Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0017168 (gastroesophageal reflux disease)
 11,783 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Obesity, or the presence of a body mass index exceeding 30 kg/m2, has assumed epidemic proportions in the United States. More than a cosmetic issue, obesity is associated with many comorbidities that contribute to multiple organ dysfunction, illness, and shortened life span. This review covers new and emerging information on the relationship of obesity to common and debilitating hepatic and gastrointestinal disorders, including nonalcoholic steatohepatitis, gastroesophageal reflux, gallstones, and increased risk of colon cancer. Understanding the role of obesity in these disorders should lead to new insights into the pathogenesis of common liver and gastrointestinal diseases and to new treatment strategies for the practicing gastroenterologist.
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PMID:Obesity: effects on the liver and gastrointestinal system. 1058 86

Regardless of the type and dose of beverage involved, alcohol facilitates the development of gastroesophageal reflux disease by reducing the pressure of the lower esophageal sphincter and esophageal motility. Fermented and nondistilled alcoholic beverages increase gastrin levels and acid secretion. Succinic and maleic acid contained in certain alcoholic drinks also stimulate acid secretion. Low alcohol doses accelerate gastric emptying, whereas high doses delay emptying and slow bowel motility. Alcohol facilitates the development of superficial gastritis and chronic atrophic gastritis--though it has not been shown to cause peptic ulcer. Alcoholic beverages, fundamentally wine, have important bactericidal effects upon Helicobacter pylori and enteropathogenic bacteria. The main alcohol-related intestinal alterations are diarrhea and malabsorption, with recovery after restoring a normal diet. Alcohol facilitates the development of oropharyngeal, esophageal, gastric, and colon cancer. Initial research suggests that wine may be comparatively less carcinogenic.
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PMID:The effects of alcohol consumption upon the gastrointestinal tract. 1115 64

The literature for the proliferative effect of bile acids on the GI tract has been reviewed and three hypotheses developed regarding their carcinogenicity. Considered as a unit, the GI tract is protected from this carcinogenicity in different ways in the esophagus, stomach, small bowel and colon. Uncharged BAs can enter the esophageal epithelial cells by reflux of gastroduodenal juices in humans, and in animals by surgical alteration of the GI tract or by adding bile concentrate to the diets, and this can initiate GERD and eventually cancer. Acid suppressant therapy used to treat GERD patients, converts stomach pH to >4. This will remove the charges on conjugated bile acids allowing them entry into the epithelium thus casting doubt on the efficacy of acid suppression. From these observations, we postulate that (a) uncharged BA in daily contact with the esophagus can cause GERD and eventually cancer. This might explain the cancers obtained by Fein et al. (b) Clinical trials designed to test the effectiveness of acid suppressants will be meaningless since up to approximately 87% of these patients (in one study) have bile in their refluxate, and this, combined with acid suppressants, will initiate carcinogenesis. (c) Bile reaching a colon made sterile by antibiotics or other means, will not be deconjugated and so, with pKa's of 2 and 4, will be uncharged and therefore can easily enter the colonic cells where the pH is >6. This should be of some concern, especially on a high-fat diet when more bile enters the colon. A group of physicians noted that approximately 47% of patients with esophageal cancers also had some form of colon cancer and postulated that an etiological factor in the environment was responsible. Could this factor be bile? Reactions of certain bile salts with epithelial cells suggest a useful role for them in chemotherapy. Experiments to test hypotheses a, b and c are presented in the addendum.
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PMID:Three hypotheses linking bile to carcinogenesis in the gastrointestinal tract: certain bile salts have properties that may be used to complement chemotherapy. 1220 78

Obesity is the most prevalent and serious nutritional disease among western countries and is rapidly replacing undernutrition as the most common form of malnutrition in the world. Approximately 300,000 deaths a year are currently associated with overweight and obesity, second only to cigarette smoking as a leading cause of preventable death in the United States. Obesity effects 9 organ systems and is a risk factor for gastroesophageal reflux disease, nonalcoholic fatty liver disease, cholelithiasis, and colon cancer. Evidence-based guidelines on the identification, evaluation, and treatment of overweight and obesity have recently been developed by the National Institutes of Health to help practitioners effectively manage their patients. The body mass index is used to classify weight status and risk of disease. Treatment for obesity includes lifestyle management, consisting of diet therapy, physical activity, and behavioral modification, and may include pharmacotherapy or surgery based on level of risk. Currently only 2 medications, sibutramine and orlistat, are approved for long-term use. An initial weight loss of 10% of body weight achieved over 6 months is a recommended target. This article reviews the evaluation and management of the adult obese patient.
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PMID:Medical management of obesity. 1223 Mar 15

This article has identified several crucial decision points in the management of GERD. Although there seems to be a strong epidemiologic association with esophageal adenocarcinoma, the clinical and economic benefits of screening endoscopy are not clear. Given the low incidence of this cancer, it is conceivable that screening programs in these patients, such as colon cancer screening and breast cancer screening, may provide a greater health benefit at a lower incremental cost. Surveillance endoscopy in BE is another contentious issue, with the surveillance interval and cost-effectiveness hinging on the cancer risk. As more precise estimates of cancer risk, accounting for publication bias, are derived, the economics of surveillance will require further evaluation. Finally, several, management strategies seem to improve outcomes for patients with uninvestigated GERD, but the incremental costs of the more effective step-down approach seem minimal. More important than the initial strategy may be the ability to implement a systematic approach to care that ensures that patients attempt step-down when symptoms are resolved and do not remain on potent therapy indefinitely when it is not necessary. The results of prospective effectiveness trials are anticipated to validate the findings of these economic analyses.
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PMID:Decision making in gastroesophageal reflux disease. What are the critical issues? 1248 72

