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

A vascular interruption to the azygoportal zone, achieved by devascularisation about the cardia and a closed transmural ligation of the varices is described, which is combined with a simultaneous truncal vagotomy, pyloroplasty procedure and a fundoplication. This fourfold method combats the bleeding varices at several points: a direct disruption of vascular paths, haemodynamic control, reduced influence of peptic factors, the management of coincident ulcer pathology and the prevention of gastro-oesophageal reflux. The results from 5 patients are encouraging. This abdominal operation is swift, comparatively atraumatic and may be undertaken in emergency cases and in at-risk patients on an elective basis.
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PMID:[Azygoportal interruption, fundoplication and vagotomy in hemorrhagic esophageal varices]. 30 62

Recurrent bleeding, the high occurrence of encephalopathy, and the impairment of hepatic function in the successful cases of portasystemic shunts have led to increasing dissatisfaction with these procedures in recent years. Between March 1974 and November 1990 we have operated on 15 children for bleeding esophageal varices using the Sugiura procedure (esophageal transection with paraesophagogastric devascularization). In two cases the entire procedure was performed via the thoracic approach. The spleen was left in place in five cases. We have had no mortality. Operative complications included bleeding in the early postoperative period in two children and partial leakage from the esophageal suture in two others. Follow-up was from 4 years 3 months to 16 years 8 months with an average of 10 years 4 months. Long-term results have been gratifying in 12 patients (80%) with disappearance of the varices and no evidence of recurrent bleeding. Three children (20% of the patients) had recurrent bleeding 4 1/2 years, 4 years 2 months, and 2 1/2 years after the surgical procedure. In all cases there was no evidence of esophageal stenosis, gastroesophageal reflux, or hiatal hernia, nor signs of encephalopathy nor impairment of hepatic function. In our opinion the Sugiura procedure is a valid procedure in the surgical treatment of esophageal varices bleeding in the pediatric age with a high rate of success (80%) and without late complications.
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PMID:Sugiura procedure in the surgical treatment of bleeding esophageal varices in children: long-term results. 147 3

The effect of sclerotherapy of esophageal varices on the gastroesophageal reflux was studied. Gastroesophageal reflux was monitored by a 24-h pH-monitoring catheter introduced into the distal esophagus. The results of pH monitoring of 16 patients who underwent sclerotherapy were compared with those of 21 patients with untreated varices. Seven of the 16 treated patients showed high occurrence rates of gastroesophageal reflux comparable to those observed in cases with severe reflux esophagitis. In the untreated group, only one patient showed pathological reflux (there was a significant difference between treated and untreated groups; p less than 0.01). When the level of reflux was compared with factors that might influence sclerotherapy-induced gastroesophageal reflux, there was a positive correlation between the magnitude of reflux and amount of sclerosant injected paravariceally in the submucosal tissue (p less than 0.05). The results indicate that the paravariceal injection of sclerosant for the treatment of esophageal varix may cause pathological gastroesophageal reflux after sclerotherapy is completed.
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PMID:Gastroesophageal reflux after endoscopic injection sclerotherapy. 153 60

An electron microscopical examination has been made of the fine structure and disposition of pancreatic polypeptide immunoreactive cells associated with the egg-forming apparatus in Diclidophora merlangi. The cell bodies are positioned in the parenchyma surrounding the ootype and taper to axon-like processes that extend to the ootype wall. The terminal regions of these processes branch and anastomose and, in places, the swollen endings or varicosities form synaptic appositions with the muscle fibres in the ootype wall. The cells are characterized by an extensive GER-Golgi system that is involved in the assembly and packaging of dense-cored vesicles. The vesicles accumulate in the axons and terminal varicosities, and their contents were found to be immunoreactive with antisera raised to the C-terminal hexapeptide amide of pancreatic polypeptide. It is concluded that the cells are neurosecretory in appearance and that, functionally, their secretions may serve to regulate ootype motility and thereby help co-ordinate egg production in the worm.
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PMID:The ultrastructure and immunogold labelling of pancreatic polypeptide-immunoreactive cells associated with the egg-forming apparatus of a monogenean parasite, Diclidophora merlangi. 186 90

Esophageal varices nearly always rupture at or just above the gastro-esophageal junction. Mucosal changes on top of the varices, the so-called red colour sign, are found in the majority of patients with a positive bleeding history. An increase of intraabdominal pressure and consequently a sudden pressure rise in the varices is thought of as a trigger cause. The larger the esophageal varices the higher the intravariceal and the transmural varix pressures. The portal pressure in patients with portal hypertension is subjected to considerable changes. Therefore, hemodynamic measurements at rest may have a prognostic value with regard to predisposition to hemorrhage, but they are less significant than endoscopic parameters. Disturbances of blood hemostasis and ascites indicating an impaired liver function are essential predisponable factors for the onset of bleedings. A peptic lesion caused by acid gastric-esophageal reflux is of less importance for the occurrence of variceal hemorrhage.
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PMID:[Pathogenetic factors of hemorrhage from esophageal varices]. 222 84

