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

Among the pathogenetic mechanisms for the occurrence of gastroesophageal reflux disease, Helicobacter pylori infection is indicated. The conclusions are absolutely opposite. The object of our work was to assume ex juvantibus to what extent the eradication of the Helicobacter pylori infection would accelerate the healing of patients with reflux oesophagitis and would reduce the number of relapses. To investigation were submitted 42 patients with reflux oesophagitis with confirmed Helicobacter pylori infection, classified according to Savary-Miller. A group of 22 patients was treated 10 days with triple drug combination of omeprazole, amoxillin and metronidazol with the purpose of eradication of the infection, after which they continued with ranitidin up to 30 days, and a second group of 20 patients treated only with ranitidine for 30 days. The subjective complaints, endoscopic finding and present infection were followed up. A considerably higher number of recovered patients after eradication of the Helicobacter infection was established and the number of relapses for the six-month period of observation was considerably reduced.
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PMID:[The treatment of reflux esophagitis in patients with a Helicobacter infection of the gastric mucosa]. 1084 37

Parietal cell protrusion (PCP), swelling and bulging of parietal cells, has been observed in the oxyntic mucosa of patients receiving omeprazole. The frequency of this event and the underlying mechanisms remain to be clarified. As such, it is unknown whether there is a relation with either serum gastrin or Helicobacter pylori infection, and whether PCP predisposes to the development of fundic gland cysts (FGC). We therefore investigated the development of PCP and FGC in gastroesophageal reflux disease (GERD) patients treated with omeprazole and correlated findings to duration of therapy, gastrin, and H pylori infection. In a randomized, double-blinded study, GERD patients were evaluated by endoscopy with biopsy sampling for histology and culture at baseline, and after 3 and 12 months' therapy with omeprazole 40 mg daily. H pylori-positive patients were randomized to additional eradication therapy or placebo antibiotics at baseline. All histological slides were scored blinded for time and outcome of culture for the presence of PCP and FGC. Fasting serum samples from all visits were used for gastrin measurements. The prevalence of PCP increased during omeprazole therapy from 18% at baseline to 79% and 86% at 3 and 12 months (P < .001, baseline v both 3 and 12 months). The prevalence of FGC increased from 8% to 17% and 35% (P < .05, baseline v 12 months). The prevalence of PCP and FGC did not differ among the H pylori-positive and H pylori-negative patients at baseline (PCP 16% v 20% and FGC 7% v 8%, respectively). Whereas H pylori eradication did not significantly affect development of PCP (P = .7), FGC developed significantly more often in the H pylori-eradicated patients when compared with persistent H pylori-positive patients (P < .05). PCP development was related to serum gastrin rise during therapy. In conclusion, PCP occurs in most patients within the first months of omeprazole treatment and is related to increased gastrin levels. FGC develops more gradually and is enhanced by H pylori eradication.
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PMID:Parietal cell protrusions and fundic gland cysts during omeprazole maintenance treatment. 1115 Mar 84

The 1998 Guidelines of the American College of Gastroenterology recommend that diagnostic testing for Helicobacter pylori infection should only be performed if treatment is intended, and that testing for H. pylori is not indicated in patients on long-term treatment with a proton pump inhibitor (PPI) for gastro-oesophageal reflux disease (GORD). Moreover, a recent evidence-based workshop evaluating major clinical strategies for the management of GORD reported, with an 'A' category (maximum of evidence), that eradication of H. pylori does not heal or prevent relapse of GORD. In detail, it seems that H. pylori infection per se has no effect on the pathogenic mechanisms determining either reflux or its complications. The relationship between H. pylori and oesophagitis is mediated by the effect of H. pylori on gastric acid secretion; in particular, by the proximal extension of gastritis and related impairment of gastric secretory function. In general, if the corpus is infected, the amount of acid available for reflux is less and the probability of excessive oesophageal acid exposure leading to oesophagitis reduced. However, the clinical relevance of corpus H. pylori infection as a biological antisecretory agent (and of H. pylori eradication) seems small or absent, at least in the long run. Conversely, the previous claim of an increased risk of atrophic gastritis in H. pylori-infected patients treated long term with PPI drugs appears not to be confirmed by subsequent studies. In conclusion, H. pylori infection may, in some circumstances, be moderately favourable and, in other circumstances, it may be neutral, with respect to the management of GORD.
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PMID:Should we eradicate Helicobacter pylori in patients with recurrent gastro-oesophageal reflux disease? 1092 92

