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

Cough is a symptom frequently encountered by the otolaryngologist--head and neck surgeon. Although most coughs are self limited, chronic cough often proves to be a frustrating problem. Seventy-two infants and children under age 16 with a normal chest radiogram have now been evaluated for chronic cough persisting for longer than 4 weeks. Cough-variant asthma was the most common cause of cough, followed by sinusitis, gastroesophageal reflux, aberrant innominate artery, psychogenic cough, and subglottic stenosis. Chronic cough is best managed by first following an individualized diagnostic protocol designed to determine the etiology of the cough. This is followed by specific therapy to treat the underlying disorder. Children with persistent cough and normal chest radiograph are best served when referred promptly for evaluation by an otolaryngologist when the primary physician's initial efforts at diagnosis and treatment are not effective. Endoscopy is underutilized in practice and its importance understated in the literature. It is particularly helpful in establishing a precise diagnosis in infants under 18 months of age.
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PMID:Chronic cough in infants and children: an update. 204 39

Globus pharyngeus and post-nasal drip are common patient complaints encountered in general otolaryngologic practice. Although these complaints have been traditionally ascribed to stress and sinusitis respectively, recently it has been suggested that they are secondary to gastroesophageal reflux, either by a direct effect on the pharynx and posterior larynx or by referred sensation along vagal pathways from the lower esophagus. This reflux could alter the motor tone of the laryngoesophagus and contribute to the pathogenesis of dysphonias. If globus and post-nasal drip are secondary to gastroesophageal reflux, then reduction of stomach pH should reduce the frequency and severity of these complaints. To test these hypotheses in a clinical setting, a large population of patients with vocal disorders was analyzed for the incidence of these complaints. Twenty healthy patients with globus and/or postnasal drip were then entered in a double-blind random placebo-controlled study to assay the efficacy of cimetidine in treating these complaints. No significant difference was found between cimetidine and placebo.
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PMID:A double-blind controlled study of the efficacy of cimetidine in the treatment of the cervical symptoms of gastroesophageal reflux. 219 5

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

The latest developments in the understanding of the etiopathogenesis of bronchial asthma in childhood are briefly described. The Authors emphasize the central role of inflammation and different cell types recruitment and distinguish three phases: early, late and chronic inflammation. Current views on bronchial hyperreactivity and the vicious circle represented by causative allergic and extra-allergic factors are discussed. Clinically, the role of respiratory infections, sinusitis, gastroesophageal reflux, and so-called asthma-equivalent symptoms (recurrent laryngospasm, asthma-equivalent chronic cough) are also discussed. Lastly, the pharmacologic activity of the main classes of drugs on the various stages of asthmatic response are reviewed and the rationale for appropriate use is presented.
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PMID:[Allergic bronchial asthma in childhood: etiopathogenic, clinical and therapeutic considerations]. 268 50

Chronic cough is a common symptom in many different disease processes. Because the most effective way to eliminate a chronic cough is to identify and treat the underlying disease, the physician must approach the paediatric patient based on his or her knowledge of the differential diagnosis. The most common causes of cough in children are upper respiratory tract infections, asthma, rhinitis, sinusitis, and gastroesophageal reflux. By using a systematic approach, the cause of a chronic cough can almost always be found, and the cough successfully treated. Asthma is the cause of most undiagnosed chronic coughs but sinusitis, rhinitis, and gastroesophageal reflux must also be considered in difficult patients.
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PMID:Treatment options in the child with a chronic cough. 768 7

