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

Reflux of gastric contents into the esophagus has for long been accepted as a cause of esophagitis, failure to thrive, and anemia. But, at the same time, gastro-esophageal reflux (GER) is recognized as a physiological phenomenon occurring now and then in every one, especially in the postprandial period. Esophageal pH monitoring is an attractive technique for separating "physiological" from "pathological" GER incidence and duration by measuring incidence and duration. In principle, esophageal pH monitoring is simple, but in practice there are technical and clinical problems. The pH monitoring equipment, the type of electrode, the location of the electrode are examples of equipment and/or methodology related influencing factors. Age, position, duration of the investigation (day/night, fasting/postprandial), feeding and drugs are patient related factors. Despite all these factor, pH data have been shown to be reproducible. The major advantages of pH monitoring are that it evaluates GER in (1) physiological circumstances over (2) a prolonged duration. (3) The investigation can be repeated and can therefore (4) evaluate the efficacy of treatment. (5) The possibility of establishing a relation in time between pH changes and symptoms constitutes another advantage of the technique.
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PMID:Esophageal pH monitoring: methodology, indication and interpretation. 185 12

The effect of a meal on the rate of transient lower esophageal sphincter (LES) relaxations and patterns of gastroesophageal reflux was investigated in 49 patients referred for evaluation of gastroesophageal reflux. Esophageal motility and pH were recorded concurrently before and after a standard meal. In the patients with symptomatic reflux, the meal induced a four- to sevenfold increase in the gastroesophageal reflux through two mechanisms: a four- to fivefold increase in the rate of transient LES relaxations and an increase in the proportion of transient LES relaxations accompanied by reflux from 47% to 68%. Overall the rate of reflux episodes that occurred by mechanisms other than transient LES relaxation did not increase significantly. An exception to these findings were those in six patients with chronically absent basal LES pressure in whom transient LES relaxations could not be scored. In these patients, reflux increased postprandially through mechanisms other than transient LES relaxation. These findings confirm the pivotal importance of transient LES relaxations in the pathogenesis of gastroesophageal reflux.
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PMID:Provocation of transient lower esophageal sphincter relaxations by meals in patients with symptomatic gastroesophageal reflux. 186 94

Continuous long-term esophageal pH monitoring has become the preferred test to quantify acid gastroesophageal reflux. Because reflux to a limited extent is physiologic, the determination of optimal thresholds to separate normal from abnormal reflux is mandatory. Esophageal pH was measured during 24 hours in 509 healthy thriving infants, aged 3 days to 1 year, using a glass microelectrode with an external reference electrode connected to a portable recorder. Percentiles of the four parameters studied (reflux index or percent of the investigation time with a pH less than 4, number of episodes with a pH less than 4 during 24 hours, number of episodes lasting greater than 5 minutes, the duration of the longest episode (in minutes) are presented. A percentile curve of the reflux index regarding the age distribution shows that the normal range for the reflux index during the first 12 months of life is about 10% (95 percentile), decreasing from 13% at birth to 8% at 12 months. Application of an age-related percentile curve offers a close-to-reality possibility of data interpretation and illustrates that there is inevitably an overlap of data between normal and abnormal populations, because reflux is a phenomenon occurring to some extent in every human being.
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PMID:Gastroesophageal reflux, as measured by 24-hour pH monitoring, in 509 healthy infants screened for risk of sudden infant death syndrome. 189 95

The authors report on their experience acquired in the surgical treatment of functional esophageal disease (achalasia, diffuse esophageal spasm, diverticula and gastroesophageal reflux). The authors affirm that a correct and meticulous functional study of the esophagus is fundamental for the adoption of precise surgical plotting, in order to circumvent all of the complications and failures described in Literature. Such an objective can be achieved intraoperatively thanks to myotomy and fundoplication with the aid of intraoperative manometry (IEM) that, when performed in the course of myotomy, circumvents the execution of incomplete procedures (incomplete myotomies). The same holds true in the case of anti-reflux plasty (Nissen's in particular) where IEM enables a plication that is neither too wide nor too narrow, too long, too short, but "calibrated". Then, instrumental probes are even more capable of assessing the effects of functional surgery, by enabling the documentation of perfect postoperative results. More precisely they make it possible to study patients presenting with motor disorders pre-operatively, as in the case of achalasia or diverticula, and to sanction their resolution postoperatively. In addition they enable documentation of the effectiveness of Nissen's fundoplication, performed either to prevent gastroesophageal reflux after myectomy or to treat primary reflux. This is made possible by studying not only the tone at a distance, but especially relaxation in the course of deglutition. Finally, pH-metry permits the documentation of the complete clearing of gastroesophageal reflux, even when physiologic and post-prandial (hypercompetent Nissen).
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PMID:[Evaluation of esophageal function in surgically-treated patients]. 190 48

