Gastroesophageal reflux symptoms and nasal symptoms affect the severity of bronchitis symptoms in patients with chronic obstructive pulmonary disease

Background

Cough and sputum production (symptoms of bronchitis) are common in chronic obstructive pulmonary disease (COPD). Extrapulmonary comorbidities, such as gastroesophageal reflux disease (GERD) and post-nasal drip, also cause bronchitis symptoms. The impact of extrapulmonary comorbidities on the severity of bronchitis symptoms in COPD is unknown. The aim of this study was to quantify bronchitis symptoms and assess the impact of GERD and nasal symptoms on the severity of bronchitis symptoms in COPD.

胃食管反流与慢性咳嗽关系的临床观察

[目的]探讨胃食管反流(GER)与慢性咳嗽的关系,以及GER所致的慢性咳嗽——胃食管反流性咳嗽(GERC)的临床特征、诊断和治疗.[方法]50例GERC患者(病例组)和30例健康体检者(对照组)纳入研究,行24h食管pH监测来分析慢性咳嗽与GER的相关性.病例组患者随机分为2亚组,A亚组22例,给予雷尼替丁(150mg,2次/d);B亚组28例,给予奥美拉唑(20mg,2次/d)和莫沙比利(5mg,3次/d)口服;疗程均为8周.比较病例组与对照组24 h食管pH监测指标,病例组中A、B亚组疗效和治疗后24 h食管pH监测指标变化.[结果]病例组患者Demeester总积分均≥12.7,各项反流指标均显著高于对照组(P＜0.05).病例组患者治疗8周后24h食管pH监测各项反流指标均较治疗前降低(P＜0.05),B亚组疗效优于A亚组(z=2.332,P＜0.05);且B亚组24 h食管pH监测各项反流指标均较A亚组降低(P＜0.05).[结论]GER与慢性咳嗽密切相关,是导致GERC的一个重要原因,对GERC患者应给予抑酸和抗反流治疗.     

Gastroesophageal reflux disease and sinusitis: their role in patients with chronic cough.

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.     

Gastroesophageal reflux disease in patients with rheumatoid arthritis

Abstract

Objective. Patients with rheumatoid arthritis (RA) are frequently complicated with gastric mucosal injury; however, there are few reports investigating gastroesophageal reflux disease (GERD) among patients with RA. We investigated the frequency of GERD and the correlation between GERD and the clinical characteristics of RA including patient's global assessment (PGA).

Methods. Patients with RA were investigated for GERD using self-administered frequency scale for the symptoms of GERD (FSSG). The correlation between GERD and the clinical characteristics of RA was analyzed statistically.

Results. Two hundred and eleven patients in Japan were investigated. The prevalence of GERD among patients with RA (24.6%) was significantly higher than that in the Japanese population (11.5%) (p < 0.001). FSSG was positively correlated with modified health assessment questionnaire (mHAQ), PGA, evaluator's global assessment (EGA) (p < 0.001), disease activity score (DAS)28-erythrocyte sedimentation rate (ESR) (p < 0.05), DAS28-C-reactive protein (CRP), simplified disease activity index (SDAI) and clinical disease activity index (CDAI) (p < 0.001). The patients with GERD showed significantly higher scores in mHAQ, PGA, EGA, tenderness joint count, DAS28-ESR, DAS28-CRP, SDAI and CDAI (p < 0.001). Furthermore, the patients with GERD showed lower remission rates based on DAS28-ESR (p < 0.05), DAS28-CRP, SDAI and CDAI (p < 0.001).

Conclusion. GERD complicated with RA increases PGA and the indices of disease activity. GERD symptoms analyzed using FSSG may be desirable to avoid the overestimation as part of the total management of patients with RA.     

Gastroesophageal reflux disease: prevalence and associated factors

BACKGROUND: O gastroesophageal reflux is a high prevalent disease with prevalence rates ranging from 21 to 56% in different countries. OBJECTIVE: To study the epidemiology and the prevalence of gastroesophageal reflux disease among adult population (20 years and old) at the city of Pelotas, southern Brazil. METHODOLOGY: A population-based cross-sectional study was conducted. Household interviews were done between October 1999 and January 2000. Association between gastroesophageal reflux disease and age, sex, skin color, years of formal education, income per capita, marital status, psychological variables (insomnia, stressful psychosocial events in the last year, psychological distress), body mass index, smoking and weekly consumption of alcoholic beverages was assessed through logistic regression. RESULTS: Three thousands and nine-hundred thirty four (3,934) individuals were interviewed. A prevalence of 31,3% (CI 95% 29.9%-32.8%). After allowing for confounding gastroesophageal reflux disease was significantly associated with female sex, living without partner, low level of formal education, insomnia, psychological distress, reported stressful psychosocial events in the last year, obesity and overweight. CONCLUSION: Gastroesophageal reflux disease is a high prevalent disease and its main associated factors are sex, anthropometric variables and psychological characteristics.     

