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

In order to study the effect of the new M1-selective antimuscarinic compound telenzepine on physiological esophageal acid exposure, ten healthy volunteers underwent a 24-hour esophageal pH-monitoring during a one week treatment with either tablets containing telenzepine 3 mg nightly or placebo in a double-blind cross-over trial. Side-effects were recorded, and stimulated salivary output was assessed. Using a cut-off pH less than 4, under telenzepine a significant reduction of reflux time and of maximum reflux duration was observed in supine position. Using a cut-off pH less than 2, reflux time was reduced during and after meals, number of refluxes was decreased during meals, and esophageal clearance was improved with telenzepine in supine position. Telenzepine reduced salivary output significantly on day 4 and on day 7. From the results it can be concluded that the drug is not contraindicated in peptic ulcer patients with heartburn. As telenzepine reduces gastroesophageal reflux time during and after meals and in supine position it may be tried as adjuvant treatment in esophageal reflux disease.
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PMID:The effect of the M1-selective telenzepine on esophageal acid exposure in healthy volunteers. 306 Nov 81

The aetiologic factors in gastro-oesophageal reflux disease include the free reflux of gastric juice, the composition of refluxed juice, the defensive mechanisms of the oesophagus, which are both mechanical and mucosal, and, sometimes, gastric abnormalities. Symptoms include heartburn, odynophagia, chest pain, dysphagia, regurgitation, and, occasionally, haemorrhage. Respiratory symptoms may occur. Diagnosis is based on determining the pressure and frequency of reflux (for which pH monitoring is preferred), testing for symptoms that may be caused by reflux, and assessing the degree of oesophagitis, for which endoscopy and histology are the only known techniques.
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PMID:Aetiology, pathogenesis, and clinical manifestations of gastro-oesophageal reflux disease. 306 36

In a double-blind, randomized study, the clinical effects of 5 mg and 10 mg of cisapride three times daily were compared with those of 10 mg of metoclopramide three times daily in 114 patients with symptoms of gastroesophageal reflux, mainly diurnal and nocturnal heartburn and regurgitation. The symptoms significantly (P less than 0.001) improved in the three groups; the mean severity score decreased by at least 78% after four weeks of treatment. Initial symptoms were more severe in the cisapride-treated patients, especially in those receiving 10 mg three times daily; however, the patients' condition after four weeks was similar in the three groups. Central nervous system side effects were reported by one patient from each of the cisapride-treated groups and by nine of the 43 metoclopramide-treated patients (P less than 0.02). Six metoclopramide-treated patients and one cisapride-treated patient dropped out of the study because of side effects. These findings favor the use of cisapride when prokinetic treatment of gastroesophageal reflux is considered.
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PMID:Cisapride and metoclopramide in the treatment of gastroesophageal reflux disease. 307 10

We studied 14 patients with PSS, 12 females and 2 males with a mean age of 43.6 and a medium of 8 years disease. All of the patients were selected for this study according to updated ARA criteria and were included in a prospective protocol to investigate digestive involvement. This protocol consists of a complete medical history, physical examination, radiologic and endoscopic studies, parasitological and microbial flora investigation. The symptoms more frequently seen were: pyrosis (78%), gastroesophageal regurgitation (50%), flatulence (50%), dysphagia (42%) and chronic diarrhea (21%). The radiologic findings commonly seen were: distal esophageal aperistalsis (78%), gastroesophageal reflux (57%), dilatation of intestinal loops (35%), changes of the mucosal folds (35%). A mild esophagitis was seen endoscopically in 64% of the patients, moderate and severe in 7% respectively. The study of the microbial flora showed contaminations with enterobacteria in 5 patients (35%). After statistical analysis we concluded that the digestive compromise by PSS is frequent, being the esophagus more commonly affected (80%), at the beginning in the form of reflux esophagitis and later in esophageal stenosis, the compromise of the small intestine (40%) is manifested by chronic diarrhea or dyspeptic flatulence, which correlates well the radiologic findings and the bacterial overgrowth in this organ. The colonic compromise generally is asymptomatic, and the common finding is dilatation os the colonic loops. Finally, the bacterial overgrowth in the small intestine is a secondary involvement to the intestinal compromise of Progressive Systemic Sclerosis.
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PMID:[Digestive involvement in progressive systemic sclerosis]. 322 28

In a multicenter, double-blind trial, 284 patients with gastroesophageal reflux disease were evaluated before, during, and after six weeks of treatment with either placebo or ranitidine (150 mg twice daily). Randomization resulted in two comparable patient groups. Ranitidine treatment was significantly more effective than placebo treatment in decreasing the frequency and the severity of heartburn during both daytime and nighttime assessment periods. There was a significant correlation between improvement in heartburn symptoms and decrease in antacid consumption; hence, patients receiving ranitidine consumed significantly fewer antacid tablets. Among patients with endoscopic esophagitis at baseline, the overall change in endoscopic classification after six weeks of therapy was significantly better for the ranitidine-treated patients. The ranitidine-treated group had less evidence of erosions and ulcerations as well as greater healing. There were no differences between the groups with respect to changes in esophageal mucosal sensitivity to acid perfusion or changes in histologic grading of esophageal mucosal biopsy specimens. The ranitidine safety profile was similar to that of previous studies. We conclude that, in patients with gastroesophageal reflux disease, ranitidine therapy, 150 mg twice daily, markedly reduced the heartburn symptoms of reflux disease and significantly improved the endoscopic appearance of the esophageal mucosa.
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PMID:Ranitidine therapy for gastroesophageal reflux disease. Results of a large double-blind trial. 330 70

