Conditions We Treat: Chronic Cough and LPR

Reflux also may occur during the deep inhalation taken before forceful exhalation by a person with asthma. Sinusitus – There is controversy about whether GERD can contribute to chronic sinusitis, although most of the data suggests that there is no relationship. It is more likely that sinusitis and GERD are confused with each other, rather than that GERD causes the sinusitis. Both problems can be associated with sore throats, and chronic cough. Nocturnal Choking – Some people awake an hour or so after going to be with attacks of choking and retching.

Moreover, GER is generally a singular event in time, whereas the vomiting process is commonly several back-to-back events that may ultimately completely empty all stomach contents and yet still persist (“dry heaves”). The difference between GER and GERD (gastroesophageal reflux disease) is a matter of severity and associated consequences to the patient. Treatment for GER and GERD in infants and children include mild elevation of the infant for 15-30 minutes following a feeding, serving smaller but more frequent feedings and thickening of formula or pumped breast milk with rice cereal. In older children, it is worthwhile to maintain a dietary journal to help identify GERD and food relationships.

But the symptoms of LPR are often different than those that are typical of gastroesophageal reflux disease (GERD). Difficulty breathing is one of the more frightening symptoms of acid reflux and the chronic form of the condition, which is called gastroesophageal reflux disease (GERD). GERD can be associated with breathing difficulties such as bronchospasm and aspiration. These difficulties can sometimes lead to life-threatening respiratory complications.

The condition develops when the stomach acid travels back through the food pipe and reaches the back of the throat. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Acid Reflux in (GER and GERD) in Children and Teens, April 2015. GERD and pyloric stenosis If your baby projectile vomits in the first few weeks of life, keep an eye out for symptoms of pyloric stenosis, since it can sometimes be confused with GERD in infants. In addition to forceful vomiting at feedings, symptoms of pyloric stenosis include blood in the vomit, constant hunger, dehydration and constipation.

Reflux, including silent reflux, is extremely common in babies. In fact, it’s estimated that up to 50 percent of infants experience reflux within the first three months of life. Lying on the back means that babies don’t have the benefit of gravity to help keep food in the stomach.

Although acid reflux is a normal, harmless part of infancy, in some infants it can lead to problems that range in severity. With GERD, reflux leaks into the esophagus at a steady rate and is most active during sleep. But in patients with LPR, the reflux occurs more sporadically, occurring maybe three or four times a day during waking hours, Matthews said.

Medications work in different ways and a combination of medications may help to best control your symptoms. Your doctor is the best source of information on how to use these medications. Multiple small meals spread throughout the day is preferable to fewer larger meals. Less food in the stomach at a time will lead to less reflux.

This helps the food in your stomach remain there instead of traveling into your esophagus while you’re sleeping. I’m Dr. David Johnson. Hopefully this is helpful for you, and when you see your next case of laryngopharyngeal reflux, you can make some meaningful differences in these patients going forward. Thanks for listening. So, my plea to you is to take a good voice history, listen to the patient, look for habituation, develop a relationship with a speech-therapy rehabilitation clinician or a laryngologist who has a vested interest in voice.

Talk to your doctor if you have any LPR symptoms. Untreated LPR may eventually lead to voice disorders or throat ulcers, so early treatment is key. Many people have a mysterious cough after eating. It might happen after every meal or only occasionally. There are several possible causes of this, including acid reflux, asthma, food allergies, and dysphagia, which refers to difficulty swallowing.

Work with you doctor to figure out what’s causing your dysphagia. Sometimes simple exercises are enough to fix the problem. In more serious cases, you may need an endoscopic procedure or surgery.

The non-PPI responder is the worst patient to send to an antireflux surgeon. Medical treatment is based on neutralizing stomach acid, reducing or eliminating stomach acid and improving gastric emptying. Neutralizing stomach acid can be achieved by using over-the-counter antacids in liquid or tablet form such as Sucralfate suspension, Maalox, and Ryopan. Reducing or eliminating stomach acids can be achieved with H-2 blockers, which are drugs that depress acid production, such as Cimetadine (Tagamet), Ranitidine (Zantac), or Famotidine (Pepcid). These are also now available over-the-counter at lower dosage.

If there is not a satisfactory response to this maximal treatment, 24 hour pH testing should be done. If there are no symptoms or signs of complications and no suspicion of other diseases, a therapeutic trial of acid suppression with H2 antagonists often is used. If H2 antagonists are not adequately effective, a second trial, with the more potent PPIs, can be given. Sometimes, a trial of treatment begins with a PPI and skips the H2 antagonist. If treatment relieves the symptoms completely, no further evaluation may be necessary and the effective drug, the H2 antagonist or PPI, is continued.

According to the studies in the literature, pathological GERD can be found in 30% to 80% of patients with asthma. On the other hand, patients with esophagitis are more likely to have asthma than patients without esophagitis. In the ProGERD study,[2] the occurrence of asthma depended on longer GERD duration and was more prominent in male and older subjects. The kind of GERD disease, weight and gender did not have significant relationship with asthma.[1] A recent systematic review[3] of 28 epidemiological studies found a 59.2% weighted average prevalence of GERD symptoms in asthmatic patients, compared to 38.1% in controls.

Therefore, the pro-motility agents are reserved either for patients who do not respond to other treatments or are added to enhance other treatments for GERD. Antacids may be aluminum, magnesium, or calcium based. Calcium-based antacids (usually calcium carbonate), unlike other antacids, stimulate the release of gastrin from the stomach and duodenum. Gastrin is the hormone that is primarily responsible for the stimulation of acid secretion by the stomach. Therefore, the secretion of acid rebounds after the direct acid-neutralizing effect of the calcium carbonate is exhausted.

I study all of these patients with pH monitoring. I keep them on therapy during monitoring, but almost never will you find that these patients have ongoing reflux disease. Once we get out of a “restful voice,” the inflammation in the laryngeal area increases. When these patients come in and are already on proton pump inhibitor (PPI) therapy but are not responding, it’s important to take a good voice history.

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January 29, 2015

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