1
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Frankel A, Ong HS, Smithers BM, Nathanson LK, Gotley DC. Efficacy of laparoscopic fundoplication in patients with chronic cough and gastro-oesophageal reflux. Esophagus 2023; 20:170-177. [PMID: 36201134 PMCID: PMC9813203 DOI: 10.1007/s10388-022-00953-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 09/06/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND The outcome of anti-reflux surgery in patients with suspected gastro-oesophageal reflux-induced cough is frequently uncertain. The aims of this study were to assess the efficacy of laparoscopic fundoplication for controlling cough in patients with chronic cough without asthma, who have pathologic gastro-oesophageal reflux, and to identify predictors of response. METHODS From a prospective database of 1598 patients who have undergone laparoscopic fundoplication, 66 (4%) with proven gastro-oesophageal reflux disease (GORD) and chronic cough without asthma were studied. All patients underwent gastroscopy and 24-h pH monitoring before operation. Heartburn and regurgitation were assessed using a modified DeMeester score. Severity of cough before and after surgery was self-assessed by the patient using a visual analog scale at a minimum of 12 months post-operatively (median 43 mo; range: 14-104 mo). Patients were considered to have responded to fundoplication if they had no cough or the cough had improved by 50% or more after operation. RESULTS Cough and heartburn/regurgitation were relieved in 61% (40/66) and 90% (44/49) of the patients, respectively. The presence of typical GORD symptoms or oesophagitis, and pH study variables did not predict the response of the cough to fundoplication. CONCLUSION Refinement in the aetiological diagnosis of chronic cough due to GORD is necessary for improved outcome. Patients diagnosed with GORD-related chronic cough need to be counseled regarding their expectations from anti-reflux surgery.
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Affiliation(s)
- Adam Frankel
- Discipline of Surgery, The University of Queensland, Princess Alexandra Hospital Clinical School, Level 4, Building 1, 199 Ipswich Rd, Woolloongabba, QLD, 4102, Australia.
| | - Hock Soo Ong
- Department of General Surgery, Singapore General Hospital, Singapore, Singapore
| | - B Mark Smithers
- Discipline of Surgery, The University of Queensland, Princess Alexandra Hospital Clinical School, Level 4, Building 1, 199 Ipswich Rd, Woolloongabba, QLD, 4102, Australia
- Mater Private Hospital, South Brisbane, QLD, Australia
| | - Les K Nathanson
- Department of Surgery, Royal Brisbane Hospital, Herston, QLD, Australia
| | - David C Gotley
- Discipline of Surgery, The University of Queensland, Princess Alexandra Hospital Clinical School, Level 4, Building 1, 199 Ipswich Rd, Woolloongabba, QLD, 4102, Australia
- Mater Private Hospital, South Brisbane, QLD, Australia
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2
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Han M, Ooka R, Kikumoto H, Oh W, Bu Y, Hu S. Measurements of exhaled airflow velocity through human coughs using particle image velocimetry. BUILDING AND ENVIRONMENT 2021; 202:108020. [PMID: 34127875 PMCID: PMC8188782 DOI: 10.1016/j.buildenv.2021.108020] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 05/13/2021] [Accepted: 05/29/2021] [Indexed: 05/27/2023]
Abstract
The sudden outbreak of coronavirus (COVID-19) has infected over 100 million people and led to over two million deaths (data in January 2021), posing a significant threat to global human health. As a potential carrier of the novel coronavirus, the exhaled airflow of infected individuals through coughs is significant in virus transmission. The research of detailed airflow characteristics and velocity distributions is insufficient because most previous studies utilize particle image velocimetry (PIV) with low frequency. This study measured the airflow velocity of human coughs in a chamber using PIV with high frequency (interval: 1/2986 s) to provide a detailed validation database for droplet propagation CFD simulation. Sixty cough cases for ten young healthy nonsmoking volunteers (five males and five females) were analyzed. Ensemble-average operations were conducted to eliminate individual variations. Vertical and horizontal velocity distributions were measured around the mouth area. Overall cough characteristics such as cough duration time (CDT), peak velocity time (PVT), maximum velocities, and cough spread angle were obtained. The CDT of the cough airflow was 520-560 m s, while PVT was 20 m s. The male/female averaged maximum velocities were 15.2/13.1 m/s. The average vertical/horizontal cough spread angle was 15.3°/13.3° for males and 15.6°/14.2° for females. In addition, the spatial and temporal distributions of ensemble-averaged velocity profiles were obtained in the vertical and horizontal directions. The experimental data can provide a detailed validation database the basis for further study on the influence of cough airflow on virus transmission using computational fluid dynamic simulations.
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Affiliation(s)
- Mengtao Han
- School of Architecture and Urban Planning, Huazhong University of Science and Technology, Wuhan, China
| | - Ryozo Ooka
- Institute of Industrial Science, The University of Tokyo, Tokyo, Japan
| | - Hideki Kikumoto
- Institute of Industrial Science, The University of Tokyo, Tokyo, Japan
| | - Wonseok Oh
- Institute of Industrial Science, The University of Tokyo, Tokyo, Japan
| | - Yunchen Bu
- School of Engineering, The University of Tokyo, Tokyo, Japan
| | - Shuyuan Hu
- School of Engineering, The University of Tokyo, Tokyo, Japan
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3
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Launois C, Mulette P, Ancel J, Dury S, Hagenburg J, Lebargy F, Dormoy V, Deslee G, Perotin JM. [Treatment of GERD in asthma]. Rev Mal Respir 2021; 38:733-742. [PMID: 34016495 DOI: 10.1016/j.rmr.2021.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 03/25/2021] [Indexed: 11/28/2022]
Abstract
Gastro-oesophageal reflux disease (GORD) is one of the most frequent conditions associated with asthma. GORD has an impact on asthma control and quality of life of asthmatic patients. Its treatment relies on lifestyle modifications, anti-acidic treatment with proton pump inhibitors (PPI) and/or surgical management by fundoplication in some situations. The impact of lifestyle modifications has not been analysed on asthma outcomes alone. Several randomised controlled trials assessed the efficacy of PPI on asthma control, peak expiratory flow and/or quality of life. The impact of fundoplication in asthma has mainly been analysed in retrospective or prospective observational studies. This review highlights the limited impact of GORD treatment on asthma control. Current guidelines are to restrict GORD treatment in asthma to asthmatic patients with actual symptomatic GORD. Given the lack of controlled studies, the place of surgical management of GORD in asthma is currently not defined.
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Affiliation(s)
- C Launois
- Service des maladies respiratoires, CHU de Reims, 45, rue Cognacq-Jay, 51092 Reims cedex, France
| | - P Mulette
- Service des maladies respiratoires, CHU de Reims, 45, rue Cognacq-Jay, 51092 Reims cedex, France
| | - J Ancel
- Service des maladies respiratoires, CHU de Reims, 45, rue Cognacq-Jay, 51092 Reims cedex, France
| | - S Dury
- Service des maladies respiratoires, CHU de Reims, 45, rue Cognacq-Jay, 51092 Reims cedex, France; EA 4683, université de Reims Champagne-Ardenne, 51092 Reims, France
| | - J Hagenburg
- Service des maladies respiratoires, CHU de Reims, 45, rue Cognacq-Jay, 51092 Reims cedex, France
| | - F Lebargy
- Service des maladies respiratoires, CHU de Reims, 45, rue Cognacq-Jay, 51092 Reims cedex, France; EA 4683, université de Reims Champagne-Ardenne, 51092 Reims, France
| | - V Dormoy
- Inserm UMR-S 1250, P3Cell, université de Reims Champagne-Ardenne, 51092 Reims, France
| | - G Deslee
- Service des maladies respiratoires, CHU de Reims, 45, rue Cognacq-Jay, 51092 Reims cedex, France; Inserm UMR-S 1250, P3Cell, université de Reims Champagne-Ardenne, 51092 Reims, France
| | - J-M Perotin
- Service des maladies respiratoires, CHU de Reims, 45, rue Cognacq-Jay, 51092 Reims cedex, France; Inserm UMR-S 1250, P3Cell, université de Reims Champagne-Ardenne, 51092 Reims, France.