Gastroesophageal reflux in patients with asthma and chronic bronchitis

To determine the relationship between gastroesophageal (GE) reflux and pulmonary disease, we studied 21 asthmatics, 30 chronic bronchitics, 6 patients with GE reflux and no pulmonary symptoms, and 10 control subjects; GE reflux was diagnosed by pH monitoring and GE scintiscanning. Frequency of GE reflux in the asthmatics was 57%; in the chronic bronchitics it was 56%. Pulmonary function tests did not show any differences between patients with or without reflux. The GE reflux episodes were more numerous but shorter in asthmatics than in chronic bronchitics. Patients with digestive symptoms alone were no different from chronic bronchitics with respect to reflux. The mechanism whereby reflux triggers pulmonary problems was investigated using the following 2 tests: scintiscan for pulmonary aspiration, and esophageal acid infusion (0.1N HCl). Six pulmonary aspirations were detected. Only asthmatics, with or without reflux, showed any significant variations in maximal expiratory flow at 50% and 25% of VC after HCl infusion. Thus, our results show that asthmatics differ from chronic bronchitics by the characteristics of their reflux.     

Prevalence of upper respiratory symptoms in patients with symptomatic gastroesophageal reflux disease.

This study evaluated the prevalence of upper respiratory symptoms (URS) among patients with symptomatic gastroesophageal reflux disease (GERD). Seventy-four subjects with heartburn completed a URS questionnaire before dual-probe, 24-h esophageal pH monitoring. The URS questionnaire was also completed by 74 normal volunteers without previous or current symptoms of GERD. Esophageal pH monitoring results were classified as normal, distal, or proximal and distal gastroesophageal reflux using standardized criteria. Mean URS scores (+/- SD) were 8.31 +/- 3.98 in the 52 subjects with GERD and 4.57 +/- 3.57 in the 22 subjects with negative pH probe studies, p = 0.02. Subjects with negative pH probe studies and normal volunteers scored similarly on the URS questionnaire. Reflux episodes/24 h correlated with URS scores, r = 0.47, p = 0.0001. Seventy-five percent of subjects with upper reflux, 68% of subjects with lower reflux, 36% of subjects with normal esophageal pH studies, and 9% of normal volunteers reported laryngeal symptoms for at least 5 d/mo. Sixty-nine percent of subjects with upper reflux, 50% of subjects with lower reflux, 31% of subjects with normal pH studies, and 14% of normal volunteers reported nasal symptoms for at least 5 d/mo. URS are frequent among subjects with GERD. Keywords: rhinitis; upper airway; gastroesophageal reflux     

Gastroesophageal reflux disease in children: association between symptoms and pH monitoring

OBJECTIVE: The prevalence of symptoms associated with gastroesophageal reflux disease (GERD) in patients with abnormal results of pH monitoring has been investigated in adults and infants. A questionnaire suitable for children between 7 and 16 years of age has been proposed, but this tool has so far not been validated. In the present study the items of the questionnaire are validated against results from an esophageal 24-h study of pH. MATERIAL AND METHODS: Ninety-nine children aged from 7 to 16 years referred from two outpatient clinics for suspected GERD completed the 7-point questionnaire regarding symptoms during the week prior to a pH study. The frequency of symptoms was investigated in patients with abnormal versus normal pH (reflux index >/< 5.0). A group of healthy children (n = 284) served as controls to estimate the frequency of symptoms in the normal population. RESULTS: It was found that 37/99 (37%) of patients had an abnormal pH study result. Regurgitation/vomiting yielded the best symptom discrimination, and was reported by 46% with abnormal versus 24% with normal pH-study results (p = 0.029). A weighted score including the five best discriminating symptoms was positive in 75% versus 44% (OR 3.78, CI 1.52-9.37, p = 0.006). In a comparison of children with abnormal pH studies and healthy controls, a correct diagnosis based on five symptoms could be obtained in 75% and 94%, respectively. CONCLUSIONS: A relatively weak association was found between reflux symptoms and a positive pH study in 7-16-year-old children referred for pH monitoring. Thus, the questionnaire is not a diagnostic tool, and its potential use is limited to epidemiological studies.     

