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

It is imperative to assess the psychosocial factors that may influence the subjective experiences and pain behavior of persons with chronic unexplained chest pain. Both psychologists and physicians tend to rely on self-report measures of psychological distress, which provide little unique information about patients with chronic chest pain to differentiate them from patients with other painful disorders such as irritable bowel syndrome, gastroesophageal reflux disease, or coronary artery disease. However, assessment of pain-coping strategies, spouse responses to the patient's pain behaviors, and pain thresholds for esophageal balloon distention do differentiate patients with chronic chest pain from healthy controls and patients with various other chronic pain disorders. Specifically, chronic chest pain patients tend to use relatively passive pain-coping strategies such as praying and hoping, and to report relatively high levels of spouse reinforcement of pain behaviors. Finally, in response to esophageal balloon distention, chronic chest pain patients display low pain thresholds that do not generalize to stimulation by mechanical finger pressure. Preliminary evidence suggests these low thresholds are due primarily to a tendency to set low standards for making pain judgments regarding esophageal stimuli of moderate-to-high intensity levels.
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PMID:Psychosocial and psychophysical assessments of patients with unexplained chest pain. 159 68

Prescribing patterns of 13 residents in a medical outpatient clinic were evaluated between March and June 1986. Prescribed drugs influencing the gastrointestinal tract were also analyzed in order to define quality of the therapeutic process. Advertising for these special drugs in 3 Swiss medical journals was analyzed and compared with the prescribing behavior of participating physicians. 6300 patients with 3346 prescriptions (0.5 prescription/patient) were enrolled in the study. 16.5% of all prescriptions involved cardiovascular, 13.5% gastrointestinal, 9.5% non steroidal antirheumatic, 9.1% analgesic, 7.7% psychotropic and 7.4% antibiotic drugs. The share of 14 other classes of drugs was less than 4%. 471 prescriptions of gastrointestinal acting drugs were distributed over 288 patients (0.6 prescription/patient). 160 patients had irritable bowel syndrome, 40 ulcer disease, 23 inflammatory/infectious bowel disease, 18 gastroesophageal reflux, 18 anal diseases, 11 other gastrointestinal disorders and 15 were treated without diagnosis. Distribution of drugs was as follows: 27.5% bulk laxatives, 26% antacids, 15.7% H2-receptor antagonists, 13.5% anticholinergic agents, 4.9% laxatives, 3.4% loperamide, 9% other drugs. There was an increase in prescriptions per visit from 0.8 in 1980 to 1.5 in 1986. No important influence of drug advertising in 3 different medical journals published between January and June 1986 could be found. Considering the documented diagnoses, the therapeutic decisions were correct in 95.5% of cases treated. In conclusion, drug prescribing habits are permissive, the therapeutic approach is acceptable and the influence of drug advertising is negligible.
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PMID:[The evaluation of prescribing practice in a general internal medicine outpatient clinic with special reference to gastrointestinal medicines]. 227 Apr 51

A prospective study of the value of preoperative oesophageal manometry in selecting patients for gastro-oesophageal reflux surgery has been performed. One hundred and twenty-six consecutive patients had a floppy Nissen fundoplication with a median follow-up period of 48 months (range 21-96 months). Reflux was controlled in 116 patients (92.1 per cent). One hundred and five patients (83.3 per cent) had a clinically satisfactory result (Visick grades 1 and 2). Poor results were largely due to recurrent reflux, technical failure or the irritable bowel syndrome. An unsatisfactory result was not more likely in those with upright reflux, an oesophageal motility disorder or a competent cardia as defined by manometry. Preoperative oesophageal studies, other than those required to make an accurate diagnosis, were found to have no value in deciding the suitability of patients for surgical correction of gastro-oesophageal reflux.
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PMID:Oesophageal manometry and pH recording does not predict the bad results of Nissen fundoplication. 230 12

