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

16 HIV seropositive patients among the 180 treated at the Hospital Muniz and the Hospital Posadas in Buenos Aires between December 1988 and December 1989 were referred to the Hospital Posadas Endoscopy Service for esophageal studies. The 16 patients were prospectively studies by means of fiberoscopy, radiology, biopsies, virology, mycology, and brush cytology. Early treatment is of utmost importance because opportunistic infections may aggravate the general condition, increase immune system effects, and probably permit greater replication of HIV, in addition to producing symptoms. 14 patients were male and 2 female. Ages ranged from 18 to 41 and averaged 32 years. 10 were male homo- or bisexuals and the other 6 were intravenous drug users. 14 of the patients consulted because of specifically esophageal symptoms. 12 reported dysphagia, 8 odynophagia, and 6 retrosternal pain. 9 patients presented various symptoms. 15 of the 16 symptomatic patients had some pathology related to HIV. The remaining case presented a small submucus tumor and gastroesophageal reflux. The symptoms had appeared between 10 days and 1 year prior to study. Symptoms did not provide accurate diagnostic clues. 11 cases of esophageal candidiasis were diagnosed endoscopically by isolated or confluent white plaques. 3 patients classified as grade 1 or 2 on the basis of the intensity and density of plaques had mild symptoms, and 8 classified as grade 3 or 4 had more severe symptoms. 7 of the 11 patients also had oral candidiasis. 4 of 6 patients presenting ulcerative pathology were diagnosed virologically with herpes simplex virus type 2. Herpetic ulcers were single or multiple and were deep with slightly raised edges. No ulcers attributable to cytomegalovirus were diagnosed. 4 of the 11 patients with candidiasis also had ulcers, in 2 cases herpetic. The studies indicated a change in the stage of HIV infection following Centers for Disease Control criteria in 10 cases. AIDS was diagnosed in 7 cases based on esophageal findings. Endoscopic study and the samples obtained guided treatment in the 16 patients. In 1 case a repeat endoscopy led to a change in treatment. It is recommended that endoscopy be performed in all patients with esophageal symptoms. Radiology was relatively ineffective, with 50% of diagnoses in error. Histopathology required multiple biopsies and was less sensitive than endoscopy and cytology. Cytology was highly specific and sensitive.
 ...
PMID:[Esophageal pathology in patients with the AIDS virus. Etiology and diagnosis]. 182 Jun 92

Recent studies suggest human immunodeficiency virus (HIV) may be the cause of HIV-associated idiopathic esophageal ulcer (IEU). However, other causes of esophageal disease in HIV-infected patients have not been evaluated for appropriate comparison. Over a 14-month period 13 patients with IEU as determined by clinical, endoscopic, and pathologic criteria were identified. During the same period nine HIV-infected patients with cytomegalovirus (CMV) esophagitis and one HIV-infected patient each with herpes simplex virus esophagitis and gastroesophageal reflux disease (GERD) were also identified. Polymerase chain reaction (PCR) and in situ DNA hybridization (ISH) were performed on paraffin-embedded tissue formed on paraffin-embedded tissue of endoscopic biopsies of ulcer tissue using standard techniques. Eleven of 13 IEU patients (85%) as compared to seven of nine patients (78%) with CMV had HIV detected by PCR (P = 0.38). HIV was also detected in ulcer tissue from biopsy material from the patient with GERD but not herpes simplex virus esophagitis. In PCR-positive patients, ISH confirmed the presence of HIV in four patients (57%) with CMV and eight (73%) with IEU (p = 0.31). HIV was found only in inflammatory cells and not squamous epithelial cells. Given the similar prevalence of detection of HIV by PCR and ISH in ulcer tissue from both groups of HIV-infected patients as well as the location in rare inflammatory cells, we conclude that HIV infection of squamous mucosa does not appear to be the primary cause of IEU.
 ...
PMID:Evaluation of idiopathic esophageal ulceration for human immunodeficiency virus. 767 79

