Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0017168 (gastroesophageal reflux disease)
 11,783 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Eosinophilic bronchitis is a recently described condition in patients with chronic cough, sputum eosinophilia, normal spirometry and no evidence of bronchial hyperreactivity. The aim of the study was to assess the causes of chronic cough and to identify the prevalence of eosinophilic bronchitis as a cause of chronic cough. Thirty-six patients [mean age 45.4 +/- 14.3 years (range 16-69 years), M/F: 4/32] with an isolated chronic cough lasting for more than 4 weeks were recruited from the outpatient clinic. In all patients, after a full history and physical examination, blood eosinophil count, eosinophilic cationic protein (ECP), serum total and specific IgE levels were measured. Spirometry, methacholine provocation test, skin prick tests, ear, nose and throat examination, induction of sputum and esophageal pH testing were performed. The mean duration of cough was 31.3 +/- 52.3 months. Sputum eosinophilia greater than 3% was present in 12 (33.3%) patients and they were diagnosed as eosinophilic bronchitis. Their induced sputum had a mean eosinophil count of 8.3% and a mean ECP level of 98.5 mg x l(-1), which were higher than the others (P=0.003, both). The diagnosis of the remaining patients were postnasal drip syndrome in eight, gastroesophageal reflux disease in eight, post-infectious cough in two and cough-variant asthma in one patient. In conclusion, eosinophilic bronchitis is an important cause of chronic cough and should be considered in the assessment of patients before regarding them as having idiopathic chronic cough.
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PMID:Eosinophilic bronchitis as a cause of chronic cough. 1281 57

Chronic cough is a debilitating symptom for which patients commonly seek medical attention. Among adult non-smokers who are not taking an angiotensin-converting enzyme inhibitor and have a normal or near normal chest radiograph, postnasal drip syndrome caused by a variety of rhinosinus conditions, asthma and non-asthmatic eosinophilic bronchitis and gastro-oesophageal reflux disease singly or in combination, are the most common diagnoses underlying chronic cough. Pharmacotherapy for chronic cough can be either specific or non-specific. Specific therapy is preferable and the most effective as it is directed at the aetiologies and pathophysiological mechanisms responsible for cough. In contrast, non-specific therapy is used only in limited clinical settings, as it is directed at the symptom rather than underlying aetiologies and aims only to control, rather than eliminate cough.
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PMID:Pharmacotherapy of chronic cough in adults. 1283 32

Chronic rejection (obliterative bronchiolitis) is the single most important cause of chronic allograft dysfunction and late mortality after lung transplantation. As this condition is difficult to prove using biopsy specimens, a clinical term, bronchiolitis obliterans syndrome (BOS) has been in use for >10 yrs to describe the progressive decrease of pulmonary function. However, before diagnosing a patient as having BOS, based on a sustained and progressive decrease in forced expiratory volume in one second and/or forced mid-expiratory flow between 25-75% of forced vital capacity, different confounding factors have to be eliminated. Treatment of BOS mainly consists of an increase or a change in the immunosuppressive drug regimen, which may lead to more pronounced infectious complications. Recently, two new options have become available to treat patients with BOS, treatment of gastro-oesophageal reflux and azithromycin. In the present paper, the authors give an overview of the current data on these two modalities, which may lead to a restoration of the pulmonary function in some of the patients, illustrating once more the fact that bronchitis obliterans syndrome is not always a manifestation of chronic rejection.
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PMID:Is it bronchiolitis obliterans syndrome or is it chronic rejection: a reappraisal? 1568 84

Cough is an essential protective mechanism for the airways and lungs. Cough receptors are situated in the larynx and tracheobronchial tree, and are mediated by rapidly-adapting (irritant) Adelta fibers, although other receptors such as C-fiber receptors may contribute. Cough plasticity and interactions of cough pathways may occur centrally to enhance the cough reflex. The presence of an increased cough reflex as measured by a tussive response to capsaicin or citric acid in patients with a chronic cough indicate that there is sensitisation of the cough reflex. The most common cause of acute cough is that after a common cold, which usually lasts for less than 2 weeks. Cough that persists longer may be due to asthma and its variant forms (cough variant asthma and eosinophilic bronchitis), rhinosinusitis (postnasal drip), gastro-esophageal reflux, bronchiectasis, chronic bronchitis, and angiotensin-converting enzyme (ACE) inhibitor therapy. Chronic persistent cough can contribute to a significant worsening of quality of life measures. Bronchial tumors must be excluded with a chest radiograph. The management of chronic cough includes investigation and treatment of any associated causes, which sometimes leads to control of cough. In a proportion of patients, cough may be idiopathic and remain uncontrolled. Currently-available antitussives such as dextromethorphan or codeine are modestly successful in controlling cough. New antitussives may be developed that act on the sensory receptors or prevent their sensitisation.
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PMID:Pathophysiology and therapy of chronic cough. 1582 40

