Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0017168 (gastroesophageal reflux disease)
 11,783 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Intraoperative manometry can provide an objective means of determining the correct length of myotomy in patients with esophageal motility disorders. Of the patients in this series who underwent primary repair, 94 percent were relieved of pain and dysphagia. One patient required repeat myotomy for vigorous achalasia. After a mean follow-up period of 33 months, gastroesophageal reflux had not developed in any patient, indicating that myotomy with intraoperative manometry eliminates the need for an antireflux procedure. Such a procedure in these patients with poor esophageal motility can lead to dysphagia and obstruction, which is a very difficult problem to correct. We recommend intraoperative manometric be used routinely with myotomy for esophageal motility disorders.
 ...
PMID:Intraoperative manometry: adjunct to surgery for esophageal motility disorders. 669 43

Proximal gastric vagotomy without drainage for duodenal ulcer was performed in 304 patients between 1969 and 1977. There was one operative death (0.3%) and two patients required secondary drainage (0.6%). Eleven patients died subsequently of unrelated causes. Follow-up 5 to 13 years after operation was conducted on 242 patients (80%). Of these, 141 were asymptomatic and 48 had only trivial symptoms, a success rate of 78%. Thirty-two patients had recurrent ulcer and 2 of them had Zollinger-Ellison syndrome. When these two were excluded, the recurrence rate was 12.4%. Two patients had duodenitis. Seven patients had unexplained pain and some of them may ultimately be shown to have recurrence. Appreciable esophageal reflux was seen in eight patients. Other symptoms, nearly all mild, were dumping in one, diarrhea in seven and bile reflux in six. Recurrent ulcer was treated by cimetidine initially in all 32 cases but ultimately by repeat vagotomy and antrectomy in 27, with no deaths and only one further recurrence (Zollinger-Ellison syndrome). After operative correction, the ultimate success rate (Visick grades I and II) was 90%.
 ...
PMID:Long-term results of proximal gastric vagotomy. 674 38

Gastroesophageal reflux (GER) can produce debilitating and even fatal disease in infants and children. GER is common in infancy, and most GER subsides with time or with postural and dietary therapy. Operation is justified only to control effectively by nonoperative methods. The clinical history and the patient's response to medical treatment remain the most important factors in our decision for or against operation. As in adults, esophagoscopy and esophageal biopsy are useful to document the presence of reflux in older children, but they seldom contribute to the decision for operation in infants. In our hands, gastric scintiscan has provided useful qualitative data on reflux-induced respiratory symptoms and quantitative data on gastric emptying. Esophageal pH monitoring is more quantitative for reflux evaluation and allows analysis and clinical correlations with reflux patterns. We have not used the reflux patterns to predict outcome or response to treatment in the individual patient. A prolonged average duration of reflux during sleep does appear to increase the probability that a patient with respiratory symptoms will respond to operative control of reflux. Our presently imprecise technique for patient selection, however, must not cause us to withhold operation from needy infants. For the infant who does not grow or who aspirates on a reflux board, or who requires prolonged hospitalization and for the preemie who aspirates at every extubation attempts or requires long-term nasojejunal feedings to prevent aspiration, we think antireflux surgery is appropriate, humane, and cost-effective. We see no excuse for persisting with ineffective management of a process that may result in stunting, chronic illness, persistent pain, esophageal scarring, or even respiratory death.
 ...
PMID:Surgical selection of infants with gastroesophageal reflux. 679 42

Recurrent vomiting in adults is characterized by episodes of forceful vomiting which last several hours and recur at inconstant intervals; patients are free from symptoms between episodes. The series comprised 17 male and 14 female patients whose ages ranged from 14 to 69 years. In 10 patients, the vomiting attacks were accompanied by diarrhoea, and in 10 by abdominal pain. Eight patients suffered from bilious vomiting in childhood, and 11 patients had migraine. Five patients gave a family history of recurrent vomiting. Management necessitated a sympathetic approach and balanced investigation. Prochlorperazine administered by injection was helpful in the alleviation of an acute attack, but the possible value of more specific antimigraine therapy remains to be established. Evidence supports a link with migraine, which has an association with other gastrointestinal disorders such as irritable bowel and oesophageal reflux. In cases in which pain is prominent, cholelithiasis should be carefully excluded, but cholecystectomy did not always cure vomiting attacks.
 ...
PMID:Recurrent vomiting in adults. A syndrome? 683 34

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.
 ...
PMID:Esophageal acid perfusion in coronary artery disease. Induction of myocardial ischemia. 686 55

Seven patients with cystic fibrosis who had complications of gastroesophageal reflux including abdominal pain, peptic esophagitis, upper gastrointestinal hemorrhage, and esophageal stricture are described. We believe that these are gastrointestinal complications of CF and that they may be responsible for significant morbidity. The mechanical influence of a depressed diaphragm caused by hyperinflation, along with increased abdominal pressure with chronic coughing, may contribute to GER in CF. Early detection and treatment are important not only to prevent esophageal complications but also to increase the quality of life by relief of pain and by avoiding the resultant decrease in appetite, which can contribute to malnutrition.
 ...
PMID:Complications of gastroesophageal reflux in patients with cystic fibrosis. 706

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.
 ...
PMID:Esophageal function in patients with angina-type chest pain and normal coronary angiograms. 712 35

The effects of intramuscular pethidine (1.0--3.0 mg/kg) followed by metoclopramide 10 mg intravenously, and those of a combination of pethidine 1.5 mg/kg and metoclopramide 10 mg given intramuscularly, on the lower oesophageal sphinct pressure have been studied manometrically in human volunteers. In the former group, the mean effect of all the doses of pethidine was a reduction of the lower oesophageal barrier pressure by 6.8 cmH2O from control values (p less than 0.0002), while the intravenous administration of metoclopramide resulted in a mean increase in barrier pressure of 8.75 cmH2O above the depressed level (p less than 0.0001). Following the combination of pethidine and metoclopramide given intramuscularly depression of the sphincter pressure was not totally prevented, but there was a reduction in its incidence and severity. It is suggested that pethidine is likely to increase the possibility of gastro-oesophageal reflux, and that metoclopramide is a useful adjunct in the prevention of reflux in preparation for, and after, surgery in patients who have been given pethidine for pain relief.
 ...
PMID:Pethidine, metoclopramide and the gastro-oesophageal sphincter. A study in healthy volunteers. 721 26

The clinical features of abnormal gastroesophageal reflux in infants and children extend beyond repeated vomiting and include dysphagia, pain, bleeding, failure to thrive, esophageal stricture, and recurrent respiratory symptoms including aspiration pneumonitis and cyanotic attacks. The unreliability of the traditional barium swallow examination as a diagnostic test is well known. This study reports the results of endoscopic assessment and esophageal biopsy in 100 infants and children and relates them to the clinical findings and the changes in the contrast esophagogram. The results show that further valuable diagnostic information can be gained from endoscopic examination of the esophageal mucosa, especially when there is esophagitis with ulceration, bleeding, or stricture. Endoscopic biopsies are useful to confirm the presence of esophagitis but biopsies alone do not give absolute diagnostic information.
 ...
PMID:Endoscopy and biopsy in gastroesophageal reflux in infants and children. 743 49

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.
 ...
PMID:Gastro-oesophageal reflux and exercise. Important pathology to consider in the athletic population. 748 Dec 80


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>