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)

Gastro-oesophageal reflux (GOR) and asthma are both common but there are causal associations between the two. Although frank microaspiration into the trachea has been documented, in most patients vagal reflex pathways from lower oesophageal receptors are the predominant cause of airway narrowing or cough. Equally, the smooth muscle relaxing drugs used for the treatment of asthma can cause reflux to occur as can hyperinflation associated with more significant asthma. Controlling the symptoms of GOR with H2 blockers or proton pump inhibitors does not necessarily improve asthma control, while the place for surgery as an attempt to reduce asthma symptoms is open to debate.
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PMID:Oesophageal reflux and asthma. 883 59

A nationwide retrospective study of exogenous lipid pneumonia (ELP) was carried out to update the data on this disease, with emphasis on thoracic computed tomography (CT) scan and bronchoalveolar lavage (BAL) findings. The inclusion criteria were: 1) presence of abnormal imaging features compatible with the diagnosis of ELP; 2) presence of intrapulmonary lipids; and 3) exogenous origin of the lipid pneumonia. Forty four cases were included (20 males and 24 females; mean age 62 +/- 11 yrs), of which four were occupational (chronic inhalation of cutting mist or oily vapour in an industrial environment). Thirty of the 40 nonoccupational cases were related to aspiration of liquid paraffin used for the treatment of constipation. A condition possibly favouring oil aspiration or inhalation was present in 34 patients (77%), most commonly gastro-oesophageal reflux (n = 20) and neurological or psychiatric illness (n = 14). Fever (39%), weight loss (34%), cough (64%), dyspnoea (50%) and crepitations (45%) were the most frequent symptoms. BAL was performed in 39 cases: 23% had a lymphocytic alveolitis; 14% neutrophilic alveolitis; and 31% a mixed alveolitis (lymphocytic and neutrophilic). Alveolar consolidations (57%), ground glass opacities (39%), and alveolar nodules (23%) were the most common radiological abnormalities. The changes were bilateral (79%), predominant in the posterior and lower zones of the lobes concerned (74%), hypodense (71%), and spared the subpleural zones (52%). In 13 cases, hypodensity was retrospectively established on CT scan by the presence of a "positive angiogram". This sign may be of diagnostic value when the density measurement is either not possible or not reliable. In conclusion, this study provides an update of the clinical, biological and radiological profile of exogenous lipid pneumonia and, in particular, confirms the diagnostic benefit of computed tomography scan, which revealed bilateral and hypodense changes in a large majority of cases.
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PMID:Exogenous lipid pneumonia: a retrospective multicentre study of 44 cases in France. 883 60

There is a relationship between gastroesophageal reflux disease and certain respiratory symptoms and findings. Among these are cough, laryngitis, and wheezing dyspnea. The pathophysiology of these conditions can vary from actual aspiration of gastric content to esophageal mucosal inflammation with the respiratory symptoms induced by a vagally mediated reflex mechanism.
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PMID:Respiratory complications of gastroesophageal reflux disease. 888 36

Nebulized recombinant human DNase (rhDNase) reduces sputum viscosity, improves pulmonary function, and results in a small reduction in acute respiratory exacerbations requiring intravenous antibiotics in many patients with cystic fibrosis (CF). rhDNase is now recommended for use in CF patients with moderately severe suppurative lung disease. A 14-year-old girl with suppurative lung disease [forced expiratory volume in 1 second (FEV1) 69% and forced vital capacity (FVC) 81% predicted] secondary to Kartagener's syndrome and severe gastroesophageal reflux had worsening spirometry together with intractable gastrointestinal symptoms over the previous 18 months despite conventional treatment. She was, therefore, started on 2.5 mg rhDNase once daily. Her cough lessened and the volume of sputum decreased within 72 hours of commencement of treatment; this improvement was strongly associated with a dramatic reduction in gastrointestinal symptoms. Spirometry after 4 weeks of treatment demonstrated a 20% improvement in FEV1 and a 13% improvement in FVC. These improvements have been maintained after 4 months of rhDNase therapy. The use of rhDNase should be considered in patients with Kartagener's syndrome and a multicenter trial may be justified.
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PMID:Clinical benefit from nebulized human recombinant DNase in Kartagener's syndrome. 890 3

The human cough reflex is still poorly understood, although it is known to occur independently of bronchoconstriction. Sensitization of the cough reflex is a unifying hypothesis for chronic dry cough in several conditions, including gastroesophageal acid reflux, angiotensin-converting enzyme inhibitor cough, and cough-variant asthma. The most common cause of chronic dry cough is a group of related conditions of chronic rhinitis, sinusitis, and postnasal drip. In these cases the cough reflex may be sensitized through an action of inflammatory mediators from the nasal mucosa on the airways or a reflex sensitization of airway sensory nerves. The association of cough with gastroesophageal reflux may occur through a local esophageal-tracheobronchial reflex. Angiotensin-converting enzyme inhibitor cough is a side effect of treatment in about 10% of patients; it probably results from inhibition of the degradation of kinins, particularly bradykinin, in the airway. Why some patients with asthma have cough as the principal feature of their disease is unclear. Tachykinins are probably involved in the mechanism of sensitization of the cough reflex, and the development of neuropeptide antagonists may open new research opportunities. A study that used ambulatory recording of cough in a group of subjects with asthma confirmed the presence of significant cough, the frequency of which did not correlate with lung function or diurnal variation in peak flow. This finding highlights the problem of cough in patients with asthma, a problem that probably has been underestimated in the past.
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PMID:Pathophysiology and clinical presentations of cough. 893 82

