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

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

The purpose of this study was to investigate the rate of gastric emptying of a liquid meal in young children with symptomatic gastroesophageal reflux of varying intensity. Twenty-three infants (mean age 7.0 +/- 1.4 [SEM] months, range 2 to 14 months) were evaluated for reflux by esophageal manometry, a five-hour pH probe study, and barium swallow. The rate of gastric emptying was determined by using a liquid meal of 4 ounces of cow milk formula labeled with 99mTc sulfur colloid. In seven infants with failure to thrive and objective criteria for severe reflux, the mean gastric emptying was 21.3 +/- 6.4% at one hour. In six infants with reflux and recurrent pulmonary disease, the mean gastric emptying was 19.8 +/- 5.4%. Ten infants with mild reflux, adequate weight gain, and no pulmonary symptoms emptied 44.3 +/- 6.0% of formula at one hour, and six normal adults (mean age 28.3 +/- 2 years) emptied 56.2 +/- 6.5% of formula at one hour. These data suggest that infants with severe GER have significantly delayed gastric emptying, that gastric retention may contribute to the FTT and pulmonary symptoms in these infants, and that abnormal motor function of the gastric fundus may be a significant factor in the pathogenesis of gastroesophageal reflux of infancy.
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PMID:Delayed gastric emptying in infants with gastroesophageal reflux. 689 2

This study evaluated the effect of the 270 degrees Belsey Mark IV fundoplication on 24 hour ambulatory pH metry variables. Thirty seven patients with confirmed gastro-oesophageal reflux disease who had a Belsey Mark IV antireflux procedure were evaluated preoperatively and three to six months postoperatively including endoscopy, lower oesophageal sphincter manometry, and 24 hour ambulatory pH metry. In 30 of 37 patients the Belsey Mark IV fundoplication was judged successful based on symptom relief and healing of oesophagitis. In these 30 patients percentage reflux for total, upright, and supine time (median and range) decreased significantly (p < 0.001) from 10.0% (2.7-35.3%), 10.8% (3.2-39.9%), and 6.7 (0.0-33.0%) respectively to 0.5% (0.0-7.4%), 0.6% (0.0-13.7%), and 0.1% (0.0-4.9%) after operation. This decrease in reflux time resulted predominantly from a significant (p < 0.001) reduction in the number of reflux episodes from 98 (23-231) to 14 (0-82) postoperatively. Normalisation of total reflux time (upper limit of normal for time with pH below 4:4%) was found in 89% and normalisation of total and upright and supine reflux in 64% of successfully operated patients with confirmed abnormal acid reflux before operation. A successful antireflux procedure was associated with significant (p < 0.001) increases in lower oesophageal sphincter pressure from 7.8 (0.6) mm Hg to 14.5 (0.7) mm Hg mean (SEM). In seven patients with a failed antireflux operation basal lower oesophageal sphincter pressure did not change significant;y (preoperative value 5.7 (1.3) mm Hg; postoperative value 7.8 (0.8) mm Hg). In these patients reflux time did not decrease after the operation and remained in the abnormal range in all patients. It is concluded that a successful, in contrast with a failed, Belsey Mark IV fundoplication is associated with significant decreases in total, upright, and supine reflux time. Normalisation of pH metry variables is not a prerequisite for successful antireflux surgery. A surgery. A successful 270 degree Belsey Mark IV fundoplication was associated with a significant increase in basal lower oesophageal sphincter pressure, in contrast with the failure group. Restoration of a sufficient lower oesophageal sphincter barrier is an important aim in antireflux surgery.
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PMID:Prospective evaluation of 24 hour ambulatory pH metry in Belsey Mark IV antireflux surgery. 782 67

The relation between symptom severity in gastro-oesophageal reflux disease (GORD) and quantitated oesophageal acid reflux is variable. Furthermore, when oesophageal acid exposure lies within the conventional normal range, the cause of the symptoms is unknown. This prospective study evaluated 24 hour ambulatory oesophageal pH profiles in relation to objective symptom scores in 100 dyspeptic patients who were free from ulcer and gall stones. Twenty patients had raised oesophageal acid exposure and reflux symptoms consistent with GORD, and 80 had oesophageal pH profiles within the conventional normal range. Forty four of the 80 had severe or moderate reflux symptoms and were classified as having reflux like functional dyspepsia (RFD); 36 had minimal or absent reflux symptoms, and were categorised as having non-reflux dyspepsia (NFD). While oesophageal pH profiles lay within the conventional normal range in both functional dyspepsia subgroups, patients with RFD had consistently greater acid exposure values as follows: mean (SEM) total oesophageal acid exposure time, RFD 16.2 (2.56) min v NFD 9.05 (2.0) min (p < 0.03); percentage of time with pH < 4, RFD 1.4 (0.2) v NFD 0.8 (0.2) (p < 0.03); DeMeester scores, RFD 12.8 (0.5) v NFD 11.4 (0.4) (p < 0.03). The RFD group had a pain/reflux event correlation of 23.8 (5.3)% v 8.1 (3.7)% for the NFD group (p < 0.01). This study shows that patients with RFD have oesophageal acid exposure that lies below the diagnostic threshold for GORD, but exceeds that of patients with NFD. The high pain/reflux event correlation in RFD, suggests that subthreshold oesophageal acid exposure may be associated with troublesome reflux symptoms.
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PMID:Importance of reflux symptoms in functional dyspepsia. 788 15

