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Van der Wall H, Burton L, Cooke M, Falk GL, Tovmassian D, Conway JJ. Scintigraphic Imaging of Extra-Esophageal Manifestation of Gastresophageal Reflux Disease. Laryngoscope 2024. [PMID: 39210662 DOI: 10.1002/lary.31748] [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: 06/25/2024] [Revised: 08/16/2024] [Accepted: 08/22/2024] [Indexed: 09/04/2024]
Abstract
OBJECTIVES There is currently no reference standard test for the detection of the extra-esophageal manifestations of gastroesophageal reflux disease (GERD). The current suite of diagnostic tests principally assesses reflux events in the esophagus. A new scintigraphic technique has been developed and validated against reference standards. It allows direct visualization of refluxate in the laryngopharynx and lungs. METHODS Fifty patients were assessed by scintigraphy before and after fundoplication at a single nuclear medicine facility. Standardized reflux symptom indices (RSIs) were obtained from each patient before and after surgery. Patients were scanned after oral 99 m technetium Fyton administration with early dynamic images and delayed SPECT/CT images of the head, neck, and lungs. ANOVA, Spearman correlation, and the Student's t-test were utilized for analysis. RESULTS The study population (35F, 15 M) had a mean age of 63.9 years. Mean BMI was 26.8 with 67% being overweight or obese. All patients had significant reflux. SPECT/CT showed LPR events in 45/50 and pulmonary micro-aspiration (PMA) in 45/50 preoperatively and in 36/50 and 20/50 postoperatively, respectively. The RSI, cough, and throat clearing indices showed a significant fall postoperatively (p < 0.001). Frequency of scintigraphic reflux events was reduced from a mean of 4.5 in 30 min to 2.9 (t = 9.1, p = 0.004). CONCLUSION The novel scintigraphic test detects esophageal and extra-esophageal reflux events and permits direct visualization of refluxate in the head and neck structures and lungs. It correlates well with symptoms of reflux in the esophagus and extra-esophageal structures and the response to therapy. LEVEL OF EVIDENCE Although prospective, the study did not randomize patients and in effect each patient became their own control following an intervention (fundoplication). Thus, the study is Level 3 evidence Laryngoscope, 2024.
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Affiliation(s)
- Hans Van der Wall
- CNI Molecular Imaging & Notre Dame University, Sydney, New South Wales, Australia
| | - Leticia Burton
- CNI Molecular Imaging & Notre Dame University, Sydney, New South Wales, Australia
| | - Michelle Cooke
- CNI Molecular Imaging, Sydney, New South Wales, Australia
| | - Gregory L Falk
- Concord Hospital & University of Sydney, Sydney, New South Wales, Australia
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Presence of pepsin in laryngeal tissue and saliva in benign and malignant neoplasms. Biosci Rep 2021; 40:226780. [PMID: 33103719 PMCID: PMC7670575 DOI: 10.1042/bsr20200216] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 10/08/2020] [Accepted: 10/23/2020] [Indexed: 12/15/2022] Open
Abstract
Objectives: The current study was performed to determine the presence of pepsin in saliva and laryngeal tissue among participants with benign and malignant laryngeal neoplasms. Study design: Case–control study included three groups of patients with: (1) benign laryngeal neoplasms, (2) malignant laryngeal neoplasms and (3) control subjects without symptoms or signs of laryngopharyngeal reflux (LPR). Methods: Eighty-one voluntary participants were included into study. They were recruited from a group of patients with histologically proven benign and malignant laryngeal neoplasms and in case of control subjects among patients with nasal septum deformation without symptoms of LPR. Morning saliva samples were collected preoperatively. Tumor biopsies were collected by directoscopy of larynx and the control samples from interarytenoid unit of larynx. All samples were analyzed by Enzyme-Linked Immunosorbent Assay (ELISA) and Immunohistochemistry. Results: Pepsin was found in all samples of saliva and tissue biopsies in groups with malignant and benign neoplasms. The highest concentration of pepsin was found in a group of patients with malignant laryngeal neoplasms. Patients with benign laryngeal neoplasms had lower concentrations and the control subjects presented with the lowest concentration of pepsin measured from their saliva. Differences were not statistically significant. Immunohistochemical (IHC) analysis showed the largest number of high positive samples in the group of malignant lesions. Conclusion: These results suggest that pepsin and LPR can contribute to the development of benign and malignant laryngeal neoplasms. Further prospective studies, with far more patients, are necessary to prove the role of pepsin in multifactorial etiology of laryngeal neoplasms.
