Laryngopharyngeal Reflux and Atypical Gastroesophageal Reflux Disease

Laryngopharyngeal reflux and atypical manifestations of gastroesophageal reflux disease have a high economic and social burden in the United States. There is increasing research supporting the reflex theory and hypersensitivity syndrome underlying this disease pathophysiology. Novel diagnostic biomarkers have gained more traction in the search for a more reliable diagnostic tool, but further research is needed. Current standard-of-care treatment relies on proton pump inhibitor therapy. Antireflux surgery is usually not recommended. Neuromodulators and treatments targeting specific neuronal receptors are discussed. A diagnostic algorithm is proposed for the evaluation of laryngeal symptoms suspected to be related to extraesophageal reflux disease.
Source: Gastrointestinal Endoscopy Clinics of North America - Category: Gastroenterology Authors: Source Type: research

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Background: Activation of afferent nerves in the esophagus is assumedly a major mechanisms of cough associated with GER, which may lead to sensitization of cough reflex. Transient receptor potential vanilloid (TRPV) 1 is one of the nociceptors activated by acid, whose expression is increased in the airways of chronic cough patients (Groneberg 2004) and in the esophagus of GER patients (Guarino 2010). The expression of nociceptors in the esophagus of patients with GER-associated cough is unknown.Method: We prospectively recruited untreated GER patients with (n=32, C+) and without (n=5, C-) cough. Esophageal endoscopy was pe...
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Airway pharmacology and treatment Source Type: research
ConclusionsAlthough semi-solid nutrients have several advantages, including reduced diarrhea and gastroesophageal reflux, evidence on semi-solid nutrients via the nasogastric tube is insufficient. It should be noted that semi-solid nutrient reflux can be more fatal than liquid nutrients.
Source: International Journal of Surgery Case Reports - Category: Surgery Source Type: research
CONCLUSIONS: Although GORD is common in subjects with ACS, we have not been able to show that GORD may serve as a trigger for ischaemia in these subjects. PMID: 31591635 [PubMed - as supplied by publisher]
Source: Cardiovascular Journal of Africa - Category: Cardiology Authors: Tags: Cardiovasc J Afr Source Type: research
Gastro-oesophageal reflux disease (GORD) and obesity are associated with frequent exacerbations and poor quality of life in people living with asthma. Multiple mechanisms have been proposed for the effect of obesity, including modification of inflammation affecting epithelial cell proliferation and wound repair, while the role of GORD is poorly understood and proton pump inhibitors (PPIs) are of variable efficacy. GORD might exert a deleterious effect by inducing vagal reflex, neuroinflammation and directly triggering airway inflammation (via microaspiration). Studies of reflux in animal models and human bronchial epitheli...
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Original Articles: Research letters Source Type: research
Publication date: Available online 6 June 2019Source: Pulmonary Pharmacology &TherapeuticsAuthor(s): Li Long, Kefang LaiAbstractChronic cough is one of the most common complains for patients seeking medical attention in both general practice and respiratory specialist clinics. Cough variant asthma, eosinophilic bronchitis, upper airway cough syndrome, as well as gastro-esophageal reflux disease are common conditions associated with chronic cough, and cough variant asthma, eosinophilic bronchitis account for a higher proportion of patients with chronic cough in China than in Western countries. An older female predominan...
Source: Pulmonary Pharmacology and Therapeutics - Category: Respiratory Medicine Source Type: research
BackgroundGastroesophageal reflux disease (GERD) is a common esophageal disorder. Transcutaneous electrical acustimulation (TEA), as a needleless method of electroacupuncture (EA) has been reported to improve hypotensive lower esophageal sphincters pressure (LESP) in GERD. Synchronized TEA (STEA) with inspiration has been revealed to be more effective than TEA in enhancing vagal tone.AimTo explore the effect of STEA on LESP in GERD and possible mechanisms involving autonomic functions.MethodsSixty patients were randomly allocated into a STEA group (45 patients) and sham ‐TEA group (15 patients). The ECG was recorded for ...
Source: Neuromodulation: Technology at the Neural Interface - Category: Biotechnology Authors: Tags: Clinical Research Source Type: research
During the 20th century, medicine became very good at compartmentalizing different systems of the body in order to understand them better. However, today we are increasingly realizing that different systems of the body are interconnected and cannot be completely understood in isolation. The brain-gut connection is one very important example of this phenomenon. Anatomy of the brain-gut connection What exactly is the connection between brain and gut? The brain sends signals to the digestive, or gastrointestinal (GI), tract via the sympathetic (“fight or flight”) nervous system and the parasympathetic (“rest...
Source: Harvard Health Blog - Category: Consumer Health News Authors: Tags: Complementary and alternative medicine Digestive Disorders Health Mind body medicine Pain Management Source Type: blogs
Publication date: Available online 14 March 2019Source: Pulmonary Pharmacology &TherapeuticsAuthor(s): David Muccino, Stuart GreenAbstractChronic cough, or cough lasting>8 weeks, is often associated with underlying medical conditions (ie, asthma, gastroesophageal reflux disease, nonasthmatic eosinophilic bronchitis, and upper-airway cough syndrome). In some patients with chronic cough, treatment of these underlying conditions does not resolve the cough (refractory chronic cough [RCC]), or none of these conditions are present (unexplained chronic cough [UCC]). Despite appropriate medical evaluation, patients with RCC...
Source: Pulmonary Pharmacology and Therapeutics - Category: Respiratory Medicine Source Type: research
Background: The cough reflex in childbearing women has been found to be more sensitive to chemical stimuli than that in other populations. However, the effect of age and sex on the cough reflex threshold (CRT) triggered by mechanical stimuli has not been studied.Aim: Our objective was to explore the association between age and sex, and CRT triggered by mechanical stimuli (air pulses) in childbearing women using a previously validated laryngopharyngeal endoscopic esthesiometer and laser rangefinder (LPEER).Methods: A cohort of 118 subjects, half of whom were female (49%), aged 19-95 years (a mean of 55.7 years), were prospe...
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Clinical Problems Source Type: research
A cross-sectional study performed on a continuous sample of 32 patients (mean age 46.36 ±3.31 years) with gastroesophageal reflux disease and excess body weight showed that the disturbance of sympathetic/parasympathetic relationships, disruption of segmental and compensatory increase in the suprasegmental mechanisms of autonomic regulation determines the course of gastroesophageal ref lux disease in these patients.
Source: Bulletin of Experimental Biology and Medicine - Category: Biology Source Type: research
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