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?Gastroesophageal Reflux Disease and Airway Disease?

Posted May 05 2009 5:01pm
“Gastroesophageal Reflux Disease and Airway Disease” edited by Dr. Mark R. Stein is a wonderful summary of the intimate relationship shared by these increasingly common 21st century disorders. This book was published under the direction of the National Institute of Health, Bethesda, Maryland. They claim, “Gastroesophageal Reflux Disease (GERD) is arguably the most common disease seen in clinical practice and may present with a multitude of symptoms. An ever increasing body of evidence supports the importance of GERD as a significant factor in both upper- and lower-airway disease. Until now, this information had not been presented in a coordinated volume….This book is designed to fill that void, which is also present in most textbooks on asthma and respiratory diseases.” This volume discusses the common embryologic origin, otolaryngologic, oral (dental) and the intense relationship with GERD and asthma. I am particularly impressed by the body of knowledge presented regarding asthma, neurogenic inflammation and GERD. They discuss nerves that react to acid in the esophagus by directly inducing swelling, mucus production and vasodilatation at the origin of the acid in the esophagus and simultaneously in the trachea. In addition to these direct influences on the airway the contribution of the vagus nerve is examined. “Inflammation is a necessary defense mechanism that serves to protect the body from noxious insults. The precision of the host response to such insults is critical; compromised or insufficient responses can have dire, acute consequences, while exaggerated or prolonged inflammatory responses can precipitate chronic disease. Such exaggerated inflammatory responses might precipitate chronic inflammatory diseases such as rheumatoid arthritis, inflammatory bowel disease, GERD, and asthma”. Chapter 9 points out, in infant cases of severe GERD, “Left untreated, repetitive aspiration can lead to progressive pulmonary dysfunction and ultimately bronchiectasis , pulmonary fibrosis, and death”.
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