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)

Eighty-four otherwise healthy infants with daily wheezing underwent infant pulmonary function tests (IPFTs) and 24-h esophageal pH probe studies. Fifty-four (64%) infants had positive pH probe studies, and 30 infants had negative pH probe studies. Many infants in both groups had evidence of peripheral airflow obstruction at tidal breathing and on forced expiration as measured by thoracoabdominal compression. In infants with gastroesophageal reflux (GER), only 9 of 54 (16.6%) responded to bronchodilator therapy compared to 20 of 30 (66.6%) in the group with negative pH probe studies (P < 0.0005). In infants with positive pH studies, family history of asthma (n = 16) correlated well with positive response to bronchodilators (P < 0.0005), and all infants exposed to maternal smoking (n = 11) had no response to bronchodilators. Forty-four percent of infants with a positive pH probe had no gastrointestinal symptoms suggestive of GER. In infants with a negative pH probe, family history of asthma (n = 24) correlated well with positive response to bronchodilators (P < 0.0005), and exposure to maternal smoking (n = 8) correlated well with no response to bronchodilator therapy (P < 0.0005). We conclude that silent GER is common in infants with persistent wheezing. Furthermore, infants with GER are less likely to respond to bronchodilator therapy, and exposure to maternal smoking and family history of asthma may be significant independent factors.
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PMID:Lung function in infants with wheezing and gastroesophageal reflux. 1023 Sep 20

The relation between silent gastroesophageal reflux (GER) and respiratory problems such as persistent wheezing in infants is not well-established. Between January 1994 and June 1997, we evaluated the incidence of GER in 84 otherwise healthy infants referred to the Pediatric Pulmonary Medicine Division at Kosair Children's Hospital for evaluation of daily wheezing, and we followed their clinical course for 18 months. All underwent 24-hr esophageal pH studies to evaluate GER. The pH probe study was performed at a mean age of 8.74 +/- 4.6 months. Infants with a positive GER study were treated with an H2 receptor antagonist (H2RA) and a prokinetic agent for a mean of 5.6 +/- 2.4 months. At first follow-up visit 3 weeks after esophageal pH studies infants treated with an H2RA and those who did not have GER but continued with daily wheezing were started on flunisolide nasal solution (0.025%) delivered by nebulizer (125 mcg t.i.d.). Infants in both groups were followed every 1-2 months for a mean of 18 months and if clinically improved, attempts to decrease their daily asthma medications were made. Fifty-four of 84 (64%) had positive esophageal pH studies (GER-positive group), and 24 of them (44%) had no gastrointestinal symptoms suggestive of GER. Thirty patients had normal esophageal pH studies (GER-negative group). Twenty-two of these 30 (73%) infants without GER required nebulized flunisolide, compared to 13 of 54 (24%) infants with GER (P < 0.0005). Thirty-five of 54 (64.8%) infants with GER were able to discontinue all daily asthma medications within 3 months of starting antireflux therapy, while none of the infants without GER were able to discontinue daily asthma medications during the follow-up period (P < 0.0005). We conclude that silent GER is common in infants with daily wheezing, and controlling GER improves morbidity and decreases the need for daily asthma medications.
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PMID:Gastroesophageal reflux in infants with wheezing. 1082 32

