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Article
Etiologies of chronic cough in adult patients: Is it hard to be diagnosed?

Author: Mohammad Yahya Abdul-Razaq محمد يحيى عبد الرزاق
Journal: Al-Kindy College Medical Journal مجلة كلية الطب الكندي ISSN: 18109543 Year: 2011 Volume: 7 Issue: 2 Pages: 45-50
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: Chronic cough is often the key symptom not only of chronic pulmonary diseases but for other important extrapulmonary pathologies, in particular upper airway and gastrointestinal diseases. Objective: This study was designed to determine the etiology of chronic cough and the usefulness of the available diagnostic tests in reaching its causes. Methods: One hundred patients presenting with chronic cough at Baghdad Teaching Hospital Outpatient Clinic were enrolled in this study. The patients underwent a full clinical interview, physical examination with indicated diagnostic test(s) (such as chest x ray, bronchoscope, PFT, GIT study, sinus X ray or CT). Results: An etiology of chronic cough was determined in 93% of the patients. Post nasal drip is the leading cause of chronic cough reported in 31% of the patient, while asthma gastro-esophageal reflux disease, and chronic bronchitis seen in (26, 20, and 6 % respectively). The diagnosis of chronic cough can be reached by comprehensive history, proper physical examination, and chest X ray findings in 66 % patients, further more sophisticated and invasive tests like: PFT, upper GIT study , expectorated sputum examination (AFB, Gram staining, cytology), fibrooptic bronchoscope, and full ENT evaluation including sinuses X ray or sinuses CT scanning, are need in the rest. Conclusion: The etiology of chronic cough can often be diagnosed safely with a simple initial evaluation (history, physical examination and chest X-ray). Postnasal drip, asthma and gastroesophageal reflux disease account for the etiology in more than three quarter of the patients.


Article
Lower Esophageal and Gastroesophageal Junction Mucin Histochemical Changes in Patients with Gastroesophageal Reflux Disease
تغيرات المخاطين الكيميانسيجية لاسفل المرئ والأتصال المريئي المعدي في مرضى الأرتداد المعدي المريئي

Authors: Esraa A. AL-Dujaily --- Rehab H.Al-Mudhfer --- Hadeel A. Kerbel --- Liwaa H. Al-Kelabi
Journal: Medical Journal of Babylon مجلة بابل الطبية ISSN: 1812156X 23126760 Year: 2011 Volume: 8 Issue: 2 Pages: 178-189
Publisher: Babylon University جامعة بابل

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Abstract

Background: Gastro esophageal reflux disease (GERD) is a common entity worldwide including Iraq, where by 8% of normal population described typical symptoms of GERD. About 14% of patients with dyspepsia referred for upper GI endoscopy were found to have GERD. It is associated with complications including higher incidence of lower esophageal adenocarcinoma. Many studies have clearly demonstrated that this risk is directly related to the occurrence of IM in the lower esophagus so-called (Barrett esophagus) because of injurious effect of regurgitated acid peptic secretion over a long duration the squamous epithelium become replaced by columnar epithelium which is more resistant for acidic content of gastric juice and serve as a protection for the lower esophagus. Mucin histochemistry has been found a useful method to define type and distribution of glycoprotein in the GIT, and thus to define GERD patients at risk of neoplasia. Aims of the study:1-To show the histopathological changes of lower esophagus and GEJ in patients with GERD.2-To study the mucin histochemical changes in GEJ and lower esophagus and tackle the controversy concerning the nature and significance of mucin profile in this area.Patients and methods: The study was conducted on 30 patients suffering from symptoms suggestive of GERD as study group, with additional 10 patients taken as a control group who suffered from symptom other than GERD. Endoscopic biopsies were taken from GEJ and lower esophagus about 2 cm proximal to GEJ. The histopathological features of all cases were reviewed with emphasize on squamous epithelial changes (including intra epithelial eosinophiles , basal cell hyperplasia > 20% of mucosal thickness , papillary elongation > 70% of mucosal thickness) and metaplastic , dysplastic and carcinomatous changes. PAS diastase and combined alcian blue-aldehyde fuchsin stains were used to detect Mucin histochemical changes in the studied groups.Results: Our study revealed the presence of intra epithelial eosinophiles with basal cell hyperplasia > 20% of mucosal thickness were significantly associated with GERD in 70% of patients. By using special Mucin stains incomplete IM type IIB was found in 5 patients (16.7%) with GERD. Conclusions: Basal cell hyperplasia and intraepithelial eosinophiles are frequent histological findings in biopsies of patients with GERD. Mucin histochemistry is a useful method to define IM in esophageal and junctional biopsies. However the presence of IM type IIB does not correlate with the severity of endoscopic findings in GERD.

