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- ... Laryngopharyngeal reflux of gastric content may cause laryngeal inflammation, with consequent symptoms including hoarseness, throat pain, sensation of a lump in the throat, cough, repetitive throat cleaning, excessive phlegm, dysphagia, odynophagia, heartburn and voice fatigue (1) . There is a well-established association between gastroesophageal reflux disease (GERD) and reflux laryngitis syndrome (2,3) ; however, laryngitis may also be caused by tobacco, alcoholic beverages, allergies, rhinopharyngeal infections and traumatic lesions (4) .The diagnosis of laryngopharyngeal reflux of gastric content is not easy (3,5) and treatment includes proton pump inhibitors, which may or may not improve the symptoms (6,7) . ...... Laryngopharyngeal reflux of gastric content may cause laryngeal inflammation, with consequent symptoms including hoarseness, throat pain, sensation of a lump in the throat, cough, repetitive throat cleaning, excessive phlegm, dysphagia, odynophagia, heartburn and voice fatigue (1) . There is a well-established association between gastroesophageal reflux disease (GERD) and reflux laryngitis syndrome (2,3) ; however, laryngitis may also be caused by tobacco, alcoholic beverages, allergies, rhinopharyngeal infections and traumatic lesions (4) .The diagnosis of laryngopharyngeal reflux of gastric content is not easy (3,5) and treatment includes proton pump inhibitors, which may or may not improve the symptoms (6,7) . ...... In our study it is impossible to say that the patients had supraesophageal manifestations of GERD. The diagnosis of GERD as the cause of pharyngeal manifestations of reflux is not easy (3,5,21) , and there is no strong evidence that a positive response to treatment with proton bomb inhibitors means that the laryngitis was caused by GERD (22) . ...ArticleFull-text available
Background: Dysphagia is described as a complaint in 32% of patients with laryngitis. Objective: The objective of this investigation was to evaluate oral and pharyngeal transit of patients with laryngitis, with the hypothesis that alteration in oral-pharyngeal bolus transit may be involved with dysphagia. Methods: Videofluoroscopic evaluation of the swallowing of liquid, paste and solid boluses was performed in 21 patients with laryngitis, 10 of them with dysphagia, and 21 normal volunteers of the same age and sex. Two swallows of 5 mL liquid bolus, two swallows of 5 mL paste bolus and two swallows of a solid bolus were evaluated in a random sequence. The liquid bolus was 100% liquid barium sulfate and the paste bolus was prepared with 50 mL of liquid barium and 4 g of food thickener (starch and maltodextrin). The solid bolus was a soft 2.2 g cookie coated with liquid barium. Durations of oral preparation, oral transit, pharyngeal transit, pharyngeal clearance, upper esophageal sphincter opening, hyoid movement and oral-pharyngeal transit were measured. All patients performed 24-hour distal esophageal pH evaluation previous to videofluoroscopy. Results: The evaluation of 24-hour distal esophageal pH showed abnormal gastroesophageal acid reflux in 10 patients. Patients showed longer oral preparation for paste bolus and a faster oral transit time for solid bolus than normal volunteers. Patients with laryngitis and dysphagia had longer preparation for paste and solid boluses, and a faster oral transit time with liquid, paste and solid boluses. Conclusion: A longer oral preparation for paste and solid boluses and a faster transit through the mouth are associated with dysphagia in patients with laryngitis.
