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Rodrigo ML, Heubi C, Chiou E, Scheimann A. Laryngeal clefts in Prader-Willi syndrome: Feeding difficulties and aspiration not always caused by hypotonia. Am J Med Genet A 2024:e63634. [PMID: 38619072 DOI: 10.1002/ajmg.a.63634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 03/28/2024] [Accepted: 04/05/2024] [Indexed: 04/16/2024]
Abstract
Feeding difficulties, aspiration, and failure to thrive in infancy are commonly seen in patients with Prader-Willi Syndrome (PWS) and attributed to hypotonia. Patients with PWS and laryngeal clefts were identified by review of medical records at three tertiary care children's hospitals between 2017 and 2022. We present three patients with PWS with feeding difficulties who were also found to have laryngeal clefts which likely contributed to their feeding difficulties. Additional factors such as airway anomalies should be considered in patients with PWS, especially when swallowing dysfunction, dysphagia, or abnormal swallow evaluations are present.
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Affiliation(s)
- Minna L Rodrigo
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Christine Heubi
- Division of Pediatric Otolaryngology - Head & Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Otolaryngology - Head & Neck Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
| | - Eric Chiou
- Division of Gastroenterology, Hepatology and Nutrition, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Ann Scheimann
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Simon D, Watson A, Chiou E. Duodenal Cloverleaf Deformity Associated With Eosinophilic Inflammation. J Pediatr Gastroenterol Nutr 2023; 77:e114. [PMID: 37587557 DOI: 10.1097/mpg.0000000000003916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Affiliation(s)
- David Simon
- From the Division of Pediatric Gastroenterology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
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Krasaelap A, Duncan DR, Sabe RMM, Bhardwaj V, Lerner DG, Gold BD, Boesch RP, Faure C, von Allmen D, Williams D, Chiou E, DeBoer E, Hysinger E, Maybee J, Khlevner J, Larson K, Morris K, Jalali L, McSweeney M, Brigger MT, Greifer M, Rutter M, Williams N, Subramanyan RK, Ryan MJ, Acra S, Pentiuk S, Friedlander J, Sobol SE, Kaul A, Dorfman L, Darbari A, Prager JD, Rosen R, Cocjin JT, Mousa H. Pediatric Aerodigestive Medicine: Advancing Collaborative Care for Children With Oropharyngeal Dysphagia. J Pediatr Gastroenterol Nutr 2023; 77:460-467. [PMID: 37438891 DOI: 10.1097/mpg.0000000000003882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
OBJECTIVES Aerodigestive disorders encompass various pathological conditions affecting the lungs, upper airway, and gastrointestinal tract in children. While advanced care has primarily occurred in specialty centers, many children first present to general pediatric gastroenterologists with aerodigestive symptoms necessitating awareness of these conditions. At the 2021 Annual North American Society for Pediatric Gastroenterology, Hepatology and Nutrition meeting, the aerodigestive Special Interest Group held a full-day symposium entitled, Pediatric Aerodigestive Medicine: Advancing Collaborative Care of Children with Aerodigestive Disorders. The symposium aimed to underline the significance of a multidisciplinary approach to achieve better outcomes for these complex patients. METHODS The symposium brought together leading experts to highlight the growing aerodigestive field, promote new scientific and therapeutic strategies, share the structure and benefits of a multidisciplinary approach in diagnosing common and rare aerodigestive disorders, and foster multidisciplinary discussion of complex cases while highlighting the range of therapeutic and diagnostic options. In this article, we showcase the diagnostic and therapeutic approach to oropharyngeal dysphagia (OPD), one of the most common aerodigestive conditions, emphasizing the role of a collaborative model. CONCLUSIONS The aerodigestive field has made significant progress and continues to grow due to a unique multidisciplinary, collaborative model of care for these conditions. Despite diagnostic and therapeutic challenges, the multidisciplinary approach has enabled and greatly improved efficient, high-quality, and evidence-based care for patients, including those with OPD.
