Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0017168 (gastroesophageal reflux disease)
 11,783 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Oral domperidone (30 mg/day) or placebo tablets were given to 41 patients presenting with symptoms of chronic post-prandial dyspepsia, in a double blind study. The tablets were taken three times a day before meals. The first part of the study lasted four weeks and was followed by a second four week period in which domperidone was given on an open basis to all subjects. At the end of the double-blind phase all indices but one (bitter regurgitation) as well as the gastro-oesophageal reflux cluster had significantly improved on domperidone treatment while none had done so on placebo. During the subsequent open four weeks of domperidone all items improved in both study groups. No side effects were seen in any of the participants in the study.
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PMID:A double-blind study of domperidone in the symptomatic treatment of chronic post-prandial upper gastrointestinal distress. 38 49

Intraluminal manometry has been used in a series of five studies on healthy volunteers and patients, to examine the action of domperidone on lower oesophageal sphincter pressure (LOSP), on peristaltic contraction, amplitudes and on antral, pyloric and duodenal motility. Furthermore, the effect on gastric acid secretion, pH, secretory volume and serum gastrin levels was studied. It was found that domperidone increased LOSP significantly but was less effective in patients with symptomatic gastro-oesophageal reflux than in normal volunteers. The drug also increased the amplitude of oesophageal and duodenal peristalsis but had no effect on endogenous gastrin release or on gastric acid secretion. The results suggest that this drug may be useful in the treatment of gastro-oesophageal and gastroduodenal reflux. This potential benefit is enhanced by the absence of side effects even when given in high doses.
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PMID:Evaluation of the effect of domperidone on human oesophageal and gastroduodenal motility by intraluminal manometry. 38 58

Most investigators agree that the most important goal in correcting gastroesophageal reflux is restoring or developing a competent lower esophageal sphincter. Although the sphincter can be incompetent in its normal intra-abdominal position and rarely a patient may have a competent sphincter in the thorax, generally the sphincter is much more effective in the positive pressure abdominal position. The choice of operative technique will depend upon the abnormal conditions present and the general condition of the patient. The thoracic approach is elected if there is associated intrathoracic disease warranting surgical correction, such as diffuse spasm of the esophagus, achalasia, epiphrenic diverticulum, or a pulmonary lesion requiring biopsy and possible resection. Very obese patients, patients with recurrent hernias, and patients with shortened esophagus are better managed by the thoracic approach. Patients with an essentially normal esophagus are treated with a Mark IV Belsey procedure. If shortening of the esophagus is present, a combination Collis-Nissen technique with fixation below the diaphragm is preferable. The abdominal approach is indicated when there is another intraabdominal disease known or suspected warranting surgical correction. This approach is also useful for the thin or poor risk patient. Usually, through an abdominal incision, we elect to use a modified Nissen fundoplication, with fixation of the fundoplication to the median arcuate ligament or the right crus of the diaphragm. The crural sling is returned to normal dimensions with interrupted sutures. Reflux in the absence of an hiatal hernia initially is treated medically. If symptoms are significant and intractable, a competent lower esophageal sphincter is restored, or developed by the modified Nissen procedure just described. Most reflux strictures at the esophagogastric junction are reversible by dilatation and restoration of a competent sphincter. Firm, fixed, fibrous strictures occasionally cannot be safely dilated. These may be managed by a Thal procedure to correct the stricture and a Nissen fundoplication to prevent recurrent reflux.
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PMID:Surgical treatment of gastroesophageal reflux. 39 Jul 43

6 cases of cardiorespiratory complications occurring after surgical treatment of oesophageal atresia are reported by virtue of the association of tracheal compression by the brachio-cephalic arterial trunk and of gastro-oesophageal reflux. In all cases, medical (2 cases) or surgical (4 cases) treatment of gastro-oesophageal reflux led to the disappearance of all respiratory symptoms and signs. Emphasis is placed upon the need for a routine and thorough search, radiological and endoscopic, of such associated oesophageal pathology, before proceeding to surgery on the compressive brachio-cephalic arterial trunk.
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PMID:[Compressive brachio-cephalic arterial trunk and gastro-oesophageal reflux following surgery for oesophageal atresia (author's transl)]. 39 46