- Mar 2018
- Arq Gastroenterol
- ... Необходимо также отметить, что оздоровительная физкультура позволяет снизить массу тела пациентам с излишним весом и ГЭРБ . В исследовании M.A. Mocanu и соавт. ...... При невозможности снижения массы тела при помощи диеты и фармакотерапии применяют методы ба риартрической хирургии -шунтирование желудка с гастроеюноанастомозом по Ру (наиболее эффективная процедура, позволяющая добиться ремиссии ГЭРБ у пациентов с ожирением) . ...ArticleFull-text available
Vomiting Bright Yellow Bile To Eat (🔥 10 Remedies) | Vomiting Bright Yellow Bile Heartburn Medicinehow to Vomiting Bright Yellow Bile for В последние несколько десятилетий во всём мире возрастает распространённость таких нозологических форм, как гастроэзофагеальная рефлюксная болезнь и ожирение. Сочетание данных видов патологии чаще отмечают у пациентов, имеющих проблемы в питании и образе жизни, а также генетическую предрасположенность по данным нозологиям. Отмечено, что у пациентов с ожирением повышена предрасположенность к возникновению диафрагмальных грыж и механическому повреждению гастроэзофагеального соединения, что возникает на фоне увеличенного интрагастрального давления и повышенного градиента давления между желудком и пищеводом, а также вследствие растяжения проксимального отдела желудка. Одним из основных патогенетических моментов гастроэзофагеальной рефлюксной болезни бывает спонтанная релаксация нижнего пищеводного сфинктера. Согласно последним исследованиям, при ожирении частота постпрандиальных спонтанных релаксаций нижнего пищеводного сфинктера увеличивается даже при отсутствии диафрагмальных грыж, неэрозивной гастроэзофагеальной рефлюксной болезни и рефлюкс-эзофагита. Многообразие метаболических нарушений, наблюдаемых у данных пациентов, предполагает комплексный подход к лечению, направленный как на эффективное снижение кислотно-пептического фактора, так и на коррекцию избытка массы тела. Среди основных направлений лечения обеих составляющих данной сочетанной патологии выделяют как немедикаментозные, так и медикаментозные методы лечения. Важную роль в терапии отводят мероприятиям, способствующим ведению здорового образа жизни: отказу от курения, снижению массы тела, диетическому питанию, оздоровительной физической культуре. Особое внимание среди лекарственной терапии у пациентов с гастроэзофагеальной рефлюксной болезнью и ожирением, позволяющей достичь оптимального кислотоснижающего эффекта, отводят группе ингибиторов протонной помпы (ингибиторов H+,K+-АТФазы), имеющих более низкую аффинность к печёночной цитохром Р450-ферментной системе, не оказывающей влияния на её активность и не дающей клинически значимых перекрёстных реакций с другими препаратами.
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- ... Pacijenti sa atipičnim simptomima ne moraju imati, ili se ne moraju žaliti na gorušicu [4,6]. U nastanku vanezofagealnih (atipičnih) simptoma GERB-a, od ključne važnosti su dva mehanizma : 1) mikroaspiracija i direktni štetni kontakt refluksata, 2) refleksne reakcije posredovane nervusom vagusom. ...... Znači da pogoršavanjem simptoma refluksne bolesti, što podrazumeva prisustvo atipičnih simptoma, nije utvrđeno i pogoršanje stepena refluksne bolesti (odnosno nema povezanosti u težini simptoma i proširenosti oštećenja jednjačne sluznice). Ovakav zaključak se može naći i u malom broju raspoložive literature koja se bavila ovom problematikom . Zatim, i kod pacijenata sa vanezofagealnim (atipičnim) simptomima i kod pacijenata sa tipičnim simptomima endoskopski se našao nizak stepen endoskopskih promena (tabela br. ...
- ... Gastroesophageal reflux (GER), defined as a return of gastric contents into the esophagus, is a usual cause of esophagitis in humans but can also cause extraesophageal manifestations, such as cough and laryngitis. 1 Normally, the respiratory tract is well protected from aspiration by several esophagopharyngolaryngeal reflexes as well as by the cough reflex and mucociliary barrier. 2 However, recent evidence in people suggests that GER with microaspiration (MA) of small amounts of gastric juice plays an important role in the induction and exacerbation of respiratory diseases. Microaspiration occurs in several diseases including idiopathic pulmonary fibrosis (IPF), 3,4 asthma, 5-7 cystic fibrosis, 8 and chronic obstructive pulmonary disease (COPD). ...Vomiting Bright Yellow Bile Foods To Eat And Avoid (⭐️ Common Heartburn Triggers) | Vomiting Bright Yellow Bile GERD Diethow to Vomiting Bright Yellow Bile for ArticleVomiting Bright Yellow Bile Heartburn Relief (☑ Home Remedies For) | Vomiting Bright Yellow Bile GERDhow to Vomiting Bright Yellow Bile for Full-text available
Background Gastroesophageal reflux and microaspiration (MA) of gastric juice are associated with various human respiratory diseases but not in dogs. Objective To detect the presence of bile acids in bronchoalveolar lavage fluid (BALF) of dogs with various respiratory diseases. Animals Twenty‐seven West Highland White Terriers (WHWTs) with canine idiopathic pulmonary fibrosis (CIPF), 11 dogs with bacterial pneumonia (BP), 13 with chronic bronchitis (CB), 9 with eosinophilic bronchopneumopathy (EBP), 19 with laryngeal dysfunction (LD), 8 Irish Wolfhounds (IWHs) with previous BPs, 13 healthy WHWTs, all privately owned dogs, and 6 healthy research colony Beagles Methods Prospective cross‐sectional observational study with convenience sampling of dogs. Bile acids were measured by mass spectrometry in BALF samples. Total bile acid (TBA) concentration was calculated as a sum of 17 different bile acids. Results Concentrations of TBA were above the limit of quantification in 78% of CIPF, 45% of BP, 62% of CB, 44% of EBP, 68% of LD, and 13% of IWH dogs. In healthy dogs, bile acids were detected less commonly in Beagles (0/6) than in healthy WHWTs (10/13). Concentrations of TBA were significantly higher in CIPF (median 0.013 μM, range not quantifiable [n.q.]‐0.14 μM, P < .001), healthy WHWTs (0.0052 μM, n.q.‐1.2 μM, P = .003), LD (0.010 μM, n.q.‐2.3 μM, P = .015), and CB (0.0078 μM, n.q.‐0.073 μM, P = .018) groups compared to Beagles (0 μM, n.q.). Conclusion and Clinical Importance These results suggest that MA occurs in various respiratory diseases of dogs and also in healthy WHWTs.