Pressure in oesophageal varices was measured endoscopically in 52 patients, in 16 of them central portal-vein pressure additionally by percutaneously introduced transhepatic portal-vein catheter. Only in the region of the cardia occlusion segment was the portal-vein pressure the same as that in the oesophageal varices. The larger the varices the higher the average variceal pressure. Depending on the time interval since a meal there were marked pressure variations during the day in portal-vein pressure. Intra-abdominal pressure rise (e.g. on coughing, choking or vomiting) induces a sudden and marked pressure rise in the portal vein as well as the oesophageal varices. The larger the varices the greater the danger of rupture when these pressure rises occur. Gastro-oesophageal reflux plays no role in the pathogenesis of bleeding from oesophageal varices.
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PMID:[Pathogenesis of bleeding esophageal varices]. 348 19

Among 857 patients admitted from October 1977 to December 1984 with acute upper gastrointestinal hemorrhage, 165 (19.5%) had endoscopically proved esophageal or gastric varices. Among this group, varices were considered as the actual bleeding lesion in only 83 (9.7%). Stigmata of variceal bleeding were observed in 76 (92%) including 35 venous spurts, 12 venous oozes, 20 adherent clots, and 14 "platelet aggregates." In only seven cases, variceal rupture could only be presumed, because no other lesion was present. In the other 82 patients, a lesion other than varices was the bleeding source, mostly peptic ulcers (32 = 38%) and erosive gastritis (30 = 36%). One-third of the patients with bleeding varices required more than one endoscopy to provide evidence of variceal bleeding. The most frequent bleeding point was the cardia and a good correlation between variceal size and bleeding was observed. There was no relationship with evidence of gastroesophageal reflux.
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PMID:Bleeding esophagogastric varices: an endoscopic study. 349 84

Rebleeding, the long time high occurrence of encephalopathy and the impairment of hepatic function in the successful cases have led to increasing dissatisfaction in the last years with portasystemic shunt procedures. In the past 12 years we have operated on 14 children for bleeding esophageal varices using the Sugiura procedure (esophageal transection with paraesophagogastric devascularization); in two cases the entire procedure was performed through the thoracic approach. We had no mortality. Complications include bleeding in the early postoperative period in two children and partial leakage from the esophageal suture in two others. Patient follow-up has been between 16 months and 11 1/2 years with an average of 6 1/2 years. The long term controls have been gratifying in 12 patients with disappearance of the varices and no evidence of rebleeding, esophageal strictures, gastroesophageal reflux, encephalopathy or impairment of the hepatic function; in two other patients the operations was unsuccessful. In our opinion the Sugiura procedure should be the elected operation in the surgical treatment of esophageal varices bleeding in pediatric age, after an attempt with sclerotherapy.
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PMID:[Sugiura's operation in the treatment of hemorrhaging esophageal varices]. 349 85

Acid gastroesophageal reflux was determined by long-term pH monitoring in 19 consecutive variceal bleeders after 5 to 20 (mean, 10.3 +/- 1 SEM) sclerotherapy sessions with the flexible endoscope using polidocanol 1% as sclerosant. Fifteen cirrhotics with untreated varices served as controls. Percentage time of esophageal pH less than 4 (3.3 +/- 0.7 SEM vs. 5.2 +/- 2.2 in the controls) and mean duration of reflux episodes (2.9 +/- 0.4 vs. 3.0 +/- 0.7 min) showed no significant differences between both groups. The findings indicate that repeated injection sclerotherapy with the flexible endoscope does not lead to an enhancement of acid gastroesophageal reflux.
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PMID:Effects of repeated injection sclerotherapy on acid gastroesophageal reflux. 371 Jan 4

Since 1974, 112 patients with ruptured esophageal varices, have undergone resection-anastomosis of the supracardial esophagus using the circular suture stapler. Recently, preliminary splenic artery ligature has also been associated, if possible, with systematic ligature of the gastric coronary vein and followed by cardioplasty, to prevent gastro-esophageal reflux and block subcardial venous flow. This highly selective portal decompression (HSPD) procedure provides lasting reduction in blood pressure (confirmed by manometric recordings) in the esophago-cardial region, without any reduction in the distal hepatic flow (no portocaval shunt) or increase in the proximal flow (raised portal pressure). Results were compared with those of the initial, already encouraging, protocol, and demonstrated a tangible improvement after more than one year follow-up. In 50 cases (Child A:16, B:29 and C:5), postoperative mortality was 10% (5 cases) during the first month and 7.5% (3 cases/40) during the first year. There was no specific morbidity due to the additional procedure nor cases of portocaval encephalopathy. During the first postoperative year, the frequency of hemorrhagic complications was one tenth of that during the year before surgery. These very encouraging results suggest the possibility of extending the indications for HSPD in the treatment of recurrent digestive hemorrhages from ruptured esophago-cardial varices, replacing porto-systemic shunts which are sometimes well tolerated but always anti-physiological.
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PMID:Highly selective portal decompression for bleeding esophageal varices. 387 25


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