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4
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McDonnell MJ, Hunt EB, Ward C, Pearson JP, O'Toole D, Laffey JG, Murphy DM, Rutherford RM. Current therapies for gastro-oesophageal reflux in the setting of chronic lung disease: state of the art review. ERJ Open Res 2020; 6:00190-2019. [PMID: 33693049 PMCID: PMC7927787 DOI: 10.1183/23120541.00190-2019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 08/12/2020] [Indexed: 12/13/2022] Open
Abstract
The inter-relationship between chronic respiratory disease and reflux disease in the airway reflux paradigm is extremely complex and remains poorly characterised. Reflux disease is reported to cause or contribute to the severity of a number of respiratory tract diseases including laryngeal disorders, sinusitis, chronic cough, asthma, COPD, idiopathic pulmonary fibrosis, cystic fibrosis, bronchiectasis and bronchiolitis obliterans post lung transplant. It is now appreciated that reflux disease is not simply caused by liquid acid reflux but rather by a variety of chemical refluxates originating from the stomach and duodenum due to a number of different mechanisms. Reflux disease can be challenging to diagnose, particularly proving its role in the causation of direct respiratory epithelial damage. Significant advances in oesophageal assessment and gastric biomarkers have emerged in recent years as our understanding increases. There are a number of treatments available for reflux disease, both medical and surgical, but there is a paucity of large randomised trials to evaluate their efficacy in the setting of chronic respiratory disease. Everyday clinical practice, however, informs us that treatment failure in reflux disease is common. This clinical review summarises associations between reflux disease in the setting of chronic respiratory diseases and examines available evidence regarding potential therapeutic strategies. Gastro-oesophageal reflux disease is prevalent among patients with chronic respiratory disease. A number of medical and surgical treatment options are available for GORD. This review examines available evidence in the setting of chronic lung disease.https://bit.ly/34TcMJS
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Affiliation(s)
- Melissa J McDonnell
- Dept of Respiratory Medicine, Galway University Hospitals, Galway, Ireland.,Lung Biology Group, National University of Ireland, Galway, Ireland.,Institute of Cell and Molecular Biosciences, Newcastle University, Newcastle, UK
| | - Eoin B Hunt
- Dept of Respiratory Medicine, Cork University Hospital, Cork, Ireland.,The Clinical Research Facility, University College Cork, Cork, Ireland
| | - Chris Ward
- Institute of Cell and Molecular Biosciences, Newcastle University, Newcastle, UK
| | - Jeffrey P Pearson
- Institute of Cell and Molecular Biosciences, Newcastle University, Newcastle, UK
| | - Daniel O'Toole
- Lung Biology Group, National University of Ireland, Galway, Ireland
| | - John G Laffey
- Lung Biology Group, National University of Ireland, Galway, Ireland
| | - Desmond M Murphy
- Dept of Respiratory Medicine, Cork University Hospital, Cork, Ireland.,The Clinical Research Facility, University College Cork, Cork, Ireland
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5
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Tustumi F, Bernardo WM, Mariano da Rocha JR, Szachnowicz S, Bernal da Costa Seguro FC, Bianchi ET, Takeda FR, Afonso de Miranda Neto A, Aissar Sallum RA, Cecconello I. Anti-reflux surgery for controlling respiratory symptoms of gastro-esophageal reflux disease: A systematic review and meta-analysis. Asian J Surg 2020; 44:2-10. [PMID: 32534727 DOI: 10.1016/j.asjsur.2020.04.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 03/15/2020] [Accepted: 04/05/2020] [Indexed: 02/08/2023] Open
Abstract
Gastro-esophageal reflux disease (GERD) patients have a higher prevalence of airway symptoms, such as chronic cough, wheezing, and hoarseness. The therapeutic management of patients with these symptoms is controversial. Therefore, this study aims to perform a systematic review and meta-analysis evaluating the efficacy of anti-reflux surgery for controlling respiratory symptoms related to GERD. A systematic review and meta-analysis was performed. Extraction of the data concerning proportions of participants who were not free of respiratory symptoms related to GERD (cough, wheezing, hoarseness) or not substantially improved at follow-ups (failure to cure) was performed. Of the 3,424 initially screened articles, 68 studies were included for systematic review and 61 were included for meta-analysis, with a cumulative sample size of 3,869 patients. Of all the included patients, after anti-reflux surgery, the general symptoms improvement was 80% (95% CI 75.2-84%). The numbers needed to harm (NNH) and the numbers needed to treat (NNT) were 15.21 and 1.23, respectively. Of the included patients, 83.4% (95% CI 78.3-87.5%) patients reported improvement in cough symptoms after surgery. For the wheezing symptom, 71.5% (95% CI 62.9-78.8%) reported improvement after surgery. Moreover, surgery presented better results in improving respiratory symptoms than medical therapy (risk difference: -0.46; 95% CI -0.77, -0.16). Physicians should strongly consider surgical anti-reflux procedures for controlling respiratory symptoms in GERD patients after proper patient selection. Anti-reflux surgery has shown high efficacy in improving respiratory symptoms related to GERD, even when compared to medical therapy.
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Affiliation(s)
- Francisco Tustumi
- Department of Gastroenterology, Digestive Surgery Division, University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 255, São Paulo, SP, 05403-000, Brazil.
| | - Wanderley Marques Bernardo
- Department of Gastroenterology, Digestive Surgery Division, University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 255, São Paulo, SP, 05403-000, Brazil
| | - Julio Rafael Mariano da Rocha
- Department of Gastroenterology, Digestive Surgery Division, University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 255, São Paulo, SP, 05403-000, Brazil
| | - Sérgio Szachnowicz
- Department of Gastroenterology, Digestive Surgery Division, University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 255, São Paulo, SP, 05403-000, Brazil
| | | | - Edno Tales Bianchi
- Department of Gastroenterology, Digestive Surgery Division, University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 255, São Paulo, SP, 05403-000, Brazil
| | - Flávio Roberto Takeda
- Department of Gastroenterology, Digestive Surgery Division, University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 255, São Paulo, SP, 05403-000, Brazil
| | - Antonio Afonso de Miranda Neto
- Department of Gastroenterology, Digestive Surgery Division, University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 255, São Paulo, SP, 05403-000, Brazil
| | - Rubens Antonio Aissar Sallum
- Department of Gastroenterology, Digestive Surgery Division, University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 255, São Paulo, SP, 05403-000, Brazil
| | - Ivan Cecconello
- Department of Gastroenterology, Digestive Surgery Division, University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 255, São Paulo, SP, 05403-000, Brazil
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6
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Hogea SP, Tudorache E, Fildan AP, Fira-Mladinescu O, Marc M, Oancea C. Risk factors of chronic obstructive pulmonary disease exacerbations. CLINICAL RESPIRATORY JOURNAL 2020; 14:183-197. [PMID: 31814260 DOI: 10.1111/crj.13129] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 11/07/2019] [Accepted: 12/03/2019] [Indexed: 12/13/2022]
Abstract
Chronic Obstructive Pulmonary Disease (COPD) is a chronic respiratory disease characterised by persistent respiratory symptoms and airflow limitation. COPD has a major impact on public health, mainly because of its increasing prevalence, morbidity and mortality. The natural course of COPD is aggravated by episodes of respiratory symptom worsening termed exacerbations that contribute to disease progression. Acute Exacerbations of COPD (AECOPD) can be triggered by a multitude of different factors, including respiratory tract infections, various exposures, prior exacerbations, non-adherence to treatment and associated comorbidities. AECOPD are associated with an inexorable decline of lung function and a significantly worse survival outcome. This review will summarise the most important aspects regarding the impact of different factors that contribute to COPD exacerbations.
