Effect Of Gastroesophageal Reflux Research Articles

Effects of Esophageal Acid Perfusion on Cough Responsiveness in Patients With Bronchial Asthma

The effect of gastroesophageal reflux (GER) on cough responsiveness in patients with bronchial asthma has yet to be studied in significant detail. The purpose of this study was to assess the effect of distal esophageal acid perfusion on cough responsiveness in patients with bronchial asthma. In seven patients with mild persistent bronchial asthma (mean +/- SD age, 57.7 +/- 3.7 years; four women and three men), esophageal pH was monitored by a pH meter and cough responsiveness was evaluated by single-breath aerosol inhalation of capsaicin with increasing dosage from 0.30 to 9.84 nmol. Simultaneously, esophageal perfusion was performed through an esophageal tube filled with either saline solution or 0.1 N hydrochloric acid (HCl), the order of which was selected at random, in 1-week intervals. Results were expressed as the lowest concentration of capsaicin eliciting three coughs (PD3). Spirometry was also performed during esophageal pH monitoring. A significant decrease in the geometric mean of log PD3 was observed during distal esophageal HCl perfusion (0.45 +/- 0.04 nmol) compared with that of the saline solution perfusion (0.04 +/- 0.06 nmol) [p < 0.01]. However, no significant changes were observed either in FVC, FEV1, or peak expiratory flow during the periods of the saline solution or HCl perfusion. The present data demonstrate that an increase in cough responsiveness may be induced when HCl stimulates the distal portion of esophagus in patients with bronchial asthma, suggesting that the GER would be one of the important factors that influence asthmatic status.

Barrett esophagus--esophageal carcinoma: surgical therapy

Barrett's oesophagus is an acquired condition that occurs as a consequence of gastrooesophageal reflux. Continuous exposure of the Barrett's epithelium to gastric juice may lead from a low-grade to a high-grade dysplasia and subsequently to an invasive adenocarcinoma. Therefore, the first goal of treatment for patients with Barrett's oesophagus is the prevention of reflux to eliminate the risk of a progression to dyplasia and cancer. In contrast to medical treatment antireflux surgery restores the low oesophageal sphincter, abolishes reflux of gastric contents into the oesophagus and ends the repetitive injury to both the metaplastic and normal oesophageal mucosa. In case of Barrett's carcinoma of the distal oesophagus a radical transhiatal oesophagectomy with systematic abdominal and mediastinal lymph node dissection is the procedure of choice. After forming a gastric tube the reconstruction is done by a transposition of stomach through the posterior mediastinum and a cervical anastomosis. Because of substantial complications and long-term side effects the need for extensive resection in patients with early tumour stage (pT1) is questionable. Therefore, a limited resection of distal oesophagus and proximal stomach with two-field lymphadenectomy and jejunal interposition is an attractive alternative in early Barrett's carcinoma providing a low morbidity and mortality and resulting in a 90% chance of cure in patients without lymph node metastasis.

Patey Prize 01

Background: Overexpression of TGF-β has been linked to the occurrence of excessive fibrosis in both surgical skin wounds and in renal allografts after transplantation. Its involvement in the pathogenesis of gastro-oesophageal reflux disease has not been reported. Methods: Endoscopic oesophageal biopsies were obtained from control subjects free of reflux symptoms (n = 4), patients with reflux symptoms but no oesophagitis (n = 4), patients with grade 2 oesophagitis (n = 4), patients with oesophageal strictures (n = 4) and patients with Barrett's oesophagus (n = 4). A lightcycler was employed to perform real time quantitative RT-PCR for TGF-β on the biopsies. Results: The table indicates the level of TGF-β expression according to the endoscopic findings. The values indicated are median and range. There was an increase in the level of TGF-β expression as the severity of mucosal injury progressed, so that patients with oesophageal strictures had an eight-fold higher level of TGF-β expression than control subjects. Patients with Barrett's oesophagus had the lowest levels of TGF-β expression of all patient groups. Conclusions: These findings indicate that excess TGF-β expression is related to the genesis of fibrosis in the oesophagus as a consequence of gastro-oesophageal reflux.