Gastric acid suppression could improve heartburn by healing oesophagitis or by reduction of oesophageal sensitivity to acid. To independently assess changes in oesophageal sensitivity, it would be necessary to study patients with reflux disease but no oesophagitis. The aim of this study was to investigate the effect of acid suppression on oesophageal sensitivity and to assess the time course of any measured effect. Twenty seven patients were recruited, of whom 25 completed the study (14 men and 11 women, mean (SD) age 50 (15) years). All had classic symptoms of gastro-oesophageal reflux but normal results of upper gastrointestinal endoscopy and oesophageal mucosal histological tests. Each had abnormal 24 hour pH studies and a positive acid perfusion tests. Subjects were assigned double blind to placebo (n = 11) or famotidine 40 mg twice daily (n = 14) for four weeks. Acid perfusion tests were carried out at 0, 4, 5, and 8 weeks and time to heartburn recorded. Time to heartburn (mean (SEM)) was 124 (78) seconds in the famotidine and 187 (154) in the placebo group at week 0 (NS). Compared with baseline, significant increases in time to heartburn was found with famotidine at weeks 4 (383 (102), p < 0.01) and 5 (344 (92), p < 0.01) but not week 8 (336 (90) seconds). No significant effects were found with placebo (219 (41), 146 (23), and 144 (25) seconds for weeks 4, 5, and 8). Heartburn symptom score decreased significantly with famotidine (mean scores 3.6, 1.9, 2.1, and 2.6 at weeks 0, 4, 5, and 8 (p=0.001)) and showed a significant negative correlation with time to heartburn (r(s)=-0.60; p<0.0001). It is concluded that oesophageal sensitivity to acid is reduced by famotidine independent of and effect on oesophagitis; the effect wanes one to four weeks after the end of treatment and correlates with change in heartburn score.
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PMID:Effect of famotidine on oesophageal sensitivity in gastro-oesophageal reflux disease. 817 79

In children, excess of gastroesophageal reflux causes lesions of the esophageal mucosa that we have studied by scanning and transmission electron microscopy (SEM and TEM respectively) in 27 grasp biopsies prelevated during endoscopic procedures. Ultrastructural lesions can be graded on the basis of their severity. In grade I, epithelial cells are well preserved in the deepest layers whereas the superficial cells display ultrastructural alterations such as irregular microridges or reduced intercellular junctions. In grade II, the surface is composed of extruding cells and in the intermediate layer, large intercellular spaces containing lympho-monocytic cells are visible. In grade III, the mucosal surface is characterized by crater-like erosions, degenerating cells are visible in all the layers; in two patients columnar epithelium-lined areas (Barrett's esophagus) have been identified. Our results suggest that in patients with reflux esophagitis, ultrastructural examination of grasp biopsies prelevated by pediatric endoscopes allows a grading of the anatomical lesions providing data that can not be obtained by conventional histology.
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PMID:Reflux esophagitis in children: a scanning and transmission electron microscopy study. 826 7

Motilin induces phase III activity of the gastrointestinal tract. Erythromycin has a motilin-like effect on the stomach and significantly increases the lower esophageal sphincter (LES) pressure in normal volunteers. This investigation was performed to evaluate the effects of erythromycin on esophageal function in patients with gastroesophageal reflux disease (GERD). Esophageal manometry was performed in 10 GERD patients before and after intravenous infusion of 500 mg of erythromycin. Values are expressed as mean +/- SEM. LES pressure increased from 13.9 +/- 2.9 mm Hg at baseline to 28.9 +/- 3.6 mm Hg after infusion of erythromycin (p < 0.01). The duration of contractions in the proximal, middle, and distal esophagus was significantly prolonged from 3.5 +/- 0.4 seconds, 3.8 +/- 0.4 seconds, and 4.1 +/- 0.5 seconds to 4.2 +/- 0.2 seconds, 4.6 +/- 0.5 seconds, and 5.6 +/- 0.6 seconds, respectively, after infusion of erythromycin (p < 0.05 for each comparison). Erythromycin did not effect esophageal body contraction amplitude or velocity, or the upper esophageal sphincter. Serum motilin decreased slightly after the administration of erythromycin. We concluded the following: (1) Erythromycin profoundly stimulates the defective LES in patients with GERD. This appears to be a direct motilin agonist-like effect rather than being mediated by release of endogenous motilin. (2) Erythromycin has less effect on the esophageal body, although it does prolong the duration of esophageal contractions.
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PMID:Erythromycin strengthens the defective lower esophageal sphincter in patients with gastroesophageal reflux disease. 831 Nov 29