Nutritional factors relative to IBS include diagnostic and therapeutic considerations. Etiologically, foods do not cause IBS. A small percentage of patients with childhood allergic diatheses, usually in association with atopic dermatitis and asthma, may be intolerant to one or more of wheat, corn, dairy products, coffee, tea, or citrus fruits. Diagnostically, many patients labeled as IBS subjects are in fact intolerant to the ingestion of lactose-containing foods, sorbitol, fructose, or combinations of fructose and sorbitol. A precise dietary history will characterize this group. Taken in its broadest context, IBS involves the entire hollow tract inclusive of esophagus, stomach, small bowel, and colon. The symptomatic presentation relative to the hollow organ involved allows the selection of dietary manipulations that may help to reduce symptoms. Gastroesophageal reflux, a consequence of low LES pressure in some IBS patients, may be treated with the elimination of fatty foods, alcohol, chocolate, and peppermint. Delayed gastric emptying may be helped by the elimination of fatty foods and reduction of soluble fiber. Aberrant small bowel motor function may be ameliorated by reduction of lactose, sorbitol, and fructose and the addition of soluble fiber. Gas syndromes may be improved by reduced intake of beans, cabbage, lentils, legumes, apples, grapes, and raisins. Colonic motor dysfunction may be overcome by the gradual addition of combinations of soluble and insoluble fiber-containing foods and supplements. The selective use of activated charcoal and simethicone may be helpful.
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PMID:Nutritional therapy of irritable bowel syndrome. 255 6

Gastric motor dysfunction and concomitant gastric stasis have been implicated in the pathogenesis of nonulcer dyspepsia, but a cause-and-effect relationship is not established. Essential dyspepsia refers to a subgroup of nonulcer dyspepsia patients who have no evidence of irritable bowel syndrome, gastroesophageal reflux, or pancreaticobiliary disease. In 32 patients with essential dyspepsia, and 32 randomly selected dyspepsia-free community controls of similar age and sex, we measured gastric emptying of solids using Tc99m-Sulphur Colloid in a fried egg sandwich. Subjects with neuromuscular or other diseases that may alter gastric emptying were excluded. Symptoms were assessed by a standard questionnaire. Data processing was carried out "blinded" to the subjects' clinical status. Female patients took significantly longer to empty half the initial stomach activity (mean 90 min) than female controls (mean, 73 min; p = 0.02). The rate of emptying at 25 min was also significantly less in female patients than in controls. Female and male controls, and male patients, had similar emptying times. Delayed emptying was not associated with the occurrence of postprandial pain, belching, or nausea; there was a trend for the half-time rate of emptying to be greater in patients with abdominal distention. While gastric emptying of solids is slightly delayed in females with essential dyspepsia as a group, this may not explain their symptoms.
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PMID:Lack of association between gastric emptying of solids and symptoms in nonulcer dyspepsia. 258 62

53 of 61 patients successfully completed 24 h ambulatory monitoring of oesophageal pH. The indications were: symptoms suggestive of gastro-oesophageal reflux but with normal endoscopy (19 cases); atypical chest pain with normal endoscopy (21 cases); or respiratory symptoms possibly due to reflux (13 cases). A temporal association between abnormal reflux and the presenting symptoms was demonstrated in 25 patients (47%). 6 patients were shown to have respiratory symptoms after episodes of reflux which resolved on treatment of the reflux alone. Reflux occurring only in the erect posture was observed in some patients and may have been a manifestation of the irritable bowel syndrome. Reflux as a cause of symptoms was excluded in 14 patients. The procedure was well tolerated in most patients, simple to operate, and inexpensive.
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PMID:Is 24 h ambulatory oesophageal pH monitoring useful in a district general hospital? 287 86