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- J VET INTERN MED
- ... Twice daily proton pump inhibitor (PPI) for 2-3 months is the recommendation (20). Double dose of PPI for a prolonged time is necessary since symptoms may be caused by chronic inflammation that may need extended time for its resolution. ...ArticleFull-text available
The outcomes for antireflux surgery in patients with extraesophageal symptoms of gastro esophageal reflux disease (GERD) are usually worse compared with patients with esophageal symptoms. This paper focuses on how to obtain a successful laparoscopic antireflux surgery in patients with extraesophageal symptoms. A successful laparoscopic antireflux surgery in patients with extraesophageal symptoms depends on: (I) an objective diagnosis for GERD. The diagnosis of pathological distal reflux is straightforward; however, the diagnosis of proximal reflux and to the target organs may be hard to be established; (II) the attribution of the symptoms to GERD. Extraesophageal symptoms may have a different cause than GERD even in the presence of GERD. A rational and complete workup is necessary to answer this question. A single test is not able to correlate symptoms to GERD. Judicious clinical decision based on a sum of different pieces of information is needed; and (III) the correct selection of patients based on predictors for good outcomes to show those who would benefit from surgery. Adequate surgical technical principles should be followed.
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- ... Other mechanisms that participate in GERD are the esophageal clearance disorders, whether mechanic (peristalsis or Earth's gravity) or chemical (saliva), antireflux barrier alterations (hiatal hernia, reduced LES pressure), delayed gastric emptying, or duodenal-gastric reflux. 10 The extra-esophageal pathophysiologic manifestations are based on the direct acid damage to the pharyngeal mucosa and possible bronchial microaspiration episodes, as well as esophageal distension with a vagovagal reflex that produces bronchial spasm and associated symptomatology. ...ArticleFull-text for 1 last update 14 Jul 2020 availableFull-text available
- Oct 2016
Emerging concepts in the pathophysiology of gastroesophageal reflux disease (GERD) and the constant technologic advances in the diagnosis and treatment of this clinical condition make it necessary to frequently review and update the clinical guidelines, recommendations, and official statements from the leading academic groups worldwide. The Asociación Mexicana de Gastroenterología (AMG), aware of this responsibility, brought together national experts in this field to analyze the most recent scientific evidence and formulate a series of practical recommendations to guide and facilitate the diagnostic process and efficacious treatment of these patients. The document includes algorithms, figures, and tables for convenient consultation, along with opinions on GERD management in sensitive populations, such as pregnant women and older adults.
- Francisco Huerta-Iga
- María Victoria BielsaMaría Victoria Bielsa
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- ... Otros mecanismos que participan en la ERGE son los trastornos en el aclaramiento esofágico, sea mecánico (peristalsis o la gravedad de la Tierra) o químico (saliva), alteraciones en la barrera antirreflujo (hernia hiatal, presión disminuida del EEI), un vaciamiento gástrico retrasado e incluso el reflujo duodeno-gástrico 10 . ...ArticleFull-text the 1 last update 14 Jul 2020 availableFull-text available
Los nuevos conceptos en la fisiopatología de la enfermedad por reflujo gastroesofágico (ERGE) y los constantes avances tecnológicos aplicados al diagnóstico y el tratamiento de esta condición clínica hacen necesarias la revisión for 1 last update 14 Jul 2020 frecuente y la actualización de guías clínicas, recomendaciones y posturas oficiales de los principales organismos académicos a nivel mundial. La Asociación Mexicana de Gastroenterología, consciente de esta responsabilidad, reúne a los expertos nacionales de este tema para analizar la evidencia científica más reciente y construir una serie de recomendaciones prácticas para orientar y facilitar el proceso diagnóstico y el tratamiento eficaz de los pacientes afectados por esta enfermedad. Se incluyen algoritmos, diagramas de flujo, cuadros y tablas que concentran estas recomendaciones y se agregan opiniones sobre el manejo de la ERGE en poblaciones sensibles como las mujeres embarazadas y las personas de la tercera edad.Los nuevos conceptos en la fisiopatología de la enfermedad por reflujo gastroesofágico (ERGE) y los constantes avances tecnológicos aplicados al diagnóstico y el tratamiento de esta condición clínica hacen necesarias la revisión frecuente y la actualización de guías clínicas, recomendaciones y posturas oficiales de los principales organismos académicos a nivel mundial. La Asociación Mexicana de Gastroenterología, consciente de esta responsabilidad, reúne a los expertos nacionales de este tema para analizar la evidencia científica más reciente y construir una serie de recomendaciones prácticas para orientar y facilitar el proceso diagnóstico y el tratamiento eficaz de los pacientes afectados por esta enfermedad. Se incluyen algoritmos, diagramas de flujo, cuadros y tablas que concentran estas recomendaciones y se agregan opiniones sobre el manejo de la ERGE en poblaciones sensibles como las mujeres embarazadas y las personas de la tercera edad.
