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

We studied the effects of positional treatment and cisapride (a new prokinetic agent) on the incidence and duration of gastroesophageal reflux in 22 infants (4-26 weeks old) in asleep, awake, fasted, and postcibal periods. In addition to gastroesophageal reflux (assessed by 24-h continuous esophageal pH monitoring), all infants presented with a disrupted irregular sleep pattern ("respiratory dysfunction") (assessed by a simultaneously performed cardiopneumogram). Reflux was particularly prominent during the sleep and fasted periods. Investigations (cardiopneumogram and esophageal pH monitoring) in the study population were repeated under treatment conditions (cisapride) after 13-16 days. All pH monitoring data with regard to the total investigation time decreased significantly (p less than 0.001). The treatment-related differences were largest in the asleep and fasted periods, but treatment data were not completely within normal ranges (established in age-matched asymptomatic infants), as they were for the awake periods. Associated symptoms of gastroesophageal reflux (belching, cough, nocturnal wheezing, irritability, and restlessness at night) were evaluated before and during treatment by history. A combination of positional treatment and cisapride seemed effective (objectivated by pH monitoring data and clinical improvement); cisapride did not cause adverse reactions. The disrupted sleep pattern improved significantly or disappeared (p less than 0.001) in all infants. These data suggest that in a number of young infants, gastroesophageal reflux may be associated with a disturbed, irregular sleep of poor quality, which is characterized by a typical breathing pattern (multiple, irregularly repeated, short apneas).
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PMID:Gastroesophageal reflux incidence and respiratory dysfunction during sleep in infants: treatment with cisapride. 273 61

Nine patients complaining only of chronic cough of unknown cause were prospectively studied with prolonged esophageal pH monitoring (EPM) before and after cough had disappeared as a complaint in order to determine if and why gastroesophageal reflux (GER) was causing their coughs. Coughs disappeared as a complaint an average of 161 +/- 75 days after medical therapy for GER. Comparisons of pretreatment and post-treatment EPM data revealed the following: numbers of coughs (p = 0.029), total refluxes (p = 0.001), refluxes greater than or equal to 5 min (p = 0.019), and reflux-induced coughs (p = 0.005) had significantly decreased in the distal esophagus, and total refluxes (p = 0.05) had significantly decreased in the proximal esophagus. During the entire study period, the number of coughs were significantly correlated with the number of total refluxes (p = 0.039), longest reflux (p = 0.019), number of refluxes greater than or equal to 5 min (p = 0.006), and percent of total time that pH was less than 4 (p = 0.017) in the distal esophagus. On the basis of these results, we conclude that (1) cough can be the sole presenting manifestation of GER, and it gradually responds to standard GER therapy; (2) prolonged EPM is safe, well-tolerated, and extremely useful in diagnosing clinically silent GER; (3) the mechanism by which GER causes cough is related to a critical number and/or duration of reflux episodes in the distal and/or proximal esophagus.
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PMID:Chronic cough as the sole presenting manifestation of gastroesophageal reflux. 281 91

Irwin and co-workers have designed an anatomic approach to the diagnosis and treatment of cough. In their hands, diagnosis was consistently determined and treatment successful almost without exception, if sustained. We reviewed the results of a similar approach in 139 consecutive and unselected patients referred to pulmonary specialists in two community hospitals. Thirty-nine patients demonstrated hyperreactive airways (HA) by carbachol inhalation and/or eucapnic hyperventilation of cold air. Twenty-seven of 78 without HA had postnasal drip, and 13 of 78 had a persistent cough following acute upper airway inflammation. Other less common diagnoses included chronic bronchitis, gastro-esophageal reflux, occupational bronchitis, interstitial lung disease, and psychologic causes. We were able to find the cause of cough 88 percent of the time. Treatment adjusted for noncompliance was not always a success. While all patients with HA improved, 8 percent of patients without HA or specific diagnosis did not have an improvement in their cough upon retrospective inquiry. Based on this analysis, we find that the diagnosis and treatment of cough may not be as successful as originally reported using Irwin's approach.
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PMID:Chronic persistent cough. Experience in diagnosis and outcome using an anatomic diagnostic protocol. 292

The assessment of cough starts with a search for possible causes, the commonest of which (acute or chronic inflammation of the upper airways, acute bronchial inflammation, smoking, asthma) are usually suggested by history and clinical examination. In chronic cases, where the chest X-ray is normal, the diagnosis must differentiate between ENT inflammation, asthma, post-infectious bronchial hyperresponsiveness and gastroesophageal reflux. Appropriate treatment can be administered solely when the most probable etiology has been determined.
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PMID:[Etiological diagnosis of cough]. 341 57

Pressure in oesophageal varices was measured endoscopically in 52 patients, in 16 of them central portal-vein pressure additionally by percutaneously introduced transhepatic portal-vein catheter. Only in the region of the cardia occlusion segment was the portal-vein pressure the same as that in the oesophageal varices. The larger the varices the higher the average variceal pressure. Depending on the time interval since a meal there were marked pressure variations during the day in portal-vein pressure. Intra-abdominal pressure rise (e.g. on coughing, choking or vomiting) induces a sudden and marked pressure rise in the portal vein as well as the oesophageal varices. The larger the varices the greater the danger of rupture when these pressure rises occur. Gastro-oesophageal reflux plays no role in the pathogenesis of bleeding from oesophageal varices.
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PMID:[Pathogenesis of bleeding esophageal varices]. 348 19