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Wu W, Li L, Qu C, Wang M, Liang S, Gao X, Bao X, Wang L, Liu H, Han H, Xu B, Zhou Y, Li B, Zhang Y, Wang G, Zhong C. Reflux finding score is associated with gastroesophageal flap valve status in patients with laryngopharyngeal reflux disease: a retrospective study. Sci Rep 2019; 9:15744. [PMID: 31673091 PMCID: PMC6823359 DOI: 10.1038/s41598-019-52349-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 10/16/2019] [Indexed: 12/19/2022] Open
Abstract
Endoscopic grading of gastroesophageal flap valve (GEFV) is simple and reproducible and offers useful information for reflux activity. To investigate the potential correlation between GEFV grading and reflux finding score (RFS) in patients with laryngopharyngeal reflux disease (LPRD), 225 consecutive Patients with suspected LPRD who underwent both routine upper gastrointestinal endoscopy and laryngoscope were enrolled in our study. Patients with a RFS of more than 7 were diagnosed with LPRD. The GEFV was graded as I through IV according to Hill’s classification and was classified into two groups: normal GEFV group (grades I and II) and the abnormal GEFV group (grades III and IV). The percent of GEFV grades I to IV was 39.1%, 39.1%, 12.4%, and 9.3%, respectively. Age was significantly related to an abnormal GEFV (p = 0.002). Gender, BMI, smoke and alcohol were not related to GEFV grade. Fifty-one patients (22.67%) had positive RFS. Reflux finding scores were higher in GEFV grades III and IV than I and II (p < 0.05). Endoscopic grading of GEFV is well correlated with reflux finding score in patients with LPRD. This is a simple and useful technique that provides valuable diagnostic information of LPRD.
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Affiliation(s)
- Wei Wu
- Department of Otorhinolaryngology Head and Neck Surgery, Chinese People Liberation Army 306th Hospital, Beijing, China.,State Environmental Protection Key Laboratory of Environmental Sense Organ Stress and Health, Beijing, China
| | - Lianyong Li
- State Environmental Protection Key Laboratory of Environmental Sense Organ Stress and Health, Beijing, China.,Department of Gastroenterology, Chinese People Liberation Army 306th Hospital, Beijing, China
| | - Changmin Qu
- State Environmental Protection Key Laboratory of Environmental Sense Organ Stress and Health, Beijing, China.,Department of Gastroenterology, Chinese People Liberation Army 306th Hospital, Beijing, China
| | - Min Wang
- Department of Gastroenterology, Chinese People Liberation Army 306th Hospital, Beijing, China
| | - Shuwen Liang
- Department of Gastroenterology, Chinese People Liberation Army 306th Hospital, Beijing, China
| | - Xiaopei Gao
- Department of Gastroenterology, Chinese People Liberation Army 306th Hospital, Beijing, China
| | - Xinwei Bao
- Department of Gastroenterology, Chinese People Liberation Army 306th Hospital, Beijing, China
| | - Lei Wang
- Department of Otorhinolaryngology Head and Neck Surgery, Chinese People Liberation Army 306th Hospital, Beijing, China
| | - Hongdan Liu
- Department of Otorhinolaryngology Head and Neck Surgery, Chinese People Liberation Army 306th Hospital, Beijing, China
| | - Haolun Han
- Department of Otorhinolaryngology Head and Neck Surgery, Chinese People Liberation Army 306th Hospital, Beijing, China
| | - Bingxin Xu
- Department of Otorhinolaryngology Head and Neck Surgery, Chinese People Liberation Army 306th Hospital, Beijing, China
| | - Ying Zhou
- Department of Otorhinolaryngology Head and Neck Surgery, Chinese People Liberation Army 306th Hospital, Beijing, China
| | - Baowei Li
- Department of Otorhinolaryngology Head and Neck Surgery, Chinese People Liberation Army 306th Hospital, Beijing, China
| | - Yiyan Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, Chinese People Liberation Army 306th Hospital, Beijing, China
| | - Gang Wang
- Department of Otorhinolaryngology Head and Neck Surgery, Chinese People Liberation Army 306th Hospital, Beijing, China. .,State Environmental Protection Key Laboratory of Environmental Sense Organ Stress and Health, Beijing, China.
