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Faisal Anshuman

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Up to 80% of asthmatic subjects have abnormal acid reflux. The Asthma Clinical Research Centers group of the American Lung Association studied asthmatic patients with poor symptom control who were already receiving treatment with inhaled corticosteroids and who did not present the typical symptoms associated with reflux They found no improvement in asthma control after they added a dose of esomeprazole every 12 hours. Patients in this study underwent ambulatory pH monitoring prior to treatment.

40% of patients had abnormal acid reflux, however they did not show a trend to respond better to therapy than patients with normal acid reflux. The authors wrongly concluded that acid reflux was not a problem in asthma, when in fact their data only supports the idea that acid reflux is not important. The current guidelines suggest that a therapeutic attempt with a PPI is valid, however these results do not demonstrate an improvement in asthmatic symptoms.

There is a similar situation in laryngitis. There were no differences in the resolution of laryngeal symptoms or signs of laryngopharyngeal reflux between patients who were receiving placebo and those who were receiving treatment with the PPI.

There are three pathophysiological facts that have not been considered in the case of asthma and reflux laryngitis.

The mechanical barrier is maintained by the LES. The fundamental underlying mechanism of GER has been recognized as theRTTEEI.

Preclinical studies have identified several targets for modification of RTTEEI. The central cholinergic blockade could be related to the inhibition of the occurrence of GER.

In ferrets, Blackshaw found that the gastric vagal mechanoreceptors are an optimal target for therapeutic intervention. Its response to stretching is potently affected by two drugs.

The effects prevent the occurrence of reflux in animal and human models. Both types of drugs could be used in the treatment of GER79. Baclofen reduces the frequencies of RTTEEI by more than 50%80. Poor tolerance of its side effects is the biggest problem with baclofen. Lesogaberan is a potent drug.

It is taken up in the lab by the B receptors of the GABA (B) system, which keeps the central nervous system low in extracellular levels. The reduction in TEEIRTs 81 has resulted in a reduction in reflux episodes in the phase I and IIa trials.

Domperidone and metoclopramide have been used as prokinetic agents. There were 214 patients with chronic cough and 56 had GER-related cough.

Only 24 of the 56 patients responded to therapy alone. Eighteen patients improved with the addition of metoclopramide. In the year 2000 it became necessary to use metroclopramide, bethanechol or erythromycin in prokinetic therapy for the treatment of gastroesophageal reflux after the withdrawal of cisapride. Sifrim et al studied the effects of azithromycin on gastroesophageal reflux and found that it reduced acid content and volume exposure in lung transplant patients, as well as the number of reflux events.

The risk of aspiration is reduced with the decrease in bile acids found in the bronchoalveolar lavage.

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