Side Effect of Advair or some other disease? Best answer on the web
using Advair over 9 months ago.
Symptoms began the first week of using Advair: Symptoms included loss
of voice, thick phlegm, loss of gag reflex and itching/pulling at the
back of the throat.
(AdVair usage was for 2 months only while it felt like all it did was
collapse my lungs and make me unable to breathe more and more)
Symptoms for 2 months later included: Thick yellow/green or red/brown
phlegm, constant rippig feeling at the back of my throat, supposed
Sinusitis/Post-Nasal Drip, dryness of the mouth and constant loss of
gag reflex (while pushing the back of my throat would help relieve the
aching and pain)
Symptoms from months 3-9/Present: Pulling, pushing sensation at the
back of the throat, terrible acidic taste in the morning as well as
the taste of food during the day, constant popping & gurgling of the
esophagus, uncontrollable burping, pain on the sides as well as the
tops of the areas near my lungs, constant trouble breathing, dryness
of the throat (warm water feels good for this-cold water only makes it
worse), constant scratching/painful feeling on the back of the throat,
a barbed wire feeling at the back of my mouth and Severe trouble
sleeping.
Tests have included: Barium swallow, upper esophageal testing, the
regular scope, the looking at my vocal cords and beginning of trachea
through my nose, Bravo pH Test, CAT scan, 2 X-Rays, Prilosec, Zegerid,
Levaquin, Mucinex, Moxomicillan, muscle relaxant and finally Reglan.
Ruled out diseases include: GERD, Post-Nasal Drip, Sinusitis and
basically all other diseases of the esophagus.
Current diagnosis from around 7 different doctors: Unknown, try to
take the Reglan and wash the back of your throat with Listerine.
What should I do? It's been 9-10 months now and no doctor knows what
this is -- Are there any other side effects like this or is there any
disease that exhibits all of these symptoms (it is NOT GERD)
Would you like to know about this as an answer?
tutuzdad-ga
I?ve gathered a list of possibilities, but as you know, we can?t diagnose online. Your doctors sound right on track, by looking at the tests you have had. Remember tests are not infallible and sometimes further testing is necessary. You don?t indicate if your nasal passages/sinuses were cultured, of if you were checked for nasal polyps. I would consider revisiting some of the diagnostic tests and also look to reconsidering the diagnosis. Keep in mind that all symptoms do not appear as described in all patients. Each case is different, depending on age and general medical history.
Some of the information I?ve included, you have already ruled out. Mind you, what has been ruled out appears to be the most likely causes however. I?ve come up with some several other possibilities. Beyond what I have found, I?d have to suggest further testing.
Please read each site posted for further information.
?Abstract A prospective radiologic-endoscopic study of the esophagogastric region in 266 patients, including 206 normals and 60 with esophagitis, is reported. The endoscopic classification grading severity of esophagitis was grade 1 ? normal; grades 2, 3, and 4 ? mild, moderate, and severe esophagitis, respectively. Radiology detected 22% of patients with mild esophagitis, 83% with moderate esophagitis, and 95% with severe esophagitis. Although hiatal hernia was present in 40% of normals and 89% with esophagitis, absence of radiographic hiatal hernia excluded esophagitis with 95% accuracy. The implications of this study regarding the role of radiology in evaluating patients with suspected reflux esophagitis are discussed.? http://www.springerlink.com/content/t591761l926qk024/
?Like "achalasia," "hiatus hernia" is an example of a wrong name paralyzing thinking about a disorder. Because they are called hernias, "hiatal hernias" are lumped in with inguinal, femoral and ventral hernias. We tend to assume that our instructors gave us the correct names for things!
Standard references do not even discuss their pathogenesis. It is simply taken for granted. After reviewing 636 references, Postlethwait(7) concludes they are due to increased intra-abdominal pressure in combination with weakness of the supporting structures.(8) Even a group(9) that reported experimental production of hiatus hernia by vagal stimulation concluded that most were due to increased intra-abdominal pressure. A recent review(10) lists 17 possible causes, except for increased intra-abdominal pressure, most of them nonspecific.
The central problem of "hiatus hernias" (HH), therefore, is to prove that they are not hernias. Instead, I must show that the condition is a traction phenomenon - that the fundus is drawn above the diaphragm by the tractive force of longitudinal muscle contraction (LMC).? http://www.mailbag.com/users/oesophagus/webdoc2.htm
Advair
=======
Generic Name: fluticasone and salmeterol (floo TIK a sone, sal ME te rol)
?Fluticasone is a steroid. It prevents the release of substances in the body that cause inflammation. Salmeterol is a bronchodilator. It works by relaxing muscles in the airways to improve breathing.? ADVAIR is available only by prescription and it is available in three strengths:
? ADVAIR 100/50
? ADVAIR 250/50
? ADVAIR 500/50
http://www.advair.com/treatment_for_asthma.html
http://www.drugs.com/advair.html
Do you take any of the following drugs?:
? ?amiodarone (Cordarone);
? a diuretic or "water pill";
? HIV medicines such as ritonavir (Norvir), indinavir (Crixivan), lopinavir/ritonavir (Kaletra), nelfinavir (Viracept); ? an MAO inhibitor such as isocarboxazid (Marplan), tranylcypromine (Parnate), phenelzine (Nardil), rasagiline (Azilect), or selegiline (Eldepryl, Emsam); ? antidepressants such as amitriptyline (Elavil), nortriptyline (Pamelor), desipramine (Norpramin), or imipramine (Tofranil); ? certain antibiotics such as ketoconazole (Nizoral), itraconazole (Sporanox), clarithromycin (Biaxin), erythromycin (E-Mycin, Ery-Tab, E.E.S.); or ? medicines for depression such as fluoxetine (Prozac), or fluvoxamine (Luvox).
