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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 tested the hypothesis that hyperresponsiveness of the upper airway (UAHR) is present in patients with chronic cough of diverse etiology. We determined the frequency of bronchial hyperresponsiveness (BHR), hyperresponsiveness of the upper airway, sputum eosinophilia, pulmonary aspiration, and psychological symptoms in adults with chronic cough. Consecutive adults (n = 30) presenting to a tertiary referral clinic with chronic cough were compared with a group of 20 asymptomatic adults. Measurements included histamine provocation testing with measurement of flow volume curves to determine inspiratory and expiratory airflow obstruction; hypertonic saline induced sputum for analysis of eosinophils, mast cells and lipid-laden macrophages; and a validated psychological symptom questionnaire. Symptomatic rhinitis and gastroesophageal reflux were common causes of chronic cough. BHR occurred in seven patients (23%) and in no control subjects (p < 0.05). UAHR occurred in 40% of patients with cough and in four (20%) control subjects (p > 0.05). Eosinophils were present in the sputum of more patients with cough than control subjects (50% versus 19%; p < 0.05). High degrees of eosinophilia were present in six patients with cough, including three without BHR. No subject had significant lipid-laden macrophages. There was greater somatization in patients with chronic cough; ten subjects scored in the clinically significant range (p < 0.05). Abnormalities in one or more of these tests were 7.67-fold (95% CI 1.83-34.52) more likely to occur in cough patients than control subjects. We conclude that chronic cough is a nonspecific symptom that is associated with several apparently unrelated mechanisms. These include UAHR, somatization, BHR, and eosinophilic bronchitis. UAHR cannot be implicated as a single unifying mechanism. These findings emphasize the need to systematically evaluate several different causes of cough in patients who present with chronic cough.
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PMID:A systematic evaluation of mechanisms in chronic cough. 923 Jul 50

One hundred and twenty two patients who were presenting with chronic persistent cough for more than 3-4 weeks were studied. Using anatomical and stepwise approach, we could identify the cause of chronic cough in 96% of the patients. The most common causes were due to postnasal drip syndrome (PND) (45%) and bronchial asthma (26%). We also demonstrated the important role of methacholine inhalation challenge in the diagnostic work up. The procedure could identify the patients who had bronchial hyperresponsiveness (BHR) in 52% of the cases. The severity degree of the BHR was classified into three levels. Mild or nonspecific BHR was defined as PC20 16-25 mg/ml. This could be found in many diseases such as PND and bronchiectasis. Moderate degree of BHR (PC20 8-16 mg/ml) was found in patients with PND and asthma. PC20 of less than 8 mg/ml was considered to be the most severe degree and it seemed to be specific for the diagnosis of asthma (positive predictive value 100%). Other condition that caused chronic cough were drug-induced, especially angiotensin-converting enzyme inhibitors, gastroesophageal reflux disease (GERD), idiopathic pulmonary fibrosis, subgottic cancer and idiopathic cough. These conditions may require invasive diagnostic work up, such as fiberoptic bronchoscopy and tissue biopsy. The treatment of chronic cough was according to the etiology. Thus, the patients presenting with chronic cough should be investigated to identify the cause, and it was not just only the administration of cough suppressant drugs in these patients.
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PMID:The role of the methacholine inhalation challenge in adult patients presenting with chronic cough. 925 42

Chronic cough is defined as a cough that lasts for more than three weeks. More than 90 percent of cases of chronic cough result from five common causes: smoking, post-nasal drip, asthma, gastroesophageal reflux and chronic bronchitis. Although in most patients chronic cough has a single cause, in up to one fourth of patients, multiple disorders contribute to the cough. A stepwise evaluation in patients with chronic cough can minimize the invasiveness and expense of the work-up. Initial screening of patients with chronic cough should search for smoking, occupational exposure to an airway irritant, cough-inducing medications, airway hyperresponsiveness following upper respiratory infection, chronic bronchitis or any systemic symptoms suspicious for serious disease. Patients who are not diagnosed after an initial screening are evaluated or empirically treated in a stepwise fashion for postnasal drip, asthma and reflux. Bronchoscopy is reserved for use in the few patients still without a diagnosis after the previous steps have been completed.
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PMID:Chronic cough. 933 62

