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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 connections between gastroesophageal reflux, nonallergic asthma and angina pectoris are critically reviewed. Although there is no convincing evidence of a widespread pathophysiological link, such interaction may play a role in selected cases.
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PMID:[Reflux, lung and heart]. 944 77

The syndrome of angina-like pain with normal epicardial coronary vessels is a very common and expensive clinical problem. Patients suffering from this condition frequently present a diagnostic challenge. Cardiac and musculoskeletal disorders must be excluded prior to identifying the esophagus as the source of pain. The term "chest pain of undetermined origin" (UCP) has been proposed to refer to this condition. Esophageal dysmotility was previously considered a major source for chest pain; however, recent studies indicate that esophageal reflux is the most common cause of esophageal pain. Two controlled trials of acid suppressive agents in patients with chest pain have shown that omeprazole provides effective pain relief for the majority of these individuals. Visceral hyperalgesia and psychologic disturbances are also commonly noted in patients with UCP. Much remains to be learned about the etiology of visceral hyperalgesia and the precise role of psychologic abnormalities in these patients. Until further information is available, treatment with imipramine or trazodone has been shown to offer effective relief of chest pain for subgroups of patients with UCP. Psychologic intervention is also valuable in the management of some patients. Studies of other therapeutic regimens continue to be conducted.
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PMID:Recent developments in chest pain of undetermined origin. 1095 31

Patients with recurrent angina-like chest pain with normal coronary vessels are deemed to have the syndrome of noncardiac chest pain (NCCP). These patients, despite having significant cardiac disease ruled out, often spend a restricted lifestyle believing they have cardiac disease. These recurrent episodes of chest pain may be related to gastroesophageal reflux disease (GERD), spastic motility disorders of the esophagus and esophageal (visceral) hyperalgesia. These disease entities are often difficult to diagnose and treat except for GERD and achalasia. Recent prospective double-blind studies have shown that about 44% of these patients may have underlying GERD. There is now more evidence to support the practice of empiric use of proton pump inhibitors (PPIs) as the first step in therapy. Newer modalities for diagnosis like endoscopic ultrasonography (EUS) showed that this group of patients had sustained muscular contractions of longer that 68 s during chest pain. These sustained contractions noted on EUS were secondary to isometric contraction of the circular muscle which did not cause luminal constriction nor was related to contraction of the longitudinal muscles which cannot be recorded by pressure manometry. Treatment is difficult if patients do not respond to high-dose PPIs. Other medications which are known to alter visceral hyperalgesia in low doses, such as tricyclic antidepressants like imipramine and desyrel, can be tried. Psychological intervention may be useful in the management of some of these patie
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PMID:Update on noncardiac chest pain. 1127 32

The epidemiology of NCCP is poorly described, and the available data are conflicting. Population-based studies on the prevalence of NCCP are rare; most studies have been hospital based. According to the limited studies available, the annual prevalence of NCCP is approximately 25%. Despite this significant burden, the impact and natural history of NCCP in the community has not been adequately explored. NCCP is presumed to bea heterogeneous condition. Hospital-based studies have suggested that GERD, esophageal spasm, psychiatric disease (including panic attacks), and musculoskeletal pain explain many cases of NCCP. However, unrecognized coronary artery disease and microvascular angina (cardiac syndrome X)also explain an unknown proportion of cases in the general population.Current studies suggest that NCCP is common in the general population and significantly affects QOL, yet only a minority seeks medical attention.The epidemiology of NCCP requires further study in the general population and in those attending the Emergency Department.
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PMID:Noncardiac chest pain: epidemiology, natural history, health care seeking, and quality of life. 1506 33

Precise knowledge about the anatomical constitution of the diaphragmatic pillars is essential to understand the physiologic, clinical and surgical roles of the esophageal and aortic hiatuses. Because anatomical descriptions found in the literature are dubious, we have decided to investigate this subject. Anatomical dissections and histologic sections of the right and left diaphragmatic pillars (diaphragma crura) from 43 human bodies were analyzed, comprising both non-fixed and fixed specimens. We have described a classification of the diaphragmatic pillars and their muscular branches, forming two basic arrangements (patterns I and II) around the esophageal and aortic hiatuses. Such anatomical and functional relationships between the esophagus and its diaphragmatic hiatus help explain why, during normal inspiration, a hiatal enlargement is observed first but is followed, thereafter, during deep inspiration, by a hiatal narrowing exerted by the contraction of the diaphragmatic pillars. Our results also show that the aortic hiatus does not seem to constitute a rigid ventral tendinous arc around the aorta that could impose any considerable degree of vascular compression, as suggested by other investigators. The present study provides anatomical data useful for a better understanding of gastroesophageal reflux physiology, antireflux surgery and abdominal angina.
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PMID:Anatomical investigation of the esophageal and aortic hiatuses: physiologic, clinical and surgical considerations. 1508 89

Gastroesophageal reflux disease (GERD) can be described as a clinical picture resulting from the reflux of stomach contents into the esophagus. The actual prevalence of GERD remains unestablished, although this disorder is generally common in old patients, male sex and in subsets of patients with pulmonary manifestations such as asthma. From a pathophysiological stand-point, GERD is thought to have a multifactorial etiology which involves genetics, anatomical, functional, environmental, hormonal and pharmacological factors. GERD has different clinical presentations which may be divided in three main classes: typical symptoms (heartburn and regurgitation); atypical or extraesophageal symptoms (angina-like chest pain, asthma, chronic cough and laryngitis); and complications (ulcers, strictures and Barrett's esophagus). In GERD diagnosis a key role is played by: accurate symptom evaluation, response to proton pump inhibitors and, finally, at least one in a life-time endoscopy. Moreover, barium swallow X-ray, 24-h esophageal pH monitoring and gastro-esophageal manometry can be useful to support diagnosis in some unusual cases or in cases partially or unresponsive to standard pharmacologic treatment.
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PMID:[Gastroesophageal reflux disease: clinical and pathophysiological features (part I)]. 1740 61