If you are using any of these drugs, you may not be able to use Advair, or you may need dosage adjustments or special tests during treatment.? http://www.drugs.com/advair.html
?During periods of stress or a severe asthma attack, patients who have been withdrawn from systemic corticosteroids should be instructed to resume oral corticosteroids (in large doses) immediately and to contact their physicians for further instruction. These patients should also be instructed to carry a warning card indicating that they may need supplementary systemic corticosteroids during periods of stress or a severe asthma attack.?
?Upper airway symptoms. Symptoms of laryngeal spasm, irritation, or swelling, such as stridor and choking, have been reported in patients receiving fluticasone propionate and salmeterol, components of ADVAIR HFA.?
?Discontinuation of systemic corticosteroids. Transfer of patients from systemic corticosteroid therapy to ADVAIR HFA may unmask conditions previously suppressed by the systemic corticosteroid therapy, e.g., rhinitis, conjunctivitis, eczema, arthritis, and eosinophilic conditions.?
More on this further down in my answer: ?Eosinophilic Conditions: In rare cases, patients on inhaled fluticasone propionate, a component of ADVAIR HFA, may present with systemic eosinophilic conditions, with some patients presenting with clinical features of vasculitis consistent with Churg-Strauss syndrome, a condition that is often treated with systemic corticosteroid therapy. These events usually, but not always, have been associated with the reduction and/or withdrawal of oral corticosteroid therapy following the introduction of fluticasone propionate. Cases of serious eosinophilic conditions have also been reported with other inhaled corticosteroids in this clinical setting. Physicians should be alert to eosinophilia, vasculitic rash, worsening pulmonary symptoms, cardiac complications, and/or neuropathy presenting in their patients. A causal relationship between fluticasone propionate and these underlying conditions has not been established? http://www.rxlist.com/cgi/generic4/advair-hfa_wcp.htm
?Some side effects of Advair include: ?Hoarseness (dysphonia), throat irritation, headache, cough, dry mouth or throat may occur.? http://www.medicinenet.com/salmeterolfluticasone_inhalation_disk-oral/page2.htm
Side effects of Advair
? ?Eosinophilic conditions?Fluticasone may make these conditions worse.
? Osteoporosis (bone disease)?Inhaled corticosteroids in high doses may make this condition worse. http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/500235.html
Side effects of Advair - ?Less common:
? Abdominal or stomach pain; cough producing mucus; flu-like symptoms; irritation or inflammation of eye; muscle pain; pain or tenderness around eyes and cheekbones; sleep disorders; stuffy nose; tremors; white patches in the mouth or throat or on the tongue http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/500235.html
?There is also some concern that the more potent agents, particularly fluticasone, suppress the adrenal system (which secretes natural steroids) to a greater degree than other steroid inhalants. (This is a serious side effect of oral steroids.)? http://www.umm.edu/patiented/articles/specific_drugs_used_prevent_asthma_attacks_reduce_airway_inflammation_000004_9.htm
Fungal Infection
================
While Candida (yeast, thrush) is the most usual fungal infection from steroids, it is not the only one. If you were cultured for candida only, it?s possible you have aspergillosis, or some other fungal infection. It?s possible to have a viral infection, not likely to be cultured (expensive and performed by fewer labs), and it might be a missed bacterial infection. Were your nasal sinuses cultured also?
?Side effects may include:
Bronchitis, cough, diarrhea, difficulty speaking, fungal infection of the mouth, gastrointestinal discomfort and pain, headaches, hoarseness, muscle pain, nausea, sinus problems, sore throat, upper respiratory infection or inflammation, vomiting? http://www.pdrhealth.com/drug_info/rxdrugprofiles/drugs/adv1576.shtml
Photos: ?Left: Patient with hoarseness (treated extensively with anti-reflux medication) who was using an Advair inhaler. The left cord is swollen with a white patch on it.
Right: After 30 days treatment with fluconazole and stopping the steroid inhaler the voice and vocal cords have returned to normal.?
