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Query: UMLS:C0010200 (cough)
 23,843 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The incidence of aspiration, the causative esophageal pathophysiology, and the results of surgical therapy were evaluated in 100 patients with abnormal gastroesophageal reflux documented by 24-hour esophageal pH monitoring. Based on historical evidence, 48 patients were suspected to be aspirators. Eight patients had documented episodes of aspiration (drop on esophagela pH, followed by acid taste in mouth and onset of cough or wheezing spell) during the monitoring period. Nine patients were considered to be potential aspirators because they presented oral acid regurgitation without development of pulmonary symptoms. In five patients a primary respiratory disorder (PRD) induced gastroesophageal reflux. The remaining 78 patients had abnormal reflux without aspiartion or regurgitation. Aspirators had a 75% incidence of esophageal motor abnormality on manometry, and the clearance of refluxed acid was significantly delayed in the supine position. A history of heartburn and endoscopic evidence of esophagitis were present in only half of the patients who were documented aspirators. Potential aspirators were spared from aspiration by rapid esophageal clearance of refluxed acid unaffected by changes in body position. Patients with a PRD had higher distal esophageal segment (DES) pressure and normal esophageal motility with minimal esophagitis. Nonaspirators significantly improved their clearance while in the supine position, emphasizing the protective effect of esophageal peristalsis against aspiration. An antireflux procedure in five aspirators raised the DES pressure significantly and returned the reflux status to normal by 24-hour pH-monitoring standards. The incidence of aspiration appears to be less than that suspected by history and is due to a motor disorder that interferes with the ability of the esophagus to clear reflex acid. Abnormal pulmonary symptoms can induce or result from gastroesophageal reflux and, when the latter occurs, an antireflex procedure stops both reflux and aspiration.
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PMID:Gastroesophageal reflux and pulmonary aspiration: incidence, functional abnormality, and results of surgical therapy. 3 77

In 196 cases of gastro-oesophageal reflux, simple or connected to a hiatal hernia or to a cardio-tuberous misplacement, the respiratory signs that are found in 1 patient out of 4, are analyzed. The nocturnal fits of coughing (39 cases, 20% of the reflux) is the most frequent sign of laryngo-tracheal aspiration of stomach content. This symptom of great diagnostic value, though neglected, should be looked for systematically. Other troubles are less frequent: bouts of recurring broncho-pulmonary infections, asthma attack, Mendelson's syndrome, pulmonary fibrosis. In absence of a patent cause, the symptoms should lead to suspect a reflux of stomach content in the airways. Similarly to oesophagitis, respiratory signs represent a complication sometimes serious, of gastro-oesophageal reflux, needing more frequently a surgical treatment of hiatal herniae or of the cardiac inefficiency.
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PMID:[Broncho-pulmonary manifestations and gastroesophageal reflux]. 61 79

Gastroesophageal reflux (GER) has been known to occur in infants but was thought to be normal. As a result of increased recognition of GER and a clear documentation of GER with extended (18 to 24 hour) esophageal pH monitoring, several severe complications of GER in children have become apparent. An immature cardiorespiratory system is susceptible to some complications of GER such as apnea, choking, recurrent cough or wheezing, and recurrent aspiration pneumonia. Noncardiorespiratory complications include weight loss, esophagitis, anemia, irritability, posturing, malnutrition, and developmental delays. Nursing assessment contributes to a complete clinical picture and the subsequent treatment choice of the physician. To form an accurate assessment of the child with suspected GER, the nurse must be aware of the symptoms and complications of this condition and must precisely execute diagnostic studies, particularly extended esophageal pH monitoring. Nursing responsibilities also include providing a safe yet stimulating environment for the child, teaching parents to participate in the child's care, supporting parents through hospitalization, and preparing both the parents and child for discharge and follow-up care at home.
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PMID:Nursing responsibility in the diagnosis, care, and treatment of the child with gastroesophageal reflux. 176 48

