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

Among 457 esophageal stenosis treated between 1954 and 1977, 258 (56%) were caustic stenosis. The treatment of those is the most difficult. Functionnal healding was satisfactory in 93% of the treated cases by dilatations. Four strict rules ought to be observed in the management of this cases. Immediate and long terme antibiotic treatment of the corrosive esophagitis. X rays are the only means to be used during evolution of corrosive esophagitis. No instrumental performance until sufficient cicatrization. Retrograde dilatations after gastrostomy shall be prefered in serious cases. Gastro-esophageal reflux may complicate this evolution and require surgery. Total esophageal replacement can be averted in most cases.
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PMID:[Assessment of a thirty year long experience in treatment of esophageal caustic stenosis (author's transl)]. 74 87

Findings in this study correlated a low circulating gastrin level with an incompetent lower esophageal sphincter mechanism and abnormal reflux. Such reflux, in amounts causing esophagitis distally, was treated surgically by a mechanically simple method of fundoplication. The success of this reefing method of fundoplication was explained by using physiologically active sling fibers of the gastric fundus to augment the lower esophageal sphincter. Available gastrin was used more effectively in this manner. The high incidence of associated foregut diseases suggested an embryologic factor in the development of gastroesophageal reflux. The dilated hiatus and its attendant hernia had no apparent relationship to the development of reflux esophagitis. The term symptomatic sliding hiatal hernia, therefore, seemed to be a diagnostic and therapeutic misnomer.
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PMID:The role of gastrin in the treatment of sliding hiatal hernia with reflux using the reefing method of fundoplication. 78 38

Thirty patients in which there was a clinical suspicion of esophagitis reflux were studied. After radiological and endoscopic study, the gastroesophageal reflux was determined by means the Heidelberg telemetric capsule, for this purpose HCl 0.1N was used and changes in the gastroesophageal pH were registered in the Trendelenburg position. The results were correlated with the radiological and endoscopic findings.
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PMID:[Gastroesophageal reflux. Study with Helderberg's telemetric capsule]. 82 77

Fifty-five infants and children with complications of gastroesophageal reflux required operative management for control of symptoms. All patients, except those with severe esophageal stricture, received a six-week trial with 60-degree constant elevation before an operation was considered necessary. The operation was performed to control (1) persistent vomiting, (2) vomiting with growth retardation, (3) esophagitis, (4) esophagitis with stricture, and (5) recurrent aspiration pneumonia. Preoperative and postoperative evaluation involved both X-ray fluoroscopy and esophageal manometry with pH studies. A good surgical result was not dependent upon an increase in the lower esophageal pressure following operation. The Boerema anterior gastropexy is simple and effective for controlling gastroesophageal reflux for cases uncomplicated by esophagitis, stricture, or previous operation. Complex cases with inflammatory or operative changes in the lower esophagus are more effectively treated by Nissen fundoplication.
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PMID:Evaluation of gastroesophageal reflux surgery in children. 84 May 43

In this study we determined the acute effect of bethanechol (5 mg SC) on gastroesophageal reflux (GER) and lower esophageal sphincter pressure (LESP) in 27 patients with symptomatic esophagitis. The effect of bethanechol on esophageal acid clearance was also determined in 7 of the patients. Intraluminal pH monitoring prior to bethanechol administration demonstrated free or stress-induced reflux episodes in 18 of the 27 patients. Following bethanechol (1) LESP increased significantly, (2) GER diminished or ceased in many of the patients, and (3) acid clearance times decreased significantly. Some individuals, however, continued to reflux despite LESP elevation to 30 mm Hg or more. This latter finding suggests that LESP alone is not the sole factor governing LES competency. Other factors such as improved esophageal emptying may also contribute to the beneficial therapeutic effect of bethanechol in patients with heartburn.
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PMID:Effect of bethanechol on gastroesophageal reflux. 84 31

The diagnostic significance of endoscopically early signs of oesophagitis in the absence of macroscopic evidence of epithelial abnormalities has been studied prospectively. Changes from the usually observed shininess, pale-pink colour, smooth texture, regular capillaries, sharp Z-line and a decreased mechanical resistance of the mucosa to mechanical damage do not indicate oesophagitis. Nor should one infer gastro-oesophageal reflux from these endoscopic findings. They are presumably ageing changes in the oesophagus.
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PMID:[Endoscopic diagnosis of oesophagitis: problems of differentiation from normal (author's transl)]. 85 11

