Management of extra-oesophageal symptoms of GORD in adults

Extra-oesophageal symptoms of GORD may include dental, respiratory (eg chronic cough), pharyngeal or laryngeal symptoms, noncardiac chest pain and sleep disturbance. Because these symptoms are nonspecific and GORD is common, they are often assumed to be due to GORD; however, in many patients they are likely to be due to other causes (particularly when typical symptoms of GORD are absent).

For patients with extra-oesophageal symptoms suspected to be due to GORD, high-dose proton pump inhibitor (PPI) therapy can be trialled for 8 to 12 weeks; suitable regimens are:

1esomeprazole 20 mg orally, twice daily, half to one hour before meals esomeprazole esomeprazole esomeprazole

OR

1lansoprazole 30 mg orally, twice daily, half to one hour before meals lansoprazole lansoprazole lansoprazole

OR

1omeprazole 20 mg orally, twice daily, half to one hour before meals omeprazole omeprazole omeprazole

OR

1pantoprazole 40 mg orally, twice daily, half to one hour before meals pantoprazole pantoprazole pantoprazole

OR

1rabeprazole 20 mg orally, twice daily, half to one hour before meals. rabeprazole rabeprazole rabeprazole

If symptoms do not respond after 8 to 12 weeks of therapy, it is unlikely that the cause of the symptoms is GORD. Stop PPI therapy and consider other diagnoses.

If symptoms do respond, step down or stop therapy and reinstitute it only if symptoms recur. This is preferable to continuing long-term high-dose PPI therapy (see Long-term use of proton pump inhibitors (PPIs) in adults). If symptoms recur, a repeated trial of PPI therapy can be used to determine the degree and consistency of the response to therapy. If symptoms consistently respond to PPI therapy, continue therapy with the lowest dose and frequency that controls symptoms (see Long-term use of proton pump inhibitors (PPIs) in adults).