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Lupu VV, Stefanescu G, Buga AML, Forna L, Tarca E, Starcea IM, Mihai CM, Florescu L, Cernomaz AT, Mocanu A, Tarca V, Thet AA, Lupu A. Is There a Potential Link between Gastroesophageal Reflux Disease and Recurrent Respiratory Tract Infections in Children? Diagnostics (Basel) 2023; 13:2310. [PMID: 37443704 DOI: 10.3390/diagnostics13132310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 06/28/2023] [Accepted: 07/04/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND The implications of gastroesophageal reflux disease in respiratory tract infections have been investigated over time. The aim of our study was to evaluate the relationship between these two pathologic entities and the outcome after proper antireflux treatment. METHODS A group of 53 children with recurrent respiratory tract infections admitted in the gastroenterology clinic of a children's hospital in North-East Romania was investigated for gastroesophageal reflux disease through 24 h pH-metry. Those with a Boix-Ochoa score higher than 11.99 received proton pump inhibitor treatment and were reevaluated after 2 months. RESULTS A total of 41 children were found with a positive Boix-Ochoa score. After 2 months of antireflux therapy, eight patients still had a positive Boix-Ochoa score. CONCLUSIONS Recurrent respiratory tract infections with symptoms resistant to treatment should be considered a reason to investigate for gastroesophageal reflux, because the symptoms may be due to micro- or macro-aspiration of the gastric refluxate or to an esophageal-bronchial reflex mediated through the vagal nerve.
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Affiliation(s)
- Vasile Valeriu Lupu
- Pediatrics, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Gabriela Stefanescu
- Gastroenterology, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Ana Maria Laura Buga
- Pediatrics, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Lorenza Forna
- Pediatrics, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Elena Tarca
- Department of Surgery II-Pediatric Surgery, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | | | - Cristina Maria Mihai
- Pediatrics, Faculty of General Medicine, Ovidius University, 900470 Constanta, Romania
| | - Laura Florescu
- Mother and Child Medicine Department, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Andrei Tudor Cernomaz
- 3rd Medical Department, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Adriana Mocanu
- Pediatrics, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Viorel Tarca
- Department of Preventive Medicine and Interdisciplinarity, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Aye Aung Thet
- Faculty of General Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Ancuta Lupu
- Pediatrics, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
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Paker M, Duek I, Awwad F, Benyamini L, Meshyeev T, Gil Z, Cohen JT. Long-term swallowing performance following transoral robotic surgery for obstructive sleep apnea. Laryngoscope 2018; 129:422-428. [PMID: 30443909 DOI: 10.1002/lary.27364] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2018] [Indexed: 12/16/2022]
Abstract
OBJECTIVES/HYPOTHESIS This study aimed to evaluate the long-term swallowing performance following transoral robotic surgery (TORS) to the base of tongue (BOT) in the treatment of obstructive sleep apnea (OSA). STUDY DESIGN Retrospective and prospective cohort study. METHODS Data analysis of 39 patients who underwent BOT reduction via TORS to treat OSA at our center from September 2013 to April 2016. Long-term swallowing functions were assessed using subjective self-evaluated swallowing disturbances questionnaire (SDQ) and objective fiberoptic endoscopic evaluation of swallowing (FEES). RESULTS Seven patients underwent TORS BOT reduction alone, whereas 32 had also uvulopalatoplasty ± tonsillectomy, with a surgical success rate of 71.4%. Mean time for swallowing evaluation was 27.4 ± 9.43 months. Twenty-five patients completed the SDQ with an average score of 9.26 ± 10.05. In 32%, the SDQ was positive for dysphagia. In 10 out of 14 patients who underwent FEES, swallowing problems were noticed. The most common pathological findings were food residue in the vallecula followed by early spillage of food into the hypopharynx, penetration of solid food and liquid on the vocal folds surface, and aspiration. CONCLUSIONS BOT reduction via TORS has a negative effect on long-term swallowing function. A self-assessment questionnaire can help detect patients who suffer from swallowing impairment. Postoperative objective swallowing tests are essential not only in the immediate postoperative period but also during late routine follow-up. Proper patient selection and detailed information about surgery and possible late-swallowing effect are important factors before scheduling BOT reduction via TORS for OSA treatment. LEVEL OF EVIDENCE 4 Laryngoscope, 129:422-428, 2019.
