ATYPICAL OPTIONS OF THE CURRENT GASTROESOPHAGEAL REFLUX DISEASE

ABUBAKIROVA, K.E. (2013) ATYPICAL OPTIONS OF THE CURRENT GASTROESOPHAGEAL REFLUX DISEASE. Научно-практический журнал “Вестник КазНМУ” (3). ISSN 9965-01-300-4

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Abstract

In article features of atypical options of a clinical course of gastroesophageal reflux disease are defined. Gastroesophageal reflux disease is quite often shown by development of the atypical implications proceeding under "mask" of cardiologic, bronchopulmonary, otolaryngology diseases. The most common atypical symptoms of gastroesophageal reflux disease are pains behind a breast bone and chronic tussis. Gastroesophageal reflux is a common condition affecting many patients in different parts of the world. It usually presents with the classic manifestations of heartburn and regurgitation; however, in some it can also present with extraesophageal manifestations such as chronic cough, laryngitis, asthma or chest pain. Commonly employed diagnostic tests such as esophagogastroduodenoscopy and ambulatory pH or impedance monitoring in gastroesophageal reflux, are less useful in extraesophageal syndromes due to their poor sensitivity and specificity. In contrast, empiric trials of PPI’s are shown to be cost effective; however, patients may require long-term treatment to establish effectiveness. Diagnostic testing with pH and impedance monitoring are commonly reserved for patients with partial or poor response to the initial treatment with PPI’s. Poor response to PPI therapy may be an important indicator for non-gastroesophageal reflux causes for patients’ symptoms and should initiate a search for other potential causes. Extraesophageal reflux disease (EERD) represents a wide spectrum of manifestations mainly related with the upper and the lower respiratory system such as laryngitis, asthma, chronic obstructive pulmonary disease, cough, hoarseness, postnasal drip disease-sinusitis, otitis media, recurrent pneumonia and laryngeal cancer. Non-cardiac chest pain is commonly grouped among the esophageal syndromes by the Montreal Classification, but is not one of the common symptoms of typical gastroesophageal reflux (GER) which are heartburn and regurgitation. The diagnosis and recommendations on initial empiric therapy for patients with suspected reflux related non-cardiac chest pain is similar to those of extraesophageal reflux which is why it is included in this chapter. GER contributes to extraesophageal syndromes by two mechanisms: direct (aspiration) or indirect (vagally-mediated) mechanisms. Reflux of gastroduodenal contents into the esophagus and hypophayrnx may be classified as either “high” or “distal”. The pathogenesis of “high” esophageal reflux involves reflux that traverses the esophagus and induces cough either by direct pharyngeal or laryngeal stimulation or aspiration and causes a tracheal or bronchial cough response. In “distal” esophageal reflux, cough can be produced by a vagally-mediated tracheal-bronchial reflex. Embryologic studies show that esophagus and bronchial Вестник КазНМУ, №3 (2) - 2013 5 www.kaznmu.kz tree share a common embryologic origin and neural innervation via the vagus nerve. Pressure gradient changes between the abdominal and thoracic cavities during the act of coughing, may lead to a cycle of cough and reflux. A disturbance in any of the normal protective mechanisms such as disruption of the mechanical barrier for reflux (lower esophageal sphincter) or esophageal dysmotility may allow direct contact of noxious gastroduodenal contents with the larynx or the airway. In this article we will discuss the latest knowledge of the association between extraesophageal manifestations of GER such as chronic cough, laryngitis and asthma as well as non-cardiac chest pain of esophageal origin. We will discuss the current recommendations on diagnosis and treatment options for this difficult group of patients.

Item Type: Article
Uncontrolled Keywords: gastroesophageal reflux disease, extraesophageal syndromes extraesophageal reflux syndrome; chronic laryngitis; asthma; chronic cough; reflux
Subjects: R Medicine > R Medicine (General)
Divisions: Научно-практический журнал "Вестник КазНМУ" > Выпуск №2 2013 год
Depositing User: Mr Press KazNMU
Date Deposited: 25 Jun 2013 11:25
Last Modified: 25 Jun 2013 11:25
URI: http://repository.kaznmu.kz/id/eprint/6848

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