Family Practice Advance Access originally published online on July 15, 2005
Family Practice 2005 22(6):591-603; doi:10.1093/fampra/cmi061
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Beyond heartburn: a systematic review of the extra-oesophageal spectrum of reflux-induced disease
a Centre for Integrated Health Care Research, University of Durham—Stockton Campus, Wolfson Research Institute, Queen's Campus, University Boulevard, Stockton-on-Tees TS17 6BH, UK and b Outcomes Research, AstraZeneca R&D, S-431 83 Mölndal, Sweden.
Correspondence to Pali Hungin; Email: A.P.S.Hungin{at}durham.ac.uk
Background. Gastro-oesophageal reflux disease (GORD) is a chronic condition affecting up to one-quarter of the Western population. GORD is characterized by heartburn and acid regurgitation, but is reported to be associated with a spectrum of extra-oesophageal symptoms.
Objective. The aim of this systematic review was to critically evaluate postulated extra-oesophageal symptoms of GORD.
Methods. Extra-oesophageal symptoms were identified from population-based studies evaluating their association with GORD (either defined as heartburn and/or acid regurgitation, or diagnosed in general practice). The response of these symptoms to acid-suppressive therapy was investigated using randomized, double-blind, placebo-controlled studies. Pathogenic mechanisms were evaluated using clinical and preclinical studies.
Results. An association between GORD and symptoms or a diagnosis of chest pain/angina, cough, sinusitis and gall-bladder disease was evident from three eligible population-based studies of GORD. Randomized placebo-controlled studies (n = 20) showed that acid-suppressive therapy provides symptomatic relief of chest pain, asthma and, potentially, chronic cough and laryngitis. Mechanistic models, based on direct physical damage by refluxate or vagally mediated reflexes, support a causal role for GORD in chest pain and respiratory symptoms, but not in gall-bladder disease.
Conclusion. GORD is likely to play a causal role in chest pain and possibly asthma, chronic cough and laryngitis. Further investigation is desirable, particularly for other potential extra-oesophageal manifestations of GORD such as chronic obstructive pulmonary disease, sinusitis, bronchitis and otitis. Acid-suppressive therapy is likely to benefit patients with non-cardiac chest pain, but further placebo-controlled studies are needed for other symptoms comprising the extra-oesophageal spectrum of GORD.
Keywords. Asthma, chest pain, chronic cough, gastro-oesophageal reflux disease, laryngitis.
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  L. A. Garcia Rodriguez, A. Ruigomez, E. Martin-Merino, S. Johansson, and M.-A. Wallander Relationship Between Gastroesophageal Reflux Disease and COPD in UK Primary Care Chest, December 1, 2008; 134(6): 1223 - 1230. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. Flook, R. Jones, and N. Vakil Approach to gastroesophageal reflux disease in primary care: Putting the Montreal definition into practice Can Fam Physician, May 1, 2008; 54(5): 701 - 705. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B D Havemann, C A Henderson, and H B El-Serag The association between gastro-oesophageal reflux disease and asthma: a systematic review Gut, December 1, 2007; 56(12): 1654 - 1664. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. Delaney Family Practice and the new era of electronic publishing Fam. Pract., December 1, 2005; 22(6): 581 - 582. [Full Text] [PDF]
|
|