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

Primary repair of esophageal atresia restores gastrointestinal continuity, but does not ensure normal esophageal function. To date 22 patients, six to 32 (average 15) years after repair of their esophageal atresias, have been evaluated by personal interview and esophageal manometrics and acid reflux testing. Previous barium swallow examinations had demonstrated varying degrees of anastomotic narrowing (12 patients), abnormal esophageal motor function (11 patients), gastroesophageal reflux (two patients), and hiatal hernia (one patient). Ten patients experience intermittent dysphagia for solid foods. Seven have typical symptoms of gastroesophageal reflux. Esophageal function tests including manometry and intraesophageal pH recording, have demonstrated varying abnormalities of esophageal motility in 21 patients and moderate to severe gastroesophageal reflux in 13. Two patients have required reconstruction of the esophagogastric junction for control of severe reflux esophagitis. The unexpected high incidence of gastroesophageal reflux in these patients, coupled with their abnormal esophageal motility which impairs normal acid clearing, renders them more prone to reflux esophagitis. Careful long-term evaluation for gastroesophageal reflux and its complications is indicated following primary repair of esophageal atresia. Evaluation of esophageal function with intraesophageal pressure and pH recordings is a far more sensitive indicator of esophageal physiology than the barium swallow examination.
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PMID:Long-term esophageal function following repair of esophageal atresia. 2 Aug 56

With the use of gastroesophageal withdrawal pH curve, pathophysiology after various surgical procedures for achalasia of the esophagus was investigated experimentally from the view point of postoperative reflux. A total of 68 dogs were divided into four groups and were prepared with proximal gastrectomy with end-to-end esophagogastrostomy, Wendel procedure, Heller procedure and Fundic patch operation, respectively. In the group with Fundic patch operation, efficacy of the flap valve, mucosal valve and fundoplication was also evaluated preparing them in various sizes. The results obtained may be summarized as follows: 1) Withdrawal pH measurement is a sentive mean to detect the gastroesophageal reflux. 2) Proximal gastrectomy with end-to-end esophagogastrostomy and Wendel procedure yielded worst results with severe gastroesophageal reflux. On the contrary, Fundic patch operation best controlled the gastroesophageal reflux. 3) Gastroesophageal reflux could be prevented by the Fundic patch operation with the flap valve 6 cm in length and fundoplication enclosing around 1/2 to 2/3 circumference of the distal esophagus.
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PMID:[Evaluation of antireflux effect of fundic patch operation by withdrawal pH curve (author's transl)]. 2 21

Twelve-hour continuous recording of pH at the distal end of the oesophagus was carried out in 59 patients with sliding hiatus hernia and symptoms suggestive of gastro-oesophageal reflux, and the results were compared with those obtained in normal subjects. Mean duration of pH less than or equal to 2.3, pH less than or equal to 3, pH less than or equal to 4 and pH less than or equal to 5, expressed in percentages of the total time of recording, was longer in patients than in normal subjects. There was no difference in mean number of reflux episodes between patients and normal subjects. The clearest separation between the two groups was obtained by the variable 'duration of pH less than or equal to 5'. Irrespective of the variable used, the results did not seem to be related to the degree of severity of the symptoms. Individual sensitivity of the oesophageal mucosa, the content of bilious components in the refluxed material, and the semi-quantitative character of the investigation may, in part, account for the results. Furthermore, the same investigation was carried out before and three months after a modified Belsey MK IV repair in 39 patients with hiatus hernia and symptoms indicating surgical treatment. The operation was followed by a reduction in the tendency to acid reflux, probably as a result of an increase in the competence of the gastro-oesophageal region.
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PMID:Gastro-oesophageal acid reflux in patients with symptomatic hiatus hernia and effect of a modified Belsey MK IV repair on acid reflux. 2 44

Records of 269 esophageal motility studies were reviewed to determine the relationship between lower-esophageal sphincter (LES) function and upper-esophageal sphincter (UES) pressure. Average and greatest UES pressures were similar in patients with LES pressures less than 10 mm Hg or greater than 20 mm Hg, and in patients with and without gastroesophageal reflux as determined by an intraesophageal pH electrode test. Although teliologically appealing, the belief that patients with weak lower-esophageal sphincters and gastroesophageal reflux have stronger upper-esophageal sphincters to guard against pharyngeal reflux and aspiration cannot be confirmed by current manometric techniques.
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PMID:Lower-esophageal sphincter function does not determine resting upper-esophageal sphincter pressure. 2 63

