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)

Gastro-oesophageal reflux disease (GERD) encompasses a wide range of disorders defined by either reflux-related symptoms or by complications of gastro-oesophageal reflux. The most characteristic GERD symptoms are heartburn and acid regurgitation. Patients with these symptoms are in most cases easily identifiable and diagnosis is made on the basis of symptoms alone. For patients with a decreased frequency of heartburn, diagnosis is more difficult, and endoscopy is the single best test for diagnosis of GERD. A major difference between the West and Asia is the frequency of endoscopic investigation. In Japan, the earlier high prevalence of stomach cancers resulted in the increased use of endoscopy as an investigational tool for dyspeptic symptoms and today endoscopy continues to be widely available as a diagnostic tool. However, the overall sensitivity of endoscopy for the diagnosis of GERD is less than 50% since not all patients will have oesophagitis at the time of endoscopy. Ambulatory pH monitoring is therefore a frequently used diagnostic tool as it allows correlation between reflux events and symptoms, and is especially useful in patients with atypical or extraoesophageal symptoms. Oesophageal manometry is also an excellent test to evaluate oesophageal function and to measure sphincter pressure and while it may not provide an unequivocal diagnosis of GERD it is a useful tool with which to evaluate oesophageal function.
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PMID:Review article: diagnosis and investigation of gastro-oesophageal reflux disease in Japanese patients. 1557 66

In Asia, oesophageal diseases, such as Barrett's oesophagus and oesophageal carcinoma, have traditionally been less common than in America and Europe. In recent years, however, the number of reported cases of these conditions in Japan has increased. Two large prospective studies, the Sendai Barrett's Esophagus Study (S-BEST) and the Far East Study (FEST), on the geographic prevalence of Barrett's oesophagus, have recently investigated the epidemiology of Barrett's oesophagus in Japan. Results from both studies showed that overall prevalence of the condition is lower than in the West: 0.9-1.2% in Japan compared with 1-4% in Europe and 5-12% in USA. Similar to the situation in the West, the condition was shown to be most prevalent in elderly male patients and least prevalent in patients with Helicobacter pylori. Adenocarcinoma of the oesophagus is still rare in this region, although there has been an increase in the annual death rate from 3.7 (1960) to 6.9 (1995) per 100,000 population. Risk factors for oesophageal carcinoma include a strong association with the prevalence of gastro-oesophageal reflux disease (GERD). With the increasing prevalence of GERD in the Japanese population, continued surveillance of changes in the epidemiology of columnar-lined oesophagus (a precursor of Barrett's oesophagus), Barrett's oesophagus and adenocarcinoma of the oesophagus is strongly recommended.
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PMID:Review article: Barrett's oesophagus and carcinoma in Japan. 1557 74

We compared the epidemiology of Barrett's esophagus in Japan and the West. Japan GERD Society Study Committee conducted the epidemiological survey in 2,595 patients who underwent endoscopy the first time, confirming that Barrett's mucosa was observed in 536 patients (20.8%) out of 2,577. But Barrett's esophagus (>3 cm of columnar lined epithelium) was detected only 5 (0.2%). The prevalence of typical Barrett's esophagus was markedly low in Japanese compared with Westerners. In Western, the incidence of Barrett's esophagus has increased markedly since the 1970s. It is estimated that Barrett's esophagus is found in approximately 6-12% of patients undergoing endoscopy for symptoms of GERD and in 1% or less of unselected patient populations undergoing endoscopy.
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PMID:[Epidemiology of Barrett's esophagus--comparison of Japan and the West]. 1610 Dec 18

Proton pump inhibitors (PPIs) have been used recently for gastrointestinal esophageal reflux disease (GERD) in children older than one year with good results. However, the pharmacokinetics of PPIs have not been studied in children less than two years old. The aim of our study was to evaluate the frequency of the main phenotypes of the metabolizing enzymes CYP2C19 and CYP3A4 in Mexican infants. Our results indicate no significant difference between the 0.5 and the 1.5 mg/kg doses. The percentage of CYP2C19-poor metabolizers was 17% in babies below 4 months and was not detected in children above 3 months. When a combined CYP2C19- and CYP3A4- phenotype was estimated, omeprazole levels were significantly higher in poor metabolizers than in extended metabolizers. The percentage of ultra-extensive metabolizers in children older than 3 months were 20% and 33% for CYP2C19 and CYP3A4 respectively, compared to only 6% and 9% respectively, in babies between 1 and 3 months old. In general children, under 4 months had higher omeprazole levels and an immature metabolism. Studies in children older than 2 years old have showed similar pharmacokinetics to adults. For children between 1 month old and up to 9 months, we suggest the use of the 0.5 mg/kg dose, since it prevents accumulation in poor metabolizers, caution is recommended to identify ultra-fast metabolizers, but this would require new studies.
Proc West Pharmacol Soc 2005
PMID:Metabolism of omeprazole after two oral doses in children 1 to 9 months old. 1641 73

Gastro-oesophageal reflux disease (GORD) occurs in up to 40% of adults in the West. Oesophagitis is a major determinant in the treatment of GORD but its current classification systems are subjective. In order to help to provide objective interpretation of upper gastro-intestinal (GI) endoscope examination and reduce inter-observer variability, we developed a computer image analysis system. Digital video recordings were made on patients with clinical evidence of reflux oesophagitis. Cross-sectional profiles of hue and saturation data were analysed on images from seven patients with grade B or C oesophagitis (LA grading). This analysis showed clear changes in hue (p = 0.01) and saturation (p = 0.001). These results suggest that quantification of upper GI endoscopic images is feasible and may help in objective assessment.
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PMID:Computer analysis of upper gastrointestinal endoscope images. 1675 52