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Affiliation(s)
- Miki Paker
- Department of Otolaryngology-Head and Neck Surgery, Head and Neck Center, Rambam Health Care Campus, Haifa, Israel
| | - Irit Duek
- Department of Otolaryngology-Head and Neck Surgery, Head and Neck Center, Rambam Health Care Campus, Haifa, Israel.,the Rappaport Institute of Medicine and Research, Technion-Israel Institute of Technology, Haifa, Israel
| | - Faten Awwad
- Department of Otolaryngology-Head and Neck Surgery, Head and Neck Center, Rambam Health Care Campus, Haifa, Israel
| | - Limor Benyamini
- Department of Otolaryngology-Head and Neck Surgery, Head and Neck Center, Rambam Health Care Campus, Haifa, Israel.,the Rappaport Institute of Medicine and Research, Technion-Israel Institute of Technology, Haifa, Israel
| | - Tsipi Meshyeev
- Department of Otolaryngology-Head and Neck Surgery, Head and Neck Center, Rambam Health Care Campus, Haifa, Israel
| | - Ziv Gil
- Department of Otolaryngology-Head and Neck Surgery, Head and Neck Center, Rambam Health Care Campus, Haifa, Israel.,the Rappaport Institute of Medicine and Research, Technion-Israel Institute of Technology, Haifa, Israel
| | - Jacob T Cohen
- Department of Otolaryngology-Head and Neck Surgery, Head and Neck Center, Rambam Health Care Campus, Haifa, Israel.,the Rappaport Institute of Medicine and Research, Technion-Israel Institute of Technology, Haifa, Israel
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Wilson AM, Nair P, Hargreave FE, Efthimiadis AE, Anvari M, Allen CJ. Lipid and smoker's inclusions in sputum macrophages in patients with airway diseases. Respir Med 2011; 105:1691-5. [PMID: 21831624 DOI: 10.1016/j.rmed.2011.07.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2011] [Revised: 05/22/2011] [Accepted: 07/20/2011] [Indexed: 11/25/2022]
Abstract
We studied the effect of tobacco smoking on macrophage lipid index and macrophage smokers inclusions in induced sputum in 256 patients (143 non-smokers, 81 ex-smokers and 32 current smokers). Lipid index was, using the Oil red O stain, the sum of the lipid staining droplet score (range 0-4) in 100 macrophages. Smokers inclusions were assessed using Wright's stain and graded as "none", "few", "moderate" or "many". Lipid index was significantly higher in current smokers (112.5, SD 58.5 units) than ex-smokers (29.2, SD 42.8 units) or non-smokers (13.4, SD 121.7). Smokers inclusions were present in all current smokers but only in 2 non-smokers. The mean smoking history of current smokers with few macrophage inclusions was 15.0 (SD 11.2), moderate 21.6 (SD 15.7), and many 30.0 (SD 21.9) pack years. There was a significant difference between the length of time ex-smokers had quit smoking if they had no or few smokers inclusions (mean 17.6 (SD 11.2) years) compared to those with moderate or many smokers inclusions (mean 2.8 (SD 5.8) years) (p = 0.01). Lipid index was significantly correlated with smokers inclusions (r = 0.72, p < 0.01). We conclude that smoker's inclusions within sputum macrophages is a reliable indicator of cigarette smoking and that the sputum lipid index cannot be used as an assessment of oropharyngeal reflux in cigarette smokers.