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Affiliation(s)
- Amornluck Krasaelap
- From the Division of Pediatric Gastroenterology, Hepatology and Nutrition, Children's Mercy Kansas City, Kansas City, MO
| | - Daniel R Duncan
- the Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Ramy M M Sabe
- the Department of Pediatric Gastroenterology, Hepatology and Nutrition, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, OH
| | - Vrinda Bhardwaj
- the Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital Los Angeles, Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Diana G Lerner
- the Division of Pediatric Gastroenterology, Hepatology and Nutrition, Medical College of Wisconsin, Milwaukee, WI
| | - Benjamin D Gold
- the Children's Center for Digestive Health Care, LLC, GI Care for Kids, LLC, Aerodigestive Center and Program, Children's Healthcare of Atlanta, Atlanta, GA
| | - Richard Paul Boesch
- the Division of Pediatric Pulmonology, Department of Pediatrics and Adolescent Medicine, Mayo Clinic Children's Center, Rochester, MN
| | - Christophe Faure
- the Division of Pediatric Gastroenterology, Sainte-Justine University Health Center, Université de Montréal, Montréal, QC, Canada
| | - Daniel von Allmen
- the Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Dana Williams
- the Department of Pediatric Gastroenterology and Nutrition, Phoenix Children's Hospital, Phoenix, AZ
| | - Eric Chiou
- the Division of Pediatric Gastroenterology, Hepatology & Nutrition, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
| | - Emily DeBoer
- the Department of Pediatrics, Section of Pulmonary and Sleep Medicine, Children's Hospital Colorado Breathing Institute, University of Colorado Denver, Aurora, CO
| | - Erik Hysinger
- Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Jennifer Maybee
- Children's Hospital Colorado, University of Colorado, Aurora, CO
| | - Julie Khlevner
- the Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian, New York, NY
| | - Kara Larson
- the Division of Otolaryngology, Boston Children's Hospital, Boston, MA
| | - Kimberly Morris
- the Department of Speech Pathology, Rady Children's Hospital, San Diego, CA
| | - Lauren Jalali
- the Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Maireade McSweeney
- the Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Matthew T Brigger
- the Division of Pediatric Otolaryngology, Department of Surgery, Rady Children's Hospital San Diego, University of California San Diego, San Diego, CA
| | - Melanie Greifer
- the Department of Pediatrics, Division of Pediatric Gastroenterology, New York University Grossman School of Medicine, New York, NY
| | - Michael Rutter
- the Division of Pediatric Otolaryngology, Aerodigestive and Esophageal Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Nina Williams
- the Center for Airway Disorders, Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA
| | - Ram Kumar Subramanyan
- the University of Nebraska Medical Center, Children's Hospital and Medical Center, Omaha, NE
| | - Matthew J Ryan
- the Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Sari Acra
- the Division of Pediatric Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, TN
| | - Scott Pentiuk
- the Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | | | - Steven E Sobol
- the Division of Otolaryngology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Ajay Kaul
- the Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Lev Dorfman
- the Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Anil Darbari
- Children's National Hospital, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Jeremy D Prager
- the Department of Otolaryngology, University of Colorado School of Medicine; Pediatric Otolaryngology, Children's Hospital Colorado, Aurora, CO
| | - Rachel Rosen
- the Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Jose T Cocjin
- the Division of Pediatric Gastroenterology, Sainte-Justine University Health Center, Université de Montréal, Montréal, QC, Canada
| | - Hayat Mousa
- the Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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Mukerji SS, Yenduri NJS, Chiou E, Moonnumakal SP, Bedwell JR. A multi‐disciplinary approach to chronic cough in children. Laryngoscope Investig Otolaryngol 2022; 7:409-416. [PMID: 35434349 PMCID: PMC9008181 DOI: 10.1002/lio2.778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 01/02/2022] [Accepted: 01/31/2022] [Indexed: 11/20/2022] Open
Abstract
