Assessment for Gastroesophageal Reflux Disease (GERD)

Diagnostic Considerations

The American Gastroenterological Association suggests that GERD can present with typical symptoms, such as heartburn or acid regurgitation, or atypical/extraesophageal manifestations, including chronic cough, asthma, or laryngitis 1
Up to 75% of patients with reflux-related cough may not have typical gastrointestinal symptoms like heartburn, making the connection less obvious, according to the American College of Chest Physicians 2
The absence of documented GERD symptoms or treatment does not completely rule out the condition, as it may be subclinical or manifesting through extraesophageal symptoms, as noted by the American Gastroenterological Association 3

The American College of Gastroenterology recommends an initial empiric trial of proton pump inhibitor (PPI) therapy if GERD symptoms are present 4
For patients with extraesophageal symptoms like chronic cough, a more intensive antireflux regimen might be required, as suggested by the American Thoracic Society 2

The American Gastroenterological Association recommends a 4-8 week trial of PPI therapy for suspected GERD-related symptoms, and patients may present with chronic sore throat, throat clearing, or globus sensation without any gastrointestinal complaints 5, 6

The American Gastroenterological Association suggests that extraesophageal manifestations typically require longer treatment courses than typical GERD, often 8-12 weeks minimum, and high-dose PPI therapy may be required for extraesophageal symptoms 5, 6