Smoking has been shown to be a factor in acid peptic disease. A recent U.S. multicenter trial investigating use of ranitidine in the treatment of gastroesophageal reflux disease provided an opportunity to compare smokers and nonsmokers with regard to demographic features, manifestations of disease, and symptomatic response to treatment. A comparison of characteristics of smokers and nonsmokers revealed similar pretrial clinical findings. No significant differences between groups were found with regard to previous complications or recent symptoms of gastroesophageal reflux disease. There were also no significant differences in the way smokers and nonsmokers responded to treatment. Subjects on ranitidine, regardless of their smoking status, showed significantly greater improvement in heartburn symptoms and consumed less antacid than subjects who received placebo. Results of these analyses indicate that smoking as an independent variable was not related to symptomatic response or esophageal healing and that ranitidine was similarly effective in decreasing heartburn symptoms in smokers and nonsmokers.
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PMID:Effect of smoking in a controlled study of ranitidine treatment in gastroesophageal reflux disease. 331 71

The present study documents the accuracy of a commercially available ambulatory esophageal pH instrument. The distal esophagus of five subjects with daily heartburn was monitored for 24 h in the laboratory via an antimony pH electrode. The computer output from the ambulatory unit was compared to the on-line recording in terms of all events in which the pH dropped below four. A signal detection model was used, with an on-line pH tracing serving as the criterion response. The events noted as true positives (80%) were an accurate representation by the computer output of the events of pH less than four displayed by the on-line recording. The processing done by this particular ambulatory system tends to actually "ignore" transient pH drops (18% false negatives) and, may, in fact, provide more physiologically meaningful information than hardwired analog techniques for 24-h pH monitoring. The results confirm that ambulatory pH monitoring can produce meaningful and reliable physiological data concerning gastroesophageal reflux.
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PMID:Validation of an ambulatory esophageal pH monitoring system. 334 31

Ambulatory 24-h esophageal pH monitoring is an accurate quantitative test of gastroesophageal reflux (GER). However, it does not answer the question: are the patients' symptoms due to GER? We developed a numerical scale to quantify the percent association between symptoms and pH less than 4--the symptom index (SI). In 100 consecutive patients with heartburn or chest pain, the SI for the chief complaint was either high (greater than 75%) or low (less than 25%) in 77% of cases. A similar bimodal distribution was seen when heartburn or chest pain symptoms were individually evaluated. There was a good association between high SI and the presence of GER (97.5%), as well as low SI and a normal 24-h pH study (81.1%). Endoscopy was normal in 89.5% of patients with low SI, but patients with high SI had esophagitis in only 69.7% of cases. The Bernstein test showed a poor association with the SI. Therefore, the SI gives clinically relevant information regarding the role of acid reflux and patient's symptoms. We believe this simple calculated index should be included in the analysis of 24-h esophageal pH studies.
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PMID:The symptom index: a clinically important parameter of ambulatory 24-hour esophageal pH monitoring. 334 91

A 31-year-old man with a 19-year history of rumination developed frequent episodes of heartburn and regurgitation associated with acid gastroesophageal reflux that occurred predominantly during the day. This reflux and its attendant symptoms resulted from abdominal muscle contractions at the time of gastroesophageal pressure equilibration (i.e., common cavity phenomena) consistent with the egress of air from the stomach to the esophagus. A voluntary pharyngeal maneuver unassociated with swallowing but simultaneous with the abdominal contraction resulted in a decrease in upper esophageal sphincter pressure. This lowered pressure facilitated acid esophagopharyngeal regurgitation at a velocity of 100 cm/s. Biofeedback therapy directed at relaxing the abdominal muscles during eating and avoiding the pharyngeal maneuver resulted in a decrease in reflux and marked improvement in symptoms.
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PMID:Rumination, heartburn, and daytime gastroesophageal reflux. A case study with mechanisms defined and successfully treated with biofeedback therapy. 346 41

The columnar lined (Barrett's) esophagus is an acquired condition resulting from chronic gastroesophageal reflux. The clinical spectrum of 50 consecutive cases of endoscopically consistent, histologically proven Barrett's esophagus was reviewed. The mean age of patients was 65.9 +/- 12.4 (SD) years with only four patients younger than 50 years. The predominant presenting symptoms were dysphagia, heartburn, and regurgitation. At endoscopy, the columnar lined segment extended over 6.5 +/- 3.0 cm of the lower esophagus. Specialised columnar (intestinal) epithelium was the most frequent histological type identified. Radiologic or endoscopic evidence of a hiatal hernia was present in the majority. Complications were present at endoscopy in 38 (76%) patients. Reflux esophagitis (56%) was present at the area of the squamo-columnar junction. Stricture formation (38%) and ulceration (36%) were located either at the squamo-columnar junction or more distally within the columnar epithelium. Two patients (4%) had adenocarcinoma arising in a segment of Barrett's esophagus at presentation. Treatment included physical measures, dilatation, and cimetidine. Bougienage in 20 patients was successful in alleviating dysphagia but multiple treatment sessions were often necessary. Although esophagitis readily resolved with cimetidine therapy, ulceration was generally resistant to medical therapy. Indeed, by two months, healing was achieved in only five of 12 patients. Endoscopic surveillance of 12 patients who received cimetidine (1 g/day) for at least 12 months showed no regression of the metaplastic mucosa.
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PMID:Barrett's esophagus: clinical, endoscopic, and histologic spectrum in fifty patients. 346 72


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