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Affiliation(s)
- Stanca-Patricia Hogea
- Department of Pulmonology, University of Medicine and Pharmacy "Victor Babeș", Timișoara, Romania
| | - Emanuela Tudorache
- Department of Pulmonology, University of Medicine and Pharmacy "Victor Babeș", Timișoara, Romania
| | - Ariadna Petronela Fildan
- Internal Medicine Discipline, Medical Clinical Disciplines I, "Ovidius" University of Constanta Faculty of Medicine, Constanta, Romania
| | - Ovidiu Fira-Mladinescu
- Department of Pulmonology, University of Medicine and Pharmacy "Victor Babeș", Timișoara, Romania
| | - Monica Marc
- Department of Pulmonology, University of Medicine and Pharmacy "Victor Babeș", Timișoara, Romania
| | - Cristian Oancea
- Department of Pulmonology, University of Medicine and Pharmacy "Victor Babeș", Timișoara, Romania
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7
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Pauwels A, Boecxstaens V, Andrews CN, Attwood SE, Berrisford R, Bisschops R, Boeckxstaens GE, Bor S, Bredenoord AJ, Cicala M, Corsetti M, Fornari F, Gyawali CP, Hatlebakk J, Johnson SB, Lerut T, Lundell L, Mattioli S, Miwa H, Nafteux P, Omari T, Pandolfino J, Penagini R, Rice TW, Roelandt P, Rommel N, Savarino V, Sifrim D, Suzuki H, Tutuian R, Vanuytsel T, Vela MF, Watson DI, Zerbib F, Tack J. How to select patients for antireflux surgery? The ICARUS guidelines (international consensus regarding preoperative examinations and clinical characteristics assessment to select adult patients for antireflux surgery). Gut 2019; 68:1928-1941. [PMID: 31375601 DOI: 10.1136/gutjnl-2019-318260] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 05/28/2019] [Accepted: 05/29/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Antireflux surgery can be proposed in patients with GORD, especially when proton pump inhibitor (PPI) use leads to incomplete symptom improvement. However, to date, international consensus guidelines on the clinical criteria and additional technical examinations used in patient selection for antireflux surgery are lacking. We aimed at generating key recommendations in the selection of patients for antireflux surgery. DESIGN We included 35 international experts (gastroenterologists, surgeons and physiologists) in a Delphi process and developed 37 statements that were revised by the Consensus Group, to start the Delphi process. Three voting rounds followed where each statement was presented with the evidence summary. The panel indicated the degree of agreement for the statement. When 80% of the Consensus Group agreed (A+/A) with a statement, this was defined as consensus. All votes were mutually anonymous. RESULTS Patients with heartburn with a satisfactory response to PPIs, patients with a hiatal hernia (HH), patients with oesophagitis Los Angeles (LA) grade B or higher and patients with Barrett's oesophagus are good candidates for antireflux surgery. An endoscopy prior to antireflux surgery is mandatory and a barium swallow should be performed in patients with suspicion of a HH or short oesophagus. Oesophageal manometry is mandatory to rule out major motility disorders. Finally, oesophageal pH (±impedance) monitoring of PPI is mandatory to select patients for antireflux surgery, if endoscopy is negative for unequivocal reflux oesophagitis. CONCLUSION With the ICARUS guidelines, we generated key recommendations for selection of patients for antireflux surgery.
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Affiliation(s)
- Ans Pauwels
- Department of Chronic Diseases, Metabolism and Ageing, Translational Research Center for Gastrointestinal Disorders, KU Leuven, Leuven, Belgium
| | - Veerle Boecxstaens
- Department of Chronic Diseases, Metabolism and Ageing, Translational Research Center for Gastrointestinal Disorders, KU Leuven, Leuven, Belgium.,Department of Surgical Oncology, Oncological and Vascular Access Surgery, Leuven, Belgium.,Department of Oncology, KU Leuven, Leuven, Belgium
| | | | | | - Richard Berrisford
- Peninsula Oesophago-gastric Surgery Unit, Derriford Hospital, Plymouth, Plymouth, UK
| | - Raf Bisschops
- Department of Chronic Diseases, Metabolism and Ageing, Translational Research Center for Gastrointestinal Disorders, KU Leuven, Leuven, Belgium.,Gastroenterology and Hepatology, University Hospital Gasthuisberg, Leuven, Belgium
| | - Guy E Boeckxstaens
- Department of Chronic Diseases, Metabolism and Ageing, Translational Research Center for Gastrointestinal Disorders, KU Leuven, Leuven, Belgium
| | - Serhat Bor
- Gastroenterology, Ege University School of Medicine, İzmir, Turkey
| | - Albert J Bredenoord
- Gastroenterology and Hepatology, Academic Medical Centre, Amsterdam, Netherlands
| | - Michele Cicala
- Digestive Diseases, Universita Campus Bio Medico, Roma, Italy
| | - Maura Corsetti
- Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK.,Nottingham Digestive Diseases Centre, University of Nottingham, Nottingham, UK
| | - Fernando Fornari
- Programa de Pós-Graduação: Ciências em Gastroenterologia e Hepatologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Chandra Prakash Gyawali
- Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Jan Hatlebakk
- Gastroenterology, Haukeland Sykehus, University of Bergen, Bergen, Norway
| | - Scott B Johnson
- Department of Cardiothoracic Surgery, University of Texas Health Science Center, San Antonio, USA
| | - Toni Lerut
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Lars Lundell
- Department of Surgery, Karolinska, Stockholm, Sweden
| | - Sandro Mattioli
- Department of Medical and Surgical Sciences, Universita degli Studi di Bologna, Bologna, Emilia-Romagna, Italy
| | - Hiroto Miwa
- Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Philippe Nafteux
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Taher Omari
- Department of Gastroenterology, Flinders University, Adelaide, Australia
| | - John Pandolfino
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Roberto Penagini
- Department of Pathophysiology and Transplantation, Ospedale Maggiore Policlinico, Milano, Lombardia, Italy
| | - Thomas W Rice
- Thoracic Surgery, Emeritus Staff Cleveland Clinic, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, USA
| | - Philip Roelandt
- Department of Chronic Diseases, Metabolism and Ageing, Translational Research Center for Gastrointestinal Disorders, KU Leuven, Leuven, Belgium.,Gastroenterology and Hepatology, University Hospital Gasthuisberg, Leuven, Belgium
| | - Nathalie Rommel
- Department of Chronic Diseases, Metabolism and Ageing, Translational Research Center for Gastrointestinal Disorders, KU Leuven, Leuven, Belgium.,Neurosciences, KU Leuven, Leuven, Belgium
| | - Vincenzo Savarino
- Internal Medicine and Medical Specialties, Universita di Genoa, Genoa, Italy
| | - Daniel Sifrim
- Barts and The London School of Medicine and Dentistry, Queen Mary University London, London, UK
| | - Hidekazu Suzuki
- Gastroenterology and Hepatology, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Radu Tutuian
- Gastroenteroloy, Tiefenauspital Bern, Bern, Switzerland
| | - Tim Vanuytsel
- Department of Chronic Diseases, Metabolism and Ageing, Translational Research Center for Gastrointestinal Disorders, KU Leuven, Leuven, Belgium.,Gastroenterology and Hepatology, University Hospital Gasthuisberg, Leuven, Belgium
| | | | - David I Watson
- Department of Surgery, Flinders Medical Centre, Flinders University, Adelaide, South Australia, Australia
| | - Frank Zerbib
- Department of Gastroenterology, Bordeaux University Hospital, Université de Bordeaux, Bordeaux, France
| | - Jan Tack