- Aug 2016
- for 1 last update 14 Jul 2020 ArticleArticle
The current study was undertaken to evaluate the effect of combined therapy of gabapentin and pantoprazole against forestomach and pylorus ligation–induced gastric esophageal reflux disease (GERD) in albino Wistar rats. Rats were randomly divided into five groups, each group consisting of six rats, fasted for 24 h, underwent forestomach and pylorus ligation, received normal saline (3 ml/kg, p.o.), normal control, toxic control, pantoprazole (30 mg/kg, p.o.), gabapentin (50 mg/kg, p.o.), or their combination. After 10 h, animals were killed by cervical dislocation and evaluated for pH of gastric content, volume of gastric juice, total acidity, and esophagitis index. Esophageal tissues were further analyzed for biochemical parameters such as superoxide dismutase, glutathione, catalase, thiobarbituric acid reactive substances, and protein carbonyl, and scanning electron microscopy (SEM) and histopathology were used for morphological evaluation. The results show the combination therapy of gabapentin and pantoprazole significantly inhibited the volume of gastric juice and total acidity esophagitis index and significantly increased the pH of gastric juice. Treatment with gabapentin and pantoprazole exhibited maximum antioxidant effect in comparison with monotherapy. Marked protection and restoration of normal morphology was observed through SEM and histopathology in the combination therapy as compared to monotherapy. Finally, it was concluded that combination therapy of pantoprazole and gabapentin has beneficial effect against GERD.
- Dec 2019
- HUM EXP TOXICOL
- ArticleFull-text available
Интерстициальный цистит, или болевой синдром мочевого пузыря, - хроническое воспалительное заболевание мочевого пузыря с неизвестной этиологией. Оно ухудшает качество жизни, вызывает депрессию, стресс, нарушение сексуальных функций. Несмотря на многочисленные исследования, этиология интерстициального цистита до сих пор неясна, и болезнь рассматривают как синдром раздражённого мочевого пузыря с мультифакториальным генезом. Согласно Национальному анкетированию по вопросам здоровья и питания США, у 470/100 000 человек (60/100 000 среди мужчин, 850/100 000 среди женщин) выявляют интерстициальный цистит. Диагностика болезни сложна и основывается в основном на клинических проявлениях. Боль в области малого таза, императивные позывы к мочеиспусканию, частое мочеиспускание и ноктурия - основные жалобы при этой патологии. Для установления диагноза необходимо исключение заболеваний, которые имеют схожую клиническую картину. Во многих случаях интерстициальный цистит не дифференцируют с такими видами патологии, как инфекция мочевыводящих путей, гиперактивный мочевой пузырь, обструкция или дивертикул уретры, хронический простатит, рак мочевого пузыря, вульводиния, эндометриоз и хроническая тазовая боль. Этиопатогенез заболевания до конца не изучен, что делает невозможным этиологическое лечение. В настоящее время не только продолжаются научные дискуссии по поводу причин развития заболевания, но и обсуждаются различные схемы его лечения, которое зачастую неэффективно, является паллиативным и носит временный характер. Лечение интерстициального цистита должно быть направлено на восстановление нормальной функции мочевого пузыря, предотвращение рецидива симптомов заболевания и улучшение качества жизни больных. В литературном обзоре показаны современные представления, касающиеся вопросов терминологии, эпидемиологии, диагностики и лечения интерстициального цистита.