The patients treated for oesophageal atresia present a correlation between the clinical sintomatology after recanalization characterized by disfagia, dispnea, recurrent cough, chronic pneumopaties and oesophageal anomalies. Where morphological alterations accounting for the presence of gastro-oesophageal reflux (GOR) were not evident, possible functional alterations of the motility were considered. The incidence of GOR was considerably high and, expression of a congenital alteration of the lower oesophageal sphincter and of oesophageal peristalsis, becomes even more severe due to further stretching of the gastro-esophageal junction. The authors underline that the early demonstration of histological changes, even before recanalization, and the motility disorders of the oesophagus have to be well studied, while the LES is normalized, in order to prevent and treat the possible appearance of the well-known complications of GOR.
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PMID:[Gastroesophageal reflux disease and respiratory disease]. 894 1

Cough is one of the commonest symptoms of lung disease and is a frequent problem encountered in general practice as well as in hospital practice. A wide range of disease processes may present with cough and definitive treatment depends on making an accurate diagnosis of the cause. A diagnostic work-up for patients with persistent dry cough is presented. The most common associated conditions are post-viral cough, asthma, rhinosinusitis (post-nasal drip or 'nasal catarrh') and gastro-oesophageal reflux. Treatment with angiotensin-converting enzyme inhibitors can also lead to a persistent dry cough. Specific treatment of the cause should control the cough, but this may not occur in all cases and in a sizeable proportion of patients, no associated cause can be found. An increased sensitivity of the cough reflex can be observed in patients with persistent dry cough. Symptomatic relief must be considered when the cough interferes with the patient's health and sleep but the most effective antitussive opiates cause sedation and may be addictive. Treatment of persistent dry cough remains a challenge in some patients and there is still scope for improvement in its diagnosis and effective therapy.
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PMID:Diagnosis and management of chronic persistent dry cough. 897 40

To define the role of ambulatory pH monitoring in evaluating chronic cough, we studied esophageal pH values of patients referred to a gastroenterology laboratory. Chronic cough was evaluated in 31 patients, who were grouped based on response to treatments; 11 patients (35.5%) had gastroesophageal reflux (GER)-related cough, 11 (35.5%) had pulmonary/otorhinolaryngologic-related cough (1 bronchitis, 6 asthma, 2 postnasal drip, 1 pneumonia), and 9 patients (29%) had cough of unknown etiology. Esophageal pH values of groups were compared. Excessive acid reflux distally (upright and supine) and proximally (upright) and cough symptom frequency related to acid reflux were significantly higher in patients with GER. Esophageal pH monitoring had good sensitivity (91%), specificity (82%), and positive (83%) and negative (90%) predictive values in identifying GER-related cough. In summary, ambulatory pH monitoring is an excellent test for identifying patients with GER-related cough.
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PMID:Twenty-four-hour ambulatory esophageal pH monitoring in the diagnosis of acid reflux-related chronic cough. 907 2

Case of an infant with chronic cough is reported. The most frequent causes of chronic cough were ruled out. Twenty-four hour oesophageal pH-monitoring showed a close correlation between gastro-oesophageal reflux episodes and cough attacks. The patient was successfully treated with cisapride (0.3 mg/kg t.i.d.). These findings show that irritable oesophagus syndrome can cause chronic cough.
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PMID:Irritable oesophagus syndrome as cause of chronic cough. 913 1

The most effective management of cough is specific therapy, which results in a greater than 90% response rate, so the cause should be thoroughly investigated. A chest x-ray should be taken early in the clinical investigation of chronic cough. The three most common causes of chronic cough when chest x-rays are normal are postnasal drip, bronchial asthma and gastro-oesophageal reflux. Chronic cough has more than one cause in 20% of patients, so therapy may need to be directed at multiple causes. Gastro-oesophageal reflux may complicate cough from any cause because a cough-reflux feedback cycle can develop. Hence, a four-week trial of an H2-receptor antagonist is indicated in patients with unexplained chronic cough where the history, physical examination, chest x-ray, lung function tests, ear/nose/throat examination and home peak flow monitoring all fail to elucidate a cause. Non-specific therapy should be reserved for when no diagnosis can be made, or when therapy is likely to be ineffective (e.g., lung malignancy).
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PMID:The patient with chronic cough. 915 45


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