Effects of Esophageal Acid Perfusion on Airway Hyperresponsiveness in Patients With Bronchial Asthma

The effects of gastroesophageal reflux on airway hyperresponsiveness in patients with bronchial asthma have yet to be studied in significant detail. The purpose of the present study was to determine how esophageal acid perfusion could change airway responsiveness in patients with bronchial asthma. In seven patients with bronchial asthma (mean +/- SD age, 55.1 +/- 6.4 years; four women and three men), esophageal pH was monitored by a pH meter and airway responsiveness was evaluated by aerosol inhalation of methacholine, during esophageal perfusion through an esophageal tube filled with either saline solution or 0. 1N hydrochloric acid (HCl), the order of which was selected at random, in 1-week intervals. Spirometry was also performed during esophageal pH monitoring. A significant decrease in the geometric mean of airway sensitivity or the concentration of methacholine causing a 35% fall in respiratory conductance was observed during esophageal HCl perfusion compared with that of saline solution perfusion (p < 0.01 or p < 0.003), although no significant changes were observed in vital capacity, FEV(1), peak expiratory flow, respiratory resistance, or slope of respiratory conductance during the periods of saline solution and HCl perfusion. We concluded that an increase in airway hyperresponsiveness was induced when HCl stimulated the esophagus in patients with bronchial asthma. These results suggest that esophageal reflux is one of the important factors that aggravate asthmatic status.

Effect of gastroesophageal reflux on hypertrophy of the base of the tongue.

The objective of this study was to determine a possible association between pharyngolaryngeal signs of gastroesophageal reflux (GER) and hypertrophy of the lymphoid follicles at the base of the tongue (HBT). For this purpose, 306 patients submitted to videolaryngoscopy were studied retrospectively and classified according to the presence and size of follicles on the base of the tongue. HBT was considered to be present when the follicles prevented the view of the vallecula. The patients were grouped according to the presence of videolaryngoscopic signs of GER and further subdivided according to the presence of esophageal, pharyngolaryngeal, and esophagopharyngolaryngeal symptoms, with an attempt made to relate these symptoms to the presence of HBT. HBT was detected in 62.4% (63/101) of the patients with signs of GER and in 29.3% (60/205) of patients with no signs of GER. When HBT incidence was studied according to the symptoms reported by the patient, the condition was found to be present in 57.2% (8/14) of patients with exclusively esophageal symptoms, in 63.6% (21/33) with esophagopharyngolaryngeal symptoms, and in 75% (15/20) with exclusively pharyngolaryngeal symptoms. We conclude therefore that HBT is associated with GER.

Effect of gastroesophageal reflux on hypertrophy of the base of the tongue

The objective of this study was to determine a possible association between pharyngolaryngeal signs of gastroesophageal reflux (GER) and hypertrophy of the lymphoid follicles at the base of the tongue (HBT). For this purpose, 306 patients submitted to videolaryngoscopy were studied retrospectively and classified according to the presence and size of follicles on the base of the tongue. HBT was considered to be present when the follicles prevented the view of the vallecula. The patients were grouped according to the presence of videolaryngoscopic signs of GER and further subdivided according to the presence of esophageal, pharyngolaryngeal, and esophagopharyngolaryngeal symptoms, with an attempt made to relate these symptoms to the presence of HBT. HBT was detected in 62.4% (63/101) of the patients with signs of GER and in 29.3% (60/205) of patients with no signs of GER. When HBT incidence was studied according to the symptoms reported by the patient, the condition was found to be present in 57.2% (8/14) of patients with exclusively esophageal symptoms, in 63.6% (21/33) with esophagopharyngolaryngeal symptoms, and in 75% (15/20) with exclusively pharyngolaryngeal symptoms. We conclude therefore that HBT is associated with GER. (Otolaryngol Head Neck Surg 2000;122:607-10.)

Columnar mucosa and intestinal metaplasia of the esophagus: fifty years of controversy.

To outline current concepts regarding etiology, diagnosis, and treatment of intestinal metaplasia of the esophagus and cardia. Previously, endoscopic visualization of columnar mucosa extending a minimum of 3 cm into the esophagus was sufficient for the diagnosis of Barrett's esophagus, but subsequently the importance of intestinal metaplasia and the premalignant nature of Barrett's have been recognized. It is now apparent that shorter lengths of intestinal metaplasia are common, and share many features of traditional 3-cm Barrett's esophagus. Themes and concepts pertaining to intestinal metaplasia of the esophagus and cardia are developed based on a review of the literature published between 1950 and 1999. Cardiac mucosa is the precursor of intestinal metaplasia of the esophagus. Both develop as a consequence of gastroesophageal reflux. Intestinal metaplasia, even a short length, is premalignant, and the presence of dysplasia indicates progression on the pathway to adenocarcinoma. Antireflux surgery, as opposed to medical therapy, may induce regression or halt progression of intestinal metaplasia. The presence of high-grade dysplasia is frequently associated with an unrecognized focus of adenocarcinoma. Vagal-sparing esophagectomy removes the diseased esophagus and is curative in patients with high-grade dysplasia. Invasion beyond the mucosa is associated with a high likelihood of lymph node metastases and requires lymphadenectomy. Despite improved understanding of this disease, controversy about the definition and best treatment of Barrett's esophagus continues, but new molecular insights, coupled with careful patient follow-up, should further enhance knowledge of this disease.

