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

Persistent isolated inflammation of the sphenoid sinus, an entity that is not diagnosed very often, poses a challenge to clinicians and researchers alike. Its features tend to suggest that its etiopathogenesis is different from that of more common forms of chronic rhinosinusitis. We report the case of a 54-year-old woman who had a history of distressing chronic postnasal drip and a globus sensation with opacification of the sphenoid sinus. She was diagnosed with gastroesophageal reflux, and Helicobacter pylori was detected in her gastric contents and in the inflamed mucosa of the sphenoid sinus, as well. Complete symptom relief was achieved only after she had undergone surgical sphenoidotomy and treatment with anti-H pylori medication. We discuss the potential for this ubiquitous gastric bacterium to play a role in at least some forms of chronic sinonasal inflammation.
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PMID:Does Helicobacter pylori play a role in upper respiratory tract inflammation? A case report. 1592 24

Chronic cough (more than 8 weeks) is a frequent symptom (30 millions consultations/ year). The most encountered causes are: asthma, gastro-oesophageal reflux, post nasal drip. Practically we propose the following approach: 1. clinical history, physical examination, chest-X ray, spirometry; 2. to exclude a post infection cough or secondary to an ACEI; 3. in case of high clinical probability of asthma, post-nasal drip, gastro-oesophageal reflux, to treat adequately. In case of negative clinical probability or unsuccessful treatment, metacholine test, oesophageal studies, PEF recording, CT thorax, bronchoscopy, CT sinuses are the most useful tests, using clinical history as guide. Using such an approach, treatment is successful in the vast majority of cases.
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PMID:[Chronic cough: a practical approach]. 1604 95

A variety of pulmonary and ear, nose, and throat (ENT) symptoms and disorders are considered to be extraoesophageal manifestations of gastro-oesophageal reflux disease (GORD). These extraoesophageal manifestations include asthma, chronic cough, laryngeal disorders, and various ENT symptoms. Recent studies have established that GORD underlies or contributes to chronic sinusitis, chronic otitis media, paroxysmal laryngospasm, excessive throat phlegm, and postnasal drip. Traditionally, management of extraoesophageal GORD manifestations relies on prolonged empiric therapy with high doses of proton pump inhibitors (PPI), followed by pH monitoring under PPI in refractory cases. Recent studies found no benefit of empiric long term high dose PPI therapy. The diagnostic yield of endoscopy in extraoesophageal GORD manifestations seems higher than previously appreciated while pH monitoring under PPI therapy has a low yield. Based on these new findings, a new management algorithm can be proposed that uses short term empiric PPI therapy and GORD investigations off PPI. Well designed controlled studies evaluating the proposed management algorithms and treatment approaches in this area are urgently needed.
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PMID:Extraoesophageal manifestations of gastro-oesophageal reflux. 1616 55

Most studies agree that post-nasal drip syndrome (PNDS), asthma, gastroesophageal reflux disease (GORD), and laryngopharyngeal reflux (LPR) are the commonest causes of chronic cough in the immunocompetent, non-smoking patient who is not taking an angiotensin-converting enzyme inhibitor. No diagnostic test has been found to define those who are said to have PNDS other than a response to a first-generation antihistamine. Examining the available evidence suggests that mechanical stimulation of the pharynx by mucus is not an adequate theory for the production of cough. Inflammatory mediators in the lower airways are raised in PNDS, cough variant asthma and GORD, and the theory that an inflammatory process is affecting 'one airway' is a plausible one. Nasal disease is more likely to result in cough from the co-existing involvement of the lower airways through an as yet undefined pathway, and eosinophil and mast cell mediation appear a likely mechanism.
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PMID:The aetiology of chronic cough: a review of current theories for the otorhinolaryngologist. 1648 May 51

Worldwide paediatricians advocate that children should be managed differently from adults. In this article, similarities and differences between children and adults related to cough are presented. Physiologically, the cough pathway is closely linked to the control of breathing (the central respiratory pattern generator). As respiratory control and associated reflexes undergo a maturation process, it is expected that the cough would likewise undergo developmental stages as well. Clinically, the 'big three' causes of chronic cough in adults (asthma, post-nasal drip and gastroesophageal reflux) are far less common causes of chronic cough in children. This has been repeatedly shown by different groups in both clinical and epidemiological studies. Therapeutically, some medications used empirically for cough in adults have little role in paediatrics. For example, anti-histamines (in particular H1 antagonists) recommended as a front-line empirical treatment of chronic cough in adults have no effect in paediatric cough. Instead it is associated with adverse reactions and toxicity. Similarly, codeine and its derivatives used widely for cough in adults are not efficacious in children and are contraindicated in young children. Corticosteroids, the other front-line empirical therapy recommended for adults, are also minimally (if at all) efficacious for treating non-specific cough in children. In summary, current data support that management guidelines for paediatric cough should be different to those in adults as the aetiological factors and treatment in children significantly differ to those in adults.
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PMID:Cough: are children really different to adults? 1627 Sep 37

