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

The contractile activity of the oesophageal body and of the upper and lower oesophageal sphincter (LOS) can reliably be portrayed by means of low compliance recording systems, either pneumohydraulic or with strain gauge force transducers, and at least two pressure sensors. LOS resting pressure can be assessed by both station and rapid pull-through techniques, or by the sleeve method. States of disordered LOS function, such as achalasia, can be diagnosed dependably only by manometric means. Manometry is of high diagnostic yield for motor disorders of the oesophageal body as well, although generally accepted diagnostic criteria are still lacking. In patients with angina-like chest pain, provocation tests can prove that oesophageal contraction abnormalities cause the symptoms. Edrophonium has been shown to be the most effective and best tolerated provocative agent. Transport of swallowed material through the oesophagus can reliably be recorded by radionuclide transit studies. Such studies are valuable in identifying patients with absent or impaired peristalsis and in evaluating treatment effects, e. g., the effects of mechanic dilatation in achalasia. Gastrooesophageal reflux should be recorded not only qualitatively but also quantitatively, although a definition of what is pathological and what is not has not been generally agreed upon. Recording of oesophageal intraluminal pH over longer periods of time, preferably 24 h, may have the best diagnostic yield. The advent of computer-aided analysis techniques will replace the cumbersome handscoring of motor and pH tracings and, hopefully, contribute to a better understanding and classification of oesophageal pathophysiology.
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PMID:[Methods for measuring the motor activity of the esophagus and gastroesophageal reflux]. 377 64

Several diseases of the gastrointestinal tract can cause angina-like chest pain. Differential diagnosis can be extremely difficult, especially when pathological gastroesophageal reflux is present. We present 10 cases, 2 males and 8 females, in which invasive and non invasive cardiological techniques were unable to indicate a clear diagnosis. We have therefore used a new technique which combines dynamic electrocardiography with 24 hours monitoring of esophageal pH, to correlate pain symptom with electrocardiographic changes and/or gastroesophageal reflux. Using this approach we have diagnosed the presence of isolated pathological gastroesophageal reflux in 3 patients, isolated ischemic heart disease in 2 cases, both conditions in 3 patients and no signs of either condition in the remaining 2 cases. We think that this technique is of special value in subjects suffering from both conditions (ischemic heart disease and gastroesophageal reflux). It provides objective documentation of the role of each disease in the genesis of pain which is essential in developing appropriate therapy.
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PMID:[Usefulness of the combination of the dynamic electrocardiogram with esophageal pH measurement in the differential diagnosis of chest pain]. 653 94

Regurgitation of the gastric contents into the esophagus is common and often unnoticed. When symptoms such as heartburn, a sour or bitter taste in the mouth, or even chest pain mimicking angina pectoris or myocardial ischemia prompt a patient to seek help, the factor or factors responsible for reflux must be sought. The possible underlying causes are numerous, as Dr Bachman points out in this discussion of the pathophysiology, diagnosis, and treatment of gastroesophageal reflux. The desired end point of management was well stated by Seneca over 2,000 years ago as "a good-humored stomach."
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PMID:Gastroesophageal reflux. Simple measures often suffice. 663 18

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

Ten per cent of patients with angina pectoris have normal coronary arteries and cardiac function and, despite this reassurance, continue to have chest pain. Since pain of cardiac or esophageal origin is clinically difficult to differentiate, 50 patients with severe chest pain, normal cardiac function, and normal coronary arteriography with ergotamine provocation were evaluated with a symptomatic questionnaire and esophageal function test. On 24-hour esophageal pH monitoring, 23 patients had abnormal reflux, and 27 were normal. There was no difference in the incidence and severity of chest pain, esophageal symptoms, or medication taken between refluxers and nonrefluxers. Ten refluxers and ten nonrefluxers had chest pain on exercise electrocardiography. Thirteen refluxers documented chest pain during the pH monitoring period, and in 12 it coincided with a reflux episode. Fifteen nonrefluxers documented chest pain during the monitoring period, and in only one did it coincide with a reflux episode. Of the 23 refluxers, 12 were treated with medical therapy and 11 by a surgical antireflux procedure, and all followed for two to three years. Ten (91%) of the 11 surgically treated patients are totally free of chest pain compared with five (42%) of the 12 medically treated patients. All 12 patients who had chest pain coincide with a documented reflux episode responded positively to antireflux therapy, eight surgical and four medical. It is concluded that 46% of patients complaining of angina pectoris with normal cardiac function and coronary arteriography have gastroesophageal reflux as a possible etiology. Seventy-three per cent of these patients have total abolition of chest pain by either surgical or medical antireflux therapy. Patients whose experience of chest pain coincided with a documented reflux episode on 24-hour esophageal pH monitoring had a 100% response to medical or surgical therapy. Overall, surgical therapy gave better results (91%) but was associated with an 18% temporary morbidity. Objective evaluation of reflux status and its correlation to the symptom of chest pain by 24-hour pH monitoring allows for selective therapy in these difficult to manage patients.
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PMID:Esophageal function in patients with angina-type chest pain and normal coronary angiograms. 712 35