Objectives (1) To highlight the important causes of chronic and recurrent cough in children. (2) To discuss multidisciplinary approach to management of chronic/recurrent pediatric cough. Methods Review of scholarly articles, guidelines, expert panels via PubMed and Google Scholar. Conclusion Chronic cough (CC) in children is mainly attributed to persistent bacterial bronchitis, asthma, nonspecific cough, and gastroesophageal reflux disease (GERD) symptoms. A multi‐disciplinary approach is cost‐effective and aids with earlier diagnosis and appropriate treatment. Congenital or acquired narrowing of the subglottis is the leading ENT cause for recurrent croup (RC) in children. Laryngeal cleft‐type 1 is commonly seen in children with recurrent aspiration and CC. Children are usually referred to pulmonologists for wet cough not responding to treatment. Eosinophilic esophagitis (EoE) and GERD should be considered in the differential diagnosis of CC in children with both respiratory symptoms and failure to thrive. Level of Evidence: 2a
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Affiliation(s)
- Shraddha S. Mukerji
- Department of Otolaryngology Head Neck Surgery Baylor College of Medicine, Texas Children's Hospital Houston Texas USA
| | - Naga Jaya Smitha Yenduri
- Department of Pulmonary Medicine and Critical Care Baylor College of Medicine, Texas Children's Hospital Houston Texas USA
| | - Eric Chiou
- Department of Gastroenterology and Nutrition Baylor College of Medicine, Texas Children's Hospital Houston Texas USA
| | - Siby P. Moonnumakal
- Department of Pulmonary Medicine and Critical Care Baylor College of Medicine, Texas Children's Hospital Houston Texas USA
| | - Joshua R. Bedwell
- Department of Otolaryngology Head Neck Surgery Baylor College of Medicine, Texas Children's Hospital Houston Texas USA
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Bora V, Olive A, Chiou E, Raj P, Mehta D. Eosinophilic esophagitis with and without airway involvement in children - A comparative analysis. Int J Pediatr Otorhinolaryngol 2020; 139:110422. [PMID: 33049554 DOI: 10.1016/j.ijporl.2020.110422] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/30/2020] [Accepted: 09/30/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Eosinophilic esophagitis (EoE) is an allergic disease characterized by marked eosinophilic infiltration and inflammation of the esophagus eventually leading to esophageal dysfunction. This condition at times may involve the airway leading to breathing difficulties. OBJECTIVE To compare the course of EoE in patients with or without airway involvement. METHODS A retrospective chart review was done on patients with a diagnosis of Eosinophilic Esophagitis and that were managed in our Aerodigestive clinic from 2012 to 2018. A total of 121 EoE patients were included in the study. Each patient's disease course was examined for pertinent information including - but not limited to - age at presentation, allergies, endoscopic and pathology results, treatments prescribed, and time to resolution. The data was analyzed for any differences between the airway and non-airway groups for each of these variables. RESULTS The variables that were analyzed showed no significant difference between patients suffering from EoE with (n = 19) and without (n = 102) airway involvement. However, patients with airway disease trended towards being younger in age at presentation as compared to those without airway symptoms (6.68 years vs. 9.69 years, p = 0.69). Analysis of endoscopic and pathology findings revealed no difference. Similarly, no differences were found between the prescribed treatments. Kaplan-Meier estimates of time to disease remission indicated that 50% of patients had resolution at one year, regardless of airway involvement (p = 0.31). CONCLUSIONS Our findings indicate that the disease course of patients with EoE does not vary depending on the presence of airway symptoms. Thus, patients with airway symptoms should not be diagnosed or treated any different than those without airway symptoms.
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Affiliation(s)
- Varun Bora
- Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA.
| | - Anthony Olive
- Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA; Texas Children's Hospital, 6621 Fannin Street, Houston, TX, 77030, USA.
| | - Eric Chiou
- Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA; Texas Children's Hospital, 6621 Fannin Street, Houston, TX, 77030, USA.
| | - Priya Raj
- Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA; Texas Children's Hospital, 6621 Fannin Street, Houston, TX, 77030, USA.
| | - Deepak Mehta
- Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA; Texas Children's Hospital, 6621 Fannin Street, Houston, TX, 77030, USA.
