Endoscopy in Extraesophageal Manifestations Secondary to Gastroesophageal Reflux Disease: Why Do We Insist?

The concept of extraesophageal manifestations sec ondary to gastroesophageal reflux disease (GERD) is complex and not always clear. Although several extra esophageal symptoms have been associated with GERD, only asthma, cough, and hoarseness have evidencebased support [1]. The role of upper gastrointestinal endoscopy (UGIE) in GERD is that of screening in certain highrisk groups in particular overweight white males with chronic GERD symptoms and aged > 50 years [2]. In the context of suspected extraesophageal manifestations of GERD, UGIE has a low diagnostic yield and therefore poor pre dictive value for determination of GERD as the cause of these symptoms [1]. However, despite the foregoing, UGIE is still frequently requested and little is known about endoscopic findings in this context. In this issue of GE Portuguese Journal of Gastroenterology, Zullo et al. [3] present us the first study with data on the prevalence of relevant gastroesophageal lesions in pa tients with extraesophageal GERD manifestations. The authors concluded that clinically relevant lesions namely Barrett’s esophagus, erosive esophagitis, and hiatal hernia are uncommon among young (< 50 years) patients with only extraesophageal GERD manifestations, and the use fulness of UGIE in these patients is questionable. One of the major factors that contributes to the con troversy of GERDassociated extraesophageal manifesta tions is that other potential causes have not been ade quately evaluated and/or treated before [4]. In Zullo et al. [3], UGIE was prescribed by different specialists and nothing was told about other previous tests done in inves tigation and its results. Additionally, the specificities about present or past proton pump inhibitors therapy (dosage, duration, response) have not been given. On the