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

Fiberoptic endoscopic evaluation of swallowing (FEES) was developed as an adjunct to the videofluoroscopic swallowing study and clinical examination of swallowing function in the adult. The sensory testing aspect of fiberoptic endoscopic evaluation of swallowing with sensory testing (FEESST) utilizes an air pulse stimulus of mechanoreceptors within the larynx. The study can be performed safely in children as young as premature infants and in adults. Adequate levels of cooperation can be obtained in nearly all children requiring FEESST. No cases of laryngospasm or respiratory compromise have been encountered. FEESST was initially applied to patients with dysphagia. It is now used in the study of the effects of gastroesophageal reflux on the larynx and swallowing function. The extent of pooled secretions in the hypopharynx can be used as a surrogate measure of laryngopharyngeal sensory testing. When patients managed by FEESST were compared with patients managed by videofluoroscopic swallow studies, there were no statistical differences in the rates of pneumonia or pneumonia-free interval. A learning curve is present for the operator, but with basic endoscopic skills, FEESST is a skill within the scope of practice of most pediatric endoscopists.
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PMID:Pediatric FEESST: fiberoptic endoscopic evaluation of swallowing with sensory testing. 1591 85

A variety of pulmonary and ear, nose, and throat (ENT) symptoms and disorders are considered to be extraoesophageal manifestations of gastro-oesophageal reflux disease (GORD). These extraoesophageal manifestations include asthma, chronic cough, laryngeal disorders, and various ENT symptoms. Recent studies have established that GORD underlies or contributes to chronic sinusitis, chronic otitis media, paroxysmal laryngospasm, excessive throat phlegm, and postnasal drip. Traditionally, management of extraoesophageal GORD manifestations relies on prolonged empiric therapy with high doses of proton pump inhibitors (PPI), followed by pH monitoring under PPI in refractory cases. Recent studies found no benefit of empiric long term high dose PPI therapy. The diagnostic yield of endoscopy in extraoesophageal GORD manifestations seems higher than previously appreciated while pH monitoring under PPI therapy has a low yield. Based on these new findings, a new management algorithm can be proposed that uses short term empiric PPI therapy and GORD investigations off PPI. Well designed controlled studies evaluating the proposed management algorithms and treatment approaches in this area are urgently needed.
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PMID:Extraoesophageal manifestations of gastro-oesophageal reflux. 1616 55

Extraesophageal manifestations of gastroesophageal reflux disease (GERD) can include upper airway disorders, asthma and chronic cough. They have a common pathophysiology, involving microaspiration of acid into the larynx and pharynx, and vagally mediated bronchospasm and laryngospasm. The role of extraesophageal reflux (EER) in such disorders is underdiagnosed due to the often silent symptoms and difficult confirmation of diagnosis. Laryngeal examination and quantitative evaluation of findings using the reflux finding score are essential to diagnosis and treatment. Long-term high-dose proton pump inhibitor therapy is the first-line approach to controlling symptoms. Use of treatment algorithms is necessary to manage and accurately diagnose the cause of nonresponse to treatment.
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PMID:Extraesophageal manifestations of GERD: diagnosis and therapy. 1620 Feb 28

Gastroesophageal reflux is a suspected cause of sleep-related laryngospasm [Thurnheer R, Henz A, Knoblauch A. Sleep-related laryngospasm. Eur Respir J 1997;10:2084-6], but the relationship has not been directly documented by polysomnography (PSG). We report the case of an eight-year-old girl with asthma who was referred for evaluation of awakenings with respiratory distress. The description of her events included stridorous breathing suggestive of laryngospasm. A PSG was performed with esophageal pH monitoring, and during the recording pH dropped below four on nine occasions. Following two of the pH drops, acute respiratory distress with stridor was documented in video and audio recording, supporting a causal relationship between sleep-related gastroesophageal reflux and laryngospasm.
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PMID:Sleep-related laryngospasm caused by gastroesophageal reflux. 1787 Jun 62

An important number of patients are referred to the ENT specialist because of extraoesophageal manifestations of gastroesophageal reflux. The most alarming symptom is a paroxysmal dyspnea secondary to a laryngospasm. The patients report a laryngeal choking sensation associated to an aphonia. We report three cases of laryngospasm secondary to acid gastric reflux. The diagnosis was made with the clinical history, a laryngeal examination and a 24-hour pH-monitoring enabled us to demonstrate a clear temporal relation between the reflux episodes and the choking episodes. In conclusion, the pharyngo-laryngeal reflux is a possible cause of laryngospasm. In our three patients, a high dose antiacid treatment was efficient to bring a lasting relief of the symptoms.
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PMID:[Gastroesophageal reflux: a possible cause of paroxysmal laryngeal dyspnea]. 1861 Jul 25