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Febo-Rodriguez L, Kitagawa S, Chiou E. Colonic Diverticulitis in an Infant With Hemophagocytic Histiocytosis and Prolonged Glucocorticoid Exposure. J Pediatr Gastroenterol Nutr 2019; 69:e19. [PMID: 30247423 DOI: 10.1097/mpg.0000000000002157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Liz Febo-Rodriguez
- Pediatric Gastroenterology Department, Baylor College of Medicine, Houston, TX
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Rokunohe D, Chiou E, Sun X, Tanaka L, Wolin S, Elkon K, Kawasumi M. 084 The role of interferon and retroelements in lupus-prone Ro60 knockout mouse skin. J Invest Dermatol 2018. [DOI: 10.1016/j.jid.2018.03.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Covo S, Chiou E, Gordenin DA, Resnick MA. Suppression of allelic recombination and aneuploidy by cohesin is independent of Chk1 in Saccharomyces cerevisiae. PLoS One 2014; 9:e113435. [PMID: 25551702 PMCID: PMC4281242 DOI: 10.1371/journal.pone.0113435] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 10/23/2014] [Indexed: 12/16/2022] Open
Abstract
Sister chromatid cohesion (SCC), which is established during DNA replication, ensures genome stability. Establishment of SCC is inhibited in G2. However, this inhibition is relived and SCC is established as a response to DNA damage, a process known as Damage Induced Cohesion (DIC). In yeast, Chk1, which is a kinase that functions in DNA damage signal transduction, is considered an activator of SCC through DIC. Nonetheless, here we show that, unlike SCC mutations, loss of CHK1 did not increase spontaneous or damage-induced allelic recombination or aneuploidy. We suggest that Chk1 has a redundant role in the control of DIC or that DIC is redundant for maintaining genome stability.
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Affiliation(s)
- Shay Covo
- Laboratory of Molecular Genetics, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, United States of America
| | - Eric Chiou
- Laboratory of Molecular Genetics, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, United States of America
| | - Dmitry A. Gordenin
- Laboratory of Molecular Genetics, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, United States of America
| | - Michael A. Resnick
- Laboratory of Molecular Genetics, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, United States of America
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Chiou E, Rosen R, Jiang H, Nurko S. Diagnosis of supra-esophageal gastric reflux: correlation of oropharyngeal pH with esophageal impedance monitoring for gastro-esophageal reflux. Neurogastroenterol Motil 2011; 23:717-e326. [PMID: 21592256 PMCID: PMC3139023 DOI: 10.1111/j.1365-2982.2011.01726.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Oropharyngeal (OP) pH monitoring has been developed as a new way to diagnose supra-esophageal gastric reflux (SEGR), but has not been well validated. Our aim was to determine the correlation between OP pH and gastro-esophageal reflux (GER) events detected by multichannel intraluminal impedance-pH (MII-pH). METHODS Fifteen patients (11 males, median age 10.8 years) with suspected GER were prospectively evaluated with ambulatory 24-h OP pH monitoring (positioned at the level of the uvula) and concomitant esophageal MII-pH monitoring. Potential OP events were identified by the conventional pH threshold of <4 and by the following alternative criteria: (i) relative pH drop >10% from 15-min baseline and (ii) absolute pH drop below thresholds of <5.5, 5.0, and 4.5. The 2-min window preceding each OP event was analyzed for correlation with an episode of GER detected by MII-pH. KEY RESULTS A total of 926 GER events were detected by MII-pH. Application of alternative pH criteria increased the identification of potential OP pH events; however, a higher proportion of OP events had no temporal correlation with GER (45-81%), compared with the conventional definition of pH < 4 (40%). A total of 306 full-column acid reflux episodes were detected by MII-pH, of which 10 (3.3%) were also identified by OP pH monitoring. CONCLUSIONS & INFERENCES Use of extended pH criteria increased the detection of potential SEGR events, but the majority of decreases in OP pH were not temporally correlated with GER. Oropharyngeal pH monitoring without concurrent esophageal measurements may overestimate the presence of SEGR in children.