Cough is one of the most prevalent symptoms for which patients seek the attention of their physicians. Cough may serve as a protective reflex but can also impair social well-being and can profoundly and adversely affect patient's quality of life. Short and self-limited cough often does not require therapy, whereas prolonged cough is bothersome and should prompt further workup. If possible, the underlying cause should be identified and treated accordingly. Often, the patient history helps to establish a working hypothesis, such as possible post-nasal drip syndrome or gastroesophageal reflux as a cause. Asthma, another frequent cause of prolonged cough, is readily diagnosed in most cases. The response to empirical therapy often "confirms" a suspected etiology, if not, extensive workup involving function testing such as bronchoprovocation, radiology, endoscopy, and extended search for exceptional causes is warranted. Productive cough is often related to a bronchopulmonary disease, whereas an irritant cough is often of an extrapulmonary origin.
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PMID:[Cough as a symptom--clarify or treat empirically?]. 1661 89

A case of vocal cord dysfunction (VCD) is presented, followed by a discussion of the clinical characteristics, pathogenesis, diagnosis, and management of this disorder. Special emphasis is given to clinical pearls and pitfalls for the practicing allergist. VCD is a common condition that mimics asthma. Dyspnea, cough, and chest tightness are frequent manifestations of the disease. A high degree of clinical suspicion is required to recognize VCD and diagnosis is made most confidently by laryngoscopy. The mainstay of treatment for VCD is reassurance, speech therapy, and treatment of associated comorbidities including gastroesophageal reflux disease, postnasal drip syndrome, and psychiatric conditions.
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PMID:Vocal cord dysfunction. 1694 60

VCD is often mistaken for asthma and can lead to treatment with corticosteroids and the development of significant side effects. Early and correct diagnosis will avert significant iatrogenic complications. For many individuals, the role of postnasal drip and GERD in the pathogenesis of VCD is central, as they are often associated with VCD and likely lead to increased laryngopharyngeal sensitivity and hyperreactivity. Much needs to be further elucidated in terms of the underlying pathogenesis of VCD. Management of VCD requires identification and treatment of underlying disorders and referral to speech therapists that can teach techniques of throat relaxation, cough suppression, and throat clearing suppression.
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PMID:Vocal cord dysfunction, gastroesophageal reflux disease, and nonallergic rhinitis. 1715 31

Globus pharyngeus is a symptom commonly encountered in ENT practice. The usual complaint is that of the sensation of a ball or lump in the throat generally unaccompanied by dysphagia. This sensation is often more pronounced when taking an 'empty swallow'. The precise mechanism of this remains enigmatic in many cases. Irritant factors such as gastroesophageal reflux, postnasal drip and excessive throat clearing may be contributory factors as may be stress and psychological influences. Although gastric type mucosa occupying the cervical oesophagus has been long recognised, mainly in the specialised gastrointestinal literature, there appears to be more limited awareness of the condition in ENT practice and the clinical significance of such heterotopia is not well established. We present five recent cases of globus pharyngeus encountered in our ENT practice in which rigid pharyngoesophagoscopy and biopsy revealed heterotopic gastric mucosa within the postcricoid and cervical oesophagus constituting a so-called gastric 'inlet patch'. One case re-presented with invasive adenocarcinoma within a short time. Herein we compare and contrast inlet patch with columnar lined oesophagus, discuss the potential clinical significance of inlet patch and comment upon further management of the condition.
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PMID:Heterotopic gastric mucosa in the cervical oesophagus (inlet patch) and globus pharyngeus--an under-recognised association. 1716 26

Collecting exhaled breath condensate (EBC) has become a frequently used method in respiratory researches to date. Through this method we can sample airway surface liquid non-invasively by streaming the exhaled breath through a cooled chamber and after we examine the fluid deposited on the wall of the condenser. The sample contains several mediators, biomarkers. The pH of the condensate is one of the most important markers measured in the EBC. Measuring the pH is easy, cheap and it is in the optimal range, there is no problem with the detection limit. The uncertainty of the pH assays is derived from the instability of the EBC pH which results from the altering carbon-dioxide concentration. Many articles have been published on EBC pH in different airway diseases. Acidification of the condensates has been described in bronchial asthma (especially in acute exacerbations), chronic obstructive lung disease (COPD). Due to the steroid treatment the pH has increased in both cases. In patients with bronchiectasis, cystic fibrosis and in chronic cough (bronchial asthma, gastro-esophageal reflux, postnasal drip, and unknown origin) the pH of EBC was also lower. Acidification of the airways in different diseases can play a role in the pathomechanism, and its indicator, the EBC pH might help managing patients with airway diseases.
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PMID:[The pH of the exhaled breath condensate: new method for investigation of inflammatory airway diseases]. 1758 55


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