Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0010200 (cough)
 23,843 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

It was previously shown that unexplained chronic cough is associated with asymptomatic gastroesophageal reflux. The aim of this study was to determine if distal esophageal acid is important in the pathogenesis of this cough. In 22 patients with cough and reflux as determined by 24-h ambulatory esophageal pH monitoring, distal esophageal acid perfusion was performed in a double-blind controlled fashion. Patients received both 0.1 N HCl and 0.9% saline for 15 min, in random order. Cough was recorded with a microphone and then computer analyzed. In 12 matched control subjects, 24-h ambulatory esophageal pH monitoring and distal esophageal acid perfusion studies were also performed. In patients, there was a significant increase in cough frequency, median (range): 36.5 (6 to 111) versus 8.3 (0 to 46)/15 min, p < 0.001, and amplitude, geometric mean (range): 85.2 (78.1 to 92.3) versus 73.1 (0.0 to 87.1) dB, p < 0.01, with HCl compared with saline. During HCl infusion, compared with control subjects, patients had more cough episodes, 36.5 (6 to 111) versus 0.0 (0 to 11)/15 min, p < 0.0001, with greater amplitude, 85.2 (78.1 to 92.3) versus 0.0 (0.0 to 79.6) dB, p < 0.001, but there was no difference in cough duration. We subsequently investigated whether inhibition of the induced cough was possible. In seven patients repeat esophageal acid perfusion was performed 15 min after the esophageal instillation of 4 ml of 4% lignocaine.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Pathogenesis of chronic persistent cough associated with gastroesophageal reflux. 811 76

We have analysed the clinical manifestations of nine patients with brief upper airway dysfunction (BUAD) who attended the thoracic department of a major teaching hospital between 1987 and 1991. Episodes of BUAD developed within 1-4 months of presentation in three patients but were undiagnosed for 2.5-12.5 years in six. The mean age at onset was 51 years ranging from 37 to 66 years. The episodes occurred at irregular intervals. They lasted approximately 1-5 min, were frightening and consisted of an initial phase of obstructive apneoa lasting a few seconds to 2 min and a second phase of respiratory distress with inspiratory stridor lasting 1-4 min. Daytime episodes occurred in all and at night in five, waking three of the patients from sleep. In most instances, throat irritability triggered the episodes which were often preceded by cough. Potential causes of throat irritability included respiratory tract infection, allergy, oesophageal reflux and obstructive sleep apnoea. After treatment of throat irritability BUAD has ceased for at least a year in six of the eight with adequate follow-up. In conclusion, BUAD has characteristics clinical features which should enable it to be recognized more frequently, ensuring successful management.
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PMID:Brief upper airway dysfunction. 814 10

Several studies have shown the relationship between gastro-oesophageal reflux, bronchial asthma and chronic nocturnal cough and this should not be neglected, particularly in patients who present an unfavourable development in spite of conventional treatment. For diagnosis of gastroesophageal reflux, amongst other investigations, esophageal gammagraphy of swallowing, that detects alterations in the mobility of the oesophagus, secondary to a possible oesophagitis. The objective of this study was to evaluate the clinical progress and gammagraphy of a group of children with chronic predominantly nocturnal cough (with or without bronchial asthma) with initially pathological esophageal gammagraphy, after three months of treatment with gastrokinetic drugs (cisapride against domperidone) and postural dietetic limits, in comparison with a reference group who, although having followed the limits in question had not received the pharmacological treatment. From the clinical viewpoint, cough disappeared in 64.5% of cases without significant statistical differences between the two groups. Gammagraphy became normal in 20/55 cases, improved in 10/55 cases and was unchanged in 25/55. Although there was no significant difference, gammagraphy development was better in children who received domperidone. The agreement between clinical progress and gammagraphy was 60% with a large number of false positives in the gammagraphy. We believe that the simple introduction of the postural-dietetic measures may improve the clinical control in the type of patients who present with a chronic nocturnally predominant cough that does not yield to conventional treatment.
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PMID:[Nocturnal spasmodic cough in the infant. Evolution after antireflux treatment]. 814 45