خلفية البحث: إن مرض الارتداد المعدي ألمريئي شائع الحدوث في العالم و بضمنه العراق ، حيث إن 8% من السكان يعانون من أعراض قياسية لهذا المرض, ان حوالي 14% من المرضى المحالين إلى وحدة الناظور العلوي للقناة الهضمية و الذين يعانون من عسر الهضم مصابين بهذا المرض بعد التشخيص الناظوري له. إن هذا المرض يحمل الكثير من المضاعفات والتي منها الورم السرطاني الغدي. اثبتت الدراسات المتعددة ان هذا الخطر متعلق بالحؤول المعوي في اسفل المرئ و هو ما يسمى بمرئ باريت.إن دراسة المخاطين الكيميانسيجية تعتبر طريقة مفيدة للتعرف على نوع و توزيع الغليكوبروتين في القناة الهضمية و كنتيجة لذلك يمكن التعرف على مرضى الارتداد المعدي ألمريئي المعرضين لخطر التنؤ.هدف الدراسة:1.بيان التغيرات النسيجية المرضية المصاحبة لمرض الارتداد المعدي ألمريئي.2.دراسة تغيرات المخاطين الكيميانسيجية في أسفل المرئ ومنطقه الاتصال ألمريئي لمعالجة الجدل المتعلق بطبيعة و خصوصية مظهر المخاطين في هذه المنطقة.المرضى و طرائق العمل: أجريت الدراسة على 30 مريضا يعانون من أعراض مقترحة لمرض الارتداد المعدي ألمريئي و 10 مرضى لا يعانون من هذا المرض بل من أعراض أخرى في القناة الهضمية كمجموعة سيطرة و باستخدام الناظور العلوي للقناة الهضمية أخذت خزعتين من منطقة الاتصال ألمريئي المعدي و خزعتين أخرى من مسافة 2 سم أعلى منطقة الاتصال و اعيد الفحص النسيجي للخزع مع التأكيد على التغيرات الحاصلة في الخلايا الحرشفية والتي تشمل وجود الكريات البيضاء الحمضية بين الخلايا الطلائية، فرط تنسج للخلايا القاعدية أكثر من 20% ، تطاول حلمي لأكثر من 70% من سمك الغشاء المخاطي ، حؤول و سرطان غدي. استعملت (صبغة الالشين الأزرق الممزوجة مع صبغة الالديهايد فيوسين، و صبغة الحامض الدوري مع كاشف شفس) للكشف عن التغيرات الكيميانسيجية في مجموعة الدراسة.النتائج: وجدت الدراسة و بأهمية إحصائية إن هناك 70% من الحالات المرضية المأخوذة تظهر وجود الخلايا الحمضية في داخل خلايا النسيج الظهاري الحرشفي في أسفل المرئ مع وجود فرط نمو طبقة الخلايا القاعدية و باستعمال الصبغات الخاصة بالمخاطين(الميوسين) وجد إن هناك 16.7% (5 مرضى ) من مختلف درجات مرض الارتداد المعدي ألمريئي يعانون من حالة الحؤول المعوي لأسفل المرئ من نوع 2ب غير الكامل. الاستنتاجات: يعتبر فرط النمو القاعدي ووجود الخلايا الحمضية بين خلايا النسيج الظهاري الحرشفي ظاهرة متكررة في الاستكشافات النسيجية لخزع المرضى المصابين بالارتداد المعدي ألمريئي.يعتبر الفحص الكيميانسيجي للمخاطين طريقة مفيدة لتحري الحؤول المعوي في الخزعات المريئية و الخزعات المأخوذة من منطقة الاتصال المعدي ألمريئي. بالرغم من ان وجود الحؤول المعوي نوع 2ب غير الكامل لا يرتبط مباشرة بخطورة نتائج فحص الناظور لمرضى الارتداد المعدي ألمريئي.


