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Reilly's syndrome, Neurogenic Inflammation and Gastric Asthma

Posted Jan 17 2012 8:59pm
Reilly's syndrome (page 258) Illustrated Dictionary of Eponymic Syndromes and Diseases and their Synonyms by Stanley Jablonski (National Library of Medicine)
Synonyms: Reilly's phenomenon, splanchnic vasoplegia, sympathetic irritation syndrome
A syndrome in which experimental irritation of the sympathetic nervous system with various agents, such as allergens, bacterial toxins, and physical irritants, produces vasomotor disorders, increased capillary permeability, edema, and lesions of the reticuloendothelial system.
This little-known syndrome is crucial in the understanding of gastroesophageal reflux disease (GERD), particularly when one considers non-esophageal manifestations of GERD.
The Journal of Respiratory Diseases published an article by Doctors Theodoropoulos & Ledford, “Is GERD a factor in your patient's asthma?". On page 239 they describe vagally mediated reflexes triggered by exposure to stomach acid, or mechanical distention, of the lower esophagus that may explain asthma exacerbations. The epithelial layer of the esophageal mucosa, already thinned by acid erosion, has exposed vagal nerve endings. As stomach contents are refluxed into the esophagus receptors are stimulated and transmit the signal via a neural network to the vagal nerve thereby stimulating bronchospasm. Mast cell degranulation may also contribute to smooth muscle contraction resulting in bronchoconstriction; plasma extravasation, vasodilation, and edema may be present. They go on to point out, “Vagally mediated reflexes and neurogenic inflammation have been proposed explanations for asthma exacerbations occurring in the absence of aspiration. Intra-esophageal installations studies in humans and dogs are consistent with the hypothesis of the vagal reflex triggered by exposure to acid or mechanical distention of the lower esophagus. These observations are supported by embryological evidence that the distal esophagus originates from the lung bud and that the lower esophagus and airway share innervation by the vagus nerve”.
This paradigm explains the inflammation in non-allergic asthma. This has been called "gastric asthma" by some authorities and Reilly's syndrome explains the justification. Here's to seeking the truth. Treat the "cause" and the "effects" go away.
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