The extra-esophageal manifestations of GE reflux disease are now being more frequently recognized and treated. These manifestations include ENT manifestations including reflux laryngitis, laryngeal stenosis, laryngeal carcinoma, chronic hoarseness, chronic cough and globus sensation.
Pulmonary manifestations include asthma, chronic cough, aspiration pneumonia and pulmonary fibrosis.
The association between GE reflux disease and chronic pulmonary disease has been speculated upon for many years. The pathophysiology for this connection remains poorly understood and is complicated by the fact that many of the treatments for patients with chronic lung disease and the lung disease itself can exacerbate GE reflux disease.
The two most commonly proposed theories include a neural reflex caused by acid reflux into the distal esophagus versus micro-aspiration of tiny amounts of acid into the tracheobronchial tree with resultant bronchospasm and/or pulmonary parenchymal damage. At present, there is more evidence supporting the micro-aspiration theory. Treatment of pulmonary complications of GERD remains the same as for other forms of GERD.