- Department of Chronic Diseases, Metabolism and Ageing, Translational Research Center for Gastrointestinal Disorders, KU Leuven, Leuven, Belgium.,Gastroenterology and Hepatology, University Hospital Gasthuisberg, Leuven, Belgium
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8
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Sidwa F, Moore AL, Alligood E, Fisichella PM. Surgical Treatment of Extraesophageal Manifestations of Gastroesophageal Reflux Disease. World J Surg 2018; 41:2566-2571. [PMID: 28508234 DOI: 10.1007/s00268-017-4058-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To review the current literature on the role of antireflux surgery (ARS) for the treatment of extraesophageal manifestations of GERD. The extraesophageal manifestations of gastroesophageal reflux disease (GERD) include chronic cough, laryngopharyngeal reflux, and asthma. They are responsible for significant morbidity in affected patients and a high economic burden on healthcare resources. We recently published a larger review on the symptoms, diagnosis, medical, and surgical treatment of the extraesophageal manifestations of GERD. Through our investigation, we found that the role of ARS for respiratory symptoms was unclear. Hence, we resorted through the data of our previous meta-analysis to compile a comprehensive and focused review on the role of ARS for respiratory symptoms. METHODS Using the archive of our previous meta-analysis, we selected studies extracted from the MEDLINE, Cochran, PubMed, Google Scholar, and Embase databases pertaining to the surgical treatment of extraesophageal manifestations of reflux (cough laryngopharyngeal reflux, and asthma). We applied a similar reporting methodology as was used in our previous manuscript and then hand searched the bibliographies of included studies yielding a total of 27 articles for review. We graded the level of evidence and classified recommendations by size of treatment effect per the American Heart Association Task Force on Practice Guidelines. RESULTS Observational data indicated that syndromes of chronic cough, laryngopharyngeal reflux and asthma might improve after antireflux surgery only in highly selected patients-likely those with non-acid reflux-while those patients with objective markers of asthma severity do not. Because of the varied methods of diagnosis and surgical technique, non-comparative observational data may be unreliable. Additionally, our search found no randomized controlled trials (RCTs) comparing antireflux surgery to medical therapy in the treatment of cough or laryngopharyngeal reflux. One RCT compared medical treatment to antireflux surgery in patients with asthma, but medical treatment included high-dose H2 blockers instead of PPIs. CONCLUSIONS Extraesophageal manifestations of GERD are common, costly, and difficult to treat. ARS might be effective in highly selected patients, especially in those whose extraesophageal manifestations are caused by non-acid reflux. The available data to date are generally of poor quality or outdated. Well-designed randomized controlled trials or large-scale observational cohort studies are urgently needed.
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Affiliation(s)
- Feroze Sidwa
- Brigham and Women's Hospital, Boston VA Healthcare System, Harvard Medical School, West Roxbury, Boston, MA, 02132, USA
| | - Alessandra L Moore
- Brigham and Women's Hospital, Boston VA Healthcare System, Harvard Medical School, West Roxbury, Boston, MA, 02132, USA
| | - Elaine Alligood
- Brigham and Women's Hospital, Boston VA Healthcare System, Harvard Medical School, West Roxbury, Boston, MA, 02132, USA
| | - P Marco Fisichella
- Brigham and Women's Hospital, Boston VA Healthcare System, Harvard Medical School, West Roxbury, Boston, MA, 02132, USA.
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9
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Broers C, Tack J, Pauwels A. Review article: gastro-oesophageal reflux disease in asthma and chronic obstructive pulmonary disease. Aliment Pharmacol Ther 2018; 47:176-191. [PMID: 29193245 DOI: 10.1111/apt.14416] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 05/29/2017] [Accepted: 10/20/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND When gastro-oesophageal reflux is causing symptoms or lesions in the oesophagus, this is referred to as gastro-oesophageal reflux disease (GERD). GERD can manifest itself through typical symptoms (heartburn, regurgitation) or may lead to extra-oesophageal symptoms. Extra-oesophageal manifestations of GERD gained increasing attention over the last decade, especially respiratory disorders, because of the prevalent co-occurrence with GERD. The role of GERD in the pathogenesis of respiratory disorders has become a topic of intense discussion. AIM To provide an overview of the current knowledge on the role of GERD in asthma and chronic obstructive pulmonary disease (COPD). METHODS PubMed was searched for relevant articles using the keywords: GERD, asthma, COPD, prevalence, treatment. Case reports were excluded, only English language articles were considered. RESULTS Estimates for the prevalence of GERD in asthma range from 30% to 90%, compared to an average of 24% in controls. In COPD patients, the prevalence of GERD ranges from 19% to 78% compared to an average of 18% in controls. These data indicate an increased prevalence of GERD in patients with asthma and COPD, although causality is not established and GERD treatment yielded inconsistent effects. Literature supports GERD as a risk factor for COPD-exacerbations and a predictor of the 'frequent-exacerbator'-phenotype. CONCLUSIONS Despite the high prevalence of GERD in asthma and COPD, a causal link is lacking. The results of anti-reflux therapy on pulmonary outcome are inconsistent and contradictory. Future studies will need to identify subgroups of asthmatics and COPD patients that may benefit from anti-reflux therapy (nocturnal or silent reflux).
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Affiliation(s)
- C Broers
- Department of Clinical and Experimental Medicine, Translational Research Center for Gastrointestinal Disorders (TARGID), KU Leuven, Leuven, Belgium
| | - J Tack
- Department of Clinical and Experimental Medicine, Translational Research Center for Gastrointestinal Disorders (TARGID), KU Leuven, Leuven, Belgium.,Department of Gastroenterology, Leuven University Hospitals, Leuven, Belgium
| | - A Pauwels
- Department of Clinical and Experimental Medicine, Translational Research Center for Gastrointestinal Disorders (TARGID), KU Leuven, Leuven, Belgium
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Falk GL, Van der Wall H, Burton L, Falk MG, O'Donnell H, Vivian SJ. Fundoplication for laryngopharyngeal reflux despite preoperative dysphagia. Ann R Coll Surg Engl 2017; 99:224-227. [PMID: 28252352 DOI: 10.1308/rcsann.2016.0330] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Fundoplication for laryngopharyngeal disease with oesophageal dysmotility has led to mixed outcomes. In the presence of preoperative dysphagia and oesophageal dysmotility, this procedure has engendered concern in certain regards. METHODS This paper describes a consecutive series of laryngopharyngeal reflux (LPR) patients with a high frequency of dysmotility. Patients were selected for surgery with 24-hour dual channel pH monitoring, oesophageal manometry and standardised reflux scintigraphy. RESULTS Following careful patient selection, 33 patients underwent fundoplication by laparoscopy. Surgery had high efficacy in symptom control and there was no adverse dysphagia. CONCLUSIONS Evidence of proximal reflux can select a group of patients for good results of fundoplication for atypical symptoms.