| | - Changqing Zhong
- Department of Gastroenterology, Chinese People Liberation Army 306th Hospital, Beijing, China.
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Mesallam TA, Baqays AA. Characteristics of upright versus supine reflux pattern in patients with laryngopharyngeal reflux. Braz J Otorhinolaryngol 2019; 87:200-204. [PMID: 31708431 PMCID: PMC9422475 DOI: 10.1016/j.bjorl.2019.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 04/07/2019] [Accepted: 08/10/2019] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION Many laryngeal-related problems have been attributed to laryngopharyngeal reflux including dysphonia, frequent throat clearing, chronic cough, and globus sensation. However, there is still controversy regarding diagnosis and clinical presentation of this disorder. OBJECTIVE The main objective of this study is to describe laryngopharyngeal reflux characteristics of different reflux position patterns in laryngopharyngeal reflux patients diagnosed with oropharyngeal pH monitoring. METHODS A retrospective chart review was conducted for 161 laryngopharyngeal reflux patients diagnosed with 24h oro-pharyngeal pH monitoring. Study subjects were categorized into upright and supine laryngopharyngeal reflux groups based on the pH results. The two groups were compared regarding the clinical presentation and pH characteristics. RESULTS Significant higher rates of upright laryngopharyngeal reflux position than supine laryngopharyngeal reflux position (P<0.0001) were reported among the study group. Reflux symptoms index results were significantly higher in the upright larybgopharyngeal reflux group compared to the supine laryngopharyngeal reflux group. 24h oropharyngeal pH measurements composite Ryan score was significantly higher in the upright group compared to the supine group (P<0.0001). No significant difference was found between the upright and supine laryngopharyngeal reflux groups regarding the frequency of clinical presentation or voice handicap index ratings. CONCLUSION Laryngopharyngeal reflux was found to be more prevalent occurring in the upright position among the study group. Reflux-related characteristics including pH parameters were more evident in the upright laryngopharyngeal reflux position.
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Affiliation(s)
- Tamer A Mesallam
- King Saud University, Department of Otolaryngology, Head and Neck Surgery, Riyadh, Saudi Arabia; King Saud University, Otolaryngology Department, Research Chair of Voice, Communication, and Swallowing Disorders, Riyadh, Saudi Arabia.
| | - Abdulsalam A Baqays
- King Saud University, Department of Otolaryngology, Head and Neck Surgery, Riyadh, Saudi Arabia
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Burton L, Falk GL, Parsons S, Cusi M, Van Der Wall H. Benchmarking of a Simple Scintigraphic Test for Gastro-oesophageal Reflux Disease That Assesses Oesophageal Disease and Its Pulmonary Complications. Mol Imaging Radionucl Ther 2018; 27:113-120. [PMID: 30317833 PMCID: PMC6191730 DOI: 10.4274/mirt.10438] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Objectives: Gastro-oesophageal reflux disease (GORD) is both common and troubling with a prevalence of 20-40%. We assessed the utility of a scintigraphic reflux study to evaluate the oesophageal and extra-oesophageal manifestation of disease compared to the standard tests such as pH monitoring and manometry. Methods: Patients were recruited into a prospective database of referrals to a tertiary referral center for either resistance to maximal medical therapy or extra-oesophageal symptoms of GORD. Data included 2 channel 24-hour pH monitoring and manometry results, as well as scintigraphic reflux data with late images assessing pulmonary aspiration of refluxate. Results: Study population included 250 patients (155 F, 95 M) with an average age of 60 years. Patients were clinically classified as either GORD (n=72) or laryngopharyngeal reflux (LPR) (n=178). Pulmonary aspiration of the refluxate was detected significantly more commonly in LPR patients (58/178 compared with GORD 10/72). Strong correlations were found between the scintigraphic time-activity curves in the upper oesophagus and pharynx, and ineffective oesophageal motility and pulmonary aspiration. pH studies correlated with the scintigraphic studies but did not predict aspiration similar to other modalities when evaluated by ROC analysis. Conclusion: Scintigraphic reflux studies offer a viable alternative test for GORD and extra-oesophageal manifestations of reflux disease. Strong correlations were found between measurable scintigraphic parameters and oesophageal motility and lung aspiration of refluxate. This may provide a more confident decision analysis in patients being considered for fundoplication for troubling extra-oesophageal symptoms.
