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

Gastroesophageal reflux disease (GERD) refers to symptoms or tissue damage that result from gastroesophageal reflux. Reflux esophagitis is a subset of GERD and implies the presence of esophageal inflammation, ie, esophageal erosions that are visible endoscopically, or nonerosive inflammation that can be documented by biopsies. Heartburn is the most common and specific symptom of GERD. In some patients, chest pain or respiratory symptoms may be the only presenting signs. In patients aged < 50 years with uncomplicated GERD, empiric therapy (typically with antacids or an H2-receptor antagonist) is appropriate. For older patients, those with complications, and those whose symptoms do not respond to empiric therapy, endoscopic evaluation is indicated. Many patients will improve with standard twice-daily dosing of an H2-receptor antagonist. However, GERD is generally more resistant to antisecretory pharmacologic therapy than is peptic ulcer disease. Those patients who fail to respond to standard dosing of an H2-receptor antagonist may get relief from high-dose H2-receptor antagonists or omeprazole therapy.
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PMID:Gastroesophageal reflux disease in adults: pathophysiology, diagnosis, and management. 145 52

Reflux esophagitis differs from peptic ulcer disease in many respects. Whereas nighttime acid inhibition alone achieves healing in approximately 80 to 90% of patients with peptic ulcer, more profound acid inhibition seems to be necessary in those with GERD. Conventional dosing with H2-receptor antagonists has been successful in only about 50% of the patients with reflux esophagitis. Strong, prolonged 24-hour inhibition of gastric acid secretion is probably the most important factor in the treatment of reflux esophagitis. Omeprazole, a substituted benzimidazole, produces effective 24-hour inhibition on gastric acid secretion. In doses ranging from 20-60 mg once daily, omeprazole has proved to be effective in the short-term treatment of reflux esophagitis, even in patients resistant to treatment with H2-receptor antagonists. Healing of severe, resistant reflux esophagitis therefore is no longer a clinical problem. Reflux esophagitis is a chronic, relapsing condition that cannot be compared to peptic ulcer disease in all aspects. In particular, long-term therapy must be more aggressive than the standard minimum maintenance dose used in peptic ulcer. Not only for healing, but also for prevention of recurrences, strong, prolonged inhibition of acid secretion must be provided. Experience of more than 5 years of continuous treatment with omeprazole, in doses adjusted to prevent recurrences, has demonstrated the high efficacy of this agent in the long-term management of reflux patients. Omeprazole provided the long-standing, strong acid inhibition that is so important in treating this condition. Long-term treatment with omeprazole in patients with resistant reflux disease did induce an initial rise of serum gastrin levels, two to four times the pre-entry value.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The role of omeprazole in healing and prevention of reflux disease. 157 92

We present our experience with ten cases of laparoscopic Nissen's fundoplication. Reflux esophagitis is a very common disease and is associated with a lack of response to medical treatment in a significant number of cases, yet the rate of referral to a surgeon is extremely low. We believe that the endoscopic treatment of this disease is much less invasive and more cost-effective and is associated with lower rates of complications. Indeed, our patients left the hospital at 24-48 h post-surgery and were involved in their regular activities at 4 days to 1 week thereafter. Neither mortality nor complications associated with the procedure were encountered. We believe that the feasibility and the benefits of this procedure will lead to earlier referral and hence to avoidance of long-term complications of gastroesophageal reflux disease.
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PMID:Laparoscopic Nissen's fundoplication: preliminary report on ten cases. 183 73

Between 1967 and 1989, 60 patients underwent pneumatic dilation of the cardia at our institution. Of these, 33 had not undergone any previous treatment (group 1), whereas 27 presented with recurrent dysphagia after a failure of surgical treatment (group 2). In this series there was no procedure-related mortality and a perforation occurred only in 1 patient who was treated conservatively. The mean follow-up was similar in both groups (44 and 49 months, respectively). The results of pneumatic dilation were either excellent or good in 61% of group 1 patients, and in 76% of group 2 patients. Reflux oesophagitis requiring medical therapy occurred in 1 group 2 patient. We conclude that pneumatic dilation is a safe and relatively effective procedure in patients with achalasia. Patients with a failed Heller myotomy seem to respond better than patients without previous surgery. However, the risk of gastro-oesophageal reflux after pneumatic dilation should not be underestimated.
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PMID:Early and long-term results of pneumatic dilation in the treatment of oesophageal achalasia. 187 77

Fifty two patients with abnormal acid gastro-oesophageal reflux were studied by simultaneous oesophageal pH monitoring and continuous aspiration for 16 hours. Aspirates (from discrete two hour periods) were analysed for volume, pH, bile acids (conjugated and unconjugated), trypsin, and pepsin. The results were compared with pH changes and degree of oesophagitis. Patients with oesophagitis had greater acid reflux than those without, but patients with stricture and Barrett's oesophagus had similar acid reflux to those with uncomplicated erosive oesophagitis. Pepsin concentrations were highest in patients with stricture and Barrett's oesophagus particularly during nocturnal periods. Conjugated bile acids were detected in 75% of patients, mainly during the night, but only 2% of aspirates contained concentrations likely to be cytotoxic. Unconjugated bile acids were not detected, and trypsin was seldom found. Reflux oesophagitis is caused by acid and pepsin. Bile acids and trypsin are probably unimportant.
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PMID:Composition of gastro-oesophageal refluxate. 195 60