Alimentary and cardiac autonomic nervous function was assessed in 25 patients with the irritable bowel syndrome. The vagally mediated increase in lower oesophageal sphincter pressure induced by abdominal compression was below that of 25 controls in 13 patients. Efferent vagal function, assessed by the ratio of peak acid output after insulin-induced hypoglycaemia to maximal acid output after pentagastrin, was subnormal in 7 of 23 patients. Pulse rate variability with deep respiration was subnormal in 6 of 23 patients. Abnormality in these tests did not correlate closely with the presence of oesophagitis at endoscopy or with that of gastro-oesophageal reflux on pH monitoring. Thus abnormalities in autonomic nervous reflexes might account for the frequent occurrence of gastro-oesophageal reflux and may be involved in the production of disordered gastrointestinal motility in irritable bowel syndrome.
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PMID:Abnormal vagal function in irritable bowel syndrome. 288 77

Dyspepsia, defined as chronic or recurrent upper abdominal pain or nausea, is a common occurrence. Dyspepsia without an ulcer (non-ulcer dyspepsia) is diagnosed in patients at least twice as often as peptic ulceration. Diseases that may present with similar symptoms include gastroesophageal reflux, biliary tract disease, chronic pancreatitis, and irritable bowel syndrome. A careful history and physical examination, supplemented by selected tests, usually lead to a correct diagnosis. The pathogenesis of non-ulcer dyspepsia remains unknown. Gastric acid secretion, duodenogastric reflux, psychological factors, environmental exposures, and heredity probably do not play a major role. Some patients may have motility disturbances, but whether these disturbances cause dyspepsia is unknown. Campylobacter pylori infection and associated gastritis are common in non-ulcer dyspepsia, but their etiologic role is controversial, as is the importance of chronic duodenitis. By recognizing the heterogeneity of patients who present with non-ulcer dyspepsia, more rational management may be possible. Although an empiric trial of antacids or H2 blockers has been recommended to treat dyspepsia, most controlled trials show that although these substances reduce severity of symptoms, they are no more effective than placebos in non-ulcer dyspepsia.
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PMID:Non-ulcer dyspepsia: potential causes and pathophysiology. 328 48

The effect of cimetidine and placebo was examined in 123 patients with non-ulcer dyspepsia (NUD) by means of a 12-day multi-crossover model with 5 regular interchanges between cimetidine and placebo. The evaluation of effect in individual patients was based on the number of times cimetidine was associated with less symptoms than the preceding or following placebo period. If cimetidine had no effect, the probability of being defined as a cimetidine responder was 25%. In general, cimetidine was associated with less symptoms than placebo (p less than 0.0001). Forty patients were identified as cimetidine responders (R) and the remaining patients were termed non-responders (NR). Symptoms compatible with gastroesophageal reflux were significantly more frequent in R than in NR, whereas the opposite was true for symptoms of the irritable colon syndrome. The ability of symptoms selected by stepwise logistic regression to predict response to cimetidine showed at best a sensitivity of 75% and a specificity of about 65%. No differences were found between R and NR with regard to acid secretion, endoscopic and histologic findings, or the result of an acid perfusion test. The present study supports the existence of a subgroup of cimetidine responders among patients with NUD characterized by symptoms suggestive of gastroesophageal reflux disease in the absence of confirmatory objective evidence.
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PMID:Cimetidine responders in non-ulcer dyspepsia. 329 Oct 85

The incidence of severe duodenal anomalies (MD) has been investigated in 458 patients submitted to barium meal examination and in 176 subjects comprising various clinical subgroups. The incidence of MD in patients submitted to barium meal examination was 11.6%. The incidence of MD in 25 normals was 4%, which was not significantly different from the incidence (10%) of MD in patients with gastroesophageal reflux symptoms. Compared with in normals, MD occurred with a significantly higher incidence in 45 patients with X-ray-negative dyspepsia (24%), in 36 patients with the irritable bowel syndrome (44%), and in 37 patients with asthma (38%). It is concluded that demonstration of MD in a patient is only indicative of a possible disorder.
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PMID:The incidence of severe duodenal anomalies in patients submitted to barium meal examination, in normals, and in different clinical subgroups. 343 6


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