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

Anticholinergics (in particular, ipratropium bromide [Atrovent]) are first-line therapy in patients with chronic obstructive pulmonary disease (COPD). Although more studies are needed to support the use of combination therapy, adding an inhaled beta agonist to the therapeutic regimen is reasonable in patients who remain symptomatic and need quick relief. Patients frequently receive inadequate amounts of drug with standard doses delivered by metered-dose inhalers, often as the result of improper technique, so symptomatic patients may require higher doses. Caution is recommended when the dose of inhaled sympathomimetics is increased in COPD patients with ischemic heart disease or tachyarrhythmias. The addition of an oral sympathomimetic is seldom necessary. Theophylline may be considered in outpatients who remain symptomatic despite their use of inhaled bronchodilators, but heart disease, seizure disorders, and gastroesophageal reflux are contraindications. Corticosteroid therapy remains controversial but can be helpful in patients who still have severe disease despite maximum bronchodilator therapy. Antibiotics can be of benefit in COPD patients undergoing an exacerbation who have increasing dyspnea, cough, and phlegm production.
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PMID:Drug treatment of COPD. Controversies about agents and how to deliver them. 134 54

"Corkscrew oesophagus" is characterised on the basis of two case reports and attention is drawn to thoracic pain of oesophageal origin. Corkscrew oesophagus is a radiological diagnosis and is characterised by twisted segments in the distal third of the oesophagus. The condition can sometimes be demonstrated endoscopically and it is due to a basic disturbance in the motility of the oesophagus. Painful conditions in the oesophagus are most frequently caused by gastro-oesophageal reflux or disturbances in motility and the latter is frequently complicated by reflux oesophagitis. Pain of oesophageal origin is frequently a diagnosis by exclusion and requires exclusion of ischaemic heart disease. The initial treatment should be directed to the reflux oesophagitis. The diagnosis and information about the origin of the pain and the benign course of the condition will calm the majority of the patients and remove their fear of a possible fatal heart disease.
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PMID:[Corkscrew esophagus]. 173 62

Diseases presenting with dyspepsia fall into two general categories: organic and functional. Overall, most patients with dyspepsia have no underlying identifiable disease process. The diagnostic yield of organic causes is less in younger patients, and, conversely, serious organic lesions are common in elderly dyspeptic patients. The commonest organic causes of dyspepsia are peptic ulcer disease, gastroesophageal reflux, biliary tract disease, and gastric cancer. Symptoms and physical signs may help to differentiate these organic causes from functional dyspepsia but endoscopic or radiographic/ultrasound studies are usually necessary to ensure the appropriate diagnosis. Less common organic causes of dyspepsia not to be overlooked include drugs, pancreatitis, malabsorption syndromes, metabolic disorders, ischemic heart disease, and collagen vascular disorders.
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PMID:Dyspepsia: organic causes and differential characteristics from functional dyspepsia. 189 24

The effect of oesophageal stimulation with acid on the exertional angina threshold was examined in 12 subjects. Each walked until the angina threshold was reached on four successive occasions; during two tests the oesophagus was instilled with 0.1 mol/l hydrochloric acid and during the other two with physiological saline. Oesophageal instillation was carried out for 20 min at rest before each walk. In 10 patients the angina point was reached after walking a significantly shorter distance on the treadmill when acid was instilled than when the saline was instilled. ST-segment changes and rate-pressure product were not significantly different during the acid and saline tests. The mechanism responsible for the reduction of angina threshold is not known. However, the effect was more pronounced in the 6 patients who had experienced regular oesophageal symptoms than in those who had not. Ischaemic heart disease and gastro-oesophageal reflux are both common, and the possibility that acid reflux may aggravate angina should be borne in mind, particularly when oesophageal symptoms are present.
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PMID:Oesophageal stimulation lowers exertional angina threshold. 285 64

Several diseases of the gastrointestinal tract can cause angina-like chest pain. Differential diagnosis can be extremely difficult, especially when pathological gastroesophageal reflux is present. We present 10 cases, 2 males and 8 females, in which invasive and non invasive cardiological techniques were unable to indicate a clear diagnosis. We have therefore used a new technique which combines dynamic electrocardiography with 24 hours monitoring of esophageal pH, to correlate pain symptom with electrocardiographic changes and/or gastroesophageal reflux. Using this approach we have diagnosed the presence of isolated pathological gastroesophageal reflux in 3 patients, isolated ischemic heart disease in 2 cases, both conditions in 3 patients and no signs of either condition in the remaining 2 cases. We think that this technique is of special value in subjects suffering from both conditions (ischemic heart disease and gastroesophageal reflux). It provides objective documentation of the role of each disease in the genesis of pain which is essential in developing appropriate therapy.
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PMID:[Usefulness of the combination of the dynamic electrocardiogram with esophageal pH measurement in the differential diagnosis of chest pain]. 653 94

