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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) 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.
Allergy Asthma Proc
PMID:Gastroesophageal reflux: pathogenesis, diagnosis, and treatment. 1007 9

Bronchial asthma is a disease that has been recognized for centuries, which is influenced mainly by genetic and environmental factors. The current interest of bronchial asthma is focused to ascertain the causes and the mechanisms that induce bronchoconstriction. Recently, abnormalities of the esophageal and gastric tracts have become important related areas for research. In predisposed individuals, these abnormalities can trigger or worsen the particular syndrome better known as "gastric asthma." In bronchial asthma the disorder of gastroesophageal reflux (GER) occurs more often than would be expected by chance. The neurogenic mechanism is considered to be the main cause of bronchoconstriction. The diagnosis of gastric asthma is particularly difficult and it should be considered also when GER is less evident or not recognized. In asthmatic patients the recognition of gastric abnormalities is very relevant for therapeutic problems also when GER is in a subclinical stage. In fact, many drugs used in the treatment of bronchial asthma can promote or enhance GER and subsequently they can worsen the symptoms of gastric asthma.
J Asthma 1999 Jun
PMID:Gastric asthma: an unrecognized disease with an unsuspected frequency. 1038 94

An association between gastroesophageal reflux (GER) and asthma has been suggested for many decades. Although antireflux therapy (medical and surgical) has been shown to be beneficial in patients with asthma, response to therapy has not been well quantified. The aim of this study was to evaluate long-term outcome in patients with asthma and associated GER undergoing fundoplication. From a database of more than 600 patients with GER treated surgically between 1991 and 1996, 39 patients with asthma as their primary indication for surgery were identified. Asthma symptom scores were determined using the National Asthma Education Program classification, and medication frequency scores were determined preoperatively and at latest follow-up (median follow-up 2.7 years). Comparisons were made using the Wilcoxon rank-sum test. Asthma symptom scores decreased significantly after antireflux surgery. More important, the medication scores for use of systemic corticosteroids decreased significantly postoperatively (2.2 preoperatively vs. 0.7 postoperatively; P = 0.0001). Of the nine patients who required daily oral corticosteroids, seven have discontinued treatment entirely (78%). In patients with asthma associated with GER, symptoms of asthma are improved following fundoplication. Especially important has been the ability to wean patients from systemic corticosteroids postoperatively. Fundoplication should be offered to those patients with GER-associated asthma, especially those who are steroid dependent.
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PMID:Asthma and gastroesophageal reflux: fundoplication decreases need for systemic corticosteroids. 1048 3

The relationship between asthma and gastroesophageal reflux (GER) is controversial. This paper reviews the evidence for an association between them, the effect of asthma on GER, and the effects of GER and antireflux therapy on asthma. The association between the two conditions seems firm but studies of the effects of GER on asthma and asthma on GER are contradictory. Critical review suggests that GER affects asthma symptoms but not pulmonary function. Antireflux therapy improves asthma symptoms and reduces medication requirements but does not improve pulmonary function. The paradox of GER causing asthma symptoms but not changing pulmonary function may be explained by its increasing minute ventilation rather than triggering bronchospasm.
J Asthma 1999 Dec
PMID:Gastroesophageal reflux and asthma: are they related? 1060 18

Asthma and gastroesophageal reflux (GER) are commonly associated disorders. Microaspiration is one possible link between these processes. The purpose of this study was to assess methacholine reactivity following repeated small-volume aspiration such as may occur with GER. This was also correlated with airway cytology. Five weekly intratracheal instillations of either milk (N = 8) or saline sham controls (N = 7) in volumes of 0.25 mL/kg were performed in anesthetized rabbits. Transpulmonary pressure, flow, tidal volume, central airways resistance, and dynamic lung compliance were measured in anesthetized and paralyzed animals at baseline, after 2 and 5 weeks of instillation, and 3 weeks after the last instillation. Doubling concentrations of methacholine were given until a 50% or greater increase in resistance occurred (PC50R). Bronchial washings for cytological evaluation were performed after the physiologic measurements and before each instillation. There were no significant differences in airway reactivity between baseline and all subsequent observation points within each of the two groups. However, methacholine responsiveness was significantly higher in the milk group before the final instillation (PC50R = 5.84 vs. 12.97 mg/mL, P = 0.03) and at recovery (PC50R = 6.40 vs. 10.56 mg/mL, P = 0.047) when compared to saline controls. This was associated with a higher neutrophil percentage (P = 0.01) at 5 weeks, and eosinophil percentage (P = 0.05) at recovery in the bronchial wash specimens from the milk group. These results show that repeated small-volume aspiration of milk in rabbits causes persistent inflammation and is associated with greater airway reactivity when compared to sham controls. This inflammation was accompanied by either increased neutrophils or eosinophils in bronchial lavage specimens. These findings lend support to a possible role of microaspiration in association with increased airway reactivity in patients with GER.
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PMID:Airway reactivity following repeated milk aspiration in rabbits. 1063 1

Asthma is a complex, multifactorial disease. Although airway reactivity, inflammation, and increased mucus secretion are agreed on universally as the central components of asthma, the pathophysiology of each of these is complex. This Article reviews the physiologic events resulting in symptoms of asthma. The contributions of genetics and environment to the development of the asthma phenotype are discussed. Gastroesophageal reflux and environmental allergies are prevalent conditions in asthmatic patients and often act as significant triggers for asthma symptoms.
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PMID:Pathophysiology of asthma. 1063 54