- Feb 2018
- ArticleFull-text the 1 last update 14 Jul 2020 availableFull-text available
An 84-year-old man who had been administered anticoagulants after a previous transient ischemic attack associated with non-valvular atrial fibrillation (NVAF) was referred to our hospital with epigastric pain, dysphagia, and hoarseness. These complaints appeared after changing the anticoagulant regimen from warfarin to dabigatran. Upper gastrointestinal endoscopy revealed esophageal mucosal injuries with the pathological finding of erosion. His symptoms improved within a day of switching anticoagulation medication from dabigatran to apixaban without a proton pump inhibitor. Three months after the switch to apixaban, a second upper gastrointestinal endoscopy showed clear improvement of the esophageal mucosal injuries. These findings allowed us to diagnose “dabigatran-induced esophagitis”. A small number of case reports have described dabigatran-induced esophagitis, but none have provided the details of subsequent anticoagulation therapy with another non-vitamin K antagonist oral anticoagulant. We thus demonstrate that switching medication from dabigatran to apixaban may offer an effective choice with minimum risk of embolism for NVAF patients who cannot take dabigatran because of digestive symptoms.
- Nov 2016
- the 1 last update 14 Jul 2020 ArticleArticle
Background & Aims: There is growing evidence that gastroesophageal reflux disease (GERD) may cause typical pharyngeal/laryngeal findings secondary to tissue irritation. The prevalence of those findings in GERD patients, is not well established. The aim of this study was to evaluate the prevalence of GERD signs in the laryngopharyngeal area during routine upper gastrointestinal endoscopy. Methods: Between July 2000 and July 2001, 1209 patients underwent 1311 upper gastrointestinal endoscopies and were enrolled in this study. These patients underwent a careful structured examination of the laryngopharyngeal area during upper gastrointestinal endoscopy, which was videotaped for later blinded review. All videotapes were reviewed by three gastroenterologists and one otorhinolaryngologist, who were blinded to the gastroesophageal endoscopic findings. Of these 1209 patients, two groups were formed. Group I (n=132) included patients with typical endoscopical esophageal findings of GERD (Savary 1–4). The sex- and age-matched control group II (n=132) underwent upper gastrointestinal endoscopy for different reasons, had no reflux symptoms, and revealed no endoscopic pathologies. Results: 1079 videos of upper gastrointestinal endoscopy could be fully evaluated. Laryngopharyngeal signs of GERD like interarytenoid bar, arytenoid medial wall erythema, posterior pharyngeal wall cobblestoning, or posterior cricoid wall edema were similar in both groups (44% vs. 37%) and showed no statistical difference. The only laryngopharyngeal sign, which showed a tendency to be more common in GERD patients was posterior pharyngeal wall cobblestoning (72% vs. 65%, p=0.06). Conclusion: This study is the first large systematic investigation of GERD patients for the presence and prevalence of laryngopharyngeal findings attributed to gastroesophageal reflux. Our results challenge the published diagnostic specificity of typical GERD signs in the laryngopharyngeal region.
- May 2005
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- Peter G Gibson
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- Eugene Walters
Background: Gastroesophageal reflux is common among patients with asthma but often causes mild or no symptoms. It is not known whether treatment of gastroesophageal reflux with proton-pump inhibitors in patients who have poorly controlled asthma without symptoms of gastroesophageal reflux can substantially improve asthma control. Methods: In a parallel-group, double-blind trial, we randomly assigned 412 participants with inadequately controlled asthma, despite treatment with inhaled corticosteroids, and with minimal or no symptoms of gastroesophageal reflux to receive either 40 mg of esomeprazole twice a day or matching placebo. Participants were followed for 24 weeks with the use of daily asthma diaries, spirometry performed once every 4 weeks, and questionnaires that asked about asthma symptoms. We used ambulatory pH monitoring to ascertain the presence or absence of gastroesophageal reflux in the participants. The primary outcome was the rate of episodes of poor asthma control, as assessed on the basis of entries in asthma diaries. Results: Episodes of poor asthma control occurred with similar frequency in the placebo and esomeprazole groups (2.3 and 2.5 events per person-year, respectively; P=0.66). There was no treatment effect with respect to individual components of the episodes of poor asthma control or with respect to secondary outcomes, including pulmonary function, airway reactivity, asthma control, symptom scores, nocturnal awakening, or quality of life. The presence of gastroesophageal reflux, which was documented by pH monitoring in 40% of participants with minimal or no symptoms, did not identify a subgroup of patients that benefited from treatment with proton-pump inhibitors. There were fewer serious adverse events among patients receiving esomeprazole than among those receiving placebo (11 vs. 17). Conclusions: Despite a high prevalence of asymptomatic gastroesophageal reflux among patients with poorly controlled asthma, treatment with proton-pump inhibitors does not improve asthma control. Asymptomatic gastroesophageal reflux is not a likely cause of poorly controlled asthma. (ClinicalTrials.gov number, NCT00069823.) N Engl J Med 2009;360:1487-99.