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Affiliation(s)
- G L Falk
- Sydney Heartburn Clinic , Lindfield , Australia
| | | | - L Burton
- Concord Nuclear Imaging , Sydney , Australia
| | - M G Falk
- Sydney Heartburn Clinic , Lindfield , Australia
| | - H O'Donnell
- Sydney Heartburn Clinic , Lindfield , Australia
| | - S J Vivian
- Sydney Heartburn Clinic , Lindfield , Australia
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11
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12
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Lee AL, Goldstein RS. Gastroesophageal reflux disease in COPD: links and risks. Int J Chron Obstruct Pulmon Dis 2015; 10:1935-49. [PMID: 26392769 PMCID: PMC4574848 DOI: 10.2147/copd.s77562] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
COPD is a long-term condition associated with considerable disability with a clinical course characterized by episodes of worsening respiratory signs and symptoms associated with exacerbations. Gastroesophageal reflux disease (GERD) is one of the most common gastrointestinal conditions in the general population and has emerged as a comorbidity of COPD. GERD may be diagnosed by both symptomatic approaches (including both typical and atypical symptoms) and objective measurements. Based on a mix of diagnostic approaches, the prevalence of GERD in COPD ranges from 17% to 78%. Although GERD is usually confined to the lower esophagus in some individuals, it may be associated with pulmonary microaspiration of gastric contents. Possible mechanisms that may contribute to GERD in COPD originate from gastroesophageal dysfunction, including altered pressure in the lower esophageal sphincter (which normally protect against GERD) and changes in esophageal motility. Proposed respiratory contributions to the development of GERD include respiratory medications that may alter esophageal sphincter tone and changes in respiratory mechanics, with increased lung hyperinflation compromising the antireflux barrier. Although the specific cause and effect relationship between GERD and COPD has not been fully elucidated, GERD may influence lung disease severity and has been identified as a significant predictor of acute exacerbations of COPD. Further clinical effects could include a poorer health-related quality of life and an increased cost in health care, although these factors require further clarification. There are both medical and surgical options available for the treatment of GERD in COPD and while extensive studies in this population have not been undertaken, this comorbidity may be amenable to treatment.
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Affiliation(s)
- Annemarie L Lee
- West Park Healthcare Centre, University of Toronto, Toronto, ON, Canada ; Department of Physical Therapy, University of Toronto, Toronto, ON, Canada ; Institute for Breathing and Sleep, Austin Hospital, Melbourne, VIC, Australia
| | - Roger S Goldstein
- West Park Healthcare Centre, University of Toronto, Toronto, ON, Canada ; Department of Physical Therapy, University of Toronto, Toronto, ON, Canada ; Department of Medicine, University of Toronto, Toronto, ON, Canada
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Effectiveness of Antireflux Surgery for the Cure of Chronic Cough Associated with Gastroesophageal Reflux Disease. World J Surg 2014; 39:208-15. [DOI: 10.1007/s00268-014-2769-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Adaba F, Ang CW, Perry A, Wadley MS, Robertson CS. Outcome of gastro-oesophageal reflux-related respiratory manifestations after laparoscopic fundoplication. Int J Surg 2014; 12:241-4. [PMID: 24463143 DOI: 10.1016/j.ijsu.2014.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2013] [Revised: 10/01/2013] [Accepted: 01/15/2014] [Indexed: 02/06/2023]
Abstract
AIMS Patients with refractory respiratory symptoms related to gastro-oesophageal reflux disease (GORD) such as asthma and cough are being referred for laparoscopic fundoplication (LFP), as recommended by the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). However there are limited data regarding symptomatic response to fundoplication in this group of patients. METHOD A 7 year retrospective review was performed to study the efficacy of LFP in the treatment of patients with respiratory manifestations of GORD. Patients were followed up from 4 to 6 weeks (short-term) to 6-12 months (long-term) post-operatively. RESULTS Of 208 patients who underwent LFP, 73 (35%) patients were eligible for inclusion into the study. 55 (75%) patients had improved respiratory symptoms at short-term follow-up. At long-term follow-up, 7 of these patients had recurrence of respiratory symptoms, while 4 patients had improvement not initially apparent. No significant predictive factor for the success or failure of surgery was identified. 190 (91%) of 208 patients had symptomatic improvement in GORD at short-term follow-up. CONCLUSION LFP is effective with the response rates over 75% in the control of respiratory manifestation of GORD, compared to over 91% response rate in the control GOR symptoms alone. More research is needed to identify factors to aid patient selection to improve response rate.
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Affiliation(s)
- Franklin Adaba
- Department of Upper Gastrointestinal Surgery, Worcestershire Acute Hospitals NHS Trust, Charles Hastings Way, Worcester WR5 1DD, UK.
| | - Chin W Ang
- Department of Upper Gastrointestinal Surgery, Worcestershire Acute Hospitals NHS Trust, Charles Hastings Way, Worcester WR5 1DD, UK
| | - Anthony Perry
- Department of Upper Gastrointestinal Surgery, Worcestershire Acute Hospitals NHS Trust, Charles Hastings Way, Worcester WR5 1DD, UK
| | - Martin S Wadley
- Department of Upper Gastrointestinal Surgery, Worcestershire Acute Hospitals NHS Trust, Charles Hastings Way, Worcester WR5 1DD, UK
| | - Charles S Robertson
- Department of Upper Gastrointestinal Surgery, Worcestershire Acute Hospitals NHS Trust, Charles Hastings Way, Worcester WR5 1DD, UK
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Faruqi S, Sedman P, Jackson W, Molyneux I, Morice AH. Fundoplication in chronic intractable cough. COUGH 2012; 8:3. [PMID: 22812601 PMCID: PMC3499264 DOI: 10.1186/1745-9974-8-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Accepted: 06/29/2012] [Indexed: 12/15/2022]
Abstract
Background Airway reflux is a common cause of chronic cough and this is often refractory to medical therapy. Surgery in the form of Nissen fundoplication has been highly successful in the treatment of the classic reflux symptoms of heartburn and dyspepsia. There is a paucity of data regarding response to fundoplication in patients presenting with chronic cough. Methods We retrospectively reviewed the case notes of patients from the Hull Cough Clinic who had undergone Nissen fundoplication over the past 6 years. Demographic details, duration of symptoms, presence of other symptoms, results of oesophageal studies, outcome and complications were recorded. Patients were contacted by post and asked to complete a questionnaire detailing current symptoms. In a subgroup with continued troublesome cough 24 hour pharyngeal pH measurements were undertaken. Results Forty seven patients underwent fundoplication. The average duration of pre-operative cough was 8 years. Gastro intestinal symptoms were present in the majority. In 30 (64%) patients a positive response to treatment was recorded. Mild dysphagia or bloating was seen in 18 patients following surgery. Four patients needed repeat surgical intervention for modification of fundoplication. One patient developed aspiration pneumonia eight weeks following surgery and died of a myocardial infarction. Two thirds of patients with persisting cough had evidence of airway reflux on pharyngeal pH monitoring. Conclusion In these patients with intractable cough a long term response rate of 63% represents a useful therapeutic option. Treatment failure is more frequent than for classic peptic symptoms and may be related to persistent gaseous reflux.
