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

Oesophageal motility studies have greatly enhanced our knowledge of the physiology of the oesophagus. The abnormalities, particularly of the LOS, that occur in gastro-oesophageal reflux disease have been extensively studied. Although motility studies have relatively little impact on the clinical management of the majority of patients with oesophagitis, they are indicated when there is diagnostic doubt and most especially when surgical treatment is being considered. In numerical terms oesophageal motility studies are required most often for the investigation of obscure dysphagia or non-cardiac chest pain. Research is continuing to expand our knowledge of the oesophageal dysmotility syndromes.
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PMID:Oesophageal motility: recent advances and implications. 637 90

Technological advances in the investigation of oesophageal motility have resulted in progressive awareness of gastro-oesophageal reflux disease and motor disorders of the oesophagus as causes of obscure "noncardiac" chest pain, as well as for unexplained swallowing difficulties. Oesophageal motility studies should also be undertaken before surgery for reflux oesophagitis.
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PMID:Clinical applications of oesophageal motility studies? 649 77

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

Review of esophageal motility tracings performed during a three-year period yielded 112 patients who underwent the test because of chest pain of unclear etiology. Thirteen patients had high-amplitude peristaltic contractions. All 13 patients had pressurelike pain, ten had dysphagia, and six had symptoms of gastroesophageal reflux. The presence of an elevated lower esophageal sphincter pressure in five patients suggested a spectrum of hypertensive disorders of the esophagus variously affecting the body, the sphincter, or both. This latter subgroup responded to esophageal bougienage. Six patients had objective evidence for gastroesophageal reflux. These patients had at least partial relief from antireflux measures. High-amplitude peristaltic contractions should be considered in the differential diagnosis of noncardiac chest pain, since recognition of this entity can lead to appropriate management and symptom relief.
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PMID:High-amplitude peristaltic esophageal contractions associated with chest pain. 663 65

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

The symptoms of chest pain and dysphagia together with the typical radiological features of non-peristaltic segmental oesophageal contractions allowed the diagnosis of diffuse oesophageal spasm to be made in ten patients at The Prince Charles Hospital over the last six years. Eight patients have undergone long oesophageal myotomy with sparing of the lower oesophageal sphincter. All patients had immediate postoperative relief of symptoms, with postoperative cine radiographic examination in all patients demonstrating an inert oesophagus with adequate drainage and no gastro-oesophageal reflux. Two patients subsequently developed progressive dysphagia, one requiring a modified Heller's procedure. Because of the good result in six patients, sparing of the lower oesophageal sphincter with long oesophageal myotomy is recommended.
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PMID:Long oesophageal myotomy for diffuse spasm of the oesophagus. 695 65

Current methods to evaluate patients with esophageal disease include barium swallow with fluoroscopy, which is useful in demonstrating structural defects. Disordered motility is better evaluated with a cine-esophagram. Recent application of radioisotopes has been useful in evaluation of esophageal reflux and the post-treatment of achalasia. Esophageal motility studies may evaluate lower esophageal sphincter and upper esophageal sphincter pressures and the response of the body of the esophagus to series of swallows. Since there is no "gold standard" for the evaluation of reflux esophagitis, some of the tests designed to evaluate reflux and the patient's reaction to acid in the esophagus include the acid infusion test, the standard acid reflux test, the acid clearance test, and 24-hour pH monitoring. Endoscopy with either the flexible or the rigid instrument is important for the diagnosis of obstruction or esophagitis and allows direct visualization of the esophagus. The treatment of reflux esophagitis is discussed. The differential diagnosis of dysphagia may include achalasia, diffuse esophageal spasm, and mechanical obstruction of the esophagus due to rings, webs, strictures, and benign or malignant tumors. The evaluation of dysphagia should include radiologic as well as endoscopic evaluation. Treatment of obstruction varies according to the nature of the lesion. The Mallory-Weiss syndrome or bleeding from the mucosal tears of the gastroesophageal junction and Boerhaave's syndrome, spontaneous esophageal perforation, are two disorders associated with vomiting. The Mallory-Weiss syndrome usually resolves without specific therapy, but a high index of suspicion is required for patients with chest pain after vomiting, as spontaneous perforation necessitates immediate surgery. Most diverticula need no treatment, but the Zenker diverticulum, if symptomatic, should probably be surgically repaired.
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PMID:Evaluation and management of diseases of the esophagus. 703 70

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


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