- Apr 2009
- NEW ENGL J MED
Highlights of the National Asthma Education and Prevention Program's Expert Panel Report 3 (EPR-3): Guidelines for the Diagnosis and Management of Asthma-Full Report 2007 are presented in this EPR-3 summary report. The updated guidelines emphasize the importance of asthma control. Asthma control is the degree to which the manifestations of asthma are minimized by therapeutic intervention and the goals of therapy are met. Because asthma is highly variable, the level of control must be monitored on a periodic basis to determine whether therapy should be maintained or adjusted (stepped up if necessary, stepped down if possible). On the other hand, asthma severity is the intrinsic intensity of the disease process, most easily and directly measured in a patient not receiving long-term control therapy. For managing asthma, the recommendation is to assess severity to initiate therapy and assess control to adjust therapy. Recommendations for managing asthma include an expanded section on childhood asthma with addition of an age group 5 to 11 years old (earlier guidelines combined this group with adults). The guidelines provide new recommendations on patient education in settings beyond the physician's office, and new advice for controlling environmental factors that can cause asthma symptoms. The concepts of current impairment (frequency and intensity of symptoms, low lung function, and limitations of daily activities) and future risk (likelihood of exacerbations, progressive loss of lung function, or adverse side effects from medications) support a new approach to assessing and monitoring the patient's level of asthma control through use of multiple measures. The guidelines stress that some patients can still be at high risk for frequent exacerbations even if they have few day-to-day effects of asthma.Moreover, EPR-3 confirms the importance of teaching patients skills to self-monitor and manage asthma and to use a written asthma action plan, which should include instructions for daily treatment and ways to recognize and handle worsening asthma. New recommendations encourage expanding educational opportunities to reach patients in a variety of settings, such as pharmacies, schools, community centers, and patients' homes. A new section addresses the need for clinician education programs to improve communication with patients and to use system-wide approaches to integrate the guidelines into health care practice. The guidelines describe new evidence for using multiple approaches to limit exposure to allergens and other substances that can worsen asthma; research shows that single steps are rarely sufficient. EPR-3 also expands the section on common conditions that can affect asthma and notes that management of these conditions may help to improve asthma control. Expert Panel Report 3 continues the use of a stepwise approach to control asthma. When assessing the level of asthma control to determine the need for adjusting therapy, EPR-3 reconfirms the importance of assessing patient adherence to medication, inhaler technique, and environmental control measures before making a step up in therapy. The stepwise approach expands from 4 steps to 6 steps of care. Medications have been repositioned within these 6 steps. Recommendations on medications are updated to reflect the latest evidence on effectiveness and safety. EPR-3 reaffirms that patients with persistent asthma need both long-term control medications to control asthma and prevent exacerbations and quick-relief medication for symptoms, as needed. EPR-3 also reaffirms that inhaled corticosteroids are the most effective long-term control medication across all age groups. New recommendations on treatment options such as leukotriene receptor antagonists and cromolyn for long-term control; long-acting beta-agonists as adjunct therapy with inhaled corticosteroids; omalizumab for severe asthma; and albuterol, levalbuterol, and corticosteroids for acute exacerbations are included.
- Nov for 1 last update 14 Jul 2020 2007Nov 2007
- J ALLERGY CLIN IMMUN
Study objectives: To investigate the prevalence of gastroesophageal reflux (GER) among patients with asthma and to determine the effect of omeprazole on the outcome of asthma in patients with GER. Design: A double-blind, placebo-controlled crossover study. Setting: Asthmatic patients who attended the pulmonary outpatient clinic of Turku University Central Hospital, Finland. Patients: One hundred seven asthmatic patients. Interventions: The patients who were found to have GER in ambulatory esophageal pH monitoring were randomized to receive either omeprazole, 40 mg qd, or placebo for 8 weeks. After a 2-week washout period, the patients were crossed over to the other treatment. Spirometry was performed at baseline and immediately after both treatment periods. Peak expiratory values, use of sympathomimetics, and pulmonary and gastric symptoms were recorded daily in a diary. Results: Pathologic GER was found in 53% of the asthmatic patients. One third of these patients had no typical reflux symptoms. Daytime pulmonary symptoms did not improve significantly (p = 0.14), but a reduction in nighttime asthma symptoms (p = 0.04) was found during omeprazole treatment. In the patients with intrinsic asthma, there was an improvement in FEV1 values (p = 0.049). Based on symptom scores, 35% of the patients were regarded as responders to 8-week omeprazole treatment. The reflux (time [percent] of pH < 4) was found to be more severe (p = 0.002) in the responders. Conclusions: There is a high prevalence of GER in the asthmatic population. This reflux is often clinically “silent.” After an 8-week omeprazole treatment, there was a reduction in nocturnal asthma symptoms, whereas daytime asthma outcome did not improve. There seems to be a subgroup of asthma patients who benefit from excessive antireflux therapy. An interesting study was made by Ekström and Tibbling.