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 21,142 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Regurgitation of the gastric contents into the esophagus is common and often unnoticed. When symptoms such as heartburn, a sour or bitter taste in the mouth, or even chest pain mimicking angina pectoris or myocardial ischemia prompt a patient to seek help, the factor or factors responsible for reflux must be sought. The possible underlying causes are numerous, as Dr Bachman points out in this discussion of the pathophysiology, diagnosis, and treatment of gastroesophageal reflux. The desired end point of management was well stated by Seneca over 2,000 years ago as "a good-humored stomach."
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PMID:Gastroesophageal reflux. Simple measures often suffice. 663 18

In part I of this article we report on 89 hypertensive patients who underwent 9 months of treatment with oxprenolol HCl 160 mg in a slow-release formulation plus cyclopenthiazide 0.25 mg and potassium chloride 600 mg (Trasidrex; Ciba-Geigy). Blood pressures, both supine and standing, and pulse rates were consistently controlled by this regimen throughout the 9 months of treatment, regardless of the time of day at which these parameters were measured, i.e. morning or afternoon. Seventy-six patients completed the trial. The most common symptom or sign occurring during treatment was headache, the next most common being heartburn. No patient developed angina while on the regimen. Three patients discontinued the study owing to unwanted effects. This study represents a total of 28237 patient-days of treatment. In part II of the trial we studied the effects of a similar regiment in 67 patients for 1 year preceded by a 2-week wash-out period. Forty-six of the patients completed a full year's treatment. Statistically significant reductions in blood pressures and pulse rates occurred after commencement of active treatment and were maintained throughout the study period. Four patients withdrew from the study owing to adverse effects, 1 patient died of an acute myocardial infarction, and 1 patient was considered a treatment failure. This study represents 19858 patient-days of treatment.
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PMID:Oxprenolol slow-release with cyclopenthiazide KCl in the treatment of essential hypertension. A multicentre general practice study. 701 37

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

The purpose of this study was the feasibility, safety and analysis of the ischemic nature of the association of an injection of dipyridamole and an exercise test at low level exertion on an exercise bicycle for 4 minutes. The ischemic nature of this combination was assessed on the basis of three criteria: the onset of angina-type pain, electrical changes and scintigraphic abnormalities. The test could be carried out by all patients and the most common adverse events were headache (6.5%) and heartburn (3.5%). The 17 patients in this study who had one or more stenoses in excess of 70% presented with angina-type pain (3/17); electrical abnormalities (9/17) and scintigraphic abnormalities in all cases. Of the six patients who had lesions between 50 and 70%, 1 presented with angina symptoms, 2 with electrical abnormalities and 5 with scintigraphic abnormalities. Seven patients in this study showed no significant lesions when subjected to coronary artery angiography. However, angina-type pain and electrical signs were observed in 2 cases and one false positive result by scintigraphy. This study shows that it is possible to combine the injection of dipyridamole with an exercise test involving a low level of exertion on an exercise bicycle which gives a good diagnostic value to the CT scan. The frequency of clinical and electrical signs of ischemia makes it necessary to take the same precautions as for a peak exercise test.
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PMID:[Myocardial ischemia caused by the injection of dipyridamole followed by low level exertion on an exercise bicycle]. 836 96

Indications to manometric measurements in patients complaining for esophageal disorders are discussed. Such symptoms most frequently include: dysphagia, heartburn, and angina-like pain after exclusion of the coronary artery disease. Radiological and endoscopic examinations should precede esophageal motility measurements to eliminate organic causes of patients' complaints. Initial manometric measurements may be repeated after the application of pharmacologic stimuli or functional tests. Most frequent esophageal motor disorders have been described.
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PMID:[Manometric examination in diagnosis of esophageal motility disorders]. 896 71

Since angina and heartburn can feel the same, excluding cardiac disease may be the first order of business. That done, clinical findings and laboratory tests can help identify the esophageal disturbance. Gastric acid reflux, motility disorders, and visceral nerve hypersensitivity--alone or in combination--can cause chest pain, and each may call for a different pharmacologic regimen.
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PMID:Managing the patient with atypical chest pain. 910 14

