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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 paper describes the physiology of swallowing, the methods for the assessment of esophageal motility, and the motility disorders of the tubular part and the lower sphincter of the esophagus, except for gastroesophageal reflux disease. Primary esophageal motility disorders are achalasia (incomplete relaxation of the lower sphincter in response to swallowing), diffuse esophagospasm (simultaneous repetitive contractions), and the nutcracker esophagus (propulsive peristalsis with abnormally high amplitude). Besides, there are non-specific as yet unclassified contraction abnormalities. Since hypermotile contraction abnormalities can mimic chest pain of cardiac origin, differential diagnosis of anginal chest pain should include esophageal motility disorders. Contraction abnormalities of the esophagus may occur in diffuse scleroderma, after therapeutic radiation of the mediastinum, and possibly after sclerotherapy of esophageal varices.
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PMID:[Motility disorders of the esophagus]. 356 Nov 40

The usefulness of oesophageal manometry as a clinical tool has been assessed in 202 patients requiring detailed investigation for troublesome oesophageal symptoms, who first presented between June 1979 and May 1982. Only 12 were found to have specific motility disorders such as achalasia and scleroderma. A total of 147 had a variety of non-specific motility disorders and, of these, 112 (76.2 per cent) had coexistent gastro-oesophageal reflux. There was a significant association between the symptoms of dysphagia and the occurrence of predominantly non-propagated motor activity in the oesophagus. A similarly significant relationship existed between crushing chest pain and oesophageal spasm. Despite this statistical association, detection and treatment of gastro-oesophageal reflux was found to be the most useful part of clinical management. Symptoms of associated motility disorders resolved in more than 90 per cent of patients treated by Nissen fundoplication. Preoperative assessment of motility was of no value in detecting those who might develop postoperative dysphagia. Oesophageal manometry is useful for the assessment of a small proportion of patients with oesophageal symptoms in whom gastro-oesophageal reflux has been excluded by vigorous investigation, including 24 h pH recording.
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PMID:Clinical implications of abnormal oesophageal motility. 359 42

We report a 25-yr-old woman who suffered incapacitating chest pain caused by upper esophageal sphincter (UES) dysfunction. She presented with a long history of severe episodic chest pain associated with gurgling noises in her chest and was unable to belch despite feeling a need to do so during pain episodes. Fluoroscopic and manometric studies confirmed that the patient's chest pain and gurgling noise were associated with dysfunction of the belch reflex. Although reflux of gas from the stomach into the esophageal body occurred normally, the extreme esophageal distention resulting from the gas reflux failed to trigger UES relaxation. Consequently, there was no venting of gas across the UES. The gurgling noise was caused by the gastroesophageal reflux of gas and the pain was associated with profound esophageal distention. A manometric study of the UES revealed absent or incomplete UES relaxation in response to abrupt esophageal distention by gastroesophageal gas reflux, so that the nadir of UES pressure always exceeded esophageal body pressure. The distended esophagus was repeatedly cleared by secondary peristalsis. To our knowledge this is the first description of chest pain caused by dysfunction of the belch reflex. We speculate that the mechanism described in this patient may account for a subgroup of patients with "chest pain of esophageal origin."
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PMID:Dysfunction of the belch reflex. A cause of incapacitating chest pain. 362 25

Sixty patients with anginalike chest pain of noncardiac origin were studied to determine the diagnostic value of 24-h ambulatory esophageal pH and pressure monitoring. The results of these 24-h studies were compared with those obtained by established methods, including x-rays, endoscopy with biopsy, conventional esophageal manometry, and acid perfusion test. Esophageal origin of the chest pain was considered to be likely if the familiar pain sensation was reproduced by the acid perfusion test, or if the pain occurred during an episode of gastroesophageal reflux, severe motor disorders, or both. When the results of established methods were combined and interpreted according to predetermined criteria, esophageal origin of the pain was shown to be likely in 27% of the patients. The 24-h recordings, alone, showed the esophagus to be the likely cause of the pain in 35% of the patients. Combination of all conventional examinations and of 24-h recordings made esophageal origin of the pain likely in 48% of the patients.
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PMID:24-hour recording of esophageal pressure and pH in patients with noncardiac chest pain. 369 14

