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

There have been a number of reports on the complications of the Angelchik silicone prosthesis since Angelchik and Cohen first reported the use of the device in 46 patients with gastroesophageal reflux. The exact incidence of complications is difficult to estimate; however, the company estimates 0.81 per cent for migration and 0.15 per cent for erosion of the prosthesis. The purpose of this paper is to review our experience with 13 complications related to the Angelchik prosthesis in eight patients referred to Emory University Hospital. These complications consisted of recurrent reflux esophagitis in six patients, intractable dysphagia in two, esophageal stricture in two, displacement of the prosthesis in two, disruption of the prosthesis in one patient, and gastric erosion in two patients. The management of these complications required removal of the prosthesis and performance of a Nissen fundoplication in six patients. Distal esophagectomy with esophagogastrostomy was performed in one patient, and colon interposition was performed in another patient. In summary, serious complications of the Angelchik prosthesis implanted for gastroesophageal reflux and their management are presented.
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PMID:Complications of the Angelchik prosthesis in the management of gastroesophageal reflux. 395 73

The pathologic reports of all 1,020 esophageal biopsy specimens obtained between 1975 and 1981 in patients with symptoms of gastroesophageal reflux were reviewed. Barrett's esophagus was identified in 84 patients (8 percent). The 362 patients seen between 1980 and 1981 were reviewed in detail. The symptoms in patients with Barrett's esophagus differed from those of the patients without Barrett's esophagus. Dysphagia was more often present in the former group (34 percent versus 16 percent, p less than 0.05) and epigastric distress was less frequent (11 percent versus 27 percent, p less than 0.05). Objective findings of hiatal hernia, esophageal stricture, and esophageal ulcers occurred more commonly in patients with Barrett's esophagus than in those without Barrett's esophagus (70 percent versus 48 percent, 31 percent versus 4 percent, and 14 percent versus 6 percent, respectively, p less than 0.05). Mid esophageal strictures were associated almost exclusively with Barrett's esophagus (five of six patients). At esophagoscopy, erythema was seen more commonly with Barrett's esophagus. The diagnosis was suspected by the endoscopist in only 34 percent of patients subsequently demonstrated histopathologically to have Barrett's esophagus. There was no significant difference in the prevalence of a positive Bernstein test result or gastroesophageal reflux on upper gastrointestinal series in patients with and without Barrett's esophagus. However, a hypotensive lower esophageal sphincter was found more commonly in patients with Barrett's esophagus (100 percent versus 53 percent, p less than 0.05). Thirteen of the 84 patients with Barrett's esophagus (15 percent) had a coexistent adenocarcinoma arising from Barrett's mucosa. These patients, when compared with the patients with Barrett's esophagus without carcinoma, were more often male (77 percent versus 51 percent, p = 0.1), more often had dysphagia (69 percent versus 34 percent, p less than 0.05), and more frequently had a comparatively short duration of symptoms (67 percent versus 36 percent, p less than 0.05). Our findings suggest that patients with Barrett's esophagus have a high risk of development of carcinoma. Because the entity is often not recognized at endoscopy, routine esophageal biopsy should be performed on all patients undergoing esophagoscopy for symptoms of gastroesophageal reflux. Patients with known Barrett's esophagus should be followed closely with repeated endoscopy and biopsy.
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PMID:Barrett's esophagus: its prevalence and association with adenocarcinoma in patients with symptoms of gastroesophageal reflux. 396 36

The significance of marked eosinophilic infiltration in esophageal mucosal biopsy specimens was evaluated in 11 patients. The patients were generally young, with an average age of 14.6 years; all had diffuse intraepithelial eosinophilia in several biopsies. Ten patients (91%) had evidence for reflux esophagitis, which was associated with esophageal stricture in three of the six patients older than 1 year. Marked esophageal eosinophilia might therefore indicate prolonged or severe gastroesophageal reflux. One patient with peripheral eosinophilia, a history of asthma, and concurrent idiopathic eosinophilic gastroenteritis lacked evidence of reflux and represents a case of idiopathic esophagitis. Critical review of the literature establishes three additional cases. Idiopathic eosinophilic esophagitis is an unusual variant of idiopathic, but presumably allergic, eosinophilic infiltration of the gastrointestinal tract.
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PMID:Marked eosinophilia in esophageal mucosal biopsies. 409 Nov 82

A total of 82 patients with gastroesophageal reflux were consecutively treated with stapled, uncut gastroplasty and complete fundoplication over a 12-year period. The conditions treated included symptomatic reflux; esophageal stricture; massive hernia; collagen esophagus; short esophagus; Barrett's esophagus; recurrent, massive bleeding or anemia; small gastric remnant after gastrectomy; and acute volvulus. The transthoracic approach of stapled, uncut gastroplasty gives superb exposure. Outstanding features of the procedure are the safety and versatility resulting from the small amount of fundus required, no need either to ligate short gastric vessels or to suture the esophagus itself, and preservation of anatomical continuity between the wrapping fundus and the wrapped gastric tubular segment. There have been no deaths and no cases of anatomical or symptomatic recurrence in the series. Complications included some nondebilitating and mainly self-limiting symptoms.
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PMID:Stapled, uncut gastroplasty for hiatal hernia: 12-year follow-up. 638 91

