الفهرس 
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Abstract
It is extremely common that patients with gastroesophageal reflux disease (GERD) experience symptoms, approximately 20% of adults reporting having heartburn, acid reflux or both at least once a week and approximately 40% reporting that such symptoms occur at least one a month. If extra-esophageal manifestations are taken into consideration, it is believed that the real prevalence of pathological reflux might be underestimated. The denomination ’atypical symptoms’ is synonymous with GERD-related esophageal symptoms. Although the extra-esophageal manifestations of GERD constitute heterogeneous disease groups; some general characterizations can be made.
The diagnosis can be particularly difficult due to the great prevalence of ’silent GERD’ in the population. Traditional exams, such as endoscopy of the upper digestive tract and contrast-enhanced radiological examination of the esophagus, stomach and duodenum, can be useful in the diagnosis of GERD and are still important tools for the detection of esophageal complications. However, these exams might not confirm GERD, and, when they do, they do not establish a causal relationship between GERD and extra-esophageal symptoms. The most sensitive exam for the detection of GERD is 24-h pHmetry, which plays an important role in the evaluation of patients with extra-esophageal manifestations.
Nevertheless, 24-h pHmetry might not confirm the causal relationship between GERD and the extra-esophageal symptoms. Therefore, the empirical test with antireflux measures (behavioral and pharmacological) can be useful in establishing the diagnosis. Atypical manifestations generally require more aggressive and longer-term antisecretion therapy than do typical GERD symptoms.
It is noteworthy that the behavioral measures to avoid the exacerbation of pathological reflux are indicated for all patients suspected of having GERD and presenting atypical symptoms. The principal behavioral measures are as follows: elevating the head of the bed (by 15 cm); exercising moderation regarding some types of food that have been correlated with symptoms (fat, citrus, coffee, alcoholic beverages, carbonated beverages, tomato-based products, chocolate, etc.); avoiding lying down within two hours after meals; avoiding large meals; avoiding wearing tight clothes; stopping smoking; and (in cases of obesity) losing weight.
Surgical procedures for persistent symptoms of acid reflux include: Laparoscopic fundoplication: Minimally invasive surgery: performed using laparoscopy. Over 90 percent of people having this procedure have satisfactory results. Endoscopic fundoplication: This operation may be performed from inside the esophagus using an endoscope. Endoscopic radiofrequency ablation, Also known as the Stretta procedure, May be performed as outpatient surgery. Lower incidence of side effects as compared to other anti-reflux surgery. Like a microwave, this device heats the tissues of the valve, causing them to scar and close tighter.