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

Laryngopharyngeal reflux is a new term given to gastroesophageal reflux leading to atypical symptoms in the upper aerodigestive tract. The manifestations of laryngopharyngeal reflux are varied and include chronic hoarseness, globus pharyngeus, sore throat, chronic cough, asthma, paroxysmal laryngospasm, and other less common symptoms. Making the diagnosis requires accurate history taking and can be confirmed by fiberoptic examination of the pharynx and larynx, as well as by ambulatory esophageal and pharyngeal pH monitoring. Stepwise treatment regimens are very effective in treating this condition, which exacerbates or imitates many seemingly unrelated disorders.
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PMID:Laryngopharyngeal reflux: a modern day "great masquerader". 932 11

The neuroanatomic proximity of the larynx to the hypopharynx and proximal esophagus make it particularly vulnerable to diseases that occur in those 2 areas. This is particularly true of gastroesophageal reflux disease (GERD). There is increasing awareness of this relationship, and dysphonias from gastroesophageal reflux (GER) are far more common than previously realized. The symptoms and findings of reflux laryngitis, vocal nodules, Reinke's edema, contact ulcer and granuloma, laryngeal stenosis, and paroxysmal laryngospasm are presented, and diagnostic protocols for each disorder are suggested. The treatment varies with the severity of each problem. Conservative lifestyles and dietary control are helpful, but long-term medical therapy with H2, H1, and prokinetic drugs are usually needed. Surgical therapy may be indicated for such life-threatening problems as laryngeal stenosis and paroxysmal laryngospasm. The need for physician and patient awareness, research, and improved and less expensive therapy are discussed.
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PMID:Role of refluxed acid in pathogenesis of laryngeal disorders. 942 33

Gastroesophageal reflux is generally a benign condition, which resolves spontaneously, and which is usually manifested by digestive signs. More recently, laryngotracheal conditions such as laryngospasm, laryngomalacia and recurrent laryngitis, have been ascribed to gastroesophageal reflux. However, there is not a single common mechanism linking these two pathologies and different theories are postulated. Diagnosis of gastroesophageal reflux is based essentially on prolonged pH monitoring, where a negative result unfortunately cannot rule out reflux responsibility. Thus, in the end, in the face of a sufficient body of evidence, it is the effectiveness of the anti-reflux treatment which will make it possible to establish a link between gastroesophageal reflux and the laryngotracheal manifestations observed.
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PMID:Laryngotracheal manifestations of gastroesophageal reflux in children. 1009 2

Muscular tension dysphonia, episodic laryngospasm, globus, and cough may be considered to be hyperfunctional laryngeal symptoms. Suggested etiological factors for these symptoms include gastroesophageal reflux, psychological problems, and/or dystonia. We propose a unifying hypothesis that involves neural plastic change to brainstem laryngeal control networks through which each of the above etiologies, plus central nervous system viral illness, can play a role. We suggest that controlling neurons are held in a "spasm-ready" state and that symptoms may be triggered by various stimuli. Inclusion criteria for the irritable larynx syndrome are episodic laryngospasm and/or dysphonia with or without globus or chronic cough; visible or palpable evidence of tension or tenderness in laryngeal muscles; and a definite symptom-triggering stimulus. thirty-nine patients with irritable larynx syndrome were studied. Gastroesophageal reflux was felt or proven to play a major role in a large number of the group (>90%), and about one third were deemed to have psychological causative factors. Viral illness seemed quite prevalent, with one third of patients able to relate the onset of symptoms to a viral illness that we feel might lead to central nervous system changes. Our proposed hypothesis includes a mechanism whereby acquired plastic change to central brainstem nuclei may lead to this form of hyperkinetic laryngeal dysfunction. It gives structure and reason to an array of therapy measures and suggests direction for basic research.
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PMID:The irritable larynx syndrome. 1049 60

Gastroesophageal reflux disease (GERD) is the most common esophageal disease. It typically presents with heartburn and regurgitation, but it may also cause atypical symptoms, either alone or in combination. About 20 to 60 percent of patients with GERD have ENT symptoms without any heartburn. The most common ENT symptom is a globus sensation, yet there are many possible clinical signs such as laryngitis, pharyngitis, sinusitis, laryngospasm, laryngeal edema and granuloma that may mislead the initial work-up. In this work the pathophysiology, symptomatology, diagnostic measurements and therapeutic options of GERD are discussed. It is suggested that GERD has to be included into differential diagnostic approaches especially when routine treatment of these ENT diseases failes.
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PMID:[Reflux-associated diseases of the otorhinolaryngology tract]. 1155 31

Problematic airway responses in infants are common. Reflux-induced apnea affects nearly 1% of infants and involves airway closure or laryngospasm. Recurrent or chronic stridor, caused by dynamic or structural airway abnormalities, occurs in up to 1 in 100 babies. It can be difficult to distinguish microaspiration, which may represent inadequate airway protection mechanisms, from reflexive responses to esophageal refluxate, which may represent overeffective airway protection mechanisms. The diagnosis of gastroesophageal reflux (GER) in babies can be facilitated by a careful history in conjunction with esophageal pH probe monitoring, laryngoscopic evaluation, bronchoalveolar lavage, or nuclear medicine scintigraphy. Conservative lifestyle measures for treating supraesophageal manifestations of infantile GER include prone positioning and thickened feedings. Prokinetic and acid-suppressing therapies are widely used, but their efficacy is incompletely established, and none is currently approved by the US Food and Drug Administration for this purpose. Fundoplication is not indicated if nonsurgical management can prevent serious problems during the child's maturation phase when many of these manifestations spontaneously resolve. Much remains to be learned about the developmental aspects of these supraesophageal manifestations of GER. This information not only will provide a greater understanding of developmental pathophysiology, but also will improve the clinical care of large numbers of infants.
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PMID:An overview of reflux-associated disorders in infants: apnea, laryngospasm, and aspiration. 1174 27

