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Query: UMLS:C0017168 (gastroesophageal reflux disease)
 11,783 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Despite new effective drugs, like omeprazole, reducing gastric acid output and relieving gastro-oesophageal reflux disease (GERD) symptoms in most patients, there are still clear indications for surgical treatment of this chronic disease. The main indications are failure to control symptoms by medical treatment, noncompliance to medication and development of complications. Recent developments in minimal access surgery have modified the surgical approach to the treatment of GERD. The antireflux surgical procedures can be endoscopically performed reproducing all the essential component steps of the equivalent open operations, but with all the advantages of minimal access surgery. The fundoplication procedures are mainly performed laparoscopically and the thoracoscopic approach is chosen in patients with short oesophagus, morbid obesity or other contraindications to the laparoscopic approach. The short-term results of endoscopic antireflux surgery are at least as good than after open surgery. A review on the laparoscopic and thoracoscopic antireflux procedures is presented.
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PMID:Laparoscopic and thoracoscopic antireflux surgery. 757 70

Gastro-oesophageal reflux disease (GORD) ranges from episodic symptomatic reflux without oesophagitis to severe oesophageal mucosal damage, such as Barrett's metaplasia or peptic stricture. The multifactorial pathogenesis of GORD prevents medical cure of the disease. GORD is a chronic disease with a high tendency to relapse, requiring a long term treatment strategy in practically all patients. Complete healing of all mucosal lesions is not necessarily the aim of treatment in all patients. In milder forms of reflux disease, symptom relief is the most important goal. Many patients with mild GORD do well on symptomatic self-care with antacids and/or alginate. In addition, lifestyle changes should be advised to all patients: these improve symptoms and enhance the efficacy of therapy. In the acute treatment of GORD the prokinetic drug cisapride has been shown to be effective in relieving symptoms and healing grade I to II oesophagitis. Cisapride decreases symptomatic and endoscopic relapse in patients with mild GORD. Histamine H2-receptor antagonists are effective in relieving reflux symptoms in about 50% of patients, but with regard to healing, H2-antagonists appear to be mainly effective in grades I and II and not in higher grades of oesophagitis. Maintenance treatment with H2-antagonists is mainly symptomatically effective in patients with mild GORD. Proton pump inhibitors (PPIs) provide significantly higher healing rates of reflux oesophagitis than H2-antagonists, even in the more severe cases of oesophagitis and Barrett's ulcers. PPIs are also effective in patients with oesophagitis refractory to treatment with H2-antagonists. PPIs have become the drugs of first choice in healing of all patients with more severe forms of reflux oesophagitis, and increasingly also for patients with milder forms of oesophagitis, certainly those who fail to respond to other drugs. In maintenance treatment of GORD, PPIs are the most effective drugs, offering the possibility of keeping nearly all patients in remission with adjusted doses. Current patient data of up to 5 years indicate the safety of this strategy for this period, but the exact consequences of strong acid inhibition over a longer period still have to be clarified. At present, all but a few patients with GORD can be managed adequately by medical therapy.
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PMID:Pharmacological management of gastro-oesophageal reflux disease. 760 Oct 11

The natural history of gastroesophageal reflux disease is usually that of a chronic disorder. Spontaneous remission is rare, and cure even more so, especially in more severe cases. Treatment of esophagitis has been eased in most cases with current drugs, but recurrence is almost the rule after discontinuation of therapy. Therefore, long-term treatment is required in many patients. The drugs of preference for long-term treatment are acid inhibitors given at the lowest dose that suppresses symptoms. Surgical treatment should be reserved for the rare patient who cannot be managed satisfactorily with conservative treatment. Because of the high risk of adenocarcinoma in Barret's esophagus, endoscopic surveillance of all patients with acceptable surgical risk is recommended.
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PMID:[Therapy of gastroesophageal reflux disease]. 790 54

An increasing number of infant's with gastroesophageal reflux (GER) and respiratory disease and are being cared for at home. These infants have a chronic disease requiring long-term medical care. However, once the infant's condition stabilizes, home care is preferable to prolonged hospitalization. Nursing care of the infant with GER and respiratory disease is a challenging process that is complicated by the severity of GER and the degree of respiratory compromise. An understanding of disease process, family process, and skills of assessment are essential in planning care for these infants and their families.
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PMID:Home care of the infant with gastroesophageal reflux and respiratory disease. 804 Jul 99

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

Gastroesophageal reflux disease is a chronic disorder that requires long-term therapy in most patients. The appropriate medical therapy should be individualized to the severity of symptoms, the degree of esophagitis and the presence of other acid-reflux complications. Lifestyle changes should form the basis of any therapeutic approach. In patients with mild to moderate disease, initial therapy with histamine H2-receptor antagonists in conventional dosages is suggested. Prokinetic agents are potentially useful in patients with impaired esophageal or gastric motor function, but their efficacy as single agents does not appear to surpass that of standard doses of H2 blockers. Sucralfate, a cytoprotective agent, is an additional therapeutic option. For patients with more severe disease, omeprazole and lansoprazole provide unequaled healing rates and accelerated symptom relief. In most patients, maintenance therapy is vital. Surgery is indicated in patients whose disease is refractory to medical therapy and in those who develop complications not amenable to medical therapy.
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PMID:Contemporary medical therapy for gastroesophageal reflux disease. 901 79