Two infants with torticollis and hiatus hernia (Sandifer Syndrome) are presented. Both infants improved with medical management. Abnormal head and neck positioning is attributed to esophagitis secondary to gastroesophageal reflux, with or without hiatus hernia. Since esophagitis due to reflux is not necessarily accompanied by vomiting, infants with torticollis shoud be studied for gastroesophageal reflux. If present, medical management is usually successful.
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PMID:Torticollis with hiatus hernia in infancy. Sandifer syndrome. 85 42

6 patients whose peptic oesophageal stricture caused by reflux oesophagitis was treated surgically with Nissen fundoplication and oesophageal dilatation are reported. In 5 patients oesophageal dilatation was performed intraoperatively and in one postoperatively 2 months after Nissen fundoplication. One patient whose stricture had been treated for 12 years with repeated dilatation required several dilatations postoperatively as well, but now, 6 months after operation, the need and frequency of dilatations are definitely decreasing. Our results of the Nissen fundoplication operation and simultaneous oesophageal dilatation are very promising. We feel that in the surgical treatment of benign peptic oesophageal stricture, particularly if the aetiology of the stricture isgastro-oesophageal reflux, more conservative operations of this type will displace other procedures consisting of resection of the stricture with or without intestinal interposition.
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PMID:Surgical treatment of peptic oesophageal stricture with Nissen fundoplication and intraoperative dilatation. 86 81

Hoarseness, asthma, and bronchitis are common but sometimes obscure manifestations of gastroesophageal reflux, the etiology of when respiratory symptoms predominate. In 300 consecutive patients who underwent surgical correction for gastroesophageal reflux, 129 (43%) had major respiratory complaints. Group 1 patients (82, 64%) were those referred for respiratory problems alone. In Group 2 (patients referred because of peptic complaints), 47 had associated respiratory problems in various combinations, including an additional 10 patients who had bronchiectasis. Treatment with appropriate surgical resection, in addition to antireflux procedures, was carried out in these people. Noticeable relief of respiratory symptoms was obtained in 96 (74%) of the 129 patients; 30 were improved and 2 were unchanged. Recurrent hiatus hernia or esophagitis was documented in 21 (7%) of the 300 patients.
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PMID:Hiatus hernia and the respiratory tract. 92 77

The operations of Nissen, Hill, and Belsey are adequate in controlling esophaegeal reflux in the majority of patients. In a small percentage however, objective and subjective evidence of esophagitis persists in spite of repeated operations to restore lower esophageal sphincter competency. These failures are then usually treated by operative procedures of great magnitude involving organ interposition. Repeated antireflux operations directed to the gastroesophageal area may in some instances result in impairment of blood supply with an increased risk of both esophageal and gastric fistulae. In the past many observers have felt that reflux esophagitis resulted solely from the effects of acid-pepsin secretions bathing the distal esophagus. Recently experimental and clinical data have indicated the importance of duodenal contents in the etiology and perpetuation of reflux esophagitis. During a recent two year period, 6 patients with persistent reflux esophagitis uncontrolled by repeated antireflux procedures have been seen on our service. These 6 patients, underwent 12 unsuccessful antireflux operations elsewhere. Three of the 6 patients had also been subjected to vagotomy-antrectomy for a coexisting duodenal ulcer. A marked lowering of gastric acidity took place but esophageal reflux and esophagitis persisted. These three patients were treated on our service by takedown of the Billroth I anastomosis, closure of the duodenal stump and diversion of the duodenal contents into a Roux-en-Y limb. Three other patients who had undergone unsuccessful antireflux procedures alone were subjected to antral resection, Roux-en-Y diversion and transthoracid vagotomy. This simplified appraoch to the treatment of persistent esophageal reflux uncontrolled by repeated antireflux procedures has given satisfactory results. The operation should be considered when technical considerations preclude further surgical attempts to perform another effective antireflux operation. Total duodenal diversion should, however, not be considered as the primary operation for the patient suffering from reflux esophagitis. However, in circumstances discussed above this direct approach appears preferable to major resectional procedures.
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PMID:Total duodenal diversion for treatment of reflux esophagitis uncontrolled by repeated antireflux procedures. 97 51


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