?A more extensive fungal infection from a steroid inhaler. Candida is the most common organism.? http://www.voicedoctor.net/media/photo/inflammatory/inflammatory.html
?Examples of disease-causing organisms that may be found during a throat culture include: ? Candida albicans. This fungus causes thrush, an infection of the mouth and tongue and sometimes of the throat. See an illustration of thrush in the mouth . ? Neisseria meningitidis. This bacteria can cause meningitis.
? Group A streptococcus. This bacteria can cause strep throat, scarlet fever, and rheumatic fever. If strep throat is suspected, a test called a rapid strep test (or quick strep) may be done before doing a throat culture. With a rapid strep test, results are received in less than 10 minutes (instead of 1 to 2 days with a throat culture). If the rapid strep test results are positive, antibiotics can be started immediately. A throat culture is more accurate than the rapid strep test.
The rapid strep test can give false-negative results even when strep bacteria are present. When the results of a rapid strep test are negative, many health professionals recommend doing a throat culture to confirm that strep throat is not present.? http://www.webmd.com/hw/strep_throat/hw204006.asp
I?d have a second look at GERD and the possibility of a fungal infection of the throat. It can be difficult to get a good sample for fungal culture, and the first swab may have been mishandled. Your symptoms certainly sound like a fungal infection. Acid reflux also can cause your symptoms. Even with Prilosec, acid can still reflux and cause burn and scar tissue.
GERD
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?What are the symptoms of GERD? - The main symptoms are persistent heartburn and acid regurgitation. Some people have GERD without heartburn. Instead, they experience pain in the chest, hoarseness in the morning, or trouble swallowing. You may feel like you have food stuck in your throat or like you are choking or your throat is tight. GERD can also cause a dry cough and bad breath.? http://digestive.niddk.nih.gov/ddiseases/pubs/gerd/
How GERD is diagnosed:
http://www.ehealthmd.com/library/heartburn/HB_diagnosis.html
Eosinophilic Conditions (Allergies)
===================================
?Postnasal drip ? Postnasal drip is a condition that develops when secretions from the nose chronically drip into the back of the throat. These secretions can cause throat inflammation and trigger a cough. Underlying causes of postnasal drip include allergies, colds, and sinusitis. In addition, some people have chronic inflammation of the nasal passages and a runny nose, which can also cause postnasal drip.
People with postnasal drip may complain of symptoms including stuffy or runny nose, a sensation of liquid in the back of the throat, or frequently having to clear their throat. However, some people have so-called "silent" postnasal drip; they have postnasal drip but do not realize it. A healthcare provider may suspect postnasal drip in a person with a chronic cough based on the appearance of the patient's throat. Postnasal drip is usually treated in a patient with chronic cough when no other apparent cause is present.
Asthma ? Asthma is the second most frequent cause of chronic cough in adults, and is the leading cause in children. Coughing may be accompanied by wheezing and shortness of breath. However, some people have a condition known as cough variant asthma, in which cough is the only symptom of asthma. (See "Patient information: Overview of managing asthma").
Asthma is suspected as the cause of the cough if a person has a history of multiple allergies or has a family history of asthma. Asthma-related cough may be seasonal, may follow an upper respiratory infection, or may get worse on exposure to cold, dry air, or certain fumes or fragrances.
Gastroesophageal reflux disease ? Gastroesophageal reflux disease, or GERD, develops when acid from the stomach flows back (refluxes) into the tube connecting the stomach and the throat (the esophagus). The presence of this acidic material in the esophagus, throat, or even the lungs can lead to chronic irritation and coughing. (See "Patient information: Gastroesophageal reflux disease").
GERD is the third most common cause of chronic cough. Many patients with cough due to GERD complain of heartburn or a sour taste in the mouth. However, these symptoms are absent in more than 40 percent of patients with cough due to reflux.?
?Use of ACE inhibitors ? Medications known as angiotensin converting enzyme (ACE) inhibitors cause a chronic cough in up to 20 percent of patients who take them. ACE inhibitors are used in the treatment of heart disease, high blood pressure, and kidney disease. The reason these medicines cause cough is not entirely clear, but may be related to chemical changes that lead to stimulation of cough receptors in the airways.? http://patients.uptodate.com/topic.asp?file=lung_dis/2299
Sinusitis and Post Nasal Drip
==============================
?Post nasal drip is an unscientific term that refers to the sensation of thick phlegm in the throat, which can become infected. It is annoying because normally the throat is moistened by the nasal secretions and throat mucous glands. This is part of the mucous - nasal cilia system that defends us from disease. When the amount of liquid secreted by the nose and sinus is reduced, and the cilia of the nose and sinus slow down, the fluid thickens and you become aware of its presence. Since the thick phlegm associated with post nasal drip is unpleasant and often infected because it is "just laying there" and not moving, our bodies naturally try to get rid of it, to the annoyance of our partners. Whether post nasal drip is caused by pollution, chemical exposure, or severe infection, the treatment requires that the cilia mucous system be brought back to normal.? http://www.dentist.net/sinus-post-nasal-drip.asp
?Sore throat is a symptom of many medical disorders. Infections cause the majority of sore throats and are contagious. Infections are caused either by viruses such as the flu, the common cold, mononucleosis, or by bacteria such as strep, mycoplasma, or hemophilus.While bacteria respond to antibiotic treatment, viruses do not.?
