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

Allergic rhinitis is a risk factor for the development of asthma, and, conversely, asthma often is present in patients with rhinitis (17-25% in children and 20-50% in adults). Up to 80% of patients with asthma have allergic, nonallergic, or mixed rhinitis. Gastroesophageal reflux can be identified in 25-50% of patients with asthma and may be asymptomatic. Topical nasal corticosteroids typically reduce rhinitis symptoms more effectively than oral or topically administered histamine 1 antagonists but are similar in terms of ocular symptom reduction. The leukotriene D4 antagonist montelukast, as well as loratadine (29%), has been found to reduce nasal symptoms (27%) but the combination (33%) provided little additional benefit. Subcutaneous injections with a monoclonal anti-immunoglobulin E antibody for ragweed or birch allergic rhinitis have produced few anaphylactic reactions but when reactions occur, they appear 90-120 minutes after the injection. In the patients who received 300 mg of omalizumab every 3 or 4 weeks for ragweed allergic rhinitis, there were 23% fewer mean nasal symptoms than in placebo-treated subjects. In that study, antihistamines but not nasal corticosteroids were used during the study period. Overall, 70.7% of patients reported treatment as good or excellent compared with 40.8% in placebo-treated patients. The impact of omalizumab or other anti-immunoglobulin E therapies on rhinitis and asthma is being investigated. In patients experiencing acute, purulent, rhinosinusitis, treatment with a nasal corticosteroid helps relieve symptoms sooner than antibiotic and decongestant therapy alone. Treatment of rhinitis or rhinosinusitis and gastroesophageal reflux should be part of the management of patients with asthma.
Allergy Asthma Proc
PMID:Therapy in the management of the rhinitis/asthma complex. 1476 41

Gastroesophageal reflux (GER) is a potential trigger of asthma. Approximately 77% of asthmatics report heartburn. GER is a risk factor for asthma-related hospitalization and oral steroid burst use. Asthmatics may be predisposed to GER development because of a high prevalence of hiatal hernia and autonomic dysregulation and an increased pressure gradient between the abdominal cavity and the thorax, over-riding the lower esophageal sphincter pressure barrier. Asthma medications may potentiate GER. Potential mechanisms of esophageal acid-induced bronchoconstriction include a vagally mediated reflex, local axonal reflexes, heightened bronchial reactivity, and microaspiration, all resulting in neurogenic inflammation. Anti-reflux therapy improves asthma symptoms in approximately 70% of asthmatics with GER. A 3-month empiric trial of twice-daily proton pump inhibitor given 30 to 60 minutes before breakfast and dinner can identify asthmatics who have GER as a trigger of their asthma.
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PMID:Gastroesophageal reflux: a potential asthma trigger. 1557 68

Twenty-two children (13 boys and 9 girls) with chronic cough were treated with the leukotriene receptor antagonist montelukast (Singulair tbl. 5 mg) administered once daily for four weeks. In 14 children (68%), the cough ceased during the third week of treatment. Children responding to montelukast were found to have higher blood levels of eosinophil cationic protein (S-ECP) in the pretreatment blood sample than children with no response (responders 14.88+/-2.651 microg/l versus nonresponders 6.62+/-0.948 microg/l; p<0.01). Blood S-ECP levels remained higher also in the post-treatment blood sample in responders (10.55+/-1.631 microg/l) compared to nonresponders (6.13+/-0.937 microg/l; p<0.05). The difference is statistically significant. There were also differences in absolute eosinophil blood count and IgE blood levels between the two groups in the pretreatment blood sample. Using 24-hour pH-metry, two children not responding to therapy were subsequently diagnosed to have gastroesophageal reflux. Judging from the results, one might deduct that patients with chronic cough who have increased levels of serum ECP and absolute eosinophil blood counts are likely to benefit from treatment with montelukast.
J Asthma 2004 Oct
PMID:Treatment of chronic cough in children with montelukast,a leukotriene receptor antagonist. 1558 30

Asthma-like symptoms, infrequently, may be secondary to other diseases like: gastro-esophageal reflux, allergic bronchial-pulmonary aspergillosis, Churg-Strauss syndrome, sarcoidosis or carcinoid syndrome. The diagnosis is often made after months of unsuccessful treatment. The authors discuss clinical picture and diagnostic problems in case of symptomatic bronchial asthma in course of hyperserotoninemia.
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PMID:[Hyperserotoninemia as a cause of symptomatic bronchial asthma]. 1563 Nov 96

Asthma is a well-recognized disease and one of the most common illnesses in childhood. More recently, gastroesophageal reflux disease has increasingly been appreciated as a common daily occurrence in children and adolescents. These two diagnoses often present in tandem, with their coexistence being more frequent than would be expected for a chance occurrence. The mainstay of asthma management is the regulation and control of chronic airway hyperreactivity and inflammation. Children who do not respond to standard asthma regimens should be evaluated for other sources of their pulmonary symptoms, most notably gastroesophageal reflux. Baseline assessment of pulmonary function tests followed by an empiric trial of proton pump inhibitor therapy, using double the standard doses commonly used in acid-related disorders and administered for 3 months, is a cost-effective, noninvasive diagnostic strategy. Children who fail to exhibit pulmonary symptom improvement should be evaluated for both medication compliance and proper administration. Twenty-four-hour esophageal pH monitoring with concurrent dairy recordings of their symptoms is recommended to ascertain adequacy of acid suppression and confirm the diagnosis in those who continue to have symptoms. Children with acid-related causes of their pulmonary symptoms often require long-term treatment. Studies have confirmed the efficacy, safety, and tolerability of proton pump inhibitors in the treatment of children and adolescents. Surgery should be reserved for those with severe disease and those who are unable to comply with pharmacologic treatment.
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PMID:Asthma and gastroesophageal reflux disease in children: exploring the relationship. 1575 98

