Author/Editor		Tepeš, Bojan
Title		Atipični simptomi in znaki gastroezofagealne refluksne bolezni
Translated title		Extraoesophageal symtoms and signs of gastroesophageal reflux disease
Type		članek
Source		Zdrav Vestn
Vol. and No.		Letnik 75, št. 4
Publication year		2006
Volume		str. 247-51
Language		slo
Abstract		Background Gastroesophageal reflux disease (GERD) is very common in developed world, with the prevalence of disease is between 6 and 20%. Pathologic reflux can provoke not only typical symptoms (heartburn and regurgitation) but also atypical symptoms and diseases of extraoesophageal organs (pulmonary, ENT, mouth). High prevalence of GERD in patients with unexplained chest pain, asthma, chronic cough, chronic laryngitis, hoarsness and dental erosions is not a proof of causality. GERD can cause these diseases with reflux of acid and pepsin into pharynx, lungs and mouth (reflux theory) or through vasovagal mechanisms (reflex theory). Conclusions Good therapeutic success with medical or operative treatment in early methodologically not well conducted studies has not been completely proven in double-blind placebo controlled studies. GERD is an ethyological reason for these extraoesophageal symptoms and diseases in an approximately one third of patients. With diagnostic modalities that we have now, we cannot clearly define in which patient is GERD is an ethyologic factor or a contributer, before we start the treatment. In patients suspected of having GERD, there is therapeutic option of a trial with high dose of proton pump inhibitor for 3 to 6 months. In other patients with low clinical suspicion of GERD, 24-hour pH testing should be done first.
Summary		Izhodišča Gastroezofagealno refluksno bolezen (GERB) ima danes od 6% do 20% ljudi v razvitem delu sveta. Patološki refluks lahko ob tipičnih simptomih (zgaga, regurgitacija) povzroči tudi atipične simptome in bolezni sosednjih organov požiralnika (pljuč, ORL, usta). Visoka prevalenca GERB-a pri bolnikih z atipičnimi simptomi (prsna bolečina, kronični kašelj, kronično vnetje glasilk, kronična hripavost, erozije zob...) pa še ni zadosten dokaz za vzročno povezanost. GERB naj bi večino omenjenih simptomov in bolezni povzročil zaradi refluksa kisline in pepsina v grlo, pluča oz usta (refluksna teorija) ali preko vazovagalnega refleksnega mehanizma (refleksna teorija). Zaključki Dobrih rezultatov zdravljenja z zdravili ali operativnim zdravljenjem v metodološko slabše zastavljenih raziskavah zgodnjega obdobja niso povsem potrdili rezultati novejših prospektivnih, dvojno slepih, s placebom kontroliranih raziskav. Glede na zadnje raziskovalne podatke naj bi BERB vplival na približno tretjino bolnikov z nekaterimi pljučnimi oz. ORL simptomi. Trenutno ni na voljo ustreznih diagnostičnih metod za ugotavljanje, pri katerih bolnikih je GERB osnovni ali pomožni etiološki dejavnik. V večini primerov ob kliničnem sumu na povezavo posamezne bolezni z GERB-om naredimo terapevtski poskus z visokimi odmerki zaviralca protonske črpalke tri do šest mesecev. Če pa je sum na povezavo z GERB-om manjši, je na prvem mestu 24-urna pH-metrija.
Descriptors		GASTROESOPHAGEAL REFLUX CHEST PAIN ASTHMA COUGH PULMONARY FIBROSIS