This paper is a review of esophageal anatomy, physiology and pathophysiology. The diagnosis and therapy of benign and malignant esophageal strictures are discussed including the specifics of esophageal dilation and tumor ablation procedures. The diagnosis and therapy of esophagitis in the immunocompromised (HIV, chemotherapy, transplant recipient) host is discussed. The pathophysiology and treatment of achalasia and esophageal spasm are reviewed. Finally, current concepts of the pathophysiology and therapy of gastroesophageal reflux disease. Emphasis is placed on the dual sphincter theory of gastroesophageal junction competence and the need for maintenance anti-secretory therapy.
 ...
PMID:Esophageal dysphagia. 820 80

The yield of upper gastrointestinal endoscopy (esophago-gastroduodenoscopy; EGD) in human immunodeficiency virus (HIV)-infected patients based on presenting symptoms has not been well studied. We studied consecutive patients with documented HIV infection undergoing EGD at a large innercity hospital between August 1, 1990 and December 31, 1993; all had presenting symptoms and indications for EGD prospectively recorded at the time of EGD. All endoscopic abnormalities were routinely subjected to biopsy, and extensive histopathological evaluation was performed. EGD was considered helpful when the findings stimulated specific therapeutic intervention other than antifungal or antacid medications. The specific indications for EGD in 156 patients were as follows: esophageal symptoms, 102 patients (65%); abdominal pain, 18 (12%); upper gastrointestinal bleeding, 25 (16%); refractory nausea and vomiting, 11 (7%). Overall, pathologic findings were identified in 116 patients (74%): in refractory esophageal symptoms, 82%; upper gastrointestinal bleeding, 92%; abdominal pain, 39%; nausea and vomiting, 27%. EGD with biopsy identified a specifically treatable opportunistic disorder other than Candida in 80 patients (51%), including idiopathic esophageal ulcer (22%) or viral esophagitis and/or duodenitis (29%). EGD was not helpful in 22.3% of cases, those involving Candida (12.3%) and peptic ulcer disease (PUD)-related causes (10%). The mean CD4 count of patients with opportunistic pathologic findings (24/mm3, n = 79) was significantly lower than that of patients with PUD/gastroesophageal reflux disease (GERD) (167/mm3, n = 9) or negative EGDs (165/mm3, n = 35). Overall, the results of EGD influenced patient management in 78% of cases. We conclude that selective symptom-specific use of EGD, particularly in patients with esophageal symptoms refractory to antifungal therapy or gastrointestinal bleeding, usually identifies specifically treatable abnormalities, whereas EGD is less useful for the evaluation of abdominal pain or nausea and vomiting.
 ...
PMID:Symptom-specific use of upper gastrointestinal endoscopy in human immunodeficiency virus-infected patients yields high dividends. 895 33