Gastroesophageal reflux disease (GERD) often presents as typical symptoms such as heartburn or acid regurgitation. However, a subgroup of patients presents a collection of symptoms and signs that are not directly related to esophageal damage. These are known collectively as the extraesophageal manifestations of GERD, such as non-cardiac chest pain, laryngitis, chronic cough, hoarseness, asthma or dental erosion. They have a common pathophysiology, involving microaspiration of acid into the larynx and pharynx, and vagally mediated bronchospasm and laryngospasm. The role of extraesophageal reflux in such disorders is underestimated due to often silent symptoms and difficult confirmation of diagnosis. Endoscopy and pH monitoring are insensitive and therefore not useful in many patients as diagnostic modalities. Thus, anti-secretory therapy by proton pump inhibitor is used as both a diagnostic trial and as a therapy in the majority. Attention to optimizing therapy and judicious use of endoscopy and reflux monitoring are needed to maximize treatment success.
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PMID:[Extraesophageal manifestations of gastroesophageal reflux disease]. 1907 97

Mutations of SCN4A encoding the skeletal muscle sodium channel Nav 1.4 cause several types of disease, including sodium channel myotonias. The latter may be responsible for neonatal symptoms, including severe neonatal episodic laryngospasm (SNEL). Establishing the diagnosis of SCN4A-related SNEL early in the neonatal period is crucial because treatment is available that can reduce laryngospasm and improve vital and cerebral outcome. We report 2 new unrelated French patients who presented with SNEL. The first patient was initially diagnosed with laryngomalacia and underwent laryngeal surgery in the neonatal period before being diagnosed with myotonia at 14 months of age. The episodes of laryngospasm disappeared spontaneously, although occasional circumstances such as cold exposure could trigger laryngeal reactions; in addition, he developed myotonia corresponding to an adult myotonia permanens phenotype. This patient is now 24 years old and leading a normal life. The second patient was initially diagnosed with gastroesophageal reflux, then SNEL; his condition improved with carbamazepine treatment, and he is now 6 months old. The diagnostic sequence in both patients was the same: first, severe episodic apneic attacks necessitating hospitalization occurring in the first week of life; second, observation of muscle hypertrophy and peripheral hypertonia with a clear myotonic pattern on electromyogram (at 14 and 3 months of age, respectively); third, genetic testing revealing de novo SCN4A G1306E mutation. Both patients have had good therapeutic response to sodium channel blockers (carbamazepine or mexiletine).
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PMID:Diagnosis and outcome of SCN4A-related severe neonatal episodic laryngospasm (SNEL): 2 new cases. 2395 73

There are many different types of sleep disorders. The majority of sleep-related breathing disorders can be attributed to sleep apnoea syndrome. Nocturnal choking sensation is a different symptom, for which we present two cases. Nocturnal choking sensation is a terrifying symptom for the patient and the diagnostic approach can be challenging. Aside from sleep choking syndrome, this symptom may appear with nocturnal laryngospasm, insular epilepsy and nocturnal gastro-oesophageal reflux. A thorough patient history and observation of the nocturnal event, sometimes supported by EEG findings, may provide the clue to the diagnosis. These kinds of nocturnal symptoms are best analyzed in a clinic specialized in both epilepsy and sleep disorders.
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PMID:[Nocturnal choking sensation]. 2402 Jun 23

Asthma is a disorder of the lungs characterized by increased responsiveness of the airways, as manifested by episodes of wheezing and increased resistance to expiratory airflow because of varying degrees of smooth muscle contraction, edema of the mucosa, and mucus in the lumen of the bronchi and bronchioles. The stimuli vary widely and include antigens, infection, air pollutants, respiratory tract irrtants, exercise, and emotional factors. This condition is completely different from distress breathing because of laryngotracheal spasm. One of its causes is the gastric content reflux through the pharynx to the larynx because of gastroesophageal reflux disease (GERD), in addition to the typical human avian flu that may cause immediate suffocation by laryngospasm owing to acute larygotrachitis. A patient suffered from GERD without esophageal symptoms, which was diagnosed and treated as bronchial asthma during his five emergency admissions. The admissions were because of episodic attacks of severe air hunger owing to an extreme throat tightening. The patient was being treated for as long as two years. After the correct diagnosis was made and treatment of laporascopic fundaplication was performed, the longstanding "bronchial asthma", after all, completely disappeared. The concept of "not asthma, but GERD" seems undervalued, unappreciated, even misunderstood among patients with intractable asthma. Therefore, such a case is reported in detail, similar cases are mentioned briefly as well, and a mechanism responsible for GERD-originated larryngo-or laryngotracho-spasm is proposed.
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PMID:Not asthma, but GERD: case report. 2455 29

There is a strong association between gastroesophageal reflux and pharyngolaryngeal reflux as factors leading to respiratory disease, manifested as dysphonia, wheezing, coughing, recurrent laryngitis, bronchial obstruction, laryngospasm and apparent life-threatening events (ALTEs). These manifestations can be mild or severe and may sometimes put the patient's life at risk. We present two cases of patients with severe laryngitis who required endotracheal intubation, one of which underwent tracheostomy. The diagnostic methods and their limitations and the patients outcomes are described.
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PMID:[Severe laryngitis associated to gastroesophageal reflux]. 2456 87


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