**Abstract**

Esophageal diseases are diagnosed by gastroenterological processing indicated due to typical gastrointestinal symptoms, but typical gastrointestinal symptoms are not the only possible manifestation of esophageal disease. There are also external symptoms such as chronic cough, laryngitis, pharyngitis, oropharyngeal dysphagia, odynophagia, laryngopharyngeal reflux, dysphonia, sinusitis, ear pain, and changes in laryngopharyngeal mucosa (erythema, edema, ventricular obliteration, cricoid hyperplasia and pseudosulcus). Extraesophageal symptoms are common in esophagitis and GERD, and studies show increasing prevalence of LPR in patients with GERD, as well as an association of reflux disease with cough and dysphonia symptoms. The aim of the chapter is to describe these extraesophageal symptoms of esophageal disease and how to recognize and treat them, in order to facilitate gastroenterologists' diagnostic processing of patients with these symptoms, improve their treatment and assessment of the therapy effectiveness, prevent the development of stronger symptoms, and encourage multidisciplinary cooperation and exchange of knowledge, scientific and clinical work.

**Keywords:** chronic cough, chronic laryngitis, dysphonia, esophagitis, laryngopharyngeal reflux

#### **1. Introduction**

Due to anatomical location and function, esophageal motility disorders, inflammatory diseases, gastroesophageal reflux (GER), esophageal rings and webs, tumors and other esophageal conditions and diseases can cause many extraesophageal symptoms, which are increasingly recognised and diagnosed by otolaryngologists, pulmonologists, cardiologists, and, of course, gastroenterologists. Certain pathophysiological conditions that are not localized in the esophagus may be the first symptoms of esophageal disease or signs associated with the onset of esophageal disease. One of the etiological factors is the pathophysiological mechanism of the increase in intra-abdominal pressure that occurs during weight gain and in pregnancy. Another etiological factor is the pathophysiological mechanism of relaxation of the lower esophageal sphincter that may occur due to coronary heart disease drug therapy rich in nitrates. A similar thing happens during antirheumatic therapy in rheumatoid arthritis and some degenerative

**Figure 1.** *Extraesophageal manifestation of esophageal diseases.*

diseases of the locomotor system. Other conditions that may be associated with gastroesophageal reflux and esophageal diseases include diabetes mellitus, which results in prolonged gastric stagnation and consequent prolonged gastric emptying, and duodenal ulcer, duodenal stenosis, or malignant gastric disease in which delayed gastric emptying is present. So far, it is a well-known fact that the appropriate speed of food passage through the gastrointestinal tract, which is conditioned by a series of autoregulatory processes, is important. An optimal rate of passage is required - small enough to complete food digestion and absorption of substances and large enough to supply the body with the necessary nutrients in a timely manner [1]. The most common atypical symptoms of esophageal disease, primarily esophagitis and gastroesophageal reflux disease (GERD), will be listed here. For better visibility and easier understanding, the classification of atypical extraesophageal symptoms was performed according to the criterion of anatomical localization (**Figure 1**):


And last but not least, the biopsychosocial dimensions of esophageal diseases and extraesophageal symptoms are being recognized, too.
