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Query: UMLS:C0002962 (angina)
 21,142 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Massive obesity is associated with serious co-morbidities. After failure of extensive conservative measures, surgical procedures have developed as the only successful method for sustained weight loss. Criteria for operation are: presence of serious diseases associated with morbid obesity; greater than 45 kg above ideal weight or body mass index greater than 40 kg/m2 for usually greater than 5 years; failure of sustained weight loss on extensive conservative regimens; commitment to lifelong follow-up; and acceptable operative risk. Angina pectoris itself is not a contraindication to these operations. Patients who do not quite meet the weight criteria may still be candidates for an obesity operation in certain instances, e.g., debilitating musculoskeletal pains in weight-bearing joints, diabetes, significant hypertension, reflux esophagitis, urinary stress incontinence. Although current operations result in lasting weight loss of greater than 50% of excess weight in the majority of patients, the surgical candidate must understand and accept the principles of the procedures, the potential for serious complications, the dietary necessities, and occasional failures.
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PMID:Morbid obesity: selection of patients for surgery. 150 8

Chronic Esophageal reflux induces reflux esophagitis, which is a common finding in gastroenterological practice. Reflux esophagitis produce symptoms like pirosis, regurgitation and in some cases respiratory complains resembling asthma or angina-like chest pain. The pathophysiology of this disease is based on a multifactorial origin, which usually results in the chronic evolution of the disease. In recent years, there have appeared new evidences pointing out to alterations in the relaxing mechanisms of the lower esophageal sphincter; however, some patients having reflux esophagitis show normal shincteric pressure. The sweep action of esophageal smooth muscle is a key point for sending back to stomach the eventually refluxed material; it has been demonstrated that this sweeping action is impaired in many patients having reflux esophagitis. Incompetence of lower esophageal sphincter seems to be related a local to neural alteration rather than to smooth muscle functional disturbance. Recent findings stablis a link between local nitric oxide release and relaxation of the lower esophageal sphincter. Esophageal mucosaldisplay an intrinsic resistance to HCL, pepsin, bilis and enzymes deleterious action by a blockade of back-defusion of hydrogen ions contained in the refluxed material. Nevertheless, some other luminal and non-luminal factors are involved in this mucosalprotection. When these intrinsic resistance factors are abated, tisular lesions like ersion, ulcer and Barret's mucosal changes can occur; is of particular interest because its potential malignant evolution. Esophageal reflux usually resolves with medical treatmen, but in some particular cases surgical correction is indicated for improving the antireflux barrier.
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PMID:[Reflux esophagitis]. 776 23

Heartburn and epigastric pain are the leading symptoms of reflux disease. Next to other symptoms like pharyngeal burning, regurgitation and retrosternal pain, chronic hoarseness and coughing as well as angina pectoris symptoms may point towards a pathological reflux. In endoscopically verified reflux esophagitis proton pump inhibitors are the treatment of first choice. Aim of therapy is loss of symptoms, healing of epithelial defects and prevention of Barrett's esophagus. If a columnar epithelium-lined esophagus is seen, surveillance is recommended in one- or two-year intervals.
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PMID:[Reflux disease and Barrett esophagus--monitoring and therapy]. 802 95

Esophageal investigation was performed successfully in 52 patients who were initially suspected of suffering from angina pectoris, but the pain was subsequently shown to be not of cardiac origin by radionuclide myocardiac perfusion and (or) coronary angiography in 74% of cases, and by EKG and poor response to anti-angina therapy in 26% of the cases. In 82.7% of the patients the diagnosis was gastroesophageal reflux disease (GERD), in 3.8% Nutcracker esophagus, and in 5.8% lower esophageal sphinctor hypertension. In the remaining 7.7% the diagnosis was unknown. In 43 patients with GERD, gastroesophageal reflux (GER) investigation showed GER symptoms in 61.5%, reflux esophagitis was confirmed with endoscopy in 45.3%. Abnormal esophageal manometry was found in 53.8%, positive provocative test in 42.9%, excessive radionuclide GER in 50%, and increased duration of hyperacidity in 57.1%. However, a combined study of the procedures mentioned above showed that the diagnosis was consistent with GERD in 82.3% of the patients. Chest pain was completely relieved in 34% of the cases and significantly relieved in 50%. No response was ilicited in 16% of the cases after 1-2 weeks of anti-reflux therapy. It is found that chest pain induced by GERD is very common, esophageal endoscopy and motor studies are helpful in the diagnosis of GERD and other esophageal motor diseases, and anti-reflux therapy is a reliable measure when a patient complains of unknown chest pain and GER symptoms.
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PMID:[Diagnosis and treatment of angina-like chest pain in 52 cases]. 826 55

Cases of diagnosis of angina pectoris and myocardial infarction erroneously made in patients suffering from reflux esophagitis are reported. The description and analysis are given of the causes underlying the above misdiagnosis and clinical manifestations of reflux esophagitis.
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PMID:[Errors in the diagnosis of a cardial syndrome in reflux esophagitis]. 932 93

Heartburn, suggesting gastroesophageal reflux, is common. Epidemiological studies have shown that 36% to 44% of adults experience heartburn at least once a month, 14% weekly and 7% once a day. Heartburn and regurgitations are the typical symptoms of gastroesophageal reflux disease (GERD). When present as predominant symptoms, they are quite specific but not very sensitive. Clinical severity of GERD does not predict the severity of the underlying condition. The diagnostic approach to patients with GERD depends on the clinical presentation and the question to be answered -Is abnormal reflux present? Is there mucosal injury? Are symptoms due to reflux? Several techniques such as barium swallow, endoscopy, ambulatory pH monitoring, esophageal manometry and 24 h pH/motility can be used to answer those questions. Barium swallow is not much help in diagnosing reflux esophagitis because reflux can occur in more than 25% of asymptomatic patients. It is most useful in demonstrating structural abnormalities such as strictures and hiatal hernia. The importance of hiatal hernia in the pathogenesis of GERD has been controversial. Recent studies suggest that GERD patients with hiatal hernia present with greater extent of reflux and more severe esophagitis. Endoscopy is the best diagnostic study for mucosal evaluation. Ambulatory 24 h pH monitoring is indicated for patients with atypical symptoms of reflux such as chest pain or pulmonary symptoms, or those who do no respond to therapy. The evaluation of duodenogastroesophageal reflux or alkaline reflux can be measured, but the clinical importance of this test remains controversial. Esophageal manometry allows measurement of the lower esophageal sphincter pressure (LES) and the evaluation of esophageal peristalsis. There is a lack of correlation between LES and reflux esophagitis. The role of peristaltic dysfunction in GERD is unclear, but the high percentage of abnormal contractions suggests a more severe form of GERD. Esophageal motility study can document the presence of effective esophageal peristalsis in patients before antireflux surgery. Twenty-four hour pH/motility is not yet available widely. It is useful in patients who have several daily attacks. There is a correlation with acid reflux in approximately 40% of events. Investigation of noncardiac angina-like chest pain is best achieved by standard esophageal manometry combined with provocative testing. Most laboratories performing these studies use acid perfusion and pharmacostimulation with either bethanechol or edrophonium to reproduce the patient's chest pain during esophageal manometry. Esophageal balloon distension is considered to give the highest yield as a provocative test in patients with angina-like chest pain. It is believed that abnormal esophageal nociception is not simply related to underlying motor dysfunction but also to the presence of a visceral sensory abnormality.
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PMID:Assessment of clinical severity and investigation of uncomplicated gastroesophageal reflux disease and noncardiac angina-like chest pain. 934 76