Gastroesophageal reflux disease is a very common condition that is usually manifested by heartburn or regurgitation. Reflux esophagitis, caused by mucosal exposure to the backflow of caustic gastric contents, is primarily a result of lower esophageal sphincter dysfunction. Diagnostic workup varies but commonly includes esophagoscopy, 24-hour esophageal pH monitoring, and radiography of the upper gastrointestinal tract. Treatment, which progresses from simple life-style changes and antacids to histamine2 receptor antagonists to omeprazole (Prilosec) or surgery, is tailored to individual needs and is generally successful.
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PMID:Gastroesophageal reflux disease. When antacids aren't enough. 203 Oct 30

Gastroesophageal reflux is a daily occurrence in the general population. Reflux esophagitis is less common but still a considerable clinical problem. The results of medical therapy are generally clearly inferior to those seen in peptic ulcer disease. After healing relapse is rapid and maintenance has not been proved superior to placebo. The promising results with omeprazole (inducing pronounced acid inhibition) and surgery (strengthening anti-reflux mechanisms) indicate that a more aggressive approach may be needed in future treatment. Additional studies also using combinations of drugs both in the healing stage and during maintenance is needed. These should be compared to the long-term results of surgery.
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PMID:Healing, relapse rates and prophylaxis of reflux esophagitis. 256 16

'Gastro-esophageal reflux' is the passage of gastric content into the esophagus. Resulting typical symptoms are denoted as 'reflux like dyspepsia'. 'Reflux esophagitis' is the endoscopic or microscopic evidence of damage to the esophageal mucosa. Long-term intraesophageal pH-monitoring will establish 'pathologic gastroesophageal reflux' when 'acid exposure' time exceeds 5% of the monitoring time. GERD, 'gastro-esophageal reflux disease', is present when symptoms and/or esophagitis are caused by reflux. 'Columnar lined esophagus' is a better expression than 'Barret's esophagus'. Esophageal acid exposure increases during the day with a peak in the evening and little reflux after midnight. Treatment should probably be concentrated to evening time and not so much to night time.
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PMID:Gastro-esophageal reflux disease. 324 93

The columnar lined (Barrett's) esophagus is an acquired condition resulting from chronic gastroesophageal reflux. The clinical spectrum of 50 consecutive cases of endoscopically consistent, histologically proven Barrett's esophagus was reviewed. The mean age of patients was 65.9 +/- 12.4 (SD) years with only four patients younger than 50 years. The predominant presenting symptoms were dysphagia, heartburn, and regurgitation. At endoscopy, the columnar lined segment extended over 6.5 +/- 3.0 cm of the lower esophagus. Specialised columnar (intestinal) epithelium was the most frequent histological type identified. Radiologic or endoscopic evidence of a hiatal hernia was present in the majority. Complications were present at endoscopy in 38 (76%) patients. Reflux esophagitis (56%) was present at the area of the squamo-columnar junction. Stricture formation (38%) and ulceration (36%) were located either at the squamo-columnar junction or more distally within the columnar epithelium. Two patients (4%) had adenocarcinoma arising in a segment of Barrett's esophagus at presentation. Treatment included physical measures, dilatation, and cimetidine. Bougienage in 20 patients was successful in alleviating dysphagia but multiple treatment sessions were often necessary. Although esophagitis readily resolved with cimetidine therapy, ulceration was generally resistant to medical therapy. Indeed, by two months, healing was achieved in only five of 12 patients. Endoscopic surveillance of 12 patients who received cimetidine (1 g/day) for at least 12 months showed no regression of the metaplastic mucosa.
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PMID:Barrett's esophagus: clinical, endoscopic, and histologic spectrum in fifty patients. 346 72

The study comprises 31 patients with gastro-oesophageal reflux disease who received 8 weeks' treatment with ranitidine. Sixteen of the patients received in addition maintenance treatment with ranitidine (150 mg twice daily) for another 6 months, and fundoplication was performed on 15 patients. There was a significant improvement in endoscopic and histologic findings, a decrease in gastric acid secretion, and a reduction of symptoms during short-term treatment with ranitidine. No further improvement was seen in any of the factors after half a year of ranitidine. After surgery the total reflux time during 24 h decreased to practically zero, all patients had normal endoscopic findings and negative acid perfusion tests, and reflux symptoms had disappeared completely. Anti-reflux surgery was superior to treatment with ranitidine. Reflux oesophagitis is therefore not improved any further by a half year's treatment with ranitidine beyond what is achieved with short-term therapy.
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PMID:Maintenance treatment with ranitidine compared with fundoplication in gastro-oesophageal reflux disease. 353 5


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