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

There exists great confusion concerning the different techniques for the treatment of gastroesophageal reflux. For instance, we apply the term fundoplication to different operations that often have nothing to do with the original description, and there is a serious lack of knowledge of the historical origins of many of these operations. This analysis is the result of a large review of the operations, and of the original papers as they were published.
Dis Esophagus 1998 Apr
PMID:An approach to the historical evolution of surgical operations for the treatment of gastroesophageal reflux. 977 62

The effect of experimental gastroesophageal reflux on mitotic activity in the squamous epithelium, as well as in the submucosal glands, of the esophagus was investigated in dogs. The lower esophageal sphincter was destroyed in four dogs using a Wendel cardioplasty, a simple esophagotomy was carried out in four other animals, and four unoperated dogs were taken as controls. Two weeks later, mucosal samples from the esophagus were taken after in vivo labeling of the animals with bromodeoxyuridine. In all mucosal samples the proliferative parameters were estimated in the squamous epithelium, in the submucosal glands and in their excretory ducts. After the cardioplasty, the proliferative parameters were increased (P < 0.05) not only in the esophageal epithelium but also in the submucosal glands and in their excretory ducts (P < 0.05). The amplitude of the proliferative response was more than ten times larger in the latter than that in the surface epithelium. Gastroesophageal reflux is a potent proliferative stimulant to the esophageal squamous epithelium, but also to the cells of the submucosal esophageal glands and their excretory ducts.
Dis Esophagus 1998 Apr
PMID:Gastroesophageal reflux triggers proliferative activity of the submucosal glands in the canine esophagus. 977 63

In a prospective endoscopic and bioptic study, 141 control subjects and 359 patients with symptoms of gastroesophageal reflux (GER) were included to determine the prevalence of cardial epithelium inflammation or 'carditis' and to determine the prevalence of Helicobacter pylori in this area. Two biopsies at the antrum, four distal to the squamous-columnar junction and two proximal in the esophageal mucosa, were taken. Patients with gastroesophageal reflux were divided into four groups, according to the severity of endoscopic findings: patients without esophagitis, patients with erosive esophagitis, patients with short-segment and long-segment Barrett's esophagus (BE). Control subjects had normal histological findings at the cardia in 90% of cases, fundic mucosa being present twice as cardial epithelium. Carditis was present in 8% of cases and intestinal metaplasia (IM) in 2%. On the contrary, patients with GER had carditis in nearly 50% of cases. Intestinal metaplasia was present in 12% of cases with GER without esophagitis or erosive esophagitis, in 35% of cases with short-segment BE and in 65% of the cases with long-segment BE. IM at the antrum was present in only 5% of cases. Helicobacter pylori at the squamous-columnar junction was present in 13% of control subjects and in 30% of the patients with GER. It is concluded that carditis is an easy and objective marker for the presence of chronic gastroesophageal reflux and the presence of Helicobacter pylori at this region must be carefully evaluated in order to determine some pathogenic role for the development of Barrett's esophagus.
Dis Esophagus 1998 Apr
PMID:'Carditis': an objective histological marker for pathologic gastroesophageal reflux disease. 977 65

Studies have reported that normal males have significantly more physiologic gastroesophageal reflux (GER) than women but little difference in reflux parameters is seen between younger and older normal individuals. The aims of this study were to investigate the influence of age and gender on GER in symptomatic patients. We reviewed 353 24-h pH studies performed in patients with reflux symptoms. The following parameters were assessed: % time pH < 4 of total, upright and supine periods; total reflux episodes; total reflux episodes > 5 min; longest reflux episode. These parameters were analyzed according to age and gender using non-parametric tests. The median age was 47 years and this was used as the cutoff between younger and older patients. Also, an elderly group (age > or = 65) was analyzed. Age did not influence % time pH < 4 for total, upright and supine periods. However, older symptomatic patients had longer reflux episodes. As with normal subjects, male patients had significantly (P < 0.05) more reflux than females, comparing median values for the percentage times pH < 4: total 4.7 vs 2.7%; upright 5.2 vs 3.3%; supine 1.2 vs 0.4%; total reflux episodes 63 vs 45; episodes > 5 min (2 vs 0) and longest reflux episode 9 vs 5 min. Therefore, different cutoff values may be necessary for males and females in diagnosing abnormal reflux.
Dis Esophagus 1998 Apr
PMID:Influence of age and gender on gastroesophageal reflux in symptomatic patients. 977 66

