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

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

The technique of 24 hour esophageal pH monitoring (24 hour pH test) is described. Experience with the 24 hour pH test in 393 patients with suspected esophageal disease has shown the clinical usefulness of the test in objectively determining the presence of gastroesophageal reflux. The test was effective in evaluating atypical symptoms of gastroesophageal reflux such as respiratory symptoms and chest pain and, in children, failure to thrive and recurrent pneumonia. The 24 hour pH test was particularly useful in evaluating patients who were referred with other abdominal or thoracic disease and had, in addition, symptoms suggestive of gastroesophageal reflux on history. The test helped to unsnarl the cause of recurrent symptoms after an esophageal myotomy for achalasia or an antireflux procedure. Of 179 patients with typical symptoms of gastroesophageal reflux, 27% had normal 24 hour test results and were subsequently diagnosed as having another cause for their symptoms. Of 146 patients who had normal findings on esophagoscopy, 54% were shown to have abnormal gastroesophageal reflux on 24 hour pH monitoring, indicating lack of sensitivity of endoscopy to detect reflux. In addition, the 24 hour pH test identified patterns of abnormal reflux and indicated those patients most at risk for development of stricture. The test is well tolerated by the patients, simple to use, and dependable when performed and read as described. The clinical use of the 24 hour pH test brings objectivity to the evaluation of exophageal disease that has hitherto not been available.
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PMID:Technique, indications, and clinical use of 24 hour esophageal pH monitoring. 736 33

Esophageal electrical potential difference (PD) was studied in 9 patients with symptomatic gastroesophageal reflux and in 9 healthy control subjects. None of the patients revealed gross mucosal damage by radiography or endoscopy, but all of them showed positive acid perfusion studies. In the stomach and across the lower esophageal sphincter PD profiles were remarkably similar in patients and controls. Throughout the lower esophagus however, PD values were slightly higher in patients with symptomatic reflux than in healthy volunteers. These data are in contrast to a previous investigation, in which patients with reflux-induced gross mucosal damage revealed a decreased PD in the lower esophagus. Thus it is concluded that PD measurements of the lower esophagus do not appear to be a valuable test in the differentiation of chest pain of cardiac and esophageal origin.
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PMID:Esophageal transmural potential difference in patients with symptomatic gastroesophageal reflux. 737 98

Gastro-oesophageal reflux is commonly found in the general population, and has recently been demonstrated to occur more frequently during exercise than at rest. This fact is significant to the substantial number of athletes who complain of exertional upper gastrointestinal symptoms and exercise-induced chest pain. A diagnosis of exercise-induced gastro-oesophageal reflux can be confirmed by means of ambulatory pH monitoring. A positive diagnosis allows for appropriate management of the individual. This can involve simple measures, such as recommendations for changes in diet, timing of meals, and nature of exercise. However, pharmacological intervention may be required. A decrease in morbidity associated with cardiac origins of exercise-induced pain can also be expected with a more comprehensive understanding of this pathology.
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PMID:Gastro-oesophageal reflux and exercise. Important pathology to consider in the athletic population. 748 Dec 80

Gastroesophageal reflux disease (GERD) is a common condition, and it is now generally recognized that modern medical therapy allows the physician to both heal the esophagitis and relieve the patients from troublesome symptoms such as heartburn, acid regurgitation and disabling chest pain. In addition, long-term therapy with potent acid inhibitory drugs can maintain these patients in clinical remission. The indications for antireflux surgery and long-term medical therapy have developed and changed with time but are today essentially similar, and in fact, it can be hypothesized that the outcome of a short-term "therapeutic trials" with the proton pump inhibitor would be a useful clinical tool, not only as a diagnostic test for the disease but also in the selection process before referring the patient to antireflux surgery. Antireflux surgery is designed to improve the function of the antireflux barrier by reconstructing the physiology of the gastroesophageal junction. Studies have shown that a fundoplication procedure improves the strength and length of the lower esophageal sphincter and also restitutes the flutter valve mechanism. However, since gastroesophageal reflux disease is a common disorder, it is impossible for every patient to be attended by an expert surgeon, and this might be one important reason for the sometimes poor results presented after surgical treatment. When the question arises about which type of long-term therapy should be chosen in each clinical situation, this situation should also partly be influenced by some epidemiological information. If we assume that we expose a hypothetical group of 100 patients with symptomatic, chronic severe reflux disease, also presenting endoscopic evidence of esophagitis of varying severity, available clinical information would suggest that only 25 can be considered suitable for antireflux surgery, depending on the frequently associated complicating medical disorders and the age distribution of the actual patient population. Therefore, it deserves to be emphasized that the majority of patients with complicated reflux disease are not fit for surgery and should consequently be managed medically. For younger patients with disabling GERD, antireflux surgery is still the gold standard and obviously very cost effective.
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PMID:The knife or the pill in the long-term treatment of gastroesophageal reflux disease? 750 32