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Affiliation(s)
- Andrew M Wilson
- Firestone Institute for Respiratory Health, St Joseph's Healthcare and Department of Medicine, McMaster University, 50 Charlton Avenue East, Hamilton, Ontario, Canada L8N 4A6
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Cohen JT, Manor Y. Swallowing disturbance questionnaire for detecting dysphagia. Laryngoscope 2011; 121:1383-7. [PMID: 21671239 DOI: 10.1002/lary.21839] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Accepted: 01/11/2011] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To assess the accuracy of the swallowing disturbance questionnaire (SDQ) that had originally been designed and validated for detecting swallowing problems among patients with Parkinson's disease and was now applied for identifying patients with dysphagia associated with various other etiologies. STUDY DESIGN Prospective. METHODS One-hundred patients with the complaint of swallowing disturbances who underwent a full swallowing survey at the Tel-Aviv Voice and Swallowing Disorder Clinic participated. They all filled in the SDQ. The collected data included patient characteristics, medical history, and the results of an oromotor examination and a fiberoptic endoscopic evaluation of swallowing (FEES). The SDQ results were compared to the FEES and oromotor examination findings. RESULTS The responses to the questions in the SDQ were highly correlated with the findings of the oral part of the oromotor examination (85.71% sensitivity, 87.6% specificity). Items on the laryngopharyngeal phase reliably assessed dysphagia symptoms in correlation to the FEES examination (67.3% sensitivity, 76.7% specificity). The total SDQ score correlated with the total oromotor and the FEES scores (79.7% sensitivity, 73% specificity). CONCLUSIONS The SDQ is a sensitive and accurate tool for identifying patients with true swallowing disturbances arising from different etiologies and for indicating the need for more in-depth instrumental swallowing evaluations.
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Affiliation(s)
- Jacob T Cohen
- Voice and Swallowing Disorders Clinic, Department of Otolaryngology Head and Neck Surgery, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
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Manor Y, Giladi N, Cohen A, Fliss DM, Cohen JT. Validation of a swallowing disturbance questionnaire for detecting dysphagia in patients with Parkinson's disease. Mov Disord 2008; 22:1917-21. [PMID: 17588237 DOI: 10.1002/mds.21625] [Citation(s) in RCA: 136] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Underreporting of swallowing disturbances by Parkinson's disease (PD) patients may lead to delay in diagnosis and treatment, alerting the physician to an existing dysphagia only after the first episode of aspiration pneumonia. We developed and validated a swallowing disturbance questionnaire (SDQ) for PD patients and compared its findings to an objective assessment. Fifty-seven PD patients (mean age 69 +/- 10 years) participated in this study. Each patient was queried about experiencing swallowing disturbances and asked to complete a self-reported 15-item "yes/no" questionnaire on swallowing disturbances (24 replied "no"). All study patients underwent a physical/clinical swallowing evaluation by a speech pathologist and an otolaryngologist. The 33 patients who complained of swallowing disturbances also underwent fiberoptic endoscopyic evaluation of swallowing (FEES). According to the ROC test, the "optimal" score (where the sensitivity and specificity curves cross) is 11 (sensitivity 80.5%, specificity 81.3%). Using the SDQ questionnaire substantially reduced Type I errors (specifically, an existing swallowing problem missed by the selected cutoff point). On the basis of the SDQ assessment alone, 12 of the 24 (50%) noncomplaining patients would have been referred to further evaluation that they otherwise would not have undergone. The SDQ emerged as a validated tool to detect early dysphagia in PD patients.
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Affiliation(s)
- Yael Manor
- Department of Neurology, Movement Disorders Unit, Parkinson Center, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.
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Galmiche JP, Zerbib F, Bruley des Varannes S. Review article: respiratory manifestations of gastro-oesophageal reflux disease. Aliment Pharmacol Ther 2008; 27:449-64. [PMID: 18194498 DOI: 10.1111/j.1365-2036.2008.03611.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Respiratory manifestations represent one of the most prevalent and difficult-to-manage extra-oesophageal syndromes of gastro-oesophageal reflux disease. AIMS To review the epidemiology, pathophysiological mechanisms and therapeutic outcomes of reflux-related respiratory disorders. METHODS Search of the literature published in English using PubMed database. RESULTS There is a discrepancy between the high prevalence of reflux in asthmatics and the limited efficacy of antireflux therapies. Asthma per se may cause reflux. Patients with difficult-to-treat asthma and/or nocturnal symptoms should be screened for reflux. Reflux can induce chronic cough through different mechanisms including micro-aspiration and both local and central reflexes. Cough and reflux may precipitate each other. A meta-analysis found no significant difference between placebo and proton pump inhibitors in the resolution of cough. Encouraging results have been reported, following antireflux surgery in patients selected on the basis of pH-impedance monitoring. Attention has been drawn to obstructive sleep apnoea syndrome. CONCLUSIONS The role of gastro-oesophageal reflux disease in the pathogenesis of miscellaneous respiratory disorders has been discussed for decades and established in asthma and cough. However, no major therapeutic advances have been reported recently. Future trials should concentrate on patient selection and the control of efficacy using recently developed technologies, such as pH-impedance monitoring.