A retrospective analysis of 113 consecutive cases of benign esophageal stricture, all secondary to gastroesophageal reflux, 100 treated conservatively, 13 treated surgically, has been carried out in conjunction with a postal questionnaire of patients. Patients were requested to grade both their swallowing ability and the acceptability of their treatment. Of those responding to questionnaire, 88% of patients treated conservatively found their treatment acceptable or better, and 72% were left with either no or minimal restriction of diet. There was no correlation between either the total number or frequency of dilatations and the result achieved. Similarly, patient satisfaction appears largely independent of these variables. Doctors should be wary of taking recurrence of a stricture after initial dilatation as indicating a poor eventual outcome or a dissatisfied patient. There was no difference in terms of either the result or patient satisfaction between conservatively treated and surgically treated patients.
Dis Esophagus 1998 Apr
PMID:A patient's perspective on the management of peptic esophageal stricture: experience and results in 113 consecutive cases. 977 67

Antireflux surgery usually gives long lasting control of gastroesophageal reflux disease, but late failures can occur from fundoplication wrap disruption. Disruption presumably occurs when physiological mechanical stresses cause the sutures to pull out of the fundoplication wrap. We hypothesized that complete fundoplications (fundus sutured to fundus) would withstand disruptive forces better than partial fundoplications (fundus sutured to esophagus). Forty-eight rats underwent fundoplication (24 partial and 24 complete). Fundoplication wraps were disrupted by distending the stomach (bursting pressure technique) and by distracting the wrap in a tensiometer (breaking strength technique). Bursting pressures were similar in the partial (103.7 +/- 13.5 mmHg) and complete (100.5 +/- 13.1 mmHg) fundoplication wraps (P = 0.93, not significant). In both groups, all disruptions occurred by sutures tearing through the stomach wall. Breaking strength was also equivalent for the two types of wrap. Partial wraps disrupted at 6.69 +/- 1.49 N and complete wraps disrupted at 6.52 +/- 1.28 N (P = 0.77, not significant). Sutures tore out of the stomach side of the partial wrap in five rats and out of the esophagus in the other seven rats with partial wraps. Disruption occurred by sutures tearing through the stomach in all rats with complete fundoplications. This experimental study in the rat did not show any difference in the ability of partial and complete fundoplication wraps to withstand disruptive forces.
Dis Esophagus 1998 Oct
PMID:Fundoplication wrap disruption: an experimental study in rats. 1007 5

Studies in human beings and animals have shown that esophageal exposure to duodenal and gastric contents may be important for the development of Barrett's esophagus and its complications, including adenocarcinoma and epidermoid carcinoma. Diethylnitrosamine (DEN) is a carcinogen that stimulates the development of epidermoid carcinoma in the esophagus of mice. The aim of this study was to evaluate the effect of gastroduodenal and gastric content reflux on induction of esophageal carcinogenesis. Gastroesophageal reflux (GER) and gastroduodenoesophageal reflux (GDER) were produced by cardioplasty and esophagoduodenostomy. The chosen carcinogen was DEN, diluted in drinking water, given 3 days a week for 20 consecutive weeks. One hundred Wistar female rats were divided into six groups, as follows: group 1 (18 rats), cardioplasty without DEN; group 2 (18 rats), cardioplasty with DEN; group 3 (10 rats), only water; group 4 (17 rats), cardioplasty with DEN; group 5 (17 rats), esophagoduodenostomy with DEN; group 6 (20 rats), only DEN. GER in isolation induced papillomatosis or ulceration in 22.2% of rats and, when associated with DEN, induced papillomatosis in 61.1% of rats. GDER in isolation induced marked esophagitis in 61.1% of rats, Barrett's esophagus in 16.7% and esophageal adenocarcinoma in 16.7%; when associated with DEN, 23.5% of rats presented marked esophagitis, papillomatosis or ulceration, whereas 76.5% had esophageal carcinoma, with 70.6% epidermoid carcinoma and 5.9% adenocarcinoma. Rats treated with water alone did not show histologic abnormalities of the esophageal mucosa. Rats treated with DEN alone developed papillomas in 50.0% of the cases and remained histologically unchanged in 50.0%. There was no development of low- or high-grade dysplasia in any group. The conclusions are that (1) GDER is significantly more deleterious to esophageal mucosa than GER; (2) in this study, GER did not present carcinogenic potential in relation to the esophagus; (3) GDER in isolation is an esophageal carcinogen, producing Barrett's esophagus and esophageal adenocarcinoma; (4) esophageal oncogenesis caused by GDER is potentiated by DEN, inducing esophageal epidermoid carcinoma; (5) in this study, DEN in isolation did not generate tumors in the esophagus of rats.
Dis Esophagus 1999
PMID:Influence of surgically induced gastric and gastroduodenal content reflux on esophageal carcinogenesis--experimental model in Wistar female rats. 1046 42