?Allergy: The same pollens and molds that irritate the nose when they are inhaled also may irritate the throat. Cat and dog danders and house dust are common causes of sore throats for people with allergies to them.
Irritation: During the cold winter months, dry heat may create a recurring, mild sore throat with a parched feeling, especially in the mornings. This often responds to humidification of bedroom air and increased liquid intake. Patients with a chronic stuffy nose, causing mouth breathing, also suffer with a dry throat. They need examination and treatment of the nose. Pollutants and chemicals in the air can irritate the nose and throat, but the most common air pollutant is tobacco smoke. Other irritants include smokeless tobacco, alcoholic beverages, and spicy foods. A person who strains his or her voice (yelling at a sports event, for example) gets a sore throat not only from muscle strain but also from the rough treatment of his or her throat membranes.? http://www.sinuscarecenter.com/aao/throa_aao.htm
?The major causes of rhinitis/sinusitis are viral infection, bacterial infection, allergy, and blockage of natural openings between the nose and sinuses. As a pulmonary specialist, I see many patients referred for chronic cough, and the vast majority have rhinitis/sinusitis with post nasal drip as the cause. Most referred patients with chronic cough do not have asthma or any lung disease as a cause.
Unfortunately there is much confusion and disagreement among physicians about diagnosis and treatment of upper airway inflammation. Confusion is mainly about diagnosis, disagreement mainly about treatment. This web site is devoted to clarifying these issues as much as possible, and to helping patients with chronic cough get proper treatment.? http://www.lakesidepress.com/pulmonary/Cough/questions.htm
?Viral infection is a major cause of asthma, so viral rhinitis may be a prelude to asthma attacks in susceptible patients (mainly people who already have a history of asthma). Asthma can also develop following viral rhinitis. Finally, some patients suffering primarily from asthma also have concomitant rhinosinusitis.? ?Asthma can also develop following sinusitis?. http://www.lakesidepress.com/pulmonary/Cough/questions.htm
Nasal Polyps
============
?The following conditions are associated with multiple benign polyps:
? Bronchial asthma - In 20-50% of patients with polyps
? CF - Polyps in 6-48% of patients with CF
? Allergic rhinitis
? AFS - Polyps in 85% of patients with AFS
? Chronic rhinosinusitis
? Primary ciliary dyskinesia
? Aspirin intolerance - In 8-26% of patients with polyps
? Alcohol intolerance - In 50% of patients with nasal polyps
? Churg-Strauss syndrome - Nasal polyps in 50% of patients with Churg-Strauss syndrome ? Young syndrome (ie, chronic sinusitis, nasal polyposis, azoospermia)
? Nonallergic rhinitis with eosinophilia syndrome (NARES) - Nasal polyps in 20% of patients with NARES
Most studies suggest that polyps are associated more strongly with nonallergic disease than with allergic disease. Statistically, nasal polyps are more common in patients with nonallergic asthma (13%) than with allergic asthma (5%), and only 0.5% of 3000 atopic individuals have nasal polyps. Several theories have been postulated to explain the pathogenesis of nasal polyps, although none seems to account fully for all the known facts. Some researchers believe that polyps are an exvagination of the normal nasal or sinus mucosa that fills with edematous stroma; others believe polyps are a distinct entity arising from the mucosa. Based on a review of the literature and several intricate studies of the bioelectric properties of polyps, Bernstein derived a convincing theory on the pathogenesis of nasal polyps, building on other theories and information from Tos.
In Bernstein's theory, inflammatory changes first occur in the lateral nasal wall or sinus mucosa as the result of viral-bacterial host interactions or secondary to turbulent airflow. In most cases, polyps originate from contact areas of the middle meatus, especially the narrow clefts in the anterior ethmoid region that create turbulent airflow, and particularly when narrowed by mucosal inflammation. Ulceration or prolapse of the submucosa can occur, with reepithelialization and new gland formation. During this process, a polyp can form from the mucosa because the heightened inflammatory process from epithelial cells, vascular endothelial cells, and fibroblasts affects the bioelectric integrity of the sodium channels at the luminal surface of the respiratory epithelial cell in that section of the nasal mucosa. This response increases sodium absorption, leading to water retention and polyp formation.? http://www.emedicine.com/ped/topic1550.htm
Nasal Polyp illustration
http://www.umm.edu/imagepages/9226.htm
Sinus Illustration
http://www.entnet.org/healthinfo/sinus/normal_sinus.cfm
?Your comment that the patient is being treated with Advair implies that he has asthma. Prominent eosinophilia of this degree in an asthmatic raises the possibility of: a) aspirin-exacerbated respiratory disease with nasal polyposis and perhaps associated sinusitis; b) allergic bronchopulmonary mycosis (mainly aspergillosis). Check serum IgE levels for marked elevation and obtain chest X-Ray when he is acutely symptomatic looking for migratory infiltrates; c) Churg-Strauss syndrome- look for chest X-Ray abnormalities, granulomatous changes, positive serum ANCA (found in 60-79% of Churg-Strauss patients)? ?Allergic broncho-pulmonary aspergillosis (ABPA) cause prominent pulmonary symptoms with migratory infiltrates and fever responsive to steroid therapy. However, the skin manifestations described by you would be very unusual in ABPA. A negative immediate skin test to Aspergillus fumigatus would be strong evidence against this diagnosis.? http://www.aaaai.org/AADMC/ate/category.asp?cat=1050
Churg-Strauss syndrome
=======================
?Churg-Strauss syndrome (CSS), or allergic granulomatous angiitis, is a rare syndrome that affects small- to medium-sized arteries and veins. Wegener granulomatosis (WG), Churg-Strauss syndrome, and the microscopic form of periarteritis (ie, microscopic polyangiitis) are 3 closely related vasculitic syndromes that affect medium- and small-sized vessels and are associated with antibodies to neutrophil cytoplasmic antigens (ANCAs).