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Affiliation(s)
- Shoaib Faruqi
- Department of Cardiovascular and Respiratory Studies, Castle Hill Hospital, Hull York Medical School, University of Hull, Cottingham, HU16 5JQ, UK.
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[Laparoscopic fundoplication results in the treatment of the non-gastrointestinal symptoms of gastroesophageal reflux]. Cir Esp 2012; 90:238-42. [PMID: 22404897 DOI: 10.1016/j.ciresp.2011.12.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2011] [Revised: 12/08/2011] [Accepted: 12/10/2011] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Gastroesophageal reflux disease (GERD) can trigger typical and atypical symptoms (cough, dysphonia, asthma…). GERD with typical symptoms has well established surgical indications, but it is not the case when the symptoms are atypical. Our aim is to assess the effectiveness of laparoscopic surgery in those patients in whom the surgical indication was mainly due to atypical symptoms. MATERIAL AND METHODS Between 1998 and 2011 laparoscopic fundoplication was performed on of 318 patients with GERD, of whom 14 (4%) had atypical symptoms as the main indication. Typical symptoms were present in 12 (86%) cases, and atypical symptoms were: cough in 5 (36%) cases, respiratory symptoms 5 (36%), dysphonia 2 (14%), vocal chords granuloma 1 (7%) and larynx spasm 1 (7%). The GERD diagnosis was established due to evidence of an anatomical or functional alterations of the gastroesophageal junction (hiatus hernia, pathological manometry or pH-metry). The clinical histories of the patients were reviewed and they were given a gastrointestinal quality of life (Gastrointestinal Quality of Life Index [GIQoL]) questionnaire was completed, as well as a subjective assessment (0 to 4) of the modification of their atypical symptoms. RESULTS A clinical improvement was observed in both the atypical and typical GERD in 12 patients (86%), with the symptoms score decreasing from 3.7 to 0.7. A significant improvement (P<.05) from the pre-surgical value 107(±26) to 122 (±10) points was obtained in the quality of life (GIQoL) in 11 patients (79%). CONCLUSION Laparoscopic fundoplication is an effective technique in the treatment of the atypical symptoms of GERD.
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Chang AB, Lasserson TJ, Gaffney J, Connor FL, Garske LA. Gastro-oesophageal reflux treatment for prolonged non-specific cough in children and adults. Cochrane Database Syst Rev 2011; 2011:CD004823. [PMID: 21249664 PMCID: PMC6885040 DOI: 10.1002/14651858.cd004823.pub4] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Gastroesophageal reflux disease (GORD) is said to be the causative factor in up to 41% of adults with chronic cough. Treatment for GORD includes conservative measures (diet manipulation), pharmaceutical therapy (motility or prokinetic agents, H(2)-antagonist and proton pump inhibitors (PPI)) and fundoplication. OBJECTIVES To evaluate the efficacy of GORD treatment on chronic cough in children and adults with GORD and prolonged cough that is not related to an underlying respiratory disease, i.e. non-specific chronic cough. SEARCH STRATEGY We searched the Cochrane Airways Group Specialised Register, the Cochrane Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, review articles and reference lists of relevant articles. The date of last search was 8 April 2010. SELECTION CRITERIA All randomised controlled trials (RCTs) on GORD treatment for cough in children and adults without primary lung disease. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial quality and extracted data. We contacted study authors for further information. MAIN RESULTS We included 19 studies (six paediatric, 13 adults). None of the paediatric studies could be combined for meta-analysis. A single RCT in infants found that PPI (compared to placebo) was not efficacious for cough outcomes (favouring placebo OR 1.61; 95% CI 0.57 to 4.55) but those on PPI had significantly increased adverse events (OR 5.56; 95% CI 1.18 to 26.25) (number needed to treat for harm in four weeks was 11 (95% CI 3 to 232)). In adults, analysis of H(2) antagonist, motility agents and conservative treatment for GORD was not possible (lack of data) and there were no controlled studies of fundoplication. We analysed nine adult studies comparing PPI (two to three months) to placebo for various outcomes in the meta-analysis. Using intention-to-treat, pooled data from studies resulted in no significant difference between treatment and placebo in total resolution of cough (OR 0.46; 95% CI 0.19 to 1.15). Pooled data revealed no overall significant improvement in cough outcomes (end of trial or change in cough scores). We only found significant differences in sensitivity analyses. We found a significant improvement in change of cough scores at end of intervention (two to three months) in those receiving PPI (standardised mean difference -0.41; 95% CI -0.75 to -0.07) using generic inverse variance analysis on cross-over trials. Two studies reported improvement in cough after five days to two weeks of treatment. AUTHORS' CONCLUSIONS PPI is not efficacious for cough associated with GORD symptoms in very young children (including infants) and should not be used for cough outcomes. There is insufficient data in older children to draw any valid conclusions. In adults, there is insufficient evidence to conclude definitely that GORD treatment with PPI is universally beneficial for cough associated with GORD. Clinicians should be cognisant of the period (natural resolution with time) and placebo effect in studies that utilise cough as an outcome measure. Future paediatric and adult studies should be double-blind, randomised controlled and parallel-design, using treatments for at least two months, with validated subjective and objective cough outcomes and include ascertainment of time to respond as well as assessment of acid and/or non-acid reflux.
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Affiliation(s)
- Anne B Chang
- Queensland Children's Respiratory Centre and Queensland Children's Medical Research InstituteRoyal Children's Hospital, Brisbane and Menzies School of Health Research, CDU, DarwinHerston RoadHerstonBrisbaneAustralia4029
| | - Toby J Lasserson
- The Cochrane CollaborationCochrane Editorial Unit29 Queen Elizabeth StreetLondonUKSE21 2LP
| | - Justin Gaffney
- Royal Children's HospitalRespiratory MedicineHerston RoadHerstonBrisbaneAustralia4029
| | - Frances L Connor
- Royal Children's HospitalGastroenterologyHerston RoadHerstonBrisbaneAustralia4029
| | - Luke A Garske
- Princess Alexandra HospitalRespiratory MedicineIpswish RdWoolloongabbaBrisbaneAustraliaQ4102
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Malfertheiner MV, Kandulski A, Malfertheiner P, Schreiber J. [Bronchopulmonary manifestations of gastroesophageal reflux disease]. Internist (Berl) 2010; 51 Suppl 1:246-54. [PMID: 20098976 DOI: 10.1007/s00108-009-2506-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Gastroesophageal reflux disease (GERD) is a common disease in the western world. Usually it occurs with typical symptoms like heartburn and regurgitation, but almost every third GERD-patient presents with extraesophageal symptoms and diseases in which a causal relation with GERD is discussed. The extraesophageal symptoms possibly associated with GERD are chronic cough, bronchial asthma, sleep disturbances including obstructive sleep apnea, hoarseness, dental erosions, non-cardiac chest pain and idiopathic pulmonary fibrosis. This article gives an overview of the reflux-associated diseases of the airways as well as the proposed pathomechanisms and therapeutic options.
