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

Impaired gallbladder motility is common in gallstone patients and might be associated with other gastrointestinal defects. Twenty patients with small stones in an opacified gallbladder at oral cholecystography and 20 healthy subjects homogeneous for sex, age and body size were studied by ultrasonography to assess gallbladder and gastric emptying simultaneously in response to a standard liquid meal (120 kcal, 11 g fat, 200 mL). The same subjects underwent ambulatory 24-h gastro-oesophageal pH monitoring. Dyspeptic symptoms were specifically investigated using a questionnaire. Gallstone patients had a significantly larger fasting (P < 0.05) and residual (P < 0.005) gallbladder volume with slower (P < 0.05) and less complete (ANOVA, 0.001 < P < 0.05) gastric emptying than healthy control subjects. The speed of antral emptying was significantly correlated with the speed of gallbladder emptying (n = 40, r = +0.31, P < 0.05). Pathological gastro-oesophageal reflux was present in 75% and 15% of patients and control subjects respectively (P < 0.05). Overall, 95% of gallstone patients had abnormal pH profiles resulting from pathological gastro-oesophageal reflux and/or prolonged gastric alkalinization. The speed of post-prandial antral emptying was significantly correlated with the duration of the longest gastro-oesophageal reflux episode (r = +0.30, P < 0.03) and duodeno-gastric reflux episode (r = +0.80, P < 0.02). Best predictors for gastric alkalinization were the following indices of gallbladder function: large fasting volume (P = 0.03), large ejection volume (P = 0.009) and slower emptying (P = 0.032). Gallbladder and gastric motility were similar in patients with (n = 12) and without (n = 8) dyspeptic symptoms. Pathological gastro-oesophageal reflux was found in 83% of dyspeptic patients and in 25% of patients without dyspepsia (P < 0.01). When reflux was present, it was significantly less in asymptomatic than in dyspeptic patients [time at pH < 4, median (range): 6.4% (3.2-22.6%) vs. 47.8% (2.1-87%), P < 0.05]. This study shows that a subgroup of gallstone patients with small-mainly asymptomatic-stones have impaired gallbladder and gastric motility as well as abnormal gastro-oesophageal pH-profiles. These findings point to the existence of multiple functional defects of the upper gastrointestinal tract in gallstone disease.
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PMID:Impaired gallbladder and gastric motility and pathological gastro-oesophageal reflux in gallstone patients. 927 28

In the complex pathogenesis of genuine ulcer disease Helicobacter pylori (H. pylori) is an essential, although not on its own sufficient, causal factor. Eradication of the infection heals the active ulcer and, in the long term, leads to a drastic reduction in ulcer recurrence and attendant complications. Some patients remain symptomatic even without ulcer recurrence, and in these, pre-existing, exacerbated or induced gastro-oesophageal reflux disease is probably of some significance. Possible causes of ulcer relapse are reinfection, the use of ulcerogenic drugs and persistent gastric hypersecretion. In adults, and probably also in children from the age of six years, H. pylori reinfection is rare, provided that a sensitive and specific test for H. pylori is carried out at the earliest 4 weeks after concluding anti-bacterial treatment. The most common cause of the reappearance of H. pylori is recrudescence - true reinfection hardly ever occurs. The healing of H. pylori-associated ulcer disease improves the patient's quality of life and possibly also life expectancy. Computer-aided calculations, together with a randomized controlled study, have shown not only that individual patients benefit, but that also the health system profits financially. The hypothetical negative effects of H. pylori eradication treatment are still being controversially discussed.
Baillieres Best Pract Res Clin Gastroenterol 2000 Feb
PMID:Consequences of Helicobacter pylori cure in ulcer patients. 1074 94