Eosinophil-associated conditions, such as asthma and eosinophilic bronchitis, have been associated with chronic persistent cough, usually responding to corticosteroid therapy. This case study reports a case of persistent cough associated with gastro-oesophageal reflux (GOR) and hypereosinophilia. Treatment of GOR with proton pump inhibitors and fundoplication did not control the cough. However, high dose prednisolone, but not inhaled corticosteroids, did. The presence of the FIP1L1-PDGFRA fusion gene in myeloid cells was confirmed by fluorescence in situ hybridisation analysis using CHIC2 deletion as a surrogate marker. The cough and other disease features were subsequently suppressed by the tyrosine kinase inhibitor, imatinib. This is the first case of persistent cough caused by hypereosinophilic syndrome characterised by FIP1L1-PDGFRA fusion gene and aberrant tyrosine kinase activity.
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PMID:Cough and hypereosinophilia due to FIP1L1-PDGFRA fusion gene with tyrosine kinase activity. 1638 54

The quality of doctor-patient communication is critical for the practice of medicine. Studies show that effective communication results in patient satisfaction and improved compliance. To better understand one aspect of this complex phenomenon we estimated the ability of people to comprehend 11 commonly used medical terms. We used multiple choice questions in a telephone survey of 1167 Icelanders aged 16-75 years. Results (% of participants with correct answers): Gastroesophageal reflux (72), emphysema (25), steroids (40), one tablet twice a day (79), side effects (67), bronchitis (68), white blood cells (56), erythrocyte sedimentation rate (33), diabetes mellitus (72), antibiotics (87), chronic obstructive pulmonary disease (42). Variables associated with better comprehension were: Female gender (better in 7/10 questions), university degree (10/10) and high income (9/10). Decision tree analysis showed that education had the most impact. The youngest participants (age 16-24) had the worst outcome in seven out of 10 questions. The results define certain medical terms that require more careful explanation than others. They also indicate that those of young age, low socioeconomic status and less educated require more help in understanding medical terms. Interestingly, 21% of participants failed to understand a very simple medication order, emphasizing the importance of explaining these in detail. The data may also have implications for informed consent. A larger study exploring the public comprehension of multiple medical terms should be considered.
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PMID:[Public comprehension of medical terminology.]. 1681 14

Gastroesophageal reflux disease has frequently been implicated in a wide variety of complications beyond the esophagus. These so-called "extraesophageal" disorders range from diseases of the respiratory tract, such as asthma and bronchitis, to more remote sites and conditions such as otitis and dental erosion. Many articles proposing a link between reflux disease and a multitude of extraesophageal complications have been published, but indisputable evidence that these conditions are caused by reflux disease is rare. Much of the support for a link between reflux disease and a number of extraesophageal complications is based on the observation that reflux disease frequently coexists with other disorders. A causal link is difficult to prove, however, and this review aims to critically evaluate the available evidence, looking, where possible, at longitudinal studies, expert diagnoses, and response to acid-suppressive therapy as a means of determining the true relationship between GERD and its putative extraesophageal complications.
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PMID:The frontiers of reflux disease. 1700 20

Gastroesophageal reflux is a potential cause of allograft dysfunction after lung transplantation due to microaspiration, lung inflammation, and development of bronchitis obliterans. A 16-year-old Japanese boy who had been suffering from interstitial lung disease received bilateral lung transplant from a braindead donor in the United States. Three months after lung transplantation, his lung function has not increased as expected. Spirometory revealed forced vital capacity (FVC) of 1.11 l (33% of predicted) and forced expiratory volume in one second (FEV1.0) of 0.81 l (28% of predicted). All possible etiologies, including infection, acute and chronic rejection, and other abnormalities were investigated. The only positive finding was the presence of gastroesophageal reflux. He first underwent pyroloplasty which did not improve lung function. Twenty-four-hour pH monitor performed after surgery revealed frequent gastroesophageal reflux. He eventually underwent laparoscopic fundoplication 9 months after initial lung transplantation. His lung function gradually improving after fundoplication, an FVC was 1.56 l (44% of predicted) and FEV1 was 1.25 l (33% of predicted).
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PMID:[Gastroesophageal reflux as a cause of pulmonary dysfunction after lung transplantation]. 1792 4

Cough is a common presenting symptom of many patients managed by allergists. For patients with chronic cough who are nonsmokers, have normal spirometry, and are not being treated with an ACE inhibitor, diagnosis usually focuses on differentiation between postnasal drip syndrome, asthma, gastroesophageal reflux disease, and nonasthmatic eosinophilic bronchitis, alone or in combination. Patients with severe COPD or GERD should be referred to appropriate specialists for those conditions. The management of conditions commonly treated by allergists (e.g., allergic rhinitis, asthma, sinusitis) follows the recommendations of current guidelines and/or practice parameters.
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PMID:Chronic cough: the allergist's perspective. 1795 6

Despite a meticulous protocol involving diagnostic testing and trials of empirical therapy, there may be no obvious cause for a chronic cough in up to 42% of cases referred for specialist evaluation. In some cases, failure to consider causes that include the asthma/eosinophilic airway syndromes such as eosinophilic bronchitis and atopic cough, or nonacid gastroesophageal reflux disease may explain diagnostic failure. However, a distinct group of patients may be considered to have true idiopathic cough. Current published evidence suggests a certain patient phenotype, namely, middle-aged females with prolonged nonproductive cough and cough reflex hypersensitivity. Almost nothing else is known about this clinical entity and currently no specific therapy exists.
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PMID:Does idiopathic cough exist? 1800 3


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