Gastroesophageal reflux (GER) is common in those with asthma, with 77% of asthmatics complaining of heartburn, with 41% experiencing reflux-associated respiratory symptoms. Likewise, 24% of those with asthma that is difficult to control have "clinically silent" GER. There are no studies examining nocturnal reflux symptoms in asthmatics. Esophageal dysmotility is also common, and abnormal esophageal acid contact times on 24h esophageal pH tests were found in 82% of asthmatics examined consecutively. Most asthmatics with GER also have abnormal esophageal acid contact times while in the supine position, reflecting sleep time. Endoscopic evidence of esophagitis was found in 43% of asthmatics. Two mechanisms of bronchoconstriction induced by esophageal acid have been proposed: a vagally mediated reflex, by which esophageal acid in the distal esophagus causes reflex bronchoconstriction, and microaspiration. Although there is conflicting evidence, distal esophageal acid causes a decrease in peak expiratory flow rates, an increase in respiratory resistance, and an increase in minute ventilation. If microaspiration is present, there is further augmentation of this airway response. Although only a few studies have been performed in those with nocturnal asthma with GER, one study in a pediatric population showed that esophageal acid infusions caused more airway responses at 04:00 than at 24:00. Also, asthmatic children with nocturnal asthma symptoms have a higher reflux score, with a positive correlation between reflux score and nighttime-associated wheezing. Despite these findings in children, a study performed in sleeping adults with nocturnal asthma noted no alterations in airflow resistance with esophageal acid, concluding that GER contributed little to the nocturnal worsening of asthma. There are also gastroesophageal circadian issues that may influence GER in asthmatics. Gastric acid secretion peaks at approximately 21:00, and gastric emptying is delayed when a meal is given at 20:00 versus 08:00. Esophageal acid clearance is delayed significantly during sleep, and acid clearance occurs during arousals. Upper esophageal sphincter (UES) pressure also decreases with sleep onset, which may predispose to microaspiration. Further research is needed to clarify what role nocturnal reflux has on nocturnal asthma and airway inflammation and whether circadian rhythm factors alter airway responses to esophageal acid.
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PMID:Nocturnal asthma: role of nocturnal gastroesophageal reflux. 1051 87

Laparoscopic fundoplication controls heartburn and regurgitation, but the effects on the respiratory symptoms of gastroesophageal reflux disease (GERD) are unclear. Confusion stems from difficulty preoperatively in determining whether cough or wheezing is actually caused by reflux when reflux is found on pH monitoring. To date, there is no proven way to pinpoint a cause-and-effect relationship. The goals of this study were to assess the following: (1) the value of pH monitoring in establishing a correlation between respiratory symptoms and reflux; (2) the predictive value of pH monitoring on the results of surgical treatment; and (3) the outcome of laparoscopic fundoplication on GERD-induced respiratory symptoms. Between October 1992 and October 1998, a total of 340 patients underwent laparoscopic fundoplication for GERD. From the clinical findings alone, respiratory symptoms were thought possibly to be caused by GERD in 39 patients (11%). These 39 patients had been symptomatic for an average of 134 months. They were all taking H2-blocking agents (21%) or proton pump inhibitors (79%). Seven patients (18%) were also being treated with bronchodilators, alone (3 patients) or in combination with prednisone (4 patients). Median length of postoperative follow-up was 28 months. In 23 patients (59%) a temporal correlation was found during 24-hour pH monitoring between respiratory symptoms and episodes of reflux. Postoperatively heartburn resolved in 91% of patients, regurgitation in 90% of patients, wheezing in 64% of patients, and cough in 74% of patients. Cough resolved in 19 (83%) of 23 patients in whom a correlation between cough and reflux was found during pH monitoring, but in only 8 (57%) of 14 of patients when this correlation was absent. Cough persisted postoperatively in the two patients who did not cough during the study. These data show that pH monitoring helped to establish a correlation between respiratory symptoms and reflux, and it helped to identify the patients most likely to benefit from antireflux surgery. Following laparoscopic surgery, respiratory symptoms resolved in 83% of patients when a temporal correlation between cough and reflux was found on pH monitoring; heartburn and regurgitation resolved in 90%.
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PMID:Effect of laparoscopic fundoplication on gastroesophageal reflux disease-induced respiratory symptoms. 1067 37

Gastroesophageal reflux (GER) is implicated in the pathogenesis of respiratory symptoms in childhood. It should be taken into account especially in the differential diagnosis of children presenting with wheezing. Although, oesophageal pH monitorization has been reported to be the best technique in the evaluation of GER, radionuclide studies have also been shown to be very sensitive recently. In this study, 82 children presenting with recurrent wheezing (n = 74) and/or vomiting (n = 28) (mean age 17.4 months; range 3-48 months) were evaluated. GER scintigraphy was performed to determine the frequency of GER. GER was determined in 18 of the 82 cases (21.9%). The GER was found in 21.1% of children with recurrent wheezing and in 16.6% of children suffering from recurrent vomiting. GER scintigraphy should be kept in mind in the evaluation of children with the complaint of recurrent wheezing since it is a noninvasive and easily applicable method.
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PMID:Results of the gastroesophageal reflux assessment in wheezy children. 1079 82