Occult (silent) gastroesophageal reflux disease (GER, GERD) is believed to be an important etiologic factor in the development of many inflammatory and neoplastic disorders of the upper aerodigestive tract. In order ot test this hypothesis, a human study and an animal study were performed. The human study consisted primarily of applying a new diagnostic technique (double-probe pH monitoring) to a population of otolaryngology patients with GERD to determine the incidence of overt and occult GERD. The animal study consisted of experiments to evaluate the potential damaging effects of intermittent GER on the larynx. Two hundred twenty-five consecutive patients with otolaryngologic disorders having suspected GERD evaluated from 1985 through 1988 are reported. Ambulatory 24-hour intraesophageal pH monitoring was performed in 197; of those, 81% underwent double-probe pH monitoring, with the second pH probe being placed in the hypopharynx at the laryngeal inlet. Seventy percent of the patients also underwent barium esophagography with videofluoroscopy. The patient population was divided into seven diagnostic subgroups: carcinoma of the larynx (n = 31), laryngeal and tracheal stenosis (n = 33), reflux laryngitis (n = 61), globus pharyngeus (n = 27), dysphagia (n = 25), chronic cough (n = 30), and a group with miscellaneous disorders (n = 18). The most common symptoms were hoarseness (71%), cough (51%), globus (47%), and throat clearing (42%). Only 43% of the patients had gastrointestinal symptoms (heartburn or acid regurgitation). Thus, by traditional symptomatology, GER was occult or silent in the majority of the study population. Twenty-eight patients (12%) refused or could not tolerate pH monitoring. Of the patients undergoing diagnostic pH monitoring, 62% had abnormal esophageal pH studies, and 30% demonstrated reflux into the pharynx. The results of diagnostic pH monitoring for each of the subgroups were as follows (percentage with abnormal studies): carcinoma (71%), stenosis (78%), reflux laryngitis (60%), globus (58%), dysphagia (45%), chronic cough (52%), and miscellaneous (13%). The highest yield of abnormal pharyngeal reflux was in the carcinoma group and the stenosis group (58% and 56%, respectively). By comparison, the diagnostic barium esophagogram with videofluoroscopy was frequently negative. The results were as follows: esophagitis (18%), reflux (9%), esophageal dysmotility (12%), and stricture (3%). All of the study patients were treated with antireflux therapy. Follow-up was available on 68% of the patients and the mean follow-up period was 11.6 +/- 12.7 months.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:The otolaryngologic manifestations of gastroesophageal reflux disease (GERD): a clinical investigation of 225 patients using ambulatory 24-hour pH monitoring and an experimental investigation of the role of acid and pepsin in the development of laryngeal injury. 189 64

Gastroesophageal reflux (GER) has been known to occur in infants but was thought to be normal. As a result of increased recognition of GER and a clear documentation of GER with extended (18 to 24 hour) esophageal pH monitoring, several severe complications of GER in children have become apparent. An immature cardiorespiratory system is susceptible to some complications of GER such as apnea, choking, recurrent cough or wheezing, and recurrent aspiration pneumonia. Noncardiorespiratory complications include weight loss, esophagitis, anemia, irritability, posturing, malnutrition, and developmental delays. Nursing assessment contributes to a complete clinical picture and the subsequent treatment choice of the physician. To form an accurate assessment of the child with suspected GER, the nurse must be aware of the symptoms and complications of this condition and must precisely execute diagnostic studies, particularly extended esophageal pH monitoring. Nursing responsibilities also include providing a safe yet stimulating environment for the child, teaching parents to participate in the child's care, supporting parents through hospitalization, and preparing both the parents and child for discharge and follow-up care at home.
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PMID:Nursing responsibility in the diagnosis, care, and treatment of the child with gastroesophageal reflux. 154 68

Fiberoptic laryngoscopic examinations were performed on 40 patients with gastroesophageal reflux disease, 25 of whom had persistent laryngeal symptoms (dysphonia, cough, globus sensation, frequent throat clearing, or sore throat) and 15 without laryngeal symptoms who served as disease controls. Ten patients with laryngeal symptoms but none of the controls had laryngoscopic findings consistent with reflux laryngitis. Dual-site ambulatory pH recordings were obtained with the pH electrodes spaced 15 cm apart and with the proximal sensor positioned just distal to the upper esophageal sphincter. Patients in the three groups (disease controls: group 1; patients with symptoms but without laryngoscopic findings: group 2; and patients with both laryngeal symptoms and findings: group 3) were comparable in terms of age, smoking habit, the presence of esophagitis, and distal esophageal acid exposure. Proximal esophageal acid exposure was, however, significantly increased in groups 2 and 3, and nocturnal proximal esophageal acidification occurred in over half of these patients but in none of the group 1 patients. We conclude that the subset of reflux patients who experience laryngeal symptoms show significantly more proximal esophageal acid exposure (especially nocturnally) and often have laryngoscopic findings of posterior laryngitis not observed in control reflux patients.
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PMID:Proximal esophageal pH-metry in patients with 'reflux laryngitis'. 198 28

