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

Gastro-oesophageal reflux can lead to peptic oesophagitis and stricture formation. This is particularly true in infants in whom the condition should be suspected if the patient presents with vomiting, anaemia and failure to thrive. The anatomy of the oesophago-gastric junction is described. The inferior oesophageal sphincter is the main barrier to reflux, and marks the functional junction between oesophagus and stomach. It is under nervous and hormonal control. It is weak in the neonate who therefore frequently refluxes. An hiatus hernia can cause problems due to its bulk but the main problem of peptic oesophagitis is due to gastro-oesophageal reflux. The radiological examination should be carried out carefully with the patient swallowing in a prone position. The patient should be put in the Trendenlenberg position and compression applied to the abdomen. Reflux is intermittent and a negative examination should be repeated if the clinical findings suggest a diagnosis of peptic oesophagitis. Associated pyloric stenosis should always be excluded. Radiological examination of the gastro-oesophageal junction remains the quickest, simplest, and most convenient and safe technique as long as its limitations are appreciated.
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PMID:Gastro-oesophageal reflux, hiatus hernia and the radiologist, with special reference to children. 32 Oct 66

Two patients with intraluminal esophageal diverticulum are described and illustrated. Both had chronic esophagitis. One had a distal esophageal stricture, while the other showed persistent retrograde gastroesophageal reflux following hiatal hernia repair. Possible causes are considered, based on the presumption of intermittently or chronically increased intraluminal pressure associated with an area of congenital or acquired weakness of the esophageal wall.
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PMID:Intraluminal diverticulum of the esophagus. 40 28

To evaluate the role of gastroesophageal reflux (GER) as a possible cause of recurrent pulmonary disease, 30 children, aged 1 to 18 years, were studied prospectively with esophageal function tests. These included esophagram (30 patients), esophageal manometry (29 patients), pH probe (Tuttle) test (29 patients), and esophagoscopy with esophageal biopsy (23 patients). The patients studied had either chronic asthma or two or more documented pneumonias within a one-year period. Nineteen (63%) had GER based on two or more positive tests. Eighteen had positive Tuttle tests; 13 had abnormal manometry studies; nine had esophagitis on biopsy; six had esophagitis on esophagoscopy; and five had reflux on esophagram. Of those with GER, 17 had a history of nocturnal cough and eight vomited during infancy. Children with recurrent pulmonary disease should have esophageal function testing to exclude GER as the cause.
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PMID:Recurrent pulmonary disease in children: a complication of gastroesophageal reflux. 44 Aug 2

Gastro-oesophageal reflux and hiatal incompetence were analysed in 191 patients using a new radiographic contrast medium, polyiodostyrene, with the same density (1.0 g/cm3) as ordinary gastric contents, and correlated with supplementary oesophagoscopy and intraluminal pressure measurements. A normal hiatus seems to be an important protection against gastro-oesophageal reflux. An incompetent hiatus involves a real risk for oesophagitis. A low-density, low-viscosity contrast medium improves the roentgenologic diagnosis of gastro-oesophageal reflux.
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PMID:Hiatal incompetence and gastro-oesophageal reflux. 52 4

In 196 cases of gastro-oesophageal reflux, simple or connected to a hiatal hernia or to a cardio-tuberous misplacement, the respiratory signs that are found in 1 patient out of 4, are analyzed. The nocturnal fits of coughing (39 cases, 20% of the reflux) is the most frequent sign of laryngo-tracheal aspiration of stomach content. This symptom of great diagnostic value, though neglected, should be looked for systematically. Other troubles are less frequent: bouts of recurring broncho-pulmonary infections, asthma attack, Mendelson's syndrome, pulmonary fibrosis. In absence of a patent cause, the symptoms should lead to suspect a reflux of stomach content in the airways. Similarly to oesophagitis, respiratory signs represent a complication sometimes serious, of gastro-oesophageal reflux, needing more frequently a surgical treatment of hiatal herniae or of the cardiac inefficiency.
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PMID:[Broncho-pulmonary manifestations and gastroesophageal reflux]. 61 79

The accepted diagnostical procedures to prove a gastroesophageal reflux by direct or indirect methods do not allow any quantification and are of limited sensitivity. A quantification is possible by use of a gamma-camera with a computer-system after application of a small amount of 99m Tc-DPTA (reflux scintiscan). The high accuracy of this method could be proven by evaluation of 51 patients with suspected gastroesophageal reflux esophagitis or after total gastrectomy. The results were compared with the histological findings. With this method we found after total gastrectomy the expected high incidence of relux. The long-term results after semifundoplication were not as good as after fundoplication. The reflux scintiscan is a less invasive, but reliable method to detect the gastroesophageal reflux.
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PMID:[Functional scintigraphy in the diagnosis of gastroesophageal reflux (author's transl)]. 65 81