Respiratory tract disease was the main indication for surgery in 45 out of the 102 children operated upon for GER in the last 7 years: twenty-four had recurrent bronchitis and pneumonia, 18 had bronchitis with constriction (true asthma in 10), 2 had unbearable cough and 1 apnoeic crises. All had been medically treated before without success. The diagnosis of GER has been accepted only in patients with abnormal results in three or more of the following tests: barium swallow, extended pH-metering, manometry, endoscopy-biopsy and gastro-oesophageal scintigraphy. Nissen fundoplication cured GER in all cases, and its effect on respiratory tract disease after an average follow-up of 17 months (range 6 to 48) was rather encouraging: twenty-six children cured (57%), 9 improved (21%) and 10 remained unchanged (22%). Failures were more frequent in children with bronchoconstriction (45%) and in those without prior digestive symptoms (36%). Surgery is probably indicated more often in the treatment of respiratory tract diseases associated with GER in children than it was previously thought, but indications remain difficult and the results are uncertain in children with either asthma or bronchoconstriction.
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PMID:[Results of surgical treatment of gastroesophageal reflux with respiratory manifestations]. 360 85

Both upper and lower respiratory tracts can be affected by food allergy. In infants these symptoms may be due exclusively to food allergy or may result from the effect of food allergy and another co-factor (gastro-esophageal reflux, immunodeficiency, concomitant allergy to inhalants, etc.). The incidence of food-induced asthma is not well know. In this study, using open and double blind food challenge, we found that the incidence of IgE-mediated, food-induced asthma in children is 5.7%. The most offending foods were milk, eggs, and peanuts. Food allergy respiratory symptoms were almost always associated with other clinical manifestations (cutaneous, gastrointestinal). In fact we have been able to demonstrate only one isolated case of cough due to food allergy. It follows that the recognition of food dependent-IgE-mediated asthma is essentially limited to these cases characterized by food allergy with asthmatic expression.
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PMID:[Incidence of asthma caused by food allergy in childhood]. 369 22

This study was carried out on 104 patients of whom 94 were asthmatic and 10 patients presented with a spasmodic intractable cough; all presented with symptoms evocative of an associated gastro-oesophageal reflux (RGO). The clinical symptoms revealed a nocturnal cough (67%), cough preceeding asthma (46%) and heartburn in 60%. The asthma was severe (type III and IV in 89% of cases), or dependent on corticosteroids (37% of cases). pH monitoring of the oesophagus is the most sensitive examination (88% with positive results) slightly ahead of manometry and scintigraphy (both 81%), these examinations were clearly superior to radiographic examination (49%) and oesophageal fibroscopy (36%). The combination of pH monitoring and of scintigraphy enabled 98% of RGO cases to be identified by their clinical data. Medical treatment with Tagamet, Gaviscon and Primperan (alone or in combination) produced an improvement in the respiratory symptoms in 50% of the cases. Of the 14 surgically treated, 7 obtained an improvement in their respiratory symptoms. Seven of the ten patients with spasmodic cough were improved by medical treatment. Our study shows the frequency of oesophageal reflux in patients with severe asthma. In half of them RGO intervened as an aggravating factor and the medical treatment of RGO led to a clear improvement in the respiratory symptoms.
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PMID:[The association of asthma and gastroesophageal reflux: strategy of paraclinical studies]. 383 97

We evaluated the effect of domperidone, a novel prokinetic agent, on symptoms and esophageal and gastric motility in 15 infants (six boys), mean age 7.9 months, with moderate to severe gastroesophageal reflux (GER) and upper gastrointestinal motility disturbances. Patients received domperidone orally for 6 weeks and underwent weekly assessment of five GER-associated symptoms, weight change, and side effects. Mean total symptom scores significantly improved after treatment (P less than 0.01). Vomiting, "spitting," and coughing each improved significantly. Postprandial reflux time (defined as esophageal pH less than 4.0) and percent peristaltic esophageal contractions improved significantly (p less than 0.05). Gastric fundic contractions, present in only four infants before treatment, occurred in nine after domperidone administration. Although mean gastric emptying of isotope-labeled formula was not improved, it improved greater than or equal to 10% over baseline in nine patients. Peristaltic amplitude, lower esophageal sphincter pressure, and esophageal acid clearance time were unchanged. Side effects were minimal. We conclude that domperidone is a useful and safe agent for treatment of gastroesophageal reflex in infants because it addresses the motility abnormalities inherent in the pathophysiology of the disorder.
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PMID:Effects of domperidone therapy on symptoms and upper gastrointestinal motility in infants with gastroesophageal reflux. 396 23

Both upper and lower respiratory tracts can be affected by food allergy. Manifestations in either may be exclusively due to food allergy (common in infants) or may result from the combined effects of food allergy plus another defect such as gastroesophageal reflux, a congenital defect of the heart or tracheo-bronchial tree, an immunodeficiency syndrome such as isolated IgA or IgG4 deficiency, or a concomitant inhalant allergy. Chronic rhinitis is the most common respiratory tract manifestation of food allergy. When it occurs in conjunction with lung disease, it may be a helpful indicator of activity of the allergic lung disease and of the patient's compliance in following a specific diet. Recurrent serous otitis media may be solely or partially due to food allergy. Large tonsillar and adenoid tissues, sometimes with upper airway obstruction, may be caused, or aggravated by, food allergies. Lower respiratory tract disease manifested by chronic coughing, wheezing, pulmonary infiltrates, or alveolar bleeding may also occur. Lower respiratory tract involvement is generally associated with a greater delay in onset of symptoms and with a larger quantity of allergen ingestion than chronic rhinitis. Food allergy should be considered when there is a history of prior intolerance to a food in childhood or of symptoms beginning soon after a particular food was introduced into the diet. It is an important consideration in patients who have chronic respiratory tract disease which does not respond adequately to the usual therapeutic measures and is otherwise unexplained.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Respiratory diseases and food allergy. 623 77


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