Toni O. Kiljander, MD; Eija-Riitta M. Salomaa, MD; Eino K. Hietanen, MD; and Erkki O. Terho MD
|
|
- Ambrose Houston
- 6 years ago
- Views:
Transcription
1 Gastroesophageal Reflux in Asthmatics* A Double-Blind, Placebo-Controlled Crossover Study With Omeprazole Toni O. Kiljander, MD; Eija-Riitta M. Salomaa, MD; Eino K. Hietanen, MD; and Erkki O. Terho MD Study objectives: To investigate the prevalence of gastroesophageal reflux (GER) among patients with asthma and to determine the effect of omeprazole on the outcome of asthma in patients with GER. Design: A double-blind, placebo-controlled crossover study. Setting: Asthmatic patients who attended the pulmonary outpatient clinic of Turku University Central Hospital, Finland. Patients: One hundred seven asthmatic patients. Interventions: The patients who were found to have GER in ambulatory esophageal ph monitoring were randomized to receive either omeprazole, 40 mg qd, or placebo for 8 weeks. After a 2-week washout period, the patients were crossed over to the other treatment. Spirometry was performed at baseline and immediately after both treatment periods. Peak expiratory values, use of sympathomimetics, and pulmonary and gastric symptoms were recorded daily in a diary. Results: Pathologic GER was found in 53% of the asthmatic patients. One third of these patients had no typical reflux symptoms. Daytime pulmonary symptoms did not improve significantly (p 0.14), but a reduction in nighttime asthma symptoms (p 0.04) was found during omeprazole treatment. In the patients with intrinsic asthma, there was an improvement in FEV 1 values (p 0.049). Based on symptom scores, 35% of the patients were regarded as responders to 8-week omeprazole treatment. The reflux (time [percent] of ph < 4) was found to be more severe (p 0.002) in the responders. Conclusions: There is a high prevalence of GER in the asthmatic population. This reflux is often clinically silent. After an 8-week omeprazole treatment, there was a reduction in nocturnal asthma symptoms, whereas daytime asthma outcome did not improve. There seems to be a subgroup of asthma patients who benefit from excessive antireflux therapy. (CHEST 1999; 116: ) Key words: asthma; gastroesophageal reflux; omeprazole Abbreviations: GER gastroesophageal reflux; LES lower esophageal sphincter; PEF peak expiratory flow Gastroesophageal reflux (GER) has been found to occur in 32 to 80% of asthmatic patients. 1,2 Although the association is evident, it has been difficult to establish a causal relationship between asthma and GER. Asthma is known to promote *From the Departments of Respiratory Medicine and Clinical Allergology (Drs. Kiljander, Salomaa, and Terho) and Clinical Physiology (Dr. Hietanen), Turku University Central Hospital, Finland. This study was supported by the Finnish Anti-Tuberculosis Association Foundation, the Väinö and Laina Kivi Foundation, and the Research Foundation of Respiratory Diseases. Manuscript received January 5, 1999; revision accepted May 25, Correspondence to: Toni Kiljander, MD, Department of Respiratory Medicine and Clinical Allergology, Turku University Central Hospital, Alvar Aallon tie 275, Preitilā, Finland; toni.kiljander@utu.fi reflux by increasing the pressure gradient between the thorax and the abdomen. 3,4 On the other hand, two mechanisms by which GER can aggravate or even cause asthma have been proposed, namely microaspiration of gastric contents, 5 7 and vagally mediated esophagobronchial reflex The hypothesis that GER can trigger or exacerbate asthma is For editorial comment see page 1150 supported by several clinical trials that have shown an amelioration in asthma symptoms and/or an improvement in pulmonary function after antireflux therapy Not all clinical trials have been able to confirm such results, and even those that have, have only been able to show minor improvement in CHEST / 116 / 5/ NOVEMBER,
2 asthma symptoms and/or pulmonary function, 12,14,16 19 or have not been placebo controlled. 13,15,20 It has been shown that after antireflux therapy is started, a duration of up to 2 to 3 months is required before asthma symptoms are relieved. 13,15 Harding et al 15 have shown that 27% of GER patients require 20 mg of omeprazole to stop acidic reflux. Most studies so far have not met all of the following criteria (which the present study did): adequate antireflux therapy, a treatment period of sufficient duration, and placebo control. The objectives of the present study are as follows: (1) to investigate the prevalence of GER in the outpatient asthmatic population, and (2) to determine the effect of omeprazole on asthma symptoms and pulmonary function. following variables were recorded daily in a diary: cough, dyspnea, wheezing, heartburn, regurgitation, chest pain, and nighttime asthma symptoms. A scoring system used previously 13,15 was utilized: symptoms were recorded on a scale of 0 (no symptoms) to 3 (severe symptoms). Afterwards, the weekly pulmonary (cough, dyspnea, wheezing) and gastric (heartburn, regurgitation, chest pain) symptom scores (both 0 to 63) and nighttime asthma symptom score (0 to 21) were calculated by summing the daily scores. The patients were considered to be free of typical GER symptoms if they had heartburn, regurgitation, chest pain, and dysphagia less than once a week. The patients were regarded as responders to the antireflux therapy if their pulmonary symptom score or PEF or FEV 1 values improved on omeprazole from the baseline, and if the improvement was 20% when compared to placebo therapy. 15,18 The study was approved by the Ethics Committee of the Turku University Central Hospital, and every patient gave written informed consent. Ambulatory ph Monitoring Patients Materials and Methods In order to get as heterogeneous a group of asthmatic patients as possible, the only inclusion criteria was a diagnosis of asthma, which was made according to the guidelines defined by the American Thoracic Society. 24 The patients were considered to have asthma if they had reversible bronchial obstruction, documented by a 15% increase in FEV 1 after sympathomimetic inhalation, or a 20% decrease in FEV 1 after methacholine challenge, or 20% diurnal variation in peak expiratory flow (PEF) values. Asthma was considered to be extrinsic if at least one positive reaction was found in skin prick tests with common allergens. One hundred seven asthmatic patients from the pulmonary outpatient department of the Turku University Central Hospital participated in the study. Thirty-five of the patients (33%) were male and 72 (67%) were female. The mean age was 49 years old (range, 21 to 76). The results of the skin prick tests were positive in 43 patients (40%), negative in 44 patients (41%), and not available in 20 patients (19%). Twenty of the patients (19%) were smokers. Study Design Ambulatory esophageal ph monitoring was performed on all 107 patients. The patients whose ph recordings were abnormal were randomized in a double-blind fashion to receive either omeprazole, 40 mg qd, or placebo for 8 weeks. The patients were advised to take the study medication just before breakfast. After a 2-week washout period, the patients were crossed over to the other treatment for 8 weeks. Treatment was preceded by a 1-week pretreatment phase, during which the baseline data were collected. Drugs were provided by Astra Finland (Masala, Finland), who was also responsible for randomization. Compliance with the trial medication was measured by tablet counts after both treatment periods. An attempt was made to maintain asthma medication unchanged, but in case of a deterioration of asthma, attending physicians were allowed to change medication when required. Oral steroid courses that were needed were counted. All treated patients underwent flow-volume spirometry before the first treatment period and immediately after both treatment periods. PEF values, the use of sympathomimetics, and the ph recordings were made using semidisposable monocrystant antimony ph catheters (Synectics Medical; Stockholm, Sweden) that have two channels for ph monitoring and a built-in waterperfused channel for manometric identification of the lower esophageal sphincter (LES). ph electrodes, which were 15 cm apart, were calibrated before each procedure. A ph probe was passed transnasally into the stomach and then slowly withdrawn, and a distal ph electrode was positioned 5 cm above the LES, as determined by the change in ph between the stomach and the esophagus. 