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

This paper reports a series of 52 patients with Barrett's (or columnar-lined) oesophagus from one medical unit diagnosed over a six-year period. The commonest associated symptoms were heartburn, regurgitation and dysphagia but 10 patients had no oesophageal symptoms and two had no symptoms at all. Gastrointestinal bleeding (overt or occult) was observed in almost one-third of patients. At diagnosis, 26 patients had oesophagitis, 23 had oesophageal ulceration and 10 had benign oesophageal strictures. An association between oesophageal ulceration and non-steroidal anti-inflammatory drug ingestion was suggested by the data and patients with oesophageal ulceration were significantly older than patients with uncomplicated Barrett's oesophagus. No patient had adenocarcinoma of the oesophagus at diagnosis and neither carcinoma nor dysplasia were seen during a mean period of 16.4 months. However, 17 per cent of patients in the series had malignancies in other sites. Most patients did well on medical treatment and only two were referred for anti-reflux surgery (both for non-healing oesophageal ulcers). Barrett's oesophagus was seen in 10 per cent of patients with gastro-oesophageal reflux at endoscopy. Oesophageal ulceration in patients with Barrett's oesophagus made up 21 per cent of oesophageal ulcers seen and benign oesophageal stricture in patients with Barrett's oesophagus constituted 13 per cent of all benign strictures seen. Barrett's oesophagus is common in our population and despite complications, it can be managed successfully, at least in the short term, by conservative means.
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PMID:Barrett's oesophagus: a clinical study of 52 patients. 349 62

We reviewed the radiographic findings in thirty patients with columnar-lined (Barrett's) esophageal mucosa. Gastroesophageal reflux was observed in 90%, hiatal hernia in 83%, stricture in 80% and esophageal ulceration in 33%. Superficial nodular mucosal changes were detected on 50% of the air contrast esophagrams. Prominence of this pattern may be associated with dysplastic or early malignant change. In addition, four conditions associated with secondary lower esophageal sphincter incompetence were identified in our patient group. These were scleroderma, previous myotomy for achalasia, previous gastric surgery and long-term indwelling nasogastric tubes.
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PMID:Barrett's esophagus: radiological and clinical considerations. 648 Jun 62

Drug histories were obtained from 76 patients at the time of initial Eder-Puestow dilatation for benign oesophageal stricture. Six patients had consumed drugs known to cause oesophageal ulceration (emepronium bromide and potassium preparations). Of the remaining 70 patients, 22 had regularly taken a non-steroidal anti-inflammatory drug before the onset of dysphagia compared with 10 patients in a control group matched for age and sex; this difference was significant (p less than 0.02). Non-steroidal anti-inflammatory drugs may have a causative role in the formation of oesophageal stricture in patients with gastro-oesophageal reflux, in whom they should be prescribed with caution.
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PMID:Non-steroidal anti-inflammatory drugs and benign oesophageal stricture. 680 92

Barrett esophagus has become a common lesion in the esophagus; it is presumably caused by reflux esophagitis. Double-contrast barium esophagraphy improves radiographic evaluation of Barrett esophagus. The presence of midesophageal stricture, mucosal reticular pattern, and deep esophageal ulceration suggests the presence of Barrett esophagus. Other findings, such as hiatal hernia, thickened mucosal folds, and gastroesophageal reflux, are also frequently seen in Barrett esophagus but are not specific. Adenocarcinoma may complicate Barrett mucosa, usually with severe dysplasia. Adenocarcinoma has morphologic forms similar to squamous cell carcinoma in the esophagus. Barium esophagram, CT scans, and endoscopic sonography are used to evaluate and stage adenocarcinoma in the esophagus.
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PMID:Barrett esophagus and adenocarcinoma. 797 6

History taking is the first step in the evaluation of a patient. An analysis of the information obtained provides the basis for the choice and order of diagnostic tests. In addition, it provides the clinician with the necessary information to determine the relevance of "abnormal tests" to the patient's problem. Dysphagia is a reliable symptom that indicates an abnormality in the swallowing mechanism. The history should contain a detailed description of the symptoms associated with dysphagia from the onset. Especially relevant are questions to determine if dysphagia is experienced every day or intermittently, with solid food or liquids or both, as well as presence and timing of associated symptoms such as, choking, coughing and regurgitation, changes in speech, heartburn and chest pain. It is clinically useful to divide swallowing into three phases: oral, pharyngeal and esophageal. Oral dysphagia is usually due to a neurologic disorder, decreased salivary flow or painful oropharyngeal lesions. Pharyngeal dysphagia is most frequently caused by neuromuscular disorders and less frequently by a Zenker's diverticulum, neoplasm or a mucosal web. Esophageal dysphagia is caused by a structural narrowing, such as produced by a peptic stricture, neoplasm or a Schatzki's ring or by a primary motility abnormality, such as achalasia or diffuse esophageal spasm or by motility abnormalities produced by inflammation caused by gastroesophageal reflux, medication-induced esophageal ulceration or infectious esophagitis.
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PMID:Art and science of history taking in the patient with difficulty swallowing. 846 26

