Model to Select On-Therapy vs Off-Therapy Tests for Patients With Refractory Esophageal or Extraesophageal Symptoms

It is not clear whether we should test for reflux in patients with refractory heartburn or extraesophageal reflux (EER) symptoms, such as cough, hoarseness, or asthma. Guidelines recommend testing patients by pH monitoring when they are on or off acid-suppressive therapies based on pretest probability of reflux, determined by expert consensus. However, it is not clear what constitutes a low or high pretest probability of reflux in these patients. We aimed to develop a model that clinicians can use at bedside to estimate pretest probability of abnormal reflux.
Source: Gastroenterology - Category: Gastroenterology Authors: Tags: Clinical —Alimentary Tract Source Type: research

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This article reviews the current literature regarding established and proposed EE-GERD, reporting on all available options for its correct diagnosis and therapeutic management. Expert opinion: MII-pH could help to identify a hidden GERD that causes EE. Unfortunately, standard MII-pH analysis results are often unable to define this association. New parameters such as the mean nocturnal baseline impedance and post-reflux swallow-induced peristaltic wave index may have an improved diagnostic yield, but prospective studies using impedance-pH are needed. PMID: 31322443 [PubMed - as supplied by publisher]
Source: Expert Review of Gastroenterology and Hepatology - Category: Gastroenterology Tags: Expert Rev Gastroenterol Hepatol Source Type: research
Conclusions: Successful treatment of GER-associated cough may be associated with the attenuation of neurogenic and neutrophilic inflammation. PMID: 31303089 [PubMed - as supplied by publisher]
Source: Journal of Asthma - Category: Respiratory Medicine Tags: J Asthma Source Type: research
Conclusion: The specific items on our questionnaire relating to patient characteristics, complications, and triggers of cough, represent useful tools for diagnosing the primary disease producing cough.
Source: In Vivo - Category: Research Authors: Tags: Clinical Studies Source Type: research
It is not clear whether we should test for reflux in patients with refractory heartburn or extra-esophageal reflux (EER) symptoms, such as cough, hoarseness, or asthma. Guidelines recommend testing patients by pH monitoring when they are on or off acid-suppressive therapies based on pre-test probability of reflux, determined by expert consensus. However, it is not clear what constitutes a low or high pre-test probability of reflux in these patients. We aimed to develop a model that clinicians can use at bedside to estimate pre-test probability of abnormal reflux.
Source: Gastroenterology - Category: Gastroenterology Authors: Source Type: research
AbstractPatients with gastroesophageal reflux disease (GERD) may present with a variety of symptoms, including heartburn, regurgitation, dysphagia, chronic cough, laryngitis, or even asthma. Therefore, the clinical presentation of GERD varies among individuals and conversely symptoms not always correspond to the presence of actual reflux. For that reason, the diagnosis poses certain challenges to the physician. To overcome these challenges, a thorough clinical examination followed by objective functional testing could improve diagnostic accuracy. In addition, a proper evaluation of patients with GERD can help in identifyin...
Source: Updates in Surgery - Category: Surgery Source Type: research
Authors: Gelardi M, Ciprandi G Abstract Introduction: Gastroesophageal reflux (GER) is a common disease usually limited to the oesophagus. Laryngopharyngeal reflux (LPR) is an inflammatory reaction of the mucosa of pharynx, larynx, and other associated upper respiratory organs, caused by a reflux of stomach contents outside the oesophagus. LPR is considered to be a relatively new clinical entity with a vast number of clinical manifestations which are treated sometimes empirically and without a correct diagnosis. However, there is disagreement between specialists about its definition and management: gastroenterologi...
Source: Journal of Biological Regulators and Homeostatic Agents - Category: Biomedical Science Tags: J Biol Regul Homeost Agents Source Type: research
ConclusionsThe diagnostic evaluation should include multiple tests, in addition to a thorough clinical examination.
Source: World Journal of Surgery - Category: Surgery Source Type: research
CONCLUSION: The most common causes of CC include GERC, CVA, and UACS, and their diagnosis is based on the characteristics of the underlying disease. PMID: 28081319 [PubMed - in process]
Source: Turkish Journal of Medical Sciences - Category: Journals (General) Tags: Turk J Med Sci Source Type: research
Conclusions: Recent studies demonstrate the potential diagnostic role of MII-pH monitoring. Surgical intervention provides resolution of extraesophageal symptoms less reliably than typical symptoms when the patient has GERD.
Source: Annals of Surgery - Category: Surgery Tags: Meta-Analysis Source Type: research
Conclusion Hyperexcitability of T5 and T6 sympathetic preganglionic fibers appears to be the main etiology of LPR. SNEPI can reduce LES relaxation and improve blood flow to the mucosa, thereby increasing the stability of the vagus reflex and laryngopharyngeal mucosal defense factors. To the best of our knowledge, this case represents the first report of a patient with LPR refractory to PPIs who was successfully treated with SNEPI alone. SNEPI can be considered as an alternative to anti-reflux procedures. References 1. Vakil N, van Zanten SV, Kahrilas P, et al. Global Consensus Group. The Montreal definition and classificat...
Source: Innovations in Clinical Neuroscience - Category: Neuroscience Authors: Tags: Case Report Current Issue Medical Issues Neurologic Systems and Symptoms Neurology antireflux procedure autonomic regulation laryngopharyngeal reflux refractory Sympathetic nerve entrapment point injection Source Type: research
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