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There are some controlled studies which have been reported comparing H2-receptor antagonists and fundoplication

There are some controlled studies which have been reported comparing H2-receptor antagonists and fundoplication. threshold of pH 4 has been questioned [34-37]. Impedance monitoring can detect both acid and non acid reflux and is very useful especially in patients who are resistant to PPI therapy. Blondeau reported a case of cough induced by omeprazole, therefore physicians should be alert to the possible onset or exacerbation of cough during PPI therapy [45]. On the basis of current knowledge, other causes of cough should be investigated in patients who do not respond to PPI therapy and the role of non acid reflux should be defined. Recent studies suggest that impedance-pH monitoring with careful analysis of the symptom-reflux temporal relationship may help to select the right patients who can truly benefit from treatment of GERD [46,47]. In the case of unfavorable results during the investigation off therapy, we should avoid PPIs and repeat pH-impedance monitoring after 6-12 months [18]. A recent follow-up study showed that most of patients with chronic cough experienced improved after 2 years [48]. The empirical therapy with PPI usually double dose for at least three months is the most common approach. Baldi have found that a four-week trial of double-dose PPI therapy appeared to be an effective criterion for selecting Miglitol (Glyset) those patients who will respond well to standard PPI therapy. More than 80% of those patients who responded to PPI therapy experienced a positive response to the initial trial [28]. In patients who have documented reflux and do not respond to PPI therapy, it is proposed to perform a pH-impedance monitoring on therapy and define the role of non acid reflux. Antireflux surgery may be the solution for patients with refractory acid or non acid reflux and a good temporal correlation between reflux events and symptoms. Allen and Anvari analyzed surigical treatment of GERD in treating chronic cough and reported that laparoscopic Nissen fundoplication is effective in the control of cough in patients with GERD, with or without main respiratory disease. After surgery, half of the patients experienced complete resolution and one third experienced significant improvement of their cough. In addition, it has been shown that this response to surgical treatment may be dependent on the presence of common GERD symptoms [50]. Further investigation should be conducted to determine the role of reflux inhibitors such as baclofen and lesogabaren in patients with chronic cough [51-55]. Additionally, some centrally acting agents such as morphine and gabapentin may have therapeutic benefit in these patients by inhibition of the esophago-bronchial reflex and central sensitization [56,57]. GERD-related asthma Asthma and GERD are frequently associated, as it is usually concluded by a systematic review of studies [58]. It has Miglitol (Glyset) been shown that asthma patients do indeed go Rabbit Polyclonal to ZNF420 on to develop GERD, but an increased incidence of asthma in patients with GERD should be considered controversial [58]. Asthmatic patients whose symptoms are getting worse after meals, and or patients who do not respond to anti-asthmatic therapy should be suspected of having GERD-related asthma. Similarly, patients who have GERD symptoms before the onset of asthma symptoms should be considered to have reflux induced asthma [59]. Kiljander found that slightly more than half of asthmatic patients experienced abnormal esophageal acid exposure by pH monitoring. However, one third of these patients experienced no common reflux symptoms [60]. Additionally, Legett analyzed patients with difficult to control asthma by using 24-h pH monitoring with distal and proximal pH probe [61]. It has been shown that this prevalence of reflux at the distal probe was 55% and at the proximal probe 35%. A large population-based epidemiological investigation showed that subjects with the combination of asthma and GERD experienced a higher prevalence of asthma Miglitol (Glyset) and respiratory symptoms as compared to patients without reflux symptoms [62]. Moreover, Sontag reported that compared to controls, asthmatics have significantly more frequent and more severe day and night reflux symptoms and significantly more of the pulmonary symptoms attributed to GERD [63]. You will find two proposed mechanisms that can explain the correlation between GERD and asthma. Direct contact of gastric acid with the upper airway, in some cases due to microaspiration, and a vagovagal reflex brought on by acidification of the distal portion of the esophagus can cause bronchospasm [64]. The relationship between GERD and airway hyperactivity can be detected using provocation assessments during lung function assessment. Airway hypersensitivity can occur in parallel with GERD. This can be exhibited with capsaicin or citric acid tests. Whether increased GER can provoke such hypersensitivity is still controversial. Moreover, it has been shown that.