In 1951, Churg and Strauss first described the syndrome in 13 patients who had asthma, eosinophilia, granulomatous inflammation, necrotizing systemic vasculitis, and necrotizing glomerulonephritis.
The American College of Rheumatology (ACR) has proposed 6 criteria for the diagnosis of Churg-Strauss syndrome. The presence of 4 or more criteria yields a sensitivity of 85% and a specificity of 99.7%. These criteria are (1) asthma (wheezing, expiratory rhonchi), (2) eosinophilia of more than 10% in peripheral blood, (3) paranasal sinusitis, (4) pulmonary infiltrates (may be transient), (5) histological proof of vasculitis with extravascular eosinophils, and (6) mononeuritis multiplex or polyneuropathy.?
?Churg-Strauss syndrome is a granulomatous small-vessel vasculitis. The cause of this allergic angiitis and granulomatosis is not known. No data have been reported regarding the role of immune complexes or cell-mediated mechanisms in this disease, although autoimmunity is evident with the presence of hypergammaglobulinemia, increased levels of immunoglobulin E (IgE), rheumatoid factor, and ANCA.? http://www.emedicine.com/med/topic2926.htm
Dysphagia
=========
What is dysphagia?
Dysphagia is a term that means "difficulty swallowing." It is the inability of food or liquids to pass easily from the mouth, into the throat, and down into the esophagus to the stomach during the process of swallowing.
What causes dysphagia?
To understand dysphagia, we must first understand how we swallow. Swallowing involves three stages. These three stages are controlled by nerves that connect the digestive tract to the brain. http://www.chop.edu/consumer/your_child/wellness_index.jsp?id=-8619
Achalasia
? A disease of the esophagus caused by the abnormal function of nerves and muscles of the esophagus that makes swallowing difficult. There may sometimes be chest pain. Regurgitation of undigested food can occur, as can coughing or breathing problems due to entry of food into the lungs. The underlying problems are weakness of the lower portion of the esophagus and failure of the lower esophageal sphincter to open and allow passage of food. Achalasia may occur at any age but is predominantly a disease of young adults. Diagnosis is made by an X-ray, endoscopy , or esophageal manometry (to measure the pressure in the esophagus). Treatment includes medication, dilation (stretching) to widen the lower part of the esophagus, and surgery to open the lower esophagus. A fairly recent approach involves injecting medicines into the lower esophagus to relax the sphincter.? http://www.medicinenet.com/eosinophilic_esophagitis/glossary.htm
Hiatal Hernia
==============
?A para-esophageal hiatal hernia that is large, particularly if it compresses the adjacent esophagus, may impede the passage of food into the stomach and cause food to stick in the esophagus after it is swallowed. Ulcers also may form in the herniated stomach due to the trauma caused by food that is stuck or acid from the stomach. Fortunately, large para-esophageal hernias are uncommon.? http://www.medicinenet.com/hiatal_hernia/page2.htm
?Another mechanism that prevents reflux is the valve-like tissue at the junction of the esophagus and stomach just below the sphincter. The esophagus normally enters the stomach tangentially so that there is a sharp angle between the esophagus and stomach. The thin piece of tissue in this angle, composed of esophageal and stomach wall, forms a valve that can close off the opening to the esophagus when pressure increases in the stomach, for example, during a belch. When a hiatal hernia is present, two changes occur. First, the sphincter slides up into the chest while the diaphragm remains stationery. As a result, the pressure normally generated by the diaphragm overlying the sphincter and the pressure generated by the sphincter no longer overlap, and as a result, the total pressure at the gastro-esophageal junction decreases. Second, when the gastro- esophageal junction and stomach are pulled up into the chest with each swallow, the sharp angle where the esophagus joins the stomach becomes less sharp and the valve-like effect is lost. Both changes promote reflux of acid.? http://www.medicinenet.com/hiatal_hernia/page3.htm
? Severe chest pain
? Difficulty swallowing (dysphagia)
? Obstruction of your esophagus
http://www.mayoclinic.com/health/hiatal-hernia/DS00099/DSECTION=2
Regurgitation
=============
?Regurgitation is the spitting up of food from the esophagus or stomach without nausea or forceful contractions of abdominal muscles. A ring-shaped muscle (sphincter) between the stomach and esophagus normally helps prevent regurgitation. Regurgitation of sour or bitter-tasting material can result from acid coming up from the stomach. Regurgitation of tasteless fluid containing mucus or undigested food can result from a narrowing (stricture) or a blockage of the esophagus. The blockage may result from acid damage to the esophagus, cancer of the esophagus, or abnormal nerve control that interferes with coordination between the esophagus and its sphincter at the opening to the stomach. Regurgitation sometimes occurs with no apparent physical cause. Such regurgitation is called rumination.