Recurring substernal chest pain is an important clinical problem, causing anxiety for patients and their physicians because of the fear of possible cardiac disease. The differential diagnosis includes coronary artery disease, oesophageal disorders such as acid reflux disease and motility disturbances, musculoskeletal problems, psychological disorders including panic attacks, and a new 'fly in the ointment'--microvascular angina. History alone usually cannot distinguish cardiac from non-cardiac chest pain. After exclusion of significant coronary artery disease, attention must be turned to oesophageal disorders, which may be seen in as many as 50% of these patients. Oesophageal motility disorders, particularly the nutcracker oesophagus, are common, but the relationship between pain and abnormal contraction pressures is not well established. Provocative tests such as edrophonium (Tensilon) and balloon distension help to identify the oesophagus as the source of chest pain but do not direct therapy. Recent studies with ambulatory oesophageal monitoring suggest that gastro-oesophageal reflux may be a more common cause of chest pain than motility disorders. This is an important finding as acid reflux is a treatable problem, while therapies for motility disorders may only worsen reflux disease. The recent observation that oesophageal disorders are frequently associated and interact with psychological disorders such as anxiety, depression, somatization and panic attacks complicates the evaluation and understanding of chest pain. How these various abnormalities may be linked is an unresolved issue. Increased central nervous system stimulation and altered visceral and/or central pain sensitivity could be the common factors. It is hoped that further research into these areas will lead to new understandings of and possible solutions to the complex problem of non-cardiac chest pain.
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PMID:Investigation and management of non-cardiac chest pain. 191 53

A boy with hiatus hernia following the repair of the left postero-lateral diaphragmatic hernia (Bochdalek's hernia) was reported. At the age of one month, the repair of Bochdalek hernia was performed with transabdominal approach. At that time the stomach was located in the normal position. Eight days after the repair he developed vomiting and hiatus hernia was revealed by barium esophagram. Antireflux surgery was required because there was no response to the conservative management for two months. Esophageal pH study and manometric study were very useful for the diagnosis of hiatus hernia or GER and the evaluation of antireflux surgery.
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PMID:Association of hiatus hernia with postero-lateral diaphragmatic hernia (Bochdalek's hernia). 193 48

Esophageal pH monitoring is the accepted standard for the investigation of gastroesophageal reflux (GER) in adults. A postal questionnaire was sent to 912 United Kingdom paediatric physicians & surgeons. Five hundred forty-seven (61%) replied, with 124 (22.7%) currently using the technique, mostly in conjunction with barium swallow and/or esophagoscopy. The use of pH monitoring to quantify GER was also accepted in principal as being the best determinant of reflux by a further 186 (34%), but as yet was unavailable in their hospitals. Pediatricians were also questioned as to their management of children with GER. The majority were treated medically with a variety of antireflux medication, with only 237 (42%) referring cases for surgery.
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PMID:Esophageal pH monitoring for gastroesophageal reflux: a United Kingdom study. 194 57

