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)

Gastroesophageal reflux (GER) into the laryngopharynx causes or contributes significantly to a variety of upper respiratory problems in children. The pH probe, laryngeal examinations, and broncholveolar lavage results for children with subglottic stenosis, recurrent croup, apnea, chronic cough, laryngomalacia, recurrent choanal stenosis, vocal fold nodules, and chronic sinusitis/otitis/bronchitis were reviewed in an effort to quantify the role of GER in each of these disorders. This review suggests that GER plays a causative role in subglottic stenosis, recurrent croup, apnea, and chronic cough. It is an important inflammatory cofactor in laryngomalacia and possibly in true vocal cord nodules and problematic recurrent choanal stenosis. GER is also an important inflammatory cofactor in chronic sinusitis/otitis/bronchitis but may be the result of chronic illness in the older patients.
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PMID:Role of gastroesophageal reflux in pediatric upper airway disorders. 994 54

Gastroesophageal reflux (GER) is a common problem confronting physicians involved in the care of children and adults. With the association of GER with asthma and chronic cough, physicians specializing in allergy/immunology require information on the pathogenesis, diagnosis, and management of GER. Eosinophilic esophagitis or eosinophilic gastroenteritis are poorly understood entities that may also lead to symptoms mimicking GER and are associated in many cases with underlying hypersensitivity of unknown immunologic mechanism.
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PMID:Gastroesophageal reflux: pathogenesis, diagnosis, and treatment. 1007 9

Gastroesophageal reflux disease (GERD) is the abnormal retrograde flow of gastric contents into the esophagus. While disorders of the esophagus related to GERD are fairly well characterized, supraesophageal symptoms may be nonspecific and easily missed. Fewer than half of the patients with otolaryngologic complications of reflux exhibit the classic findings of heartburn and regurgitation. GERD has been implicated in a broad range of disorders including laryngitis, chronic hoarseness, globus pharyngeus, laryngeal carcinoma, cricopharyngeal hypertension, Zenker's diverticulum, and chronic cough. A high index of suspicion is essential for timely diagnosis and treatment of the otolaryngologic manifestations of GERD.
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PMID:Otolaryngologic manifestations of gastroesophageal reflux disease. 1031 2

Eosinophilic bronchitis presents with chronic cough and sputum eosinophilia, but without the abnormalities of airway function seen in asthma. It is important to know how commonly eosinophilic bronchitis causes cough, since in contrast to cough in patients without sputum eosinophilia, the cough responds to inhaled corticosteroids. We investigated patients referred over a 2-yr period with chronic cough, using a well-established protocol with the addition of induced sputum in selected cases. Eosinophilic bronchitis was diagnosed if patients had no symptoms suggesting variable airflow obstruction, and had normal spirometric values, normal peak expiratory flow variability, no airway hyperresponsiveness (provocative concentration of methacholine producing a 20% decrease in FEV(1) ([PC(20)] > 8 mg/ml), and sputum eosinophilia (> 3%). Ninety-one patients with chronic cough were identified among 856 referrals. The primary diagnosis was eosinophilic bronchitis in 12 patients, rhinitis in 20, asthma in 16, post-viral-infection status in 12, and gastroesophageal reflux in seven. In a further 18 patients a diagnosis was established. The cause of chronic cough remained unexplained in six patients. In all 12 patients with eosinophilic bronchitis, the cough improved after treatment with inhaled budesonide 400 micrograms twice daily, and in eight of these patients who had a follow-up sputum analysis, the eosinophil count decreased significantly, from 16.8% to 1.6%. We conclude that eosinophilic bronchitis is a common cause of chronic cough, and that sputum induction is important in the investigation of cough.
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PMID:Eosinophilic bronchitis is an important cause of chronic cough. 1086 88

An increasing amount of evidence indicates that gastroesophageal reflux disease (GERD) is a contributing factor to hoarseness, throat clearing, throat discomfort, chronic cough, and shortness of breath. The association between GERD and these supraesophageal symptoms may be elusive. Heartburn and regurgitation are absent in more than 50% of patients. Acid reflux should be considered if signs of GERD are present, symptoms are unexplained, or symptoms are refractory to therapy. The diagnosis of GERD may be unclear, despite a careful history and initial evaluation. A high index of suspicion is required to make the diagnosis. An empiric trial of antireflux therapy is appropriate when GERD is suspected. Multiprobe ambulatory pH monitoring is currently the diagnostic test of choice, but the level of sensitivity and specificity for supraesophageal manifestations of GERD is uncertain. Response to antireflux therapy is less predictable than typical GERD. More intensive acid suppression and longer treatment duration are usually required.
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PMID:Supraesophageal manifestations of gastroesophageal reflux disease. 1043 98

Muscular tension dysphonia, episodic laryngospasm, globus, and cough may be considered to be hyperfunctional laryngeal symptoms. Suggested etiological factors for these symptoms include gastroesophageal reflux, psychological problems, and/or dystonia. We propose a unifying hypothesis that involves neural plastic change to brainstem laryngeal control networks through which each of the above etiologies, plus central nervous system viral illness, can play a role. We suggest that controlling neurons are held in a "spasm-ready" state and that symptoms may be triggered by various stimuli. Inclusion criteria for the irritable larynx syndrome are episodic laryngospasm and/or dysphonia with or without globus or chronic cough; visible or palpable evidence of tension or tenderness in laryngeal muscles; and a definite symptom-triggering stimulus. thirty-nine patients with irritable larynx syndrome were studied. Gastroesophageal reflux was felt or proven to play a major role in a large number of the group (>90%), and about one third were deemed to have psychological causative factors. Viral illness seemed quite prevalent, with one third of patients able to relate the onset of symptoms to a viral illness that we feel might lead to central nervous system changes. Our proposed hypothesis includes a mechanism whereby acquired plastic change to central brainstem nuclei may lead to this form of hyperkinetic laryngeal dysfunction. It gives structure and reason to an array of therapy measures and suggests direction for basic research.
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PMID:The irritable larynx syndrome. 1049 60

