Reflux disease

Cough is currently a huge unmet clinical need, as none of the currently available treatments are reliably effective [2]. However, there are many treatments which are currently used, with variable levels of success. In addition, if it is caused by another condition, such as gastro-oesophageal reflux disease, then treatment of that may reduce cough. 

On the pathophysiological side, hyperactive nNOS has been implicated in A/-methyl-D-aspartate (NMDA)-receptor-mediated neuronal death in cerebrovascular-stroke. Some disturbances of smooth muscle tone within the gastrointestinal tract (e.g., gastroesophageal reflux disease) may also be related to an overproduction of NO by nNOS in peripheral nitrergic nerves. 

Gastrin Releasing Peptide Gastroesophageal Reflux Disease (GERD)... 

The proton pump inhibitors are used for treatment or symptomatic relief of various gastric disorders, including gastric and duodenal ulcers, GERD, or pathological hypersecretory conditions. Painful, persistent heartburn 2 or more days a week may indicate acid reflux disease which can erode the delicate lining of the esophagus,... 

Explain the underlying causes of gastroesophageal reflux disease (GERD). 

O GERD can be divided into three distinct categories erosive esophagitis, non-erosive reflux disease, and Barrett s esophagus. 

Adapted from Williams DB, Schade RR. Gastroesophageal reflux disease. In DiPiro JT, Talbert RL, Yee GC, et al, eds. Pharmacotherapy A Pathophysiologic Approach. 6th ed. McGraw-Hill, New York McGraw-Hill 2005 615, with permission. 

Hour ambulatory pH monitoring may be the only way to objectively prove that symptoms are reflux-related in patients with atypical symptoms or non-erosive reflux disease. Ambulatory pH monitoring may also be useful in patients whose symptoms are not improving on adequate doses of acid-suppressing therapy. 

The PPIs are superior to H2RAs in patients with moderate to severe GERD. This includes not only patients with erosive esophagitis or complicated symptoms (Barrett s esophagus or strictures), but also those with non-erosive reflux disease who have moderate to severe symptoms. Symptomatic relief is seen in approximately 83% of patients and healing rates at 8 weeks as judged by endoscopy are 78%.1... 

Patients with Endoscopy-Negative Reflux Disease... 

GERD gastroesophageal reflux disease H2RA histamine2-receptor antagonist LES lower esophageal sphincter... 

DeVault KR, Castell DO. Updated guidelines for the diagnosis and treatment of gastroesophageal reflux disease. Am J Gastroenterol 2005 100 190-200. 

Wong WM, Wong BCY. Definition and diagnosis of gastroesophageal reflux disease. J Gastroenterol Hepatol 2004 19 S26-S32. 

FIGURE 15-2. Approach to the patient presenting with ulcer-like symptoms. GERD, gastroesophageal reflux disease HP Helicobacter pylori ... 

Refer to Chapter 14 on gastroesophageal reflux disease for more information on the PPIs. The PPI omeprazole is superior to both ranitidine and misoprostol for preventing recurrence of NSAID-associated PUD. In one study, omeprazole 20 mg daily was compared to misoprostol 200 meg twice daily for NSAID-associated PUD prevention. At 6 months, the omeprazole-treated group had significantly fewer ulcers than those taking misoprostol. Furthermore, more patients discontinued ulcer prophylaxis in the misoprostol group due to adverse events.26... 

ETEC enterotoxigenic Escherichia coli GERD gastroesophageal reflux disease GI gastrointestinal... 

Father died at age 45 from coronary disease, mother alive at age 62 with type 2 diabetes mellitus, hypertension, hyperlipidemia, and gastroesophageal reflux disease... 

Weight loss, initially intentional through diet and exercise, but now unintentionally excessive Type 2 diabetes, requiring insulin Gastroesophageal reflux disease... 

Gastrointestinal Gastroesophageal reflux disease, gastrointestinal (Gl) bleeding, and abdominal distention. 

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