Although gastroesophageal reflux disease (GERD) can be effectively treated by proton-pump inhibitors, surgery is still the only means of definitive cure of the disease. After introduction of laparoscopic surgery, there has been a clear trend to surgical repair of the incompetent cardia. The indications for surgical treatment are: endoscopically proven esophagitis, persistent or recurrent complaints under medical treatment, esophageal stricture and/or pH-metrically proven acid reflux as well as reflux-induced coughing (chronic aspiration). Although the laparoscopic antireflux operations is a technically demanding procedure, it can be performed with similar results as compared to conventional surgery. The operative technique is reported in detail. From January 1992 to March 1997, 146 consecutive patients with GERD have been operated on laparoscopically. The overall conversion rate was 8.2% (n = 12). 133 patients were operated on according to the Nissen procedure including hiatoplasty. The Toupet operation was performed in only one case. 84 men and 42 women had a mean age of 49 years (20-76). The median duration of symptoms was 48 months (1-600). Except five patients all had medical treatment for at least 2 years. Twice pneumatic balloon dilatation of an esophageal stricture was necessary preoperatively. The median operation time was 210 minutes (70-660). Conversion to open surgery because of intraoperative complications was necessary in 6 patients. Postoperative complications occurred in 14 patients, all of them being successfully treated conservatively. No patient died. 121 patients (90.3%) had follow up examinations for at least 6 months. Retreatment was necessary in 5 cases: 1x slipped Nissen (laparoscopic repair), 1x intrathoracic hernia (conventional reoperation), 2x dysphagia > 4 months postoperatively (endoscopic balloon dilatation) and 1x recurrent ulcer (conventional operation). With a correct indication, laparoscopic Nissen repair for GERD is a suitable, safe and definitive treatment.
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PMID:Laparoscopic antireflux surgery--technique and results. 933 5

With the widespread availability of ambulatory esophageal pH monitoring, there has been recently renewed interest in the so-called 'extraesophageal' complications of gastroesophageal reflux disease (GERD). There are two proposed mechanisms by which reflux can cause extraesophageal symptoms or disease: refluxed acid may reach the oropharynx and/or respiratory tract and cause direct irritation; or acid contact with the esophageal mucosa may trigger neural reflexes, which, in turn, produce symptoms. Evidence is most compelling for an association between GERD and unexplained dental erosions, posterior laryngitis, chronic unexplained cough and intrinsic asthma. The clinician should be aware of these associations, and patients with these conditions should be questioned carefully about associated GERD symptoms. When GERD and any of these conditions coexist, intensive medical antireflux therapy is indicated. Twenty-four hour pH monitoring may be required in selected patients to document the relationship between reflux and the extraesophageal complication or to ensure that the medical therapy provided has eliminated acid reflux.
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PMID:Extraesophageal complications of gastroesophageal reflux disease. 934 78

Chronic cough, defined as cough that persists for 3 weeks or longer, is one of the most common symptoms evaluated by a primary-care physician. With the exclusion of cigarette smoking, postnasal drip, asthma, and gastroesophageal reflux are responsible for more than 80% of the causes of chronic cough. Elicitation of a thorough history and performance of a physical examination will usually provide clues about the cause of chronic cough. The use of diagnostic tests including methacholine challenge, gastroesophageal reflux studies, and sinus imaging is based on clinical suspicion. Treatment of chronic cough is aimed at the underlying cause.
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PMID:Assessment of the patient with chronic cough. 947 8

Ambulatory pH monitoring of the distal esophagus is the most accurate diagnostic study for patients with suspected gastroesophageal reflux disease (GERD). The measurement of proximal esophageal acid exposure time may be useful in patients with atypical reflux symptoms. The aim of this study is to evaluate if proximal esophageal pH monitoring provides useful information beyond that learned with distal esophageal pH monitoring. We routinely performed dual-channel pH monitoring with pH electrodes positioned at 20 and 5 cm above the manometric lower esophageal sphincter from January 1992 to August 1995. All patients scored their esophageal symptoms from zero (none) to four (severe). We compared proximal esophageal reflux (PR) in patients with typical symptoms (i.e., heartburn, regurgitation) and in patients with atypical symptoms (i.e., chest pain, cough, hoarseness, and asthma). We compared symptom profiles between patients with and without PR. We reviewed our experience in patients with abnormal PR, but with a normal amount of distal esophageal reflux (DR). We studied 441 consecutive patients. There were no significant differences in PR between patients with typical and atypical symptoms. There were no differences in symptom profiles between patients with normal and abnormal PR. There were no differences of PR between the different atypical symptoms. PR did not correlate with the severity of the patient's symptoms. PR correlated well only with DR. Twenty-four patients had isolated abnormal PR, but only six patients improved with antireflux therapy. We conclude that routine ambulatory esophageal pH monitoring of the proximal esophagus appears to be of little value. The decision to offer patients an empiric trial of antireflux therapy for suspected GERD should not be based on the presence or absence of PR.
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PMID:Dual-channel ambulatory esophageal pH monitoring. A useful diagnostic tool? 939 98