The role of antireflux operations in the elderly is ill-defined. Often, these patients are managed medically despite refractory symptoms for fear of surgical morbidity and mortality by referring physicians. This investigation was done to review the referral patterns and results of antireflux operations for patients more than 60 years old. The charts of all patients undergoing operation for reflux were reviewed during an eight year period from 1981 to 1989. One hundred and three patients underwent Nissen fundoplication. All patients had been treated with H2 blockers or antacids, or both, prior to referral for operation. Group 1 (N = 43) consisted of all patients who were 60 years of age and group 2 (N = 60), all patients less than 60 years of age. The mean age of those in group 1 was 70.6 years versus 43.7 years for those in group 2. The mean duration of symptoms was far greater in the elderly group versus the younger group (14.4 versus 4.1 years) (p less than 0.001). Twenty-eight patients in group 1 were referred for surgical treatment because of complications of reflux versus only four in group 2 (p less than 0.01) in whom intractability was the main indication for surgical treatment. The specific complications of gastroesophageal reflux disease that led to the referral of elderly patients for operation were stricture, bleeding, aspiration and Barrett's esophagus. There was one death and this occurred in a 46 year old woman who had a massive pulmonary embolism postoperatively. The mean duration of follow-up study was 5.1 years. Improvement in symptoms was noted by 37 patients in group 1 versus 56 in group 2. We conclude that elderly patients are most often referred for antireflux operations for complications of reflux versus younger patients in whom intractability is the most common indication. Earlier referral is warranted if reflux symptoms persist despite adequate medical therapy. Despite advanced esophageal disease, the results of antireflux operations are good, and surgical morbidity and mortality rates are low enough to warrant intervention in this group of patients, provided no medical contraindications exist.
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PMID:Referral patterns and the results of antireflux operations in patients more than sixty years of age. 194 84

Thirty consecutive patients with globus sensation who were referred to a psychosomatic clinic prospectively underwent otolaryngological, videokinematographic, and manometric examinations of pharynx and esophagus to evaluate whether morphological abnormalities or motility disorders underlay their symptom. When indicated by findings, 24-hour pH-metry, scintigraphy of bolus transport, and esophagogastroscopy were performed. Seven patients were shown to have achalasia, 10 had "hypochalasia" (lower esophageal sphincter relaxation less than 75% with esophageal contraction abnormalities but no complete distal aperistalsis), and 1 had diffuse esophageal spasms; 2 patients had also hyperplastic lingual tonsils, 1 had tonsillitis, and 1 had a cervical spondylophyte. Nutcracker esophagus and nonspecific contraction abnormalities were found in 7 patients, and gastroesophageal reflux with esophagitis and a low lower esophageal sphincter resting pressure was found in 1; only 3 patients had normal esophageal motility. None had volunteered dysphagic symptoms at primary evaluation. Psychometric investigations in consenting patients showed no higher mean scores for state and trait anxiety, depression, hysteria, and hypochondriasis than in general medical outpatients. Esophageal motor disorders may, before giving rise to dysphagia, be sensed more vaguely and induce the globus sensation. However, only disappearance of the sensation after treatment allows inferring an etiological significance of such a disorder.
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PMID:High incidence of esophageal motor disorders in consecutive patients with globus sensation. 195 17

Nonpropulsive esophageal contractions radiologically described as tertiary contractions or "corkscrew" esophagus suggest the presence of an underlying motility disorder and may lead to impaired acid clearance. The goals of this study were to determine the prevalence and role of gastroesophageal reflux (GER) in patients with tertiary contractions. Thirty-five consecutive patients with spontaneous, repetitive, nonpropulsive esophageal contractions noted on esophagography were studied with endoscopy, infusion esophageal manometry, and 24-h ambulatory pH monitoring. All patients had esophageal symptoms, mainly dysphagia, heartburn, and chest pain, but only three were found to have esophagitis by endoscopy and biopsy. Nineteen patients had repetitive, nonlumen-obliterating, nonperistaltic (tertiary) contractions, six had corkscrew esophagus, and 10 had forceful, lumen-obliterating simultaneous contractions (rosary bead esophagus). Twenty patients (58%) had GER by pH criteria with mean values: % time pH less than 4, 40.9; %upright pH less than 4, 41; %supine pH less than 4, 44.3%; number of episodes with greater than 5 min of pH less than 4, 12. Esophageal motility revealed "nutcracker" esophagus in eight, low LESP in two, and nonspecific esophageal motility disorder in 10. Symptoms or severity of nonperistaltic contractions did not correlate with GER. Radiologically demonstrable free reflux or the presence of heartburn did not predict GER. We conclude that 1) GER occurs in up to 58% of patients with nonpropulsive (tertiary) esophageal contractions on esophagography, and may play a role in the induction of abnormal peristaltic activity of the esophageal body; 2) GER is usually not associated with endoscopic evidence of esophagitis or characteristic symptoms, and is recognized by 24-h pH monitoring. We speculate that detection and treatment of GER may improve the symptomatic management of patients with nonpropulsive esophageal contractions.
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PMID:Nonpropulsive esophageal contractions and gastroesophageal reflux. 199 26


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