Sys Rev Pharm 2020;11(6):992-996 A multifaceted review journal in the field of pharmacy 992 Systematic Reviews in Pharmacy Vol 11, Issue 6, Jun-July 2020 Pathogenesis, diagnosis and treatment of GERD patients with asthma as extra esophageal manifestations Afrita Amalia Laitupa 1 , Iswan Abbas Nusi 2 1 Faculty of Medicine, University of Muhammadiyah Surabaya, Surabaya, Indonesia 2 Department of Internal Medicine, Division of Gastroentero-Hepatology, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo Teaching Hospital, Surabaya, Indonesia. ABSTRACT Asthma is one of the clinical manifestations of GERD. Both symptoms can occur simultaneously even though they occur in different organs. Asthma occurs in the respiratory tract while GERD occurs in the digestive tract. One of the factors of these two diseases is the lifestyle of people who tend to be more easily exposed to the diseases, such as the large number of smokers and fast food outlets that can increase the obesity. This study aims to determine the correlation between GERD and asthma. This is very important to be observed in order to provide the good quality treatment that suits the needs of patients and cure GERD with Asthma as well as esophageal reflux and protect the esophageal mucosa thus the prognosis and quality of life of patients can increase. In regard to observe and understand the pathway in the pathogenesis, diagnosis, and therapy, this study proves that treating GERD in patients with bronchial asthma will reduce asthma attack and improve the patient's quality of life hence patients can carry out normal daily activities. Correspondence: Iswan Abbas Nusi Department of Internal Medicine, Division of Gastroentero-Hepatology, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo Teaching Hospital, Surabaya, Indonesia. iswannusi2015@yahoo.com INTRODUCTION Gastroesophageal reflux disease (GERD), based on the Montreal classification in 2006, is a condition that occurs due to reflux of gastric contents which can cause symptoms and or cause disturbing complications (Tjokroprawiro, Setiawan, Santoso, & Soegiarto, 2007). This disease is complex, chronic, and often causes recurrence which increase a risk of morbidity and has the potential to produce complications (Heidelbaugh, Gill, Van Harrison, & Nostrant, 2008). Symptoms of GERD, based on the Montreal classification in 2006, are divided into two, namely the gastroesophagus and extra esophagus. Gastroesophageal manifestations are classic symptoms such as heartburn and regurgitation, while extra esophageal manifestations include asthma, chronic cough, sore throat, or chest pain. Establishing the diagnosis of GERD can be conducted by various methods such as endoscopy, barium esophagography, esophageal pH monitoring, esophageal manometry, acid perfusion tests, PPI tests, and new esophageal scintigraphy techniques (Naik & Vaezi, 2013). Asthma, according to the Global Initiative for Asthma (GINA) in 2015, is a heterogeneous disease. It is usually with symptom by chronic airway inflammation. The other respiratory symptoms are wheezing, shortness of breath, chest feels heavy, and cough that varies from time to time and episodic, accompanied by limited variable expiratory air flow. Asthma attacks can be triggered by a variety of factors. One of the is gastroesophageal reflux which can be the potential triggers in patients with asthma (Health, 1995). GERD and asthma can occur together in a patient without being interconnected and both can be mutually burdensome. Besides that, both can arise from the occurrence of one another, GERD which causes asthma or asthma that causes GERD (Jiang & Huang, 2005). The mechanism of the correlation between GERD and asthma is very important to be known by the clinician in order to provide comprehensive management to reduce the recurrence rate thus it can improve the quality of life of patients. This article will discuss the pathogenesis, diagnosis, and treatment of GERD with asthma as an extra esophageal manifestation. Epidemiology The prevalence of GERD and its complications in Asia, including Indonesia, are generally lower compared to western countries, however recent data shows that the prevalence is increasing due to lifestyle changes that increase the risk of person affected by GERD, such as smoking and obesity. Indonesia has yet to have completed epidemiological data regarding this condition. Reports from the Lelosutan SAR et al in FKUI / RSCM-Jakarta study show that out of 127 research subjects undergoing SCBA endoscopy, 22.8% (30 subjects) suffered from esophagitis (Indonesian Society of, 2014). The study of 6,000 GERD patients from several countries in Europe shows that the most common extrasophageal symptoms were chest pain (14.5%), followed by chronic cough (13%), laryngeal disorders (10.4%), and asthma (4, 8%). Similar results were also found in a study in Korea of 1712 GERD patients whose most symptoms were chest pain (48.4%), chronic cough (32%), laryngitis (24.2%) and asthma (17.3%) (Min et al., 2014). Reported from 15 million Americans who suffer from asthma, around 50-80% also have GERD. Korea's national health insurance data reports that the prevalence of GERD symptoms is around 45-71% in patients with asthma which is higher than the prevalence of GERD in patients with chronic obstructive pulmonary disease (28%) (Shirai et al., 2015). Based on a study conducted by Susanto et al., it was found that a history of oral bronchodilator use was proven endoscopically to have