Supra-oesophageal manifestations of gastro-oesophageal reflux disease.

The extra-oesophageal signs that are most commonly related to gastro-oesophageal reflux include chest pain, asthma, chronic cough, posterior laryngitis and dental erosions. It is characteristic to find in such patients a poor presence of symptoms and endoscopic and pH-metric findings that are common in typical reflux. The therapeutic response to antisecretory drugs has become the most cost-effective tool for the diagnosis and treatment of this condition. Both the evidence available and expert agreement in consensus conferences support the use of proton pump inhibitors with doubled standard doses for at least 12 weeks in most cases. While an acceptable response is achieved with this significant acid inhibition, there are still questions to be answered in these and other aspects, such as the true prevalence, path physiology and diagnosis of this condition. It is therefore necessary and increasingly useful to create multidisciplinary teams with the aim to improve and promote understanding and the care of patients suffering from these supra-oesophageal symptoms caused by gastro-oesophageal reflux.