The aim of the study was to evaluate the incidence and the etiology of Mallory-Weiss syndrome in children. The study population comprised 2720 children aged 5 months to 18 years who had undergone upper gastrointestinal endoscopy. Mallory-Weiss syndrome was diagnosed in eight (0.3%) of the examined children. Endoscopic examination in five of them revealed linear mucosal tears, mostly above and in one case also below the gastroesophageal junction. In three children a linear scar in the lower portion of the esophagus was seen. No signs of active bleeding were revealed in any of the cases. In four children, Mallory-Weiss syndrome was accompanied by gastritis and duodenitis; two of these children had Helicobacter pylori infection. The concomitant diseases were H. pylori-positive duodenal ulcer (1), bronchial asthma and gastroesophageal reflux disease (1), carbon monoxide poisoning (1). In one case Mallory-Weiss syndrome was diagnosed in early pregnancy. Mallory-Weiss syndrome should be considered, along with others, as a cause of acute upper gastrointestinal bleeding in children. There is a great variety of etiologic factors in Mallory-Weiss syndrome in children.
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PMID:Mallory-Weiss syndrome in children. 1094 65

Concerning the relationship between Helicobacter pylori infection and gastro-oesophageal reflux disease (GORD), the debate is ongoing whether the infection confers protection, is harmful or whether both entities are independent. Epidemiological evidence is given for an increased prevalence of GORD and a decreased prevalence of H. pylori infection in the western world. The assumpton derived from it is that H. pylori protects from GORD. Pathophysiological aspects need to consider the type and expression of gastritis which is associated with varying changes of gastric function. Depending on the type of gastritis, acid secretion may either increase or decrease and thereby impact on acid exposure of the oesophagus. Other changes related to the role of H. pylori in pathophysiology of GORD are still hypothetical. Clinical data are controversial whether or not GORD increases after H. pylori eradication. Prospective studies including characterization of strains and gastric physiology will clarify this issue. An accelerated induction of gastric mucosal atrophy in patients on long-term proton pump inhibitors is reported in most available studies. An increase of inflammatory activity in fundic and corpus mucosa is a consistent phenomenon. Therefore, in the authors' opinion, eradication appears advisable.
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PMID:Helicobacter pylori infection and gastro-oesophageal reflux disease: coincidence or association? 1100 6

In our country, it is reported that reflux esophagitis(GERD) has been increasing like in European countries. One of the reasons for this tendency may be the arrival of the aging society. Another explanation is the lowering of Helicobacter pylori infection rate in the younger generation. Though the Los Angeles classification is mainly used at present, the Savary-Miller classification is also clinically important. For the initial treatment of GERD, proton pump inhibitor(PPI) has been mainly used, while there is large problems in the ideal way of maintenance therapy. The guideline on the GERD treatment is also being considered, based on EBM.
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PMID:[Clinical update of GERD]. 1100 4

The gastric acid secretion was evaluated by serum pepsinogen I/II ratio and serum Helicobacter pylori IgG antibody titer in gastroesophageal reflux disease(GERD) patient. GERD patients was 81 patients. Los-Angeles classification (LA)O, so called endoscopy negative reflux disease, was 6 patients, and LA-O-B patients was 68 patients. Helicobacter pylori infection ratio in GERD patients was 50.6%(41/81 patients). Pepsinogen I/II ratio in Helicobacter pylori positive GERD patients was no significant different from Helicobacter pylori negative GERD patients. We concluded that the gastric acid secretion in GERD patients was normal secretion.
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PMID:[Gastric acid secretion in gastroesophageal reflex disease]. 1100 5