The integrity of the oesophageal mucosa depends upon an equilibrium between aggressive factors, predominantly acid and pepsin, and protective mechanisms. Protective mechanisms operate within the oesophageal mucosa as pre-epithelial, epithelial and post-epithelial defences. Only the protective components of the oesophageal pre-epithelial defence can be tested in vivo in humans. It has been recently demonstrated that human oesophageal submucosal glands elaborate mucous secretion rich in bicarbonate and non-bicarbonate buffers, mucin, prostaglandin E(2), epidermal growth factor (EGF) and transforming growth factor alpha (TGFalpha). This oesophageal secretion, accompanied by similarly protective factors within the swallowed saliva, defines the protective potential of the oesophageal pre-epithelial defence that exists in the form of a mucus-buffer layer covering the oesophageal mucosa and which retards the back-diffusion of hydrogen ions. It has also been demonstrated that patients with severe erosive reflux oesophagitis exhibit qualitative impairment in both the salivary and oesophageal components of the oesophageal pre-epithelial defence. Furthermore, patients with endoscopically negative gastro-oesophageal reflux disease have a significantly stronger oesophageal pre-epithelial defence than patients with erosive reflux oesophagitis. On the other hand, African-Americans, who are less likely to develop erosive reflux oesophagitis, have a stronger oesophageal pre-epithelial defence than do Caucasians. The salivary component of the oesophageal pre-epithelial defence can be enhanced by mastication and the administration of cisapride, whereas oesophageal secretion can only be significantly augmented by cisapride.
Baillieres Best Pract Res Clin Gastroenterol 2000 Oct
PMID:Mechanisms of oesophageal mucosal defence. 1100 4

The role of duodenogastro-oesophageal reflux (DGOR), once erroneously termed 'bile reflux', in causing oesophageal mucosal damage has been an area of interest in both animal and human studies. However, due to the lack of appropriate techniques for accurately measuring DGOR, extrapolation of findings from animal studies to humans was difficult to make. The recent advent of the Bilitec system, an ambulatory bilirubin monitoring device, is increasing our knowledge of the specific role of DGOR in oesophageal diseases. Studies suggest that the DGOR without acid reflux may result in symptoms but unless acid reflux is present simultaneously, it does not cause oesophagitis. Therefore, our therapies should aim at reducing both DGOR and acid reflux. Studies show that this may be accomplished by anti-reflux surgery or the use of proton pump inhibitors, which, by reducing gastric volume, decrease the damaging potential of both acid and DGOR.
Baillieres Best Pract Res Clin Gastroenterol 2000 Oct
PMID:Duodenogastro-oesophageal reflux. 1100 5

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.
Baillieres Best Pract Res Clin Gastroenterol 2000 Oct
PMID:Helicobacter pylori infection and gastro-oesophageal reflux disease: coincidence or association? 1100 6

Gastro-oesophageal reflux disease (GORD) is a highly prevalent condition in Western countries; at least 20% of the population have weekly symptoms. The incidence appears to be rising in the West and in some developing countries. Heartburn, based on a carefully elicited history, is reasonably specific for identifying GORD if it is a predominant complaint. Symptoms, however, appear to correlate poorly with oesophagitis; hence, severe symptoms do not indicate there is greater oesophageal damage. Only one-third to one-half of patients with GORD undergoing endoscopy have oesophagitis. GORD is usually a chronic disease but one-third may lose their symptoms over time. An ill-defined subset of patients over time may progress to develop abnormal acid exposure or oesophagitis, or both, when none existed at baseline. GORD has a significant negative impact on quality of life to the same degree as other chronic medical conditions, but impairment in quality of life is independent of oesophagitis.
Baillieres Best Pract Res Clin Gastroenterol 2000 Oct
PMID:Epidemiology and natural history of reflux disease. 1100 7

There are numerous tests for which a diagnostic value in the context of gastro-oesophageal reflux disease has been claimed. Some of these tests (e.g. the acid perfusion test) have become obsolete after the advent of 24-hour oesophageal pH monitoring. With the latter test not only can excessive reflux be identified, but also, and more importantly, a temporal relationship can be demonstrated between a patient's symptoms and reflux episodes. Radiographical examination of the oesophagus has largely been replaced by endoscopy, although the use of the former test is still indicated in certain circumstances (e.g. in the differentiation of sliding from para-oesophageal hiatus hernia). In clinical practice, the so-called proton pump inhibitor test has gained considerable popularity. Despite several studies on the specificity and sensitivity of this test, its value has not yet been established with sufficient accuracy. Conventional manometric evaluation of lower oesophageal sphincter pressure has been over-emphasized as a diagnostic test in gastro-oesophageal reflux disease.
Baillieres Best Pract Res Clin Gastroenterol 2000 Oct
PMID:Diagnosis of reflux disease. 1100 8

