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

The respiratory symptoms of gastro-oesophageal reflux, which sometimes includes massive and fatal inhalation, are well-known in infants. In older children the digestive signs are not clinically evident and the reflux mainly, if not exclusively, can be translated by recurring respiratory symptoms. The series of 36 cases presented in this work concerns children between 3 months and 15 years old, for whom the first signs were respiratory, with often a silent gastro-oesophageal reflux for several months, and even several years in some cases. The physiopathology of the respiratory symptoms concerns principally the repeated alimentary aspiration and/or gastric content during nocturnal decubitus. The pulmonary lesions caused by the reflux can be either localized, with atelectasis, obstructive emphysema or bronchiectasis, or generalized with granulomatous reactions around the food particles. Other respiratory conditions such as asthma or cystic fibrosis can be also associated with gastro-oesophageal reflux. The diagnostic criteria are discussed.
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PMID:[Recurrent bronchopneumopathies caused by gastroesophageal reflux in children. Clinical, x-ray and histologic studies of 36 cases]. 61 80

Gastroesophageal reflux is the commonest esophageal cause of chronic intermittent aspiration. The authors investigated 1000 consecutive patients with reflux with reference to their medical history, and by barium esophagography, esophageal manometry and pH studies. In patients with respiratory complications, chest roentgenography and pulmonary function tests were also performed. Of the total number, 279 patients aspirated either by coughing and choking during swallowing or as a result of night reflux; of these, 159 had associated respiratory symptoms, which included cough, voice change, recurrent respiratory infection, bronchiectasis and asthma. Of the patients with aspiration, 120 had surgical correction of reflux because conservative management failed. This form of reflux control improved the symptoms of cough and voice change and the condition of patients with recurrent infections or bronchiectasis, but alleviated the symptoms in only 8 of 28 asthmatic persons.
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PMID:Aspiration and gastroesophageal reflux. 67 82

Hoarseness, asthma, and bronchitis are common but sometimes obscure manifestations of gastroesophageal reflux, the etiology of when respiratory symptoms predominate. In 300 consecutive patients who underwent surgical correction for gastroesophageal reflux, 129 (43%) had major respiratory complaints. Group 1 patients (82, 64%) were those referred for respiratory problems alone. In Group 2 (patients referred because of peptic complaints), 47 had associated respiratory problems in various combinations, including an additional 10 patients who had bronchiectasis. Treatment with appropriate surgical resection, in addition to antireflux procedures, was carried out in these people. Noticeable relief of respiratory symptoms was obtained in 96 (74%) of the 129 patients; 30 were improved and 2 were unchanged. Recurrent hiatus hernia or esophagitis was documented in 21 (7%) of the 300 patients.
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PMID:Hiatus hernia and the respiratory tract. 92 77

A successful, systematic, anatomic, diagnostic protocol for evaluating patients with chronic cough was presented in 1981. To determine whether it was still valid, we prospectively evaluated, over a 22-month interval, 102 consecutive and unselected immunocompetent patients complaining of cough an average of 53 +/- 97 months (range, 3 wk to 50 yr). Utilizing the anatomic, diagnostic protocol modified to include prolonged esophageal pH monitoring (EPM), the causes of cough were determined in 101 of 102 (99%) patients, leading to specific therapy that was successful in 98%. Cough was due to one condition in 73%, two in 23%, and three in 3%. Postnasal drip syndrome was a cause 41% of the time, asthma 24%, gastroesophageal reflux (GER) 21%, chronic bronchitis 5%, bronchiectasis 4%, and miscellaneous conditions 5%. Cough was the sole presenting manifestation of asthma and GER 28 and 43% of the time, respectively. While history, physical examination, methacholine inhalational challenge (MIC), and EPM yielded the most frequent true positive results, MIC was falsely positive 22% of the time in predicting that asthma was the cause of cough. Laboratory testing was particularly useful in ruling out suspected possibilities. We conclude that the anatomic diagnostic protocol is still valid and that it has well-defined strengths and limitations.
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PMID:Chronic cough. The spectrum and frequency of causes, key components of the diagnostic evaluation, and outcome of specific therapy. 217 28

