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

Esophageal cancer is a pathology with a remarkable geographical variety, considered to be a disease of the poor. The common incidence reported in western countries of 3 per 100,000 per year, contrasts with 140 per 100,000 reported in Central Asia in an area that is known as the "esophageal cancer belt". Among a wide spectrum of potential etiologic agents, the use of alcohol and tobacco remain the most frequently reported. The most common pathologic type is squamous cell carcinoma, although is important to consider that in the past decades, a shift to adenocarcinoma has been consistently observed. This phenomenon might have an explanation in the inclusion of tumors of the cardia and the importance of metaplasic Barret's epithelium and gastroesophageal reflux. As it happens in the majority of gastrointestinal tumors, diagnosis is often done late in esophageal cancer. The most common presenting symptoms of esophageal cancer are dysphagia and weight loss. Others are, odynophagia, upper GI bleeding, hoarseness and respiratory symptoms. In patients with advanced disease, diagnostic studies are confirmatory in nature. The combined use of contrast esophagogram and endoscopy yield to a diagnostic accuracy above 95%. These studies have to be complimentary. Computed tomography is the best modality for staging tumors of the esophagus. Although its accuracy varies from one study to another, demonstration of disease beyond the esophagus precludes surgical treatment. Endoluminal ultrasound has assumed an important role as part of the staging studies, considered by some authors superior to CT scanning. Its use is not considered rutinary because of the difficulty on passing the instrument through an obstructive lesion, and to the fact that this technology is not widely available. In the majority of patients, surgical treatment is considered to be palliative, due to the presence of advanced disease at the time of diagnosis. From the multiple surgical options available, transhiatal esophagectomy without thoracotomy is one of the more widely accepted techniques. Controversy persists regarding the optimal surgical approach to the disease. It is well accepted that prognosis depends more in the biology of the tumor and the stage of the disease rather than the surgical procedure. Overall five year survival after esophageal resection is 20%, regardless of the surgical option. Other alternatives are standard transthoracic esophagectomy, the thoraco-abdominal approach and the triple approach with extensive lymphadenectomy of cervical, mediastinal and abdominal areas. These latter procedures carry more morbidity and mortality rates. It is probably the multimodality approach with pre or postoperative chemotherapy and radiotherapy what can impact in further improvement of the poor survival rates for this disease. This combined approach is currently being investigated under control prospective randomized trials.
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PMID:[Esophageal cancer]. 948 May 21

The importance of a hoarse voice or voice change in children has not been stressed in the literature in the same way as it has been in adults. We present 21 children who had been suffering from chronic hoarseness for more than three months and had on fibre-optic laryngoscopy findings suggestive of gastroesophageal reflux. None of them had complained of gastroesophageal symptoms. Twenty-four hour pH monitoring revealed that 13 (62 per cent) of these children had gastroesophageal reflux, seven (33 per cent) having gastroesophageal reflux more than three times the upper limit of normal. The pH graphs highlighted frequent refluxes, ranging from 0.4 to 37.4 refluxes per hour (median of 7.3 refluxes/hour). The majority of these refluxes occurred when the child was awake as opposed to asleep, with a median of 14.8 refluxes/hour and 0.9 refluxes/hour respectively (p = 0.0009). The refluxes were classically of short duration. This study suggests that gastroesophageal reflux plays a direct role in the pathogenesis of chronic laryngitis and hoarseness in children.
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PMID:Hoarseness and gastroesophageal reflux in children. 953 46

Gastroesophageal reflux may be responsible for atypical extra-esophageal symptoms, such as chest pain, dyspnea, chronic cough, or hoarseness. Prospective studies of gastroesophageal reflux have indicated reflux as the cause for chronic cough in 10 to 20% of patients. The precise mechanism by which reflux causes cough remains uncertain, although the possibility that the cough is caused by stimulation of the esophageal mucosa receptors rather than aspiration is suggestive from some studies. Prolonged esophageal pH monitoring affords an opportunity to document objective gastroesophageal reflux. Furthermore, pH monitoring gives the opportunity to correlate temporally acid reflux events with the onset of certain symptoms.
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PMID:[Clinical, diagnostic and pathogenetic aspects of reflux-associated cough]. 960 88