Barrett's esophagus was diagnosed in 26 men in a five-year period by demonstrating esophageal specialized columnar epithelium in target biopsies obtained at endoscopy or in peroral suction biopsies of the esophageal mucosa. The clinical, radiologic and manometric features of these patients were reviewed retrospectively. Esophageal lesions associated with this epithelium included distal and midesophageal strictures and ulcers, alone or in combination, or simply esophagitis. One patient had an associated adenocarcinoma. Twenty of 26 (77%) had heartburn or regurgitation, 16 (62%) had easily elicited reflux of barium while supine and 16 of 17 tested had lower esophageal sphincter pressure in the incompetent range. Ninety-six percent had one or more of these parameters positive. This series demonstrates a wide spectrum of esophageal lesions in Barrett's esophagus, and supports the concept that this lesion occurs as a consequence of gastroesophageal reflux and erosive esophagitis. The case of adenocarcinoma in this series adds to the concern that the columnar lined lower esophagus may be a premalignant lesion.
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PMID:Barrett's esophagus. Clinical review of 26 cases. 68 53

Although the lower esophageal ring is an important cause of dysphagia in adults, its pathogenesis is unknown. To better define the relationship between the lower esophageal ring and esophageal reflux, we analyzed, retrospectively, the records of 18 hospitalized patients with radiologically demonstrated rings (16 confirmed by endoscopy and/or surgery). In 16 of these patients, evidence of esophageal reflux including at least one of the following was present: overt esophagitis noted at endoscopy or surgery (14 cases), histologic evidence of esophagitis (3 cases), and/or symptoms of pyrosis or free reflux (13 cases). These findings suggest that 1. reflux is frequently associated with lower esophageal rings and may play a role in their pathogenesis; 2. the radiologic finding of a ring should serve as a clue to the possibility of esophageal reflux and 3. long-term control of dysphagia in these patients may depend upon control of the associated reflux as well as mechanical disruption of the ring.
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PMID:The lower esophageal ring and esophageal reflux. 68 61

Esophagitis is caused by a gastro-esophageal reflux sometimes reflecting anatomical inadequacy of structures that secure the relationships between the cardia and the diaphragm, fundus of the stomach, and other surrounding viscera, but more often due to functional deficiency of lower esophageal sphincter (LES), this representing the main factor for maintenance of the mechanism of cardial continence. Manometric studies of intraluminal pressures in the esophagus have revealed the presence of a high-pressure segment in the distal esophagus, where a mean pressure of 12-13 mm Hg obtains over a length of 3 or 4 cm. In the first two weeks of extrauterine life the LES is between 0.5 and 1 cm long, with a pressure of 3 mm Hg; pressure values in the LES equal adult values at about one month of age, showing that neuromuscular control of the sphincter has been achieved. Gastro-esophageal reflux, however, is very common in the newborn and not enough by itself to cause peptic disease of the esophagus; this requires the concomitance of morphological defects of the esophageal mucosa and/or dynamic-functional disturbances. This, according to the authors, is why esophagitis actually occurs in only about 60% of patients with radiologically and pHmetrically demonstrated gastro-esophageal reflux.
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PMID:[Current views concerning the etiopathogenesis of reflux esophagitis in children]. 69 24

A problem of some complexity is the management of pathological gastro-esophageal reflux due to the presence of cardio-hiatal malformation, malposition of the cardia and gastric tuberosity, a congenitally short esophagus, and the like. Sometimes, however, there is no demonstrable morphological aleration and the condition, characterized by primitive hypotonia of the LES, goes under the name of infant chalasia of the esophagus. The general policy is to try first a conservative treatment consisting of dietary and postural measures and the administration of metoclopramide and d;ugs that protect the esophageal mucosa; this stage, however, should not be prolonged beyond 6 weeks. The presence of gastro-esophageal reflux associated with hiatal hernia; the presence of severe esophagitis or peptic stenosis of the esophagus and the persistence of symptoms after an adequate period of conservative therapy constitute as many indications for surgical correction. Good results can be obtained by restoring or strengthening the failing function of the LES, as is done quite successfully with funduplication after Nissen or with method of Belsey-Mark IV.
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PMID:[Current trends in the treatment of reflux esophagitis in childhood]. 69 26


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