Impaired oesophageal peristalsis may play a major pathogenetic role in gastro-oesophageal reflux disease (GORD). Therefore 55 patients with suspected GORD were studied simultaneously by ambulatory 24-hour pH and pressure monitoring with three pressure transducers (3, 8 and 13 cm above the lower oesophageal sphincter) in order to to test for a relationship between oesophageal motility and GOR. Twenty-one patients (38%) had pathological reflux; these patients had significantly more simultaneous contractions than patients without pathological GOR (30.1 +/- 3.3% vs. 19.0 +/- 1.8%, P = 0.002, mean +/- SEM). Further analysis revealed a significant difference between groups in the occurrence of simultaneous contractions in the mid-oesophagus (33.7 +/- 3.8% vs. 23.9 +/- 1.8%, P = 0.012), but not in the distal oesophagus (34.4 +/- 2.7% vs. 33.9 +/- 3.1%, P = 0.90). In addition, a moderate but highly significant correlation between the rate of simultaneous contractions and reflux time was found (r = 0.463, P = 0.0005). Mean amplitude and mean duration of the contractions were no different between groups, neither in the proximal (43.4 +/- 3.3 mmHg vs. 44.9 +/- 1.9 mmHg, P = 0.68 and 2.4 +/- 0.2s vs. 2.5 +/- 0.1s, P = 0.50, respectively) nor in the distal oesophagus (48.8 +/- 4.6 mmHg vs. 54.2 +/- 3.4 mmHg, P = 0.34 and 3.0 +/- 0.2s vs. 2.9 +/- 0.2s, P = 0.71, respectively). It was concluded that pathological GOR is associated with an increased occurrence of simultaneous contractions in the mid, but not in the distal, oesophagus.
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PMID:24-hour oesophageal motility in gastro-oesophageal reflux disease (GORD): increased occurrence of simultaneous contractions. 872 17

Gastro-oesophageal reflux is common in preterm infants, but the role of gastric emptying as a causal factor has not been studied before. Gastric emptying was therefore measured in 19 healthy preterm infants (median gestational age 32 weeks) while concurrently measuring 24 hour lower oesophageal pH, using an antimony pH electrode, positioned manometrically. Real time ultrasonic images of the gastric antrum were obtained, and measurements of antral cross-sectional area (ACSA) were made immediately before a nasogastric feed and then during subsequent gastric emptying until ACSA returned to its pre-feed value. Half emptying time (50% delta ACSA) was calculated as the time taken for the ACSA to fall to half the maximal postprandial increment. Mean (SEM) reflux index for the group was 11.9 (2.0)%; number of reflux episodes per 24 hours: 15.4 (1.7); and number of reflux episodes longer than five minutes 5.5 (0.8). Average half emptying times for an individual infant were: median (range) 46 (18-105) minutes. There was no association between gastric emptying rates and any of the indices of gastro-oesophageal reflux, either during the entire 24 hour period for which the lower oesophageal pH was recorded, or in the postprandial periods after the feeds which were studied ultrasonically. Gastro-oesophageal reflux was also unrelated to feed volume and feed type. Asymptomatic gastro-oesophageal reflux is common in preterm infants, but gastric emptying time is not a determinant of it. Inappropriate relaxation of the lower oesophageal sphincter or abnormal oesophageal motility offer more plausible explanations.
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PMID:Gastric emptying and gastro-oesophageal reflux in preterm infants. 894 95

Saliva, with a neutral pH, mucous content and inhibitory factors of the stomach acid secretion, can be considered a protecting element of the esophageal mucosa in the gastroesophageal reflux. 39 Wistar rats 175-225 g were used divided in seven groups: "C" control, "E-A" esophago-gastrostomy. "E-M" esophago-myectomy, "S-C" only sialoadenectomy, "S-EA" sialoadenectomy plus esophagogastrostomy, "S-EM" sialoadenectomy plus esophago-myectomy. 15 days later the rats were sacrificed, the esophagus was taken out for its histological examination and blood samples were drawn. The comparison between the control and treated groups, showed a significant deterioration of the EA, SEA and SEM groups regarding the final weight, and the SC group in the white series and ions. Many of the animals with esophagus operations showed vomit signs and general affectation. None of the groups showed esophageal lesions in the histology, from which it can be deduced that, in the rat, a 90% saliva absence doesn't produce negative effects on the esophageal mucosa either in acid presence or not.
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PMID:[Saliva in experimental gastroesophageal reflux]. 966 66


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