A wide variety of types of pulmonary diseases and respiratory symptoms have been associated with gastroesophageal reflux (GER). Asthma, chronic bronchitis, bronchiectasis, and pulmonary fibrosis have all been linked to GER, but causal mechanisms have been difficult to establish. To characterize pulmonary function abnormalities in older children and young adults (age 7-23 years) with GER, lung function was evaluated in 22 patients being treated for reflux. The patients were divided into two groups: nine subjects (Group 1) had no history of pulmonary symptoms. Thirteen subjects (Group 2) had known pulmonary disease; all had diagnosed asthma, and five had a history of recurrent pneumonia. Lung volumes and spirometry were measured. Airway reactivity was assessed by measuring change in flows following isocapneic hyperventilation of subfreezing air. The presence of "small airway" disease was assessed by air-helium flow volume curves and the single breath oxygen test. Lung size, as indicated by measurement of total lung capacity, was normal in all patients. Flow rates, density dependence of maximal expiratory flow, single breath oxygen test, and tests of airway reactivity were abnormal only in Group 2 patients and were normal in the Group 1 patients. That not all children with GER have abnormal pulmonary function suggests that, if there is a causal relationship between GER and lung disease, it is multi-factorial in nature. Children with GER who do have lung disease have evidence of airway obstruction, maldistribution of ventilation, and increased airway reactivity, but do not have restricted lung volumes.
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PMID:Pulmonary function in older children and young adults with gastroesophageal reflux. 376 70

Gastroesophageal reflux (GER) is a functional entity which is defined as "the involuntary reflux of the gastric contents in the oesophagus, without vomiting and without the involvement of either the gastric, abdominal or diaphragmatic muscles". It is therefore a question of a syndrome which is independent of the anatomical abnormalities in the cardio-tuberositic region (i.e. hiatal hernia). It may also show itself through digestive symptoms, thoracic pains, ENT symptoms and breathing complications. The presence of the latter has been clearly established in certain circumstances: --in infants, GER can cause obstructive apneas, which are responsible for sudden inexplicable deaths (SID): GER and SID have very similar epidemiological characteristics; polygraphic recordings showed that a reflux may immediately precede the onset of obstructive apnea; the instillation of 0.1 N hydrochloric acid in the oesophagus of children with GER causes an apnea. Medical or surgical treatment of the reflux prevents the recurrence of these accidents; --in adults, and older children, GER is responsible for coughs, recurring bronchopneumopathies and asthma; long-term recordings of the oesophageal pH have proved that there is a time-relationship between the two events. Scintigraphic studies have shown the pulmonary contamination by a radioactive isotope placed in the stomach the previous evening. GER has been equally suspected for conditions such as lung abscess, bronchiectasis and hemoptysis, but here it is more difficult to prove. With certain pulmonary fibroses, histological lesions have been compared with those observed during inhalation bronchopneumopathies, but it is difficult to establish a link with a reflux; --functional respiratory studies have not produced a specific functional entity for patients with GER; --careful medical treatment or surgical correction of GER lead to the sedation of respiratory symptoms (RS) in the majority of cases; --the association frequency of a GER and of RS is difficult to establish because of the diversity of the means of diagnosis employed in the past and also because of the heterogeneity of the studied populations, but the frequency is nevertheless high, indeed significantly higher than the prevalence of GER in the general population. The mechanisms which link GER and RS are not well known: first of all, there is the failure of normal antireflux mechanisms and also certain hormonal, alimentary (coffee, alcohol, tobacco, etc.) and therapeutic (theophylline, betamimetics) factors, which facilitate the reflux.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[Gastroesophageal reflux and pulmonary disease]. 636 Feb 60

Chronic cough is a common symptom presenting to all clinicians. Every effort should be made to determine the cause(s) of cough because specific therapy has a higher likelihood of success than empiric therapy. Evaluation begins with a complete history, physical examination, routine health screen laboratory testing, chest film, and pulmonary function testing. Further investigation should be guided by the response to treatment of the most likely diagnostic possibilities: postnasal drip, cough-variant asthma, gastroesophageal reflux, chronic bronchitis, bronchiectasis, and ACE inhibitor induced. The majority of each patient's workup can be performed and ordered by the primary care physician.
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PMID:Chronic cough. 787 96

