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Query: UMLS:C0008031 (chest pain)
 17,248 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Gastroesophageal reflux disease (GERD) is a common condition, and it is now generally recognized that modern medical therapy allows the physician to both heal the esophagitis and relieve the patients from troublesome symptoms such as heartburn, acid regurgitation and disabling chest pain. In addition, long-term therapy with potent acid inhibitory drugs can maintain these patients in clinical remission. The indications for antireflux surgery and long-term medical therapy have developed and changed with time but are today essentially similar, and in fact, it can be hypothesized that the outcome of a short-term "therapeutic trials" with the proton pump inhibitor would be a useful clinical tool, not only as a diagnostic test for the disease but also in the selection process before referring the patient to antireflux surgery. Antireflux surgery is designed to improve the function of the antireflux barrier by reconstructing the physiology of the gastroesophageal junction. Studies have shown that a fundoplication procedure improves the strength and length of the lower esophageal sphincter and also restitutes the flutter valve mechanism. However, since gastroesophageal reflux disease is a common disorder, it is impossible for every patient to be attended by an expert surgeon, and this might be one important reason for the sometimes poor results presented after surgical treatment. When the question arises about which type of long-term therapy should be chosen in each clinical situation, this situation should also partly be influenced by some epidemiological information. If we assume that we expose a hypothetical group of 100 patients with symptomatic, chronic severe reflux disease, also presenting endoscopic evidence of esophagitis of varying severity, available clinical information would suggest that only 25 can be considered suitable for antireflux surgery, depending on the frequently associated complicating medical disorders and the age distribution of the actual patient population. Therefore, it deserves to be emphasized that the majority of patients with complicated reflux disease are not fit for surgery and should consequently be managed medically. For younger patients with disabling GERD, antireflux surgery is still the gold standard and obviously very cost effective.
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PMID:The knife or the pill in the long-term treatment of gastroesophageal reflux disease? 750 32

A combination of the typical symptoms heartburn and regurgitation may be considered virtual proof of gastroesophageal reflux disease. In the case of the atypical symptoms dysphagia, odynophagia, pharingitis, reflux-induced attacks of respiratory distress and intermittent chest pain further diagnostic investigation is indicated. Endoscopy reveals patchy reddening and possibly erosions, ulcers and strictures. Although the decisive pathophysiological factor in reflux disease is motility, the use in particular of acid suppressors represents an important part of treatment; in more severe reflux esophagitis (grades III and IV), proton pump inhibitors are the drugs of first choice. Gastro-esophageal reflux disease is a chronic condition with a recurrence rate of 60-80 percent. For prophylaxis, the minimum dose of antacids required to treat the stage must be administered.
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PMID:[Gastroesophageal reflux. Pathophysiology, diagnosis and rational therapy]. 819 14

Gastroesophageal reflux disease is a chronic disease whose incidence is often underestimated. Approximately 10% of the population in the United States experience heartburn each day. In addition, as many as 50% of patients with unexplained chest pain, chronic hoarseness, or asthma may be suffering from gastroesophageal reflux disease. Disease severity ranges from occasional, mild heartburn to erosive esophagitis and its complications. Endoscopy and air-contrast barium radiography are important diagnostic tools. Esophageal pH monitoring can confirm excessive reflux in patients with atypical symptoms or in patients who do not respond to drug therapy. Depending on severity, gastroesophageal reflux disease may be managed through lifestyle modification, antacid and/or antirefluxant drugs, promotility (prokinetic) drugs, fundoplication, and/or acid-suppressant agents (eg, H2-receptor antagonists, proton pump inhibitors). Safety, effectiveness, patient compliance, and cost factors must be considered in determining the most appropriate long-term maintenance therapy.
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PMID:Gastroesophageal reflux disease. Current strategies for patient management. 876 11