The presence of common symptoms, such as heartburn and regurgitation, usually make the diagnosis of gastroesophageal reflux disease (GERD) fairly straightforward. However, extraesophageal symptoms of GERD, such as asthma, noncardiac chest pain, and hoarseness, are often not recognized and therefore are poorly managed. This article sheds light on the atypical manifestations of GERD as well as current approaches to diagnosis and treatment.
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PMID:Recognizing atypical manifestations of GERD. Asthma, chest pain, and otolaryngologic disorders may be due to reflux. 992 93

Gastroesophageal reflux disease (GERD) is the abnormal retrograde flow of gastric contents into the esophagus. While disorders of the esophagus related to GERD are fairly well characterized, supraesophageal symptoms may be nonspecific and easily missed. Fewer than half of the patients with otolaryngologic complications of reflux exhibit the classic findings of heartburn and regurgitation. GERD has been implicated in a broad range of disorders including laryngitis, chronic hoarseness, globus pharyngeus, laryngeal carcinoma, cricopharyngeal hypertension, Zenker's diverticulum, and chronic cough. A high index of suspicion is essential for timely diagnosis and treatment of the otolaryngologic manifestations of GERD.
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PMID:Otolaryngologic manifestations of gastroesophageal reflux disease. 1031 2

An increasing amount of evidence indicates that gastroesophageal reflux disease (GERD) is a contributing factor to hoarseness, throat clearing, throat discomfort, chronic cough, and shortness of breath. The association between GERD and these supraesophageal symptoms may be elusive. Heartburn and regurgitation are absent in more than 50% of patients. Acid reflux should be considered if signs of GERD are present, symptoms are unexplained, or symptoms are refractory to therapy. The diagnosis of GERD may be unclear, despite a careful history and initial evaluation. A high index of suspicion is required to make the diagnosis. An empiric trial of antireflux therapy is appropriate when GERD is suspected. Multiprobe ambulatory pH monitoring is currently the diagnostic test of choice, but the level of sensitivity and specificity for supraesophageal manifestations of GERD is uncertain. Response to antireflux therapy is less predictable than typical GERD. More intensive acid suppression and longer treatment duration are usually required.
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PMID:Supraesophageal manifestations of gastroesophageal reflux disease. 1043 98

Appropriate use of modern medical therapy for gastroesophageal reflux disease (GERD), particularly proton pump inhibitors, should result in effective control of symptoms in most GERD patients. Possible causes of poor response to GERD treatment include: a non-compliant patient, lack of appropriate therapy or insufficient dose, or an incorrect diagnosis. Endoscopy plays an important role in the management of GERD and other associated conditions. If the presence of esophagitis is detected then this confirms a diagnosis of GERD. Endoscopy can identify the presence of Barrett's esophagus, with a biopsy taken to confirm intestinal metaplasia. Endoscopy should ideally be used in patients with chronic GERD symptoms (persisting for 3 years or more), in those aged over 40, and particularly in Caucasian males who are at high risk of developing Barrett's esophagus. pH monitoring can also be used to confirm the diagnosis of GERD. It also has a role where the endoscopy findings are normal and in patients with atypical symptoms, such as chest pain, asthma/cough or hoarseness. It is a useful tool to document effectiveness of GERD treatment. Esophageal and gastric pH monitoring during treatment with acid suppressing therapy will confirm the control of gastric acid and the absence of continued reflux. Similarly, pH monitoring can be used to evaluate the effectiveness of antireflux surgery.
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PMID:My approach to the difficult GERD patient. 1044 8