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Affiliation(s)
| | | | | | - Mel Cusi
- University of Notre Dame, Sydney, Australia
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Anzić S, Turkalj M, Župan A, Labor M, Plavec D, Baudoin T. Eight weeks of omeprazole 20 mg significantly reduces both laryngopharyngeal reflux and comorbid chronic rhinosinusitis signs and symptoms: Randomised, double-blind, placebo-controlled trial. Clin Otolaryngol 2017; 43:496-501. [DOI: 10.1111/coa.13005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2017] [Indexed: 12/13/2022]
Affiliation(s)
- S.A. Anzić
- ENT Department; Children's Hospital Srebrnjak; Zagreb Croatia
| | - M. Turkalj
- Department for Allergy and Pulmonology; Children's Hospital Srebrnjak; Zagreb Croatia
- Faculty of Medicine; J.J. Strossmayer University of Osijek; Osijek Croatia
| | - A. Župan
- Department for Allergy and Pulmonology; Children's Hospital Srebrnjak; Zagreb Croatia
| | - M. Labor
- Faculty of Medicine; J.J. Strossmayer University of Osijek; Osijek Croatia
- Department of Medicine; University Hospital Center Osijek; Osijek Croatia
| | - D. Plavec
- Faculty of Medicine; J.J. Strossmayer University of Osijek; Osijek Croatia
- Research Department; Children's Hospital Srebrnjak; Zagreb Croatia
| | - T. Baudoin
- ENT Department; University Hospital Center Sisters of Charity; Zagreb Croatia
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Zhao J, Gregersen H. Diabetes-induced mechanophysiological changes in the esophagus. Ann N Y Acad Sci 2016; 1380:139-154. [PMID: 27495976 DOI: 10.1111/nyas.13180] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 06/17/2016] [Accepted: 06/20/2016] [Indexed: 12/13/2022]
Abstract
Esophageal disorders are common in diabetes mellitus (DM) patients. DM induces mechanostructural remodeling in the esophagus of humans and animal models. The remodeling is related to esophageal sensorimotor abnormalities and to symptoms frequently encountered by DM patients. For example, gastroesophageal reflux disease (GERD) is a common disorder associated with DM. This review addresses diabetic remodeling of esophageal properties and function in light of the Esophagiome, a scientifically based modeling effort to describe the physiological dynamics of the normal, intact esophagus built upon interdisciplinary approaches with applications for esophageal disease. Unraveling the structural, biomechanical, and sensory remodeling of the esophagus in DM must be based on a multidisciplinary approach that can bridge the knowledge from a variety of scientific disciplines. The first focus of this review is DM-induced morphodynamic and biomechanical remodeling in the esophagus. Second, we review the sensorimotor dysfunction in DM and how it relates to esophageal remodeling. Finally, we discuss the clinical consequences of DM-induced esophageal remodeling, especially in relation to GERD. The ultimate aim is to increase the understanding of DM-induced remodeling of esophageal structure and sensorimotor function in order to assist clinicians to better understand the esophageal disorders induced by DM and to develop better treatments for those patients.