25 In 78 patients (73%), the LES location was also checked manometrically by using the slow-pullthrough technique. An external reference electrode was attached to the skin of the chest wall. ph was monitored 5 and 20 cm above the LES, and was stored at 4 s intervals using a portable recorder (Digitrapper Mk III; Synectics Medical). The parameters measured were those described by Johnson and De- Meester. 26 After ambulatory recording, the data was downloaded into an IBM-compatible computer using appropriate analysis software (EsopHogram; Gastrosoft; Irving, Tx). ph monitoring was considered to be abnormal if total time ph 4 was 4.5% or if the DeMeester score was During ph monitoring, the patients carried on their normal daily routines. They were instructed to keep a diary, noting respiratory and gastric symptoms, meals, and recumbent times. All patients were asked to stop possible antacid, H2-blocker, prokinetic, or proton pump inhibitor medications at least 3 days before ph monitoring, and they were also told to avoid these drugs during the monitoring. Pulmonary Function Tests Patients were advised to measure their PEF values (Spira Peak Flowmeter; Spira; Helsinki, Finland) three times every morning within an hour after awakening, and to write the best result down in a diary. All spirometric measurements were made using Flowscreen spirometry (Jaeger GmbH; Würzburg, Germany) that was calibrated according to instructions before each procedure. The normal values used were made especially for the Finnish population. 28 Statistical Analysis The statistical analysis was performed using methodology developed for crossover design with two periods and two treat Clinical Investigations
3 ments. 29 When comparing diary information, the average scores for the 3 last weeks at the end of both treatment periods were used. Because the outcome variables were discrete and/or not normally distributed, the analyses were conducted with a nonparametric Mann-Whitney U test using appropriate statistical software (SAS Release 6.12; SAS Institute; Cary, NC). When mentioned, the 2 test was utilized. Before testing the treatment effect, carryover effect was tested using 0.10 as a level of significance. 30 In other tests, p values 0.05 were interpreted as statistically significant. Results Fifty-seven of 107 asthma patients (53%) were found to have pathologic GER in the ambulatory esophageal ph recording and were randomized. A comparison of the patients who had GER with those patients who did not have GER is shown in Table 1. Of the 57 patients with GER, 20 patients (35%) had no typical reflux symptoms. Fifty-two patients completed both treatment periods. Three patients dropped out while receiving placebo treatment (two because of intense gastric symptoms), and two dropped out while receiving the active drug. Eighteen of these 52 patients (35%) were male and 34 (65%) were female. Their mean age was 50 years (range, 21 to 75); PEF, 455 L/min (range, 250 to 700); and FEV 1 % of predicted, 81 (range, 31 to 114). Eight patients (15%) were smokers, and all but three used regular inhaled steroids. No patients had to be excluded from the final analysis because of poor compliance with the trial medication. No carryover effect was detected after the washout period. The variables that were followed and their p values are shown in Table 2. There was a significant improvement in the gastric symptom score with omeprazole treatment compared to placebo treatment (p ). Also, the pulmonary symptom score improved (Fig 1, 2), but this was not statistically significant (p 0.14). There was a small but statistically significant relief in nighttime asthma symptoms (p 0.04). Pulmonary function did not improve; on the contrary, there was a statistically significant decline in FEV 1 values. With 95% confidence, this decline was 0.15 L. Seven oral steroid courses were used during omeprazole treatment, nine were used during placebo treatment, and two were used during the washout period. There were 18 patients (35%) whose pulmonary symptom scores improved 20% while receiving omeprazole, and they were thus regarded as responders. No PEF or FEV 1 responders were found. The pulmonary symptom scores of the responders and the nonresponders are shown in Figure 3. Reflux (time [percent] ph 4) was more severe (p 0.002) in the patients who responded to the omeprazole therapy than in the patients who did not respond (Fig 4). GER was more common among patients with intrinsic asthma (27/44; 61%) than in patients with extrinsic asthma (19/43; 44%). However, the difference was not statistically significant (p 0.11). In patients with extrinsic asthma, the only variable that improved with omeprazole treatment was the gastric symptom score (p 0.002). In patients with intrinsic asthma, there was also an amelioration in the gastric symptom score (p 0.01) and, in addition, a statistically significant improvement in FEV 1 (p 0.049). Table 1 Comparison of Patients With and Without Pathologic GER in Ambulatory Esophageal ph Monitoring* Variables With GER, n 57 Without GER, n 50 p Value Age, yr 49 (21 75) 49 (22 76) Men 20 (35) 15 (30) Women 37 (65) 35 (70) Smokers 10 (18) 10 (20) NS Theophylline users 7 (12) 5 (10) NS Inhaled steroid users 51 (89) 39 (78) NS -Sympathomimetic users 52 (91) 40 (80) NS Patients having mostly nocturnal asthma symptoms 8 (14) 13 (26) NS Positive skin prick test results 19 (33) 24 (48) NS Time percent ph 4 upright 10.1 ( ) 1.7 ( ) Time percent ph 4 supine 4.0 ( ) 0.0 ( ) Time percent ph 4 total 9.0 ( ) 1.3 ( ) DeMeester score 27.2 ( ) 5.6 ( ) *Data are presented as No. (%) or mean (range) unless otherwise noted; NS not significant; 2 test was used in counting p values unless otherwise noted. Data are presented as median (75 25% quartiles). Statistically significant difference using Mann-Whitney U test. CHEST / 116 / 5/ NOVEMBER,
4 Table 2 Weekly Pulmonary (Cough, Dyspnea, and Wheezing), Gastric (Regurgitation, Heartburn, and Chest Pain; 0 63), and Nighttime Asthma Symptom Scores (0 21), Use of Rescue Sympathomimetics, and PEF and FEV 1 Values at the Baseline and at the End of Each Treatment Period (Average of the 3 Last Weeks at the End of the Period)* Variables Baseline First Treatment Period Second Treatment Period p Value Pulmonary symptom score 15.0 ( ) 8.7 ( ) 8.6 ( ) 0.14 Pulmonary symptom score 9.0 ( ) 7.0 ( ) 3.2 ( ) Gastric symptom score 9.0 ( ) 0.0 ( ) 5.6 ( ) Gastric symptom score 12.0 ( ) 4.0 ( ) 0.0 ( ) Nighttime asthma symptom score 1.0 ( ) 1.0 ( ) 0.7 ( ) 0.04 Nighttime asthma symptom score 0.0 ( ) 0.3 ( ) 0.0 ( ) Use of rescue sympathomimetics 3.0 ( ) 4.7 ( ) 2.0 ( ) 0.12 Use of rescue sympathomimetics 1.0 ( ) 3.0 ( ) 1.7 ( ) PEF, L/min 400 ( ) 390 ( ) 390 ( ) 0.24 PEF, L/min 470 ( ) 440 ( ) 450 ( ) FEV 1, L 2.2 ( ) 2.3 ( ) 2.2 ( ) 0.01 FEV 1, L 3.0 ( ) 3.2 ( ) 2.9 ( ) *Data are presented as median (75 25% quartiles); Mann-Whitney U test was used to calculate p values. For patients (n 27) who received omeprazole, 40 mg/d, during the first treatment period and placebo during the second treatment period. For patients (n 25) who received placebo during the first treatment period and omeprazole, 40 mg/d, during the second treatment period. Statistically significant improvement. Decline during omeprazole treatment. Discussion We found a high prevalence (53%) of GER in the asthmatic population. This is in accordance with previous studies, which have shown GER in 32 to 80% of asthmatic patients. 1,2 It is of interest that 35% of the patients who had GER in ph monitoring were free of typical reflux symptoms. Irwin et al 31 have similarly shown GER to be clinically silent in 24% of asthmatic patients. Although theophylline has been shown to reduce the pressure of the LES and thus potentially promote GER, 32 it has been shown that the influence of theophylline or other asthma medication on the prevalence of GER in asthmatic patients is minor. 2 We did not find any difference in the use of any asthma medication between patients with or without GER. Our study showed some improvement in asthma Figure 1. Weekly pulmonary (cough, dyspnea, and wheezing) and gastric (regurgitation, heartburn, and chest pain) symptom scores (0 to 63; medians) of the patients (n 27) who received omeprazole, 40 mg/d, during weeks 1 through 8 and placebo treatment during weeks 11 through 18. Weeks 9 through 10 were the washout period. The score at week 0 is the baseline value Clinical Investigations
