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

Over one half of the cases of chronic severe childhood asthma, refractory to conventional therapy and without other over aetiology, are associated to gastroesophageal reflux (GER). The aetiopathogenic role of GER in asthma is uncertain, and is only confirmed when therapy of the former induces evident improvement of the latter. We have instituted medical antireflux therapy over two years in 17 patients (17.6%) became asymptomatic after less than three months of therapy, and a further four (23.5%) by the sixth month. Seven patients showed clinical improvement by the third month (41%) and even a greater one by the sixth month, only very slight symptoms persisting thereafter. In three cases (17.6%) there was no improvement after two years of outcome of asthma and the persistence or not of pathological between the outcome of asthma and the persistence or not of pathological 24-hour pHmetry. On the contrary. macroscopic oesophagitis disappeared in the cases of asthma with good outcome, but persisted in all the cases who remained symptomatic. In conclusion, we consider that medical management of GER associated to asthma should be maintained for at least six months (if the clinical course so permits) before considering a surgical indication.
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PMID:[Asthma and gastroesophageal reflux. Outcome of asthma after longterm medical treatment of the reflux]. 198 May 81

The Expert Panel Report 2. Guidelines for the Diagnosis and Management of Asthma (1) begins its section on controlling factors that precipitate or worsen asthma with the statement: "For successful long-term asthma management, it is essential to identify and reduce exposures to relevant allergens and irritants and to control other factors that have been shown to increase asthma symptoms and/or precipitate asthma exacerbations." The presence of allergy to indoor allergens and certain seasonal fungal spores has been found to be a risk factor for asthma in epidemiologic studies around the world. Generally between 70% and 85% of asthmatic populations studied have been reported to have positive skin-prick tests. Exposure of allergic patients to inhalant allergens increases airway inflammation, airway hyper-responsiveness, asthma symptoms, need for medication, severe attacks, and even death due to asthma. Environmental tobacco smoke exposure has been shown to increase the prevalence of childhood asthma and to increase asthma symptoms and bronchial hyperresponsiveness while reducing pulmonary function in children chronically exposed. Exposure to other indoor irritants, largely products of unvented combustion, has also been found to increase asthma symptoms. Outdoor air pollution increases asthma symptoms; levels of specific pollutants correlate with emergency room visits and hospitalization for asthma. Rhinitis/sinusitis and gastroesophageal reflux are commonly associated with asthma, and treatment of these conditions has been shown to improve asthma. In patients sensitive to aspirin and nonsteroidal anti-inflammatory drugs or metabisulfites, exposure to these agents can precipitate severe attacks of asthma. Viral infections are common causes for exacerbations of asthma. Infections with Mycoplasma pneumoniae and Chlamydia pneumoniae contribute to acute exacerbations and perhaps to long-term morbidity, as well. This chapter will discuss preventive and therapeutic measures that have been found effective in reducing the impact of aggravating or precipitating factors in patients with asthma.
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PMID:Allergen and irritant control: importance and implementation. 1068 68

Gastroesophageal reflux (GER) and asthma occur together frequently. The relationship has been recognized for more than 2,000 years but has not been appreciated until recently. Attempts to determine the number of asthmatics that currently have GER (prevalence) have shown a higher-than-expected prevalence. Of the approximately 200 published studies on the relationship between GER and asthma, the true prevalence of GER in asthmatics, however, can be estimated from fewer than 20 of the studies. These studies, which comprise highly selected referred populations, are unlikely to reflect the overall population of patients with asthma. Nevertheless, the estimated prevalence of GER in asthmatics is between 60-80% in adults and 50-60% in children. No attempts have been made to determine the incidence of GER in asthmatics. To identify asthmatics who develop GER over time would be a formidable task, requiring decades of close follow-up of asthmatics who do not now have GER. Despite the lack of data on the incidence of GER, data on the prevalence raise an important issue: If the prevalence of GER in adult asthmatics is similar to the prevalence of GER in child asthmatics, what is the true incidence of GER? There are two potential answers: (1) all of the child asthmatics with GER grow up to become the adult asthmatics with GER (GER incidence = 0%); and (2) some child asthmatics with GER outgrow either the GER or the asthma; some adults with asthma develop GER while others with GER develop asthma (low, medium, or high incidence depending on the numbers). It is not unreasonable to suspect that some child asthmatics with GER become adult asthmatics with GER, and that children with GER who apparently "outgrow" their asthma surface later as adults with both asthma and GER. Because most children leave their pediatricians after adolescence, the information required to demonstrate continued asthma or GER is lost. As a result, the medical community sees two completely different populations, each with very similar conditions: childhood asthma with GER and adult asthma with GER. If the high prevalence of GER in asthmatics is clinically relevant, it should be readily explainable. We suggest that the GER/asthma relationship consists of a self-propagating situation whereby reflux aggravates asthma, which in turn induces further reflux. In the early course of the disease, asthma may not be apparent, as aspiration-induced pulmonary symptoms may occur very infrequently-perhaps once or twice a year. With time, however, aspiration may become more frequent, and the pulmonary tree may become hypersensitive. The individual may be diagnosed as having asthma. The pulmonary tree becomes increasingly hypersensitive, to a variety of stimuli. In such a scenario, the initial contribution of acid aspiration is no longer apparent, as the primary focus is on the asthma. In any individual patient, the emphasis may be placed on the GER if reflux symptoms predominate or on asthma if pulmonary symptoms predominate. The result is confusion over whether a patient with GER has asthma or whether a patient with asthma has GER. The unending debate about whether GER is a cause of the asthma or a result of the asthma becomes the focus of attention. At such a point, the question of whether GER exists in asthmatics or whether pulmonary symptoms exist in refluxers is irrelevant. For the individual patient, gastric contents refluxed into the pulmonary tree is an undesirable event, whether cause or effect, and it is up to the physician to determine how such events can be stopped.
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PMID:Gastroesophageal reflux disease and asthma. 1077 68

