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

Esophageal transection by means of an anastomotic clip or button is a simple and useful approach to the management of haemorrhage due to esophageal varices. We have used this technique in four cases (three Prioton clips, and one autosuture) and completed the procedure with periesophageal, left gastric and fundal veins ligation. The patients have been followed up for periods ranging between five months and six years. No one has rebled. Splenoportographic controls showed good results of disconnection, and endoscopic follow up revealed variceal cure. There was no GER and in one single case we had to dilate for mild stenosis. This is a simple and effective procedure for the control of variceal haemorrhage in the short and middle ranges, and can induce cure directing portal flow through other alternative ways.
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PMID:[Treatment of portal hypertension in children]. 661 Oct 98

Distal esophageal function and LES competence were evaluated in 21 patients by means of esophageal manometry and standard pHmetry after Sujura mod. operation for bleeding esophageal varices. This operation involves complete devascularization of 10-12 cm. of distal esophagus, disruption of anatomic anti-reflux mechanism, excision of nearly one cm. of muscular tissue at lower esophageal sphincter level. Intraoperative manometry was performed in 8 patients and demonstrated a significant shortening of high pressure zone, while lower esophageal sphincter pressure did not show significant variations. Postoperatively gastroesophageal reflux at pHmetry was not observed (five patients had pathological reflux preoperatively). No significant variations of resting lower esophageal sphincter pressure and no peristaltic alterations were observed. In conclusion despite the marked anatomic alterations related to this procedure, sphincter dynamics and distal esophageal function remain nearly normal.
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PMID:Functional evaluation of distal esophagus and lower esophageal sphincter after esophagogastric devascularization, esophageal transection and antireflux procedure for bleeding esophageal varices. 661 25

Because of the great interest in the problem of gastroesophageal reflux, much emphasis has been placed on factors which control the competence of the lower esophageal sphincter (LES). Much study has been devoted to the effect of hormones and drugs on the LES. Of the various diagnostic methods available, 24-hour pH testing seems to offer the most information regarding reflux and its complications. Medical therapy should be given a careful trial before surgical procedures for reflux are considered. Diagnostic esophagoscopy is usually performed with fiberoptic instruments. Open-tube esophagoscopes are still preferable for most types of endoscopy is usually performed with fiberoptic instruments. Open-tube esophagoscopes are still preferable for most types of endoscopic therapy. However, flexible fiberscopes may be used for injection of esophageal varices and for laser coagulation of bleeding lesions or even tumors. Guide wires may be introduced through flexible scopes to aid in the dilation of esophageal strictures and also to aid in the placement of prosthetic tubes in patients with obstructing cancers. The performance of esophagoscopy by practitioners of several disciplines has resulted in fragmentation of the specialty. Ideally, all esophagoscopists should be competent with both open-tube and fiberoptic scopes and should be familiar with all of the newer knowledge of the physiology and pharmacology of the esophagus and its sphincters.
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PMID:Chevalier Jackson lecture. Esophagology: an update. 681 24

The precipitating factor in bleeding oesophageal varices is unknown. To investigate this problem 10 patients who had bled from oesophageal varices were examined by manometry, pH monitoring and gastroscopy to determine whether gastro-oesophageal reflux occurred. No evidence for reflux was found. These results, together with previously published reports, cast doubt on peptic oesophagitis or reflux as an aetiological factor in the initiation of oesophageal variceal bleeding.
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PMID:Gastro-oesophageal reflux: an aetiological factor for bleeding in oesophageal varices? 696 35

A morphometric study of the distal esophageal mucosa (within 5 cm above the gastroesophageal junction) has been carried out in a group of 11 cirrhotic patients undergoing esophageal transection with SPTU gun for variceal bleeding. The relative thickness of the papillae (62.2 +/- 3.9%) and basal zone (11.8 +/- 1.9%) were within normal limits. Polymorphonuclear infiltrates were not found either in the lamina propria or in the epithelium. The absence of histopathologic changes in the esophageal mucosa from patients with liver cirrhosis and bleeding esophageal varices confirms the hypothesis that gastroesophageal reflux does not play a pathogenic role in the development of variceal bleeding.
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PMID:Morphometric study of the esophageal mucosa in cirrhotic patients with variceal bleeding. 697 45

Twenty-five adult patients with liver cirrhosis, and another 30 patients with no liver disease but referred with symptoms suggestive of gastroesophageal reflux disease were selected at random. Twenty-four hour ambulatory intra-esophageal pH measurement and upper gastrointestinal endoscopy were carried out on all patients recruited. Applying the former test, 16 (64%) of the patients with liver cirrhosis have gastroesophageal reflux disease. This figure is comparable with the 70% (21/30) rate recorded in the group of dyspeptic patients clinically thought to have the disorder. A positive endoscopic diagnosis was much lower at 12% and 23%, respectively. No significant differences were observed among liver disease patients when they were subdivided in accordance with the etiology of liver cirrhosis and the grade of esophageal varices. We conclude that gastroesophageal reflux disease occurs at a high frequency (64%) in patients with liver cirrhosis and portal hypertension, irrespective of the etiology of cirrhosis and the grade of esophageal varices. It is therefore considered to be the main cause of esophagitis in these patients, and that it might play a role in initiating a variceal bleeding episode. The latter hypothesis needs further evaluation.
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PMID:Frequency of gastroesophageal reflux in patients with liver cirrhosis. 827 Feb 39

