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

Thirty-two patients with symptomatic gastroesophageal reflux disease were investigated by esophagogastroduodenoscopy, 24 h pH monitoring, esophageal manometry and measurement of gastric emptying of solids, in order to elucidate the relative importance of lower esophageal sphincter tone, amount of acid reflux and gastric emptying on the degree of esophagitis. The mechanical competency of lower esophageal sphincter was significantly deranged in patients with moderate/severe esophagitis than in patients with mild esophagitis. The gastric emptying time was significantly delayed in patients with moderate/severe esophagitis than in patients with mild esophagitis. No relationship was observed between amount of acid reflux, lower esophageal sphincter function and gastric emptying time. Our results suggest that resting pressure of lower esophageal sphincter and the gastric motor function play a major role in severity of reflux esophagitis.
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PMID:[The role of esophageal sphincter tonus and of gastric motility in the extent of reflux esophagitis]. 155 47

We recorded esophageal alkaline exposure time (AET) in 52 patients with gastroesophageal reflux and in 20 control subjects to determine whether esophageal pH monitoring can measure reflux of bile acids and trypsin from the duodenum. Patients underwent a further 16-h study (divided into 2-h periods) in which AET was correlated with bile acid and trypsin concentrations in esophageal aspirates. Patients had greater nocturnal AET than controls (22.7 versus 0.9%, p = 0.005). Patients with a stricture had a greater AET than patients with erosive esophagitis (25.2 versus 13%, p less than 0.05). There was no relationship between esophageal bile acid concentrations and AET, and total bile acid concentrations were similar regardless of whether a 2-h period contained alkaline episodes. Esophageal bile acid concentrations were no different, in patients with a normal esophagus, esophagitis, stricture, or Barrett's esophagus. Trypsin was found in only 5% of aspirates, and could not be predicted by AET. We conclude that measurement of AET is not useful in the clinical evaluation of duodeno-esophageal bile reflux, and bile acids and trypsin are not important in the pathogenesis of reflux esophagitis.
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PMID:Bile acids and trypsin are unimportant in alkaline esophageal reflux. 155 3

Much has been learned about the pathophysiology of gastro-esophageal reflux (GER) since it was initially described by Asher Winkelstein in 1935. With the development and refinement of esophageal function tests in the past decades, the diagnostic modalities have become available for a deliberate and systematic evaluation of antireflux mechanisms. Some of the newer concepts of the pathogenesis of reflux esophagitis are reviewed in this article.
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PMID:What has the surgeon to know about pathophysiology of reflux disease? 156 14

Few data have concerned gastric peptic activity in reflux esophagitis. Gastric basal and pentagastrin-stimulated acid, pepsin, sialic acid (marker of gastric mucus erosion) and choline (marker of duodenal refluxate) outputs were measured in 75 patients with gastroesophageal reflux. Fifty-one patients had erosive esophagitis (grade greater than or equal to II) and 24 had no esophagitis or esophagitis grade I. In 12 patients of each group, gastric secretory parameters were correlated with results of 24-hour esophageal pH-metry. Stimulated pepsin output was significantly higher in patients with esophagitis than in the others (P less than 0.001). Basal pepsin output was significantly higher in women with esophagitis than in women without esophagitis (P less than 0.05). Acid, sialic acid, and choline outputs did not differ between the two groups. Thirty-seven and 49 percent of patients with esophagitis had elevated basal and stimulated pepsin outputs, respectively, as compared with 33 and 29 percent of patients without esophagitis. Thirty-one percent of patients with esophagitis had gastric acid hypersecretion, as compared with 25 percent of patients without esophagitis. There was no correlation between gastric secretory parameters and data obtained from esophageal pH-metry. Nevertheless, esophageal acid exposure was higher in patients with esophagitis than in patients without esophagitis. These results suggest that gastric proteolytic content is a pathophysiological factor for erosive esophagitis.
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PMID:[Gastric secretion of pepsin in gastroesophageal reflux complicated or not with peptic esophagitis]. 156 41