5 Figure 2. Weekly pulmonary (cough, dyspnea, and wheezing) and gastric (regurgitation, heartburn, and chest pain) symptom scores (0 to 63; medians) of the patients (n 25) who received placebo treatment during weeks 1 through 8 and omeprazole, 40 mg/d, during weeks 11 through 18. Weeks 9 through 10 were the washout period. The score at week 0 is the baseline value. symptoms after 8-week omeprazole treatment; however, the improvement was not statistically significant. This is in accordance with several studies with H2 blockers and proton pump inhibitors, 19,21 23 which have failed to significantly reduce asthma symptoms in asthmatic patients with GER. On the other hand, Harper et al, 13 who studied 15 nonallergic asthma patients with symptomatic GER, were able to achieve a statistically significant improvement in daytime asthma symptoms after 8-week ranitidine therapy. Unfortunately, their study was not placebo controlled. Similarly to Harper et al, 13 we were also able to show a statistically significant improvement in the pulmonary function of patients with intrinsic Figure 3. Medians of the weekly pulmonary (cough, dyspnea, and wheezing) symptom scores (0 to 63) of the patients who responded (n 18; 20% improvement) to the omeprazole treatment and the patients who did not respond (n 34). For this representation, the omeprazole and the placebo groups were combined regardless of the order in which they received the drugs. CHEST / 116 / 5/ NOVEMBER,
6 Figure 4. Medians (75 to 25% quartiles) of ph 4 (percent) of the total time and in the supine and upright positions in the patients who responded (n 18); 20% improvement in the pulmonary symptom score) to the omeprazole treatment and in the patients who did not respond (n 34). The Mann-Whitney U test was used. * statistically significant. asthma after 2 months of omeprazole treatment. In another study with nonallergic asthmatic patients, both medical (cimetidine) and surgical antireflux therapy were found to be significantly more effective in reducing asthma symptoms than placebo therapy. In this study, pulmonary function did not improve significantly after antireflux therapy. 14 Recently Levin et al, 33 who studied nine asthmatic patients with symptomatic GER, have shown that omeprazole, 20 mg qd for 8 weeks, significantly improves PEF values and quality of life when compared to placebo therapy. Furthermore, two groups 15,18 have shown that some asthmatic patients with GER respond to omeprazole therapy. Meier et al 18 administered omeprazole, 20 mg bid for 6 weeks, to 15 asthmatic patients with esophagitis and symptoms of pyrosis in a placebo-controlled crossover study. They found an improvement of 20% in FEV 1 in four patients (27%). All responders and only 6 of 11 nonresponders had a complete healing of esophagitis. This has raised a discussion as to whether they would have been able to get more responders with longer treatment. Harding et al 15 studied 30 asthmatic patients with symptomatic GER. They found that 20 patients (67%) responded to 3 months of omeprazole treatment with 20% decrease in asthmatic symptoms and 6 patients (20%) responded with 20% increase in PEF values. Unlike Meier et al 18 and Harding et al, 15 we did not reach a 20% increase in FEV 1 or PEF values with any of the patients; unlike Levin et al, 33 we were not able to show a significant improvement in daytime asthma symptoms after 2 months of omeprazole treatment. There are at least two possible explanations. Firstly, we feel that our patients asthma was in good control already at the baseline (all but three patients used regular inhaled steroids, and the mean FEV 1 was 81% of predicted), and thus it was difficult to reach a 20% increase in the pulmonary function or a statistically significant improvement in the asthma symptoms. Secondly, in the present study, we have shown that GER is relatively severe in the asthmatic patients who respond to omeprazole treatment. Since our inclusion criteria did not include the presence of typical reflux symptoms, it is probable that reflux in our patients was milder and the prevalence of esophagitis was probably lower than in the previous studies 15,18,33. We found 18 patients (35%) to be asthma symptom responders to 2 months of omeprazole treatment. Our finding is less than 67% what Harding et 1262 Clinical Investigations
7 al found. 15 This could be due to the fact that their study was not placebo controlled, whereas the present study was. Although it has been shown that even mild GER without esophagitis is sufficient to cause pulmonary symptoms, 14 we found GER to be more severe in patients whose pulmonary symptoms were relieved with the omeprazole treatment than in patients whose pulmonary symptoms did not improve with omeprazole (Fig 4). Of interest is that even those patients who were regarded as responders showed improvement in their pulmonary symptoms only after several weeks of omeprazole treatment (Fig 3). This is in accordance with previous studies 13,15 that have shown that asthma symptom improvement lags behind the typical reflux symptom improvement. An interesting study was made by Ekström and Tibbling. 34 They studied 37 patients with nocturnal asthma and found significantly lower morning PEF values in those patients who had pathologic nocturnal GER compared to patients with no GER at night, suggesting a relationship between GER and nocturnal asthma. Similarly to our study, some previously published placebo-controlled studies with H2 blockers have been able to show an amelioration in nighttime asthma symptoms. 12,16,17 Conversely, Ford et al 22 were not able to show a significant improvement in patients with nocturnal asthma and GER after omeprazole treatment. There may be several explanations for this: they studied only 11 patients, the length of treatment was only 4 weeks, and the dose of omeprazole was perhaps not sufficient (20 mg). A retrospective study of a surgical treatment of GER in asthmatic patients also showed a marked relief in asthma symptoms in patients with intrinsic asthma having a predominance of nocturnal symptoms. 35 There is evidence that especially asthmatic patients with excessive proximal esophageal reflux might benefit from antireflux therapy, 15,36 although contradictory reports have been published. 37 In conclusion, there is a high prevalence of GER in the asthmatic population. This reflux is often clinically silent. In this study, we have shown that daytime asthma outcome did not improve with 8-week omeprazole therapy. However, there seems to be a subgroup of asthmatic patients who benefit from excessive antireflux therapy. These responders seem to have relatively severe reflux, and they possibly are patients with intrinsic asthma having predominantly nighttime asthmatic symptoms. References 1 Vincent D, Cohen-Jonathan AM, Leport J, et al. Gastrooesophageal reflux prevalence and relationship with bronchial reactivity in asthma. Eur Respir J 1997; 10: Sontag SJ, O Connel S, Khandelwal S, et al. Most asthmatics have gastroesophageal reflux with or without bronchodilator therapy. Gastroenterology 1990; 99: Holmes PW, Campbell AM, Barter CE, et al. Changes of lung volumes and lung mechanics in asthma and normal subjects. Thorax 1978; 33: Moote DW, Lloyd DA, McCourtie DR, et al. Increase in gastroesophageal reflux during methacholine-induced bronchospasm. J Allergy Clin Immunol 1986; 78: Tuchman DN, Boyle JT, Pack AI, et al. Comparison of airway responses following tracheal or esophageal acidification in the cat. Gastroenterology 1984; 87: Donnelly RJ, Berrisford RG, Jack CIA, et al. Simultaneous tracheal and esophageal ph monitoring: investigating refluxassociated asthma. Ann Thorac Surg 1993; 56: Jack CIA, Calverley PMA, Donnelly RJ, et al. Simultaneous tracheal and oesophageal ph measurements in asthmatic patients with gastro-oesophageal reflux. Thorax 1995; 50: Mansfield LE, Hameister HH, Spaulding HS, et al. The role of the vagus nerve in airway narrowing caused by intraesophageal hydrochloric acid provocation and esophageal distention. Ann Allergy 1981; 47: Schan