In rumination, small amounts of food are regurgitated from the stomach, usually 15 to 30 minutes after eating. The material often passes all the way to the mouth where a person may chew it again and reswallow it. Rumination occurs without pain or difficulty in swallowing. Rumination is common in infants. In adults, rumination most often occurs among people who have emotional disorders, especially during periods of stress.? http://www.merck.com/mmhe/sec09/ch119/ch119b.html
Globus Sensation
===================
?Globus sensation is due to inflammation. Inflammation of many different anatomic regions will produce a globus sensation: the nasopharynx ("roof of the throat"), soft palate ("roof of the mouth," including the uvula, that little punching bag in the back of your mouth), base of tongue, posterior pharyngeal wall ("back of the throat"), larynx ("voice box"), hypopharynx ("lower throat") and esophagus ("swallowing tube.")
Common causes:
Gastroesophageal reflux disease.
Chronic throat infection.
http://www.doctorhoffman.com/xglobus.htm
Other causes of globus:
?Cervical spondylitis (arthritis in the neck)
Cervical spondylitis is a very common condition and not all sufferers get globus. However some probably suffer from increased muscle tension in the neck and around the larynx causing globus.
Goitre (enlargement of the thyroid gland) General enlargement, nodules and inflammation in the thyroid gland are quite common and can occasionally cause a globus sensation. More often it can also be a coincidental finding.
Certain medications
Patients taking diuretics ('water tablets' usually prescribed for high blood pressure), ACE inhibitors (a specific type of drug taken for high blood pressure and heart failure) and antimuscarinics (a group of drugs used in a diverse of variety of conditions such as irritable bowel, urinary problems and psychiatric conditions) can have irritating or drying effects on the throat and occasionally cause a globus sensation.
Anxiety and depression
-----------------------
Patients are naturally worried that there is a serious cause for the globus sensation frequently fearing they may have cancer. Fortunately throat cancer is extremely uncommon particularly in people who do not smoke or drink excessively and most cases are obvious from other associated symptoms or on examination. There is a higher incidence of anxiety disorders (including panic attacks) and depression in patients with globus. Globus may be experienced by individuals at times of emotional stress particularly when they feel unable to express their feelings or when it would be inappropriate to show their feelings.? http://www.nexiumresearch.com/globus_pharyngis.html
?Globus Sensation - Globus sensation (previously called globus hystericus) is the sensation of having a lump in the throat when there is no lump. Globus sensation may result from abnormal muscle activity or sensitivity of the esophagus. It sometimes occurs when stomach acid and enzymes flow backward from the stomach into the esophagus (gastroesophageal reflux). Globus sensation also may occur with frequent swallowing and drying of the throat brought on by anxiety or another strong emotion or by rapid breathing. The feeling produced by globus sensation is similar to that experienced when feeling all choked up, such as during events that trigger grief, anxiety, anger, pride, or happiness.? http://www.merck.com/mmhe/sec09/ch119/ch119b.html
?Recent studies suggest that gastroesophageal reflux disease (GERD) may be a major cause of globus sensation. However, the incidence and severity of GERD in patients with globus sensation without reflux symptoms are unknown. In order to establish the relationship between globus sensation in the jugular fossa and GERD, 20 patients attending our ear, nose and throat (ENT) outpatient clinic with globus sensation were investigated with 24-h pH monitoring.? ?This study suggests that globus may be associated with reflux, and acidity does not have to reach the pharynx to produce globus sensation.? http://www.springerlink.com/content/1233mxa7xbcadw2f/
Barrett?s Esophagus
====================
?Barrett's esophagus itself isn't associated with specific symptoms. But, heartburn and acid reflux ? the sensation of bad-tasting liquid that may enter your mouth from your throat ? are common indicators of GERD. And having GERD can lead to Barrett's esophagus.