We determined the prevalence of gastroesophageal reflux disease (GERD) symptoms and the associations between GERD symptoms and asthma morbidity in a population of adolescents with asthma. Two thousand, three hundred and ninety-seven students attending six middle schools in Seattle completed the International Study of Asthma and Allergy in Children (ISAAC) written and video survey that included additional questions pertaining to GERD symptoms and asthma morbidity. Based on their responses, children were categorized as having undiagnosed current asthma, physician-diagnosed current asthma, or no asthma symptoms. The prevalence of GERD symptoms occurring at least weekly or daily was determined for each group. The asthma morbidity outcomes were emergency department visits, physician visits, missed school days, and use of inhaled medications for respiratory symptoms within the past year. Associations between GERD symptoms and asthma morbidity outcomes were determined using logistic regression. The prevalence of GERD symptoms was significantly higher among students with current asthma (19.3%; 95% confidence interval (CI), 14.9-24.2) than students with no asthma symptoms (2.5%; 95% CI, 1.8-3.4). In children with current asthma (n = 296), symptoms of GERD that occurred at least weekly were strongly associated with emergency department visits (odds ratio (OR), 5.0; 95% CI, 2.6-9.6), physician visits (OR, 2.5; 95% CI, 1.3-4.6), missed school (OR, 2.0; 95% CI, 1.1-3.7), and inhaled medication use (OR, 2.5; 95% CI, 1.3-4.7). The associations between GERD symptoms and emergency department visits, physician visits, and inhaled medication use were stronger among children with asthma who reported daily GERD symptoms (n = 14) than among children reporting weekly GERD symptoms (n = 57). The prevalence of GERD symptoms was greater in adolescents with current asthma than in those without asthma. In addition, the presence of at least weekly GERD symptoms was strongly associated with greater asthma morbidity and the use of asthma medications.
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PMID:Prevalence and impact of gastroesophageal reflux in adolescents with asthma: a population-based study. 1654 33

The causes of coughing are multiple. Research into the physiology of coughing has established that interactions amid C-fibers and rapidly activating receptors in humans have the most significant effect on stimulation of coughing. Precipitants of coughing include gastroesophageal reflux and sinusitis. Stimulation of vagal afferents by esophageal irritation and aspiration of acidic gastric contents or vapors are the most frequently cited causes of cough associated with gastroesophageal reflux or laryngopharyngeal reflux. Sinusitis may precipitate coughing from other mechanisms including aspiration of postnasal drainage and sinopulmonary reflex. Taking a lesson on how these conditions affect asthmatic patients, this article will review how these two conditions may also influence cough in normal patients.
Allergy Asthma Proc
PMID:Gastroesophageal reflux disease and sinusitis: their role in patients with chronic cough. 1659 91

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 seven-year-old white male presented with recurrent bouts of paranasal sinusitis, streptococcal pharyngotonsillitis, lower respiratory tract infections, continuous low-grade fever, and conjunctivitis, which required frequent use of antibiotics over a period of two years. A careful review of systems also revealed a six-month history of arthralgia affecting his knees, elbows, and hands, which limited his daily activities. Prominent in the history were recurrent bouts of a generalized salmon-red, nonpruritic rash, which was most pronounced on the face and trunk and which was exacerbated by fever. His past medical history revealed severe bouts of gastroesophageal reflux disease, chronic intermittent bloody mucous diarrhea, and atopic dermatitis. A detailed review of the patient's family pedigree over five generations revealed a strong genetic predisposition for autoimmune diseases of several types. His physical examination revealed a thin, pale, chronically ill-appearing male, bilateral conjunctivitis, and pale nasal mucosae with no lymphadenopathy, organomegaly, arthritis, or rash. All laboratory results were unremarkable except for a positive rheumatoid factor and a suboptimal antibody response to immunization with pneumococcal vaccine. A diagnosis of juvenile rheumatoid arthritis of the systemic onset type was established, and, based upon his humoral immune deficiency, treatment with intravenous immunoglobulin was initiated with remarkable improvement in his symptomatology.
Allergy Asthma Proc
PMID:Recurrent infections and joint pain. 1672 38

Asthma is one of the most common chronic illnesses in children. Children with asthma often suffer from night coughing, wheezing and breathlessness that disturb their sleep. Nocturnal asthma is often associated with such problems as difficulty falling asleep, restless sleep, difficulty maintaining sleep, daytime sleepiness, and daytime tiredness. These sleep problems not only occur in children but also in their parents, and furthermore affect their daytime activity. People with asthma should be aware that nocturnal asthma is associated with more severe symptoms and increased mortality. Several underlying mechanisms that may shed light on how and why nighttime seems to exacerbate asthma symptoms include the inflammation process, airway resistance, and bronchial hyper-responsiveness (all circadian factors) as well as gastro-esophageal reflux (a non-circadian factor). Nurses should understand the mechanisms of nocturnal asthma and conduct sleep assessments comprehensively in order to design and implement appropriate strategies to improve the sleep quality of children with asthma.
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PMID:[The sleep problems among children with asthma]. 1687 99


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