Swallowing is a complex mechanism based on the coordinated collaboration of tongue, pharynx and esophagus. Disturbances of this interplay or disorders of one or several of these components lead to dysphagia, non-cardiac chest pain or regurgitation. The major primary esophageal motility disorders--achalasia, diffuse esophageal spasm, hypercontractile esophagus ('nutcracker esophagus') and non-specific motility disorder--are of unknown etiology. Other esophageal diseases, such as cervical diverticula or gastroesophageal reflux disease, might also be caused by a primary esophageal motility disorder. Medical treatment of esophageal disorders with esophageal hyper- or dysmotility requires agents that reduce esophageal contractile force (anticholinergic agents, nitrates, calcium antagonists). Despite the beneficial effect of the various drugs on esophageal motility parameters, the clinical benefit of medical treatment of esophageal motility disorders is rather disappointing. Calcium channel antagonist, alone or in combination with anticholinergics or nitrates, can be used as a medical trial, especially in mild achalasia. However, medical therapy is clearly inferior to pneumatic balloon dilation therapy. Recently, botulinum toxin injection was suggested as a therapeutic option in achalasia patients with good results on lower esophageal sphincter pressure (LESP) and symptom scores that were similar to the results achieved by pneumatic balloon dilation. Hypercontractile esophagus shows a good manometric response to calcium channel antagonists, but only little clinical effect in terms of improvement of symptoms. Diffuse esophageal spasm is a relatively rare disease and few clinical studies are available. The use of calcium channel antagonists can be beneficial, at least in some patients with diffuse esophageal spasm. From clinical and epidemiological studies, there is some evidence of a 'psychological' component in the pathogenesis or perception of esophageal symptoms. There is some clinical benefit from centrally acting drugs such as benzodiazepines or antidepressants. With the exception of botulinum toxin for achalasia, medical therapy of primary esophageal motility disorders is rather limited and the clinical results are poor. Further understanding of esophageal pathophysiology as well as development of new receptor-selective drugs might increase our chances of a successful treatment of primary esophageal motility disorders.
Dis Esophagus 1999
PMID:Esophageal pharmacology and treatment of primary motility disorders. 1077 Mar 58

The purpose of this study was to correlate gastroesophageal reflux evaluated by 24-h pH study to esophageal motility, diameter of the esophagus and diaphragmatic hiatus, and patient age. We recorded radiographic findings from barium esophagrams in 91 patients (47 women, 44 men) with a mean age of 52 years (range 17-18 years), who had 24-h pH monitoring of the esophagus. All patients had one or more symptoms related to the upper aerodigestive system, and both studies were performed within 2 days of each other. The average diameters of the esophagus and hiatus were 24 mm and 19 mm respectively. The correlation coefficient (r) between patient age and diameter of the esophagus was -0.22. No correlation was found between the diameter of the hiatus and the size of the esophagus or patient age. Esophageal diameter is significantly wider in patients with esophagitis than in patients who have no esophagitis. Thirteen of 27 patients with absent primary peristalsis had abnormal pH results. The diameter of the esophagus may be affected by aging, but was not affected by the presence of dysmotility. The caliber of the hiatus was stable and was narrower than the diameter of the esophagus. The hiatus tended to be wider when esophagitis existed.
Dis Esophagus 1999
PMID:Reflux evaluation: correlation between pH results, esophagitis, esophageal dysmotility, patient age, and esophageal caliber. 1077 Mar 67

For oesophageal epithelial changes to develop from gastro-oesophageal reflux disease (GORD), the character of the refluxate must be acid enough to cause injury. Experimentally, copious perfusion of the oesophagus with weak acid is quite harmless. However, hydrochloric acid alone with a pH below 3.0 may cause oesophageal injury. Cola drinks are strongly acidic (pH 2.5). This study analyses the influence of and possible interaction between cola consumption and oesophagitis. Twenty rats were divided into two groups of 10. The animals received saline (pH 7.0) or cola (pH 2.6) per OS with 24 h free access to these solutions. After the experiment the oesophagus was dissected. The mucosa was macroscopically and histopathologically examined, and flow cytometric analysis was used to look for proliferative activity. The histopathological analysis showed that there is no difference between saline and cola. But the findings of cell cycle analysis showed that the effects of cola and saline in inducing oesophageal mucosal damage are different. In the cola group the values were G0/G1, 7.33 +/- 2.88; S, 29.88 +/- 2.88; G2/M, 0.10 +/- 0.01; PI (proliferative-regenerative index), 29.76 +/- 2.88. The rat cell population g0/g1 phases were found to be low (p < 0.01), and the cell population S and PI phases were found to be significantly elevated compared with the control group (p < 0.01). (G0/G1, 79.30 +/- 5.97; S, 16.06 +/- 8.27; G2/M, 4.66 +/- 4.03; PI, 20.03 +/- 6.01). These results were reflected in the proliferative index, which is used as a measure of the regeneration index. The data show that cola has proliferative and regenerative effects on the oesophageal mucosa, and it is possible that its regenerative effect is caused as a result of an irritant effect.
Dis Esophagus 1999
PMID:Cola drinks consumption and oesophagitis. 1077 Mar 68


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