Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0017168 (gastroesophageal reflux disease)
 11,783 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Hypertension is a significant and prevalent risk factor for the development of cardiovascular disease and target organ damage. The urgency of treatment of high blood pressure depends on the level of blood pressure elevation and the presence of coexistent risk factors for cardiovascular disease. Likewise, the level to which blood pressure is reduced is not restricted to the definition of high blood pressure but instead depends on the underlying disease. Diabetes and renal insufficiency, for example, require blood pressure goals below those that are traditionally defined. In the absence of contraindications, beta-blockers and diuretics are still recommended as first-line agents for treatment of uncomplicated hypertension. Calcium channel antagonists also may reduce mortality. In patients with diabetes, ACE inhibitors are effective first-line agents in type 1 and type 2 diabetic patients who are hypertensive or have microalbuminuria. ACE inhibitors may be beneficial in patients with nondiabetic renal insufficiency as well. Calcium channel antagonists may have some effect in retarding progression of diabetic nephropathy although a recent trial found a higher incidence of death as a secondary endpoint in hypertensive diabetic patients who were treated with calcium channel antagonists. Beta-blockers seem to be safe and well tolerated in patients with mild to moderate intermittent claudication, although patients with rest pain or limb ischemia have not been studied. Beta-blockers should not be used in patients with asthma. Dihydropyridine calcium channel antagonists are the preferred treatment of hypertension in patients with Raynaud's but should be avoided in patients with severe gastroesophageal reflux disease. NSAIDs, particularly piroxicam and indomethacin, raise mean blood pressure by approximately 5 mm Hg, enough to consider a change of either NSAID or antihypertensive to one that is not as affected by NSAIDs. Cyclosporine A can induce hypertension by its vasoconstrictive effects, particularly on the kidney. Calcium channel antagonists may antagonize this vasoconstriction while allowing the clinician to reduce the dose of cyclosporine A required to achieve its immunosuppressive effect.
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PMID:Evaluation and treatment of hypertension. 1046 27

The problem of coupling of gastroesopahgeal reflux disease (GERD) and type 2 diabetes mellitus (DM2) remains to be elucidated. The relevant data are contradictory, but certain authors believe that GERD may sometimes be regarded as a complication of DM2. The possible pathogenetic mechanisms include diabetic nephropathy (leading to motor dysfunction of the upper digestive tract and dysregulation of the tone of the lower sphincter) and diabetic gastropathy (delayed gastric evacuation and disturbed motor and tonic functions of the upper gastrointestinal tract are additional preconditions for the development of pathologic gastroesophageal reflux). 78 patients with DM2 were divided into 2 groups depending on duration of the disease (below and above 7 years). The control group was comprised of 40 subjects with normal glucose tolerance. The presence and severity (frequency of erosive oesophageal lesions) of GERD were directly related to the duration of DM2. Other factors with which GERD is associated include insulin requirements and diabetic neuropathy. Patients with DM2 more frequently than controls suffer asymptomatic GERD resulting from visceral neuropathy. Patients with long-standing DM2 need examination of the upper digestive tract by instrumental methods (oesophagogastroduodenoscopy, 24hr potentiometry) even in the absence of continuous complaints of heartburn, acid regurgitation, and other typical manifestations of GERD for the early recognition of the disease and timely prescription of antireflux therapy.
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PMID:[Peculiarities of gastroesophageal reflux disease in patients with type 2 diabetes mellitus]. 2321 16