[Recently, considerable interest has been focused on the extra-oesophageal manifestations of gastro- oesophageal reflux disease. Vago-vagal reflex mechanisms have been shown to play a leading role in the pathogenesis of the extra-oesophageal manifestations. In addition, proximal reflux and subsequent chemical irritation of the respiratory tract mucosa are important factors in the development of respiratory symptoms. In contrast to the uncomplicated cases of gastrooesophageal reflux disease, the recognition of these variations may pose a diagnostic challenge right because of the lack of typical symptoms. Successful diagnosis rests with the cooperation of the general practitioner, the specialist observing the extra-oesophageal symptom and the gastroenterologist. The establishment of the pathogenic role of gastro-oesophageal reflux may require verification by oesophageal functional tests. Treatment is based on long-term administration (for at least 3 months if respiratory symptoms are present) of an increased-dose proton pump inhibitor. In the long term, laparoscopic anti-reflux surgery is a realistic alternative to medical treatment in suitable patients. Dietary and life-style education of patients has an important complementary role in the successful long term management.]