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

Pediatric sinusitis can be a challenging disease to treat, whether by a primary care physician or an otolaryngologist. When initial appropriate therapy fails to resolve the disorder, frustration may develop on the part of the patient, the family, and the physician. In addition to treatment with appropriate antibiotics for a sufficient length of time, other associated conditions that can exacerbate the condition must be considered and addressed as necessary. These may include viral upper respiratory infections, allergic rhinitis, immune deficiencies, asthma, and gastroesophageal reflux disease. Unless all associated conditions have been optimized, treatment of chronic sinusitis will often be unsuccessful. Recognition that there may be another factor contributing to the patient's continuing illness should prompt appropriate evaluation and occasionally referral to appropriate specialists. Except for the unusual pediatric patient with a truly anatomic disorder or an underlying chronic illness such as cystic fibrosis, proper medical management will almost always resolve chronic sinusitis.
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PMID:Medical management of pediatric chronic sinusitis. 1105 14

Gynaecological malignancies affect the respiratory system both directly and indirectly. Malignant pleural effusion is a poor prognostic factor: management options include repeated thoracentesis, chemical pleurodesis, symptomatic relief of dyspnoea with oxygen and morphine, and external drainage. Parenchymal metastases are typically multifocal and respond to chemotherapy, with a limited role for pulmonary metastatectomy. Pulmonary tumour embolism is frequently associated with lymphangitic carcinomatosis, and is most common in choriocarcinoma. Thromboembolic disease, associated with the hypercoagulable state of cancer, is treated with anticoagulation. Inferior vena cava filter placement is indicated when anticoagulation cannot be given, or when emboli recur despite adequate anticoagulation. Palliative care has a major role for respiratory symptoms of gynaecological malignancies. Treatable causes of dyspnoea include bronchospasm, fluid overload and retained secretions. Opiates are effective at relieving dyspnoea associated with effusions, metatases, and lymphangitic tumour spread. Non-pharmacological therapies include energy conservation, home redesign, and dyspnoea relief strategies, including pursed lip breathing, relaxation, oxygen, circulation of air with a fan, and attention to spiritual suffering. Identification and treatment of gastroesophageal reflux, sinusitis, and asthma can improve many patients' coughs. Chest wall pain responds to local radiotherapy, nerve blocks or systemic analgesia. Case examples illustrate ways to address quality of life issues.
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PMID:Pulmonary medicine and palliative care. 1135 3

In the study reported, the authors examined risk factors for repeated hospital admissions for asthma in a rural/suburban setting. Charts of patients who were hospitalized two or more times with the diagnosis of asthma between June 1991 and January 1998 were reviewed. A questionnaire was completed for each admission for 65 patients. The results demonstrated an equal male-to-female ratio, with a mean age of 27 years. Hispanics represented 12% of the patients although they accounted for only 2.5% of the general population in the area under study. The mean number of hospital admissions was 3.2. A history of depression existed in 25% of the patients. Noncompliance was admitted in 38%. Twenty-five percent were active tobacco smokers. Acknowledged triggers of asthma included viral infections (74%), exercise (50%), weather conditions (43%), dust (38%), cats (36%), sinusitis (32%), pollen (32%), gastroesophageal reflux disease (31%), dogs (30%), smoke (28%), and emotional stress (15%). Medications at time of admission included albuterol (98%), salmeterol xinafoate (26%), theophylline (38%), ipratropium bromide (55%), nedocromil sodium (20%), cromolyn sodium (35%), prednisone (49%), and inhaled corticosteroids (69%). Ninety-five percent had access to a primary care physician. Fifty-seven percent had a pulmonary and 11% had an allergy consult. These data suggest that patients in rural/suburban areas with repeated hospitalizations for asthma have a high probability of noncompliance, depression, and allergenic triggers. Gastroesophageal reflux was a common recognized trigger. Inhaled steroids were underused, whereas ipratropium and theophylline were overused. Bilingual education on asthma and triggers and social support are necessary even in rural healthcare settings without a large minority population.
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PMID:A retrospective study of risk factors for repeated admissions for asthma in a rural/suburban university hospital. 1140 60

Cough is a common symptom in office practice. Though troublesome, it serves to maintain normal function of respiratory tract. Chronic or recurrent cough may be caused by variety of diseases, asthma being the most common amongst them. Cough, wheeze and breathlessness are classical features of asthma syndrome. Many diseases may lead to this syndrome. Asthmatic children present with cough of variable intensities and patterns. At times, wheeze and breathlessness may not be clinically apparent. It was well known that all that wheezes is not asthma but now it is well understood that every asthmatic child does not wheeze. In an acute attack of asthma, cough often starts at the end of wheezing episode. It leads to expulsion of thick, stringy mucus often in the form of casts. Though cough is a minor symptom during acute attack, it ensures removal of secretions and avoid complications. Cough is a prominent symptom in persistent asthma especially between acute exacerbations. Episodic nocturnal cough may be the only symptom of chronic asthma. Children with cough variant asthma do not wheeze. It is postulated that they have milder degree of airway hyperresponsiveness and higher wheezing threshold. However, they show all the characteristics of asthma on laboratory tests. Cough represents bronchial hyperresponsiveness and is not a measure of asthma. Hence it may be caused by many diverse etiologies such as gastroesophageal reflux, enlarged adenoids, sinusitis or tropical eosinophilia. Cough in such conditions mimicks asthma and relevant tests may be necessary for proper diagnosis.
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PMID:Cough and asthma. 1141 73