慢性肾衰竭患者缺血性心血管疾病危险因素的研究进展

由动脉粥样硬化(AS)所致的缺血性心血管疾病是终末期肾脏病(ESRD)患者最常见的并发症。ESRD患者存在多种导致心血管疾病的危险因素,近年研究发现高同型半胱氨酸血症(Hcy)、氧化应激和微炎症反应参与了慢性肾衰竭(CRF)患者AS的发生和发展,探讨各因素之间的关系,及其在CRF患者AS形成中的作用将可能为这类患者缺血性心血管疾病的防治提供新的方法。     

Evaluation of upper abdominal symptoms using the Frequency Scale for the Symptoms of Gastroesophageal Reflux Disease in patients with laryngopharyngeal reflux symptoms

BACKGROUND: The purpose of the study was to evaluate upper abdominal symptoms in laryngopharyngeal reflux (LPR) patients and changes in both upper abdominal and LPR symptoms before and after acid-suppression therapy. METHODS: In 100 patients with LPR symptoms, upper abdominal and LPR symptoms were evaluated by using the Frequency Scale for the Symptoms of Gastroesophageal Reflux Disease (FSSG) and the LPR symptom scoring system, respectively. In the 52 assessable patients, changes in these symptoms before and after acid-suppression therapy were evaluated. RESULTS: Upper abdominal symptoms were reported by 96/100 LPR patients: 89 responded positively to at least one of the questions about acid reflux-related symptoms and 89 to at least one of those about dysmotility-like symptoms. There was poor correlation between positive rates to FSSG upper abdominal symptom questions and the frequency of reported laryngopharyngeal symptoms. There were significant reductions in the frequency of acid reflux-related symptoms, dysmotility-like symptoms, and laryngopharyngeal symptoms after acidsuppression therapy. The LPR symptom score decreased to less than half the pretreatment score in 25 subjects (therapeutic response group). The pretreatment frequency of dysmotility-like symptoms seemed to be higher in the nonresponse group than in the response group, although the difference was not significant. There was no significant difference between the two groups in the pretreatment frequency of acid reflux-related symptoms. CONCLUSIONS: The majority of these Japanese LPR patients experienced some form of upper abdominal symptoms. The frequency of dysmotility-like symptoms was similar to that of acid reflux-related symptoms. The pretreatment frequency of dysmotility-like symptoms, but not of acid reflux-related symptoms, might be a predictor of patient response to acid-suppression therapy.     

Laryngopharyngeal reflux in patients with symptoms of gastroesophageal reflux disease

Laryngopharyngeal reflux (LPR) has been extensively studied in patients with laryngeal signs and symptoms, gastroesophageal reflux being identified in approximately 50%. Few studies have investigated the incidence and significance of LPR in GERD patients. Two-hundred and seventy-six consecutive patients referred with symptoms of gastroesophageal reflux had dual probe 24 h pH, esophageal manometry, GERD and ENT questionnaires. LPR was defined as at least three pharyngeal reflux events less than pH 5.0 with corresponding esophageal reflux, but excluding meal periods. Fourty-two percent of patients were positive for LPR on 24 h pH monitoring and 91.3% corresponded with an abnormal esophageal acid score. Distal esophageal acid exposure was significantly greater (P < 0.001) in patients with LPR but symptoms of GERD and regurgitation scores showed no significant differences between patients with positive and negative LPR on 24 h pH. There was no significant difference between the incidence of LPR in patients with or without laryngeal symptoms. There is a high incidence of LPR in patients with GERD but its significance for laryngeal symptoms is tenuous. Fixed distance dual probe pH monitoring allows documentation of conventional esophageal reflux and LPR.     

Acute upper gastrointestinal hemorrhage in patients with chronic renal disease

In order to reassess the role of duodenal ulcers as a cause of acute upper gastrointestinal hemorrhage in patients with chronic renal failure, 20 consecutive patients with moderate to severe chronic renal failure and a comparison group of patients without renal disease who were seen for acute upper gastrointestinal hemorrhage were reviewed. Gastric bleeding sites (gastric ulcer in 35 percent and gastritis in 20 percent) rather than duodenal ulcers were the most common sources of bleeding and were significantly associated with the use of ulcerogenic drugs. Patients with renal disease in whom acute upper gastrointestinal hemorrhage developed had significantly more morbidity and a trend toward higher mortality than the comparison group of patients without renal disease. It is concluded that gastric mucosal lesions, at least in part due to the use of ulcerogenic drugs, are the most common cause of significant acute upper gastrointestinal hemorrhage in patients with chronic renal failure.     

