Optimization of GERD therapy with extraesophageal manifestations: Esophageal protection in the focus of the clinician

Abstract

Gastroesophageal reflux disease (GERD) is characterized by a high prevalence in the population, a chronic, progressive course, and a significant deterioration in patients' quality of life. Typical complaints of GERD include heartburn and acid regurgitation, but some patients may experience upper respiratory, respiratory system, and oral symptoms, as well as sleep physiology disorder. These symptoms and disorders are known collectively as the extraesophageal manifestations of GERD, which are a common reason for seeking medical attention from otolaryngologists, pulmonologists, dentists, and other interdisciplinary specialists. In clinical practice, the most common extraesophageal manifestation of GERD is considered to be laryngopharyngeal reflux, associated with such symptoms as cough, hoarseness/change of voice, repetitive throat clearing, excessive phlegm, pain, or sensation of a lump in the throat. Despite a large number of published papers on this issue, clinicians continue to struggle with choosing the optimal diagnostic approach and a rational treatment strategy when managing patients with LPR and underlying GERD. The article provides an analysis of an update on the mechanisms of development of GERD-associated LPR, diagnostic approaches, and treatment optimization options, including introduction of esophageal protectors in treatment regimens. The authors also presented their own clinical observation, highlighting the need for a multidisciplinary approach and a balanced, comprehensive assessment of clinical data and laboratory and instrumental findings when following up patients with suspected extraesophageal manifestations of GERD.