Gastroesophageal reflux and asthma: can the paradox be explained?

The reported effects of asthma on gastroesophageal reflux (GER), effects of GER on asthma and the effects of antireflux therapy on asthma are conflicting. The purpose of this paper is to review the evidence for a relationship between the two conditions. A search of the MEDLINE 1966 to 1999 database, combining the terms GER and asthma, was used to identify studies of the effects of acid perfusion of the esophagus, the physiological equivalent of GER and the effects of both medical and surgical antireflux therapy on asthma. Bibliographies of the identified papers were also reviewed. The collected evidence suggests that GER causes asthma symptoms but has minimal effects on pulmonary function. Both medical and surgical antireflux therapy can improve asthma symptoms and asthma medication requirements without improving pulmonary function. The paradox of GER causing symptoms without affecting pulmonary function may be because of the retrosternal discomfort that accompanies GER increases minute ventilation and respiratory sensation. Despite an extensive body of literature, many questions remain about the relationship between GER and asthma. A review of the data suggests a strong association between the two conditions, and that GER worsens asthma symptoms without affecting pulmonary function. Asymptomatic GER does not worsen asthma. Antireflux therapy may have a role in asthma patients with symptomatic GER, possibly being most beneficial for those with reflux-associated respiratory symptoms. Unfortunately, many studies contain flaws such as a lack of controls and small sample sizes. Further properly designed controlled trials, including ones that measure the effects of GER and antireflux therapy on quality of life, are needed to understand better the role of GER in asthma.

Gastroesophageal Reflux in Patients with Subglottic Stenosis

WALNER, DAVID L.; STERN, YORAM; GERBER, MARK E.; RUDOLPH, COLIN; BALDWIN, CONSTANCE Y.; COTTON, ROBIN T.Author Information

Gastroesophageal Reflux and Asthma: Are They Related?

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.

Gastroesophageal reflux in patients with subglottic stenosis.

To determine the incidence of gastroesophageal reflux in patients with subglottic stenosis (SGS) and to determine if upper esophageal reflux occurs in addition to lower esophageal reflux in these patients. Esophageal pH probe studies were reviewed in patients diagnosed as having SGS. A tertiary care pediatric medical center. All patients diagnosed as having SGS between January 1990 and July 1996 who had undergone monitoring with an overnight esophageal pH probe. Seventy-four patients qualified for the study. All 74 patients underwent lower probe testing, and 55 of the 74 underwent dual (upper and lower) probe testing. The percent of time a pH measurement of less than 4.0 was recorded in the upper and lower esophagus. A lower probe pH measurement of less than 4.0 more than 10% of the study time was considered high risk for developing reflux-associated pathologic symptoms. A lower probe pH measurement of less than 4.0 for 5% to 10% of the study time was considered a marginal risk for developing reflux-associated pathologic symptoms. Upper probe criteria for reflux-associated symptoms have not been established. Therefore, patients were grouped as having a pH of less than 4.0 in the upper esophagus for 0%, 0.1% to 0.9%, 1.0% to 1.9%, 2.0% to 3.0%, or more than 3% of the study time. Thirty-seven of the 74 patients who underwent lower probe testing had a pH of less than 4.0 more than 5% of the study time, and 24 had a pH of less than 4.0 more than 10% of the study time. Twelve of the 55 patients who underwent upper probe testing had no measurable reflux; 27 of the 55 had a pH of less than 4.0 more than 1% of the study time; 14 had a pH of less than 4.0 more than 2% of the study time, and 11 had a pH of less than 4.0 more than 3% of the study time. Gastroesophageal reflux is frequently present in patients with SGS. Gastric contents frequently reach the upper and lower esophagus in these patients. In addition, the high incidence of gastroesophageal reflux in these patients suggests that it may play a role in the development of SGS. The possible effect of gastroesophageal reflux on the surgical repair of SGS requires further study.

