reflux gastro-oesophagien: point de vue du pneumologue

Gastroesophageal reflux [GER] is a common situation that can express with digestive, extra-digestive, respiratory or otolaryngologic symptoms. Some chronic pulmonary disorders include in their setting GER as well. This review will address pathogenesis, clinical signs, complications and treatment of GER with a special focus towards the pulmonologist field. GER is a physiological post-prandial phenomenon of limited duration. It is induced by transient lower esophageal sphincter relaxation [tLESR] or by factors that impede LES function by reducing its tone or disrupting its contractions. Extra-digestive symptoms are caused by vagal stimulation through common autonomic pathways to the esophagus and bronchi. This reflex is triggered by gastric acid stimulation of esophageal receptors and by acid micro-aspirations into the airways. The responsibility of GER towards respiratory symptoms is often difficult to attest despite thorough investigations. Results of one to three-month treatment trial with proton pump inhibitors can be of value. Gastroesophageal assessment is mandatory as pulmonary manifestations might indicate disease severity

Mesotheliome - asbeste au Liban: un probleme a retenir

To estimate the incidence of pleural mesothelioma and its relationship with the occupational and environmental exposure to asbestos in Chekka region. Between 1991 and 2000, 22 cases of malignant mesothelioma were diagnosed at Hotel-Dieu de France Hospital. Eighteen cases were epidemiologically investigated. Fifteen among these 18 patients [83%] had a positive exposure history exposure was occupational in 11 cases and environmental in 4 cases.The tumor was attributable to Eternit Company in 12 cases among the exposed 15 [80%]. These 12 cases were secondary to occupational exposures in 8 and to environmental exposure in 4 cases. Mean latency period between exposition and diagnosis was 29 years. Fifteen patients died from the progression of their disease after a median survival of 8 months. The relationship between pleural mesothelioma and Eternit Company with the related occupational and environmental risk in Chekka region is obvious.The assessment of the incidence needs a national cancer registry.Despite the protective measures taken by the government since-1996, an increase in the incidence is suspected in the coming ten years because of the long latency period of the disease