Respiratory symptoms in children may be associated with underlying gastro-oesophageal reflux (GOR). We reviewed the case notes of 20 children who presented to us from June 1993 to June 1994 with respiratory symptoms and GOR. The patients consisted of 16 Malays, two Chinese and two Indians with equal number of males and females. Their age at diagnosis was less than one year in 17 patients. The earliest age at presentation was at the third day of life. All patients had major respiratory manifestations i.e. recurrent wheezing, recurrent cough and pneumonia. In addition, three patients had stridor and six patients had apparent life threatening episodes (ALTE). Fourteen patients required ventilation because of respiratory failure. Diagnosis of GOR was based on clinical grounds supported by barium oesophagogram in seven patients and ultrasound examination in 11 patients. Eight patients were fundoplicated because of ALTE and recurrent severe bronchospasm. On follow up, 14 patients had hyperactive airways requiring inhaled bronchodilator and steroid therapy.
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PMID:Gastro-oesophageal reflux in children with severe respiratory symptoms--clinical spectrum and management. 1096 86

Vocal cord dysfunction (VCD) is a condition of paradoxical adduction of the vocal cords during the inspiratory phase of the respiratory cycle. VCD often presents as stridorous breathing, which may be misdiagnosed as asthma. The mismanagement of this disorder may result in unnecessary treatment and iatrogenic morbidity. An association with psychogenic factors has been reported, and a higher incidence of anxiety-related illness has been demonstrated in patients with VCD. Definitive diagnosis of VCD is made by visualization of adducted cords during an acute episode using nasopharyngeal fiber-optic laryngoscopy. Diagnosis can be problematic, because it may be difficult to reproduce an attack in a controlled setting. To maximize diagnostic yield during laryngoscopy, provocation of symptoms using methacholine, histamine, or exercise challenges have been used. We report a case of an 11-year-old boy, wherein hypnotic suggestion was used as an alternative method to achieve a diagnosis of VCD. The patient was admitted to the pediatric intensive care unit for elective fiber-optic laryngoscopy to confirm a diagnosis of VCD. The patient had a 4-year history of refractory asthma, severe gastroesophageal reflux disease (GERD) for which he had undergone a Nissen fundoplication, and suspected VCD. At 9 years of age the patient began manifesting monthly respiratory distress episodes of a severe character different from those that had been attributed to his asthma. Typically, he awoke from sleep with shortness of breath and difficulty with inhalation. He described a "neck attack" during which he felt as if the walls of his throat were "beating together." The patient was at times noted by his mother to exhibit a "suckling" behavior before onset of his respiratory distress episodes. On 4 occasions the patient became unconscious during an attack and then spontaneously regained consciousness after a few minutes. On these occasions, he was transported by ambulance to the hospital and the severe difficulty with inhalation resolved within a few minutes on treatment with oxygen and bronchodilators. Sometimes he was noted to manifest wheezing for several hours, which was responsive to bronchodilator therapy. Given the severity of the patient's disease, it was imperative to determine whether VCD was a complicating factor. It was proposed that an attempt be made to induce VCD by hypnotic suggestion while the patient underwent a fiberscopic laryngoscopy to establish a definitive diagnosis. The patient and his mother gave written consent for this procedure. He was admitted for observation to the pediatric intensive care unit for the induction attempt. The patient requested that no local anesthesia be applied in his nose before passage of the laryngoscope because he wanted to eat right after the procedure. Therefore, the nasopharyngeal laryngoscope was inserted while he used self-hypnosis as the sole form of anesthesia. He demonstrated no discomfort during its passing. Once the vocal cords were visualized, the patient was instructed to develop an episode of respiratory distress while in a state of hypnosis by recalling a recent "neck attack." His vocal cords then were observed to adduct anteriorly with each inspiration. The patient then was asked to relax his neck. When he did, the vocal cords immediately abducted with inspiration, and he breathed easily. After removal of the laryngoscope, the patient alerted from hypnosis and said he felt well. He reported no recollection of the procedure, thus demonstrating spontaneous amnesia that sometimes is associated with hypnosis. Because the diagnosis of VCD was confirmed, the patient was encouraged to use self-hypnosis and speech therapy techniques to control his symptoms. He also was referred for counseling. To our knowledge this is the first description in the medical literature of the use of hypnotic suggestion for making a diagnosis of VCD. (ABSTRACT TRUNCATED)
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PMID:Hypnosis as a diagnostic modality for vocal cord dysfunction. 1109 24