Preliminary experience with the combined use of 24 pH-metering and Holter ECG monitoring in the differential diagnosis of angina-like-pain (ALP) is reported. Twenty patients aged 24-65 (15 females and 5 males) all with angina-like-pain were studied. The aim of the study was to differentiate between oesophageal and cardiac causes of the various types of chest pain and to investigate the possibility of their coexistence. 50% of the ALP patients with a negative non-invasive cardiological report presented a pathological gastroesophageal reflux. In 5% of the cases simultaneous coronary insufficiency and pathological gastro-oesophageal reflux was noted. The importance of performing both Holter recordings and pH-metering before subjecting patients to coronarography is therefore emphasised.
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PMID:[24-hour pH measurement and Holter ECG monitoring in studying patients with angina-like chest pain. Our experience]. 371 93

Five different tests were used to evaluate oesophageal function in 22 patients who presented to a cardiac unit with acute chest pain but whose cardiological investigations were negative. Eight patients had an abnormality on oesophagoscopy, 10 had an abnormal pH monitoring study, six had a positive acid infusion test, 10 had an abnormal manometric study and six had an abnormal oseophageal transit scintiscan. Concordance for the three tests of gastro-oesophageal reflux disease was low at 28%, and for the two tests of oesophageal motility only 55%. Only two patients had normal results in all five tests.
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PMID:Investigation of non-cardiac chest pain--which oesophageal test? 373 62

The origin of chest discomfort in patients with mitral valve prolapse is controversial. We performed esophageal manometry in 18 patients with mitral valve prolapse, chest pain, and no significant coronary artery disease at cardiac catheterization. Fourteen of the 18 had esophageal disorders: five had diffuse esophageal spasm and two had hypertensive lower esophageal sphincter-motility disorders associated with chest pain syndromes; five mitral valve prolapse patients had hypotensive lower esophageal sphincters, a finding that increases the probability of symptomatic gastroesophageal reflux; and two had nonspecific motor abnormalities. Esophageal disorders may provide an explanation for chest discomfort experienced by certain patients with mitral valve prolapse.
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PMID:Esophageal disorders in patients with chest pain and mitral valve prolapse. 376 96

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

We performed antireflux surgery on 13 adults with both gastroesophageal reflux (GER) and asthma. The duration of asthma ranged from 7 months to 43 yr. Twelve patients had chronic heartburn, 10 had nocturnal cough and wheezing, eight had chest pain, and one was asymptomatic for GER. GER was determined by a combination of esophagoscopy with biopsy, manometry, and esophageal pH testing. Postoperative follow-up ranged from 13 months to 5 yr. Six patients were completely free of all wheezing episodes, six still had wheezing but the frequency and severity had markedly decreased, and one remained unchanged. Of 11 patients who required chronic bronchodilator therapy, four were able to completely stop and six decreased the dose by more than half; one required the same amount of therapy. Of the seven corticosteroid-dependent patients, two were weaned completely, three were being tapered, one remained unchanged, and one required a smaller dose for nasal polyps although he was free of wheezing and had stopped bronchodilators. Three patients, all of whom dramatically improved after surgery, died during their follow-up course: one died suddenly 8 months postoperatively during a walk after dinner from apparent status asthmaticus; one died 9 months postoperatively of refractory congestive heart failure; and one died 30 months postoperatively of metastatic adenocarcinoma of unknown source. We conclude that surgical correction of GER in selected adults with both asthma and GER may significantly decrease or eliminate pulmonary symptoms and the need for asthmatic medications.
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PMID:Is gastroesophageal reflux a factor in some asthmatics? 381 16

Although the standard acid reflux test is often used to diagnose gastroesophageal reflux (GER), the cost and benefit of this diagnostic test has never been evaluated. In this study, 184 consecutive referrals with esophageal symptoms were interviewed and had an esophagram, an esophageal manometry, and a modified acid reflux test (MART). The results were analyzed to determine how frequently MART altered the clinical diagnosis and to assess the cost of the new information. Patients with typical symptoms of GER (heartburn or regurgitation) were compared to those with atypical presentation (chest pain or dysphagia). Previously unsuspected GER was demonstrated in 63% of the atypical group, whereas no altered diagnosis was made in the typical group. There was no statistically significant difference between the two groups when mean lower esophageal sphincter pressures and mean pH scores were compared. MART was cost effective only in the atypical group, in which the cost of an altered diagnosis was $633.00.
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PMID:Modified acid reflux test. A benefit and cost analysis. 392 44


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