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Affiliation(s)
- Jingbo Zhao
- Giome Academia, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Hans Gregersen
- GIOME, Department of Surgery, Prince of Wales Hospital and Chinese University of Hong Kong, Shatin, Hong Kong SAR.,GIOME, College of Bioengineering, Chongqing University, Chongqing, China
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Günbey E, Gören İ, Ünal R, Yılmaz M. An evaluation of olfactory function in adults with gastro-esophageal reflux disease. Acta Otolaryngol 2015; 136:214-8. [PMID: 26479309 DOI: 10.3109/00016489.2015.1099735] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
CONCLUSION To the best of the authors' knowledge, this study is the first to evaluate the olfactory function of adult patients diagnosed with GERD. The results revealed that adults with GERD have diminished olfactory function. OBJECTIVE This study aimed to evaluate the olfactory abilities of subjects using the 'Sniffin' Sticks' olfactory test. METHODS A total of 35 men and women aged 18-60 years with a diagnosis of GERD and 45 healthy controls were included in the study. The Sniffin' Sticks olfactory test results of the two groups were compared, and the relationship between the study findings and the olfactory parameters was evaluated. RESULTS The odor threshold (10.1; 9.5, p = 0.016), odor identification (9.6; 8.1, p < 0.001), and odor discrimination (10.7; 8.9, p < 0.001) of the GERD group were significantly lower than those of the control group. A statistically significant positive correlation was detected between the accompanying chronic pharyngitis, chronic sinusitis, and odor parameters. A significant correlation was not detected between the laryngeal findings and the olfactory parameters.
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Affiliation(s)
- Emre Günbey
- a Department of Otorhinolaryngology , Faculty of Medicine, Ondokuz Mayis University , Samsun , Turkey
| | - İbrahim Gören
- b Department of Gastroenterology , Faculty of Medicine, Ondokuz Mayis University , Samsun , Turkey
| | - Recep Ünal
- a Department of Otorhinolaryngology , Faculty of Medicine, Ondokuz Mayis University , Samsun , Turkey
| | - Melikşah Yılmaz
- a Department of Otorhinolaryngology , Faculty of Medicine, Ondokuz Mayis University , Samsun , Turkey
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Mesallam TA, Malki KH, Farahat M, Bukhari M, Alharethy S. Voice problems among laryngopharyngeal reflux patients diagnosed with oropharyngeal pH monitoring. Folia Phoniatr Logop 2014; 65:280-7. [PMID: 24861352 DOI: 10.1159/000362835] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND AND OBJECTIVES There is a lack of consensus regarding the clinical presentation and diagnosis of laryngopharyngeal reflux (LPR). The aim of this study was to explore voice-related abnormalities in a group of LPR patients, diagnosed with a 24-hour oropharyngeal pH monitoring. PATIENTS AND METHODS Eighty-two patients with voice-related problems participated in the study. Diagnosis of LPR was made using a 24-hour oropharyngeal pH monitoring. Patients were divided accordingly into positive and negative pH groups. Comparisons between the two groups were done, including results of clinical presentation, Voice Handicap Index-10 (VHI-10), reflux symptom index (RSI), reflux finding score (RFS), and acoustic measurements. The correlation was conducted between Ryan scores and other variables including VHI-10, RSI, and RFS. RESULTS Significant differences were found between the two groups for RSI and VHI-10. No significant differences were found between the two groups regarding clinical presentation, RFS or acoustic measures. Significant positive correlations were found between the Ryan composite measurements and both severity ratings (VHI-10, RSI). CONCLUSION LPR clinical presentation appears to be non-specific in terms of symptoms and laryngeal findings. LPR appears to have an effect on the patients' self-perception of voice problems. Further studies are needed to clarify the effect of LPR on acoustic measurements.