³⁴ They studied 37 patients with nocturnal asthma and found significantly lower morning PEF values in those patients who had pathologic nocturnal GER compared to patients with no GER at night, suggesting a relationship between GER and nocturnal asthma. Similarly to our study, some previously published placebo-controlled studies with H2 blockers have been able to show an amelioration in nighttime asthma symptoms.¹²,16–¹⁷ Conversely, Ford et al²² were not able to show a significant improvement in patients with nocturnal asthma and GER after omeprazole treatment. There may be several explanations for this: they studied only 11 patients, the length of treatment was only 4 weeks, and the dose of omeprazole was perhaps not sufficient (20 mg). A retrospective study of a surgical treatment of GER in asthmatic patients also showed a marked relief in asthma symptoms in patients with intrinsic asthma having a predominance of nocturnal symptoms.³⁵ There is evidence that especially asthmatic patients with excessive proximal esophageal reflux might benefit from antireflux therapy,¹⁵,36although contradictory reports have been published.³⁷
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Study objective: To evaluate experience using a therapeutic trial of proton-pump inhibitor therapy with or without a prokinetic agent in diagnosis and treatment of gastroesophageal reflux disease (GERD)-related cough. Design: A review of experience with 214 patients with cough of > 3 weeks referred over 3.5 years. An anatomic diagnostic protocol was used to identify and treat those with GERD-related cough. Setting: A pulmonary specialty practice affiliated with the University of Rochester School of Medicine and Dentistry. Patients: One hundred eighty-three patients were identified with chronic cough and were included in the study. Thirty-one patients were disqualified because of abnormal chest radiographic findings, inadequate follow-up, or cough being not the primary complaint. Fifty-six patients were identified as having GERD-related cough. Interventions: A once-daily dose of a proton-pump inhibitor was prescribed. A prokinetic agent was added if esophageal dysfunction was suspected or response was inadequate. Those who did not respond underwent 24-h esophageal pH monitoring. Results: GERD was the single cause of cough in 24 patients (43%). Twenty-nine patients (52%) had GERD plus another cause, and 3 patients (5%) had GERD with more than two causes. Twenty-four patients (43%) had cough only, while 32 patients (57%) had other symptoms of GERD. Proton-pump therapy was successful in 42 patients (79%). Twenty-four patients responded to proton-pump inhibitor therapy, and 18 patients responded when metoclopramide or cisapride was added. The remaining two patients responded to a histamine type-2 blocker or cisapride alone. The cough was eliminated or markedly improved in 38 patients (86%) after 4 weeks and by 8 weeks in the remaining 6 patients. Six of the nonresponders had aspiration diagnosed by bronchoscopy. Four patients had fundoplication recommended, and two patients responded to alternative interventions. Conclusions: Four to 6 weeks of a proton-pump inhibitor alone or in combination with a prokinetic agent successfully diagnoses and treats four of five patients with GERD-related cough. Twenty-four– hour esophageal pH monitoring will confirm the diagnosis in the others. These patients may be candidates for fundoplication. Nonresponders often aspirate as an additional aggravating factor. (CHEST 2003; 123:679–684)
- Mar 2003
- ArticleFull-text available
- Dec 2010
Despite the wealth of publications on the topic of gastroesophageal reflux and its variants, there are still many unsettled questions before one accepts the prevalent cult of ''reflux disease''. This study is summarizing the results of the critical analysis of the literature, 436 articles , during the last 30 years. The golden test to identify the patient group suffering from this rather common phenomenon is still lacking. The claimed extra-esopha-geal manifestations especially in the larynx are non-specific and may be caused by other factors well-known within the domain of vocology. The response to therapeutic intervention still lacks serious well-controlled studies to allow drawing reasonable conclusions. An outstanding feature of the publications is that most of them fall in the category of ''review''. It seems that there is a tendency to perpetuate the concept without objective criticism. Following the analysis, a recommendation for a new plan of original well-controlled multi-center studies is highlighted.
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- Aly M N El-MakhzangyAly M N El-Makhzangy
- Peter Milad
- ArticleFull-text available
- Oct 2012
Gastroesophageal reflux induced cough is a common cause of chronic cough, and proton pump inhibitors are a standard therapy. However, the patients unresponsive to the standard therapy are difficult to treat and remain a challenge to doctors. Here, we summarized the experience of successful resolution of refractory chronic cough due to gastroesophageal reflux with baclofen in three patients. It is concluded that baclofen may be a viable option for gastroesophageal reflux induced cough unresponsive to proton pump inhibitor therapy.