In adults, several extra-digestive manifestations (cough, asthma, angina-like chest pain, ENT symptoms, dental erosions and even sleep disturbances) may be due to gastro-oesophageal reflux disease (GORD). In some cases, symptoms are triggered by an oesophageal reflex vagally mediated, while other symptoms are mainly related to the irritant effect of the refluxed material. The link with GORD is often difficult to establish because of the lack of typical digestive symptoms of GORD and of erosive oesophagitis in most of the cases. An empirical trial of double dose PPI therapy for 2 to 3 months can be done as the initial step in the diagnosis and treatment while oesophageal 24-hour pH monitoring is recommended by others to establish a temporal relationship between symptoms and reflux events. The optimal management algorithm remains to be determined. In some case, oesophageal luminal impedance monitoring could be useful to demonstrate a link between symptoms and a non-acid GORD. Traditionally, management of extra-oesophageal GORD manifestations relies on prolonged high doses of PPIs but the symptomatic efficacy of such treatment has been discussed recently. In case of adequate response, treatment can be tapered down to determine the minimal required maintenance dose. Anti-reflux surgery could be an alternative in some cases.
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PMID:[Extra-esophageal manifestations of gastroesophageal reflux disease in adults]. 1892 24

The conduct research is demonstrating typical sickly particularities of patients are ill with gastroesophageal reflux disease and stenocardia. It allows revealing these patients clinically. Besides there are association between frequency of beginnings of erosive reflux-esophagitis by patients with stenocardia and degree of serious myocardial ischemia.
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PMID:[Clinical value of gastroesophageal reflux disease in patients with stable angina]. 1933 32

Gastroesophageal reflux disease (GERD) may manifest typically with heartburn and regurgitation or may have atypical manifestations as laryngitis, asthma, chronic cough or noncardiac chest pain (NCCP). While typical GERD is easy to be recognized, the atypical extraesophageal symptoms of the disease make the diagnosis difficult because most patients do not have heartburn or regurgitation. Most common atypical manifestations include ear, nose and throat (ENT), pulmonary or cardiac symptoms. GERD should be included in the differential diagnosis of patients with atypical symptoms, especially when alternative diagnoses are excluded. NCCP is defined as recurring angina-like substernal chest pain of noncardiac origin. We present the most recent epidemiologic data, pathophysiology, diagnosis and treatment of NCCP. The major causes of NCCP are GERD and esophageal dysmotility. By far, GERD has been demonstrated to be the most frequent source of NCCP. After a complete cardiac evaluation, the patient with NCCP will be referred to a gastroenterologist. All recent studies suggest the use of PPI test as the first diagnostic tool in patients with NCCP. The invasive diagnostic tests (especially, the 24-hour pH monitoring and esophageal manometry) are used only in those cases who do not respond to PPI therapy. Patients with GERD-related NCCP require long-term treatment with a PPI.
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PMID:[Noncardiac chest pain and gastroesophageal reflux disease]. 2070 Sep 64

Chest pain is one of the most common symptoms driving patients to a physician's office or the hospital's emergency department. In approximately half of the cases, chest pain is of cardiac origin, either ischemic cardiac or nonischemic cardiac disease. The other half is due to noncardiac causes, primarily esophageal disorder. Pain from either origin may occur in the same patient. In addition, psychological and psychiatric factors play a significant role in the perception and severity of the chest pain, irrespective of its cause. Chest pain of ischemic cardiac disease is called angina pectoris. Stable angina may be the prelude of ischemic cardiac disease; and for this reason, it is essential to ensure a correct diagnosis. In most cases, further testing, such as exercise testing and angiography, should be considered. The more severe form of chest pain, unstable angina, also requires a firm diagnosis because it indicates severe coronary disease and is the earliest manifestation of acute myocardial infarction. Once a diagnosis of stable or unstable angina is established, and if a decision is made not to use invasive therapy, such as coronary bypass, percutaneous transluminal coronary angioplasty, or stent insertion, effective medical treatment of associated cardiac risk factors is a must. Acute myocardial infarction occurring after a diagnosis of angina greatly increases the risk of subsequent death. Chest pain in women warrants added attention because women underestimate their likelihood to have coronary heart disease. A factor that complicates the clinical assessment of patients with chest pain (both cardiac and noncardiac in origin) is the relatively common presence of psychological and psychiatric conditions such as depression or panic disorder. These factors have been found to cause or worsen chest pain; but unfortunately, they may not be easily detected. Noncardiac chest pain represents the remaining half of all cases of chest pain. Although there are a number of causes, gastroesophageal disorders are by far the most prevalent, especially gastroesophageal reflux disease. Fortunately, this disease can be diagnosed and treated effectively by proton-pump inhibitors. The other types of non-gastroesophageal reflux disease-related noncardiac chest pain are more difficult to diagnose and treat. In conclusion, the cause of chest pain must be accurately diagnosed; and treatment must be pursued according to the cause, especially if the cause is of cardiac origin.
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PMID:Chest pain of cardiac and noncardiac origin. 2083 93


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