Gastroesophageal reflux disease (GERD) is less prevalent in Asia than in the West, but there is now evidence to suggest that its frequency is rapidly rising in Asia. The different prevalence rates reported in various Asian studies may represent different points in the 'rising' phase of GERD. The cause for the lower but increasing prevalence of GERD in Asia is not known, but genetics and to some extent environmental factors, may have initially protected Asians against GERD. However, with the recent globalization of economies, the associated lifestyle changes in many developing Asian countries may have tipped the balance in favor of the development of GERD.
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PMID:Gastroesophageal reflux disease in Asian countries: disorder of nature or nurture? 1691 77

The algorithms utilised in the diagnosis of chronic cough advocate sequential investigations and treatment trials for asthma-like syndromes, post-nasal drip and gastro-oesophageal reflux disease; however, the role of bronchoscopy is unclear. In the present authors' specialist clinic (North West Lung Centre Cough Clinic, Manchester, UK), flexible bronchoscopy is included in the diagnostic work-up of patients with chronic unexplained cough. In a retrospective review, the authors report on their experiences. Over an 18-month period, patients followed a diagnostic algorithm that included: chest radiography; pulmonary function; methacholine challenge; ear, nose and throat examination; and empirical reflux treatment. Where diagnosis remained elusive, bronchoscopy was performed. A total of 82 bronchoscopies were carried out for the sole indication of chronic cough. Patient age (mean+/-SD) was 54.9+/-11.22 yrs, with a median (range) cough duration of 5 (0.5-30) yrs. In nine (11%) subjects, a diagnosis was made on inspection or biopsy. These included seven cases of tracheobronchopathia osteochondroplastica (TPO), one case of elongated uvula and one case of endobronchial amyloidosis. All TPO patients had early changes, with a typical nodular appearance to the tracheal cartilage, without significant airway obstruction. These subtle changes could not have been predicted from less invasive procedures and would have been missed without bronchoscopy. Flexible bronchoscopy is indicated in persistent unexplained cough and may reveal contributing pathology.
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PMID:Airway abnormalities at flexible bronchoscopy in patients with chronic cough. 1792 12

The new millennium has seen distinct changes in the pattern of gastrointestinal disease in the Asia-Pacific region. These changes are important as more than half of the world's population come from the region and therefore impact significantly on the global disease burden. The highest incidence of gastric cancer (GCA) has been reported from Asia and GCA remains a very important cancer. However time-trend studies have shown a decrease in GCA incidence in several countries in Asia. A rise in cardio-esophageal cancers as seen in the West has not been reported. On the other hand, colorectal cancer has been steadily increasing in Asia with age-standardized incidence rates of some countries approaching that of the West. The pattern of acid-related diseases has also changed. Gastroesophageal reflux disease is a fast emerging disease with an increasing prevalence of reflux esophagitis and reflux symptoms. The prevalence of peptic ulcer disease has at the same time declined in step with a decrease in H. pylori infection. Many of the changes taking place mirror the Western experience of several decades ago. Astute observation of the epidemiology of emerging diseases combined with good scientific work will allow a clearer understanding of the key processes underlying these changes. With rapid modernization, lifestyle changes have been blamed for an increase in several diseases including gastroesophageal reflux disease, nonalcoholic fatty liver disease and colorectal cancer. A worrying trend has been the increase in obesity among Asians, which has been associated with an increase in metabolic diseases and various gastrointestinal cancers. Conversely, an improvement in living conditions has been closely linked to the decrease in GCA and H. pylori prevalence.
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PMID:Changing trends in gastrointestinal disease in the Asia-Pacific region. 1797 Aug 73

We describe two new familial severe infantile spasm syndromes (ISSs) unrelated to Aristaless-related homeobox (ARX) gene mutation. Family A contains two male siblings each with dysmorphism, profound psychomotor delay, gastroesophageal reflux, infantile spasms, hypsarrhythmia, prominent independent central apneas, and early death. Family B contains two male siblings with dysmorphism, profound psychomotor delay, ambiguous genitalia, macular hypoplasia, neurosensory hearing deficit, gastroesophageal reflux, infantile spasms, no hypsarrhythmia, apneas, and early death in one sibling. Etiologic workup and ARX gene sequencing were negative. This indicates that several familial ISSs exist but are not genetically characterized.
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PMID:Two new familial severe infantile spasm syndromes in males. 1923 48

Esophageal cancer is a major health hazard in many parts of the world. The incidence of adenocarcinoma is rising in white men, particularly in the nonendemic areas, such as the West. Barrett's metaplasia, gastroesophageal reflux, hiatal hernia, and obesity are thought to play a role in these cases. In addition, the most common location of esophageal carcinoma has shifted to the lower third of the esophagus. Unfortunately, esophageal carcinoma is often diagnosed late; therefore, most therapeutic approaches are palliative. Advances have been made in staging procedures and in therapeutic approaches. The NCCN Esophageal Cancer Guidelines emphasize that palpable advances have been made in the treatment of locoregional esophageal carcinoma. Similarly, endoscopic palliation of esophageal carcinoma has improved substantially due to improving technology. A number of new chemotherapeutic agents are on the horizon including antireceptor agents, vaccines, gene therapy, and antiangiogenic agents. The panel expects numerous advances in the treatment of esophageal carcinoma in the future.
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PMID:Esophageal cancer. Clinical practice guidelines in oncology. 1976 47


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