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Affiliation(s)
- J P Galmiche
- CHU Nantes, Service Hépato-Gastroentérologie, Institut des Maladies de l'Appareil Digestif and Institut National de Santé et de Recherche Médicale, Nantes, France.
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Increased Risk of Graft Failure in Kidney Transplant Recipients After a Diagnosis of Dyspepsia or Gastroesophageal Reflux Disease. Transplantation 2008; 85:344-52. [DOI: 10.1097/tp.0b013e318160d4c4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Patwari AK, Bajaj P, Kashyp R, Anand VK, Gangil A, Jain A, Kapoor G. Diagnostic modalities for gastroesophageal reflux. Indian J Pediatr 2002; 69:133-6. [PMID: 11929028 DOI: 10.1007/bf02859372] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To evaluate commonly utilized diagnostic modalities to detecting Gastroesophageal Reflux (GER). METHODS Sixty children aged 1-72 months (mean age 14.7 months) with symptoms suggestive of Gastroesosphageal Reflux (GER) were investigated and subjected to upper gastrointestinal endoscopy and esophageal biopsy (EB), gastroesophageal scintiscanning (GS) and 24 hour ambulatory pH monitoring. RESULT GER was detected in 28 (46.7%) cases by one or more diagnostic modalities. Ambulatory 24 hour pH monitoring was positive in higher proportion (43.3%) of cases in comparison to other modalities, followed by EB (38.3%) and GS (30%). Considering 24 hour pH monitoring as the gold standard, esophageal biopsy was positive in 22/26 cases (84.6%) detected by 24 hour pH monitoring with a specificity of 97.1% as compared to 17/26 cases (65.4%) by gastroesophageal scintiscanning with a specificity of 97.1%. When compared with EB results, amongst various parameters measured during 24 hour pH monitoring, Reflux index (RI) ranked highest (sensitivity 95.6 % and specificity 89.2 %) followed by duration of longest episode > 20 minutes and Euler Byrne score. Oscillatory index, calculated from tracings of pH monitoring, even though ranked lower because of its low sensitivity helped to pick up 2 cases missed by EB and RI. CONCLUSION Our results suggest that a combination of diagnostic modalities may be required to diagnose GER in young children. Ambulatory 24 hour pH monitoring appears to be the single best investigation and combining it with EB and/or GS can help to detect maximum number of cases.
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Affiliation(s)
- A K Patwari
- Department of Pediatrics LHMC and Associated Kalawati Saran Children's Hospital, New Delhi, India.
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Abstract
Because of the common nature of asthma and the attention this disease has been given in recent years, it is important to consider the possibility of other disorders that may present in a similar manner to asthma. Failure to consider alternative diagnoses often leads to inappropriate treatment with medications such as systemic corticosteroids that result in untoward morbidity. This review will discuss several diseases originating not only in the tracheobronchial tree but also in extrapulmonary sites, such as the gastrointestinal tract, that may be mistakenly diagnosed as asthma. Newly described entities such as irritant vocal cord dysfunction and exercise-induced hyperventilation syndrome are discussed in this article, as is new information pertaining to well-established diseases such as Churg-Strauss syndrome and sarcoidosis.
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Affiliation(s)
- B J Goldberg
- Department of Allergy and Clinical Immunology, Kaiser-Permanente Medical Center, Los Angeles, CA 90027, USA
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Abstract
BACKGROUND Occupational asthma (OA), is an important clinical condition with substantial morbidity and associated costs. Since the original description of OA we have learned a great deal about the natural history. The prognosis of OA is determined by many factors. These factors and confounding variables in the presentation of OA will be presented. RESULTS A review of the available literature indicates that OA may have complete resolution or may persist for years following its initial presentation. CONCLUSION The importance of timely removal or adequate respiratory protection from potential sources of OA is highlighted.
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Affiliation(s)
- A Montanaro
- Division of Allergy and Clinical Immunology, Oregon Health Sciences University, Portland 97201, USA
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