Angina-like chest pain frequently arises from the esophagus. However, when a patient has chest pain, the gravity of possible myocardial ischemia indicates that a cardiac workup must be done. Those individuals with typical anginal pain who have normal multistage exercise tests or normal coronary arteriograms and any person with atypical chest pain should be thoroughly evaluated for esophageal disease. This evaluation should include a barium swallow, a Bernstein test, esophageal manometry, and, if indicated, esophagoscopy. Reproduction of the chest pain with the Bernstein test incriminates gastroesophageal reflux disease. Esophageal manometry is required to make the diagnoses of achalasis, DES, and hypertensive LES or esophageal body (Table 1).
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PMID:Chest pain: differentiating esophageal disease from angina pectoris. 716 Jan 64

To assess the frequency of esophageal disease in patients with angina-like chest pain and normal coronary arteriograms, 16 patients underwent esophageal manometric studies, acid perfusion (Bernstein) tests, upper gastrointestinal series and cholecystograms. Five patients had evidence of esophageal diseases. Three of the five had manometric criteria of increased nonperistalsis; one patient had idiopathic diffuse esophageal spasm while the other two patients had acid infusion tests which reproduced the presenting chest pain and the manometric findings were regarded as a motor disturbance of the esophagus secondary to chronic gastroesophageal reflux. The remaining two patients had symptomatic gastroesophageal reflux--one with an acid infusion test positive for pressure like chest pain and the other with a decreased resting lower esophageal sphincter pressure associated with reflux of barium on upper gastrointestinal series. All five patients had improvement of symptoms during a follow up period of seven to 17 months. Manometric studies in 18 normal subjects of similar age revealed no evidence of esophageal disease. Since esophageal disorders capable of causing chest pain were diagnosed in one-third of the patients (5/16 or 31%), it is suggested that investigations for esophageal disease, specifically directed at gastroesophageal reflux-induced abnormalities and idiopathic diffuse esophageal spasm, be included in the evaluation of patients with angina-like chest pain of uncertain origin.
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PMID:Esophageal disease in patients with angina-like chest pain. 723 36

Noncardiac chest pain is a common but important clinical challenge with respect to diagnostic strategy as well as therapeutic intervention. The most common esophageal disorder associated with chest pain syndrome is gastroesophageal reflux; 24-hour ambulatory monitoring of esophageal pH and the determination of the symptom index are useful in patient evaluation. A high frequency of abnormal esophageal motility has been reported in noncardiac chest pain, but its clinical significance remains controversial. Patients with chest pain and normal coronary angiogram may have microvascular angina. Musculoskeletal conditions account for at least 10% of the cases of noncardiac chest pain. The potential effects of stress and altered psychological states in this phenomenon must be considered. The role of panic attacks in the production of pain needs to be clarified. Investigations to elucidate the exact cause of chest pain as well as its treatment should be individualized to the patient.
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PMID:Pathophysiology and management of noncardiac chest pain. 760 35

Chronic Esophageal reflux induces reflux esophagitis, which is a common finding in gastroenterological practice. Reflux esophagitis produce symptoms like pirosis, regurgitation and in some cases respiratory complains resembling asthma or angina-like chest pain. The pathophysiology of this disease is based on a multifactorial origin, which usually results in the chronic evolution of the disease. In recent years, there have appeared new evidences pointing out to alterations in the relaxing mechanisms of the lower esophageal sphincter; however, some patients having reflux esophagitis show normal shincteric pressure. The sweep action of esophageal smooth muscle is a key point for sending back to stomach the eventually refluxed material; it has been demonstrated that this sweeping action is impaired in many patients having reflux esophagitis. Incompetence of lower esophageal sphincter seems to be related a local to neural alteration rather than to smooth muscle functional disturbance. Recent findings stablis a link between local nitric oxide release and relaxation of the lower esophageal sphincter. Esophageal mucosaldisplay an intrinsic resistance to HCL, pepsin, bilis and enzymes deleterious action by a blockade of back-defusion of hydrogen ions contained in the refluxed material. Nevertheless, some other luminal and non-luminal factors are involved in this mucosalprotection. When these intrinsic resistance factors are abated, tisular lesions like ersion, ulcer and Barret's mucosal changes can occur; is of particular interest because its potential malignant evolution. Esophageal reflux usually resolves with medical treatmen, but in some particular cases surgical correction is indicated for improving the antireflux barrier.
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PMID:[Reflux esophagitis]. 776 23

The explantation of the cause of recurrent chest pain may be a considerable problem. In the first place coronary heart disease should be excluded. classical anginal pain features do not determine unequivocally its cause. One third of patients with anginal pain have normal coronarograms. Patients with chest pain of unexplained origin are a serious clinical problem. Recently, more attention has been paid to the possible role of functional oesophageal disturbances in such symptoms. Gastro-oesophageal reflux and abnormalities in motor function such as "nutcracker oesophagus", diffuse oesophageal oontraction, conditions of increased lower oesophageal sphincter tonus, or non-specific disturbances of motor function may be the cause of pain even of anginal character. However, both reflux and oesophageal motor function disturbances are frequently observed in healthy persons without could be the cause of chest pain. Confirmation of the connection between the symptoms and oesophageal disturbances may require the application not only of X-ray examinations and endoscopy but also manometric and pH-metric examinations and challenge tests (intraoesophageal balloon inflation, test with edrophonium, Bernstein test). Simultaneous monitoring of pH and pressures in the oesophagus during many hours seems to be particularly useful. An important role in the pathophysiology of chest pain may be played by abnormal perception of visceral stimuli ("irritable oesophagus")-so it is useful to supplement the studies with psychological tests.
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PMID:[Role of functional esophageal disturbances in the development of chest pain]. 797 38


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