- Xianghuai Xu
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- Han-Jing Lv
- Si-Wei Liang
- ArticleFull-text available
Background Gastroesophageal reflux disease (GERD) is a common cause of chronic cough. Both acid and nonacid reflux is thought to play a role in the initiation of coughing and cough hypersensitivity. The GABAB receptor agonist lesogaberan was developed as a peripherally restricted anti-reflux therapy that reduces the frequency of transient lower esophageal sphincter relaxations (TLESR; the major cause of reflux) in animals and in patients with GERD. GABAB receptor agonists have also been shown to possess antitussive effects in patients and in animals independent of their effects on TLESR, suggesting that lesogaberan may be a promising treatment for chronic cough. Methods We have assessed the direct antitussive effects of lesogaberan (AZD3355). The effects of other GABAB receptor agonists were also determined. Coughing was evoked in awake guinea pigs using aerosol challenges with citric acid. Results Lesogaberan dose-dependently inhibited citric acid evoked coughing in guinea pigs. Comparable effects of the GABAB receptor agonists baclofen and 3-aminopropylphosphinic acid (3-APPiA) on cough were also observed. Baclofen produced obvious signs of sedation and respiratory depression. By contrast, both lesogaberan and 3-APPiA (both inactivated centrally by GABA transporters) were devoid of sedative effects and did not alter respiratory rate. Conclusions Together, the data suggest that lesogaberan and related GABAB receptor agonists may hold promise as safe and effective antitussive agents largely devoid of CNS side effects.
- Oct 2012
- Apr 2013
OBJECTIVES/HYPOTHESIS: Oropharyngeal (OP) pH monitoring has been developed to detect supra-esophageal gastric reflux (SEGR). The results obtained with OP pH-metry and multichannel intraluminal impedance/pH monitoring (MII/pH) were compared. STUDY DESIGN: Diagnostic study. METHODS: Ten patients (age 46.33 ± 9.86 years) presenting with chronic coughing underwent simultaneous OP and MII/pH recording. A 2-minute interval was allowed between events detected with both techniques to be considered simultaneous. RESULTS: A total of 515 reflux episodes were recorded with MII/pH (acid: 181; weakly acid: 310; weakly alkaline: 24); 180 (35%) reached the highest impedance channel (hypo-pharynx); 74/180 (41%) were not related to a change in pH, according to the antimony electrode of the MII/pH catheter located at the upper esophageal sphincter. The OP monitoring measured 39 acid events; 17 (43.6%) were swallows according to MII, and 15 (38.5%) were not associated with MII or pH change. Only seven episodes were detected simultaneously with both techniques (1.3% for MII vs. 18% for OP; P = 0.0002). We found 49 pH-only refluxes at the pH sensor in the hypo-pharynx with MII/pH; only three (6.1%) correlated with OP reflux. Correlation in time between cough and reflux events was positive in 5/10 patients for MII (symptom index 5/10, symptom association probability 4/10), but in 0/10 patients according to OP pH metry. CONCLUSION: OP pH metry detected less reflux episodes than MII/pH; 35% of the OP events were swallows according for 1 last update 14 Jul 2020 to impedance. Time correlation between cough and reflux could not be demonstrated with OP pH metry.OBJECTIVES/HYPOTHESIS: Oropharyngeal (OP) pH monitoring has been developed to detect supra-esophageal gastric reflux (SEGR). The results obtained with OP pH-metry and multichannel intraluminal impedance/pH monitoring (MII/pH) were compared. STUDY DESIGN: Diagnostic study. METHODS: Ten patients (age 46.33 ± 9.86 years) presenting with chronic coughing underwent simultaneous OP and MII/pH recording. A 2-minute interval was allowed between events detected with both techniques to be considered simultaneous. RESULTS: A total of 515 reflux episodes were recorded with MII/pH (acid: 181; weakly acid: 310; weakly alkaline: 24); 180 (35%) reached the highest impedance channel (hypo-pharynx); 74/180 (41%) were not related to a change in pH, according to the antimony electrode of the MII/pH catheter located at the upper esophageal sphincter. The OP monitoring measured 39 acid events; 17 (43.6%) were swallows according to MII, and 15 (38.5%) were not associated with MII or pH change. Only seven episodes were detected simultaneously with both techniques (1.3% for MII vs. 18% for OP; P = 0.0002). We found 49 pH-only refluxes at the pH sensor in the hypo-pharynx with MII/pH; only three (6.1%) correlated with OP reflux. Correlation in time between cough and reflux events was positive in 5/10 patients for MII (symptom index 5/10, symptom association probability 4/10), but in 0/10 patients according to OP pH metry. CONCLUSION: OP pH metry detected less reflux episodes than MII/pH; 35% of the OP events were swallows according to impedance. Time correlation between cough and reflux could not be demonstrated with OP pH metry.
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- Liv Vandermeulen
- Bart Roosens
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