Reflux laryngitis is a common disease and is probably only one of several laryngeal manifestations associated with GERD. The hypothesis that GER causes laryngeal symptoms and conditions remains to be definitively proved. In many patients, the cause of laryngeal symptoms may well be multifactorial, and to identify definitively those patients in which GER may be playing a role remains a challenge. Documentation of GER using 24-h pH monitoring may assist in identifying such patients. Pharyngeal pH probe monitoring, although not without limitations, may be the optimal method to evaluate such patients in terms of documenting the presence of EPR. A suggested algorithm based on the available data in evaluating and treating patients with suspected reflux laryngitis is shown in Figure 5. First, rule out other causes of hoarseness and laryngitis. An ENT consultation is appropriate for hoarseness present >4 wk. Second, empirically treat with PPIs b.i.d. for 2-3 months, as esophageal and pharyngeal pH monitoring is costly, not readily available, time consuming, and not sensitive in making the diagnosis of GERD related laryngitis. If the patient improves after 2-3 months, therapy should be stopped and the patient observed. If symptoms recur, reinstitution of the PPI at the lowest possible dose or with use of an H2RA to maintain remission should be initiated. Third, if no improvement is noted, the patient should undergo 24-h pH monitoring with an esophageal and, if possible, a pharyngeal probe if the diagnoses of GERD and EPR are still in question. In patients in whom there is a high suspicion for GERD, pH monitoring should be performed on PPI therapy to determine whether acid suppression is adequate. A pH probe should be placed in the stomach if the question to be answered is whether 1) the PPI regimen is maintaining a pH of >4, or 2) if the addition of a bedtime H2RA maintains nocturnal intragastric pH of >4 (52-56). Patients with a completely normal pH study who are on no medications should be referred back to the ENT physician for further evaluation, as other risk factors for chronic laryngitis such as voice overuse may benefit from concomitant voice therapy. If upright reflux is the predominant reflux pattern, increasing the b.i.d. PPI dose is reasonable; but if nighttime supine reflux is predominant, recent literature suggests that the addition of a bedtime H2RA will suppress nocturnal acid breakthrough. There are, however, no long-term studies with the PPI plus H2RA regimen that document persistent nocturnal acid suppression and that show clinically significant differences in patients with nocturnal acid breakthrough. Surgery should be cautiously considered for patients who are unresponsive to PPI therapy and who have documented or undocumented evidence of GERD or EPR. The body of experience concerning GERD and the extraesophageal manifestations of GERD suggests that patients who do not respond to adequate PPI acid suppression will do poorly after antireflux surgery.
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PMID:ENT manifestations of gastroesophageal reflux. 1095 Jan 1

A review of a combined gastroenterology and laryngology clinic was conducted to determine the effectiveness of treatment and the predictive value of clinical findings and investigations. Data were collected prospectively. Investigations were performed according to clinical criteria. Patients with symptoms suspected to be due to laryngopharyngeal reflux (based on a positive oesophageal pH test and/or changes on videolaryngoscopy consistent with posterior laryngitis) were treated with omeprazole for at least two to three months. There were 87 patients; the most common symptoms were cough (38 per cent) and hoarseness (36 per cent); 77 per cent had some symptoms suggestive of gastro-oesophageal reflux. Sixty-seven patients were given omeprazole. A good response to laryngo-pharyngeal symptoms was seen in 37 patients (55 per cent). The presence of reflux symptoms was not a predictor of a good response. Increasing severity of oesophageal acid exposure over the 24 hours of pH testing was associated with a better symptom response (Spearman rank correlation, p = 0.01). Posterior laryngitis was not associated with the response to treatment, although there was a trend towards an association between improvement in laryngitis (after treatment) and improvement in symptoms (p = 0.08). The response to proton pump inhibitors was lower than other published results. Oesophageal pH monitoring may have a role in predicting which patients will respond to proton pump inhibitors. This study does not support the decision to treat with anti-secretory therapy, based only on the presence of posterior laryngitis.
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PMID:Presumed laryngo-pharyngeal reflux: investigate or treat? 1096 77

Gastroesophageal reflux disease (GERD) is one of the most common diagnoses in a gastroenterologist's practice. Gastroesophageal reflux describes the retrograde movement of gastric contents through the lower esophageal sphincter (LES) to the esophagus. It is a common, normal phenomenon which may occur with or without accompanying symptoms. Symptoms associated with GERD include heartburn, acid regurgitation, noncardiac chest pain, dysphagia, globus pharyngitis, chronic cough, asthma, hoarseness, laryngitis, chronic sinusitis and dental erosions. The introduction of fiberoptic instruments and ambulatory devices for continuous monitoring of esophageal pH (24-hour pH monitoring) has led to great improvement in the ability to diagnose reflux disease and reflux-associated complications. The development of pathological reflux and GERD can be attributed to many factors. Pathophysiology of GERD includes incompetent LES because of a decreased LES pressure, transient lower esophageal sphincter relaxations (TLESRs) and deficient or delayed esophageal acid clearance. Uncomplicated GER may be treated by modification of life style and eating habits in an early stage of GERD. The various agents currently used for treatment of GERD include mucoprotective substances, antacids, H(2) blockers, prokinetics and proton pump inhibitors. Although these drugs are effective, they do not necessarily influence the underlying causes of the disease by improving the esophageal clearance, increasing the LESP or reducing the frequency of TLESRs. The following article gives an overview regarding current concepts of the pathophysiology and pharmacological treatment of GERD.
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PMID:Pathophysiology and pharmacological treatment of gastroesophageal reflux disease. 1106 Apr 72


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