Hospital admissions for childhood asthma have increased during the past few decades. The aim of this study was to describe the need for mechanical ventilation for severe asthma exacerbation in children in Finland from 1976 to 1995. We reviewed medical records and collected data retrospectively from all 5 university hospitals in Finland, thus covering the entire population of about 5 million. The endpoints selected were the number of admissions and readmissions leading to mechanical ventilation, duration of stay in the hospital, and mortality. Moreover, asthma medications prescribed prior to admission and administered in the intensive care unit (ICU), as well as the etiology of the exacerbation associated with mechanical ventilation were examined. Mechanical ventilation was required in 66 ICU admissions (59 patients). This constituted approximately 10% of all 632 admissions for acute asthma to an ICU. The number of admissions decreased from 1976 to 1995: 41 admissions between 1976 and 1985 vs. 25 admissions during the next 10-year period. The mean age at admission to the ICU was 3.6 years, and 46% of the patients were boys. Prior to the index admission, 70% of the patients had used asthma medication such as oral bronchodilator (50%), inhaled bronchodilator (20%), theophylline (38%), inhaled glucocorticoid (18%), oral glucocorticoid (5%), and cromoglycate (7%). Respiratory infection was by far the most common cause of all the exacerbations (61%), followed by food allergy (8%) and gastroesophageal reflux (3%). In 28% of cases the cause of the severe asthma exacerbation could not be identified. In the mechanically ventilated patients readmissions occurred 38 times between 1976 and 1985 vs. 5 times between 1986 and 1995. Five of the patients who received mechanical ventilation died, and in 3 of these patients asthma was the event causing death. In conclusion, there has been decrease in the number of first and repeat ICU admission for asthma requiring mechanical ventilation between 1970 and 1995. This trend occurred despite a simultaneous 5% yearly increase in hospital admissions for childhood asthma during these 2 decades.
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PMID:Mechanical ventilation in children with severe asthma. 1138 71

Understanding the role of inflammation in childhood asthma has led to major changes in the approach to management of this disease. Based on the guidelines from the NIH, inhaled long-term control medications that target the underlying inflammatory processes in asthma are now recommended as the mainstay of drug treatment. Long-term control medications are recommended for all children who have asthma symptoms that occur more frequently than twice weekly or nocturnal symptoms more than twice monthly. Environmental control measures to decrease allergen exposure are important, as is attention to sinusitis and GER. The main impediment to improved asthma care is poor patient compliance. Many patients do not understand the role and importance of prophylactic medications in asthma treatment. Further, inconvenient dosing regimens, difficulties with metered-dose inhalers, and fear of potential side effects have all contributed to poor patient compliance. Increased efforts at patient education are needed to improve adherence to asthma plans. These efforts at improving patient compliance, along with improved physician adherence to the guidelines from the NIH, are needed to decrease the morbidity and mortality of childhood asthma.
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PMID:Asthma in the school-aged child. 1260 Jan 35

Asthma in adults is associated with comorbidities such as obesity, gastro-oesophageal reflux, dysfunctional breathing and mental disorders. Herein, we provide an overview of the current state of evidence on these comorbidities in childhood asthma. The prevalence, known mechanisms and possible treatment options for each comorbid condition will be discussed. Obesity is an increasing health problem in children, but its relationship with asthma remains unclear. Allergic rhinitis is a very common comorbidity in asthma, both in children and in adults, but its effect on childhood asthma severity has not been studied. The prevalence and treatment options of dysfunctional breathing, a known comorbidity in adult asthma, have not yet been studied in paediatric asthma. Food allergies appear to cause more severe reactions in patients with asthma. Depressive disorders are more prevalent in childhood asthma than in healthy children, but seem to be poorly recognised and treated in children. Although gastro-oesophageal reflux is commonly thought to be a comorbid disease complicating asthma, it remains uncertain whether treatment improves asthma control. In conclusion, knowledge of asthma comorbidities in childhood is sparse. Further studies are urgently needed to identify the prevalence, and, more importantly, the effects of these comorbidities and their treatment on the degree of asthma control in children.
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PMID:Comorbidities of asthma during childhood: possibly important, yet poorly studied. 2093 Feb 1