Prokinetic agents are being used increasingly in medical therapy for gastro-oesophageal reflux disease (GERD). This study examined the effect of 10 mg q.d.s., oral cisapride, or placebo, taken for 12 weeks, on 48 patients with symptoms and endoscopic evidence of GERD. Objective evaluation of benefit was obtained by endoscopy and biopsy, oesophageal manometry, acid reflux provocation test and 24-h oesophageal pH monitoring. Cisapride significantly increased lower oesophageal sphincter pressure (P = 0.003) against baseline and also against placebo, in patients (n = 9) with an hypotensive lower oesophageal sphincter pressure (P < 0.01). The frequency of dyspeptic symptoms was significantly improved in the cisapride group (P = 0.03). Antacid intake, global evaluation of symptoms and a VAS score for symptoms were all better than placebo but failed to reach significance (global evaluation by patients, P = 0.07). Overall, there was no significant improvement in oesophagitis at either 6 weeks (P < 0.05 > 0.3) or 12 weeks (P = 0.07). However, if patients with grades I and II oesophagitis at entry were excluded, cisapride had a significantly greater effect than placebo, 6 weeks (P = 0.05), 12 weeks (P = 0.04). In those with oesophageal ulceration, cisapride was significantly more effective than placebo in inducing healing. Gastro-oesophageal reflux was very variable on both 24-h pH monitoring and acid reflux provocation test. In spite of a 50% decrease in acid exposure on 24-h pH monitoring (cisapride group, mean % pH < 4 day: entry 18.9%, 12 weeks 9.6%), there were no significant intra- or intergroup differences for percentage of time < pH 4, or frequency and duration of episodes, neither pre- or post-prandially, day or night, except for the number of post-prandial episodes during acid reflux provocation tests, which decreased significantly more with cisapride than with placebo (P < 0.05). Thus, oral cisapride when taken for 12 weeks promoted healing of oesophagitis and improved symptoms in patients with GERD; although an increase in lower oesophageal sphincter pressure was observed and a reduction in acid reflux was measured, no significant decrease of acid exposure was seen.
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PMID:Cisapride in the treatment of gastro-oesophageal reflux disease. 848 71

Gastroesophageal reflux disease poses special diagnostic and therapeutic challenges in the elderly. These patients may not report the classic symptoms of dysphagia, chest pain, and heartburn, and they are more likely to develop severe disease and complications such as esophageal ulceration and bleeding. Therapeutic options include lifestyle changes, medication, and surgery. Polypharmacy and changes in renal, hepatic, and gastrointestinal function can complicate treatment. Proton pump inhibitors can help optimize disease management. The most common primary presenting symptoms of GERD in the elderly are regurgitation, dysphagia, dyspepsia, vomiting, and noncardiac chest pain, rather than heartburn. Because the elderly commonly take multiple drugs for various comorbidities, drug interactions and treatment responses must be carefully assessed in this patient population. Nonpharmacologic measures may be helpful but often do not relieve nighttime GERD symptoms.
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PMID:Diagnosis and treatment of gastroesophageal reflux disease in the elderly. 1106 Sep 61

Patients who present with uncontrolled esophageal acid reflux symptoms require endoscopy to determine the presence or absence of ulcers and stenoses, acid reflux testing to determine if acid reflux is present, and manometry to evaluate esophageal peristalsis and spastic states. These studies are usually done in stages, at separate times. Esophageal manometry catheters currently in use have an incorporated infusion channel. This allows instillation of a dilute acid meal after esophageal manometry has been completed. Standard acid reflux testing can then be done using dynamic positioning and physiologic maneuvers. When combined with an esophagogastroduodenas copy (EGD), these three studies provide all information necessary within 2-3 h to determine further treatment of these patients. A total of 210 patients underwent these studies. A hiatus hernia was present in 84%. An ineffective lower esophageal sphincter was found in 64%. Esophageal hypocontractility was present in 18%, hypercontractility in 14%, and dysmotility in 36%. Upper esophageal sphincter was weak in 42%, hypercontractile in 42%, and dysmotile in 32%. Acid reflux disease was found in the hiatus hernia in 14% and acid reflux to the level of the lower esophagus in 16%, middle esophagus in 13%, and upper esophagus in 40%. Distal esophagitis was present in 47%, esophageal ulceration in 29%, gastric prolapse in 11%, gastritis in 52%, bile reflux disease in 10%, and Barrett's epithelium in 5%. In conclusion, an extremely high number of patients with esophageal acid reflux disease show dysmotility patterns. Standard acid reflux testing using dynamic positioning will identify most patients with significant acid reflux disease. When combined with an EGD, complete testing for acid reflux disease can be performed at one setting. Further study is needed comparing dynamic acid reflux testing to 24-h pH testing.
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PMID:Standard acid reflux testing revisited. 1131 39

Although gastro-oesophageal reflux (GOR) symptoms diminish in 80% of babies by their first birthday, this common problem causes parents and babies much distress. In extreme cases, GOR is linked to oesophageal ulceration and faltering growth. But most infants have uncomplicated GOR without a definitive cause. GOR symptoms can resolve using agents or special infant formulae that thicken the gastric contents. It is important to try and avoid invasive procedures in children with GOR.
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PMID:Reflux: causes and treatments. 1263 Jan 51

Chronic gastroesophageal reflux disease was diagnosed in a 22-year-old female Tennessee Walking Horse that had signs of bruxism and ptyalism. Esophageal ulceration was detected via endoscopy. Compared with the damage to the proximal portions of the esophagus, the severity of the ulceration increased toward the gastroesophageal junction. Esophageal ulceration attributable to chronic gastric acid reflux is usually secondary to pyloric outflow obstruction in horses. In the horse of this report, there was no evidence of either a chronic pyloric or duodenal obstruction that could have resulted in esophageal ulceration. Esophageal ulceration in this horse was attributed to gastroesophageal reflux disease, a common condition in humans in which the underlying abnormality is functional incompetence of the gastroesophageal junction. Treatment is directed at decreasing gastric acidity and protecting the ulcerated mucosa. In the horse of this report, treatment was unsuccessful and the horse was euthanatized; a physical cause of gastroesophageal reflux disease was not identified during an extensive postmortem examination.
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PMID:Idiopathic gastroesophageal reflux disease in an adult horse. 1523 Apr 53


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