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

A number of disorders of the respiratory tract and some even outside the respiratory tract can cause cough. A systematic approach towards a patient of chronic cough consisting of detailed history, physical examination of upper as well as lower respiratory tract, complete blood counts, tuberculin test, chest X-ray, and peak flow rate testing will give the diagnosis in majority of children. Pulmonary tuberculosis and asthma are the two commonest conditions diagnosed. If the initial work up is inconclusive, further laboratory testing and imaging studies should be considered. Thus, radiolabelled milk scan, barium swallow and 24-hour pH monitoring would diagnose gastroesophageal reflux. Spirometry, methacholine/exercise challenge test or a therapeutic trial may be required for confirming bronchial asthma. Flexible bronchoscopy is useful for evaluation for suspected aspiration syndromes and any anatomical or dynamic problem of the airway (e.g. tracheomalacia). Spiral and high resolution computed tomography (HRCT) along with magnetic resonance imaging are the modern day imaging techniques used for studying mediastinal masses, airway obstruction and even lung parenchyma (HRCT). Sputum examination for type of cells and bacteria can be useful, especially if pseudomonas or acid-fast bacilli are identified. Pseudomonas suggests cystic fibrosis (an uncommon disease in India) which can be confirmed by sweat chloride test and gene mutation studies.
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PMID:Clinical approach to a patient with cough. 1141 72

Gastrooesophageal reflux (GER) and asthma bronchiale are frequent diseases. Asthma affects some 3-10% of adults. Gastrooesophageal reflux is present in some 45-89% asthmatic patients. Symptoms of GER are not only gastrooesophageal, and recently increased attention is focused on extraoesophageal symptoms where in particular the relationship of GER and asthma or chronic cough is investigated. At our clinic we implemented a pilot study with the objective to monitor the presence of pathological GER in patients with asthma and to assess whether antireflux therapy will influence the respiratory complaints of the patients. The group was formed by 14 patients selected at random with different severity of asthma and different symptoms of GER. The patients had a baseline examination evaluating the presence of GER (24-hour pH metry) and pulmonary function (FEV1). In case of a pathological GER the patients were treated by antireflux therapy and then check-up examinations were made. It was found that after treatment of GER in patients with asthma in particular subjective symptoms improved such as cough and pyrosis which leads to a substantial improvement of the quality of life. On the other hand reflux treatment did not exert a basic effect on pulmonary functions and it was not possible to reduce the medication of asthma.
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PMID:[Pathologic gastroesophageal reflux in patients with bronchial asthma]. 1150 15

Gastroesophageal reflux (GER) is one of the three most common causes of chronic cough in children, along with postnasal drip syndrome and asthma. There may be no gastrointestinal symptoms up to 50-75% of the time. GER plays a causative role in chronic cough, asthma without allergy and posterior laryngitis. GER most commonly provokes coughing by stimulating an esophageal-bronchial reflex and by irritating the lower respiratory tract by microaspiration. Twenty-four-hour pH monitoring of the distal esophagus is the most accurate diagnostic method for children with suspected GER and it helps to establish a temporal correlation between cough and GER. The first step of the treatment is the association of postural and dietetic measures and medications (prokinetics and antacids). The length of the treatment is a minimum of 3 months up to the age of walking. Surgical treatment must be reserved for the failure of medical treatment. The benefits of minimally invasive surgery are evident in children with chronic cough, who have a faster recovery with fewer complication than after open surgery.
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PMID:[Chronic cough and gastroesophageal reflux in children]. 1168 86

Chronic cough of unknown etiology is often difficult to diagnose, thus, there exists controversy regarding the management of such patients. Although the ACCP (American College of Chest Physicians) statement in 1998 recommended that treatment should follow testing, recent evidence suggests that empirical treatment of GERD is more cost-effective than testing followed by treatment, in both chronic cough and non-cardiac chest pain. In this paper, we evaluated the cost-effectiveness in managing patients with chronic unexplained cough by building a decision model, and compared the cost-effectiveness of six most common management strategies. The outcome of our analysis demonstrates that empirical treatment is the cheapest option, while testing followed by treatment is the most expensive option with the shortest time course.
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PMID:Empirical treatment of chronic cough--a cost-effectiveness analysis. 1182 15

Psychogenic cough, also known as "habit cough," is a well-documented condition in the pediatric and adolescent population, with numerous cases reported in the medical literature. Many of these patients are strikingly similar in their clinical characteristics and, although the data are limited, a variety of treatment options may be successful in terminating this form of cough. However, psychogenic cough in adults has been reported infrequently and is less well defined. We report two cases of psychogenic cough in adult patients referred to our service for an evaluation of refractory, chronic cough and review the relevant medical literature. Our patients seemingly represent the first cases of psychogenic cough reported in the geriatric population and share clinical features with children, adolescents, and young adults. One case is unique in the sense that the cough responded to a distracter in the form of a throat lozenge, and this patient consumed > or = 20 lozenges/day for approximately 13 years. Psychogenic cough should be considered in adult patients who present with a chronic cough of no obvious organic basis that has failed therapy directed at postnasal drip, asthma, and gastroesophageal reflux. We propose criteria to assist in making a diagnosis of psychogenic cough in adult patients and review the limited information that exists concerning treatment modalities.
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PMID:Psychogenic cough in adults: a report of two cases and review of the literature. 1189 31