Gastroesophageal reflux disease (GERD) is the most common esophageal disease. Besides the typical presentation of heartburn and acid regurgitation, either alone or in combination, GERD can cause atypical symptoms. An estimated 20 to 60 percent of patients with GERD have head and neck symptoms without any appreciable heartburn. While the most common head and neck symptom is a globus sensation (a lump in the throat), the head and neck manifestations can be diverse and may be misleading in the initial work-up. Thus, a high index of suspicion is required. Laryngoscopy can confirm the diagnosis of laryngopharyngeal reflux. Erythema of the posterior larynx may be seen, and the true vocal cords may be edematous. Treatment should be initiated with a histamine H2 receptor blocker or proton pump inhibitor. Lifestyle changes are also beneficial. Untreated, GERD can lead to chronic laryngitis, dysphonia, chronic sore throat, chronic cough, constant throat clearing, granuloma of the true vocal cords and other problems.
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PMID:Head and neck manifestations of gastroesophageal reflux disease. 1075 Aug 74

Cough becomes chronic after three weeks of evolution. Chronic cough is due to four syndromes in 90% of cases: postnasal drip syndrome, asthma, gastroesophageal reflux and chronic bronchitis. Each syndrome needs a specific therapeutic approach. Antitussive drugs like dextromethorphan are prescribed in cases of complicated cough. Cough secondary to angiotensin converting enzyme inhibitors must not be neglected. In case of failure of initial check up or lack of response to specific therapy, a more thorough examination must be conducted in a specialized centre.
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PMID:[Chronic cough]. 1052 11

Using the anatomic, diagnostic protocol, the cause of chronic cough can be determined 88% to 100% of the time, leading to specific therapy with success rates of 84% to 98%. Gastroesophageal reflux disease (GERD), along with postnasal drip syndrome (PNDS) and asthma, is one of the three most common causes of chronic cough in all age groups. When GERD is the cause of chronic cough, there may be no gastrointestinal (GI) symptoms up to 75% of the time, and, in these cases, the term "silent GERD" is used. The most sensitive and specific test for GERD is 24-hour esophageal pH monitoring. In interpreting this test, it is essential not only to evaluate the duration and frequency of the reflux episodes but also to determine the temporal relationship between reflux and cough events. Patients with normal standard reflux parameters still may have reflux diagnosed as the likely cause of cough if a temporal relationship exists. The definitive diagnosis of cough resulting from GERD can only be made if cough goes away with antireflux therapy. When 24-hour esophageal pH monitoring cannot be done, an empiric trial of antireflux medical therapy is appropriate when GERD is a likely cause of chronic cough. It is likely in the following settings: patients with prominent GI symptoms consistent with GERD and/or those with no GI complaints and normal chest x-rays, who are not taking angiotensin-converting enzyme inhibitors and who are not smoking, and in whom asthma and PNDS have been excluded. However, if empiric treatment fails, it cannot be assumed that GERD has been ruled out as a cause of chronic cough; rather, objective investigation for GERD is recommended, because the empiric therapy may not have been intensive enough or it may have failed. In treating patients with chronic cough resulting from GERD, cough has been reported to resolve with medical therapy 70% to 100% of the time. Mean time to recovery may take as long as 161 to 179 days, and patients may not start to get better for 2 to 3 months. In patients who fail to respond to maximal medical therapy, antireflux surgery can be successful.
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PMID:Anatomical diagnostic protocol in evaluating chronic cough with specific reference to gastroesophageal reflux disease. 1071 65

Mast cells and eosinophils may play a role in the pathophysiology of chronic cough in nonasthmatics. It is unknown, however, whether degranulation of these cells occurs in the airways of such patients. Thirty-five nonsmoking patients referred with a chronic nonproductive cough (mean cough duration 76.2 months) were evaluated using a comprehensive diagnostic protocol. Bronchoalveolar lavage (BAL) cell differentials and BAL histamine, tryptase and eosinophilic cationic protein (ECP) concentrations were determined. Ten nonsmoking healthy volunteers served as controls. Diagnostic subgroups were identified: eight postnasal drip syndrome (PNDS), seven cough variant asthma (CVA), seven gastro-esophageal reflux (GOR), seven dual aetiology and six idiopathic. Nonasthmatic coughers (NAC) were characterized as those patients without bronchial hyperresponsiveness on histamine challenge and whose cough had either responded to therapy for PNDS or GOR or failed to improve with antiasthma therapy. There was a significant increase in both eosinophil and mast cell numbers (p<0.05) and in histamine levels (p = 0.027) when NAC patients were compared with controls. Tryptase and ECP levels were elevated in 7 of 23 and 6 of 23 NAC patients, respectively. In conclusion, airway inflammatory cell numbers are not only increased but also activated, suggesting an important role for airways inflammation in the pathophysiology of chronic nonproductive cough.
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PMID:Bronchoalveolar lavage findings in patients with chronic nonproductive cough. 1083 24


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