A telltale sign of Barrett's esophagus ? which your doctor can notice with a lighted instrument ? occurs when the color of the tissue lining the lower esophagus changes from its normal pink to a salmon color. This cellular process, called metaplasia, is caused by repeated and long-term exposure to stomach acid.? http://www.mayoclinic.com/health/barretts-esophagus/HQ00312/DSECTION=2
?Barrett's esophagus does not cause symptoms itself and is important only because it seems to precede the development of a particular kind of cancer?esophageal adenocarcinoma. The risk of developing adenocarcinoma is 30 to 125 times higher in people who have Barrett's esophagus than in people who do not. This type of cancer is increasing rapidly in white men. This increase may be related to the rise in obesity and GERD.
For people who have Barrett's esophagus, the risk of getting cancer of the esophagus is small: less than 1 percent (0.4 percent to 0.5 percent) per year. Esophageal adenocarcinoma is often not curable, partly because the disease is frequently discovered at a late stage and because treatments are not effective.? http://digestive.niddk.nih.gov/ddiseases/pubs/barretts/index.htm#4
RAD (Reactive Airway Disease)/ RADS (Reactive Airway Dysfunction Syndrome)
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?Ten individuals developed an asthma-like illness after a single exposure to high levels of an irritating vapor, fume, or smoke. In most instances, the high level exposure was the result of an accident occurring in the workplace or a situation where there was poor ventilation and limited air exchange in the area. In all cases, symptoms developed within a few hours and often minutes after exposure. We have designated the illness as reactive airway dysfunction syndrome (RADS) because a consistent physiologic accompaniment was airways hyperreactivity. When tested, all subjects showed positive methacholine challenge tests. No documented preexisting respiratory illness was identified nor did subjects relate past respiratory complaints. In two subjects, atopy was documented, but in all others, no evidence of allergy was identified. In the majority of the cases, there was persistence of respiratory symptoms and continuation of airways hyperreactivity for more than one year and often several years after the incident. The incriminated etiologic agent varied, but all shared a common characteristic of being irritant in nature. In two cases, bronchial biopsy specimens were available, and an airways inflammatory response was noted. This investigation suggests acute high level, uncontrolled irritant exposures may cause an asthma-like syndrome in some individuals which is different from typical occupational asthma. It can lead to long-term sequelae and chronic airways disease. Nonimmunologic mechanisms seem operative in the pathogenesis of this syndrome.? http://www.chestjournal.org/cgi/content/abstract/88/3/376
?Evidence has been accumulating that respiratory syncytial virus (RSV) lower respiratory tract infection (LRTI) in infants may be linked to subsequent development of reactive airway disease (RAD) in childhood, and therefore research into the prevention of RSV LRTI may have important implications for the prevention of RAD. This article reviews the epidemiological evidence linking RSV and RAD and some of the theories concerning cellular and molecular mechanisms of post-viral airway inflammation in order to understand how RSV prophylaxis may assist in reducing the occurrence of RSV LRTI and RAD.? http://www.resmedjournal.com/article/PIIS0954611102912977/abstract
?Why make the distinction? Why not just call it all asthma until you're sure it's not? There are three main reasons why doctors are hesitant to label a child as having asthma when the diagnosis is unsure: ? Other illnesses such as bronchiolitis are not very responsive to medications used for asthma. So, treating these children as asthmatics only subjects them to medications they don't need. ? Other more serious illnesses may go undiagnosed if the reactive airways are due to other factors but just labeled as asthma. By diagnosing reactive airways disease, this leaves the door open to entertain other ideas as to the cause of the wheezing. ? And finally, there are many insurance companies who make obtaining health insurance difficult or very expensive if there is a child in the house with a "pre-existing condition." It would be unfortunate to label a child as asthmatic and cause insurance problems for the family when over the course of time the cause of the reactive airways disease turned out to not be asthma.? http://parenting.ivillage.com/tp/tphealth/0,,hf1k,00.html
?Heartburn (reflux esophagitis) also leads to asthma attacks. This often occurs at night, when laying flat allows acid to seep back into the swallowing tube and throat. If the acid leaks into your breathing passages, choking and wheezing result. If your asthma attacks don?t seem to be caused by colds, allergens, or other respiratory irritation, consider reflux.? http://quickcare.org/resp/cough.html
?3. Reactive airway disease. This is actually not considered a form of asthma, but it looks and acts similarly to asthma. In this type, the child has asthma attacks only during colds. The lungs are hypersensitive to cold viruses, causing the airways to constrict. The child is generally well in between colds.? http://www.askdrsears.com/html/8/T080700.asp
Miscellaneous possibilities:
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? Zenker's diverticulum is a common, false, pharyngeal diverticulum that arises above the cricopharyngeus muscle. ? Mid-esophageal diverticulum may be associated with diffuse esophageal spasm or mediastinal fibrosis. ? Epiphrenic diverticula are often associated with achalasia.