Eighteen patients ranging in age from 32-82 years with benign distal esophageal stricture underwent and survived fundic patch operation. Twelve of these patients had undergone esophageal dilatation but without success. Five had had surgery for hiatal hernia using Hill, Belsey or Lortat-Jacob techniques. Middle laparotomy was done in five and left thoracotomy in thirteen. A fundic patch with a 270 degrees fundoplication was performed in seven and a fundic patch with 360 degrees fundoplication in the remaining eleven. The average hospital stay was 12.3 days. Dysphagia disappeared in seventeen and persisted for eight months in one patient. Three patients required instrumental dilatation for a few months. Endoscopic examination, pH study and X-ray fluoroscopy were done. Gastroesophageal reflux was nil in patients treated with Nissen's 360 degrees fundoplication and three of these 7 patients without Nissen's fundoplication had gastroesophageal reflux. Epithelialization of the patched esophageal wound was evident 6 months after the operation.
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PMID:Results of fundic patch operation for severe stricture of the esophagus. 641 87

Fourteen cases (7 males and 7 females) of neonatal gastro-oesophageal reflux seen at the University of Benin Teaching Hospital in the period 1977-82 were analysed. They all presented with persistent vomiting from birth; 64% of the infants were small for gestational age (SGA). All infants had plain abdominal and chest radiographs and barium meal examination. Eleven neonates had a major gastro-oesophageal reflux but no case of hiatus hernia, oesophagitis or oesophageal stricture was found. Over 80% of patients responded to conservative treatment. There were two deaths. We recommend that SGA newborns presenting with persistent vomiting in the presence of a normal plain abdominal radiograph should be treated as a case of gastro-oesophageal reflux until proven otherwise.
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PMID:Gastro-oesophageal reflux in Nigerian newborn infants. 647 61

It is widely acknowledged that Barrett's esophagus in adults is an acquired condition resulting from prolonged gastroesophageal reflux. Barrett's esophagus is rare in childhood, even though gastroesophageal reflux occurs commonly in the pediatric age group. When a columnar-lined esophagus is present in children, it is often regarded as a congenital anomaly rather than as a consequence of chronic gastroesophageal reflux. Over a 5-yr period (1978-1982), we retrospectively studied Barrett's esophagus in children 19 yr of age or younger who were evaluated for gastroesophageal reflux and whose symptoms warranted esophagoscopy and esophageal biopsy. Esophageal biopsies were performed on 103 patients with gastroesophageal reflux. Thirteen children (age range, 8 mo-19 yr) had Barrett's esophagus, for a prevalence of 13%. Gastroesophageal reflux was documented in these children by upper gastrointestinal radiographs or pH monitoring. Radiographs demonstrated esophageal stricture in 5 of the 13 children; none had hiatal hernia. Children presented with symptoms suggestive of gastroesophageal reflux and esophagitis: vomiting, abdominal pain, odynophagia, dysphagia, and heartburn. All children had a past history of excessive regurgitation during infancy. Histologically, three types of columnar epithelium were present: gastric fundic type (11 patients), junctional-type columnar epithelium reminiscent of gastric cardia (7 patients), and specialized columnar (metaplastic intestinal) type (2 patients). We believe that Barrett's esophagus is more common in children than had previously been appreciated. In these children, we suggest that the distal columnar-lined esophagus resulted from chronic gastroesophageal reflux and is not a congenital anomaly.
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PMID:Barrett's esophagus in children: a consequence of chronic gastroesophageal reflux. 669 Mar 59

A 56-yr-old man with severe reflux esophagitis, Barrett's esophagus, and a peptic lower esophageal stricture underwent subtotal resection of the Barrett's esophagus with colonic interposition. After the interposition procedure, gastroesophageal reflux was eliminated, as evidenced by absence of clinical and radiographic findings and by the results of a later continuous pH probe recording. Despite the absence of reflux, 8 yr after the colonic interposition the patient was found to have adenocarcinoma in the remnant of the Barrett's esophagus. This case indicates that elimination of gastroesophageal reflux does not necessarily lead to regression of Barrett's mucosa, nor does it prevent development of adenocarcinoma. As a result, patients with Barrett's esophagus should remain under long-term surveillance for dysplasia and adenocarcinoma, even after successful antireflux therapy. If esophagectomy is performed, every attempt should be made to resect all of the esophagus lined by Barrett's mucosa.
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PMID:Adenocarcinoma in Barrett's esophagus after elimination of gastroesophageal reflux. 669 Mar 63

The results of this study demonstrate that there is abnormal esophageal function in patients who have undergone repair of esophageal atresia. The diagnostic tests used may be too sensitive as the abnormalities demonstrated have little clinical relevance. In addition, there was an inverse relationship between signs and symptoms of esophageal dysfunction and the age of the child. The abnormalities are probably intrinsic and only secondarily affected by surgical treatment. Increased tension at the gastroesophageal junction is a likely factor in the production of gastroesophageal reflux. Esophageal dysfunction does not necessarily lead to detrimental gastroesophageal reflux with the sequela of repeated respiratory infections, failure to gain weight or esophageal stricture. Only patients who have such signs or symptoms need to undergo evaluation of esophageal function to determine if there is an abnormality. The results of the studies then document the need for an antireflux procedure.
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PMID:Esophageal function after repair of esophageal atresia. 671 Feb 97

Drug histories were obtained from 76 patients at the time of initial Eder-Puestow dilatation for benign oesophageal stricture. Six patients had consumed drugs known to cause oesophageal ulceration (emepronium bromide and potassium preparations). Of the remaining 70 patients, 22 had regularly taken a non-steroidal anti-inflammatory drug before the onset of dysphagia compared with 10 patients in a control group matched for age and sex; this difference was significant (p less than 0.02). Non-steroidal anti-inflammatory drugs may have a causative role in the formation of oesophageal stricture in patients with gastro-oesophageal reflux, in whom they should be prescribed with caution.
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PMID:Non-steroidal anti-inflammatory drugs and benign oesophageal stricture. 680 92


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