In addition to heartburn and regurgitation, cough is a frequent nonspecific complaint of patients with gastroesophageal reflux disease. The incidence of alternative etiologies for patients with chronic cough who are undergoing antireflux surgery is not known. To determine this, and the response of chronic cough to fundoplication, we performed a retrospective review of 129 patients with proven gastroesophageal reflux referred for surgical therapy. Chronic cough was present in 37 (29%) preoperatively. No differences were found in age, sex, or preoperative manometric findings between those with and without chronic cough. Patients with cough had a higher number of lower esophageal reflux events on preoperative 24-hour pH testing, and were more likely to have persistent dysphagia after surgery. Fifty-nine percent of patients with cough had an alternative etiology for cough, compared to 36% of those without cough. Of the common alternative etiologies, only a history of postnasal drip occurred more frequently in those with cough. Complete resolution of cough occurred in 24 patients (64%), with another 10 (27%) reporting significant improvement. The average cough score improved significantly regardless of which coexisting etiology the patients may have had. Additionally, heartburn and regurgitation were improved in 94% of all patients.
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PMID:Laparoscopic antireflux surgery and its effect on cough in patients with gastroesophageal reflux disease. 1198 13

Around 10-20% of the population suffer from the hallmark symptoms of heartburn, regurgitation, sour burping and retrosternal pain. Based on their characteristic medical history alone, such patients can usually be presumed to have gastroesophageal reflux disease (GERD). In around 30-50% of them, the endoscopic examination will reveal the typical erosions and ulcerations in the esophagus. In addition to the clinical symptoms, endoscopy plays a central role in diagnosing GERD. An endoscopy is always indicated whenever these warnings symptoms are present. In patients with persistent reflux problems, endoscopy is indicated to diagnose erosive reflux esophagitis. This procedure should include a routine biopsy taken distal to the Z-line to enable histological detection of the metaplasia associated with Barrett's esophagus. Although the majority of patients exhibit the classical symptoms and respond to acid suppression therapy, endoscopy may not find erosions (non-erosive reflux disease NERD). In these cases, further diagnostic steps must be taken to verify the diagnosis of gastroesophageal reflux disease. There are patients, moreover, who exhibit unclear, uncharacteristic reflux symptoms, such as respiratory diseases with bronchial asthma, chronic bronchitis, chronic cough or ENT problems like posterior laryngitis and globus sensation (a lump in the throat). In these uncertain cases and in patients with NERD, 24-hour pH monitoring can verify and objectify and acid gastroesophageal reflux. An association can then be made between acid reflux and symptomatology. As an alternative, trial therapy with a proton pump inhibitor can help identify patients who have acid-related problems and symptoms. Other functional tests such as radiographic examination, manometry or scintigraphy are less well suited, if at all, for primary diagnostics of gastroesophageal reflux disease.
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PMID:[Diagnosis of gastroesophageal reflux]. 1207 Oct 79

Following the experience of asthma, characterised by the presence of bronchial hyper-responsiveness, the notion has been accepted that the chronic cough of disease occurs as a result of altered sensitivity of the afferent limb of the cough reflex. Methods for testing for the 'threshold' for eliciting the cough reflex have also been borrowed from asthma care. In the main aerosols are inhaled that contain the relevant stimulus.A number of factors influence the cough response to inhaled aerosols. The distribution of the inhaled aerosol is important as certain chemically sensitive receptors are distributed in different regions of the lungs. The larynx and central airways are important but so too are the peripheral airways. The degree of bronchodilatation is also important as airway narrowing can, itself, induce coughing in man.Asthma, oesophageal reflux and rhinitis patients experience increased coughing, that is associated with increased sensitivity to inhaled capsaicin. In syndromes of chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD) increased sensitivity to coughing with capsaicin is common. This appears a specific effect of the pathogenic process of the disease. Modification of the disease process can lessen coughing and the sensitivity to capsaicin.
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PMID:Chronic cough and the cough reflex in common lung diseases. 1209 71

Gastro-esophageal reflux disease (GERD) and postnasal drip syndrome (PNDS) are common causes of chronic cough. In patients with normal chest radiographs, GERD most likely causes cough by an esophageal-bronchial reflex. When GERD causes cough, there may be no gastrointestinal symptoms up to 75% of the time. While 24-h esophageal pH monitoring is the most sensitive and specific test in linking GERD and cough in a cause and effect relationship, it has its limitations. There is no general agreement on how to best interpret the test and it cannot detect non-acid reflux events. While some patients improve with minimal medical therapy, others require intensive regimens. Surgery may be efficacious when intensive medical therapy has failed. Because there are no pathognomonic findings of PNDS, the diagnosis is inferential and is based upon a combination of clinical findings, the results of ancillary testing, and the response to specific therapy. Specific therapy depends upon the rhinosinus disease(s) causing the PND. A common error in managing PNDSs is to assume that all H(1)-antagonists are equally efficacious. The second-generation, relatively non-sedating H(1)-antagonists have been found to be less effective than the first-generation agents in treating cough due to non-histamine-mediated PNDSs.
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PMID:Diagnosis and treatment of chronic cough due to gastro-esophageal reflux disease and postnasal drip syndrome. 1209 81

On systematic investigation, patients with persistent cough are often diagnosed as having asthma, gastro-oesophageal reflux (GOR) and post-nasal drip; often, there is no associated diagnosis. Cough-variant asthma and eosinophilic bronchitis are conditions presenting with cough, usually associated with airway eosinophilia and responding well to corticosteroids. These conditions including asthma are best grouped as 'eosinophil-associated cough'. Analysis of induced sputum for eosinophils is an important tool in the investigation of chronic persistent cough. Reliable ambulatory counters for cough have been developed and the contribution of cough count and intensity to the severity of cough have been partly evaluated, and used in assessing antitussive therapies. Self-scoring evaluations are still widely used, but the inclusion of quality of life tools specifically adapted to the evaluation of cough appears to be a useful tool that can directly measure the impact of chronic cough. We need a greater assessment and evaluation of all these tools.
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PMID:Assessment and measurement of cough: the value of new tools. 1209 81


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