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

Gastroesophageal reflux disease (GERD) can be described as a clinical picture resulting from the reflux of stomach contents into the esophagus. The actual prevalence of GERD remains unestablished, although this disorder is generally common in old patients, male sex and in subsets of patients with pulmonary manifestations such as asthma. From a pathophysiological stand-point, GERD is thought to have a multifactorial etiology which involves genetics, anatomical, functional, environmental, hormonal and pharmacological factors. GERD has different clinical presentations which may be divided in three main classes: typical symptoms (heartburn and regurgitation); atypical or extraesophageal symptoms (angina-like chest pain, asthma, chronic cough and laryngitis); and complications (ulcers, strictures and Barrett's esophagus). In GERD diagnosis a key role is played by: accurate symptom evaluation, response to proton pump inhibitors and, finally, at least one in a life-time endoscopy. Moreover, barium swallow X-ray, 24-h esophageal pH monitoring and gastro-esophageal manometry can be useful to support diagnosis in some unusual cases or in cases partially or unresponsive to standard pharmacologic treatment.
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PMID:[Gastroesophageal reflux disease: clinical and pathophysiological features (part I)]. 1740 61

Gastroesophageal reflux disease (GERD) may manifest typically with heartburn and regurgitation or may have atypical manifestations as laryngitis, asthma, chronic cough or noncardiac chest pain (NCCP). While typical GERD is easy to be recognized, the atypical extraesophageal symptoms of the disease make the diagnosis difficult because most patients do not have heartburn or regurgitation. Most common atypical manifestations include ear, nose and throat (ENT), pulmonary or cardiac symptoms. GERD should be included in the differential diagnosis of patients with atypical symptoms, especially when alternative diagnoses are excluded. NCCP is defined as recurring angina-like substernal chest pain of noncardiac origin. We present the most recent epidemiologic data, pathophysiology, diagnosis and treatment of NCCP. The major causes of NCCP are GERD and esophageal dysmotility. By far, GERD has been demonstrated to be the most frequent source of NCCP. After a complete cardiac evaluation, the patient with NCCP will be referred to a gastroenterologist. All recent studies suggest the use of PPI test as the first diagnostic tool in patients with NCCP. The invasive diagnostic tests (especially, the 24-hour pH monitoring and esophageal manometry) are used only in those cases who do not respond to PPI therapy. Patients with GERD-related NCCP require long-term treatment with a PPI.
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PMID:[Noncardiac chest pain and gastroesophageal reflux disease]. 2070 Sep 64

The aim of the study was to determine the frequency of functional and organic dyspepsia and possible predictors for organic dyspepsia in coronary artery disease (CAD) patients. The 150 patients (109 men; mean age 62.61 +/- 10.23 yr) undergoing coronary artery by-pass grafting because of stable pectoral angina due to significant CAD were enrolled in the study. Dyspepsia was determined by the existence of epigastralgy, heartburn, nausea and vomiting. Dyspepsia with endoscopic lesions was defined as organic, and dyspepsia with normal endoscopy was defined as functional. Multivariate analysis (logistic regression) was used to estimate predictive values of some independent clinical and demographic variables in relation to organic dyspepsia (dependent variable). One hundred thirty-five (90%) patients had at least one symptom of dyspepsia. Eighty five patients (63%) had organic dyspepsia, and 50 (37%) patients had functional dyspepsia (P < 0.001). Patients with organic dyspepsia had more dyspeptic symptoms than patients with functional dyspepsia (1.92 +/- 0.88 vs. 1.38 +/- 0.87, P < 0.001). More dyspeptic symptoms correlated with heavy GD lesions (r = 0.267; P < 0.0001). Multivariate analysis revealed independent correlation of consuming low-dose aspirin (standardized coefficient beta = 11.701, P = 0.004), diabetes (beta = 2.921, P = 0.027), cigarette smoking (beta = 2.910, P = 0.037) and nausea (beta = 3.620, P = 0.015) with organic dyspepsia. The study showed high frequency of dyspepsia, especially organic dyspepsia, in CAD patients. Three or more dyspeptic symptoms, low-dose aspirin, cigarette smoking, diabetes and nausea, increased the probability of organic dyspepsia. Therefore, for patients with combination of dyspeptic symptoms and present risk factors the endoscopic examination should be considered.
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PMID:[Frequency and characteristics of dyspepsia in coronary artery disease patients]. 2085 6


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