Fifteen consecutive patients referred because of suspicion that gastroesophageal reflux was the cause of their chronic, unexplained cough underwent combined ambulatory esophageal manometry and pH-metry in order to correlate cough episodes with gastroesophageal and gastrohypopharyngeal acid reflux. Cough episodes, which were recognized manometrically as phasic bursts of brief simultaneous elevations in all intraesophageal pressure leads, were markedly underreported by patients. If all cough events were considered, that is, single coughs plus "bursts" of coughing, patients reported on average 10% of the total manometrically recorded coughs, whereas if only cough bursts were considered, patients reported an average of 23%. Gastrohypopharyngeal acid reflux preceded 1% and 1.8%, whereas gastroesophageal reflux preceded 9% and 13%, of the total coughs and cough bursts, respectively. One percent and 1.6% of total coughs and cough bursts, respectively, appeared to precipitate reflux. Gastrohypopharyngeal reflux events were rare, with only 15 episodes recorded in nine of the 15 patients. In 13 asymptomatic volunteers, no episodes of gastrohypopharyngeal acid reflux were recorded. This study suggests that ambulatory esophageal manometry/pH-metry provides an objective measure of temporal relationships between cough episodes and acid reflux events that is superior to relying on the patients' reporting of cough episodes. In this study population, the incidence of a direct temporal correlation between reflux and cough episodes was relatively low. However, a high proportion of patients had gastrohypopharyngeal reflux, suggesting that acid reflux to the laryngeal inlet may indirectly play a role in chronic unexplained cough.
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PMID:Combined ambulatory esophageal manometry and dual-probe pH-metry in evaluation of patients with chronic unexplained cough. 817 26

A 69-year-old female was admitted for the evaluation of chronic persistent cough of about six week duration which was particularly worse at night and did not respond to antibiotics or cough medicines. She did not smoke and had no history of allergies or abnormal inhalations. Eosinophil counts, serum IgE, CRP, titers of cold hemagglutinin (CHA), and antibody to mycoplasma were all within normal ranges. Chest X-ray films and respiratory function tests showed no abnormalities. Because of her complaint of mild heartburn, gastroesophageal reflux (GER) was thought to be a possible cause of her chronic cough. Upper gastrointestinal X-ray films revealed barium reflux up to the cervical esophagus, and gastrointestinal fiberoscopy showed reflux esophagitis. Bronchial biopsy specimens taken by fiberoptic bronchoscopy showed chronic inflammatory changes of bronchial mucosa with focal squamous metaplasia, mucosal basement membrane thickening, and lymphocytic infiltration in the submucosa. She made favorable progress following treatment with a histamine H2 blocker and cisapride for six weeks. She met Irwin's criteria and we concluded that her cough was caused by GER. We speculate that repeated tracheobronchial microaspirations of refluxed gastric acid may cause chronic inflammatory changes of the bronchial mucosa resulting in persistent cough.
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PMID:[A case of chronic persistent cough caused by gastroesophageal reflux]. 827 65

A 76-year-old male patient suffered from recurrent bacterial pneumonia of the right upper lobe and both lower lobes since 2 years after total gastrectomy for gastric cancer. He was treated with antibiotics repeatedly without complete remission. Meanwhile, chronic cough, purulent sputum, and persistent bilateral pulmonary infiltration developed gradually. Upper digestive tract endoscopy showed moderate reflux esophagitis. For diagnosis, we performed upper digestive tract scintigraphy, a "modified-salivagram", to detect aspiration and GER. Although aspiration was not detected, GER reaching to the upper portion of the esophagus was observed 46 min after taking radio-labeled albumin, and chronic aspiration pneumonia with GER was thus diagnosed. Bed blocks and gragling with ponvidone-iodine after meals and before sleep greatly improved the symptoms of cough and sputum. The bilateral infiltrative shadows disappeared with resolution of symptoms. Chronic aspiration resulting from GER is an important cause of chronic airway infection. Even if a patient with reflux esophagitis is asymptomatic, chronic aspiration pneumonia should be suspected in cases of recurrent or persistent pneumonia in both lower lobes. The "modified-salivagram" is a sensitive test to detect aspiration and GER in hypoacidic states, such as in total gastrectomy and elderly patients.
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PMID:[A case of chronic aspiration pneumonia after total gastrectomy caused by gastroesophageal reflux revealed by a "modified-salivagram"]. 827 18