Gastroesophageal reflux (GOR) is a major cause of morbidity and failure to thrive particularly in neurologically impaired children. Clinical manifestations of GOR in children range from regurgitation, food refusal, irritability, failure to thrive, hematemesis, wheezing and aspiration pneumonia, apnoea and apparent life threatening events in infants to clinically silent reflux. Although, no one test is always best to diagnose GOR, 24 hour esophageal pH monitoring remains the 'gold standard' for diagnosis. Barium radiography is useful for the diagnosis of associated anatomical abnormalities and endoscopy enables a histological diagnosis of esophagitis. Therapy for gastroesophageal reflux disease is now well established. Proper positioning of the baby and thickening of feeds is beneficial in uncomplicated GOR. Prokinetic agents like cisapride should be tried if dietary management and antacids are ineffective. Metoclopramide or domperidone may be tried in neurologically impaired children. H2-receptor antagonists are indicated in GOR complicated by esophagitis. Ranitidine is regarded to be more potent. Cimetidine has additional spectrum of adverse effects and sufficient information is not available on famotidine. Omeprazole has been shown to be effective in treating GOR-esophagitis resistant to H2 antagonist therapy even in high risk patients.
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PMID:Gastroesophageal reflux in children. 1113 70

Cough is a common symptom in office practice. Though troublesome, it serves to maintain normal function of respiratory tract. Chronic or recurrent cough may be caused by variety of diseases, asthma being the most common amongst them. Cough, wheeze and breathlessness are classical features of asthma syndrome. Many diseases may lead to this syndrome. Asthmatic children present with cough of variable intensities and patterns. At times, wheeze and breathlessness may not be clinically apparent. It was well known that all that wheezes is not asthma but now it is well understood that every asthmatic child does not wheeze. In an acute attack of asthma, cough often starts at the end of wheezing episode. It leads to expulsion of thick, stringy mucus often in the form of casts. Though cough is a minor symptom during acute attack, it ensures removal of secretions and avoid complications. Cough is a prominent symptom in persistent asthma especially between acute exacerbations. Episodic nocturnal cough may be the only symptom of chronic asthma. Children with cough variant asthma do not wheeze. It is postulated that they have milder degree of airway hyperresponsiveness and higher wheezing threshold. However, they show all the characteristics of asthma on laboratory tests. Cough represents bronchial hyperresponsiveness and is not a measure of asthma. Hence it may be caused by many diverse etiologies such as gastroesophageal reflux, enlarged adenoids, sinusitis or tropical eosinophilia. Cough in such conditions mimicks asthma and relevant tests may be necessary for proper diagnosis.
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PMID:Cough and asthma. 1141 73

Chronic lung disease of prematurity (CLD) is largely confined to preterm infants who require mechanical ventilation in the newborn period. Its development is associated with preterm labour and pulmonary inflammation secondary to oxidant stress, barotrauma of mechanical ventilation and antenatally--or postnatally--acquired respiratory tract infection. Pathological studies have shown that infants dying of established CLD have airway wall thickening secondary to increased airway wall smooth muscle mass, alveolar hypoplasia and pulmonary vascular re-modelling. These structural abnormalities are likely to account for the clinical problems of arterial hypoxemia and hypercapnia, tachypnea, recurrent wheezing and decreased exercise tolerance. Severity of the structural components may account for the clinical variation that is observed in a particular child. Management of CLD is aimed at decreasing the effects of hypoxemia and in maximising somatic, and by implication lung, growth. Low flow domiciliary oxygen and bronchodilators are used for arterial hypoxemia and recurrent wheezing. Systemic and inhaled corticosteroids may be beneficial but it is unclear if such treatment alters the natural history of CLD in the developing lung. Gastro-esophageal reflux should be sought in these infants and they should receive immunizations or immunoprophylaxis against respiratory tract pathogens. There is considerable concern that survivors of CLD may develop respiratory failure in early--or late--middle age.
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PMID:Chronic lung disease of prematurity: clinical and pathophysiological correlates. 1166 9


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