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Beyond heartburn: extraesophageal manifestations of gastroesophageal reflux disease.

A variety of extraesophageal presentations of chronic acid reflux disease may be encountered in practice, and it is important to diagnose and manage them appropriately. Some of these patients are asymptomatic; others have symptoms most commonly associated with a pulmonary or otolaryngologic disorder. An aggressive trial of antireflux medication can often improve or resolve these symptoms, indicating that gastroesophageal reflux disease is the primary contributing component. In cases where such medication trials fail, additional diagnostic methods may be needed to determine the source of the symptoms.