CA, Harding SM, Haile JM, et al. Gastroesophageal reflux-induced bronchoconstriction: an intraesophageal acid infusion study using state-of-the-art technology. Chest 1994; 106: Harding SM, Schan CA, Guzzo MR, et al. Gastroesophageal reflux-induced bronchoconstriction: is microaspiration a factor? Chest 1995; 108: Lodi U, Harding SM, Coghlan HC, et al. Autonomic regulation in asthmatics with gastroesophageal reflux. Chest 1997; 111: Goodall RJR, Earis JE, Cooper DN, et al. Relationship between asthma and gastro-oesophageal reflux. Thorax 1981; 36: Harper PC, Bergner A, Kaye MD. Antireflux treatment for asthma: improvement in patients with associated gastroesophageal reflux. Arch Intern Med 1987; 147: Larrain A, Carrasco E, Galleguillos F, et al. Medical and surgical treatment of nonallergic asthma associated with gastroesophageal reflux. Chest 1991; 99: Harding SM, Richter JE, Guzzo MR, et al. Asthma and gastroesophageal reflux: acid suppressive therapy improves asthma outcome. Am J Med 1996; 100: Ekström T, Lindgren BR, Tibbling L. Effects of ranitidine treatment on patients with asthma and history of gastrooesophageal reflux: a double blind crossover study. Thorax 1989; 44: Gustafsson PM, Kjellman N-IM, Tibbling L. A trial of ranitidine in asthmatic children and adolescents with or without pathological gastro-oesophageal reflux. Eur Respir J 1992; 5: Meier JH, McNally PR, Punja M, et al. Does omeprazole (Prilosec) improve respiratory function in asthmatics with gastroesophageal reflux? A double-blind, placebo-controlled crossover study. Dig Dis Sci 1994; 39: Teichtal H, Kronborg IJ, Yeomans ND, et al. Adult asthma and gastro-oesophageal reflux: the effects of omeprazole therapy on asthma. Aust N Z J Med 1996; 26: Sontag S, O Connel S, Greenlee H, et al. Is gastroesophageal reflux a factor in some asthmatics? Am J Gastroenterol 1987; 82: Nagel RA, Brown P, Perks WH, et al. Ambulatory ph monitoring of gastro-oesophageal reflux in morning dipper asthmatics. BMJ 1988; 297: Ford GA, Oliver PS, Prior JS, et al. Omeprazole in the CHEST / 116 / 5/ NOVEMBER,
8 treatment of asthmatics with nocturnal symptoms and gastrooesophageal reflux: a placebo-controlled crossover study. Postgrad Med J 1994; 70: Boeree MJ, Peters FTM, Postma DS, et al. No effects of high-dose omeprazole in patients with severe airway hyperresponsiveness and (a)symptomatic gastro-oesophageal reflux. Eur Respir J 1998; 11: American Thoracic Society. Definitions and classification of chronic bronchitis, asthma and pulmonary emphysema. Am Rev Respir Dis 1962; 85: Klauser AG, Schindlbeck NE, Muller-Lissner SA. Esophageal 24-h ph monitoring: is prior manometry necessary for correct positioning of the electrode? Am J Gastroenterol 1990; 85: Johnson LF, DeMeester TR. Twenty-four-hour ph monitoring of the distal esophagus: a quantitative measure of gastroesophageal reflux. Am J Gastroenterol 1974; 62: Jamieson JR, Stein HJ, DeMeester TR, et al. Ambulatory 24-h esophageal ph monitoring: normal values, optimal thresholds, specificity, sensitivity, and reproducibility. Am J Gastroenterol 1992; 87: Viljanen A. Reference values for spirometric, pulmonary diffusing capacity and body plethysmographic studies. Scand J Clin Invest 1982; 159(Suppl42): Jones B, Kenward MG. Design and analysis of crossover trials. London, UK: Chapman and Hall, Grizzle JE. The two-period change-over design and its use in clinical trials. Biometrics 1965; 21: Irwin RS, Curley FJ, French CL. Difficult-to-control asthma: contributing factors and outcome of a systematic management protocol. Chest 1993; 103: Stein MR, Towner TG, Weber RW, et al. The effect on theophylline on the lower esophageal sphincter pressure. Ann Allergy 1980; 45: Levin TR, Sperling RM, McQuaid KR. Omeprazole improves peak expiratory flow rate and quality of life in asthmatics with gastroesophageal reflux. Am J Gastroenterol 1998; 93: Ekström T, Tibbling L. Gastro-oesophageal reflux and nocturnal asthma. Eur Respir J 1988; 1: Perrin-Fayolle M, Gormand F, Braillon G, et al. Long-term results of surgical treatment for gastroesophageal reflux in asthmatic patients. Chest 1989; 96: Schnatz PF, Castell JA, Castell DO. Pulmonary symptoms associated with gastroesophageal reflux: use of ambulatory ph monitoring to diagnose and to direct therapy. Am J Gastroenterol 1996; 91: Gastal OL, Castell JA, Castell DO. Frequency and site of gastroesophageal reflux in patients with chest symptoms: studies using proximal and distal ph monitoring. Chest 1994; 106: Clinical Investigations
Chronic cough and gastro-oesophageal reflux: a double-blind placebo-controlled study with omeprazole
Eur Respir J 2000; 16: 633±638 Printed in UK ± all rights reserved Copyright #ERS Journals Ltd 2000 European Respiratory Journal ISSN 0903-1936 Chronic cough and gastro-oesophageal reflux: a double-blind
More informationEffects of anti-reflux surgery on chronic cough and asthma in patients with gastro-oesophageal reflux disease
RESPIRATORY MEDICINE (2000) 94, 1166 1170 doi:10.1053/rmed.2000.0944, available online at http://www.idealibrary.com on Effects of anti-reflux surgery on chronic cough and asthma in patients with gastro-oesophageal
More informationNo effects of high-dose omeprazole in patients with severe airway hyperresponsiveness and (a)symptomatic gastrooesophageal
Eur Respir J 1998; 11: 1070 1074 DOI: 10.1183/09031936.98.11051070 Printed in UK - all rights reserved Copyright ERS Journals Ltd 1998 European Respiratory Journal ISSN 0903-1936 No effects of high-dose
More informationThe Prevalence of Gastroesophageal Reflux in Asthma Patients without Reflux Symptoms
The Prevalence of Gastroesophageal Reflux in Asthma Patients without Reflux Symptoms SUSAN M. HARDING, MELANY R. GUZZO, and JOEL E. RICHTER Division of Pulmonary, Allergy, and Critical Care Medicine, Department
More informationCurrent reviews of allergy and clinical immunology (Supported by a grant from Astra Pharmaceuticals, Westborough, Mass)
Current reviews of allergy and clinical immunology (Supported by a grant from Astra Pharmaceuticals, Westborough, Mass) Series editor: Harold S. Nelson, MD Gastroesophageal reflux and asthma: Insight into
More informationChronic persistent cough and gastro-oesophageal
Thorax 1991;46:479-483 Department of Thoracic Medicine A J Ing A B X Breslin Department of Gastroenterology M C Ngu Concord Hospital, Sydney, NSW 2139, Australia Reprint requests to: Dr Ing Accepted 17
More informationTemporal associations between coughing or wheezing and acid reflux in asthmatics
Gut 21;49:767 772 767 Department of Veterans AVairs Medical Center in Albuquerque, New Mexico, USA B Avidan A Sonnenberg Veterans AVairs Hospital in Hines, Illinois, USA T G Schnell S J Sontag Correspondence
More informationExtraesophageal presentations of gastroesophageal reflux disease: the case for aggressive diagnosis and treatment
JOEL E. RICHTER, MD Dr. Richter is chairman of the Department of Gastroenterology at the Cleveland Clinic Foundation, specializing in esophageal diseases with particular interest in GERD, achalasia, and
More informationA asthma is now well recognized [l], although the
Simultaneous Tracheal and Esophageal ph Monitoring: Investigating Reflux-Associated Asthma Raymund J. Donnelly, FRCSE, Richard G. Berrisford, FRCS, Catherine I. A. Jack, MRCP, Jane A. Tran, BTech, and
More informationr(i The Fellowship of Postgraduate Medicine, 1994 report has described improvement of nocturnal asthma with omeprazole, a much more effective
Postgrad Med J (1994) 70, 350 354 r(i The Fellowship of Postgraduate Medicine, 1994 Omeprazole in the treatment of asthmatics with nocturnal symptoms and gastro-oesophageal reflux: a placebo-controlled
More informationThe Frequency of Gastroesophageal Reflux Disease in Nutcracker Esophagus and the Effect of Acid-Reduction Therapy on the Motor Abnormality
Bahrain Medical Bulletin, Vol.22, No.4, December 2000 The Frequency of Gastroesophageal Reflux Disease in Nutcracker Esophagus and the Effect of Acid-Reduction Therapy on the Motor Abnormality Saleh Mohsen
More informationPrevalence of Bronchial Asthma in Patients with Endoscopically-Documented Esophagitis
94 Annals of Clinical & Laboratory Science, vol. 34, no. 1, 2004 Prevalence of Bronchial Asthma in Patients with Endoscopically-Documented Esophagitis G. Riccioni, 1 R. Della Vecchia, 2 V. Menna, 1 C.