The physiopathology of chronic cough remains obscure. We evaluated the possibility that chronic cough in nonasthmatic subjects is associated with airway inflammation, and if this is so, what the relationship between this inflammation and the possible etiology of cough might be, as well as its response to inhaled steroids. Nineteen nonsmoking, nonasthmatic subjects referred for a persistent cough (mean: 3.8 yr) were evaluated and compared with 10 normal subjects. The evaluation included a respiratory questionnaire, a physical examination, allergy skin-prick tests, chest and sinus radiographs, esophageal pH monitoring, measurements of expiratory flows, methacholine and citric acid challenges, and flexible bronchoscopy for bronchoalveolar lavage (BAL) and bronchial biopsies. Fourteen subjects further accepted participation in a randomized, double-blind crossover trial of inhaled beclomethasone (500 micrograms four times daily) and a placebo for 1 mo each. Four groups of subjects were identified according to the presence of postnasal discharge (n = 4), gastroesophageal reflux (n = 6), both conditions (n = 5), or neither (n = 4). Subjects with chronic cough had an increased number of inflammatory cells in their bronchoalveolar lavage fluid (BALF), but there was no significant difference between the four subgroups of coughers. As compared with control subjects, the bronchial biopsies of subjects with chronic cough showed increased epithelial desquamation (p = 0.004) and inflammatory cells (p = 0.005), particularly mononuclear cells (p < 0.01), in addition to submucosal fibrosis, squamous-cell metaplasia, and loss of cilia. These findings were not significantly different between the different etiologic groups. In subjects with chronic cough, basement-membrane thickness was normal and not different from that of control subjects.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Airway inflammation in nonasthmatic subjects with chronic cough. 830 50

Because aspiration pneumonia contributes significantly to morbidity and mortality in hospitalized patients, this study was undertaken to identify risk factors for morbidity and mortality associated with aspiration pneumonia. Patients with a discharge diagnosis of aspiration pneumonia in 1985 and 1990 were studied. Factors associated with death from aspiration pneumonia were: altered mental status, cerebrovascular accident, endotracheal intubation, tachycardia, and hypoxemia. Fever, cough, and unilateral infiltrates on chest radiograph were associated with survival. Attention to proper positioning of comatose patients, aggressive treatment of gastroesophageal reflux, and strict attention to endotracheal tubes and tracheostomies should decrease the morbidity and mortality associated with aspiration pneumonia.
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PMID:Risk and outcome of aspiration pneumonia in a city hospital. 835 Mar 75

History taking is the first step in the evaluation of a patient. An analysis of the information obtained provides the basis for the choice and order of diagnostic tests. In addition, it provides the clinician with the necessary information to determine the relevance of "abnormal tests" to the patient's problem. Dysphagia is a reliable symptom that indicates an abnormality in the swallowing mechanism. The history should contain a detailed description of the symptoms associated with dysphagia from the onset. Especially relevant are questions to determine if dysphagia is experienced every day or intermittently, with solid food or liquids or both, as well as presence and timing of associated symptoms such as, choking, coughing and regurgitation, changes in speech, heartburn and chest pain. It is clinically useful to divide swallowing into three phases: oral, pharyngeal and esophageal. Oral dysphagia is usually due to a neurologic disorder, decreased salivary flow or painful oropharyngeal lesions. Pharyngeal dysphagia is most frequently caused by neuromuscular disorders and less frequently by a Zenker's diverticulum, neoplasm or a mucosal web. Esophageal dysphagia is caused by a structural narrowing, such as produced by a peptic stricture, neoplasm or a Schatzki's ring or by a primary motility abnormality, such as achalasia or diffuse esophageal spasm or by motility abnormalities produced by inflammation caused by gastroesophageal reflux, medication-induced esophageal ulceration or infectious esophagitis.
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PMID:Art and science of history taking in the patient with difficulty swallowing. 846 26

The pathophysiology and diagnosis of gastroesophageal reflux disease (GERD) are discussed. GERD is a clinical syndrome involving the reflux of gastric contents into the esophagus. It is distinguished from the reflux that occurs normally in the general population. A low pressure exerted by the lower esophageal sphincter (LES) and inappropriate spontaneous relaxation of the LES may contribute to the development of GERD. Other possible contributory factors are increased intra-abdominal pressure and impaired esophageal clearance. The amount and concentration of refluxed gastric acid, proteolytic enzymes, and bile acids are among the determinants of the extent of esophageal injury. Heartburn is a specific symptom of GERD. Other symptoms include coughing, wheezing, hoarseness, epigastric pain, and regurgitation. Upper-GI roentgenography, endoscopy, biopsy, 24-hour ambulatory pH monitoring, and esophageal manometry have been used to diagnose and evaluate the disease. The complications of GERD are strictures, hemorrhaging, perforation, aspiration, and Barrett esophagus. The causes of GERD are incompletely understood, but low LES pressure seems important. GERD may lead to serious complications. A broad array of diagnostic approaches is available.
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PMID:Pathophysiology and diagnosis of gastroesophageal reflux disease. 847 26


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