Lege Artis Medicinae

[THE INFLUENCE OF GASTROESOPHAGEAL REFLUX DISEASE AND ITS TREATMENT ON ASTHMATIC COUGH]

BÖCSKEI Csaba, VICZIÁN Magdolna, BÖCSKEI Renáta, HORVÁTH Ildikó

SEPTEMBER 20, 2005

Lege Artis Medicinae - 2005;15(08-09)

[INTRODUCTION - Gastroesophageal reflux is known to cause chronic cough and it is also implicated in worsening of asthma. We conducted a prospective study to examine the clinical significance of gastroesophageal reflux disease in asthmatic patients with chronic cough, to analyse the temporal relationship between reflux events and coughing and to assess the effect of esomeprazole treatment on respiratory symptoms and lung function in these patients. PATIENTS AND METHODS - 126 asthmatic patients with chronic dry cough were studied. Diagnosis of gastroesophageal reflux disease was based on typical symptoms and the effectiveness of therapeutic test or on pH monitoring, while control group consisted of the patients without gastroesophageal reflux (negative pH results). The study group patients received the proton pump inhibitor esomeprazole (40 mg/day for three months) and standard treatment for asthma was continued. During the study pulmonary function tests (forced expiratory volume in one second and peak expiratory flow) were evaluated four times and the reflux symptom scores as well, using a questionnaire. RESULTS - The results of pH monitoring showed that 64% of cough episodes were related to acid reflux and in 91% of reflux events preceded coughing. Esomeprazole treatment (40 mg/day for three months) not only diminished gastroesophageal reflux symptoms but also improved asthma outcome measures. Baseline pulmonary function values increased significantly together with a decrease in symptom scores and the use of rescue medication. In most patients included in the extended part of the study for another three months, the dose of inhaled steroids could be reduced with sustained therapy against gastroesophageal reflux. CONCLUSION - Our data shows that reflux events preceded coughing in most cases and that treatment of gastroesophageal reflux disease caused an improvement in different outcome measures of asthma suggest that gastroesophageal reflux disease worsens asthma and its treatment is of clinical importance in the effective management of these patients.]

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[MARITAL STRESS, DEPRESSIVE SYMPTOMS AND CARDIOVASCULAR VULNERABILITY IN WOMEN]

BALOG Piroska, MÉSZÁROS Eszter

[INTRODUCTION - Marital stress and depression have proved to be independent biopsychosocial risk factors for cardiovascular disorders. At the same time their interaction increases cardiovascular vulnerability. The Stockholm Female Coronary Risk Study has shown that marital stress was statistically significantly associated with depressive symptoms, in both groups of healthy women and in patients, even after adjusting for age, educational level, menopausal status, body mass index, cigarette smoking, sedentary lifestyle and the severity of heart failure. METHODS - The aim of this study was to investigate the effect of marital stress on depressive symptoms and psychosocial vulnerability in women with coronary heart disease and in healthy women, cohabiting and currently working. Data were obtained from the Hungarostudy 2002, representing the Hungarian population over the age of 18, according to age, sex and county. RESULTS - The results have shown that an increase in marital stress contributes to an increase in psychosocial vulnerability (depression, anxiety, vital exhaustion, sleep complaints) in healthy women and in women with cardiovascular disorders as well. Higher depression has been related with higher marital stress as well. DISCUSSION - The relation between marital stress and depression seems to be independent from socio-cultural, economical differences: the same results have been found in Hungarian and Swedish women. This relation seems to be bidirectional: a bad marriage increases the prevalence rate of depressive symptoms and depression worsens marital quality. At the end we propose a conceptual framework for how marital stress and depression increases cardiovascular vulnerability in women, emphasizing circular causality.]

Lege Artis Medicinae

[BIVENTRICULAR PACING - A NEW TREATMENT OPTION IN CONGESTIVE HEART FAILURE]

BŐHM Ádám

[Cardiac resynchronisation therapy with biventricular pacing is a new treatment option in patients with moderate-to-advanced heart failure and left bundle branch block. Cardiac resynchronisation therapy leads to improved haemodynamics at diminished energy cost. Beneficial effects include reverse remodelling resulting in decreased heart size and ventricular volumes, improved ejection fraction and decreased functional mitral regurgitation. The haemodynamic improvements are associated with a significantly better quality of life, improved exercise tolerance and less frequent hospitalisation. Several randomised trials have evaluated the short- and longterm effect of biventricular pacing on haemodynamics and clinical parameters and recent preliminary data suggest that cardiac resynchronisation therapy can reduce the mortality. Despite major advances of lead and pacemaker techniques, the implantation of a biventricular pacemaker is still a challenging and complex procedure. To introduce the left ventricular pacing lead into the sinus coronarius may cause difficulties. Approximately one third of the patients do not respond to the therapy, therefore better pre-implant identification of the responders are needed. For patient selection and follow- up echocardiography has a major role.]