Gastroesophageal reflux disease is a common problem that frequently presents with atypical complaints including nausea, hiccups, globus sensation, chest pain, hoarseness, coughing, or various pulmonary complaints. Diagnosis may be difficult, as these patients often do not have radiographic or endoscopic evidence of esophagitis. In these difficult cases, prolonged esophageal pH monitoring provides an accurate method of quantitating acid reflux parameters and correlating symptoms with reflux episodes in an outpatient setting. Current equipment is compact, durable, and not difficult to use or extremely expensive. Data analysis, with a particular emphasis on acid-exposure time (total, upright, supine), reliably discriminates between abnormal and normal subjects but it is not a perfect "gold standard" for gastroesophageal reflux disease. Indications for esophageal pH monitoring include: (1) atypical symptoms of acid reflux with normal endoscopy, (2) typical reflux symptoms unresponsive to medical therapy, and (3) the follow-up of reflux disease after either medical or surgical therapy. This test is currently performed primarily by gastroenterologists, but we believe many other groups may find this technology helpful. To meet these expanding applications, test refinements are necessary, particularly easier methods of placing the pH probe and better standards for defining abnormal pH parameters in older patients. The future for esophageal pH monitoring is bright. This technology has the potential to do for the diagnosis of gastroesophageal reflux disease what endoscopy has done for the diagnosis of peptic ulcer disease.
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PMID:Prolonged ambulatory esophageal pH monitoring in the evaluation of gastroesophageal reflux disease. 220 64

Studies were done to evaluate the lower oesophageal sphincter function of chronic smokers compared with non-smokers and to ascertain the acute effects of smoking on the sphincter and the occurrence of acid reflux. All subjects (non-smokers, asymptomatic cigarette smokers, and smokers with oesophagitis) were studied postprandially with a lower oesophageal sphincter sleeve assembly, distal oesophageal pH electrode, and submental electromyographic electrodes. The two groups of cigarette smokers then smoked three cigarettes in succession before being recorded for an additional hour. As a group, the cigarette smokers had significantly lower lower oesophageal sphincter pressure compared with non-smokers but the sphincter was not further compromised by acutely smoking cigarettes. Cigarette smoking did, however, acutely increase the rate at which acid reflux events occurred. The mechanisms of acid reflux during cigarette smoking were mainly dependent upon the coexistence of diminished lower oesophageal sphincter pressure. Fewer than half of reflux events occurred by transient lower oesophageal sphincter relaxations. The majority of acid reflux occurred with coughing or deep inspiration during which abrupt increases in intra-abdominal pressure overpowered a feeble sphincter. We conclude that cigarette smoking probably exacerbates reflux disease by directly provoking acid reflux and perhaps by a long lasting reduction of lower oesophageal sphincter pressure.
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PMID:Mechanisms of acid reflux associated with cigarette smoking. 231 31

Gastroesophageal reflux is frequently viewed as a "nuisance" problem that affects a large number of individuals with variable frequency. When physicians conceptualize the complications of gastrointestinal reflux, they generally consider them a localized esophageal problem resulting in irritation of the esophagus, bleeding esophagitis, occasional stricture formation, and the development of Barrett's esophagus. However, attention has again been focused on the potential relationship between gastroesophageal reflux and pulmonary diseases (cough, asthma, recurrent pneumonia), chest pain, and hypopharyngeal or oral disease. This paper reviews our current understanding of the extraesophageal manifestations of gastroesophageal reflux.
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PMID:Extraesophageal manifestations of gastroesophageal reflux disease. 272 48

Nocturnal gastro-oesophageal reflux is known to be particularly damaging to the oesophageal mucosa, being associated with stricture formation and columnarisation. At present, this can only be detected by prolonged intra-oesophageal pH monitoring. A total of 50 patients with endoscopic oesophagitis were evaluated by ambulatory pH monitoring to detect the presence of nocturnal reflux. Whether certain symptoms in the presence of a hiatal hernia would identify those patients with reflux at night was investigated. Thirty-three patients had nocturnal reflux, two-thirds of whom had a hiatal hernia. Heartburn at night was of limited value (specificity = 65%) in detecting acid reflux whereas regurgitation and cough showed greater specificity (88% and 100% respectively) but lacked sensitivity (45% and 12% respectively). The combination of nocturnal symptoms and a hiatal hernia in patients with endoscopic oesophagitis correctly identified 58% of patients with nocturnal reflux and was highly specific (100%). This study has confirmed that symptoms and endoscopic findings can detect a significant proportion of 'at risk' patients, but the remainder will require pH monitoring to assess their pattern of acid exposure.
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PMID:Symptoms and endoscopic findings--can they predict abnormal nocturnal acid gastro-oesophageal reflux? 265 Jun 3


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