Effects of Gastroesophageal Reflux on the Oral Cavity

The effects of chronic exposure of the oral cavity to gastric acid can be many and varied. Soft tissue symptoms (nonspecific burning and sensitivity) have been mentioned in the literature, but pathognomonic soft tissue lesions have not been documented. Dental erosion can be considered to be the predominant oral manifestation of gastroesophageal reflux disease. Erosion begins with subtle changes in the surface enamel and can progress to severe loss of tooth substance. Because the causes of such tooth lesions may be multifactorial, combining the effects of erosion, attrition, and abrasion and because of the subtle changes present in the beginning stages of such lesions, diagnosis may be difficult. Although the basic mechanism of erosion in gastroesophageal reflux patients is the dissolution of enamel and dentin due to acid exposure, a multitude of other factors can modify the effects of gastric acid. Salivary parameters, in particular, may play an important role in affecting oral pH after reflux episodes. Once dental erosion is diagnosed, thorough evaluation is necessary to document the extent of damage and to detect a cause, which may have both intrinsic and extrinsic components. Treatment goals include eliminating the causes of acid exposure, preventing the effects of acid exposure when it is not controllable, treating symptoms of soft tissue irritation and dental erosion, and restoring the dentition to an esthetically and functionally acceptable level.

Diffuse Supraglottic Swelling in an Infant: A Consequence of Gastroesophageal Reflux?

Diffuse Supraglottic Swelling in an Infant: A Consequence of Gastroesophageal Reflux?

Diffuse supragiottic swelling in an infant: A consequence of gastroesophageal reflux?

Diffuse supragiottic swelling in an infant: A consequence of gastroesophageal reflux?

The Effect of Gastroesophageal Reflux on Laryngotracheal Reconstruction

To determine the need for preoperative evaluation for gastroesophageal reflux disease (GERD) in all children undergoing laryngotracheal reconstruction (LTR) and to assess the effect of GERD on the outcome of LTR. Prospective, single-blind observational study. Tertiary care children's hospital. Seventy-four pediatric patients with laryngotracheal stenosis who underwent LTR at the Children's National Medical Center, Washington, DC, from October 1, 1986, through August 31, 1994. Evaluation for and treatment of GERD, LTR, endoscopy, and removal of granulation tissue. Successful decannulation and number of endoscopies required to remove laryngeal and tracheal granulation tissue. Seventy-four patients underwent 82 LTRs. The senior surgeon was blinded to the status of GERD evaluation and treatment. Four groups were identified: 37 patients (40 LTRs) with no preoperative evaluation for GERD; 10 patients (11 LTRs) with normal findings on preoperative evaluation for GERD; seven patients (nine LTRs) with abnormal findings on preoperative evaluation for GERD but who failed to receive appropriate treatment; and 20 patients (22 LTRs) with abnormal findings on preoperative evaluation for GERD who received appropriate therapy. Severity and extent of stenosis as determined by multicentricity of stenosis, type of repair, and duration of stent were similar in the four groups. The effect of GERD and its treatment on the outcome of LTR was measured by the number of endoscopies necessary for removal of granulation tissue following reconstruction and successful decannulation. Statistical analyses indicate that (1) all children do not require preoperative evaluation for GERD; (2) neither the presence of GERD nor its treatment are major factors in determining the outcome of LTR. Preoperative evaluation for GERD and its treatment do not favorably affect the outcome of LTR.

Effect of gastroesophageal reflux on drooling in children with cerebral palsy: [formula omitted], D.S. Reddihough #, A.G. Catto-Smith∗, Depts. of Gastroenterology and Child Development & Rehabilitation #, Royal Children's Hospital, Melbourne, Australia

Effect of gastroesophageal reflux on drooling in children with cerebral palsy: [formula omitted], D.S. Reddihough #, A.G. Catto-Smith∗, Depts. of Gastroenterology and Child Development & Rehabilitation #, Royal Children's Hospital, Melbourne, Australia

Acid-reflux disorders.

In recent years, the concept of acid-reflux disorders has been broadened to include not only the effects of gastroesophageal reflux on the esophageal mucosa but also the role of acid reflux in laryngeal and pulmonary symptoms. This review discusses the effects of reflux on the esophagus, larynx, and lungs, emphasizing similarities and differences between gastrointestinal and respiratory manifestations of acid reflux. Esophageal Reflux Pathophysiology For the past 20 years, it was assumed that the lower esophageal sphincter is the primary determinant of esophageal reflux. It is now recognized, however, that transient relaxation of the lower esophageal sphincter, not the resting . . .