A patient, an 80-year-old female, had complained of a cough for 20 weeks, and was not cured by cough medicine. Gastroesophageal reflux was considered as the cause of the cough because of her symptoms and gastrointestinal fiberscopy (GIF) and barium meal studies. She made favorable progress on a histamine H2 blocker and cysapurid for 4 weeks. Therefore we diagnosed her cough as caused by gastroesophageal reflux. We also studied the incidence of chronic persistent cough in patients suspected of gastroesophageal reflux because of symptoms and GIF results. Among 676 cases examined by GIF at Niigata-kenritsu Myoko Hospital, we detected 7 cases who complained of heartburn and in whom we observed hiatal hernia and reflux esophagitis by GIF. Only one of them, the present case, complained of a cough. CPC caused by gastroesophageal reflux is not seen frequently, but the possibility of GER as the cause of CPC should be considered.
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PMID:[A case of chronic persistent cough (CPC) caused by gastroesophageal reflux (GER) (including a study of CPC caused by suspected GER)]. 157 43

Famotidine, a potent and long-acting H2-receptor antagonist, has been evaluated in patients with gastroesophageal reflux disease (GERD). From intraesophageal pH monitoring and clinical studies, b.i.d. dosing of this selective compound is necessary for achieving adequate results. The results of large double-blind trials performed in patients with erosive reflux esophagitis compare favorably with those reported using cimetidine and ranitidine. Famotidine appeared to be effective in ranitidine-resistant patients with severe GERD, and achieved healing rates superior to ranitidine in a comparative trial. Recent data also show that long-term treatment with famotidine seems to be effective in preventing recurrence in most patients with healed reflux esophagitis. Famotidine is a very useful H2-receptor antagonist for the treatment of most patients with GERD.
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PMID:Famotidine in gastroesophageal reflux disease (GERD). 157 91

Reflux esophagitis differs from peptic ulcer disease in many respects. Whereas nighttime acid inhibition alone achieves healing in approximately 80 to 90% of patients with peptic ulcer, more profound acid inhibition seems to be necessary in those with GERD. Conventional dosing with H2-receptor antagonists has been successful in only about 50% of the patients with reflux esophagitis. Strong, prolonged 24-hour inhibition of gastric acid secretion is probably the most important factor in the treatment of reflux esophagitis. Omeprazole, a substituted benzimidazole, produces effective 24-hour inhibition on gastric acid secretion. In doses ranging from 20-60 mg once daily, omeprazole has proved to be effective in the short-term treatment of reflux esophagitis, even in patients resistant to treatment with H2-receptor antagonists. Healing of severe, resistant reflux esophagitis therefore is no longer a clinical problem. Reflux esophagitis is a chronic, relapsing condition that cannot be compared to peptic ulcer disease in all aspects. In particular, long-term therapy must be more aggressive than the standard minimum maintenance dose used in peptic ulcer. Not only for healing, but also for prevention of recurrences, strong, prolonged inhibition of acid secretion must be provided. Experience of more than 5 years of continuous treatment with omeprazole, in doses adjusted to prevent recurrences, has demonstrated the high efficacy of this agent in the long-term management of reflux patients. Omeprazole provided the long-standing, strong acid inhibition that is so important in treating this condition. Long-term treatment with omeprazole in patients with resistant reflux disease did induce an initial rise of serum gastrin levels, two to four times the pre-entry value.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The role of omeprazole in healing and prevention of reflux disease. 157 92

