Supraesophageal Reflux Disease (SERD)

Abstract

Supraesophareal reflux disease is a form of acid reflux manifested not by heartburn but rather by respiratory or laryngeal symptoms. It is caused by reflux of acidic gastric contents into the larynx. Esophagoscopy is usually normal, but inspection of the larynx may reveal signs such as edema or erythema. Conventional pH monitoring is not sensitive enough to detect reflux to the upper esophagus, but the yield is improved with the combination of impedance monitoring (MII) with pH monitoring. Other possible diagnostic methods are the Dx–pH measurement system that measures aerosolized droplets of acid in the oropharynx, and salivary pepsin that can be used as a diagnostic marker. These methods, however, are not commonly available. Lifestyle modifications may improve the symptoms but the backbone of therapy is proton pump inhibitors. A therapeutic trial of proton pump inhibitor twice daily for 2 months is usually enough to produce symptomatic improvement. Some carefully selected patients may also benefit from anti-reflux surgery. Due to the nonspecific nature of the symptoms and the difficulty in diagnosis it is accepted that failure of a properly administered therapeutic trial should prompt further investigation for another diagnosis.