Dyspepsia drains a substantial proportion of healthcare resources in industrialized countries and an appropriate management strategy is needed. An aetiological role for Helicobacter pylori infection has been demonstrated in a number of pathological conditions associated with dyspepsia, such as peptic ulcer and gastric malignancies, but not in functional dyspepsia. Endoscopy and diagnosis-based treatment, H. pylori testing and eradication therapy, history taking and empirical therapy, are the main tools that are currently available for managing patients with upper gastrointestinal symptoms. Endoscopy identifies malignancies and organic diseases of the proximal gut and therefore provides reassurance to both doctors and patients. It should be recommended in older patients with suspicious symptoms and it has proven to be more cost-effective than empirical H2-receptor antagonists in patients with ulcer-like symptoms. Empirical eradication in all dyspeptics without suspicious symptoms is a cost-effective approach that cures the majority of peptic ulcers. Nevertheless, it does not control symptoms in the majority of patients, it may exacerbate gastro-oesophageal reflux disease, and it encourages antibiotic resistance. The realities of current clinical practice require empirical therapy in most, if not all, the dyspeptics seen by general practitioners. A detailed history taking can help to diagnose gastro-oesophageal reflux disease and to identify suspicious symptoms. Furthermore, identification of dyspepsia subgroups may provide guidance for empirical therapy. Nevertheless, even analysis of individual symptoms does not provide a sufficient diagnostic yield to differentiate functional from organic dyspepsia and appropriate investigations are needed in patients with poor response to short-term therapy or frequent relapses.
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PMID:Review article: the continuing dilemma of dyspepsia. 1105 Apr 84

Four proton pump inhibitors (PPIs) are currently marketed in various parts of the world, and all of these (lansoprazole, omeprazole, pantoprazole, and rabeprazole) are available for prescription use in the United States. As a therapeutic group, the PPIs are highly useful for the relief of symptoms and healing of gastroesophageal reflux disease, gastric and duodenal ulcer disease, eradication of Helicobacter pylori infection, prevention and treatment of nonsteroidal anti-inflammatory drug (NSAID)-associated damage, management of hypersecretory states such as Zollinger-Ellison syndrome, and care of patients with non-variceal upper gastrointestinal bleeding, or non-ulcer dyspepsia. The pathophysiologic basis of these management benefits lies in the potent gastric acid inhibitory effects of the PPIs. There are differences between the PPIs in their pharmacokinetics, pharmacodynamics, influence by food and antacids, clinical efficacy, and potential for drug interactions. It is not always clear whether these often subtle variations are necessarily of clinical importance. The physician's choice of one PPI over another must rest with her/his interpretation of the clinical importance of the generally small differences between PPIs, their approval for treatment of specific clinical indications within the physician's practice jurisdiction, and the strength of the evidence based on the quantity and quality of the supporting clinical trials.
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PMID:Are the orally administered proton pump inhibitors equivalent? A comparison of lansoprazole, omeprazole, pantoprazole, and rabeprazole. 1107 51

The incidence of esophageal tumors, and of adenocarcinoma in particular, has risen markedly in recent years in the developed countries. The use of a variety of histopathological and biological markers is now offering promising prospects for the future. Vertical tumor invasion, intratumoral microvessel density, antimucin monoclonal antibodies, flow cytometry, telomerase activity, and overexpression of cyclin D1 have been correlated with the staging and prognosis of esophageal carcinomas. By combining these markers with Lugol staining, a practical new method of staging esophageal tumors may become available in the coming years. As is well known, Barrett's mucosa is a preneoplastic condition. Discussions in the literature concerning short forms of Barrett's esophagus and their relationship to inflammation of the gastric cardia appear to describe two different scenarios--a gastroesophageal reflux condition for short forms of Barrett's esophagus, and an inflammatory phenomenon (perhaps unrelated to Helicobacter pylori infection) for inflammation of the gastric cardia. Cost-benefit studies of follow-up procedures in Barrett's esophagus have yet to be conducted, and considerable efforts--mainly using biological markers--are being made to identify those patients who are at greatest risk. Although the frequency of gastric tumors has declined in recent years, many as yet unclear aspects of these tumors have been studied. Technological progress has not led to substantial changes in the diagnostic procedures used, although autofluorescence methods and three-dimensional reconstruction have been analyzed. Laparoscopy, preferably combined with the use of ultrasound probes, may be a valuable tool for staging. The suggestion that endoscopy should be avoided in young patients (the "treat but do not scope" approach) has been seriously questioned, as it may lead to early cancer being overlooked. There is thought to be an intermediate stage of gastric cancer (between the early and advanced stages) in which the muscularis propria, but not the serosa, is invaded. Endoscopic ultrasonography is becoming increasingly established as a basic tool for the staging of gastric cancer. Gastric MALT lymphoma can be cured by H. pylori eradication therapy in many cases, but there is still uncertainty regarding the limitations of this approach.
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PMID:Diagnosis of esophagogastric tumors. 1120 80


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