The diagnosis of gastroesophageal reflux disease (GERD) entails the identification of patients with esophagitis and its complications as well as patients who have symptoms but no mucosal disease. Endoscopy is mandatory to establish a diagnosis of reflux esophagitis, to exclude other esophageal disease and to permit directed biopsy if columnar metaplasia, dysplasia or carcinoma is suspected. The lesions of reflux esophagitis--erosions, ulceration, stricturing and metaplasia--should be identified and graded independently, using a classification system such as the recently described "MUSE" (Metaplasia, Ulcer, Stricture, Erosions) system. Fluoroscopy can identify associated structural changes such as stricturing or esophageal shortening. Measures of esophageal acid exposure time may be used to quantify reflux before and after treatment; however, if the patient has typical symptoms but no esophagitis, a temporal association between symptoms and episodes of esophageal acidification should be sought. Ambulatory 24-hour esophageal pH-monitoring with accurate event-marking provides recordings suitable for an objective statistical analysis, which was evaluated prospectively in 14 patients. Computerized analysis of 24-hour esophageal pH recordings diagnosed 5 patients as having acid-related symptoms although only 3 of 5 patients fulfilling the criteria for pathological reflux had pH-related chest pain. This finding was confirmed by 5 experts who analyzed all recordings visually, unaware of the result of the computer analysis. The Bernstein test should be reserved for patients whose symptoms are too infrequent to permit an objective assessment of symptom occurrence during pH monitoring. In conclusion, i) endoscopy is the test of choice for the diagnosis of esophagitis but it should be supplemented by a standardized and reliable scoring system for disease severity; ii) ambulatory esophageal pH recording with accurate event-marking is the test of choice for the diagnosis of GER-related symptoms, but it should be supplemented by an objective assessment of the temporal relationship between symptoms and esophageal pH; and iii) esophageal manometry is the test of choice for evaluating esophageal peristalsis and LES (lower esophageal sphincter) function but, in the context of GERD, its main indication is the assessment of GERD patients who are being considered for surgery. The widespread use of other tests for clinical purposes must await a better understanding of the pathophysiological mechanisms which can lead to the development of GERD.
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PMID:Diagnostic assessment of gastroesophageal reflux disease: what is possible vs. what is practical? 157 93

A ringlike structure around the cardia has proven to be sufficient in preventing gastroesophageal reflux, as seen with the Angelchick prosthesis. To avoid the insertion of a nonabsorbable foreign body, a scarring was induced by implanting a Vicryl scarf around the esophagogastric junction. Reflux disease was induced in 18 dogs by circular cardiomyomectomy. In 12 dogs, a Vicryl scarf was laid around the cardia; six dogs served as controls. All of the dogs in the control group either died or had to be sacrificed due to severe reflux esophagitis. All animals receiving the scarf survived the entire duration of the experiment. Endoscopically, only one case of temporary reflux esophagitis could be detected. Long-term pH-metry demonstrated complete reflux suppression after the third postoperative month. Radiographically, esophagogastric transit was always unimpaired. On autopsy, the scarf was found to have changed into a slim scarring after the sixth postoperative month and then remained unaltered. We conclude that inducing scarring around the cardia is as effective in reflux prevention as the silicone ring.
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PMID:Vicryl-scarf-induced scarring around esophagogastric junction as treatment of esophageal reflux disease. An experimental study in the dog. 158 92

The aim of the present study was to evaluate pressure changes of the UES under conditions that simulate the effects of gastroesophageal reflux (GER), that are, balloon esophageal distension and acid perfusion 0.1 N. Studies were performed in eight healthy subjects and fourteen patients with reflux esophagitis (RE), divided in two groups according to symptoms, 6 patients with heartburn and 8 patients with heartburn and regurgitation. We have employed the Dent sleeve to monitor UES pressure. The catheter was located with the help of a side-hole manometric catheter placed in the opposite side of the Dent sleeve; thereafter, it was anchorated. Perfusion of acid at 5 and 10 cm below the UES induces a pressure increase statistically significant, (paired data). This pressure increase is shown when mean values of the 5 minutes are considered as well for every minute. On the after hand, esophageal balloon distension did not produce pressure increases in any of the groups.
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PMID:[Continuous monitoring of the upper esophageal sphincter with the Dent device, during acid perfusion or distension with balloon of the esophageal body]. 159 60


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