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[TRAVEL MEDICINE IN GP PRACTICE]

FELKAI Péter, KOVÁCS Erzsébet

[The authors describe the basic ideas of travel medicine, as a newly introduced interdiscipline of the medical science in Hungary. Recently, this segment is considered to be the part of Insurance Medicine, on the other hand the methods and the practice of the travel medicine is based on the other medical specialities’ knowledge. Due to the growing number of travellers in our country as well as the consequences of the joining Hungary to EU, travel medicine could play an important role in the improvement of the Hungarian travellers’ attitude to their health care status, the prevention against the emerged infectious diseases, and in the medical assistance for the international tourism. Travel medicine also a good guideline for the fit-for-travel considerations, made by the GPs. Hungary with its advantageous geographical position appears to be an excellent stopover for any medical evacuation from East European or other surrounding countries. That is why we would like to establish a first travel medicine facility in central Europe. It is expectable that the Hungarian travellers require more and more information regarding to their health care possibilities and prevention during their trip. The first authentic person is being asked by the patients’ are GPs. The GP’s tasks are: diagnosis and the treatment of travel related diseases, the pre-travel advices. All the mentioned factors are a new challenge for the GPs in Hungary.]

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[TREATMENT OF GASTROESOPHAGEAL REFLUX DISEASE]

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[In the acidic type of gastroesophageal reflux disease treatment is based on the use of proton pump inhibitors. Efficiency of the treatment is primarily assessed by the changes in symptoms. A long-term, continuous drug use is invariably necessary. In typical cases an increased dose or combination therapy is rarely required, however, in the presence of extraesophageal symptoms, the use of higher doses has been found to be beneficial. The minimum efficient drug amount is usually determined by gradually decreasing the dose. Surgery is mainly recommended for young patients, but it is indispensable in the management of complications or in volume reflux. Endoscopic antireflux therapy is still considered a clinical trial. Treatment of Barrett’s oesophagus by drugs or antireflux surgery does not decrease the incidence of Barrett’s cancer - the mostly recommended approach is endoscopic ablation.]

Lege Artis Medicinae

[THE RELATIONSHIP BETWEEN GASTROESOPHAGEAL REFLUX DISEASE AND DAYTIME SLEEPINESS]

VÁRDI Visy Katalin, DEMETER Pál, CSABA Iván, GYULAI Nóra, SIKE Róbert, TÓTH G. Tamás, NOVÁK János, MAGYAR Pál

[INTRODUCTION - Recent studies have shown a potential relationship between gastroesophageal reflux disease and daytime sleepiness. The increased sleepiness is one of the symptoms due to decreased daytime performance caused by the breathing difficulties during sleep. The aim of this study was to analyse the potential relationship between gastroesophageal reflux disease (GERD) and daytime somnolence. PATIENTS AND METHODS - The Epworth Sleepiness Scale was used to assess daytime somnolence for 134 patients undergoing upper panendoscopy and it was correlated to the severity of the endoscopic findings, according to the Savary-Miller classification. Data was analysed witf multivariant linear and logistic regression analysis. RESULTS - A positive tendency was found between reflux disease and daytime somnolence along with the severity of GERD. In the case of the more severe type - Savary-Miller III - the increase of daytime somnolence was significantly higher (p<0,05), than in the case of nonerosive type wich represents the mildest degree of reflux disease. CONCLUSION - According to the results of the study the more severe forms of GERD can influence the effect on daytime somnolence.]

Lege Artis Medicinae

[Atypical forms of the gastroesophageal reflux disease]

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[There is growing interest in the gastroenterology literature towards gastroesophageal reflux disease (GERD) these days. The prevalence of the disease is much higher than estimated earlier and it frequently appears in atypical forms. Literature data suggests that 30-40% of the individuals suffer from gastroesophageal reflux disease. A broad spectrum of presentation of gastroesophageal reflux disease exists, e.g. noncardiac chest-pain, ear-nose-throat symptoms, pulmonary symptoms, dental erosions, chronic cough and hiccups. Atypical forms often cause diagnostic and treatment difficulties. Authors analyze the frequency, morbidity and the pathomechanism of the extraesophageal manifestations, based on self-experience. The main goal of the review is to help to establish the diagnosis of GERD, to recognize its atypical signs and to outline the diagnostic steps to be taken. Most up-to-date treatment strategies are also presented. By the demonstration of interesting cases, authors emphasize the diagnostic importance of intragastric pH-monitoring.]

Lege Artis Medicinae

[NSAID-ASSOCIATED GASTROPATHY: RECENT ASPECTS OF PREVENTION]

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