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

Acute exacerbation of chronic bronchitis (AECB) is a very common condition, which presents with deteriorating sputum production and dyspnoea in a patient with pre-existing COPD or chronic bronchitis. As these symptoms are relatively non-specific and also the presenting feature of a wide range of other conditions, the physician should carefully consider the differential diagnosis before deciding on whether or not a patient indeed has AECB. The differential diagnosis can be summarised as pneumonia, pneumothorax, cardiac failure/cor pulmonale, bronchiectasis, asthma, tuberculosis, sinusitis and other forms of upper respiratory tract sepsis, diffuse panbronchiolitis, lung cancer, gastro-oesophageal reflux, the presence of a foreign body in the airway, melioidosis, and lung abscess. This article aims to discuss these conditions, with brief presentation of clinical cases, in the evaluation of differential diagnosis of AECB.
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PMID:Solutions for difficult diagnostic cases of acute exacerbations of chronic bronchitis. 1158 3

In this article, the literature regarding the effects of gastroesophageal reflux disease (GERD) on otolaryngologic disorders in infants and children is reviewed. We specifically focus on studies that suggest how GERD may be associated with sinusitis, cough, laryngitis, airway obstruction, apnea, recurrent croup, laryngomalacia, stridor, and subglottic stenosis in children.
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PMID:Update on gastroesophageal reflux disease in pediatric airway disorders. 1174 30

A small effect (1 cm) of inhaled corticosteroids (ICS) on the 1-year growth of asthmatic children was observed in studies published during the 1990s. A high volume of literature published during the past year confirmed mild growth suppression at one year, but provided information on the effects of longer-term treatment. These developments are important, since the effect was previously unknown and the findings have major implications for asthma caregivers and the communication that they have with asthmatic children and their parents. The possibility that this is an idiosyncratic effect received conflicting support. These studies collectively provide support for ICS use and ease the minds of caregivers, parents, and children. The risk of growth retardation can be lessened and managed by the employment of several simple strategies: (1) monitor growth; (2) use the minimal effective dose; (3) optimize steroid-sparing strategies (smoke and allergen environmental controls, vaccinate for influenza, diagnose and treat rhinitis, sinusitis, and gastroesophageal reflux disease, use add-on therapy with a second controller rather than doubling the ICS dose if control is inadequate); and (4) use spacing devices (for pressurized metered-dose inhalers) and mouth rinsing. Open and accurate communication with patients and parents about this possible effect is essential to minimize nonadherence. Ultimately, no child whose disease severity warrants ICS therapy should be denied the tremendous benefits that this therapy can provide because of relatively minor concerns about growth effects.
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PMID:Growth effects of asthma and asthma therapy. 1175 23

The importance of discovering and treating hidden factors that exacerbate asthma as specified in component 2 of the 1997 National Heart Lung and Blood Institute (NHLBI) expert panel report guidelines has been overshadowed by a disproportionate emphasis on component 3 (pharmacologic therapy). This has resulted in disease management models that consist of a two-step classification-treatment system in which little regard is given to the evaluation of underlying contributing factors. In addition to the identification of environmental allergens, an aggressive evaluation of other potential factors that may contribute to asthma is essential to optimal, efficient, and cost-effective asthma care. These factors include sinusitis, allergic rhinitis, and gastroesophageal reflux. Diagnostic testing for sinusitis and/or gastroesophageal reflux is warranted even in the absence of suggestive signs or symptoms for many patients with asthma classified in the moderate and severe ranges by NHLBI guidelines. A disease management algorithm for gastroesophageal reflux disease in the patient with asthma is proposed.
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PMID:Hidden factors in asthma. 1177 90

Sinusitis and asthma often coexist in patients. In fact, these airways disorders are similar histologically, with tissue eosinophils, increased glandular tissue, and edema. Medical or surgical therapy for sinusitis often greatly improves asthma, suggesting that sinusitis may exacerbate asthma. Possible mechanisms by which asthma could be worsened by sinus disease include neural reflex pathways and interference with the important nasal functions of heating, humidification, and filtration. Health professionals treating asthmatic patients should consider sinusitis as a possible underlying cause, in addition to other triggers (e.g., allergic rhinitis and gastroesophageal reflux disease).
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PMID:Sinusitis and asthma: associated airway diseases. 1189 46


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