The Expert Panel Report 2. Guidelines for the Diagnosis and Management of Asthma (1) begins its section on controlling factors that precipitate or worsen asthma with the statement: "For successful long-term asthma management, it is essential to identify and reduce exposures to relevant allergens and irritants and to control other factors that have been shown to increase asthma symptoms and/or precipitate asthma exacerbations." The presence of allergy to indoor allergens and certain seasonal fungal spores has been found to be a risk factor for asthma in epidemiologic studies around the world. Generally between 70% and 85% of asthmatic populations studied have been reported to have positive skin-prick tests. Exposure of allergic patients to inhalant allergens increases airway inflammation, airway hyper-responsiveness, asthma symptoms, need for medication, severe attacks, and even death due to asthma. Environmental tobacco smoke exposure has been shown to increase the prevalence of childhood asthma and to increase asthma symptoms and bronchial hyperresponsiveness while reducing pulmonary function in children chronically exposed. Exposure to other indoor irritants, largely products of unvented combustion, has also been found to increase asthma symptoms. Outdoor air pollution increases asthma symptoms; levels of specific pollutants correlate with emergency room visits and hospitalization for asthma. Rhinitis/sinusitis and gastroesophageal reflux are commonly associated with asthma, and treatment of these conditions has been shown to improve asthma. In patients sensitive to aspirin and nonsteroidal anti-inflammatory drugs or metabisulfites, exposure to these agents can precipitate severe attacks of asthma. Viral infections are common causes for exacerbations of asthma. Infections with Mycoplasma pneumoniae and Chlamydia pneumoniae contribute to acute exacerbations and perhaps to long-term morbidity, as well. This chapter will discuss preventive and therapeutic measures that have been found effective in reducing the impact of aggravating or precipitating factors in patients with asthma.
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PMID:Allergen and irritant control: importance and implementation. 1068 68

A high prevalence of gastroesophageal reflux disease (GER) in asthma patients has been shown in several reports from North America and Europe. However, no data from Southern Europe are available. This paper evaluates the prevalence of abnormal reflux in asthmatics, the pattern of acid reflux when present, and the relationship between asthma and GER. Eighty-one consecutive ambulatory patients with clinically stable asthma (41 women; median age 40 years, range 17-69 years) were prospectively evaluated. All patients had a thorough digestive history; baseline pulmonary function studies, including bronchoprovocation methacholine test; and ambulatory 24-hr esophageal pH monitoring. Reflux symptoms were present in 40 patients (49%). Twelve patients had abnormal GER as defined by pH testing, giving a prevalence rate of 15% (95% confidence interval 8%-24%). The presence of acid reflux was not associated with a more severe respiratory disease. Abnormal GER seems not to be a clinically significant problem in many patients with asthma in our area.
J Asthma 2000 Apr
PMID:Prevalence of gastroesophageal reflux in asthma. 1080 6

Gastroesophageal reflux is a potential trigger of asthma that may be clinically silent. This study examines the prevalence of gastroesophageal reflux in asthma patients without reflux symptoms. This prospective cohort study evaluated 26 patients with stable asthma without reflux symptoms using esophageal manometry and 24-h esophageal pH testing. Gastroesophageal reflux was considered present if esophageal acid contact times were abnormal. Demographic variables were analyzed to determine if they predicted the presence of gastroesophageal reflux. Asthma patients with asymptomatic gastroesophageal reflux were compared with 30 age-matched asthma patients with symptomatic gastroesophageal reflux. The prevalence of abnormal 24-h esophageal pH tests in asthma patients without reflux symptoms was 62% (16 of 26). Demographic variables did not predict abnormal 24-h esophageal pH tests in asthma patients with asymptomatic gastroesophageal reflux. Asthma patients with asymptomatic gastroesophageal reflux had higher amounts of proximal esophageal acid exposure (p < 0.05) compared with asthma patients with symptomatic gastroesophageal reflux. Because demographic variables do not predict abnormal 24-h esophageal pH tests in asthma patients without reflux symptoms, 24-h esophageal pH testing is required. This study suggests that gastroesophageal reflux is present in asthma patients, even in the absence of esophageal symptoms.
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PMID:The prevalence of gastroesophageal reflux in asthma patients without reflux symptoms. 1090 16

Asthma management is based on step therapy incorporated into an individualized patient treatment plan. Medication selection is based on differing degrees of asthma severity. With proper assessment of the patient and a severity level incorporating the patient's needs, a clinician can create a credit card treatment plan for each patient. The assessment should include both PEFR and symptom monitoring as a means of incorporating the CDC's severity guidelines and treatment options into the credit card plan. Evaluation of technique, review of home monitoring outcomes, and reinforcement during clinic visits is likely to be helpful for those patients who do home monitoring. Note, however, that not all patients should be treated using this self-management approach. Asthma associated with comorbidities may be a reason to manage patients more closely either by clinic visit or telephone. Asthma in both older and pregnant patients presents issues of drug safety (Evans, Brown, & Morain, 1997). The common comorbidities of chronic obstructive pulmonary disease, sinusitis, GERD, cardiovascular disease and diabetes present unique issues of difficulty of diagnosis and drug safety. By following individualized asthma management plans, patients should be able to achieve prevention or reduction of chronic symptoms. They should also notice an improvement in physical activity, the reduction or elimination of exacerbations and improved overall satisfaction.
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PMID:Improving self-care in adults with asthma using peak expiratory flow rate home monitoring. 1103 85


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