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Query: UMLS:C0017168 (gastroesophageal reflux disease)
 11,783 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Asthma may have several etiologies. It is well-known that there are allergic subjects with low IgE bound to mast cells, with negative specific RAST and with weakly positive skin tests, but with a positive provocation test with pneumo-allergens. Food allergy, isolated or associated is also not a negligible cause. Non-allergic subjects often respond to triggering factors: Gastro-oesophageal reflux Neuro-endocrine origin Infectious origin Physical origin (exercise). In our study, we place the emphasis on two types of extremely severe asthma, linked to intolerance of aspirin and metabisulphites and often associated.
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PMID:[The etiologies of asthma]. 219 89

In a number of patients there is evidence of an unfavourable interaction between gastro-oesophageal reflux (GER) and pulmonary disease, that takes the form of a vicious circle: first GER can induce and maintain chronic bronchopulmonary inflammation by recurrent unnoticed aspirations and, secondly chemical irritation of the oesophageal mucosa causes airway obstruction by vagally-mediated reflexes. Obstructive airway disease in turn favours GER via anatomical functional and physiological factors. Thus the prevalence of GER is increased to 30-40% in patients with asthma and chronic bronchitis, as compared with only 5-10% in the general population. A positive history of productive cough, nocturnal respiratory symptoms and recurrent hoarseness may be helpful in detecting an important relationship between GER and chronic airway disease. The modified Bernstein-test, radionuclide studies and detailed sleep studies are suitable methods of establishing the diagnosis. Antireflux diets, H2-antagonists and antacids are accepted treatment in the adult, and may obviate surgical procedures in most patients. In clinical practice the relationship between GER and pulmonary diseases should be considered routinely, in order to initiate early and effective treatment and to end the vicious circle.
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PMID:[Gastroesophageal reflux and lung diseases]. 219 7

The author examined 30 patients with clinical symptoms of gastroesophageal reflux. The patients suffered of bronchial asthma (19) and chronic obstructive bronchitis (11). Intraesophageal and intragastric proteolysis with subsequent digestion of the protein substrate in solutions with different concentration of hydrogen ions (pH 1.68 and 8.15). Gastroesophageal reflux was observed in 25 and duodenogastroesophageal in 16 patients. The gastric and duodenal contents reached the upper portions of the esophagus in 14 of the 30 patients. The obtained findings indicate frequent effects of proteases on the bronchi.
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PMID:[Gastroesophageal reflux in patients with chronic nonspecific lung diseases]. 220 49

The symptoms and presentations of gastroesophageal reflux disease are rather numerous. These include the typical symptoms, such as heartburn, regurgitation, water brash, or dysphagia. However, reflux may also be responsible for such symptoms as hoarseness, pulmonary aspiration, or asthma. It may also be an important cause of noncardiac chest pain. Thus, gastroesophageal reflux disease may be considered a disease with more than just "esophageal" symptoms.
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PMID:The spectrum of the symptoms and presentations of gastroesophageal reflux disease. 222 66

Rhinoconjunctivitis induced by pollen exposure and bronchial asthma are generally easily recognizable clinically. In asthma a number of differential diagnoses such as ciliary dyskinesia, cystic fibrosis and gastro-oesophageal reflux must be considered. The predominant symptoms are coughing and wheezing. Investigations into the complex nature of mediator release and IgE synthesis have established a predominantly inflammatory pattern of reactions largely responsible for induction and maintenance of bronchial hyperresponsiveness due to both acute and chronic processes. Future therapeutic consequences may be derived from anti-inflammatory strategies. This has already lead to reassessment and upgrading of use of corticosteroids in paediatric asthma.
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PMID:[Pollinosis and bronchial asthma: pathogenesis, immunology, clinical aspects]. 223 88

The authors report a study of 140 patients presenting with a non-allergic respiratory tract disease (121 cases of asthma--19 cases of spasmodic cough). Gastro-oesophageal reflux was detected by 24-hour pHmetry in 86 of these patients. In 34 of them (i.e. 40% of cases), the gastro-oesophageal reflux appeared to be responsible for the initial respiratory tract symptoms. These 34 patients were submitted to a therapeutic trial of high dose anti-H2 therapy for at least two months. Only those patients in whom a marked improvement or even complete resolution of the respiratory tracts symptoms was observed underwent anti-reflux surgery. Out of the 13 patients undergoing surgery, there were two failures and 11 good results after a follow-up of more than 18 months.
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PMID:[Gastroesophageal reflux and respiratory manifestations: diagnostic approach, therapeutic indications and results]. 224 Oct 79

