Diagnosis and treatment of patients with nonacid gastroesophageal reflux-induced chronic cough

Diagnosis and treatment of patients with nonacid gastroesophageal reflux-induced chronic cough

They are abnormal in that they do not accompany swallows and they last for a long time, up to several minutes. These prolonged relaxations allow reflux to occur more easily. The transient LES relaxations occur in patients with GERD most commonly after meals when the stomach is distended with food. Transient LES relaxations also occur in individuals without GERD, but they are infrequent. The first part of the small intestine attached to the stomach.

If the damage goes deeply into the esophagus, an ulcer forms. An ulcer is simply a break in the lining of the esophagus that occurs in an area of inflammation. Ulcers and the additional inflammation they provoke may erode into the esophageal blood vessels and give rise to bleeding into the esophagus. Regurgitation is the appearance of refluxed liquid in the mouth. In most patients with GERD, usually only small quantities of liquid reach the esophagus, and the liquid remains in the lower esophagus.

non acid reflux definition

The best way to take antacids, therefore, is approximately one hour after meals, which is just before the symptoms of reflux begin after a meal. Since the food from meals slows the emptying from the stomach, an antacid taken after a meal stays in the stomach longer and is effective longer. For the same reason, a second dose of antacids approximately two hours after a meal takes advantage of the continuing post-meal slower emptying of the stomach and replenishes the acid-neutralizing capacity within the stomach. Elevation of the upper body at night generally is recommended for all patients with GERD.

GERD Complications

On the other hand, pH monitoring is not helpful in diagnosing nonacid reflux because it monitors acidity as an indirect marker of reflux but not the actual reflux. Therefore, in a patient not responding to PPI treatment, pH monitoring is helpful in identifying individuals who still produce acid while being on a standard or double dose of a PPI, but in whom pH monitoring is not helpful to measure nonacid reflux episodes. However, during the past two centuries, we learned that there is a subgroup of patients with typical reflux-indicating symptoms who respond insufficiently or not at all to PPI treatment, and in whom acid reflux does not seem to be the underlying disease. Present studies (2,3) estimate that this subgroup of PPI nonresponders may be as large as 20% to 30%.

It is noteworthy that symptoms and esophageal lesions do not necessarily exist together. A proportion of patients with erosive esophagitis have no symptoms, whereas 50-85% of patients with typical reflux symptoms have no endoscopic evidence of erosive esophagitis [5]. The latter group of GERD patients is considered to have nonerosive reflux disease (NERD) [1]. Gastroesophageal reflux disease (GERD) is a digestive condition in which the stomach’s contents often come back up into the food pipe. Dietary changes can help to ease symptoms.

To confirm the diagnosis, physicians often treat patients with medications to suppress the production of acid by the stomach. If the heartburn then is diminished to a large extent, the diagnosis of GERD is considered confirmed.

have proposed the symptom association probability (SAP), arguing that this parameter overcomes some of the limitations of the symptom index and symptom sensitivity index. The SAP tries to evaluate if, from a statistical approach, the pattern of reflux and symptoms during the monitoring period may have occurred by chance, or if the association of symptoms and reflux episodes is not by chance. Commercially available software programs have the ability to report the SAP in percentage based on the original methodology described by Weusten et al.

When interpreting the SAP, it is important to remember that this parameter indicates the statistical probability with which symptoms and reflux episodes are associated. Therefore, only a SAP greater than 95% (i.e., the probability of this association having occurred by chance is less than 5%) is considered positive.

EGD is a procedure in which a tube containing an optical system for visualization is swallowed. As the tube progresses down the gastrointestinal tract, the lining of the esophagus, stomach, and duodenum can be examined. Refluxed liquid that passes from the throat (pharynx) and into the larynx can enter the lungs (aspiration).

Uncomplicated GERD may be treated by modification of lifestyle and eating habits in an early stage of GERD. The various agents currently used for treatment of GERD include mucoprotective substances, antacids, H2-blockers, prokinetics and proton pump inhibitors (PPIs). Although these drugs are effective, they do not necessarily influence the underlying causes of the disease by improving the oesophageal clearance, increasing the LESP or reducing the frequency of TLESRs. The following article gives an overview regarding current concepts of the pathophysiology and pharmacological treatment of GERD stressing on pharmacoeconomic issues of the treatment and discusses the advantages and disadvantages for step-up and step-down therapy. Initially, patients can be treated by a proton pump inhibitor (PPI; standard dose, once daily) for 2-4 weeks.

For periods of time the receiver may not receive signals from the capsule, and some of the information about reflux of acid may be lost. Occasionally there is pain with swallowing after the capsule has been placed, and the capsule may need to be removed endoscopically. Use of the capsule is an exciting use of new technology although it has its own specific problems. Before the introduction of endoscopy, an X-ray of the esophagus (called an esophagram) was the only means of diagnosing GERD.

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