The effect of nitroglycerine and long acting nitrites was studied in a group of 8 normal control subjects and 12 patients with esophageal spasm. The objective response of the esophagus to these drugs was recorded by obtaining esophageal manometric studies and was correlated with response in clinical symptoms. In 7 patients who had significant gastroesophageal reflux associated with spasm, the response to nitroglycerine was unpredictable. But in the group of 5 patients with diffuse esophageal spasm without gastroesophageal reflux, the response was uniformly good. All of the patients who responded to nitroglycerine also responded to long acting nitrites. These 5 patients, who were placed on long term management with long acting nitrites, remained symptom-free from 6 months to 4 years. None of them had recurrence of symptoms while they were on long acting nitrite therapy. The study suggests that if esophageal spasm is associated with reflux, the use of nitrites is less effective in controlling spasm than it is in those who do not show this association, and that diffuse esophageal spasm can be effectively managed with long acting nitrites on a long term basis in the absence of reflux. If there is esophageal spasm associated with reflux esophagitis, nitrites may be beneficial as an adjunct to antireflux therapy.
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PMID:Esophageal spasm: clinical and manometric response to nitroglycerine and long acting nitrites. 40 45

Aldehyde fixed tissue from monkey (Macaca mulatta) corpus luteum was incubated in alkaline 3,3inch-diaminobenzidine (DAB), and prepared for electron microscopic histochemical observations. The association of microperoxisomes with the granular (GER) or agranular (AER) endoplasmic reticulum was reconstructed from serially sectioned tissues and by tilting of specimens in the microscope. Out of 107 microperoxisomes, 106 were directly associated with the AER. Two different forms of attachment were found between microperoxisomes and the AER and that of the microperoxisome are confluent. In the second, lingulate type of connection, a blunt-end structure either is inserted into an invagination of the AER, or penetrates into the lumen of the AER. The lumen of the lingula is confluent with the microperoxisome, but not with the AER. In addition to these connections, fine thread-like structures were observed extending between AER and adjacent microperoxisomes.
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PMID:Association of microperoxisomes with the endoplasmic reticulum in the granulosa lutein cells of the Rhesus monkey (Macaca mulatta). 40 4

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

Gastroesophageal reflux was tested for with a pH telemetry capsule. In 29 individuals in whom no hiatus hernia was demonstrated on barium esophagram, the transverse diameter of the intrahiatal esophagus was compared to that of the intrathoracic. When the width of the intrahiatal esophagus was two-thirds or less that of the intrathoracic, pH-proven reflux was an infrequent event. When wider, reflux occurred with high frequency.
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PMID:pH-tested reflux without hiatus hernia. 41 15

A radiologic method for the demonstration of gastroesophageal reflux in children is described, and, while recognizing limitations and pitfalls of any classification, a clinically useful system of grading of reflux is presented. The system is based primarily on the extent of retrograde flow of barium, ranging from reflux into the distal esophagus only (grade 1) to reflux with aspiration into the trachea or lungs (grade 5). The availability of a standardized radiologic technique for the demonstration of gastroesophageal reflux and a system for grading its severity may be useful in understanding the true incidence and significance of this disorder.
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PMID:Gastroesophageal reflux in infants and children: a useful classification and reliable physiologic technique for its demonstration. 41 16

Patients with esophageal atresia and/or tracheoesophageal fistula are known to have disordered esophageal motility, but the incidence of significant gastroesophageal reflux requiring anti-reflux surgery remains undocumented. We have studied a series of patients from 2 wk to 13 yr post-repair, utilizing manometric motility and acid reflux techniques. All demonstrated abnormalities of esophageal motility, including aperistalsis, low amplitude contraction, and simultaneous contractions. Lower esophageal sphincter pressures ranged from 7 to 50 mm Hg. Fourteen patients demonstrated signifcant reflux and six patients required anti-reflux surgery for recurrent pneumonia or recurrent stricture. The incidence of significant gastroesophageal reflux requiring antireflux surgery appears significant following repair of esophageal atresia and/or tracheoesophageal fistula.
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PMID:Incidence and significance of gastroesophageal reflux following repair of esophageal atresia and tracheoesophageal fistula and the need for anti-reflux procedures. 42 64


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