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

The present study was performed to compare pain-related oesophageal motility, gastro-oesophageal reflux and ST-segment deviations in patients with intermittent chest pain and normal or pathological coronary angiography. Thirty patients (11 males, 19 females; mean age 54.8 years) with normal and 15 patients (12 males, 3 females; mean age 66.7 years) with pathological coronary angiography were investigated by 24-h oesophageal pressure, pH and ECG recording. Chest pain correlated with motility abnormalities or gastro-oesophageal reflux occurred in 33% (10/30) of patients with normal coronary arteries and in 26% of patients with pathological coronary angiography. Symptomatic and asymptomatic ST-segment changes were less frequently observed in patients with normal angiography (4/30) than in patients with pathological coronary angiography (7/14; P = 0.02). Oesophageal dysfunction coincided with ST-segment deviation in 6.7% (2/30) of patients with normal and 40% (6/15) of patients with pathological coronary angiography (P = 0.02). The conclusions reached were: (1) pain-correlated abnormal motility or gastro-oesophageal reflux occurred in patients with normal and pathological coronary angiography at the same frequency; (2) ambulatory motility and pH recording alone does not appear to differentiate between cardiac and non-cardiac chest pain; (3) simultaneous ECG recording reveals a significant correlation of ST-segment deviation and gastro-oesophageal reflux or abnormal motility in patients with coronary artery stenosis.
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PMID:Ambulatory oesophageal pressure, pH and ECG recording in patients with normal and pathological coronary angiography and intermittent chest pain. 762 63

Interstitial lung diseases (ILD) are disorders of the lower respiratory tract, characterized by chronic inflammation of the lung parenchyma, varying degree of fibrosis, derangement of the alveolar walls and loss of the functional alveolar capillary units. ILD are relatively uncommon in children. Most of the interstitial lung diseases have no known etiology. In children, common diseases associated with ILD include viral respiratory tract infections (RSV, parainfluenza, etc.), gastroesophageal reflux, idiopathic pulmonary fibrosis, pulmonary hemosiderosis, eosinophilic pneumonia, pneumonitis associated with AIDS, etc. Chronic inflammation of the alveoli (alveolitis), the initial injury in ILD, and several mediators released from inflammatory cells (eosinophils, neutrophils and macrophages) can cause fibrosis and derangement of alveolar walls. Dyspnea and a non-productive cough are the cardinal symptoms of ILD. Other findings include chest pain, hemoptysis and weight loss. Clubbing of fingers occur in approximately 50 per cent of cases. Diagnosis is based on a combination of history, clinical findings, radiographic findings, pulmonary function tests and histologic findings. Open lung biopsy has been very helpful in providing information regarding the extent and nature of the damage, prognosis and response to therapy. There are 3 main aspects in the treatment of ILD. The most important step is to identify and eliminate the cause. The second is suppression of the inflammation. The third is supportive and symptomatic treatment. Corticosteroids are the drugs commonly used for suppression of inflammation. Immunosuppressive drugs (azathioprine, cyclophosphamide) have also been tried. Lung transplantation and heart transplantation have been successfully achieved in selected patients. The results of therapy should be regularly monitored by clinical symptoms, chest radiographs and serial pulmonary function studies.
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PMID:Interstitial lung diseases in children: a review. 764 31

Thirty patients with suspected esophageal originated chest pain were studied by 24 h esophageal pH monitoring. All of them complained of chest pain, heart burn, acid reflux or dysphagia. The result showed abnormal pH in 26 patients (86.7%). Sixteen of them had pH abnormalities in both day and night, whereas 8 had only abnormal day pH, and 2 pH out of the normal limits at night. Chest pain episode was correlated with the abnormalities in 18 cases (60%). Four patients with coronary heart disease showed simultaneous gastro-esophageal reflux originated chest pain; the positive correlation was obtained. Their diagnosis of cardiac chest pain was doubtful. We suggested that 24h pH monitoring was a significant method to determine the cause of chest pain.
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PMID:[24-hour esophageal pH monitoring for suspected esophageal originated chest pain]. 765 5

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


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