Recipient pneumonectomy and the necessity for meticulous hemostasis in heart-lung transplantation can result in injury to the vagus nerves as they course through the posterior mediastinum, with consequent delay in gastric emptying. This has been reported to lead to chronic aspiration and associated pulmonary sequelae. To study the association between delayed gastric emptying, bronchiectasis, and bronchiolitis obliterans after heart-lung transplantation, we performed esophageal manometry, 24-hour pH monitoring, and radioisotopic gastric emptying in 10 patients who underwent heart-lung transplantation. Three patients had grossly delayed liquid and solid emptying that was compatible with complete vagotomy. Six other patients had delayed liquid but normal solid emptying--an unexplained finding that is the reverse of what one would expect from vagal injury. Two of these 9 patients had esophageal dysmotility, but none demonstrated gastroesophageal reflux. One remaining patient had faster than normal gastric emptying for both solids and liquids. Of the 10, 2 patients have radiologic changes of bronchiectasis and 3 have biopsy evidence of obliterative bronchiolitis. There is no relationship between these sequelae and the occurrence of esophageal dysmotility, gastroesophageal reflux, or vagotomy. We conclude that gastric emptying abnormalities can occur after heart-lung transplantation, but such abnormalities are not associated with gastroesophageal reflux and the development of pulmonary sequelae, as previously reported.
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PMID:Upper gastrointestinal dysmotility in heart-lung transplant recipients. 841 18

A 67 year old male caucasian clerical worker with a background of long-standing gastro-oesophageal reflux-like dyspepsia and bronchiectasis presented to a tertiary hospital gastroenterology unit with a recent onset of dysphagia. An initial diagnosis of achalasia was made and within 1 year an established verrucous carcinoma of the upper oesophagus had developed. The tumour was inoperable due to tracheal invasion and therefore palliative treatment was given. The patient developed a tracheo-oesophageal fistula and died of pneumonia. Thus, verrucous squamous cell carcinoma of the oesophagus can occur with achalasia.
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PMID:Verrucous carcinoma of the oesophagus and achalasia. 843 56

The objective has been to identify the different etiologies and elaborate a diagnostic and therapeutical methodology for patients with chronic cough. During one year we studied prospectively 83 patients with persistent cough of daily appearance with an evolution of four or more weeks and no previous etiologic diagnosis. We worked on three diagnostic (D) levels. D1: Based on the anamnesis and physical examination. D2: Sequential incorporation of complementary exams. D3: Evaluation of the response to the specific treatment. We divided the population into 2 groups: G1 healthy children, G2 children followed in our hospital for different conditions. The mean age was 4.7 years (range, 3 months to 15 years), and the average duration of cough was 4.9 months (range, 1 to 36 months). In G1 the following causes were identified in 78 children: cough variant asthma 41 (52%), asthma+upper respiratory tract infections 8 (10%), asthma+lower respiratory tract infections 6 (7%), postnasal drip syndrome (sinusitis, adenoiditis) 5 (6%), psychogenic 6 (7%), undetermined 4 (5%), gastroesophageal reflux 2, asthma+cigarette 2, AIDS 1, Sjogren syndrome 1, vascular ring 1, cricopharyngeal foreign body 1. In G2 out of 5 children we have found: 2 children with chronic encephalopathies who had swallowing disorders and gastroesophageal reflux, 1 patient with Down syndrome presenting hypogammaglobulinemia and bronchiectasis, 1 tracheaesophageal fistula in H in a child with recurrent pneumonia, 1 lymphocytic pneumonia in an AIDS patient. The D1 was correct in 92% of the cases. The specific therapy has proved useful for achieving the remission of the symptoms. Although asthma is the most frequent cause of chronic cough, other etiologies exist and must be ruled out.
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PMID:[Chronic cough in pediatrics]. 872 72


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