage tooth enamel. Other entities constitute disorders that are assumed to have a causal association with pathological gastro-esophageal reflux: pharyngitis, sinusitis, idiopathic pulmonary fibrosis and recurrent otitis media. Most patients who have extraesophageal symptoms of GERD and no accompanying “typical” refuksne symptoms. “Typical” GERD symptoms are absent in 50% of asthmatic patients, 65% of patients with ENT complications, as well as at approximately 55% of patients with reflux acute cough. It is understood that in these patients previously proven the existence of GERD. Such a “deceitful” presentation of symptoms makes it difficult for them to connect with pathological gastroesophageal reflux. The prevalence of reflux esophagitis in patients with extraesophageal manifestations of GERD is also extremely low, ranging between 10 and 30%, with the most common form of mild esophagitis. When these symptoms it is necessary to consult a specialized physician to determine the exact origin of these symptoms, with obligatory carrying out diagnostics of the esophagus, which includes endoscopy of the upper digestive tract, pressure gauge and a 24-hour esophageal pH meter.
Two basic suggested pathophysiologic mechanism leading to the formation of extraesophageal manifestations of GERD are repeated microaspiration gastric contents and reflex mechanisms of vagus nerve. Disruption of any factor that disturbs the normal antireflux barrier and / or discharge mechanisms of the esophagus can lead to repeated exposure of the upper airways and oral cavity aggressive contents from the stomach and duodenum, and further the appearance of a wide range of symptoms. This would be a direct mechanism of “atypical” esophageal symptoms. Indirect mechanism has its surface in a common embryological origin of the innervation of the esophagus with airways and mediastinal structures. The acid-induced irritation vagal nerve reflex can lead to the appearance of dry cough and bronchoconstriction with consequent reflux-induced asthma.
Hoarseness (reflux laryngitis)
Symptoms of reflux laryngitis usually include hoarseness, cough, dysphagia, a lump in the throat (globus) and the feeling of dryness or burning sensation in the throat. It is estimated that the hoarseness caused by GERD present in about 10% of cases. It is considered that for the development of chronic inflammation of the throat responsible reflux the contents of the stomach and duodenum, as well as the stimulation of special nerve fibers in the esophagus. In patients with laryngitis (inflammation of the larynx) the presented dry mouth pathological reflux exists in 60% of patients.
In the absence of typical esophageal manifestations of GERD, patients with such symptoms usually occur by specialists, after which usually indicate a laryngoscopy. Laryngoscope mean GERD-induced laryngitis can be redness, granulomas as well as swelling of the vocal cords, though none of the characters is not specific for reflux esophagitis. In order to confirm reflux laryngitis is necessary to make a 24-hour esophageal pH meter, with a special measuring pH values in the throat.
A large number of lung diseases is directly related to gastroesophageal reflux disease, including chronic cough, recurrent pneumonia, bronchitis and interstitial fibrosis, but the incidence of asthma uzorokovane pathological reflux largest of the conditions listed. Today it is considered that about 50% of patients diagnosed with asthma, resulting in a later period of life has GERD. In contrast to the reflux laryngitis chambers patient that has asthma, reflux-induced heartburn, and has present. The link between asthma and reflux disease is not easy to set up, particularly because the very existence of asthma worsens existing GERD. As an aid in the diagnosis can serve specific clinical symptoms: nocturnal cough and worsening of asthma symptoms after eating a heavy meal or alcohol, then the first presentation of asthma in adulthood, or inefficiency of applied standard therapy for asthma. If the asthma attack occurred after the symptoms of heartburn or regurgitation, association with GORD can be set up with greater certainty.
Any cough that lasts longer than three weeks is considered to be chronic, and is the leading cause of physician general practitioner. GERD is the third leading cause of chronic cough (after sinusitis and asthma), and that in about 20% of cases. Cough caused by GERD occurs most often during the day, in an upright position, unproductive and coughing fits usually last long. T he genesis of reflux should be considered in non-smokers, in patients who have a cold or asthma and have a normal X-ray of the lungs. GERD also represents the third leading cause (20% of cases) of chronic cough (after sinusitis and asthma).
Increased secretion of saliva (hypersalivation)
When returned to the gastric content reaches the throat, leading to stimulation of the salivary glands and the consequent increased secretion of saliva (hypersalivation). Such patients produce large amounts of saliva in order to minimize unpleasant sour taste (water brush). Excessive swallowing of saliva in the esophagus and stomach in this way brings a large amount of air, which in a certain way creates a vicious circle and worsen existing regurgitation.
Lump in the throat (Globe)
It is believed that the feeling lump in the throat (permanent sensation of foreign content) between meals caused by GERD in approximately 25 – 50% of cases. This symptom is quite often occurs without a real etiological factors (quite often caused by stressful situations), and is therefore essential that these patients always contact your doctor to determine the true origin of the symptoms. It is necessary to conduct a complete examination to determine first of all that any sense of the globe is not associated with tumor process in the pharynx or esophagus. When you reject the diagnosis of neoplastic processes, it is examined to be directed towards proving GERD or functional disorders of the esophagus. Only if we exclude all the listed pathologies, need to think about the globe as transient symptoms caused by chronic stress conditions and mental prenapetoš
- Difficulty Swallowing (Dysphagia)
- Noncardiac Chest Pain
- Extraesophageal Symptoms of GERD
- Epigastric and Right Subcostal Pain
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