Gastro-oesophageal reflux disease (GORD) is a chronic disorder requiring lifelong medical therapy or surgery. In the present study we evaluated the postoperative course and effect of laparoscopic fundoplication on GORD in 27 patients with a median age of 44 (range 27-73) years. Fifteen were operated on with a Watson procedure, and 12 patients had a Nissen procedure. Median stay and convalescence after surgery was one and 10 days respectively. Three patients had to be converted into open surgery (bleeding: two, unclear anatomy: one). No major complications were seen, but four patients had postoperative complications (stenosis requiring dilatation: one, subcutaneous emphysema: one, wound sepsis: one, hernia: one. The two latter complications were seen in converted patients). Two patients had prolonged dysphagia, and two patients needed slight dietetic advice for gasbloat syndrome. In 25 of 27 patients good control of GORD was accomplished as judged by symptomatology, endoscopy and 24-hour pH measurements. It is concluded that laparoscopic fundoplication offers good control of GORD with few complications, and short hospital stay and convalescence.
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PMID:[Laparoscopic fundoplication in gastroesophageal reflux]. 904 46

Since there are few studies examining gastroesophageal reflux (GER) in healthy children beyond infancy, we report our experiences treating children older than two with this condition. GER was diagnosed by either an abnormal extended intraesophageal pH monitoring (pH study) or presence of histological esophagitis. Thirty-seven patients met the criteria, ages 3 to 19 years (mean 11) and 68% were males. Common symptoms were vomiting, abdominal or chest pain, heartburn and regurgitation. Mean duration of symptoms was 28.7 months, and six patients had severe esophagitis, and one had Barrett's esophagus. Patients with severe esophagitis were older and had strongly positive pH study parameters compared to the rest of patients (p < 0.05). All patients were treated with prokinetic and acid reducing agents for 8 to 12 weeks. Sixty-two percent responded to initial course and remained asymptomatic during the follow-up period. Nissen fundoplication was recommended to five patients (13.5% of study population) because of refractory GER. Four of these patients who required surgery had severe esophagitis. In summary, GER in normal older children is a chronic disease with potentially severe complications. All patients should be evaluated by pH study and endoscopic esophageal biopsies, and have careful follow up.
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PMID:Gastroesophageal reflux disease in children older than two years of age. 950 66

Functional dyspepsia is a chronic disorder of unknown aetiology. The lack of endoscopic abnormalities in patients with this disorder has led many physicians to believe that gastro-oesophageal reflux disease may be responsible for most symptoms. Our group has addressed this issue, by pathophysiological studies in a large cohort of Dundee patients with persistent dyspeptic symptoms. Peptic ulcer and gallstones were excluded in all patients by appropriate tests. Ambulatory pH monitoring showed oesophageal acid reflux that lay above the conventional diagnostic threshold in approximately 20% of patients. This subset was diagnosed as having gastro-oesophageal reflux disease. In the remainder, moderate or severe reflux-like symptoms were reported by approximately 44% patients, who were categorized as reflux-like functional dyspepsia. Reflux symptoms were mild or absent in 36% patients, who were categorized as non-reflux-like dyspepsia. While oesophageal pH profiles lay within the conventional normal range in both of these functional dyspepsia subgroups, patients with reflux-like functional dyspepsia had significantly greater acid exposure values, including total oesophageal acid exposure time, percentage time at a pH of less than 4.0, DeMeester scores and pain reflux event correlation. Hence patients with reflux-like functional dyspepsia have oesophageal acid exposure that lies below the diagnostic threshold for gastro-oesophageal reflux disease but exceeds that of patients with non-reflux dyspepsia. The high pain/reflux event correlation in reflux-like functional dyspepsia suggests that subthreshold oesophageal acid exposure may be associated with troublesome reflux symptoms.
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PMID:Is functional dyspepsia largely explained by gastro-oesophageal reflux disease? 989 82

Gastro-oesophageal reflux disease (GORD) is a highly prevalent condition in Western countries; at least 20% of the population have weekly symptoms. The incidence appears to be rising in the West and in some developing countries. Heartburn, based on a carefully elicited history, is reasonably specific for identifying GORD if it is a predominant complaint. Symptoms, however, appear to correlate poorly with oesophagitis; hence, severe symptoms do not indicate there is greater oesophageal damage. Only one-third to one-half of patients with GORD undergoing endoscopy have oesophagitis. GORD is usually a chronic disease but one-third may lose their symptoms over time. An ill-defined subset of patients over time may progress to develop abnormal acid exposure or oesophagitis, or both, when none existed at baseline. GORD has a significant negative impact on quality of life to the same degree as other chronic medical conditions, but impairment in quality of life is independent of oesophagitis.
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PMID:Epidemiology and natural history of reflux disease. 1100 7


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