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

The rationale and efficacy of gastroplasty in controlling gastroesophageal reflux were studied by manometry and cinefluorography in the dog. The pressure in a 7 by 3 centimeter gastric tube, constructed from the lesser curvature of the stomach and interposed between the esophagus and the stomach, was 3.6 +/- 1.0 centimeters higher than in the stomach. When abdominal compression was applied, the pressures were similar in the tube and the adjacent stomach, 19.0 +/- 4.0 and 19.4 +/- 4.0 centimeters, and free reflux was demonstrated between the two. When the gastric fundus was wrapped around the gastroplasty tube, its resting pressure was 13.1 +/- 0.5 centimeters higher than gastric pressure. During abdominal compression, the pressure in the gastric tube increased to 23.0 +/- 0.6 centimeters suggesting a flutter-valve arrangement that produced an effective antireflux barrier. These data suggest that gastroplasty can be an effective antireflux method only when combined with fundic wrap.
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PMID:An experimental study of the correction of gastroesophageal reflux by gastroplasty. 75 98

An operation has been devised to prevent gastro-oesophageal reflux in which a vertical partition is made parallel to the proximal gastric lesser curvature. The technique, which can be simply, safely and rapidly performed, prevents reflux in the following ways: 1. Increasing the effective length of the 'intra-abdominal oesophagus'; 2. Increasing the crural sling and mucosal flap valve effect; 3. Sharpening the angle of entry into the gastric reservoir; 4. Creating a flutter valve and markedly reducing the gastric cross-sectional area along which reflux can occur. The stomach is neither opened nor divided. The efficacy of the operation was investigated in six dogs which had their lower oesophageal sphincter excised by circular myomectomy before vertical gastric plication. Pre- and postoperative manometric and oesophageal pH studies were performed. Vertical gastric plication prevented the oesophagitis produced by circular myomectomy alone. The operation has been performed in 26 patients over a 2-year period. Assessment has been by clinical methods, ambulatory 24 h pH studies and endoscopy. Twenty-one patients were classified in Visick grades I and II and ambulatory pH recordings showed a marked reduction in reflux in 13 of 14 patients. The operation is technically simple, quick and safe to perform, being accurately and scientifically reproducible.
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PMID:Vertical gastric plication: an operation for gastro-oesophageal reflux. 264 23

Gastroesophageal reflux disease (GERD) is a common condition, and it is now generally recognized that modern medical therapy allows the physician to both heal the esophagitis and relieve the patients from troublesome symptoms such as heartburn, acid regurgitation and disabling chest pain. In addition, long-term therapy with potent acid inhibitory drugs can maintain these patients in clinical remission. The indications for antireflux surgery and long-term medical therapy have developed and changed with time but are today essentially similar, and in fact, it can be hypothesized that the outcome of a short-term "therapeutic trials" with the proton pump inhibitor would be a useful clinical tool, not only as a diagnostic test for the disease but also in the selection process before referring the patient to antireflux surgery. Antireflux surgery is designed to improve the function of the antireflux barrier by reconstructing the physiology of the gastroesophageal junction. Studies have shown that a fundoplication procedure improves the strength and length of the lower esophageal sphincter and also restitutes the flutter valve mechanism. However, since gastroesophageal reflux disease is a common disorder, it is impossible for every patient to be attended by an expert surgeon, and this might be one important reason for the sometimes poor results presented after surgical treatment. When the question arises about which type of long-term therapy should be chosen in each clinical situation, this situation should also partly be influenced by some epidemiological information. If we assume that we expose a hypothetical group of 100 patients with symptomatic, chronic severe reflux disease, also presenting endoscopic evidence of esophagitis of varying severity, available clinical information would suggest that only 25 can be considered suitable for antireflux surgery, depending on the frequently associated complicating medical disorders and the age distribution of the actual patient population. Therefore, it deserves to be emphasized that the majority of patients with complicated reflux disease are not fit for surgery and should consequently be managed medically. For younger patients with disabling GERD, antireflux surgery is still the gold standard and obviously very cost effective.
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PMID:The knife or the pill in the long-term treatment of gastroesophageal reflux disease? 750 32

We report the clinical and respiratory data of three neonates with flutter of the diaphragm and intercostal muscles, presenting soon after birth with respiratory failure. The breathing pattern was dirhythmic with superimposed frequencies, one regular and slow (60/min) representing the underlying respiratory rate, the other fast (> 300/min) and limited to inspiration. Nasal continuous positive airway pressure immediately normalized the breathing pattern in one infant, and improved ventilation in the two others. Pharmacologic therapy with chlorpromazine terminated the respiratory flutter and permitted weaning of ventilatory support within a few hours. Coexistent dysphagia suggested a disorder of brainstem function, although the children were otherwise developmentally normal at 8, 10, and 26 mo old. Laryngomalacia and gastroesophageal reflux were also present. We propose that the occurrence of respiratory flutter, dysphagia, laryngomalacia, and gastroesophageal reflux in a neonate constitutes a distinct clinical entity, termed the "respiratory flutter syndrome." The diagnosis of three infants with this presentation during an 18-mo period suggests that this may be a more frequent cause of respiratory failure in newborns than previously recognized.
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PMID:Respiratory flutter syndrome: an underrecognized cause of respiratory failure in neonates. 1167 3