Gastroesophageal reflux (GER) and esophageal motility were evaluated in patients with esophageal varices (EV). This study comprised 35 patients with EV, 18 patients with reflux esophagitis (RE) and 12 healthy volunteers. EV were classified according to the F factor by the Endoscopic Classification of EV of the Japanese Research Society for Portal Hypertension. The lower esophageal sphincter (LES) function in the F3 group was significantly decreased and similar to that in the RE group. The amplitude of primary peristalsis at the site of F2 or F3 EV was significantly decreased. Acid clearance was significantly delayed in the F2 and F3 groups compared to that in the healthy subjects. GER was suppressed by the presence of F3 EV and was significantly decreased in this group compared to that in the healthy subjects. An antireflux barrier is concluded to be maintained in patients with F3 EV.
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PMID:Gastroesophageal reflux and esophageal motility in patients with esophageal varies. 837 20

We investigated esophageal motility in 12 patients with esophageal varices by esophagography, scintigraphy and manometry before and after endoscopic sclerotherapy. In the manometric study, the appearance rates of the primary wave and the deglutitive relaxation decreased gradually after sclerotherapy, and the former improved within 3 months after discharge, while the latter tended to have a prolonged recovery period. The pressure of the lower esophageal sphincter was not significantly different before and after sclerotherapy. The length of the lower esophageal high pressure zone was greater than normal range before sclerotherapy, but it gradually shortened after sclerotherapy and improved by 3 months after sclerotherapy. The inducing rates of gastroesophageal reflux by abdominal compression was significantly higher at 3 months after sclerotherapy than before. In radiologic study, the esophageal transit time tended to prolong early after sclerotherapy, and it improved only slowly. We concluded that we need contrive to prevent from motility disorder of esophagus at the time of endoscopic sclerotherapy for patients with esophageal varices.
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PMID:[Effect of endoscopic sclerotherapy with esophageal varices on esophageal motility]. 865 66

The effects of ethanol upon the gastrointestinal tract (mouth, pharynx, esophagus, stomach, duodenum, Oddi's sphincter, small bowel, colon and rectum) were reviewed. Several studies showed that the incidence of cancer in the mouth and pharynx is increased in alcoholics as a consequence of ethanol effects and probably those of other compounds found in liquors. The gastroesophageal reflux disease may be induced by alcohol since it reduces the pressure in the lower and the upper esophageal sphincter, as well as the extent of primary peristalsis. Several studies showed a strong correlation between esophageal cancer and alcohol abuse. The risk for developing this kind of tumour is significantly increased when alcohol abuse and smoking coexist. Alcoholism predisposes patients to Mallory-Weiss syndrome as well as to bleeding of esophageal varices Ethanol may affect gastric secretion, motility, and permeability. Some drugs acting upon the gastric alcohol-dehydrogenase are able to affect gastric absorption of ethanol. Eradication of Helicobacter pylori increases the activity of alcohol-dehydrogenase in the pyloric antrum. The effects of alcohol upon the gastric mucosa include caustic damage, retrograde diffusion of H+, and cytoprotection. This agent may cause an acute gastritis but it is probably not involved in chronic gastritis. Whether alcohol is a risk factor for ulcer or not is unknown. Some studies found an increased incidence of gastric cancer associated with consumption of beer, wine and vodka. Some authors reported a decreased pressure in Oddi's sphincter while others found it increased in association with the consumption of ethanol. The acute and the chronic consumption of alcohol may affect the structure of small bowel as well as the absorption of nutrients. Several studies reported a significant correlation between colorectal cancer and the chronic consumption of ethanol.
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PMID:[Ethanol and the gastrointestinal tract]. 872 88

Endoscopic variceal sclerotherapy (EVS) has been considered the mainstay of therapy for bleeding esophageal varices in adults. However, recent data have shown that endoscopic variceal ligation (EVL) is just as efficacious and has fewer complications than EVS. Although there are many reports concerning EVL in adults, only a few studies have been done in children. This report describes experience with EVL in 22 children with esophageal variceal hemorrhage. Eighty-seven EVL procedures were performed during a 9-year period in 22 children. The causes of portal hypertension were biliary atresia (10), portal vein thrombosis (8), chronic active hepatitis (1), cirrhosis secondary to cystic fibrosis (2), and primary sclerosing cholangitis (1). The age range at the onset of variceal bleeding was 8 months to 19 years. Twelve patients had EVS before EVL treatment was begun. Distal esophageal varices (one to four per session) were mechanically ligated using an elastic band ligature device attached to a flexible endoscope. The aim of therapy was obliteration of distal esophageal varices by EVL, every 2 to 4 weeks, until eradication. Subsequent EVL was dictated by the status of the varices. Outcome was assessed with respect to survival, rebleeding, status of varices, and complications. The patients underwent a mean of four sessions of EVL (range, one to eight). Four patients subsequently underwent liver transplantation. Of the 18 patients remaining (average follow-up period, 5.3 years), 12 had their varices eradicated (average of four EVL sessions), four are still in treatment, one has not been evaluated in the past 4 years, and one died of liver failure. Complications included bleeding between sessions (6 patients), cervical esophageal perforation (1 patient), and transient fever (2 patients). No child has experienced symptoms of esophageal stenosis or gastroesophageal reflux. Two patients died of liver disease, unrelated to bleeding from portal hypertension. EVL is effective in controlling variceal hemorrhage in children with portal hypertension, regardless of etiology. The complication rate is low, and EVL is an acceptable and perhaps preferable alternative to EVS in children with esophageal varices.
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PMID:Management of esophageal varices in children by endoscopic variceal ligation. 886 33


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