Lower esophageal pH was continuously monitored for 15 hours in 10 asymptomatic subjects and 27 patients with symptoms of gastroesophageal reflux, and the pH measurements in symptomatic patients were compared with the results of other esophageal investigations. Symptomatic patients had significantly longer periods of reflux in the pH test than asymptomatic subjects (P less than 0.01), but there was no significant correlation between the pH measurements and the results of esophageal manometry, acid-perfusion, and acid-clearing tests. Ten patients had evidence of esophagitis at esophagoscopy, but there was no correlation between pH measurements and the findings at esophagoscopy. Two patients with esophagitis had no evidence of reflux in the pH monitoring test. The results indicate that the pH-monitoring test has a useful role in the diagnosis of gastroesophageal reflux in patients who do not have endoscopic signs of esophagitis. However, negative pH tests do not exclude the diagnosis of symptomatic reflux, and it appears that the test has no value in assessing the severity of esophageal inflammation.
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PMID:Diagnosis of symptomatic gastroesophageal reflux by prolonged monitoring of lower esophageal pH. 2 24

Given the poor prognosis in carcinoma of the oesophagus, and with the aid of advances in anaesthesia and postoperative care, surgery has progressively evolved towards wider excision and a reduction in the number of operative stages. Partial oesophagectomy, with gastrolysis and gastro-oesophageal anastomosis, via a left thoracotomy, is favoured by large number of authors. However, it involves a certain number of disadvantages: by definition a limited excision, unsuitable for carcinomas in the cervical region and a marked risk of postoperative gastro-oesophageal reflux. Total oesophagectomy offers a hope of better results from an oncological standpoint, the more so since excision may be extended superiorly (laryngectomy) or inferiorly (total gastrectomy with lymph node excision). Continuity is re-established using a colonic transplant. The operation may be performed in two stages, though a single stage procedure with two teams would appear to be preferable, overall mortality and morbidity being reduced. Finally, colonic oesophagoplasty may be used alone, as a simply palliative measure, without associated tumour excision. By short-circuiting the oesophageal stenosis, it permits continued alimentation per os and the patient's period of survival is more comfortable.
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PMID:[Surgery for carcinoma of the esophagus. Methods and techniques]. 2 83

The technique and scoring system of 24-hr pH esophageal monitoring has been modified to evaluate gastroesophageal reflux in infants and children. The data from two pediatric controls and five clinical cases are presented and compared to normal adult values. This test has better objectivity, precision, sensitivity, and reliability than contrast studies, endoscopy, esophageal biopsy, acid perfusion, or acid reflux tests. The 24-hr pH monitoring assists the evaluation of sphincter maturation, pulmonary disease, and the significance of body position. With more experience, this technique could identify children at risk fo developing severe complications of reflux esophagitis and aid in the selection of candidates for surgical intervention.
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PMID:Technique and experience with 24-hour esophageal pH monitoring in children. 2 95

Distal oesophageal pH was monitored for three hours after a standard meal in 10 young healthy subjects without symptoms of gastro-oesophageal reflux. Episodes of reflux occurred in nine of these subjects; and, in five, oesophageal pH was less than 5 for between 11 and 75% of the first postprandial hour. Intermittent incompetence of the lower oesophageal sphincter after food must, therefore, be regarded as a normal phenomenon. The method described would be suitable for the evaluation of agents believed to weaken or to strengthen the lower oesophageal sphincter.
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PMID:Postprandial gastro-oesophageal reflux in healthy people. 2 83

The lower esophageal sphincter pressure has been measured intraoperatively in 200 patients with gastroesophageal reflux and in three patients with achalasia. Lower esophageal sphincter pressure is measured before and during repair. Calibrating the cardia during performance of the median arcuate posterior gastropexy allows a sphincter pressure between 50 and 57 mm. Hg to be obtained at operation. The postoperative pressures have ranged between 15 and 25 mm. Hg, or approximately half of the intraoperative pressure. No patient with a spincter pressure of 15 mm. Hg or greater has reflux according to postoperative pH and pressure studies. Correction of reflux correlates well with relief of symptoms. Three patients with achalasia had intraoperative manometrics during myotomy. The lower esophageal sphincter pressure was lowered and the length of the lower esophageal sphincter was shortened. Dysphagia was corrected without producing reflux. This is the first report of measurement of lower esophageal sphincter pressure in anesthetized patients. Intraoperative measurement of sphincter pressure is a safe, simple, and reliable technique which allows the surgeon, for the first time, to determine the status of the lower esophageal sphincter during the operation. This technique should be standard for all operations on the gastroesophageal junction.
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PMID:Intraoperative measurement of lower esophageal spincter pressure. 2 82

In order to establish whether alcohol in amounts in amounts customarily imbibed during social drinking causes gastro-oesophageal reflux, 12 healthy young individuals, without symptoms of gastro-oesophageal reflux, were studied twice. Each time, distal oesophageal pH was monitored continuously for three hours after a standard meal which included either 180 ml 100 proof vodka or 180 ml water. The order of studies with and without alcohol was random. Peak blood alcohol concentrations ranged between 0.63 and 1.29 g/l. Eleven of the 12 subjects refluxed more after alcohol; and the difference in mean reflux scores for studies with and without alcohol was highly significant. We conclude that relatively modest quanttities of alcohol induce gastro-oesophageal reflux in healthy people.
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PMID:Induction of gastro-oesophageal reflux by alcohol. 2 30


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