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Affiliation(s)
- Eric Chiou
- Center for Motility and Functional Gastrointestinal Disorders, Children’s Hospital Boston, 300 Longwood Ave., Boston, MA 02115
| | - Rachel Rosen
- Center for Motility and Functional Gastrointestinal Disorders, Children’s Hospital Boston, 300 Longwood Ave., Boston, MA 02115
| | - Hongyu Jiang
- Center for Motility and Functional Gastrointestinal Disorders, Children’s Hospital Boston, 300 Longwood Ave., Boston, MA 02115
,Clinical Research Program, Children’s Hospital Boston, 300 Longwood Ave., Boston, MA 02115
| | - Samuel Nurko
- Center for Motility and Functional Gastrointestinal Disorders, Children’s Hospital Boston, 300 Longwood Ave., Boston, MA 02115
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Chan WW, Chiou E, Obstein KL, Tignor AS, Whitlock TL. The efficacy of proton pump inhibitors for the treatment of asthma in adults: a meta-analysis. ACTA ACUST UNITED AC 2011; 171:620-9. [PMID: 21482834 DOI: 10.1001/archinternmed.2011.116] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Gastroesophageal reflux disease occurs frequently among patients with asthma. Therapy with proton pump inhibitors (PPIs) to improve asthma control remains controversial. We sought to evaluate the efficacy of PPIs in treatment of asthma using objective and subjective outcome measures. METHODS A literature search was undertaken using MEDLINE (1950-January 2010), PubMed (1950-January 2010), EMBASE (1980-January 2010), and Cochrane Central Register of Controlled Trials (through January 31, 2010). Randomized, placebo-controlled trials evaluating the efficacy of PPIs for treatment of asthma in adults were selected. The primary outcome of interest was morning peak expiratory flow (PEF) rate. Secondary outcomes included objective (evening PEF rate and forced expiratory volume in 1 second) and subjective (asthma symptoms score and Asthma Quality of Life Questionnaire score) measures. Influence of study characteristics on outcomes was examined by subgroup analyses and meta-regression. RESULTS Eleven trials (2524 patients) met inclusion criteria. Overall, patients had a higher mean morning PEF rate after treatment with PPIs compared with placebo (mean difference, 8.68 L/min [95% confidence interval, 2.35-15.02]). No significant single large-study effect, temporal effect, or publication bias was seen. Subgroup analysis revealed a trend toward a larger improvement in morning PEF rate in studies enrolling only patients with gastroesophageal reflux disease (mean difference, 16.90 L/min [95% confidence interval, 0.85-32.95]). Analyses of secondary outcomes (asthma symptoms score, Asthma Quality of Life Questionnaire score, evening PEF rate, and forced expiratory volume in 1 second) showed no significant difference between PPIs and placebo. CONCLUSIONS Proton pump inhibitor therapy in adults with asthma results in a small, statistically significant improvement in morning PEF rate. The magnitude of this improvement, however, is unlikely to be of meaningful clinical significance. There is insufficient evidence to recommend empirical use of PPIs for routine treatment of asthma.
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Affiliation(s)
- Walter W Chan
- Division of Gastroenterology, Hepatology, and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115.
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Abstract
Functional abdominal pain (FAP) and irritable bowel syndrome (IBS) are both associated with recurrent abdominal pain and are among the most commonly diagnosed medical problems in pediatrics. The majority of patients with mild complaints improve with reassurance and time. For a distinct subset of patients with more severe and disabling illness, finding effective treatment for these disorders remains a challenge. Based on the biopsychosocial model of functional disease, the Rome III criteria have helped frame FAP and IBS in terms of being a positive diagnosis and not a diagnosis of exclusion. However, the lack of a single, proven intervention highlights the complex interplay of pathologic mechanisms likely involved in the development of childhood FAP and IBS and the need for a multidisciplinary, integrated approach. This article discusses the epidemiology, proposed mechanisms, clinical approach and therapeutic options for the management of FAP and IBS in children and adolescents.
