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

With the widespread availability of ambulatory esophageal pH monitoring, there has been recently renewed interest in the so-called 'extraesophageal' complications of gastroesophageal reflux disease (GERD). There are two proposed mechanisms by which reflux can cause extraesophageal symptoms or disease: refluxed acid may reach the oropharynx and/or respiratory tract and cause direct irritation; or acid contact with the esophageal mucosa may trigger neural reflexes, which, in turn, produce symptoms. Evidence is most compelling for an association between GERD and unexplained dental erosions, posterior laryngitis, chronic unexplained cough and intrinsic asthma. The clinician should be aware of these associations, and patients with these conditions should be questioned carefully about associated GERD symptoms. When GERD and any of these conditions coexist, intensive medical antireflux therapy is indicated. Twenty-four hour pH monitoring may be required in selected patients to document the relationship between reflux and the extraesophageal complication or to ensure that the medical therapy provided has eliminated acid reflux.
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PMID:Extraesophageal complications of gastroesophageal reflux disease. 934 78

Extraesophageal manifestations of gastroesophageal reflux disease (GERD) include chronic cough, asthma and 'acid' laryngitis. The response to medical and/or surgical therapy of these conditions is highly variable and often delayed. Of patients with GERD-related symptoms, those with extraesophageal manifestations are some of the most difficult to treat. Histamine antagonists, proton pump inhibitors and antireflux surgery have all been used to treat GERD-related asthma with variable results. Asthma patients who do not respond to high-dose acid suppression may be refractory to all forms of therapy. GERD is the third most common cause of chronic cough, and therapeutic results with acid suppression and antireflux surgery are variable. Posterior laryngitis presents as chronic hoarseness and has been shown to resolve clinically and histologically with acid suppression therapy or antireflux surgery. Results are variable, and controlled trials are lacking.
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PMID:Treatment of extraesophageal manifestations of gastroesophageal reflux disease. 934 89

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 may cause a variety of airway diseases such as asthma, aspiration pneumonia, chronic bronchitis, posterior laryngitis, and ulceration or polyp formation on the vocal cords. Among these asthma seems most common and important clinically. Reflux not only may trigger and aggravate an episode of airway obstruction but also may contribute to nocturnal symptoms. Both clinical and experimental observations suggest that the pathogenetic mechanism may be a vagal reflux following stimulation of lower esophageal receptors and/or microaspiration of gastric acid into the trachea. Diagnosis is usually based on clinical history of asthma and symptoms of gastroesophageal reflux, but in some cases, diagnostic tests such as 24-hour esophageal pH monitoring may be necessary. General measures to avoid reflux and an H2-receptor antagonist together with supportive gastric medications may be the standard treatment. If symptoms persist, proton pump inhibitor may be helpful. Antireflux surgery may provide long-term improvements. Although surgical treatment is indicated only in patients with intractable esophagitis at present, it may be used more commonly through a laparoscopic approach in the near future.
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PMID:[Gastroesophageal reflux and airway disease]. 948 78

Upper airway complications of gastroesophageal reflux occur much less frequently than those abroad to the upper esophageal sphincter; however, laryngitis, laryngeal and/or tracheal stenosis, globus syndrome, oropharyngeal dysphagia, otitis media, sinusitis, and rhinitis can all be associated with significant morbidity and occasional mortality in both adult and pediatric patients. Sudden infant death and apparent life-threatening events, both found only in pediatric patients, are even less frequently associated with gastroesophageal reflux. Today, excellent diagnostic methods are available, such as proximal 24-hour pH probe evaluations or scintigraphy, making proper diagnosis much easier than previously. Although today's medical and surgical methods do not affect the underlying pathophysiology, they are frequently very effective in controlling signs and symptoms, allowing the patients to return to resume their normal life-styles and livelihoods.
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PMID:Upper respiratory tract complications of gastroesophageal reflux in adult and pediatric-age patients. 957 76

