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

Chronic cough is a debilitating symptom for which patients commonly seek medical attention. Among adult non-smokers who are not taking an angiotensin-converting enzyme inhibitor and have a normal or near normal chest radiograph, postnasal drip syndrome caused by a variety of rhinosinus conditions, asthma and non-asthmatic eosinophilic bronchitis and gastro-oesophageal reflux disease singly or in combination, are the most common diagnoses underlying chronic cough. Pharmacotherapy for chronic cough can be either specific or non-specific. Specific therapy is preferable and the most effective as it is directed at the aetiologies and pathophysiological mechanisms responsible for cough. In contrast, non-specific therapy is used only in limited clinical settings, as it is directed at the symptom rather than underlying aetiologies and aims only to control, rather than eliminate cough.
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PMID:Pharmacotherapy of chronic cough in adults. 1283 32

Gastroesophageal reflux disease (GERD) occurs in at least one third of patients with asthma and is recognized as a potential trigger for asthma symptoms. The results of studies conducted in patients with both asthma and GERD, in which proton pump inhibitor (PPI) therapy is used to evaluate its effect on asthma outcome, are inconsistent, and many of these studies suffer from different design flaws. However, it does appear that PPI treatment may improve nocturnal asthma symptoms in patients who also have GERD. Moreover, both daytime asthmatic symptoms and pulmonary function seem to improve in some patients with PPI treatment. There is evidence that more severe GERD might predict a more favorable asthma outcome with PPI therapy. For effective management of GERD-related asthma, PPIs should be used at a dose double that of the standard dose for a minimum of 2 to 3 months. Although GERD is also known to be an important cause of chronic cough, there have been only 2 placebo-controlled trials investigating the efficacy of PPI on GERD-related chronic cough. Results of both of these trials suggest that PPI treatment relieves GERD-related chronic cough. As with GERD-related asthma, it would seem reasonable to use a double-standard dose of a PPI for a minimum of 2 to 3 months in the management of GERD-related chronic cough. However, larger, adequately planned studies are needed to confirm the role of PPIs in the management of GERD-related asthma and chronic cough.
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PMID:The role of proton pump inhibitors in the management of gastroesophageal reflux disease-related asthma and chronic cough. 1292 78

Laparoscopic Nissen fundoplication has been shown to improve overall quality of life (QOL) in patients with gastroesophageal reflux, but most studies have not addressed patients with atypical symptoms. We investigated the effect of laparoscopic Nissen fundoplication on QOL using the Gastrointestinal Quality of Life Index (GIQLI) survey modified to address both typical (heartburn, regurgitation, dysphagia) and atypical (hoarse voice, chronic cough, adult-onset asthma, vocal cord polyps) symptoms. One-hundred forty-eight patients underwent laparoscopic Nissen fundoplication for gastroesophageal reflux disease (GERD) at UCLA Medical Center from January 1, 1995 to May 1, 2002. Surveys evaluating pre- and postoperative QOL were administered after surgery: 55 per cent of patients responded (82/148). Forty-eight per cent of all patients (72/148) had atypical symptoms. Perioperative morbidity and mortality were 8.8 per cent and 0.7 per cent, respectively. Mean length of postoperative stay was 2.96 +/- 1.5 days. Mean follow-up for the entire cohort was 18.5 months. Postoperative dysphagia not present before surgery occurred in 4.7 per cent of patients. Eighty per cent of patients were medication-free following surgery. QOL scores for all participants increased significantly from 52.5 +/- 15.3 preoperatively to 72.0 +/- 14.9 postoperatively (P < 0.0001). Patients with atypical symptoms or typical symptoms alone showed significant mean QOL score increases from 48.3 +/- 17.6 preoperatively to 71 +/- 15.7 postoperatively (P < 0.0001) and from 55.7 +/- 12.6 to 72.8 +/- 14.4 (P < 0.0001), respectively. Laparoscopic Nissen fundoplication can effectively improve overall QOL for patients with GERD. Patients with atypical GERD symptoms can experience increases in QOL similar to those with only typical gastrointestinal symptoms.
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PMID:Laparoscopic Nissen fundoplication improves quality of life in patients with atypical symptoms of gastroesophageal reflux. 1457 Mar 58

The aim of this study was the assessment of citric acid cough threshold in patients with chronic cough due to GERD, confirmed by 24-hour esophageal pH- monitoring, with other reasons of chronic cough excluded. Thirty subjects with chronic cough due to GERD and 15 healthy volunteers underwent cough challenge with doubling concentrations of citric acid using Asthma Provocation System (Jaeger). The cough threshold was defined as the first concentration of citric acid that induced cough. Spirometric parameters (FEV, PEF and FVC) were measured before and 10 minutes after cough challenge in all groups. A day and night cough score diaries (verbal category descriptive score) were completed in all subjects. The cough threshold was significantly lower in GERD patients in comparison with healthy volunteers. In GERD patients the negative correlation was found between day cough score measurements and cough threshold. Citric acid cough challenge did not cause bronchoconstriction or any significant change of spirometric parameters.
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PMID:[Assessment of cough threshold in patients with gastroesophageal reflux disease]. 1458 28

The pathogenesis and clinical features of gastro-oesophageal reflux related cough are complex and the diagnostic tests available are of limited reliability. Treatment needs to be tailored to the specific needs of individual patients and other possible causes of chronic cough should be investigated. Treatment should only be considered to have failed when cough persists after administration of proton pump inhibitors at an adequate dosage for a sufficient length of time.
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PMID:Cough. 3: chronic cough and gastro-oesophageal reflux. 1522 77