Although evidence is emerging that the prevalence of Helicobacter pylori (H. pylori) is declining in all age groups, the understanding of its disease spectrum continues to evolve. If untreated, H. pylori infection is lifelong. Although H. pylori typically colonizes the human stomach for many decades without adverse consequences, children infected with H. pylori can manifest gastrointestinal diseases. Controversy persists regarding testing (and treating) for H. pylori infection in children with recurrent abdominal pain, chronic idiopathic thrombocytopenia, and poor growth. There is evidence of the role of H. pylori in childhood iron deficiency anemia, but the results are not conclusive. The possibility of an inverse relationship between H. pylori and gastroesophageal reflux disease, as well as childhood asthma, remains a controversial question. A better understanding of the H. pylori disease spectrum in childhood should lead to clearer recommendations about testing for and treating H. pylori infection in children who are more likely to develop clinical sequelae.
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PMID:Consequences of Helicobacter pylori infection in children. 2104 52

Asthma is the most common chronic disease in children. Prevalence has increased in the past 2 decades and has reached a plateau of approximately 9% of children in the United States, affecting about 6.7 million children. The increased prevalence of childhood asthma has paralleled the increased prevalence in childhood obesity. Changes in diet have also been implicated in the increased prevalence of asthma, among other risk factors. The main symptoms of asthma (ie, wheezing, coughing, and chest tightness) require medical evaluation and monitoring. The cornerstone of asthma management is medication therapy, frequently consisting of inhaled bronchodilators and corticosteroids and, when needed, therapy of corticosteroids by mouth. As part of the multidisciplinary management of this chronic disease, nutrition assessment and follow-up in childhood asthma is necessary to identify and address relevant nutrition-related problems. These problems can involve food-medication interactions, obesity, gastroesophageal reflux disease, food allergies, and other issues; therefore, individualized medical nutrition therapy is warranted. Finally, counseling to achieve a healthy balanced diet is recommended for overall health and weight management. A recent but small number of descriptive investigations agree that adherence to a Mediterranean dietary pattern can be associated with a decreased risk of current asthma symptoms in children. Although this evidence is promising, food interventions are required to substantiate an evidence-based foundation for medical nutrition therapy in childhood asthma. At this time, there is no known health risk if a Mediterranean diet is adopted.
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PMID:A medical nutrition therapy primer for childhood asthma: current and emerging perspectives. 2170 84

Objectives. To assess the induced sputum substance P (ISSP) levels in children having difficult-to-treat asthma (DA) with and without gastroesophageal reflux (GER). We aimed also to evaluate the association of GER with childhood DA, relationship of GER severity with childhood asthma control test (C-ACT), FEV(1), peak expiratory flow (PEF) variability, and ISSP. Finally, we tried to evaluate esomeprazole treatment effect on C-ACT and FEV(1) in children with DA. Methods. Spirometry, C-ACT, upper gastrointestinal endoscopy, and ISSP measurement were done for children with DA compared to healthy controls. Results. ISSP was high in DA with higher levels in the group having associated GER. In the latter group, ISSP and C-ACT improved significantly after esomeprazole treatment while FEV(1) and PEF variability did not improve. Reflux severity was positively correlated with ISSP and negatively correlated with FEV(1). Conclusions. GER was found in 49% of our patients with childhood DA. Very high ISSP levels in children with DA may be used as a marker for presence of GERD. Esomeprazole therapy improved asthma symptoms but did not improve lung function.
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PMID:Induced Sputum Substance P in Children with Difficult-to-Treat Bronchial Asthma and Gastroesophageal Reflux: Effect of Esomeprazole Therapy. 2225 35

Helicobacter pylori (H. pylori) infection is etiologically associated with gastric cancer and peptic ulcer diseases which are both important public health burdens which could be largely eliminated by H. pylori eradication. However, some investigators urge caution based on the hypothesis that eradication of H. pylori may result in an increase in the incidence of gastroesophageal reflux disease, esophageal adenocarcinoma, and childhood asthma. The ethnic Malays of northeastern Peninsular Malaysia have long had a low prevalence of H. pylori infection and, as expected, the incidence of gastric cancer and its precursor lesions is exceptionally low. The availability of a population with a low H. pylori prevalence and generally poor sanitation allows separation of H. pylori from the hygiene hypothesis and direct testing of whether absence of H. pylori is associated with untoward consequence. Contrary to predictions, in Malays, erosive esophagitis, Barrett's esophagus, distal esophageal cancers, and childhood asthma are all of low incidence. This suggests that H. pylori is not protective rather the presence of H. pylori infection is likely a surrogate for poor hygiene and not an important source of antigens involved in the hygiene hypothesis. Helicobacter pylori in Malays is related to transmission from H. pylori-infected non-Malay immigrants. The factors responsible for low H. pylori acquisition, transmission, and burden of H. pylori infection in Malays remain unclear and likely involves a combination of environmental, host (gene polymorphisms), and strain virulence factors. Based on evidence from this population, absence of H. pylori infection is more likely to be boon than a bane.
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PMID:Helicobacter pylori infection--a boon or a bane: lessons from studies in a low-prevalence population. 2360 96


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