More informationGastroesophageal reflux disease (GERD) is a frequent presentation
Insight Into the Relationship Between Gastroesophageal Reflux Disease and Asthma Fehmi Ates, MD, and Michael F. Vaezi, MD, PhD, MSc (Epi) Dr Ates is an associate professor of medicine at Mersin University
More informationT here has been considerable interest during
701 REVIEW Gastro-oesophageal reflux and bronchial asthma: current status and future directions J L Mathew, M Singh, S K Mittal... In recent years there have been several reports suggesting an association
More informationEffect of Esomeprazole 40 mg Once or Twice Daily on Asthma A Randomized, Placebo-controlled Study
Effect of Esomeprazole 40 mg Once or Twice Daily on Asthma A Randomized, Placebo-controlled Study Toni O. Kiljander 1, Ola Junghard 2, Ola Beckman 2, and Tore Lind 2 1 Department of Respiratory Medicine,
More informationPrevalence of Gastro-oesophageal Reflux Disease in 'Difficult-to-Control' Asthma and Response to Medical Antireflux Therapy
Prevalence of Gastro-oesophageal Reflux Disease in 'Difficult-to-Control' Asthma and Response to Medical Antireflux Therapy Magdy M. Emara 1, 6, Mohamad A. Habeb 2, Mohamad A. Moharam 3, Mohmad Mosaad
More informationIncreased Prevalence of Gastroesophageal Reflux in Patients with Idiopathic Pulmonary Fibrosis
Increased Prevalence of Gastroesophageal Reflux in Patients with Idiopathic Pulmonary Fibrosis RICHARD W. TOBIN, CHARLES E. POPE II, CARLOS A. PELLEGRINI, MARY J. EMOND, JIM SILLERY, and GANESH RAGHU Department
More informationGastro-oesophageal reflux related cough and its response to laparoscopic fundoplication
Thorax 1998;53:963 968 963 Departments of Medicine and Surgery, McMaster University, St Joseph s Hospital, Hamilton, Ontario, Canada L8N 4A6 C J Allen M Anvari Correspondence to: Dr C Allen. Received 10
More informationGERD is a condition which develops when the reflux of stomach contents causes troublesome symptoms and/or complications
GERD is a condition which develops when the reflux of stomach contents causes troublesome symptoms and/or complications Esophageal Syndromes Extra - esophageal Syndromes Symptomatic Syndromes Typical reflux
More informationEffects of omeprazole and cisapride treatment in Japanese asthmatics with reflux esophagitis
Allergology International (1997) 46: 167-172 Original Article Effects of omeprazole and cisapride treatment in Japanese asthmatics with reflux esophagitis Katsuya Fujimori,1 Eiichi Suzuki2 and Masaaki
More informationOral Corticosteroids Increase Esophageal Acid Contact Times in Patients With Stable Asthma*
preliminary report Oral Corticosteroids Increase Esophageal Acid Contact Times in Patients With Stable Asthma* John P. Lazenby, MD; Melany R. Guzzo, BSN; Susan M. Harding, MD, FCCP; Patricia E. Patterson,
More informationAcidic and Non-Acidic Reflux During Sleep Under Conditions of Powerful Acid Suppression*
Original Research SLEEP MEDICINE Acidic and Non-Acidic Reflux During Sleep Under Conditions of Powerful Acid Suppression* William C. Orr, PhD; Andrea Craddock, PhD; and Suanne Goodrich, PhD Background:
More informationMaximizing Outcome of Extraesophageal Reflux Disease. (GERD) is often accompanied
...PRESENTATIONS... Maximizing Outcome of Extraesophageal Reflux Disease Based on a presentation by Peter J. Kahrilas, MD Presentation Summary Gastroesophageal reflux disease (GERD) accompanied by regurgitation
More informationGASTRO-ESOPHAGEAL REFLUX DISEASE IN BRONCHIAL ASTHMA IS THERE AN ASSOCIATION?
GASTRO-ESOPHAGEAL REFLUX DISEASE IN BRONCHIAL ASTHMA IS THERE AN ASSOCIATION? *Gajanan S. Gaude and Jyothi Karanji Department of Pulmonary Medicine, J. N. Medical College, Belgaum -590010 *Author for correspondence
More informationUpdate on management of respiratory symptoms. Dr Farid Bazari Consultant Respiratory Physician Kingston Hospital NHS FT
Update on management of respiratory symptoms Dr Farid Bazari Consultant Respiratory Physician Kingston Hospital NHS FT Topics The common respiratory symptoms Cough: causes, diagnosis and therapy Update
More informationSomkiat Wongtim Professor of Medicine Division of Respiratory Disease and Critical Care Chulalongkorn University
Somkiat Wongtim Professor of Medicine Division of Respiratory Disease and Critical Care Chulalongkorn University Asthma-related Comorbidities Comorbid conditions of the upper airways Rhinitis and Sinusitis
More informationORIGINAL ARTICLE. Proximal Reflux as a Cause of Adult-Onset Asthma
ORIGINAL ARTICLE Proximal Reflux as a Cause of Adult-Onset Asthma The Case for Hypopharyngeal Impedance Testing to Improve the Sensitivity of Diagnosis Yoshihiro Komatsu, MD; Toshitaka Hoppo, MD, PhD;
More informationHigh Prevalence of Proximal and Distal Gastroesophageal Reflux Disease in Advanced COPD*
Original Research COPD High Prevalence of Proximal and Distal Gastroesophageal Reflux Disease in Advanced COPD* Robert R. Kempainen, MD; Kay Savik, MS; Timothy P. Whelan, MD; Jordan M. Dunitz, MD; Cynthia
More informationOutline. Outline. Definition. Asthma, GERD and Laryngeal Pharyngeal Reflux (LPR) Definitions
Asthma, GERD and Laryngeal Pharyngeal Reflux (LPR) Richard F. Lockey, M.D. Division of Allergy and Immunology Department of Internal Medicine University of South Florida College of Medicine and James A.