? Diffuse intramural diverticulosis may occur owing to dilation of the esophageal glands. ? Lower esophageal rings are of two types: (1) mucosal ring (Schatzki's ring, also called B ring), which is located at the squamocolumnar mucosal junction; it is common, and is associated with characteristic history; and (2) muscular ring (A ring), which is located proximal to the mucosal ring; it is uncommon, and is covered by squamous epithelium. ? Esophageal webs are most frequent in the hypopharynx and cervical esophagus and are distinguished by their location anteriorly. Webs may also occur anywhere in the esophagus. ? Rings and webs can be treated by dilation.
Upper esophageal web due to a ring formed by a squamocolumnar junction with ectopic gastric mucosa (another explanation of the Paterson-Kelly, Plummer-Vinson syndrome)? http://72.14.253.104/search?q=cache:uFl6Geyp_U4J:www.nature.com/gimo/contents/pt1/full/gimo41.html+Eosinophilic+conditions+throat+or+esophagus&hl=en&gl=us&ct=clnk&cd=6
Plummer-Vinson Syndrome (also called Paterson-Kelly or sideropenic dysphagia.)
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?Pathophysiology: The pathogenesis of PVS remains speculative. Recently, even the existence of the syndrome has been challenged. Postulated etiopathogenic mechanisms include iron and nutritional deficiencies, genetic predisposition, and autoimmune factors, amongst others.
The prevalent iron deficiency theory remains controversial. Older reports have implicated iron deficiency in the pathogenesis of esophageal webs and dysphagia in predisposed individuals. The depletion of iron-dependent oxidative enzymes may produce myasthenic changes in muscles involved in the swallowing mechanism, atrophy of the esophageal mucosa, and formation of webs as epithelial complications.
The improvement in dysphagia after iron therapy provides evidence for an association between iron deficiency and postcricoid dysphagia. Anecdotal reports have also been made of patients with PVS exhibiting impaired esophageal motility (with dysphagia) that recovers following iron therapy. Moreover, the decline in PVS seems to parallel an improvement in nutritional status, including iron supplementation.
However, population-based studies have shown no relationship between postcricoid dysphagia and anemia or sideropenia. Other studies have demonstrated that patients with webs are as likely to be iron deficient as controls, and webs are often found in patients without iron deficiency or dysphagia. Lastly, the iron deficiency theory does not explain the predilection of webs for the upper esophagus and the rarity of the syndrome in populations in which chronic iron deficiency is endemic (eg, eastern and central Africa).
PVS has also been viewed as an autoimmune phenomenon. The syndrome has been associated with autoimmune conditions such as rheumatoid arthritis, pernicious anemia, celiac disease, and thyroiditis. In one study, a significantly higher proportion of PVS patients had thyroid cytoplasmic autoimmune antibodies compared to controls with iron deficiency. The autoimmune theory, however, has gained little acceptance to date.? http://www.emedicine.com/med/topic3431.htm
?Plummer-Vinson syndrome is a disorder linked to severe, long-term iron deficiency anemia, which causes swallowing difficulty due to web-like membranes of tissue growing in the throat.? http://health.allrefer.com/health/plummer-vinson-syndrome-esophageal-web-info.html
?When the lining of the esophagus is damaged, scarring develops. When scarring occurs, the lining of the esophagus becomes stiff. In time, as this scar tissue continues to build up, the esophagus begins to narrow in that area. The result then is swallowing difficulties.
One of the conditions that can lead to esophageal strictures is gastroesophageal reflux disease. Excessive acid is refluxed from the stomach up into the esophagus. This causes an inflammation in the lower part of the esophagus. Scarring will result after repeated inflammatory injury and healing, re-injury and rehealing. This scarring will produce damaged tissue in the form of a ring that narrows the opening of the esophagus.? http://heartburn.about.com/cs/articles/a/esoph_stricture.htm
Allergies
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?While the seasonal woes of spring and autumn translate into the classic allergy annoyances of watery/itchy eyes and nose and profuse sneezing, the allergens of summer generally manifest themselves in nasal stuffiness and excess mucous in the nose and throat.
That's because the culprits vary from season to season. In early spring, the pollens of budding trees (such as birch, poplar, walnut, sycamore, oak and ash) produce the symptoms typically associated with allergies and/or hay fever. Later springtime discomfort is usually triggered by the pollens of such grasses as sweet vernal, bermuda, timothy, red top, some bluegrasses and others.? ?? Frequent headaches, particularly those located over the nose and/or forehead.
? Breathing through an open mouth (rather than through the nose).
? Stuffed-up feeling in the nose - with or without discharge.
? Plugged-up feeling in the ears.
? Itchy, scratchy throat.
http://www.netwellness.org/healthtopics/ent/entallergies.cfm
I hope this has helped you out! Please request an Answer Clarification, and allow me to respond, before you rate, if anything is unclear.
I wish you a speedy recovery!
Regards, Crabcakes
Search Terms
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Barrett?s esophagus
Eosinophilic conditions throat or esophagus
Globus sensation
Reactive airway disease
Adverse effects + Advair
Advair + Aspergillus
Advair + fungal infections
esophageal scar tissue
Churg-Strauss syndrome
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