Management of gastro-oesophageal reflux disease (GORD) patients must consider two issues: (i) how to optimize the treatment of a presenting symptom complex, and (ii) how to manage risk of adenocarcinoma associated with GORD. In most cases the need for, and potency of, pharmacological therapy used is decided by symptom assessment. Considering cost effectiveness, the three increments of pharmacological therapy are: (i) generic histamine(2)receptor antagonists, (ii) standard dose proton pump inhibitors, and (iii) higher dose proton pump inhibitors. Endoscopy is warranted if there is doubt regarding the diagnosis of GORD or if the patient relays alarm symptoms suggesting more ominous diagnoses (dysphagia, bleeding, weight loss, odynophagia). The other major indication for endoscopy is to screen for adenocarcinoma or Barrett's metaplasia in the patient with chronic symptoms. In most patients, the need for maintenance medical therapy is determined by the rapidity of symptom recurrence during a trial period off the medication.
Baillieres Best Pract Res Clin Gastroenterol 2000 Oct
PMID:Strategies for medical management of reflux disease. 1100 9

The introduction of laparoscopic anti-reflux surgery has led to a renewed interest in the operative treatment of gastro-oesophageal reflux disease (GORD). Three groups of patients can be identified who are particularly suited to laparoscopic anti-reflux surgery. Failure to respond to medical treatment has been historically the main determinant for those referred for anti-reflux surgery. With the availability of modern anti-secretory drugs most patients with chronic GORD can control their symptoms adequately by these means. Even effective medical therapy, however, is not without problems. In many patients rapid and consistent relapse of symptoms and oesophagitis occurs on cessation of therapy. Some of these patients do not want to be reliant on a form of medication that has yet to firmly establish its record for safety over many years of continued use. A second readily identifiable group of patients are those who are often described as 'volume refluxers'. They are bothered by persistent fluid regurgitation despite adequate control of their heartburn with acid suppressive drugs. Third there are those individuals who develop oesophageal strictures and those with Barrett's oesophagus and concomitant reflux symptoms and also those with respiratory complications associated with presumed aspiration of gastric juice into the pharynx and into the respiratory tree. The low morbidity associated with laparoscopic surgery that has been achieved in the best modern series means that the pendulum may swing back to surgery and therefore it is even more important that the right operation (fundoplication) is done for the right patient. Failure to create an adequate crural repair behind the wrap is associated with a risk of early post-operative para-oesophageal herniation and proximal wrap migration. The question of tailored anti-reflux surgery based on the pre-operative motor function of the body of the oesophagus is widely applied, although the scientific basis for these selective approaches is rather weak. Partial fundoplication seems to be associated with very low rates of dysphagia and of gas bloat. Assessment of the post-operative result should ideally be done by an independent observer and should consider not only traditional outcome measures but also the impact of surgery on the quality of the patient's life. Investigations on the cost effectiveness of these surgical therapeutic strategies suggest important benefits of surgery, which should be incorporated into the clinical decision process when assessing different long-term management alternatives for patients with chronic GORD.
Baillieres Best Pract Res Clin Gastroenterol 2000 Oct
PMID:Anti-reflux surgery in the laparoscopic era. 1100 10

There are significant controversies about the long-term therapy of reflux disease that arise primarily from a lack of data on the risks of the disease and its therapies over the relevant time scale of several decades. Currently, there are no appropriately structured direct comparisons between the two current major treatment options of tailored long-term acid suppression and laparoscopic anti-reflux surgery. Critical review of the available literature does not support the assertion that anti-reflux surgery has a superior risk/benefit profile when compared to long-term proton pump inhibitor (PPI) therapy, since non-controlled data indicate that although both therapies are relatively safe, morbidity and mortality rates are lowest with PPI therapy, whilst efficacy is comparable. The clinical significance of the reflux that continues to occur after both anti-reflux surgery and during PPI therapy is uncertain, but probably over-estimated. As pathological duodenogastro-oesophageal reflux affects only a small minority of reflux disease patients, issues arising from it should not be regarded as mainstream influences on the choice of long-term therapy. Notwithstanding, this type of reflux is substantially reduced by both PPI therapy and anti-reflux surgery. The choice between laparoscopic surgery and long-term tailored acid suppression should be determined primarily by assessment of operative risk, the quality of surgery available to the patient and by patient preference, after balanced explanation of the risks and benefits of each option. Given that the cost of PPI therapy is likely to drop substantially in the next few years, drug cost should not be a major pressure for the choice of anti-reflux surgery.
Baillieres Best Pract Res Clin Gastroenterol 2000 Oct
PMID:Controversies in long-term management of reflux disease. 1100 11


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