The intimate anatomical and physiologic relationship between the upper airway and esophagus consists of complex interactions between various muscles and nerves with both voluntary and involuntary patterns of control. Alterations in this harmonic relationship can lead to swallowing abnormalities ranging from dysphagia to gross aspiration, gastroesophageal reflux disease (GERD) and chronic cough. There is a paucity of data regarding pathologic alterations in the upper airway-esophageal relationship in patients with COPD. The association between GERD and respiratory symptoms is well recognized in the setting of asthma; however, the nature of this relationship remains controversial. The association of GERD and COPD is even less clear. A review of the limited data on GERD and swallowing abnormalities in patients with COPD indicate that prevalence of GERD and esophageal disorders in patients with COPD is higher than in the normal population. However, its contribution to respiratory symptoms, bronchodilator use and pulmonary function in patients with COPD remains unknown. Although dysphagia and swallowing dysfunction on videofluoroscopic swallow evaluation are common in patients with COPD, their role as exacerbators of COPD remains to be elucidated. Further clinical research is necessary to evaluate the role of GERD and swallowing dysfunction in both stable and acute exacerbation of COPD.
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PMID:Clinical implications of gastroesophageal reflux disease and swallowing dysfunction in COPD. 1472 11

Gastroesophageal reflux disease (GERD) is a common condition which is particularly prevalent in patients with asthma and chronic cough. Physiologic changes caused by asthma and chronic cough promote acid reflux. GERD is also considered by many investigators as a factor contributing to airway inflammation. An etiological relationship between GERD and asthma/chronic cough and vice versa has been supported by a large number of experimental and clinical findings and refuted by others. Although further controlled studies are needed to clarify this relationship, GERD and asthma/chronic cough appear to be linked to each other. The association of GERD with asthma and chronic cough involves nerve reflexes, cytokines, inflammatory and neuroendocrine cells and, in some patients, tracheal aspiration of refluxing gastric fluids. GERD may present with typical symptoms but can also be asymptomatic. Sensitive methods for diagnosing GERD are available, which include esophageal pH monitoring, acid provocative tests, modified barium swallow and endoscopy. Consideration of the association of GERD with asthma and chronic cough is of practical value in the management of chronic cough or asthma resistant to treatment. Treatment of GERD in patients with asthma has been consistently shown to improve respiratory symptoms but not necessarily pulmonary function tests. Surgical treatment can be a useful and cost-effective approach in selected patients with asthma and GERD.
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PMID:The association of gastroesophageal reflux disease with asthma and chronic cough in the adult. 1472 67

Chronic cough is a common problem in patients who visit physicians. The three most common causes of persistence cough in nonsmokers who were not taking an ACE inhibitor and who had a normal or stable chest radiograph are: postnasal drip, asthma and gastroesophageal reflux. After a viral upper respiratory infection, it takes sometimes seven weeks for bronchial airway hyperreactivity to return to normal. By using a standard protocol, 95 percent of patients with chronic cough can be managed successfully but in some cases it may take even five months or more to determine a diagnosis and effective treatment.
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PMID:[Chronic cough--etiological diagnosis problems]. 1475 33

Manifestations of atypical gastroesophageal reflux disease (GORD) are varied, and the presentation of atypical symptoms may occur in the absence of typical symptoms. The most sensitive and specific investigation for GORD is pH monitoring, and its application in atypical disease is utilized throughout this paper as a basis for correlating disease and pathogenesis. The less well-known areas of laryngeal manifestations, particularly chronic hoarseness and globus, are discussed in addition to recent work on orodental manifestations. Well-known areas of cardiac and respiratory manifestations, which include chronic cough and asthma, are also reviewed. Evidence from clinical trials indicates that aggressive anti-reflux therapy in patients with atypical symptoms can be effective. Where appropriate, medical therapy may involve long-term proton pump inhibitor, although further research outlining the roles of other therapies such as surgery is awaited.
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PMID:A review of the atypical manifestations of gastroesophageal reflux disease. 1499 70

The association of gastroesophageal reflux, esophagitis, and asthma has been studied for a long time, but the results are often conflicting. The aim of this study is to evaluate the prevalence of bronchial asthma and the presence of extra-esophageal symptoms in subjects with endoscopically-documented reflux esophagitis. Forty patients were divided into 2 groups: group A (22 patients) affected by endoscopically-documented esophagitis, and group B (18 patients) with positive endoscopic examination for other pathologies of the gastroenteric tract. All of the patients underwent complete medical examination, skin-prick tests, esophageal-gastric-endoscopy, and pulmonary function tests (basal and after methacholine). The prevalence of asthma was 30% in group A vs 10% in group B (odds ratio = 2.57; confidence interval = 0.75-10.25). Relationships between chronic cough and esophagitis (p<0.01) and between chronic cough and asthma (p<0.05) were found. No significant relationships were observed between esophagitis and the other respiratory symptoms considered (wheezing, chest tightness, hoarseness, bronchospasm, and dysphagia). The results confirm the increased prevalence of asthma in patients with esophagitis and they emphasize the role of gastroesophageal reflux as a trigger factor for asthma. Chronic cough represents an important symptom of asthma in subjects with esophagitis.
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PMID:Prevalence of bronchial asthma in patients with endoscopically-documented esophagitis. 1503 74


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