The present paper summarizes the various themes of research which have been developed in the department of medical gastroenterology since it was created in 1977. These include: in pancreatology, the study of chronic pancreatitis pathogenesis, acute pancreatitis pathogenesis and immunomodulation, endoscopic treatment of chronic pancreatitis, the development of new imaging techniques of the bile ducts and the pancreas, as well as the treatment of pancreatic cancer and benign or malignant biliary diseases. in hepatology, the immunomodulation of liver cirrhosis, especially alcoholic liver disease, the modulation of experimental acute and chronic hepatitis, the study of liver ischemia-reperfusion. Clinical hepatology has focused on liver transplantation, prognosis factors of chronic liver disease and treatment of portal hypertension and viral hepatitis. in gut diseases, the treatment of gastro-oesophageal reflux and its complications, the therapeutic endoscopy of the upper and lower GI and the prevention, as well as the treatment, of colon cancer, the pathogenesis and the immunopharmacology of inflammatory bowel diseases and the clinical enteral and parenteral nutrition.
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PMID:[The medical gastroenterology department]. 1258 14

In the digestive tract there is evidence for the presence of high levels of endocannabinoids (anandamide and 2-arachidonoylglycerol) and enzymes involved in the synthesis and metabolism of endocannabinoids. Immunohistochemical studies have shown the presence of CB1 receptors on myenteric and submucosal nerve plexuses along the alimentary tract. Pharmacological studies have shown that activation of CB1 receptors produces relaxation of the lower oesophageal sphincter, inhibition of gastric motility and acid secretion, as well as intestinal motility and secretion. In general, CB1-induced inhibition of intestinal motility and secretion is due to reduced acetylcholine release from enteric nerves. Conversely, endocannabinoids stimulate intestinal primary sensory neurons via the vanilloid VR1 receptor, resulting in enteritis and enhanced motility. The endogenous cannabinoid system has been found to be involved in the physiological control of colonic motility and in some pathophysiological states, including paralytic ileus, intestinal inflammation and cholera toxin-induced diarrhoea. Cannabinoids also possess antiemetic effects mediated by activation of central and peripheral CB1 receptors. Pharmacological modulation of the endogenous cannabinoid system could provide a new therapeutic target for the treatment of a number of gastrointestinal diseases, including nausea and vomiting, gastric ulcers, secretory diarrhoea, paralytic ileus, inflammatory bowel disease, colon cancer and gastro-oesophageal reflux conditions.
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PMID:Cannabinoids and the digestive tract. 1659 88

As knowledge of the human genome grows, there will be a direct impact on the management of specific diseases. Within gastroenterology and hepatology, there has been a change in the understanding of how variations or mutations in genes involved in drug metabolism or disease pathophysiology affect response to therapy. This review discusses the application of clinical pharmacogenetics to the following diseases and disorders: inflammatory bowel disease, Helicobacter pylori infections, gastroesophageal reflux disease, irritable bowel syndrome, functional dyspepsia, liver transplantation and colon cancer. Although only a few genotyping tests are regularly used in clinical practice, it is anticipated that studies will propel the routine use of many of the tests described in this review, in the future.
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PMID:Clinical application of pharmacogenetics in gastrointestinal diseases. 1702 Apr 13

Obesity, or the presence of a body mass index exceeding 30 kg/m, has assumed epidemic proportions in the United States. More than a cosmetic issue, obesity is associated with many comorbidities that contribute to multiple organ dysfunction, illness, and shortened life span. This review covers new and emerging information on the relationship of obesity to common and debilitating hepatic and gastrointestinal disorders, including nonalcoholic steatohepatitis, gastroesophageal reflux, gallstones, and increased risk of colon cancer. Understanding the role of obesity in these disorders should lead to new insights into the pathogenesis of common liver and gastrointestinal diseases and to new treatment strategies for the practicing gastroenterologist.
 ...
PMID:Obesity: effects on the liver and gastrointestinal system. 1702 37

Capsule endoscopy is a new technology that was recently introduced into clinical practice for the diagnosis of gastrointestinal diseases. As of today, three different capsule types have been produced, designed for the exploration of the small bowel (PillCam SB), the esophagus (PillCam ESO) and the colon (PillCam Colon). The PillCam SB has gained widespread acceptance as a powerful tool for the diagnosis of bleeding from the small bowel as well as for other indications. The PillCam ESO has been used to study patients with gastroesophageal reflux disease, for the screening of Barrett's esophagus, and for the screening and surveillance of esophageal varices in patients with cirrhosis. The results of the pilot studies carried out with this capsule have been encouraging. Large-scale studies are ongoing. The evaluation of the potential of the PillCam Colon capsule is still in its infancy: the two pilot studies published showed that this capsule can produce high-quality images of the colon. The potential of this capsule for clinical purposes, such as colon cancer screening, needs to be evaluated.
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PMID:Capsule endoscopy--state of the art. 1782 50


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