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Affiliation(s)
- M V Malfertheiner
- Fachbereich für Pneumologie, Otto-von-Guericke-Universität Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Deutschland
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Iqbal M, Batch AJ, Spychal RT, Cooper BT. Outcome of Surgical Fundoplication for Extraesophageal (Atypical) Manifestations of Gastroesophageal Reflux Disease in Adults: A Systematic Review. J Laparoendosc Adv Surg Tech A 2008; 18:789-96. [DOI: 10.1089/lap.2007.0165] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Affiliation(s)
- Mohd Iqbal
- Department of General Surgery, City Hospital, Birmingham, United Kingdom
| | - Andrew J. Batch
- Department of ENT Surgery, City Hospital, Birmingham, United Kingdom
| | - Robert T. Spychal
- Department of General Surgery, City Hospital, Birmingham, United Kingdom
| | - Brian T. Cooper
- Department of Gastroenterology, City Hospital, Birmingham, United Kingdom
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20
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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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Mjönes AB, Borch K, Tibbling L, Ledin T, Hultcrantz E. Hoarseness and misdirected swallowing in patients with hiatal hernia. Eur Arch Otorhinolaryngol 2007; 264:1437-9. [PMID: 17643255 DOI: 10.1007/s00405-007-0396-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2007] [Accepted: 06/28/2007] [Indexed: 10/23/2022]
Abstract
The purpose of this study was to elucidate whether misdirected swallowing is an extra-laryngeal cause of hoarseness and investigate whether the prevalence of misdirected swallowing and hoarseness in patients with hiatal hernias differ from those with and without pathological gastroesophageal reflux (GER). One hundred and ninety eight patients with hiatal hernias diagnosed via esophageal manometry and pH-reflux test and 262 subjects in the general population who did not have a hiatal hernia at endoscopy, filled in a questionnaire about symptoms on hoarseness, misdirected swallowing, and heartburn. Hoarseness (35%), misdirected swallowing to the larynx (MSL; 35%), misdirected swallowing to the nose (MSN; 22%) and heartburn (85%) were significantly more common in patients with hiatal hernia than in controls (13, 5, 1, and 6%, respectively, P<0.001). MSL and MSN in the patient group were significantly interrelated (P<0.0001). Hoarseness and MSL were not significantly associated (P<0.076). Hoarseness and MSL were as common in the hernia group with normal GER, as in the group with pathological GER. There is a predisposition for hoarseness and MSL in patients with hiatal hernias, but the cause-and-effect relationship is unclear. Hoarseness does not seem to be caused by pathological GER.
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Affiliation(s)
- Anna-Britta Mjönes
- Department of Otorhinolaryngology, University Hospital, Linköping, Sweden
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Chang AB, Lasserson TJ, Gaffney J, Connor FL, Garske LA. Gastro-oesophageal reflux treatment for prolonged non-specific cough in children and adults. Cochrane Database Syst Rev 2006:CD004823. [PMID: 17054216 DOI: 10.1002/14651858.cd004823.pub3] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Cough is a very common symptom presenting to medical practitioners. Gastroesophageal reflux disease (GORD) is said to be the causative factor in up to 41% of adults with chronic cough. However cough and GORD are common ailments and their co-existence by chance is high. Also cough can induce reflux episodes. Treatment for GORD includes conservative measures (diet manipulation), pharmaceutical therapy (motility or prokinetic agents, H(2) antagonist and proton pump inhibitors (PPI)) and fundoplication. OBJECTIVES To evaluate the efficacy of GORD treatment on chronic cough in children and adults with GORD and prolonged cough that is not related to an underlying respiratory disease i.e. non-specific chronic cough. SEARCH STRATEGY The Cochrane Register of Controlled Trials (CENTRAL), the Cochrane Airways Group Specialised Register Collaboration and Cochrane Airways Group, MEDLINE and EMBASE databases, review articles and reference lists of relevant articles were searched. The date of last search was 7th April 2006. SELECTION CRITERIA All randomised controlled trials on GORD treatment for cough in children and adults without primary lung disease. DATA COLLECTION AND ANALYSIS Results of searches were reviewed against pre-determined criteria for inclusion. Two independent reviewers selected, extracted and assessed data for inclusion. Authors were contacted for further information. Data was analysed as "intention to treat" as well as "treatment received". Paediatric and adults data were considered separately. Sensitivity analyses were performed. MAIN RESULTS Thirteen studies (3 paediatric, 10 adults) were included. Data from six were available for analysis. None of the paediatric studies could be included in meta-analysis. In adults, analysis on use of H(2) antagonist, motility agents and conservative treatment for GORD were not possible (from lack of data) and there were no controlled studies on fundoplication as an intervention. Six adult studies comparing PPI (2-3 months) to placebo were analysed for various outcomes in the meta-analysis. Enrolment of subjects for two studies were primarily from medical clinics and another 4 studies were otolaryngology clinic patients or patients with laryngitis. Using "intention to treat", pooled data from 4 studies resulted in no significant difference between treatment and placebo in total resolution of cough, Odds Ratio 0.46 (95% CI 0.19 to 1.15). Pooled data revealed no overall significant improvement in cough outcomes (end of trial or change in cough scores). Significant differences were only found in sensitivity analyses. A significant improvement in change of cough scores was found in end of intervention (2-3 months) in those receiving PPI with a standardised mean difference of -0.41 (95%CI -0.75, -0.07) using GIV analysis on cross over trials. Two studies reported improvement in cough after 5 days to 2 weeks of treatment. AUTHORS' CONCLUSIONS There is insufficient evidence to definitely conclude that GORD treatment with PPI is universally beneficial for cough associated with GORD in adults. The beneficial effect was only seen in sub-analysis and its effect was small. The optimal duration of such a trial of therapy to evaluate response could not be ascertained in the meta-analysis although two RCTs reported significant change by 2 weeks of therapy. Clinicians should be cognisant of a period (natural resolution with time) and placebo effect in studies that utilise cough as an outcome measure. Data in children are inconclusive. Future paediatric and adult studies are needed whereby studies should be double blind, randomised controlled, parallel design, using treatments for at least two months, with validated subjective and objective cough outcomes and include ascertainment of time to respond as well as assessment of acid and/or non acid reflux whilst on therapy.
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Affiliation(s)
- A B Chang
- Royal Children's Hospital, Respiratory Medicine, Herston Road, Herston, Brisbane, Queensland, Australia.