Cisapride, a prokinetic agent, has been used for the treatment of a number of gastrointestinal disorders, particularly gastro-oesophageal reflux disease in adults and children. Since 1993, 341 cases of ventricular arrhythmias, including 80 deaths, have been reported to the US Food and Drug Administration. Marketing of the drug has now been discontinued in the US; however, it is still available under a limited-access protocol. Knowledge of the risk factors for cisapride-associated arrhythmias will be essential for its continued use in those patients who meet the eligibility criteria. This review summarises the published literature on the pharmacokinetic and pharmacodynamic interactions of cisapride with concomitantly administered drugs, providing clinicians with practical recommendations for avoiding these potentially fatal events. Pharmacokinetic interactions with cisapride involve inhibition of cytochrome P450 (CYP) 3A4, the primary mode of elimination of cisapride, thereby increasing plasma concentrations of the drug. The macrolide antibacterials clarithromycin, erythromycin and troleandomycin are inhibitors of CYP3A4 and should not be used in conjunction with cisapride. Azithromycin is an alternative. Similarly, azole antifungal agents such as fluconazole, itraconazole and ketoconazole are CYP3A4 inhibitors and their concomitant use with cisapride should be avoided. Of the antidepressants nefazodone and fluvoxamine should be avoided with cisapride. Data with fluoxetine is controversial, we favour the avoidance of its use. Citalopram, paroxetine and sertraline are alternatives. The HIV protease inhibitors amprenavir, indinavir, nelfinavir, ritonavir and saquinavir inhibit CYP3A4. Clinical experience with cisapride is lacking but avoidance with all protease inhibitors is recommended, although saquinavir is thought to have clinically insignificant effects on CYP3A4. Delavirdine is also a CYP3A4 inhibitor and should be avoided with cisapride. We also recommend avoiding coadministration of cisapride with amiodarone, cimetidine (alternatives are famotidine, nizatidine, ranitidine or one of the proton pump inhibitors), diltiazem and verapamil (the dihydropyridine calcium antagonists are alternatives), grapefruit juice, isoniazid, metronidazole, quinine, quinupristin/dalfopristin and zileuton (montelukast is an alternative). Pharmacodynamic interactions with cisapride involve drugs that have the potential to have additive effects on the QT interval. We do not recommend use of cisapride with class Ia and III antiarrhythmic drugs or with adenosine, bepridil, cyclobenzaprine, droperidol, haloperidol, nifedipine (immediate release), phenothiazine antipsychotics, tricyclic and tetracyclic antidepressants or vasopressin. Vigilance is advised if anthracyclines, cotrimoxazole (trimethoprim-sulfamethoxazole), enflurane, halothane, isoflurane, pentamidine or probucol are used with cisapride. In addition, uncorrected electrolyte disturbances induced by diuretics may increase the risk of torsade de pointes. Patients receiving cisapride should be promptly treated for electrolyte disturbances.
 ...
PMID:Drug interactions with cisapride: clinical implications. 1092 50

Sequencing of HIV-1(GER) long terminal repeat (LTR) has demonstrated, for the first time in an HIV-1 primary isolate, a TAR duplication referred to as TAR1 (nucleotides +1 through +68) and TAR2 (nucleotides +69 through +136). This TAR duplication is stable during replication of HIV-1(GER) isolate in CEM cells. Analysis of LTR-CAT reporter constructs demonstrated that under Tat transactivation the HIV-1(GER)/LTR (containing TAR1 and TAR2) was expressed at a higher level than a similar construct (HIV-1(GER)DeltaTAR) containing a single TAR sequence. Among the two transcription initiation sites found in the HIV-1(GER)/LTR, only the most 5' start site was shown to be functionally active. The predicted secondary structure of the 5'-end mRNAs of HIV-1(GER) suggests it may fold into a double TAR hairpin which resembles that of HIV-2. Finally, HIV-1(GER) Tat protein shows primary sequence similarity with Tat proteins from other isolates of HIV-1 and is apparently unrelated to HIV-2 Tat proteins. This work provides the first evidence of a TAR sequence duplication in HIV-1 which increases the efficiency of transactivation by Tat. Copyright 1996 S. Karger AG, Basel
 ...
PMID:Structural and Functional Properties of HIV-1(GER) TAR Sequences. 1172 80

Gastroesophageal reflux disease and other related symptoms are common comorbidities for HIV-infected patients. Therefore, concurrent use of proton pump inhibitors and antiretrovirals is a common practice in the clinical setting. However, this practice may alter antiretroviral pharmacokinetics and lead to treatment failure due to inadequate drug exposure. Clinician awareness of these complex interactions is essential for optimal HIV management. This review summarizes the current knowledge on the interactions between proton pump inhibitors and antiretrovirals, and makes recommendations for the coadministration of proton pump inhibitors.
 ...
PMID:Drug interactions between proton pump inhibitors and antiretroviral drugs. 1742 51

