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

Gastroesophageal reflux disease (GERD) contributes to the development of many otolaryngologic symptoms and conditions, including chronic throat clearing, cough, sore throat, contact ulcer and granuloma, globus pharyngeus, cervical dysphagia, cancer of the larynx, subglottic stenosis, and cricoarytenoid arthritis. These conditions are discussed and the pathogenesis of GERD is also detailed.
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PMID:Laryngopharyngeal manifestations of gastroesophageal reflux disease. 175 20

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

The purpose of this study was to analyse the effects on gastro-oesophageal reflux (GOR) of the different manipulations used during pulmonary physical therapy (nasal suctions, oropharyngeal suctions, acceleration of expiratory flow). 115 children less than 1 year old, were divided into two groups according to the results of oesophageal pH monitoring: 44 with and 61 without pathological GOR. Nasal suctions did not significantly increase GOR in children without pathological GOR. Oropharyngeal suctions increased GOR significantly more than nasal suctions (*p = 0.031). The technique of acceleration of expiratory flow, used in 35 degrees verticalized position and supine position, increased the index of reflux and the time with oesophageal pH below 4 in children with pathological GOR. However it did not increase reflux in normal children. The index of induced reflux in the whole population was increased in the horizontal position (4.81 +/- 0.88 reflux/hour) as compared with 35 degrees verticalized (2.92 +/- 0.79 reflux/hour). These oesophageal pH measurements confirm the clinical observations often made during physical therapy (vomiting, regurgitations, reflex cough). This statistical study suggests that one should take into account the adverse factor of GOR secondary to pulmonary physical therapy. It seems better to use nasal rather than oropharyngeal suctions and also to use the acceleration of expiratory flow technique in the 35 degrees verticalized rather than in the supine position, even more so if a pathological reflux does exist.
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PMID:[Effects of respiratory physical therapy and nasopharyngeal suction on gastroesophageal reflux in infants less than a year of age, with or without abnormal reflux]. 176 30

Chronic cough persisting for two months or more that remains unexplained after extensive investigations is a common clinical problem. The purpose of this study was to determine whether such cough is associated with otherwise asymptomatic gastro-oesophageal reflux. Thirteen patients with chronic persistent cough that was unexplained after a standard diagnostic assessment were identified. All were non-smokers. The mean (SE) duration of cough was 17.8 (8.0) months. Ten had never had reflux symptoms and three had had mild symptoms only after the onset of the cough. All the patients completed standardised cough diary cards for eight weeks and underwent 24 hour ambulatory oesophageal pH monitoring. A reflux episode was defined as a fall in oesophageal pH to below 4.0. Nine control subjects were matched for age, lung function, and body mass index. The patients experienced significantly more episodes of reflux per 24 hours than the controls (115.8 (SE 31.7) versus 4.7 (1.4) and longer reflux episodes (15.5 (5.8) versus 1.7 (0.5) minutes), and the oesophageal pH was below 4.0 considerably longer (84.5 (20.2) versus 3.8 (1.3) minutes). Cough occurred simultaneously with 13% (2.2%) of reflux episodes and within five minutes in another 35% (5.8%) of episodes, whereas gastro-oesophageal reflux occurred simultaneously with 78% (5.5%) of cough episodes and within five minutes in another 12% (2.3%) of episodes. It is concluded that chronic persistent cough that remains unexplained after a standard diagnostic assessment is associated with otherwise asymptomatic gastro-oesophageal reflux. It is suggested that a self perpetuating mechanism may exist whereby acid reflux causes cough via a local neuronal oesophageal-tracheo-bronchial reflex, and the cough in turn amplifies reflux via increased transdiaphragmatic pressure or by inducing transient lower oesophageal sphincter relaxation. Further study of this mechanism and the role of specific antireflux treatment in chronic persistent cough is warranted.
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PMID:Chronic persistent cough and gastro-oesophageal reflux. 187 35

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

A questionnaire study was conducted to assess the prevalence and severity of symptoms suggestive of esophageal disorders in a general population. The study included 407 randomly selected subjects, evenly distributed in terms of sex and age, within the age span of 20-79 years. A total of 337 subjects replied (85%). Symptoms suggestive of gastroesophageal reflux were found among 25% of the participants. Cough on swallowing was common (27%), as was globus (16%) and chest pain (13%). In addition, dysphagia was reported by 10% and vomiting by 9%. The symptoms were usually mild, and moderate to severe symptoms were reported only occasionally (1-4%). No statistical correlation was found between esophageal symptoms and age, sex, or the reported consumption of tobacco, alcohol, or non-steroidal anti-inflammatory drugs. The frequency of heartburn and/or acid regurgitation was twice as common among those with symptoms of respiratory disease as among those with no respiratory complaints. A stepwise logistic regression analysis showed that a chronic cough and/or breathing difficulties were significantly related to the presence of symptoms suggestive of gastroesophageal reflux.
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PMID:The prevalence of symptoms suggestive of esophageal disorders. 200 1

Cough is a symptom frequently encountered by the otolaryngologist--head and neck surgeon. Although most coughs are self limited, chronic cough often proves to be a frustrating problem. Seventy-two infants and children under age 16 with a normal chest radiogram have now been evaluated for chronic cough persisting for longer than 4 weeks. Cough-variant asthma was the most common cause of cough, followed by sinusitis, gastroesophageal reflux, aberrant innominate artery, psychogenic cough, and subglottic stenosis. Chronic cough is best managed by first following an individualized diagnostic protocol designed to determine the etiology of the cough. This is followed by specific therapy to treat the underlying disorder. Children with persistent cough and normal chest radiograph are best served when referred promptly for evaluation by an otolaryngologist when the primary physician's initial efforts at diagnosis and treatment are not effective. Endoscopy is underutilized in practice and its importance understated in the literature. It is particularly helpful in establishing a precise diagnosis in infants under 18 months of age.
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PMID:Chronic cough in infants and children: an update. 204 39

The exact incidence of gastroesophageal reflux (GER) is unknown, although it is estimated that at least 25% of patients with GER have head and neck symptoms alone. These symptoms may consist of one or more of the following: excess salivation, hoarseness, "post-nasal drip," voice change, persistent coughing, food sticking in the throat, globus hystericus, otalgia, throat clearing, neck pain, sore throats, the sensation of a lump in the throat, choking spells, and bronchospasm. Carcinoma of the larynx and upper aerodigestive tract may be a consequence of chronic reflux. GER, especially when the classic symptoms of reflux are absent, is frequently overlooked as a cause of these problems. This article reviews the symptoms and pathophysiology of these conditions. The diagnostic and therapeutic modalities available to us in managing these patients are also discussed.
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PMID:Otolaryngologic manifestations of gastroesophageal reflux. 205 16


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