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Chang AB, Lasserson TJ, Gaffney J, Connor FL, Garske LA. Gastro-oesophageal reflux treatment for prolonged non-specific cough in children and adults. Cochrane Database Syst Rev 2005:CD004823. [PMID: 15846735 DOI: 10.1002/14651858.cd004823.pub2] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Cough is a very common symptom presenting to medical practitioners. Gastroesophageal reflux disease (GORD) is said to be the causative factor in up to 41% of adults with chronic cough. However cough and GORD are common ailments and their co-existence by chance is high. Also cough can induce reflux episodes. Treatment for GORD includes conservative measures (diet manipulation), pharmaceutical therapy (motility or prokinetic agents, H(2) antagonist and proton pump inhibitors (PPI)) and fundoplication. OBJECTIVES To evaluate the efficacy of GORD treatment on chronic cough in children and adults with GORD and prolonged cough that is not related to an underlying respiratory disease i.e. non-specific chronic cough. SEARCH STRATEGY The Cochrane Register of Controlled Trials (CENTRAL), the Cochrane Airways Group Specialised Register Collaboration and Cochrane Airways Group, MEDLINE and EMBASE databases, review articles and reference lists of relevant articles were searched. The date of last search was 4th April 2004. SELECTION CRITERIA All randomised controlled trials on GORD treatment for cough in children and adults without primary lung disease. DATA COLLECTION AND ANALYSIS Results of searches were reviewed against pre-determined criteria for inclusion. Two independent reviewers selected, extracted and assessed data for inclusion. Authors were contacted for further information. Data was analysed as "intention to treat" as well as "treatment received". Paediatric and adults data were considered separately. Sensitivity analyses were performed. MAIN RESULTS 11 studies (3 paediatric, 8 adults; 383 participants) were included. None of the paediatric studies could be included in meta-analysis. In adults, analysis on use of H(2) antagonist, motility agents and conservative treatment for GORD were not possible (from lack of data) and there were no controlled studies on fundoplication as an intervention. Five adult studies comparing PPI (2-3 months) to placebo were analysed for various outcomes in the meta-analysis. Enrollment of subjects for two studies were primarily from medical clinics and another three studies were otolaryngeal clinic patients. Using "intention to treat", pooled data from three studies resulted in no significant difference between treatment and placebo in total resolution of cough. Pooled data revealed no significant improvement in cough outcomes (end of trial or change in cough scores). Significant differences were only found in sensitivity analysis. A significant improvement in change of cough scores was found in end of intervention (2-3 months) in those receiving PPI with a standardised mean difference of -0.41 (95%CI -0.75, -0.07) using GIV analysis on cross over trials. Two studies reported improvement in cough after 5 days to 2 weeks of treatment. Significant heterogeneity was found between studies using omeprazole and other PPIs. AUTHORS' CONCLUSIONS There is insufficient evidence to definitely conclude that GORD treatment with PPI is beneficial for cough associated with GORD in adults. The beneficial effect was only seen in sub-analysis and its effect was small. The optimal duration of such a trial of therapy to evaluate response could not be ascertained in the meta-analysis although two RCTs reported significant change by two weeks of therapy. Clinicians should be cognisant of a period (natural resolution with time) and placebo effect in studies that utilise cough as an outcome measure. Data in children are inconclusive. Future paediatric and adult studies are needed whereby studies should be double blind, randomised controlled, parallel design, using treatments for at least two months, with validated subjective and objective cough outcomes and include ascertainment of time to respond as well as assessment of acid and/or non acid reflux whilst on therapy.
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Affiliation(s)
- A B Chang
- Respiratory Medicine, Royal Children's Hospital, Herston Road, Herston, Brisbane, Queensland, Australia, 4029.
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Malfertheiner P, Hallerbäck B. Clinical manifestations and complications of gastroesophageal reflux disease (GERD). Int J Clin Pract 2005; 59:346-55. [PMID: 15857335 DOI: 10.1111/j.1742-1241.2005.00370.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Gastroesophageal reflux-induced diseases are among the most common disorders and are associated with classical oesophageal manifestations of gastroesophageal reflux disease (GERD) including a range of symptoms such as heartburn, acid regurgitation and chest pain, and also organic manifestations such as oesophagitis, oesophageal strictures and ulcerations, Barrett's oesophagus and oesophageal adenocarcinoma. Recognition of its impact on other organ systems, extra-oesophageal reflux diseases, such as the ear, nose and throat (ENT) region and the bronchopulmonary system, as well as its contribution to symptoms such as chest pain and sleep disturbances, is also increasing. This paper addresses the symptoms, diseases and complications in which the abnormal reflux of gastric content to the oesophagus and adjacent organ systems is believed to be a frequent contributory factor.
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Affiliation(s)
- P Malfertheiner
- Clinic for Gastroenterology, Otto von Guericke University Magdeburg, D-39210 Magdeburg, Germany.
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Allen CJ, Anvari M. Does laparoscopic fundoplication provide long-term control of gastroesophageal reflux related cough? Surg Endosc 2004; 18:633-7. [PMID: 15026893 DOI: 10.1007/s00464-003-8821-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2003] [Accepted: 09/17/2003] [Indexed: 01/25/2023]
Abstract
BACKGROUND Of patients with chronic cough, 21% have GERD. Up to half of these patients may not respond adequately to medical, but the long-term results of antireflux surgery for cough is unknown. METHODS A total of 905 patients (209 with respiratory symptoms, mainly cough) underwent laparoscopic Nissen fundoplication. Preoperatively patients underwent esophageal motility studies, 24-h pH monitoring, and symptom evaluation using a validated scale. Of eligible patients, 81% were followed at 6 months, 73% at 2 years, and 60% at 5 years. RESULTS Before surgery, 83% of respiratory patients (RP) and 51% of nonrespiratory patients (NRP) had cough. RP had higher cough scores ( p < 0.0001), but improvement in cough compared to baseline was similar in the RP and NRP ( p = 0.1105 at 6 months, 0.4206 at 2 years, and 0.1348 at 5 years). Cough improved in 83% at 6 months, 74% at 2 years, and 71% at 5 years. CONCLUSIONS Laparoscopic Nissen fundoplication is successful in the long-term control of GERD-related cough, even in patients who fail medical therapy.
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Affiliation(s)
- C J Allen
- Department of Medicine, St Joseph's Healthcare-McMaster University, 50, Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada
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Abstract
There is no evidence to advocate medical or surgical therapy as the best therapy for GERD. The decision to have antireflux surgery must be individualized. All patients taking long-term medications for GERD should receive advice on the safety and wisdom of staying on that therapy and information on antireflux surgery. Fundoplication should be considered in three circumstances [4]: 1. Patients who are intolerant of PPI therapy because of side effects should be considered for surgery. This situation will be less common now with five PPIs, however. 2. Patients who are poorly responsive to PPI therapy should be considered for surgery. This situation is probably not common, given the effectiveness of the currently available PPIs. It is more common in patients with atypical GERD. The gastroenterologist should be as certain as possible that the patient not only has GERD, but also that the patient's symptoms are reflux related. 3. Surgery should be considered when patients desire a permanent solution to free them of the need to take medications. These patients must be warned about the potential suboptimal results, including the frequent need for medication within a few years of having the procedure and the small but real possibility of becoming worse after the operation. Even in experienced hands, 1% to 2% of patients are worse after the procedure. A careful preoperative evaluation to ensure that the patient's symptoms are reflux related and that the right operative procedure is performed offers the patient the best opportunity for success. Widespread use of endoscopic therapy for GERD is probably still several years away. The best endoscopic therapy is yet to be determined, but it will need to be safe, effective, and easy to use.
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Affiliation(s)
- J Patrick Waring
- Digestive Healthcare of Georgia, 95 Collier Road, Suite 4075, Atlanta, GA 30309, USA
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Tashjian DB, Tirabassi MV, Moriarty KP, Salva PS. Laparoscopic Nissen fundoplication for reactive airway disease. J Pediatr Surg 2002; 37:1021-3. [PMID: 12077762 DOI: 10.1053/jpsu.2002.33833] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Surgical management for gastroesophageal reflux disease (GERD)-induced reactive airway disease in children has been shown to be superior to medical therapy. Laparoscopic Nissen fundoplication is a safe and effective procedure in children. METHODS The authors performed a retrospective review of 24 patients who underwent a laparoscopic Nissen fundoplication for documented GERD and reactive airway disease. RESULTS Persistent cough was the primary symptom in 22 of 24 patients, and all but one had lipid laden macrophages on bronchoscopy. The mean length of hospital stay was 2.7 days. There were no major postoperative complications. Eighteen of 24 patients are symptom free and off all medications an average of 17 months postoperatively. The average medication burden of the 6 remaining patients was reduced from 6.8 to 2.3 medications. CONCLUSIONS Children with reactive airway disease who do not respond to medical therapy should undergo a workup for GERD. These preliminary results suggest that laparoscopic Nissen fundoplication is a potentially effective treatment for pulmonary manifestations of GERD.
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Affiliation(s)
- David B Tashjian
- Division of Pediatric Surgery, Baystate Medical Center Children's Hospital, Tufts University School of Medicine, Springfield, MA, USA
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