More informationJames P. Kemp, MD; Margaret C. Minkwitz, PhD; Catherine M. Bonuccelli, MD; and Marshelle S. Warren, MD
Therapeutic Effect of Zafirlukast as Monotherapy in Steroid-Naive Patients With Severe Persistent Asthma* James P. Kemp, MD; Margaret C. Minkwitz, PhD; Catherine M. Bonuccelli, MD; and Marshelle S. Warren,
More informationBudesonide treatment of moderate and severe asthma in children: A doseresponse
Budesonide treatment of moderate and severe asthma in children: A doseresponse study Soren Pedersen, MD, PhD, and Ove Ramsgaard Hansen, MD Kolding, Denmark Objective: The purpose of the study was to evaluate
More informationLife-long asthma and its relationship to COPD. Stephen T Holgate School of Medicine University of Southampton
Life-long asthma and its relationship to COPD Stephen T Holgate School of Medicine University of Southampton Definitions COPD is a preventable and treatable disease with some significant extrapulmonary
More informationReview article: gastric acidity ) comparison of esomeprazole with other proton pump inhibitors
Aliment Pharmacol Ther 2003; 17 (Suppl. 1): 10 15. Review article: gastric acidity ) comparison of esomeprazole with other proton pump inhibitors J. G. HATLEBAKK Department of Medicine, Haukeland Sykehus,
More informationIntragastric acidity during treatment with esomeprazole 40 mg twice daily or pantoprazole 40 mg twice daily a randomized, two-way crossover study
Aliment Pharmacol Ther 2005; 21: 963 967. doi: 10.1111/j.1365-2036.2005.02432.x Intragastric acidity during treatment with esomeprazole 40 mg twice daily or pantoprazole 40 mg twice daily a randomized,
More informationHigh Prevalence of Gastroesophageal Reflux Disease with Minimal Mucosal Change in Asthmatic Patients
Tohoku J. Exp. Med., 2006, Minimal 209, Mucosal 329-336Esophageal Change in Asthmatic Patients 329 High Prevalence of Gastroesophageal Reflux Disease with Minimal Mucosal Change in Asthmatic Patients YASUO
More informationINFLUENCE OF ANTISECRETORY THERAPY ON THE COURSE OF BRONCHIAL
INFLUENCE OF ANTISECRETORY THERAPY ON THE COURSE OF BRONCHIAL ASTHMA COMBINED WITH GASTROESOPHAGEAL REFLUX DISEASE Z. Z. Saatov, E. H. Dusmuhamedova, G. N. Sobirova Republican specialized scientific and
More informationPrevalence of Gastroesophageal Reflux Disease in Patients With Nontuberculous Mycobacterial Lung Disease*
Original Research MYCOBACTERIAL DISEASE Prevalence of Gastroesophageal Reflux Disease in Patients With Nontuberculous Mycobacterial Lung Disease* Won-Jung Koh, MD; Jun Haeng Lee, MD; Yong Soo Kwon, MD;
More informationMany patients with gastroesophageal reflux
... HEALTH ECONOMICS... Efficacy and Cost Effectiveness of Lansoprazole Versus Omeprazole in Maintenance Treatment of Symptomatic Gastroesophageal Reflux Disease Eva Vivian, PharmD; Anthony Morreale, PharmD,
More informationJournal of the COPD Foundation
221 Azithromycin in COPD and GERD Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation Original Research Azithromycin and COPD Exacerbations in the Presence or Absence of Symptoms or
More informationDual-Controller Asthma Therapy: Rationale and Clinical Benefits
B/1 Dual-Controller Asthma Therapy: Rationale and Clinical Benefits MODULE B The 1997 National Heart, Lung, and Blood Institute (NHLBI) Expert Panel guidelines on asthma management recommend a 4-step approach
More informationMeenu Singh, Joseph L. Mathew, Prabhjot Malhi, B.R. Srinivas and Lata Kumar
Comparison of Improvement in Quality of Life Score with Objective Parameters of Pulmonary Function in Indian Asthmatic Children Receiving Inhaled Corticosteroid Therapy Meenu Singh, Joseph L. Mathew, Prabhjot
More informationTORCH: Salmeterol and Fluticasone Propionate and Survival in COPD
TORCH: and Propionate and Survival in COPD April 19, 2007 Justin Lee Pharmacy Resident University Health Network Outline Overview of COPD Pathophysiology Pharmacological Treatment Overview of the TORCH
More informationDiagnosis and Management of Asthma in Children based on the British Thoracic Society and Scottish Intercollegiate Guidelines Network September 2016
Diagnosis and Management of Asthma in Children based on the British Thoracic Society and Scottish Intercollegiate Guidelines Network September 2016 Diagnosis: There is no lower limit to the age at which
More informationSpontaneous Gastroesophageal Reflux and Airway Patency during the Night in Adult Asthmatics
Spontaneous Gastroesophageal Reflux and Airway Patency during the Night in Adult Asthmatics GIUSEPPINA CUTTITTA, FABIO CIBELLA, ALFREDO VISCONTI, NICOLA SCICHILONE, VINCENZO BELLIA, and GIOVANNI BONSIGNORE
More informationUniversity of Groningen. Transdermal delivery of anticholinergic bronchodilators Bosman, Ingrid Jolanda
University of Groningen Transdermal delivery of anticholinergic bronchodilators Bosman, Ingrid Jolanda IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to
More informationTreatment of acute asthmatic exacerbations with an increased dose of inhaled steroid
12 Paediatrics and Child Health, Dunedin School of Medicine, PO Box 913, University of Otago Medical School, Dunedin, New Zealand J Garrett Preventive and Social Medicine, Dunedin School of Medicine S
More informationASTHMA RESOURCE PACK Section 3. Chronic Cough Guidelines
ASTHMA RESOURCE PACK Section 3 Chronic Cough Guidelines NHS Fife Guidelines for the Management of Chronic Cough in Adults In this section: 1. Introduction 2. Scope Guidelines for Management of Chronic
More informationAsthma: Chronic Management. Yung-Yang Liu, MD Attending physician, Chest Department Taipei Veterans General Hospital April 26, 2015
Asthma: Chronic Management Yung-Yang Liu, MD Attending physician, Chest Department Taipei Veterans General Hospital April 26, 2015 Global Strategy for Asthma Management and Prevention Evidence-based Implementation
More informationA Proton Pump Inhibitor, Lansoprazole, Ameliorates Asthma Symptoms in Asthmatic Patients with Gastroesophageal Reflux Disease
Tohoku J. Exp. Med., Proton 2006, Pump 209, Inhibitor, 181-189 Lansoprazole, in Asthma Symptoms with GERD 181 A Proton Pump Inhibitor, Lansoprazole, Ameliorates Asthma Symptoms in Asthmatic Patients with
More informationClinical effectiveness of a new antacid chewing gum on heartburn and oesophageal ph control
Aliment Pharmacol Ther 2002; 16: 2029 2035. doi:10.1046/j.0269-2813.2002.01380.x Clinical effectiveness of a new antacid chewing gum on heartburn and oesophageal ph control K. L. COLLINGS*, S. RODRIGUEZ-STANLEY*,
More informationNature and Science, 2009;7(5), ISSN ,
Study of Gastro Esophageal Reflux Disease in COD atients Adel M.Khattab*, Khaled Z. El-Karmouty**,Tamer M. Aly*, Asmaa H. Abdel Azeem* *Chest Department, Faculty of Medicine, Ain Shams University **Internal
More informationExercise-Induced Asthma
Digestive Diseases and Sciences. Vol. 41, No. 5 (May 1996). pp. 921-925 Exercise-Induced Asthma Is Gastroesophageal Reflux a Factor? RICHARD A. WRIGHT, MD, MICHAEL A. SAGATELIAN, MD, MICHAEL E. SIMONS,
More informationAssociation of gastro esophageal reflex with chronic asthma and its significance: a prospective study
International Journal of Contemporary Pediatrics http://www.ijpediatrics.com pissn 2349-3283 eissn 2349-3291 Original Research Article DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20173795 Association
More informationThe Asthma Guidelines: Diagnosis and Assessment of Asthma
The Asthma Guidelines: Diagnosis and Assessment of Asthma Christopher H. Fanta, M.D. Partners Asthma Center Brigham and Women s Hospital Harvard Medical School Objectives Know how the diagnosis of asthma
More informationOutline FEF Reduced FEF25-75 in asthma. What does it mean and what are the clinical implications?
