Vasile Liviu Drug1, Sabina Antoniu2, Barboi Bogdana Oana3, Oana Cristina Arghir4, Ion Bancila5, Simona Bataga6, Ciprian Brisc7, Cristina Cijevschi-Prelipcean8, Mihai Ciocîrlan9, Irina Ciortescu10, Liliana David11, Oana Claudia Deleanu12, Mircea Diculescu13, Anca Dimitriu14, Daniela Dobru15, Eugen Dumitru16, Dan Ionut Gheonea17, Cristian Gheorghe18, Adrian Goldis19, Mariana Jinga20, Milena Man21, Bogdan Mateescu22, Mircea Manuc23, Catalina Mihai24, Florin Mihaltan25, Traian Mihaescu26, Laurentiu Nedelcu27, Lucian Negreanu28, Carmen Monica Pop29, Ruxandra Rajnoveanu30, Adrian Saftoiu31, Andrada Seicean32, Ioan Sporea33, Carol Stanciu34, Teodora Surdea-Blaga35, Marcel Tantau36, Doina Todea37, Anca Victorita Trifan38, Ruxandra Ulmeanu39, Diana Elena Iov40, Dan Lucian Dumitrascu41. 1. Grigore T. Popa University of Medicine and Pharmacy, Iasi; Institute of Gastroenterology and Hepatology, Saint Spiridon Hospital, Iasi, Romania. . vasidrug@email.com. 2. Grigore T. Popa University of Medicine and Pharmacy, Iasi; Pneumology Hospital, Iasi, Romania. sabina.antoniu@outlook.com. 3. Grigore T. Popa University of Medicine and Pharmacy, Iasi; Institute of Gastroenterology and Hepatology, Saint Spiridon Hospital, Iasi, Romania. oany_leo@yahoo.com. 4. Faculty of Medicine, Ovidius University, Constanța; Pneumology Hospital, Constanta, Romania. arghir_oana@yahoo.com. 5. Center of Gastroenterology and Hepatology Fundeni Clinical Institute, Bucharest, Romania. ibancila@yahoo.com. 6. George E. Palade University of Medicine, Pharmacy, Sciences and Technology, Targu-Mures; County Emergency Clinical Hospital, Targu-Mures, Romania. simonabataga@yahoo.com. 7. University of Oradea, Faculty of Medicine and Pharmacy, Romania; Clinical Hospital, Oradea, Romania. brisciprian@gmail.com. 8. Grigore T. Popa University of Medicine and Pharmacy, Iasi; Institute of Gastroenterology and Hepatology, Saint Spiridon Hospital, Iasi, Romania. cristinacijevschi@yahoo.com. 9. Carol Davila University of Medicine and Pharmacy, Bucharest, Romania;. ciocirlan@gmail.com. 10. Grigore T. Popa University of Medicine and Pharmacy, Iasi; Institute of Gastroenterology and Hepatology, Saint Spiridon Hospital, Iasi, Romania. irinaciortescu@yahoo.com. 11. University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania; 2nd Department of Internal Medicine, Cluj County Emergency Clinical Hospital, Cluj-Napoca, Romania. lilidavid2007@yahoo.com. 12. Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Marius Nasta Institute of Pneumology, Bucharest, Romania. oanadeleanu@yahoo.com. 13. Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Center of Gastroenterology and Hepatology Fundeni Clinical Institute, Bucharest, Romania. mmdiculescu@yahoo.com. 14. Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Center of Gastroenterology and Hepatology Fundeni Clinical Institute, Bucharest, Romania. borcaanca@yahoo.com. 15. George E. Palade University of Medicine, Pharmacy, Sciences and Technology, Targu-Mures, Romania; County Emergency Clinical Hospital, Targu-Mures, Romania. danidobru@gmail.com. 16. Faculty of Medicine, Ovidius University, Constanța, Romania; Saint Apostol Andrei Hospital, Constanta, Romania. eugen.dumitru@yahoo.com. 17. University of Medicine and Pharmacy Craiova, Romania; County Emergency Hospital, Craiova, Romania. digheonea@gmail.com. 18. Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Center of Gastroenterology and Hepatology Fundeni Clinical Institute, Bucharest, Romania. drcgheorghe@gmail.com. 19. Department of Gastroenterology and Hepatology, Victor Babeș University of Medicine and Pharmacy, Timișoara. goldisadi@yahoo.com. 20. Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Dr. Carol Davila Central University Emergency Military Hospital, Bucharest, Romania. mariana_jinga@yahoo.com. 21. Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania; Leon Daniello Pneumology Hospital, Cluj-Napoca, Romania. manmilena50@yahoo.com. 22. Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Department of Gastroenterology, Colentina Clinical Hospital, Bucharest, Romania. bogmateescu@gmail.com. 23. Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Center of Gastroenterology and Hepatology Fundeni Clinical Institute, Bucharest, Romania. m_manuc@yahoo.com. 24. Grigore T. Popa University of Medicine and Pharmacy, Iasi; Institute of Gastroenterology and Hepatology, Saint Spiridon Hospital, Iasi, Romania. catalinamihai@yahoo.com. 25. Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Marius Nasta Institute of Pneumology, Bucharest, Romania. mihaltan@starnets.ro. 26. Grigore T. Popa University of Medicine and Pharmacy, Iasi; 2) Institute of Gastroenterology and Hepatology, Saint Spiridon Hospital, Iasi; 3) Pneumology Hospital, Iasi;. traian@mihaescu.eu. 27. Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; 2nd Department of Gastroenterology, Emergency University Hospital, Bucharest, Romania. laurnedelcu@yahoo.com. 28. University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania;2nd Department of Gastroenterology, Emergency University Hospital, Bucharest, Romania. negreanu_99@yahoo.com. 29. Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania; Leon Daniello Pneumology Hospital, Cluj-Napoca, Romania. cpop@umfcluj.ro. 30. Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania; Leon Daniello Pneumology Hospital, Cluj-Napoca, Romania. ruandra.rajnoveanu@umfcluj.ro. 31. University of Medicine and Pharmacy Craiova, Romania. adriansaftoiu@gmail.com. 32. Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania; Prof. Dr. Octavian Fodor Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania. andradaseicean@gmail.com. 33. Department of Gastroenterology and Hepatology, Victor Babeș University of Medicine and Pharmacy, Timișoara. isporea@umft.ro. 34. University of Medicine and Pharmacy "Grigore T. Popa, Iasi, Romania; Institute of Gastroenterology and Hepatology, "Saint Spiridon" Hospital, Iasi, Romania. stanciucarol@yahoo.com. 35. University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania; 2nd Department of Internal Medicine, Cluj County Emergency Clinical Hospital, Cluj-Napoca, Romania. dora_blaga@yahoo.com. 36. Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania; Prof. Dr. Octavian Fodor Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania. matantau@gmail.com. 37. Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania; Leon Daniello Pneumology Hospital, Cluj-Napoca, Romania. dtodea@umfcluj.ro. 38. Grigore T. Popa University of Medicine and Pharmacy, Iasi; Institute of Gastroenterology and Hepatology, Saint Spiridon Hospital, Iasi, Romania. ancatrifan@yahoo.com. 39. University of Oradea, Faculty of Medicine and Pharmacy, Romania; Marius Nasta Institute of Pneumology, Bucharest, Romania. r_ulmeanu@yahoo.com. 40. Institute of Gastroenterology and Hepatology, Saint Spiridon Hospital, Iasi, Romania. iovdiana95@gmail.com. 41. University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania; 2nd Department of Internal Medicine, Cluj County Emergency Clinical Hospital, Cluj-Napoca, Romania. dan_dumitrascu@yahoo.de.
Abstract
BACKGROUND AND AIMS: Gastroesophageal reflux disease (GERD) is a common condition present in daily practice with a wide range of clinical phenotypes. In this line, respiratory conditions may be associated with GERD. The Romanian Societies of Gastroenterology and Neurogastroenterology, in association with the Romanian Society of Pneumology, aimed to create a guideline regarding the epidemiology, diagnosis and treatment of respiratory conditions associated with GERD. METHODS: Delphi methodology was used and eleven common working groups of experts were created. The experts reviewed the literature according to GRADE criteria and formulated 34 statements and recommendations. Consensus (>80% agreement) was reached for some of the statements after all participants voted. RESULTS: All the statements and the literature review are presented in the paper, together with their correspondent grade of evidence and the voting results. Based on >80% voting agreement, a number of 22 recommendations were postulated regarding the diagnosis and treatment of GERD-induced respiratory symptoms. The experts considered that GERD may cause bronchial asthma and chronic cough in an important number of patients through micro-aspiration and vagal-mediated tracheobronchial reflex. GERD should be suspected in patients with asthma with suboptimal controlled or after exclusion of other causes, also in nocturnal refractory cough which needs gastroenterological investigations to confirm the diagnosis. Therapeutic test with double dose proton pump inhibitors (PPI) for 3 months is also useful. GERD induced respiratory conditions are difficult to treat; however,proton pump inhibitors and laparoscopic Nissen fundoplication are endorsed for therapy. CONCLUSIONS: This guideline could be useful for the multidisciplinary management of GERD with respiratory symptoms in current practice.
BACKGROUND AND AIMS: Gastroesophageal reflux disease (GERD) is a common condition present in daily practice with a wide range of clinical phenotypes. In this line, respiratory conditions may be associated with GERD. The Romanian Societies of Gastroenterology and Neurogastroenterology, in association with the Romanian Society of Pneumology, aimed to create a guideline regarding the epidemiology, diagnosis and treatment of respiratory conditions associated with GERD. METHODS: Delphi methodology was used and eleven common working groups of experts were created. The experts reviewed the literature according to GRADE criteria and formulated 34 statements and recommendations. Consensus (>80% agreement) was reached for some of the statements after all participants voted. RESULTS: All the statements and the literature review are presented in the paper, together with their correspondent grade of evidence and the voting results. Based on >80% voting agreement, a number of 22 recommendations were postulated regarding the diagnosis and treatment of GERD-induced respiratory symptoms. The experts considered that GERD may cause bronchial asthma and chronic cough in an important number of patients through micro-aspiration and vagal-mediated tracheobronchial reflex. GERD should be suspected in patients with asthma with suboptimal controlled or after exclusion of other causes, also in nocturnal refractory cough which needs gastroenterological investigations to confirm the diagnosis. Therapeutic test with double dose proton pump inhibitors (PPI) for 3 months is also useful. GERD induced respiratory conditions are difficult to treat; however,proton pump inhibitors and laparoscopic Nissen fundoplication are endorsed for therapy. CONCLUSIONS: This guideline could be useful for the multidisciplinary management of GERD with respiratory symptoms in current practice.