Asthma is increasing in prevalence and morbidity worldwide. Worsening of asthma symptoms during sleep and following exercise is an important component of this morbidity. Better recognition and management of nocturnal asthma and exercise-induced broncho-constriction should lead to improved outcomes. Measures to alleviate nocturnal asthma include elimination of exposure to allergens, use of measures to control contributing factors (rhinitis, sinusitis, gastroesophageal reflux, sleep apnea), maximization of the dosage of daytime asthma medications, and appropriately timed use of medications such as a long-acting inhaled beta 2 agonist, a once-daily sustained-release theophylline product, and an oral corticosteroid. Bronchoconstriction after exercise can be decreased by physical conditioning, warm-up exercises, wearing of a face mask in cold weather, postponement of exercise until at least 2 hours after a meal, and pretreatment with an inhaled beta agonist. Pretreatment with inhaled cromolyn sodium (Intal), nedocromil sodium (Tilade), or ipratropium bromide (Atrovent) may be added if necessary.
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PMID:Nocturnal asthma and exercise-induced bronchospasm. Why they occur and how they can be managed. 777 48

The occurrence of sinusitis and middle ear effusions has frequently been attributed to the obstruction of the sinus ostia and/or eustachian tube. In the intensive care unit setting, edema caused by the irritation from nasogastric, nasotracheal and orotracheal tubes has been associated with this pathology and has been responsible for occult sepsis in this population. Our investigation was performed to determine the risk of chronic otitis media with effusion necessitating myringotomy with tympanostomy tubes among tracheotomized, ventilator dependent children in a consecutive series of children admitted to our recently created stable ventilator unit. We retrospectively reviewed the medical records of all tracheotomized, chronically ventilator dependent children < 48 months of age who had been hospitalized in this unit from the initial opening in September 1990 to January 1993. Data collected consisted of patient demographics, gestational age, cognitive abilities, age at onset of mechanical ventilation, age at tracheostomy, age at myringotomy, presence of nasogastric and gastroenterostomy tubes and evidence of gastric-esophageal reflux. All children underwent a tracheostomy procedure subsequent to the onset of mechanical ventilation. Of these patients, 9/12 (75%) later required myringotomy with tympanostomy tube placement following the occurrence of chronic otitis media with effusion. Ventilation tubes for chronic otitis media with effusion were not required in 3 patients. Using a case control study design, we examined the need of myringotomy tubes for children requiring continuous mechanical ventilation versus those requiring night-time only ventilation. The risk of myringotomy tubes in the continuously ventilated group (9/9) was significantly greater than the risk in the intermittently ventilated group (0/3) P < 0.01.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Chronic otitis media requiring ventilation tubes in tracheotomized ventilator dependent children. 783 30

Cough is one of the most prevalent symptoms of bronchopulmonary diseases. If cough persists ( > 6 weeks), further workup is mandatory. The most common causes of persistent cough in nonsmokers presenting with a normal CXR are postnasal drip due to chronic rhinitis-sinusitis, cough equivalent asthma or gastroesophageal reflux. The response to empirical therapy may confirm one of these etiologies. Other causes of chronic cough need further extensive workup involving radiologic, functional and endoscopic procedures.
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PMID:[Cough--work-up and therapy]. 852 38

The evidence that links gastroesophageal reflux (GER) and sinusitis to asthma from a pathophysiologic viewpoint is reviewed. The clinical relationships are explored in disease prevalence and studies assessing whether interventions that treat either GER or sinusitis improve asthma. An overview of patient evaluation and treatment is presented.
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PMID:Gastroesophageal reflux and sinusitis in asthma. 856 8

In almost no other field is the gap between diagnostic and therapeutic knowledge and its general application so great as it is in asthma. As previously mentioned, most asthma deaths are preventable. Identification of high-risk patients, intensive education about asthma (purpose of each medication; necessity of compliance, particularly with inhaled corticosteroids; proper use of inhalers and spacer devices; home use of PEFR meter), self-treatment of mild or moderate attacks with oral corticosteroids, and written crisis plan for severe attacks explicitly telling the patient what to do and whom to call are necessary. In addition, all potential exacerating factors should be eliminated (external triggers, medication, gastroesophageal reflux, allergic rhinitis, and sinusitis). High doses of inhaled corticosteroids should be provided to all those patients, and referral to a specialist is highly recommended for such high-risk patients.
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PMID:Emergent management of acute asthma. 869 21


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