Reduced FEF25-75 in asthma. What does it mean and what are the clinical implications? Fernando Holguin MD MPH Director, Asthma Clinical & Research Program Center for lungs and Breathing University of Colorado
More informationCorporate Medical Policy
Corporate Medical Policy File Name: Origination: Last CAP Review: Next CAP Review: Last Review: esophageal_ph_monitoring 4/2011 5/2017 5/2018 5/2017 Description of Procedure or Service Acid reflux is the
More informationDR REBECCA THOMAS CONSULTANT RESPIRATORY PHYSICIAN YORK DISTRICT HOSPITAL
DR REBECCA THOMAS CONSULTANT RESPIRATORY PHYSICIAN YORK DISTRICT HOSPITAL Definition Guidelines contact complicated definitions Central to this is Presence of symptoms Variable airflow obstruction Diagnosis
More informationLansoprazole Treatment of Patients With Chronic Idiopathic Laryngitis: A Placebo-Controlled Trial
THE AMERICAN JOURNAL OF GASTROENTEROLOGY Vol. 96, No. 4, 2001 2001 by Am. Coll. of Gastroenterology ISSN 0002-9270/01/$20.00 Published by Elsevier Science Inc. PII S0002-9270(01)02244-4 Lansoprazole Treatment
More informationThis is a cross-sectional analysis of the National Health and Nutrition Examination
SUPPLEMENTAL METHODS Study Design and Setting This is a cross-sectional analysis of the National Health and Nutrition Examination Survey (NHANES) data 2007-2008, 2009-2010, and 2011-2012. The NHANES is
More informationSUMMARY THIS IS A PRINTED COPY OF AN ELECTRONIC DOCUMENT. PLEASE CHECK ITS VALIDITY BEFORE USE.
i SUMMARY ZENECA PHARMACEUTICALS FINISHED PRODUCT: ACTIVE INGREDIENT: ACCOLATE zafirlukast (ZD9188) Trial title (number): A Dose-ranging, Safety and Efficacy Trial with Zafirlukast (ACCOLATE ) in the Treatment
More informationAccuracy of Parental and Child s Reports of Changes in Symptoms of Childhood Asthma
7. Cecka JM, Gjertson DW, Terasaki PI. Pediatric renal transplantation - a review of the UNOS data. Pediatr Transplant 1997; 1: 55-64. 8. Alexander SR. Pediatric end stage renal disease. Am J Kidney Dis
More informationAsthma Management for the Athlete
Asthma Management for the Athlete Khanh Lai, MD Assistant Professor Division of Pediatric Pulmonary and Sleep Medicine University of Utah School of Medicine 2 nd Annual Sports Medicine Symposium: The Pediatric
More informationStudy No.: Title: Rationale: Phase: Study Period: Study Design: Centres: Indication: Treatment: Objectives: Primary Outcome/Efficacy Variable:
The study listed may include approved and non-approved uses, formulations or treatment regimens. The results reported in any single study may not reflect the overall results obtained on studies of a product.
More informationCauses and Clinical Features of Subacute Cough*
Original Research COUGH Causes and Clinical Features of Subacute Cough* Nam-Hee Kwon, MD; Mi-Jung Oh, MD; Tae-Hoon Min, MD; Byung-Jae Lee, MD, PhD; and Dong-Chull Choi, MD, PhD Study objectives: Cough
More informationFour-Day Bravo ph Capsule Monitoring With and Without Proton Pump Inhibitor Therapy
CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2005;3:1083 1088 Four-Day Bravo ph Capsule Monitoring With and Without Proton Pump Inhibitor Therapy IKUO HIRANO, QING ZHANG, JOHN E. PANDOLFINO, and PETER J. KAHRILAS
More informationASTHMA-COPD OVERLAP SYNDROME 2018: What s All the Fuss?
ASTHMA-COPD OVERLAP SYNDROME 2018: What s All the Fuss? Randall W. Brown, MD MPH AE-C Association of Asthma Educators Annual Conference July 20, 2018 Phoenix, Arizona FACULTY/DISCLOSURES Randall Brown,
More informationGastroesophageal reflux disease (GERD) Extraesophageal symptoms of GERD
Extraesophageal symptoms of GERD KENNETH R. DEVAULT, MD ABSTRACT Gastroesophageal reflux disease (GERD) can be the primary cause of, or an aggravating contributor to, a wide variety of conditions affecting
More informationStudy No.: Title: Rationale: Phase: Study Period: Study Design: Centres: Indication: Treatment: Objectives: Primary Outcome/Efficacy Variable:
The study listed may include approved and non-approved uses, formulations or treatment regimens. The results reported in any single study may not reflect the overall results obtained on studies of a product.
More informationNG80. Asthma: diagnosis, monitoring and chronic asthma management (NG80)
Asthma: diagnosis, monitoring and chronic asthma management (NG80) NG80 NICE has checked the use of its content in this product and the sponsor has had no influence on the content of this booklet. NICE
More informationORIGINAL ARTICLES ALIMENTARY TRACT. Bravo Catheter-Free ph Monitoring: Normal Values, Concordance, Optimal Diagnostic Thresholds, and Accuracy
CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2009;7:60 67 ORIGINAL ARTICLES ALIMENTARY TRACT Bravo Catheter-Free ph Monitoring: Normal Values, Concordance, Optimal Diagnostic Thresholds, and Accuracy SHAHIN
More information4/24/2015. History of Reflux Surgery. Recent Innovations in the Surgical Treatment of Reflux
Recent Innovations in the Surgical Treatment of Reflux Scott Carpenter, DO, FACOS, FACS Mercy Hospital Ardmore Ardmore, OK History of Reflux Surgery - 18 th century- first use of term heartburn - 1934-
More informationDual-controller therapy, or combinations REVIEW DUAL-CONTROLLER REGIMENS I: DATA FROM RANDOMIZED, CONTROLLED CLINICAL TRIALS.
DUAL-CONTROLLER REGIMENS I: DATA FROM RANDOMIZED, CONTROLLED CLINICAL TRIALS Samy Suissa, PhD ABSTRACT Dual-controller therapy, or combinations of 2 or more pharmacotherapies with complementary mechanisms
More informationFamotidine Extended Abstracts
Famotidine Extended Abstracts I) Primary literature Summary Ciccone, Decktor, et. al. Efficacy and tolerability of famotidine in preventing heartburn and related symptoms of upper gastrointestinal discomfort.