When an Infant Has a Feeding Problem

This study explored possible consequences of gastroesophageal reflux (GER) in the infant on the mother-infant subsystem within the family system. A total of 36 mother-infant pairs contributed information. A group of mother-infant dyads where the infant had GER (n = 20) was compared with a control group (n = 16). Infants with GER were more likely than infants in the control group to be a source of stress, and care giving issues beyond feeding were more of a problem for the mothers in the GER group than for mothers in the control group. In comparison to the control group of mothers, there were no higher levels of maternal separation anxiety or greater amounts of help the mother received in daily tasks when the infant had GER. Videotapes made of the mother playing with the infant were scored by a research assistant blind to the diagnosis of the baby. Subtle differences in the infant's behavior during the first play session were observed when the infant had GER. No group differences were found in a second videotaped play session several weeks later. The study provides insight into early parenting experiences when there are problems feeding the baby.

Treatment of pulmonary manifestations of gastroesophageal reflux in children two years of age or less

Apnea and worsening bronchopulmonary dysplasia as well as recurrent aspiration pneumonia have been found to be consequences of gastroesophageal reflux in infants and young children. Antireflux procedures are effective in preventing gastroesophageal reflux; however, the effect of this operation on the course of these respiratory problems in very young patients is not known. We reviewed the results in 51 patients 2 years of age or less who underwent an antireflux fundoplication for pulmonary problems attributable to severe gastroesophageal reflux unresponsive to medical treatment. Twenty-eight patients had recurrent episodes of aspiration pneumonia, 14 had nonimproving or worsening bronchopulmonary dysplasia, and 9 had unexplained apneic episodes. Seventy-three percent of these patients had coexisting congenital anomalies or acquired problems. No operative deaths and no major surgical complications occurred. There were eight late deaths occurring between 1 and 25 months postoperatively: three were due to associated congenital anomalies or acquired problems, three to sepsis, and two to sudden infant death syndrome. Of the 43 surviving children, 91 percent with preoperative recurrent aspiration pneumonia had no additional episodes after Nissen procedure. Eighty-eight percent of the infants with unexplained apneic episodes showed marked benefit and 83 percent of those with bronchopulmonary dysplasia had clinical improvement. There were no late problems attributed to the operation even when it was performed in preterm infants. Therefore, we recommend fundoplication for patients 2 years of age or less who have a persistent pulmonary problem attributed to gastroesophageal reflux that does not respond to medical therapy.

Nissen fundoplication for gastroesophageal reflux in infants

Some degree of gastroesophageal reflux is very common in infants and tends to reverse with time. Therefore, the indications for an antireflux operation are not well defined. Furthermore, the complication rate and the ability of the fundoplication to grow remain to be determined. To answer these questions, we reviewed the records of patients 6 months of age or younger who underwent a Nissen fundoplication with gastrostomy tube placement between 1979 and 1985. There were 45 patients (25 boys and 20 girls) with birth weights of 0.65 to 4.3 kg. The consequences of gastroesophageal reflux were more varied than in older children. Severe respiratory problems were common, including recurrent aspiration or bronchopulmonary dysplasia in 60% and frequent apneic and bradycardiac spells in 17%. Failure to gain weight was present in 20% and intractable vomiting in 2.0%. As expected, 78% of these patients had congenital anomalies or acquired problems which, in many cases, were important to the prognosis. The diagnosis was confirmed by barium swallow in all but one patient in whom gross reflux during feedings was present. Initially, medical management was tried for 3 to 4 weeks. In one patient, however, the severity of the respiratory problems precluded trial beyond 12 days. The recommendation for operation was based only on the severity of symptoms attributed to gastroesophageal reflux. All patients underwent Nissen fundoplication with gastrostomy tube placement at 2 weeks to 6 months of age and weighing 1.02 to 6.95 kg. The only surgical complication was one gastrostomy leak. Prematurity or preexisting anomalies led to a 20% incidence of late unrelated deaths between 2 weeks and 23 months postoperatively. Improvement in symptoms occurred in our survivors with follow-up of 5 to 72 months. We conclude: Significant gastroesophageal reflux in infancy most frequently produces respiratory problems that can be life threatening. Nissen fundoplication can be a safe and effective procedure in infants 6 months of age or younger. Fundoplication appears to have good growth potential, and no late complications or feeding problems have occurred. Consequently, surgical correction can be recommended for infants not responding to conservative medical therapy.