OBJECTIVE: To report 21 yrs of experience with pediatric flexible fiberoptic bronchoscopy in infants and children, explore newer applications, delineate potential complications, and make recommendations for its future application. DESIGN: Retrospective review. SETTING: A 20-bed pediatric critical care unit in a tertiary care, university-based children's hospital. PATIENTS: A total of 2,836 pediatric and infant fiberoptic bronchoscopies, performed over a course of 21 yrs, were reviewed. Measurement and MAIN RESULTS: A total of 2,836 children (1,536 girls) were subjected to flexible fiberoptic bronchoscopy. Of those, laryngeal mask airway was incorporated in 92 procedures (3.2%) and general anesthesia was applied in 198 cases (7%). The youngest subject was a 1-wk-old, 600-g, premature infant. The procedure resulted in diagnoses that modified patient care, particularly in tracheostomized infants and those with upper airway obstruction, plastic bronchitis of acute chest syndrome, dyskinetic cilia syndrome, immunocompromised individuals, and those with unexplained chronic cough and recurrent pulmonary infiltrates. Microbiologic and cytologic data from bronchoalveolar lavage helped confirm the diagnoses of pulmonary hemosiderosis and gastroesophageal reflux and validated the presence, or lack of, bacterial or viral pathogens. A total of 21 patients (<1%) experienced life-threatening hypoxemia, prompting termination of the procedure. Laryngospasm or bronchospasm was observed in 17 individuals (<1%) undergoing bronchoalveolar lavage, and 4% of the total population experienced mild nasopharyngeal bleeding. No fatalities were encountered. CONCLUSIONS: Pediatric flexible fiberoptic bronchoscopy is a safe diagnostic and interventional tool, even in young or extremely premature infants. Although the rate of serious complications in this report is low, general anesthetic agents and incorporation of laryngeal mask airway is advocated for severe mucoid impaction, transbronchial biopsy, and chronic pulmonary infiltrates, which may necessitate extensive bronchoalveolar lavage.
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PMID:Pediatric fiberoptic bronchoscopy: Clinical experience with 2,836 bronchoscopies. 1278 Sep 89

Sleep-related laryngospasm is a rare disorder that may cause severe disablement. It refers to episodic arousal from sleep with a sense of suffocation followed by stridor. This phenomenon, which is caused by laryngospasm, is probably secondary to gastroesophageal reflux. The reflux is the target for current treatment of this serious disorder. Treatment by acupuncture for sleep-related laryngospasm has not been previously reported in the English medical literature. We describe a previously healthy patient with sleep-related laryngospasm caused by gastroesophageal reflux refractory to current medical treatment who was treated successfully using acupuncture.
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PMID:Acupuncture therapy for sleep-related laryngospasm. 1292 Apr 45

The past decade has witnessed increasing interest in the supraesophageal (ear, nose, and throat (ENT)) symptoms potentially caused by gastroesophageal reflux disease (GERD). Hoarseness, halitosis, problems with vocal presentations, excessive phlegm, frequent throat clearing, globus sensation, sore throat, cough, aspiration, laryngospasm, and laryngeal carcinoma are some, but not all of the ENT symptoms that have been attributed to GERD (1). The availability of highly effective medical and surgical therapies allows for control of these symptoms in many patients adding to the importance of accurately diagnosing GERD.
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PMID:Should upper gastrointestinal endoscopy be part of the evaluation for supraesophageal symptoms of GERD? 1530 53

Thirty-five consecutive adult patients with paroxysmal laryngospasm (LS) and with unimpaired vocal fold mobility were prospectively studied for coexisting gastroesophageal reflux disease (GERD). Nineteen patients reported frequent (>3 episodes a week) LS episodes (FLS patients) and 16 patients reported occasional LS episodes (OLS patients). All patients underwent an extensive otorhinolaryngological (ORL) examination, upper gastrointestinal (GI) endoscopy, ambulatory 24-hr dual-channel esophageal pH monitoring, and esophageal manometry. In addition, a subset of LS patients also underwent ambulatory duodenogastroesophageal reflux (DGER) monitoring. Patients with daily LS used the symptom marker during pH monitoring indicating separate LS episodes. All FLS patients and 14 OLS patients (87%) had a diagnosis of GERD. Only 10 patients (29%) experienced heartburn and/or regurgitation. Compared to OLS patients, FLS patients generally had more severe GERD as indicated by a higher prevalence of a hiatus hernia, higher distal and proximal esophageal acid exposure times, and higher values of DGER. In six FLS patients, 21 LS episodes (91%) occurred simultaneously with acid reflux, indicating a causal association between LS and GER. On antireflux therapy consisting of omeprazole, 20 mg bid, or lansoprazole, 30 mg oid, and lifestyle measures, LS ceased completely in all patients within 6 weeks. The present study not only demonstrates the role of GER in the pathogenesis of LS and the effectiveness of antireflux therapy, but also suggests that LS in adult patients with unimpaired vocal fold mobility might be considered a typical, although most frequently unrecognized, supraesophageal manifestation of GER.
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PMID:Paroxysmal laryngospasm: a typical but underrecognized supraesophageal manifestation of gastroesophageal reflux? 1562 18


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