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Affiliation(s)
- Eric Chiou
- Center for Motility & Functional Gastrointestinal Disorders, Children’s, Hospital Boston, 300 Longwood Ave, Boston, MA 02115, USA
| | - Samuel Nurko
- Center for Motility & Functional Gastrointestinal Disorders, Children’s, Hospital Boston, 300 Longwood Ave, Boston, MA 02115, USA
- Author for correspondence: Tel.: +1 617 355 6055,
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Abstract
Functional abdominal pain (FAP) and irritable bowel syndrome (IBS) are among the most commonly diagnosed medical problems in pediatrics. Symptom-based Rome III criteria for FAP and IBS have been validated and help the clinician in making a positive diagnosis. The majority of patients with mild complaints improve with reassurance and time. For a distinct subset of patients with more severe and disabling illness, finding effective treatment for these disorders remains a challenge. Over the years, a wide range of therapies have been proposed and studied. The lack of a single, proven intervention highlights the complex interplay of biopsychosocial factors probably involved in the development of childhood FAP and IBS, and the need for a multidisciplinary, integrated approach. This article reviews the current literature on the efficacy of pharmacologic, dietary and psychosocial interventions for FAP and IBS in children and adolescents.
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Affiliation(s)
- Eric Chiou
- Center for Motility and Functional Gastrointestinal Disorders, Children’s Hospital Boston, 300 Longwood Ave, Boston, MA 02155, USA
| | - Samuel Nurko
- Center for Motility and Functional Gastrointestinal Disorders, Children’s Hospital Boston, 300 Longwood Ave, Boston, MA 02155, USA
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Chiou E, Wu TH. Guiding light in nanomedicine. IEEE Nanotechnology Mag 2008. [DOI: 10.1109/mnano.2008.920049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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McDermott MM, Mandapat AL, Moates A, Albay M, Chiou E, Celic L, Greenland P. Knowledge and attitudes regarding cardiovascular disease risk and prevention in patients with coronary or peripheral arterial disease. Arch Intern Med 2003; 163:2157-62. [PMID: 14557213 DOI: 10.1001/archinte.163.18.2157] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND We compared perceptions regarding risk of cardiovascular events and benefits of cardiovascular disease (CVD) risk factor reduction between patients with peripheral arterial disease (PAD), patients with coronary artery disease (CAD), and patients without atherosclerosis (no disease). METHODS Participants with no disease (n = 142) had a normal ankle-brachial index and no clinically evident atherosclerosis (group 1). The PAD participants (n = 136) had an ankle-brachial index less than 0.90 and no other clinically evident atherosclerosis (group 2). Participants with CAD (n = 70) had a normal ankle-brachial index and a history of heart disease (group 3). Participants were interviewed regarding risk of mortality, CVD, and the importance of CVD risk factor reduction for hypothetical patients with PAD and CAD. RESULTS All groups reported that risks of myocardial infarction, stroke, and death were higher for a patient with CAD than for a patient with PAD. Group 2 was less likely than group 3 to believe that PAD is associated with an extremely high risk of stroke (13.3% vs 28.7%; P =.005) or mortality (10.9% vs 26.6%; P =.003). Group 2 was less likely than group 1 to believe that a patient with PAD has a very high risk of myocardial infarction (13.1% vs 23.8%; P =.02), stroke (13.3% vs 27.5%; P =.003), or mortality (10.9% vs 24.3%; P =.004). Compared with group 3, a smaller percentage of patients in group 2 reported that cholesterol lowering was very important in PAD (57.5% vs 75.8%; P =.005). CONCLUSIONS Compared with other patients, those with PAD underestimated the high risk of cardiovascular events associated with PAD and the benefits of cholesterol-lowering therapy. These findings may help explain the low rates of CVD risk factor control previously reported in patients with PAD.
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Affiliation(s)
- Mary McGrae McDermott
- Departments of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Ill. 60611, USA.
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