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Affiliation(s)
- Tamer A Mesallam
- Department of Otolaryngology, Head and Neck Surgery, King Saud University, Riyadh, Saudi Arabia
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Holmqvist S, Santtila P, Lindström E, Sala E, Simberg S. The Association Between Possible Stress Markers and Vocal Symptoms. J Voice 2013; 27:787.e1-787.e10. [DOI: 10.1016/j.jvoice.2013.06.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Accepted: 06/19/2013] [Indexed: 01/26/2023]
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Eckley CA, Sardinha LR, Rizzo LV. Salivary Concentration of Epidermal Growth Factor in Adults with Reflux Laryngitis before and after Treatment. Ann Otol Rhinol Laryngol 2013; 122:440-4. [DOI: 10.1177/000348941312200705] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Objectives: The diagnosis of laryngopharyngeal reflux (LPR) is controversial. There is no correlation between the number of reflux episodes and the severity of the inflammatory response at the esophagus or the laryngopharyngeal segment. Some authors have suggested that decreased salivary epidermal growth factor (EGF) concentrations in patients with gastroesophageal reflux disease and LPR point to a breakdown in the local defenses. Our objective was to establish whether treatment of the disease influences low salivary EGF concentrations. Methods: The spontaneous whole saliva of 20 adults with LPR was sampled at a tertiary teaching hospital before and after a 16-week course of full-dose proton pump inhibitor and compared to that of 12 healthy controls. Salivary EGF concentrations were established with a commercially available enzyme-linked immunosorbent assay kit. Results: Although the mean salivary EGF concentrations were higher before treatment than after treatment and control of the disease (25,083 versus 19,359 pg/mL), this difference was not statistically significant (p = 0.065). The mean salivary EGF concentration of healthy control subjects was significantly higher (54,509 pg/mL; p < 0.0001). Conclusions: Both before and after treatment, patients with reflux laryngitis present lower salivary EGF concentrations than healthy control subjects, suggesting a primary deficit in their protective mechanisms.
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Posterior laryngitis: a study of persisting symptoms and health-related quality of life. Eur Arch Otorhinolaryngol 2012; 270:187-95. [DOI: 10.1007/s00405-012-2116-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Accepted: 07/10/2012] [Indexed: 12/16/2022]
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Clinical cough II: therapeutic treatments and management of chronic cough. Handb Exp Pharmacol 2008:277-95. [PMID: 18825346 DOI: 10.1007/978-3-540-79842-2_14] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Chronic cough is a common and frequently disruptive symptom which can be difficult to treat with currently available medicines. Asthma/eosinophilic airway disease and gastro-oesophageal reflux disease are most commonly associated with chronic cough but it may also trouble patients with chronic obstructive pulmonary disease, pulmonary fibrosis and lung cancer. Over the last three decades there have been a number of key advances in the clinical approach to cough and a number of international guidelines on the management of cough have been developed. Despite the undoubted benefit of such initiatives, more effective treatments for cough are urgently needed. The precise pathophysiological mechanisms of chronic cough are unknown but central to the process is sensitization (upregulation) of the cough reflex. One well-recognized clinical consequence of this hypersensitive state is bouts of coughing triggered by apparently trivial provocation such as scents and odours and changes in air temperature. The main objective of new treatments for cough would be to identify ways to downregulate this heightened cough reflex but yet preserve its crucial role in protecting the airway. The combined efforts of clinicians, scientists and the pharmaceutical industry offer most hope for such a treatment breakthrough. The aim of this chapter is to provide some rationale for the current treatment recommendations and to offer some reflections on the management of patients with chronic cough.
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Diagnosis and treatment of glossopharyngeal and vagal neuropathies in a patient with laryngopharyngeal reflux. Anesthesiology 2008; 109:741-3. [PMID: 18813053 DOI: 10.1097/aln.0b013e31818631e7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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McGarvey LPA, Polley L, MacMahon J. Common causes and current guidelines. Chron Respir Dis 2008; 4:215-23. [PMID: 18029434 DOI: 10.1177/1479972307084447] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Chronic cough is a common and disabling symptom. Recent guidelines have attempted to provide direction in the clinical management of cough in both primary and secondary care. They have also provided a critical review of the available literature and identified gaps in current knowledge. Despite this they have been criticized for a reliance on a low quality evidence base. In this review, we summarize the current consensus on the clinical management of chronic cough and attempt to rationalize this based on recent evidence. We have also provided an overview of the likely pathophysiological mechanisms responsible for cough and highlighted areas, where knowledge deficits exist and suggest directions for future research. Such progress will be critical in the search for new and effective treatments for cough.
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Affiliation(s)
- L P A McGarvey
- Department of Medicine, Queen's University of Belfast, Belfast, UK.
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