H1 antihistamines have been shown to have antitussive effects in patients with asthma and postnasal drip. In Japan, no study has been performed to determine whether orally administered oxatomide, H1 antihistamine, can reduce the chronic cough seen in patients with post-upper-airway infection (postinfection). Patients who had chronic cough of more than three weeks' duration and a history of post-upper-airway infection took part in the study. None had any history of nasal disease, gastroesophageal reflux, bronchial asthma, or other chronic pulmonary disease. All patients were non-smokers, and none used ACE inhibitors. They had normal CRP concentrations, peripheral white blood cell and eosinophil counts, serum IgE concentrations, titers of cold agglutinins and antibodies to Mycoplasma pneumoniae, chest roentgenograms, and respiratory function tests. A prospective randomized, open design was used. The effect of one week of treatment with dextromethorphan (D) or with D plus oxatomide (D + O) on the severity of cough, as estimated by cough diary, were examined. Twenty-two patients entered the study, and 20 were eligible for efficacy and side-effect analyses. Nine patients receiving D and 11 receiving D + O completed the protocol. Patients' characteristics before the start of the study, such as severity and duration of cough, and laboratory data, were not significantly different between the two groups. From trial day 5 to 7, improved rates of cough were significantly higher with D + O than with D alone (p < 0.05). Combination therapy with oxatomide and dextromethorphan reduces subjective perception of cough as estimated by cough diary. These results suggest that oxatomide, H1 antihistamine may improve chronic cough in patients with post-upper-airway infection.
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PMID:[Effects of oxatomide, H1-antagonist, on postinfectious chronic cough; a comparison of oxatomide combined with dextromethorphan versus dextromethorphan alone]. 952 65

Gastroesophageal reflux may be responsible for atypical extra-esophageal symptoms, such as chest pain, dyspnea, chronic cough, or hoarseness. Prospective studies of gastroesophageal reflux have indicated reflux as the cause for chronic cough in 10 to 20% of patients. The precise mechanism by which reflux causes cough remains uncertain, although the possibility that the cough is caused by stimulation of the esophageal mucosa receptors rather than aspiration is suggestive from some studies. Prolonged esophageal pH monitoring affords an opportunity to document objective gastroesophageal reflux. Furthermore, pH monitoring gives the opportunity to correlate temporally acid reflux events with the onset of certain symptoms.
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PMID:[Clinical, diagnostic and pathogenetic aspects of reflux-associated cough]. 960 88

Previously, we reported the effectiveness of treatment with oxatomide (O), an antihistamine, plus dextromethorphan (D), and that of Bakumondo-to (B), an herbal drug that inhibits the activation of C-fibers, in patients with persistent coughing after upper-airway infection. In this study, we evaluated the efficacy and side effects of combination therapy (O + D + B) in patients with postinfectious persistent cough. Patients who had been coughing for more than three weeks and had a history of upper-airway infection took part in the study. None had any history of nasal disease, gastroesophageal reflux, bronchial asthma, or other chronic pulmonary disease. All patients were non-smokers, and none used angiotensin converting enzyme (ACE) inhibitors. All had normal chest roentgenograms and normal pulmonary function. The following hematological data were obtained before treatment: peripheral eosinophil counts. CRP levels, serum IgE concentrations, and titers of cold agglutinins and antibodies to Mycoplasma pneumoniae. The effects of one week of treatment with O + D + B on the severity of coughing, as estimated with a cough diary, were examined. Thirty-six patients entered the study, but only 18 with normal hematological findings who satisfied the study criteria were eligible for efficacy and side-effect analyses. Cough scores decreased significantly from 5.1 +/- 2.4 (range, 2-9) to 1.2 +/- 1.9 (range, 0-6), and the rate of cough disappearance was 50%. Two patients reported slight drowsiness. Therapy with O + D + B reduced perception of coughing as estimated with a cough diary. These results suggest that this therapy (O + D + B) may be useful in patients with postinfectious persistent cough.
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PMID:[A pilot phase II study of combination therapy with oxatomide, an antihistamine, plus dextromethoraphan and bakumondo-to, an herbal drug, in patients with postinfectious persistent cough]. 969 46


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