Ambulatory pH monitoring of gastro-oesophageal reflux in "morning dipper" asthmatics.

Abstract

premature peripheral vascular disease-that necessitated a hospital stay of more than 30 days they took nearly as long as the elderly (aged 70 and over) to recover sufficiently to leave hospital (mean 50 5 days v 57 3 days). ConclusionsIf efficiency in a surgical service means a high throughput of patients and a low rate of cancellation we have three suggestions.(1) A surgical service might be provided with fewer beds if patients for elective operations were always admitted on the day of operation and discharged at the earliest opportunity and ifelderly patients with chronic illness were transferred to other care. The potential for such economy is, however, only 10% of the average number of beds occupied (3 * 5 of 34 5 in our study).(2) Numbers of beds should not be decreased further: physical removal of beds runs the risk that fluctuations in the need for beds can be accommodated only by cancelling elective admissions.(3) If all surgeons in a district were to increase their throughput the overall cost of health care would be increased and there would be a risk of bankrupting the district health authority. A new system of funding should be set up to encourage efficient surgical units with short waiting lists. Asthmatics with morning dipping had a history of nocturnal wheeze and a higher incidence of reflux symptoms, but measurement of oesophageal pH showed no significant difference in the amount or pattern of reflux when compared with "nondippers."Overall, 15 asthmatics had gastro-oesophageal reflux, and these participated in a randomised, double blind crossover trial of ranitidine versus placebo. No significant difference was found in the peak expiratory flow rates or subjective evaluation of well being of the patients.

No effects of high-dose omeprazole in patients with severe airway hyperresponsiveness and (a)symptomatic gastro-oesophageal reflux

“…These results are in contrast to those of some studies [9][10][11][12][13], but are comparable with those of others [14,15]. The failure to show any benefit in studies has been ascribed to several factors, including insufficient inhibition of acid reflux and the short duration of the study treatment.…”

“…Some studies have indicated that pulmonary symptoms and lung function can be improved by intensive treatment of acid reflux, both by surgery and medical treatment [9][10][11][12][13]; however this has not been confirmed in other studies [14,15]. The discrepancy between outcomes may result from the fact that these studies did not consider airway hyperresponsiveness as an inclusion criterion or an end parameter.…”

Effect of omeprazole and domperidone on adult asthmatics with gastroesophageal reflux

“…GERD is more prevalent in asthmatics compared with control populations and asthmatics frequently associate GERD symptoms with their asthma symptoms. Previous studies have estimated the prevalence of GERD in adult asthmatics at between 34% and 80% [8][9][10] . Asthma symptoms also correlated with esophageal pH events on 24-h esophageal pH monitoring [11] .…”

A Proton Pump Inhibitor, Lansoprazole, Ameliorates Asthma Symptoms in Asthmatic Patients with Gastroesophageal Reflux Disease

“…There have been many studies dealing with asthma outcome and medical anti-reflux therapy. Field and Sutherland (1998) reviewed the previously published data on medical anti-reflux therapy with H 2 -receptor blockers (H 2 blockers), cimetidine (Goodall et al 1981;Larrain et al 1991) and ranitidine (Harper et al 1987;Nagel et al 1988;Ekstrom et al 1989;Gustaffson et al 1992), and with a proton pump inhibitor (PPI) omeprazole (Ford et al 1994;Meier et al 1994;Harding et al 1996;Teichtahl et al 1996), showing that asthma symptoms were improved. Kiljander (2003) suggested that, in the management of GERD-related asthma, PPIs other than omeprazole should be used at double the standard dose.…”