atypical GERD

atypical GERD

An atypical presentation of GERD/GORD (gastro-esophageal/gastro-oesophageal reflux disease) that affects up to 30% of patients with classic GERD/GORD.
 
Clinical findings
• Lungs—asthma, cough, chronic bronchitis, pulmonary fibrosis, pneumonia.
• ENT—laryngitis, sinusitis, hoarseness, vocal nodules, globus hystericus.
• Others—noncardiac chest pain, dental erosion, hiccups.
 
Diagnosis
Diagnosis of exclusion; history of severe chest pain (postprandial or nocturnal); endoscopic esophagitis, < 50% of patients; esophageal pH monitoring (85% sensitivity); test of therapy.

Management
Atypical GERD/GORD requires longer treatment than classic GERD/GORD and is less responsive to therapy, requiring high-dose proton pump inhibitor therapy for 12 weeks; nonresponders may need fundoplication.

atypical GERD

Internal medicine An atypical presentation of GERD which affects up to 30% of Pts with classic GERD Clinical
1. Lungs–asthma, cough, chronic bronchitis, pulmonary fibrosis, pneumonia;.
2. ENT–laryngitis, sinusitis, hoarseness, vocal nodules, globus hystericus;.
3. Others–noncardiac chest pain, dental erosion, hiccups Diagnosis Dx of exclusion; Hx of severe chest pain–postprandial or nocturnal; endoscopic esophagitis, < 50% of Pts; esophageal pH monitoring–85% sensitivity; test of therapy Management Unlike classic GERD, atypical GERD requires longer treatment, is less responsive to therapy; high-dose proton pump inhibitor therapy for 12 wks; nonresponders may require fundoplication.  See GERD, Noncardiac chest pain.
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References in periodicals archive ?
"Silent GERD" refers to esophageal mucosal injury (i.e., erosion, ulceration, or Barrett's esophagus) visible in EGD without typical or atypical GERD symptoms [2].
Skip Baldino, EGS President and CEO said, The TIF procedure for reflux has the potential to help millions of patients that suffer from typical and atypical GERD symptoms.
This includes discussion of functional heartburn, pain receptors, neutral reflux in typical and atypical GERD symptoms, and molecular pathways and cortical processing.
Results from a poll presented at the meeting also showed that people with atypical GERD symptoms were more likely to have sleeping problems.
In 43 patients who showed atypical GERD symptoms (abdominal discomfort, belch, catarrh, dysphagia, choking, globus, hoarseness, cough, wheeze, or acid taste), a positive SI occurred with nonacid reflux in 23% and with acid reflux in 2% of the patients.
Extraluminal or atypical GERD is known to manifest with wheezing, often in the absence of heartburn.
(6-20) GERD patients who did not have heartburn were considered to have atypical GERD, and it was the prevailing belief that laryngopharyngeal symptoms were not the result of actual reflux of gastric contents into the throat, but rather the result of vagally mediated reflexes.
Noncardiac chest pain, subglottic stenosis, and laryngeal polyps, edema, and erythema are other common manifestations of atypical GERD. The diagnosis is difficult to establish conclusively, however, because both endoscopy and 24-hour esophageal pH testing are often negative in these patients.
In contrast, two major pathophysiologic mechanisms have been proposed for atypical GERD: microaspiration, and vagal hyperresponsiveness triggered by acid exposure in the distal esophagus.

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