Regurgitation of the gastric contents into the esophagus is common and often unnoticed. When symptoms such as heartburn, a sour or bitter taste in the mouth, or even chest pain mimicking angina pectoris or myocardial ischemia prompt a patient to seek help, the factor or factors responsible for reflux must be sought. The possible underlying causes are numerous, as Dr Bachman points out in this discussion of the pathophysiology, diagnosis, and treatment of gastroesophageal reflux. The desired end point of management was well stated by Seneca over 2,000 years ago as "a good-humored stomach."
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PMID:Gastroesophageal reflux. Simple measures often suffice. 663 18

Although coronary artery disease and gastroesophageal reflux disease are common conditions which, therefore, may coexist, it is unknown whether or not the presence of one affects the other. We performed esophageal acid perfusion tests, with concurrent blood pressure, heart rate, and 12-lead electrocardiographic monitoring, in 37 patients, 25 with angiographically documented coronary disease and 12 with normal coronary arteries. Rate-pressure product, an index of myocardial work load, was calculated. In patients with coronary disease who developed chest pain during acid perfusion, rate-pressure product increased from 10.0 +/- 1.0 x 10(3) (mean +/- SEM) basally to 15.2 +/- 1.5 x 10(3) (p less than 0.001), and 3 of 9 patients showed concomitant electrocardiogram evidence of myocardial ischemia. In addition, in coronary disease, 64% of patients with infrequent or absent reflux symptoms by history had positive acid perfusion tests, and 56% of patients with coronary disease who developed pain during esophageal acid perfusion could not distinguish that pain from their usual angina. We conclude that in coronary disease, acid perfusion (and, presumably, gastroesophageal reflux) resulting in chest pain causes rate-pressure product elevation and can induce myocardial ischemia. The presence of esophageal acid sensitivity is not accurately predicted by clinical history in coronary disease, and pain of esophageal origin is often confused with angina.
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PMID:Esophageal acid perfusion in coronary artery disease. Induction of myocardial ischemia. 686 55

Angina-like chest pain frequently arises from the esophagus. However, when a patient has chest pain, the gravity of possible myocardial ischemia indicates that a cardiac workup must be done. Those individuals with typical anginal pain who have normal multistage exercise tests or normal coronary arteriograms and any person with atypical chest pain should be thoroughly evaluated for esophageal disease. This evaluation should include a barium swallow, a Bernstein test, esophageal manometry, and, if indicated, esophagoscopy. Reproduction of the chest pain with the Bernstein test incriminates gastroesophageal reflux disease. Esophageal manometry is required to make the diagnoses of achalasis, DES, and hypertensive LES or esophageal body (Table 1).
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PMID:Chest pain: differentiating esophageal disease from angina pectoris. 716 Jan 64

What are some take-home lessons on the syndrome of unexplained chest pain? Carefully exclude heart disease, which--unlike esophageally caused chest pain--may be life-threatening. Noncardiac chest pain is a common problem: at least 25% of chest pain patients in coronary care units or emergency rooms "rule out" for heart disease. It is a problem that has been vexing physicians for at least 100 years. The pain patterns in ischemic heart disease and in the unexplained pain syndromes, particularly reflux, may be identical. The mechanism may be an "irritable" esophagus, in which the visceral pain threshold is lowered. Look carefully for gastroesophageal reflux, and treat it aggressively. Finally, in all cases, try to establish a diagnosis if at all possible. When patients are told they don't have heart disease and no further workup is pursued, more than half of them continue to have significant morbidity from their chest pain, utilizing health care facilities and visiting doctors (34,35). Research over the past two decades has enlightened us about many patients with unexplained chest pain, but unfortunately we are still confused about many others, and for this group of patients a conservative therapeutic approach may be best.
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PMID:Approach to the patient with unexplained chest pain. 783 62

Severe nonexertional (resting) chest pain may be due to myocardial ischemia, esophageal dysfunction, psychiatric disorder, or any combination thereof and frequently poses a difficult diagnostic challenge. Our aim was to investigate causes of chest pain in patients with coronary artery disease. Forty-five patients with angiographically proven obstructive coronary lesions and recurrent chest pain at rest were studied; 18 had refractory pain despite cardiac therapy (problem group), and 27 had documented myocardial ischemia (control group). Esophageal manometry, edrophonium provocation, 24-hr pH studies, and psychiatric interview were performed in all patients. The clinical evolution and the outcome of specific treatment during follow-up was used to establish the etiology of chest pain. Esophageal dysfunction was identified in all problem patients and in 52% of controls, and the esophagus was incriminated as the source of pain in 8 (44%) and 5 (18.5%), respectively. After a mean follow-up of 49 months (range 24-76 months), the cause of chest pain in the problem group was identified as panic disorder in 9 patients (50%), gastroesophageal reflux in 6 (33%), esophageal dysmotility in 2 (11%), and gallstone disease in 1 (6%). Of the control patients, 18 (67%) had ischemic pain alone, while 9 had concurrent causes: panic disorder in 5 (19%) and esophageal dysfunction in 4 (15%). Esophageal dysfunction and psychiatric disturbances are common in patients with coronary artery disease presenting with resting chest pain, and may contribute to patients' symptoms.
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PMID:Chest pain at rest in patients with coronary artery disease. Myocardial ischemia, esophageal dysfunction, or panic disorder? 924 27


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