The prevalence of pathological gastro-oesophageal reflux in children and adolescents with asthma was studied by 24 hour two level oesophageal pH monitoring in 42 subjects aged 9-20 years with moderate or severe bronchial asthma. The importance of oesophagobronchial nerve reflexes and of aspiration of gastric acid as triggers in asthma was assessed by studying whether episodes of reflux into the distal and into the proximal oesophagus were followed by asthma attacks. Twenty-one subjects (50%) had a pathological total reflux time in the distal oesophagus and six (16%) in the proximal oesophagus. Nine patients had pathological gastro-oesophageal reflux into the distal oesophagus together with symptoms of asthma during the day on which the recording took place. In three of them the episodes of asthma symptoms were significantly correlated with preceding episodes of reflux into the distal oesophagus, and in one subject to reflux into the proximal oesophagus. We conclude that pathological gastro-oesophageal reflux is common in children and adolescents with asthma, but it seems to provoke symptoms of asthma in only a few. Symptoms of asthma were more often elicited by exposure of the distal oesophagus to gastric acid, possibly by a vagal reflex, than by aspiration of gastric juice.
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PMID:Bronchial asthma and acid reflux into the distal and proximal oesophagus. 224 39

Patients with asthma who have incomplete control of their symptoms or require regular systemic steroidal therapy are said to have recalcitrant asthma. A systematic approach may significantly improve quality of life. Factors that should be evaluated include living with an antigen, occupational exposure, use of beta-adrenoreceptor blockers, use of nonsteroidal anti-inflammatory agents, sensitivity to dietary chemicals, endocrinopathies, gastroesophageal reflux, sinusitis, bronchopulmonary aspergillosis, and noncompliance. Other diseases may mimic asthma or exacerbate nonspecific bronchial hyperreactivity. These include congestive heart failure, chronic infectious bronchitis resulting from cystic fibrosis, ciliary dysfunction syndrome, and immunodeficiency syndromes, upper airway obstruction, pertussis syndrome, psychogenic coughs, bronchiolitis obliterans, chronic eosinophilic pneumonia, and vasculitides. A systematic approach to the evaluation of coexisting factors and potential exacerbating diseases is presented.
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PMID:Recalcitrant asthma: an allergist's approach. 229 75

Gastroesophageal reflux was established in 12 out of 38 patients with infectious allergic bronchial asthma out of exacerbation. According to intraesophageal pH-metry, it turned out appreciable in half of the cases. Prospective observations conducted for up to 8 years made it possible to recognize bronchial asthma in 9 out of 63 patients having initial reflux without any bronchopulmonary alterations. Diminution of the tone of the inferior sphincter of the esophagus proved by electromanometry should be regarded as the leading mechanism by which gastroesophageal reflux developed in bronchial asthma patients. In patients having gastroesophageal reflux without bronchopulmonary pathology, the tone of the upper sphincter of the esophagus was normal or elevated whereas in bronchial asthma patients with reflux, the tone of the superesophageal sphincter was naturally lowered, causing microaspiration into the bronchi of the gastric contents flown to the esophagus. It is desirable that metoclopramide (cerucal) which increases the initially reduced tone of the esophageal sphincters may be included into a complex of therapeutic measures elaborated for patients with associated bronchial asthma and gastroesophageal reflux.
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PMID:[Gastroesophageal reflux and bronchial asthma]. 233 26

We examined the effect of intraesophageal acid (either spontaneous gastroesophageal reflux or infused) on airflow resistance in 15 sleeping asthmatic subjects. We observed no significant acute or sustained changes in airflow resistance relative to periods of intraesophageal acid. Overnight changes in spirometry and lower airway resistance also demonstrated similar nocturnal worsening of bronchoconstriction despite the occurrence of spontaneous or simulated gastroesophageal reflux. The presence or absence of clinical evidence of esophagitis (Bernstein test response) did not alter the observed lack of response to intraesophageal acid. We conclude that gastroesophageal reflux contributes little to the nocturnal worsening of asthma.
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PMID:Effects of spontaneous and simulated gastroesophageal reflux on sleeping asthmatics. 235 83


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