Nontuberculous mycobacteria (NTM) are ubiquitous organisms with nearly 100 different species found in soil and water. The fatty-acid and wax-rich impermeable cell wall of the mycobacteria allow for adherence to solid substrates such as pipes and leaves, allowing the organism to persist despite treatment with common disinfectants. Mycobacteria can cause infection in both humans and animals. It is difficult to assess the incidence or prevalence of NTM disease due to multiple factors. Nontuberculous mycobacteria infection may be difficult to differentiate from colonization, and when NTM infection is diagnosed, it is not a reportable disease. Furthermore, some species such as Mycobacterium gordonae may be a contaminant. Nontuberculous mycobacteria infection is not a communicable disease, although health care-associated outbreaks have been reported, associated with a single facility or procedure. While the nontuberculous infection may affect other organs, the most common site is the lung, and the most common species is Mycobacterium avium complex, commonly referred to as MAC infection. An increasing occurrence of MAC has been reported, especially in certain populations such as middle-aged or elderly thin women, patients with chronic lung disease, human immunodeficiency virus infection, and cystic fibrosis. An association of NTM infection with gastroesophageal reflux disease has also been noted. The clinical presentation often includes chronic productive cough. Other less common symptoms include dyspnea and hemoptysis. With increased use of computed tomography and high-resolution computed tomography, patterns of MAC pulmonary infection have been described. Recently, the American Thoracic Society has outlined guidelines for the diagnosis and management of NTM infection. Treatment of NTM infection requires at least 3 effective drugs for a minimum of 12 months after sputum conversion to negative cultures. Surgical therapy may be considered for localized disease which has failed medical management. In this article, the clinical presentation, radiographic features, diagnostic evaluation, and management are discussed.
 ...
PMID:Nontuberculous mycobacterial pulmonary infections in Non-HIV patients. 1902 Mar 69

Common medical problems are often associated with abnormalities of sleep. Patients with chronic medical disorders often have fewer hours of sleep and less restorative sleep compared to healthy individuals, and this poor sleep may worsen the subjective symptoms of the disorder. Individuals with lung disease often have disturbed sleep related to oxygen desaturations, coughing, or dyspnea. Both obstructive lung disease and restrictive lung diseases are associated with poor quality sleep. Awakenings from sleep are common in untreated or undertreated asthma, and cause sleep disruption. Gastroesophageal reflux is a major cause of disrupted sleep due to awakenings from heartburn, dyspepsia, acid brash, coughing, or choking. Patients with chronic renal disease commonly have sleep complaints often due to insomnia, insufficient sleep, sleep apnea, or restless legs syndrome. Complaints related to sleep are very common in patients with fibromyalgia and other causes of chronic pain. Sleep disruption increases the sensation of pain and decreases quality of life. Patients with infectious diseases, including acute viral illnesses, HIV-related disease, and Lyme disease, may have significant problems with insomnia and hypersomnolence. Women with menopause have from insomnia, sleep-disordered breathing, restless legs syndrome, or fibromyalgia. Patients with cancer or receiving cancer therapy are often bothered by insomnia or other sleep disturbances that affect quality of life and daytime energy. The objective of this article is to review frequently encountered medical conditions and examine their impact on sleep, and to review frequent sleep-related problems associated with these common medical conditions.
 ...
PMID:Sleep-related problems in common medical conditions. 1920 22

Antiepileptic medication use in noncancer hospice/palliative care patients is not well defined. The authors report the case of a human immunodeficiency virus (HIV) patient under hospice care with increased seizure frequency. The patient is a 22-year-old female with advanced HIV disease complicated by tonic-clonic seizures, hypoalbuminemia, gastroesophageal reflux disease (GERD), and gastritis. During an admission to the hospice inpatient unit, she developed increasing seizure frequency while receiving oral phenytoin. After collaboration between the clinical pharmacist and the hospice treating physician, they simplified her medication regimen, discontinued the phenytoin, and initiated oral levetiracetam. After these adjustments to her medication regimen, the patient's seizure frequency decreased significantly. This case illustrates the challenges of anticonvulsant use in advanced disease, including drug-drug interactions, impaired pharmacokinetics parameters, and increased risk of adverse effects. The importance of continuously monitoring patients for adverse drug events and assessing patient specific factors to help guide medication selection are also highlighted.
 ...
PMID:Seizure management in a complex hospice patient. 2034 97


1 2 3 Next >>