Article
Prospective study on effect of Helicobacter pylori on gastroesophageal reflux disease
دراسة مستقبلية عن تأثير هيليكوباكتر بايلوري على مرض الجزر المعدي المريئي

Author: Sabah Jalal Shareef
Journal: Zanco Journal of Medical Sciences مجلة زانكو للعلوم الطبية ISSN: 19955588/19955596 Year: 2017 Volume: 21 Issue: 2 Pages: 1696-1700
Publisher: Hawler Medical Univeristy جامعة هولير الطبية

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Abstract

Background and objective: The Helicobacter pylori infections role in etiology of peptic ulcer is well known, but its role in gastroesophageal reflux disease is one of the important issues which has to be confirmed. We tried to find out the effect of Helicobacter pylori infection on gastroesophageal reflux disease.Methods: The current study was done on 100 patients with gastroesophageal reflux disease from January 1st to June 30th, 2014 in Rizgary Teaching Hospital, Erbil city. The diagnosis was made by history, clinical examination, and endoscopy. Helicobacter pylori infection was confirmed by gastric biopsy and histopathological examination. We tried to find out the effects of Helicobacter pylori infection in gastroesophageal reflux disease patients and its eradication on their symptoms. The data was analyzed with the statistical package for the social sciences (version 18).Results: The mean age ± SD of participants was 37.13 ± 12.5 (17-75 years). The prevalence of Helicobacter pylori infection was 75%. The endoscopy showed that 50 out of 75 patients had erosive esophagitis and 25 out of 75 patients had normal appearance known as non-erosive esophagitis. The study showed no significance of its eradication on symptoms of gastroesophageal reflux disease.Conclusion: The effect of Helicobacter pylori infection in gastroesophageal reflux disease patients was significant regarding endoscopic finding while inversely related to symptoms severity. The eradication of infection did not cause improvement in symptom severity i.e. triple therapy not advised in the course of treatment.


Article
Spirometric evaluation of gastroesophageal reflux disease (gerd) associated cough and asthma
تقييم وظائف الرئة لمرضى الجزر المعدي المريئي المترافق مع السعال والربو

Authors: Shaimaa A. H. Jassim شيماء عبد الهادي --- Afraa M. AL-Ameen عفراء محمد --- Amjad F. Ahmad امجد فوزي
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: 00419419 Year: 2014 Volume: 56 Issue: 4 Pages: 422-425
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: Gastroesophageal reflux disease can lead to esophageal complications, including esophagitis, ulceration, stricture, hemorrhage, and Barrett's esophagus. However, the spectrum of problems associated with GERD has expanded to extra esophageal sites. Chronic cough and asthma are two clinical problems caused or triggered by GERD. Spirometric changes among GERD associated cough and asthma still a topic of ongoing research.Objectives: This study was designated to evaluate the spirometric picture of GERD associated cough and asthma subjects in relation to different clinical aspects of the disease including body mass index (BMI), disease duration, presence or absence of symptoms as well as endoscopic findings. Subjects and methods: Ninety adult subjects (90) of either sex with a mean age of 40.5±12 year are involved in this study. Fifty five (55) GERD associated cough and asthma subjects served as test group while the remaining (35) served as control group. Each subject underwent spirometry and gastric endoscopy in Pulmonary Function and Endoscopy Units respectively at Ibn-Sina Teaching Hospital /Mosul.Results: Spirometric data of the control group were within the normal predicted range (80-120%) thus excluding the possibility of any asymptomatic obstructive airway disease. Whereas, the measured spirometric parameters (forced vital capacity (FVC), forced expiratory volume in 1 second ratio (FEV1%), peak expiratory flow (PEF), and forced mid expiratory flow(FMF) are significantly reduced in the test group with a clear restrictive pattern among the overweight subjects. In addition, neither the presence nor duration of symptoms affected the spirometric picture of the GERD associated cough and asthma subjects, unlike those with positive endoscopy findings who revealed significant obstructive pattern when compared to those with negative endoscopy findings. Conclusions: GERD associated cough and asthma subjects with positive endoscopy findings showed obstructive pattern of spirometry irrelevant to the presence or absence of symptoms or duration of the disease.Key words: Gastroesophageal Reflux Disease, chronic cough, asthma.

