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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

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

Exposure of the distal esophageal mucosa to acid gastric juice was quantitated by 24-hr pH monitoring in 100 individuals and was correlated with morphologic data derived from esophageal biopsies. The degree of acid exposure to the distal esophagus correlated directly with increases in both relative and absolute length of the subepithelial papillae and to relative basal zone hyperplasia. Both papillary length and basal zone hyperplasia decreased after antireflux surgery had reduced acid exposure to normal. Reflux in the recumbent position resulted in prolonged exposure of the mucosa to acid because of poor acid clearing from the esophagus. This caused longer papillae than did upright reflux, where there were more frequent reflux episodes, but with rapid acid clearance. The presence of a hiatal hernia was associated with longer papillae, lower DES pressure, increased reflux frequency, and prolonged recumbent acid clearance. Twenty-four hour pH monitoring correlated better with papillary length than did symptoms or other clinical measures of gastroesophageal reflux.
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PMID:Esophageal epithelial response to gastroesophageal reflux. A quantitative study. 2 83

One hundred and sixteen patients operated upon for hiatal hernia with gastro-oesophageal reflux and with or without reflux complications were postoperatively examined by personal interview, X-ray study, pH measurements and study of the oesophageal motility 1 to 10 years postoperatively. The patients without severe reflux complications were operated upon mainly with a modified Husfeldt hernia repair and the patients with complications, such as oesophageal stricture and shortening, underwent various surgical procedures. The main reason for unsatisfactory clinical results, with persistent reflux symptoms, was gastro-oesophageal reflux uncorrected by the surgical procedure. However, gastro-oesophageal reflux was detected even in completely asymptomatic patients. It was found that the reflux symptoms were influenced by the oesophageal motility. The clinical results were better and recurrence of hernia and the occurrence of pathological reflux were lower in patients operated upon for hernia without severe reflux complications. Creation of a competent antireflux barrier between the oesophagus and stomach for control of gastro-oesophageal reflux is much more difficult in patients with severe reflux complications.
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PMID:Gastro-oesophageal reflux after surgical treatment of hiatal hernia with and without severe reflux complications. A follow-up study. 3 60

Thirty-four patients with sliding hiatal hernia, gastroesophageal reflux, or both were treated by lesser curvature gastroplasty with partial gastric plication, using a surgical stapler. Before operation, esophageal manometric studies were performed in 33 patients and during the early postoperative period (1 to 3 months), in 34. The esophageal pH test was performed before operation in 22 patients, shortly after discharge in 27, and later in 30 patients. The clinical results were considered satisfactory in 30 patients (88%) after follow-up ranging from 18 to 33 months (average, 23 months). Before the procedure, the abdominal compression test was positive in 25 of 30 patients (83%). In early postoperative studies it was positive in 1 out of 34 patients (3%), but in the second series of postoperative studies it was positive in 9 out of 32 (28%). After instillation of hydrochloric acid into the stomach, the esophageal pH test was considered positive in 17 out of 22 patients in preoperative studies (77%). In early postoperative studies the test was positive in 3 out of 27 patients (11%) and one year later, in 7 out of 30 (23%). The later postoperative studies showed a higher number of positive reflux tests than the early studies, 28 and 23% positive in manometric and pH tests, respectively.
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PMID:Lesser curvature tubular gastroplasty with partial plication for gastroesophageal reflux: manometric and pH-metric postoperative studies. 3 10

A procedure for the treatment of sliding esophageal hiatal hernia and gastroesophageal reflux has been successfully and safely performed upon 46 patients. It is based on the placement of a ringlike silicone prosthesis around the lower part of the esophagus, below the diaphragm.
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PMID:A new surgical procedure for the treatment of gastroesophageal reflux and hiatal hernia. 15 76

A new pH capsule telemetry technique was used to measure the pH fluxes in the upper part of the gastrointestinal tract in normal volunteers, symptomatic patients and in those with hiatal herniorrhaphy during the preoperative and postoperative period. The Darvon-sized pH capsule is swallowed with ease and with minimal discomfort by a fasting patient. The pH of the surrounding media activates an FM radio transmitter within the capsule to emit a continuous radio signal which is converted by a receiver to a linear graph on a strip chart recorder. This pH capsule telemetry test is easy to perform on an ambulatory basis and allows an accurate and reproducible determination of the presence or absence of esophageal reflux in patients with and without a hiatal hernia. Its correlation with symptomatic reflux is higher than that found with a conventional gastrointestinal series examination. The technique allows a much clearer distinction to be made between those patients with real symptomatic esophagitis secondary to actual reflux and those with other esophageal, cardiac or pulmonary symptoms existing withour reflux. This study also reveals a consistently lower fasting gastric pH in patients with signs and symptoms of reflux than in normal individuals without reflux. The technique enabled a more accurate assessment of the efficacy of hiatal hernia repair and revealed a reduced degree of esophageal reflux in those patients who had undergone successful repair with fundic plication.
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PMID:A new hyrogen ion telemetry technique for evaluating gastroesophageal reflux. 23 91

Gastro-oesophageal reflux can lead to peptic oesophagitis and stricture formation. This is particularly true in infants in whom the condition should be suspected if the patient presents with vomiting, anaemia and failure to thrive. The anatomy of the oesophago-gastric junction is described. The inferior oesophageal sphincter is the main barrier to reflux, and marks the functional junction between oesophagus and stomach. It is under nervous and hormonal control. It is weak in the neonate who therefore frequently refluxes. An hiatus hernia can cause problems due to its bulk but the main problem of peptic oesophagitis is due to gastro-oesophageal reflux. The radiological examination should be carried out carefully with the patient swallowing in a prone position. The patient should be put in the Trendenlenberg position and compression applied to the abdomen. Reflux is intermittent and a negative examination should be repeated if the clinical findings suggest a diagnosis of peptic oesophagitis. Associated pyloric stenosis should always be excluded. Radiological examination of the gastro-oesophageal junction remains the quickest, simplest, and most convenient and safe technique as long as its limitations are appreciated.
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PMID:Gastro-oesophageal reflux, hiatus hernia and the radiologist, with special reference to children. 32 Oct 66

A controlled prospective study of forty-two patients shows it is feasible to correct gastroesophageal reflux complicating sliding hiatal hernia by modifying Allison's repair, using the technic of vertical mattress sutures and Dacron pledgets to approximate the crura and reattach the esophagus to the narrowed hiatus. There was no operative mortality and minimal morbidity. The follow-up period ranges from six to eighty-two months (mean, 38.5 months). One recurrence was noted clinically and verified by esophagogram, esophagoscopy, and motility studies. The remainder have no symptoms of gastroesophageal reflux, and no recurrence has been seen on repeat esophagograms.
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PMID:Surgical repair of gastroesophageal reflux with sliding hiatal hernia. 32 97

Anterior gastropexy in properly selected patients is a simple, safe, and effective procedure for the surgical correction of symptomatic esophageal reflux in the presence of a sliding type of hiatal hernia not accompanied by fibrosis and secondary shortening of the esophagus. This technic is particularly useful in poor risk, elderly, and excessively obese patients and as an adjunct to other intraabdominal procedures.
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PMID:Further experience with anterior gastric fixation in the management of hiatal hernia. 32 39


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