More informationRESPIRATORY CARE IN GENERAL PRACTICE
RESPIRATORY CARE IN GENERAL PRACTICE Definitions of Asthma and COPD Asthma is due to inflammation of the air passages in the lungs and affects the sensitivity of the nerve endings in the airways so they
More informationBronchial asthma. E. Cserháti 1 st Department of Paediatrics. Lecture for english speaking students 5 February 2013
Bronchial asthma E. Cserháti 1 st Department of Paediatrics Lecture for english speaking students 5 February 2013 Epidemiology of childhood bronchial asthma Worldwide prevalence of 7-8 and 13-14 years
More informationTurning Science into Real Life Roflumilast in Clinical Practice. Roland Buhl Pulmonary Department Mainz University Hospital
Turning Science into Real Life Roflumilast in Clinical Practice Roland Buhl Pulmonary Department Mainz University Hospital Therapy at each stage of COPD I: Mild II: Moderate III: Severe IV: Very severe
More informationCOPD. Breathing Made Easier
COPD Breathing Made Easier Catherine E. Cooke, PharmD, BCPS, PAHM Independent Consultant, PosiHleath Clinical Associate Professor, University of Maryland School of Pharmacy This program has been brought
More informationAbstract Background Theophylline is widely used in the treatment of asthma, and there is evidence that theophylline has antiinflammatory
Thorax 2000;55:837 841 837 National Heart and Lung Institute, Imperial College School of Medicine and Royal Brompton Hospital, London SW3 6LY, UK S Lim A Jatakanon K F Chung P J Barnes Napp Laboratories
More informationComparison of the Effect of Short Course of Oral Prednisone in Patients with Acute Asthma
ISPUB.COM The Internet Journal of Pulmonary Medicine Volume 7 Number 1 Comparison of the Effect of Short Course of Oral Prednisone in Patients with Acute Asthma E Razi, G Moosavi Citation E Razi, G Moosavi.
More informationORIGINAL ARTICLE. Factors Affecting Esophageal Motility in Gastroesophageal Reflux Disease
ORIGINAL ARTICLE Factors Affecting Esophageal Motility in Gastroesophageal Reflux Disease Emmanuel Chrysos, MD; George Prokopakis, MD; Elias Athanasakis, MD; George Pechlivanides, MD; John Tsiaoussis,
More informationTreatment Responses. Ronald Dahl, Aarhus University Hospital, Denmark
Asthma and COPD: Are They a Spectrum Treatment Responses Ronald Dahl, Aarhus University Hospital, Denmark Pharmacological Treatments Bronchodilators Inhaled short-acting β -Agonist (rescue) Inhaled short-acting
More informationOn the relationship between gastric ph and pressure
Gut, 1979, 20, 59-63 On the relationship between gastric ph and pressure in the normal human lower oesophageal sphincter M. D. KAYE1 From the Gastroenterology Unit, Department of Medicine, University of
More informationoesophageal sphincter pressure in man
Gut, 1987, 28, 1564-1568 Effect of the diaphragmatic contraction on lower oesophageal sphincter pressure in man R K MITTAL, D F ROCHESTER, AND R W McCALLUM From the Department of Internal Medicine, University
More informationAsthma and COPD in older people lumping or splitting? Christine Jenkins Concord Hospital Woolcock Institute of Medical Research
Asthma and COPD in older people lumping or splitting? Christine Jenkins Concord Hospital Woolcock Institute of Medical Research Concord Hospital Woolcock Institute of Medical Research Joe has asthma What
More informationCough: Make It Easy. Kreetha Thammakumpee Respiratory and Respiratory Critical Care Medicine Faculty of Medicine, Prince of Songkla University
Cough: Make It Easy Kreetha Thammakumpee Respiratory and Respiratory Critical Care Medicine Faculty of Medicine, Prince of Songkla University Cough: definition Acute < 3 wk Subacute 3-8 wk Chronic cough
More informationClearance mechanisms of the aperistaltic esophagus. The pump-gun hypothesis.
Gut Online First, published on December 14, 2005 as 10.1136/gut.2005.085423 Clearance mechanisms of the aperistaltic esophagus. The pump-gun hypothesis. Radu Tutuian 1, Daniel Pohl 1, Donald O Castell
More informationBaclofen decreases acid and non-acid post-prandial gastro-oesophageal reflux measured by combined multichannel intraluminal impedance and ph
Aliment Pharmacol Ther 23; 17: 243 21. doi: 1.146/j.136-236.23.1394.x decreases acid and non-acid post-prandial gastro-oesophageal reflux measured by combined multichannel intraluminal impedance and ph
More informationSupplementary Online Content
Supplementary Online Content Regan EA, Lynch DA, Curran-Everett D, et al; Genetic Epidemiology of COPD (COPDGene) Investigators. Clinical and radiologic disease in smokers with normal spirometry. Published
More informationRefractory GERD: What s a Gastroenterologist To Do?
Refractory GERD: What s a Gastroenterologist To Do? Philip O. Katz, MD, FACG Chairman, Division of Gastroenterology Einstein Medical Center Clinical Professor of Medicine Jefferson Medical College Philadelphia,
More informationAlimentary Pharmacology & Therapeutics SUMMARY
Alimentary Pharmacology & Therapeutics Comparison of the effects of immediate-release omeprazole oral suspension, delayed-release lansoprazole capsules and delayedrelease esomeprazole capsules on nocturnal
More informationC ough variant asthma, gastro-oesophageal reflux associated
14 ASTHMA Comparison of atopic cough with cough variant asthma: is atopic cough a precursor of asthma? M Fujimura, H Ogawa, Y Nishizawa, K Nishi... See end of article for authors affiliations... Correspondence
More informationReflux patterns and related oesophageal motor activity in gastro-oesophageal reflux disease
Gut, 199,31,633-638 633 ALIMNTARY TRACT Reflux patterns and related oesophageal motor activity in gastro-oesophageal reflux disease S Kruse-Andersen, L Wallin, T Madsen Abstract Simultaneous intraoesophageal
More informationGuideline topic: Pharmacological management of asthma Evidence table 4.11b: Add-on drugs for inhaled steroids: Long acting or oral B2 agonists
1 of 8 09/05/2018, 11:41 Guideline topic: Pharmacological management of asthma Evidence table 4.11b: Add-on drugs for steroids: Long acting or oral B2 agonists Author Year Study type Quality rating Population
More informationPutting Chronic Heartburn On Ice
Putting Chronic Heartburn On Ice Over the years, gastroesophageal reflux disease has proven to be one of the most common complaints facing family physicians. With quicker diagnosis, this pesky ailment
More informationStudy No.: Title: Rationale: Phase: Study Period: Study Design: Centres: Indication: Treatment: Objectives: Primary Outcome/Efficacy Variable:
The study listed may include approved and non-approved uses, formulations or treatment regimens. The results reported in any single study may not reflect the overall results obtained on studies of a product.
More informationGERD DIAGNOSIS & TREATMENT DISCLOSURES 4/18/2018
GERD DIAGNOSIS & TREATMENT Subhash Chandra MBBS Assistant Professor CHI Health Clinic Gastroenterology Creighton University, School of Medicine April 28, 2018 DISCLOSURES None 1 OBJECTIVES Review update
More informationG. Boyd on behalf of a UK Study group
Eur Respir J, 1995, 8, 1494 1498 DOI: 10.1183/09031936.95.08091494 Printed in UK - all rights reserved Copyright ERS Journals Ltd 1995 European Respiratory Journal ISSN 0903-1936 Salmeterol xinafoate in
More informationPepsin in bronchoalveolar lavage fluid: a specific and sensitive method of diagnosing gastro-oesophageal reflux related pulmonary aspiration
Journal of Pediatric Surgery (2006) 41, 289 293 www.elsevier.com/locate/jpedsurg BAPS Prize Pepsin in bronchoalveolar lavage fluid: a specific and sensitive method of diagnosing gastro-oesophageal reflux
More informationFVC to Slow Inspiratory Vital Capacity Ratio* A Potential Marker for Small Airways Obstruction
Original Research PSYCHOLOGICAL TESTING FVC to Slow Inspiratory Vital Capacity Ratio* A Potential Marker for Small Airways Obstruction Judith Cohen, MD; Dirkje S. Postma, MD, PhD; Karin Vink-Klooster;
More informationA comparison of global questions versus health status questionnaires as measures of the severity and impact of asthma
Eur Respir J 1999; 1: 591±596 Printed in UK ± all rights reserved Copyright #ERS Journals Ltd 1999 European Respiratory Journal ISSN 93-1936 A comparison of global questions versus health status questionnaires
More information