The availability of proton pump inhibitors and laparoscopic antireflux surgery has ushered in a new era in the management of chronic gastroesophageal reflux disease. Proton pump inhibitors allow physicians to treat nearly all patients with chronic gastroesophageal reflux with successful medical treatment. Laparoscopic antireflux surgery offers patients an opportunity to abandon their medications with an operation that is well tolerated. The major indication for antireflux surgery is failure of medical therapy. However, many patients with long-term medical therapy requirements are candidates, too. Several factors influence the decision to choose antireflux surgery, including patients' ages, costs of medications, types of symptoms the patients may have (for example, heartburn as opposed to chest pain or asthma), or complications such as Barrett's esophagus, metaplasia, or stricture formation. A through preoperative evaluation of patients being considered for antireflux surgery is essential. All patients should have an upper endoscopy and esophageal manometry. Selected patients, particularly those with nonerosive esophagitis, atypical reflux symptoms, or those in whom the diagnosis is in doubt, should have ambulatory esophageal pH monitoring. Barium swallow is helpful in evaluating patients with Barrett's esophagus, esophageal strictures, and in elderly patients who have a new onset of esophageal symptoms. Gastric testing infrequently identifies patients with significant abnormalities; however, in patients with symptoms of gastric disease it may change the type of surgery that is performed. The results of laparoscopic antireflux surgery are excellent in properly selected patients. Complications are rare and usually easily managed in the postoperative setting. The keys to successful antireflux surgery are a thorough evaluation of the patient, a thorough discussion of the advantages and disadvantages of antireflux surgery with the patient, and a skilled surgeon. Following these principles, antireflux surgery should be very successful in the great majority of patients for whom it is considered.
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PMID:Laparoscopic antireflux surgery. 910 97

The principal mechanism leading to gastro-oesophageal reflux is an increased frequency of transient lower oesophageal sphincter relaxations; other factors are oesophageal hypersensitivity to gastric juice, hiatus hernia, and possible duodenal reflux. Patients with classical symptoms such as heartburn and regurgitation may be treated pharmaceutically combined with life style counselling. If the symptoms have not improved after 6 to 12 weeks, endoscopical examination is performed and, if necessary, 24-hour pH monitoring, barium radiographing and manometry. In the case of atypical symptoms such as dysphagia, laryngitis, asthma and chest pain, there is more reason to pursue diagnostic testing. In patients with dysphagia endoscopy is indicated to exclude malignancy. Drug treatment can be subdivided into antacids, H2 receptor antagonists, cytoprotective agents, prokinetics and proton pump inhibitors. In general practice a step-up approach to treatment is preferable, while for specialist treatment a stepdown approach is more (cost-)effective. Drawbacks of medical treatment are considerable frequency of recurrence of oesophagitis, persistence of regurgitation in 'volume refluxers' and controversial data on the possible development of (pre)malignant lesions of oesophagus and stomach. Surgical treatment is a good alternative for patients with persistent severe regurgitation during medical therapy and for young patients who prefer surgery to lifelong medication. Patients with Barrett's oesophagus should undergo regular endoscopic biopsy surveillance.
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PMID:[Gastroesophageal reflux disease: pathophysiology, diagnosis and drug therapy]. 975 35

Appropriate use of modern medical therapy for gastroesophageal reflux disease (GERD), particularly proton pump inhibitors, should result in effective control of symptoms in most GERD patients. Possible causes of poor response to GERD treatment include: a non-compliant patient, lack of appropriate therapy or insufficient dose, or an incorrect diagnosis. Endoscopy plays an important role in the management of GERD and other associated conditions. If the presence of esophagitis is detected then this confirms a diagnosis of GERD. Endoscopy can identify the presence of Barrett's esophagus, with a biopsy taken to confirm intestinal metaplasia. Endoscopy should ideally be used in patients with chronic GERD symptoms (persisting for 3 years or more), in those aged over 40, and particularly in Caucasian males who are at high risk of developing Barrett's esophagus. pH monitoring can also be used to confirm the diagnosis of GERD. It also has a role where the endoscopy findings are normal and in patients with atypical symptoms, such as chest pain, asthma/cough or hoarseness. It is a useful tool to document effectiveness of GERD treatment. Esophageal and gastric pH monitoring during treatment with acid suppressing therapy will confirm the control of gastric acid and the absence of continued reflux. Similarly, pH monitoring can be used to evaluate the effectiveness of antireflux surgery.
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PMID:My approach to the difficult GERD patient. 1044 8

The assortment of diagnostic tests that are currently available for detecting gastroesophageal reflux disease (GERD) are invasive, costly and not readily available to community-based physicians. In contrast, a short course of high-dose proton pump inhibitor (PPI) as an empirical trial is an attractive alternative. This simple diagnostic test has been demonstrated to be accurate and cost-effective in patients with symptoms suggestive of GERD and those with noncardiac chest pain. Early studies in patients with extraesophageal manifestations of GERD have yielded promising results. Cost assessment of the PPI empirical trial revealed significant cost savings, mainly due to a marked decrease in utilization of invasive diagnostic tests. Thus the PPI empirical trial should be considered as the initial diagnostic step in patients with the disease spectrum of GERD.
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PMID:Empirical trials in treatment of gastroesophageal reflux disease. 1072 34