الخلفية :إن الجزر المعدي المريئي قد يؤدي إلى مضاعفات في المرئ مثل الالتهاب , تقرحات ,تضيق ونزف المرئ وممكن أن تمتد ھﺬه المشاكل إلى أجزاء خارج المرئ وقد تكون سببا في السعال المزمن والربو القصبي .الأهداف :تقييم صورة وظائف الرئة في مرضى الجزر المعدي المريئي المرتبط بالسعال والربو القصبي وعلاقتها مع مؤشر كتلة الجسم , مدة المرض ووجود أو غياب الأعراض مع نتيجة فحص التنظير الداخلي .الاشخاص وطريقة العمل :تم اختيار تصميم دراسة المقطع العرضي الوصفي واجريت الدراسة في مستشفى ابن سينا التعليمي في الموصل . شملت الدراسة تسعون شخصا تتراوح اعمارهم بين (19- 65 سنة) من كلا الجنسين 35 شخصا كعينة ضابطة و55 مريضا يعانون من الجزر المعدي المريئي والسعال والربو وبعد أخذ جميع المعلومات اجري فحص وظائف الرئة لجميع المشمولين بالدراسة ثم اجري للمرضى ناظور المعدة .النتائج:أظهرت نتائج وظائف الرئة للعينة الضابطة أنها ضمن المدى الطبيعي (80-120%)مما يؤكد عدم وجود أي مرض في الرئة بينما كانت نتائج وظائف الرئة (FVC و ( FMF, PEF,FEV1% للمرضى منخفضة معنويا مع وجود تحدد واضح في وظائف الرئة لدى المرضى ذوو كتلة الجسم العالية .و وجود نمط انسدادي في وظائف الرئة لدى المرضى اللذين كان فحص الناظور موجب بالمقارنة مع المرضى اللذين كان فحص ناظور المعدة لهم سالب. الاستنتاج: إن وظائف الرئة لمرضى الجزر المعدي المريئي ذوو نتيجة ناظور معدة موجبة أظهرت نمط انسدادي بغض النظر عن وجود أو غياب اعراض المرض أو مع مدة المرض .انخفاض قيم وظائف الرئة للمرضى اللذين كانوا يعانون من الجزر المعدى لفترة اطول من ثلاثة اشهر عند مقارنتهم مع المرضى اللذين كانت فترة مرضهم اقل. مفتاح الدلالة:الجزر(الاسترجاع) المعدي المريئي ,السعال المزمن ,الربو.

Keywords

Background: Gastroesophageal reflux disease can lead to esophageal complications --- including esophagitis --- ulceration --- stricture --- hemorrhage --- and Barrett's esophagus. However --- the spectrum of problems associated with GERD has expanded to extra esophageal sites. Chronic cough and asthma are two clinical problems caused or triggered by GERD. Spirometric changes among GERD associated cough and asthma still a topic of ongoing research. Objectives: This study was designated to evaluate the spirometric picture of GERD associated cough and asthma subjects in relation to different clinical aspects of the disease including body mass index --- BMI --- disease duration --- presence or absence of symptoms as well as endoscopic findings. Subjects and methods: Ninety adult subjects --- 90 of either sex with a mean age of 40.5±12 year are involved in this study. Fifty five --- 55 GERD associated cough and asthma subjects served as test group while the remaining --- 35 served as control group. Each subject underwent spirometry and gastric endoscopy in Pulmonary Function and Endoscopy Units respectively at Ibn-Sina Teaching Hospital /Mosul. Results: Spirometric data of the control group were within the normal predicted range --- 80-120% thus excluding the possibility of any asymptomatic obstructive airway disease. Whereas --- the measured spirometric parameters --- forced vital capacity --- FVC --- forced expiratory volume in 1 second ratio --- FEV1% --- peak expiratory flow --- PEF --- and forced mid expiratory flow --- FMF are significantly reduced in the test group with a clear restrictive pattern among the overweight subjects. In addition --- neither the presence nor duration of symptoms affected the spirometric picture of the GERD associated cough and asthma subjects --- unlike those with positive endoscopy findings who revealed significant obstructive pattern when compared to those with negative endoscopy findings. Conclusions: GERD associated cough and asthma subjects with positive endoscopy findings showed obstructive pattern of spirometry irrelevant to the presence or absence of symptoms or duration of the disease. Key words: Gastroesophageal Reflux Disease --- chronic cough --- asthma. --- الجزرالاسترجاع --- المعدي المريئي --- السعال المزمن --- الربو.

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