H. pylori is found in the stomach of patients with chronic gastritis. The infection is usually transmitted by the gastro-oral route and bacteria could be identified in saliva and dental plaque. An essential cause of chronic laryngitis is gastroesophageal reflux. The aim of the study was to evaluate if a H.pylori-associated chronic laryngitis exists. 38 patients with chronic laryngitis underwent gastroscopy. Biopsies were taken from the gastric antrum and body, lower, middle and upper esophagus. H. pylori was diagnosed by rapid urease test and histology. 14 of the patients (36.8%) were H.pylori-positive, but the bacteria could not be identified between stomach and larynx. 24 patients were H. pylori-negative. Seven patients (18.4%) suffered from esophagitis, six of these patients were H. pylori-negative. The H. pylori-infected patients received triple therapy for one week, in case of esophogitis Omeprazole 20 mg BID was prescribed. Six weeks later a follow-up endoscopy was performed. The eradication rate was 12/14 (85.7%), in all patients with reflux the esophagitis was cured. The laryngitis was clinically and endoscopically unchanged in ten of the twelve (83.3%) patients after successful treatment for H. pylori; in the remaining two patients as well as in the two H. pylori-positive patients the laryngitis was improved. In six out of the seven patients with esophagitis the laryngitis had healed completely and was improved in the remaining patient. It may be concluded that there is no evidence for the existence of H. pylori-associated laryngitis, suggesting that acid reflux is the underlying etiology.
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PMID:[Is chronic laryngitis associated with Helicobacter pylori? Results of a prospective study]. 965 3

We performed a thermographic study to observe any possible interaction between the esophageal acid perfusion and the temperature changes of skin surface in patients with gastroesophageal reflux disease (GERD). Twenty-seven patients with GERD were categorized as group I(globus symptoms with posterior laryngitis) and group II (heartburn and/or regurgitation symptoms). Patients and 6 healthy volunteers underwent Bernstein test (BT) and digital infrared thermographic imaging (DITI) simultaneously. The positive rate for BT in group I and group II was 22.2% and 55.6%, respectively, and the DITI positive rate was 55.6% for group I and 50.0% for group II. None of healthy control were positive in BT or DITI. All subjects with DITI positive were hypothermic. The overall accordance rate between DITI and BT was 69.7%. All group I patients showed a diffuse type, while in group 11, 4 patients showed diffuse type and 5 patients showed localized type (p<0.05). In patients with DITI (+)/BT (-), 83.3% showed diffuse type, whereas equal numbers of diffuse and localized type were noted in patients with DITI (+)/BT (+). In conclusion, add contact with a sensitive mucosa leads to an activation of the sympathetic nervous system in some patients with GERD, inducing skin surface hypothermia.
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PMID:Digital infrared thermographic imaging in patients with gastroesophageal reflux disease. 968 8

The principal mechanism leading to gastro-oesophageal reflux is an increased frequency of transient lower oesophageal sphincter relaxations; other factors are oesophageal hypersensitivity to gastric juice, hiatus hernia, and possible duodenal reflux. Patients with classical symptoms such as heartburn and regurgitation may be treated pharmaceutically combined with life style counselling. If the symptoms have not improved after 6 to 12 weeks, endoscopical examination is performed and, if necessary, 24-hour pH monitoring, barium radiographing and manometry. In the case of atypical symptoms such as dysphagia, laryngitis, asthma and chest pain, there is more reason to pursue diagnostic testing. In patients with dysphagia endoscopy is indicated to exclude malignancy. Drug treatment can be subdivided into antacids, H2 receptor antagonists, cytoprotective agents, prokinetics and proton pump inhibitors. In general practice a step-up approach to treatment is preferable, while for specialist treatment a stepdown approach is more (cost-)effective. Drawbacks of medical treatment are considerable frequency of recurrence of oesophagitis, persistence of regurgitation in 'volume refluxers' and controversial data on the possible development of (pre)malignant lesions of oesophagus and stomach. Surgical treatment is a good alternative for patients with persistent severe regurgitation during medical therapy and for young patients who prefer surgery to lifelong medication. Patients with Barrett's oesophagus should undergo regular endoscopic biopsy surveillance.
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PMID:[Gastroesophageal reflux disease: pathophysiology, diagnosis and drug therapy]. 975 35

Between June 1994 and June 1996, we performed a 24-hour oesophageal pH monitoring in 116 adult patients. A retrospective analysis of the data is hereby presented. The principal indications include a chronic cough, recurrent laryngitis and noncardiac chest pain. In 65.5% of our cases, a pathological gastroesophageal reflux was found during pH monitoring. The symptom-index (SI) concerning the digestive and ENT symptoms did correlate in 1/3 of the cases while it was significant in only 15% of the cases with pulmonary and cardiac symptoms. 24-hour pH monitoring remains the method of choice for the study of gastroesophageal reflux and analysis of the SI is indispensable to evaluate the correlation of symptoms with episodes of reflux.
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PMID:[24-hour esophageal pH monitoring in adults. Apropos of a series of 116 patients]. 988 Sep 84

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


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