Gastroesophageal reflux disease (GERD) is the most common gastrointestinal cause of "noncardiac chest pain." Following exclusion of a cardiac cause of chest pain, an evaluation of the esophagus is, therefore, appropriate. Barium studies, endoscopy, and esophageal manometry have little value in the diagnosis of GERD-induced chest pain. Twenty-four-hour pH monitoring with a symptom-index correction may define an association but does not prove causality between the patient's chest pain and GERD. Recent studies have implied that high-dose proton pump inhibitor (PPI) therapy for one week is an effective approach. The PPI test has excellent sensitivity/ specificity and economic savings (due to reduction in diagnostic procedures) and, accordingly, should be the diagnostic/ therapeutic approach of choice for patients with suspected GERD-induced chest pain.
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PMID:Chest pain and gastroesophageal reflux disease. 1077 71

Gastroesophageal reflux is a very common disorder. Typical symptoms are heartburn, regurgitation and chest pain. Recently, it has been demonstrated that gastroesophageal reflux may generate or worse extraesophageal symptoms such as asthma, chronic bronchitis, posterior laryngitis, and chronic cough. The diagnosis of gastroesophageal reflux is suggested by typical symptoms which improve under a therapy with proton pump inhibitors. pH-monitoring over 24 hours is able to establish directly the diagnosis by measuring acid reflux into the esophagus. Manometry detects the two most common causes of gastroesophageal reflux: insufficiency of the lower esophageal sphincter or esophageal motility abnormalities. Gastroesophageal reflux can lead to reflux esophagitis, which is diagnosed endoscopically. An endoscopy should routinely be performed in case of dysphagia, anemia, or loss of weight. A long-term sequela of gastroesophageal reflux is the development of Barrett's-esophagus, a condition which has to be verified by endoscopy and biopsy. This premalignant lesion is defined by a metaplastic change from the normal squamous mucosa to a specialized intestinal epithelium characterized by goblet cells. Because dysplasia in these metaplastic areas can lead to esophageal adenocarcinoma, regular endoscopic surveillance with biopsies is recommended. Gastroesophageal reflux can significantly impair the quality of life and can cause complications that include the neoplastic progression from Barrett's esophagus to carcinoma. Therefore, appropriate diagnostic procedures and adequate therapy are required. This article summarizes the diagnostic approach to patients with gastroesophageal reflux, reflux esophagitis and Barrett's-esophagus. The impact of endoscopy, pH-monitoring, esophageal manometry, radiology and scintigraphy are reviewed.
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PMID:[Diagnosis of gastroesophageal reflux and Barrett esophagus]. 1092 25

Gastroesophageal reflux disease (GERD) is one of the most common diagnoses in a gastroenterologist's practice. Gastroesophageal reflux describes the retrograde movement of gastric contents through the lower esophageal sphincter (LES) to the esophagus. It is a common, normal phenomenon which may occur with or without accompanying symptoms. Symptoms associated with GERD include heartburn, acid regurgitation, noncardiac chest pain, dysphagia, globus pharyngitis, chronic cough, asthma, hoarseness, laryngitis, chronic sinusitis and dental erosions. The introduction of fiberoptic instruments and ambulatory devices for continuous monitoring of esophageal pH (24-hour pH monitoring) has led to great improvement in the ability to diagnose reflux disease and reflux-associated complications. The development of pathological reflux and GERD can be attributed to many factors. Pathophysiology of GERD includes incompetent LES because of a decreased LES pressure, transient lower esophageal sphincter relaxations (TLESRs) and deficient or delayed esophageal acid clearance. Uncomplicated GER may be treated by modification of life style and eating habits in an early stage of GERD. The various agents currently used for treatment of GERD include mucoprotective substances, antacids, H(2) blockers, prokinetics and proton pump inhibitors. Although these drugs are effective, they do not necessarily influence the underlying causes of the disease by improving the esophageal clearance, increasing the LESP or reducing the frequency of TLESRs. The following article gives an overview regarding current concepts of the pathophysiology and pharmacological treatment of GERD.
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PMID:Pathophysiology and pharmacological treatment of gastroesophageal reflux disease. 1106 Apr 72


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