Combination therapy versus monotherapy for gastroesophageal reflux in children with difficult-to-treat bronchial asthma

Gastroesophageal reflux [GER] is a common disorder in children with bronchial asthma. Difficult-to-treat asthma; It has been identified as a potential trigger, complication and even differential diagnosis for asthma. GERD; Our aim was to find out the efficacy of the combined use of both the proton pump inhibitor esomep-Proton pump inhibitors; razole and the antidopaminergic prokinetic domperidone versus the sole use of esomeprazole in Prokinetics improving asthma severity in children with difficult to treat asthma. Among 178 children with difficult-to-treat asthma, GER was assessed using upper GIT endoscopy. Those who had GER were randomly divided into 2 equal subgroups the first was treated with esomeprazole for 12 weeks while the other was treated with esomeprazole and domperidone for the same period [beside the usual treatment for asthma in both groups]. Childhood-asthma control test [C-ACT], forced expiratory volume in 1st second [FEVj] [% of predicted], peak expiratory flow [PEE] variability, induced sputum substance P [SP] and endoscopic reflux score [ERS] were recorded before and after the treatment. Gastro-esophageal reflux [GER] was observed in about 45% of children with difficult-to-treat asthma. The C-ACT, induced sputum SP, ERS and FEVj showed significant improvement while PEE variability showed no significant changes when comparing combination therapy subgroup [esomeprazole and domperidone] with esomeprazole only subgroup combination of domperidone and esomeprazole was more effective in improving the endoscopic reflux score, childhood-asthma control test [C-ACT] and FEVj [% of predicted] and significantly reduced the sputum SP than the use of esomeprazole only in children with difficult-to-treat asthma

Elevated nitric oxide and endotoxemia in schistosonol hypertension

Nitric oxide [NO] is supposed to play a role in mediating vasodilatation and hyperdynamic circulation in liver cirrhosis and alcoholic hepatitis. It has been suggested that endotoxin might mediate increased synthesis of NO in endotoxemic patients with cirrhosis. The level of NO in schistosomal portal hypertension [SchPH] has not been studied, and whether endotoxemia plays a role in this condition is not known. To evaluate the level of NO and endotoxin in patients with schistosomal portal hypertension, and compare it to those in patients with post-necrotic cirrhosis and to normal individuals The study included 45 consenting patients; 27 with SchPH and living -schistosoma ova on rectal biopsy [11 Child A, 9 B, 7 C], and 1.8 with post-necrose cirrhosis [4 Child A, 6 B, 8 C]; and 15 healthy volunteers. Patients underwent upper GI endoscopy with grading of esophageal varices if present, ultrasonography with measurement of portal vein diameter, and liver biopsy. Patients and controls had plasma nitrite [NO[2]] measured as an indicator of NO production, and plasma endotoxin assayed by limulus amebocyte lysate test Patients with SchPH had significantly higher plasma NO[2] than controls [7.18 +/- 3 7 micro Mol/I vs 1.68 +/- 0.8 micro Mol/L p<0.005]. Endotoxin level was also significantly higher in SchPH than controls [0.46 +/- 0.09 Eu/ml vs. 0.15 +/- 0.05 Eu/ml. p < 0.05]. Non schistosomal patients had levels of NO[2] [6.3 +/- 3 micro Mol/L] and endotoxin [0.45 +/- 0.09 Eu/ml] similar to SchPH [both p > 0 05]. No difference was noted between Child classes in SchPH regarding NO[2] and endotoxin levels. NO[2] levels were positively correlated to the degree of portal hypertension assessed by portal vein diameter on ultrasound in SchPH. No correlation was found between NO[2] and endotoxin levels in SchPH [r = 0.48] SchPH is associated with increased NO production, and endotoxemia, similar to post-necrotic cirrhosis. The level of NO production increased with the severity of portal hypertension in this condition, and was not related to the level of endotoxemia