Acute renal failure multivariate analysis of causes and risk factors

Accepted causes (acute insults) and risk factors for the development of acute renal failure were defined, quantitatively assessed, and tested for statistical significance in 143 patients with acute tubular necrosis. Sixty-two percent of patients had more than one acute insult, and 48 percent had more than one suspected risk factor. Hypotension, excessive aminoglycoside exposure, pigmenturia, and dehydration were identified as highly significant acute insults, while it was concluded that sepsis and administration of radlocontrast material could not be incriminated as causes of acute tubular necrosis. An additive interaction between acute insults was demonstrated, and the severity of acute renal failure was related to the number and severity of acute insults. Patients with oligurlc renal failure had more severe acute Insults than patients with nonollguric renal failure. Preexisting renal disease and chronic hypertension were significant risk factors, the latter only when hypotension had been one of the acute insults. An age of more than 59 years, gout and/or chronic hyperuricemia, diabetes, and long-term diuretic administration were not found to be significant risk factors.     

Gastroesophageal reflux disease symptoms are more common in general practice in Japan

To accurately assess the prevalence of GERD symptoms in general practice. METHODS： 4139 consecutive patients （2025 men and 2114 women with a mean age of 43 years）, who first attended the Outpatient Department of General Medicine and Emergency Care at Toho University Omori Hospital, were asked to respond to the F-scale questionnaire regardless of their chief complaints. The questionnaire is a self-report instrument, written in a simple and easy-to- understand language, containing 12 questions. RESULTS： Of 4139 subjects, 1554 patients （37.6%） were identified as GERD according to their F-scale score （〉 7）. However, there were only 45 consultations （1.1%） for typical GERD symptoms. Although GERD symptoms are common in adults of all ages, the prevalence of GERD was highest in the 20-29 years age group and the age group 70-79 years had the lowest prevalence for both males and females. CONCLUSION： Although there was a high rote indicating GERD in our primary care population, only 1.1% of outpatients attended our hospital with a chief complaint of GERD symptoms. Since about one-third of GERD patients are affected by atypical symptoms, general physicians need to be cautious about extrapolating these results to patients with a chief complaint other than typical GERD symptoms.Watanabe T, Urita Y, Sugimoto M, Miki K. Gastro-esophagea reflux disease symptoms are more common in genera practice in Japan. World J Gastroenterol 2007; 13（31） 4219-4223     

Gastroesophageal reflux disease: comparison between patients with and without esophagitis, concerning age, gender and symptoms]

BACKGROUND: Patients with gastroesophageal reflux disease may or may not have endoscopic esophagitis; there are few studies comparing these groups among themselves. OBJECTIVES: This study was designed in order to evaluate differences between patients with gastroesophageal reflux disease with and without esophagitis. PATIENTS/METHODS: A hundred and twenty-two patients with gastroesophageal reflux disease characterized by esophageal endoscopy and pHmetry were included, 90 with and 32 without esophagitis. Assessment involved an anamnesis, including the following data: age, sex, heartburn, dysphasia, non-cardiac chest pain and respiratory symptoms. Heartburn was analyzed in more detail, its duration, intensity and periodicity being determined. RESULTS: No statistical significant difference was observed between the groups, regarding age, sex or presence of symptoms. However, in the group with esophagitis, heartburn classified as severe or very severe was more frequent. CONCLUSIONS: 1. The groups of patients with or without esophagitis analyzed were very similar concerning age, gender and presence of symptoms. However, regarding the heartburn's intensity, it was more intense in the group with esophagitis. 2. Among patients with gastroesophageal reflux disease, there is a large number of cases without esophagitis (26.2%) and that prolonged pH-monitoring is fundamental in its identification; 3. A better definition of reflux disease, esophagitis and pathological reflux is needed, in order to allow better diagnostic accuracy and comparisons in different studies on this subject.     

Gastroesophageal reflux disease: Important considerations for the older patients

Gastroesophageal reflux disease (GERD) is the most common upper gastrointestinal disorder seen in the elderly. The worldwide incidence of GERD is increasing as the incidence of Helicobacter pylori is decreasing. Although elderly patients with GERD have fewer symptoms, their disease is more often severe. They have more esophageal and extraesophageal complications that may be potentially life threatening. Esophageal complications include erosive esophagitis, esophageal stricture, Barrett's esophagus and adenocarcinoma of the esophagus. Extraesophageal complications include atypical chest pain that can simulate angina pectoris; ear, nose, and throat manifestations such as globus sensation, laryngitis, and dental problems; pulmonary problems such as chronic cough, asthma, and pulmonary aspiration. A more aggressive approach may be warranted in the elderly patient, because of the higher incidence of severe complications. Although the evaluation and management of GERD are generally the same in elderly patients as for all adults, there are specific issues of causation, evaluation and treatment that must be considered when dealing with the elderly.