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

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

Dyspepsia is a frequent presenting symptom amongst patients attending medical clinics worldwide. However their aetiologies differ geographically. The present study was conducted to identify the aetiologies of dyspepsia of our centre and to determine their clinical characteristics. Five hundred consecutive patients presenting with dyspepsia were studied at our Institute. All patients underwent detailed structured questionnaire, stool examination, upper gastrointestinal endoscopy, ultrasound scan of upper abdomen and sigmoidoscopy when necessary. Among 500 patients, 34% suffered from essential dyspepsia, 28% had peptic ulcer, 19.2% had cholelithiasis, 10.8% had irritable bowel syndrome and 6% had gastro-oesophageal reflux. Significantly more patients with peptic ulcer experienced night paints, pain relief with food, milk, antacids or H2 receptor antagonists and periodic pain. In patients with essential dyspepsia, pain was continuous, mild to moderate in intensity, aggravated by food or alcohol, without relief with milk, antacids or H2 receptor antagonists and night pains were absent in them.
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PMID:Aetiology and dynamics of dyspepsia in Shimla: a study of 500 patients. 761 3

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

Nissen fundoplication is the procedure of choice for gastroesophageal reflux. In the operating room at St Luke's Episcopal Hospital, Nissen fundoplication has been taken to another level. Because of the increasing trend in laparoscopic surgery and the advanced instruments available, laparoscopic Nissen fundoplication procedures are now performed on a routine basis. One advantage of laparoscopic Nissen fundoplication, as opposed to open Nissen fundoplication, is that the laparoscopic approach is far less invasive. It consists of five 11.5-mm incisions, whereas the open procedure involves a large midline incision. In addition, the overall hospital bill for the laparoscopic procedure can be less than that for an open one; for a laparoscopic Nissen fundoplication, the operating room bill is higher, but the hospital stay is shorter. Usually, the patient can go home the following day and resume daily tasks within days. With an open Nissen fundoplication, the hospital stay is about 3 to 5 days, and because of the large midline incision, a recovery time of 4 to 6 weeks is required. Not only can the patient resume daily activities sooner, but there is generally less pain associated with laparoscopic Nissen fundoplication, and the overall hospital bill is less because of the days spent in the hospital for postoperative recovery.
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PMID:Laparoscopic Nissen fundoplication. 764 60

In a randomised, multicentre trial, nizatidine 150 mg or 300 mg or placebo was administered twice daily for 6 weeks to 515 patients with gastro-oesophageal reflux disease (GORD). Antacid tablets were taken as needed for pain. Significantly superior rates of endoscopically proven complete healing (normal-appearing mucosa) versus placebo occurred after 3 weeks with nizatidine 150 mg and after 6 weeks with nizatidine 300 mg. Six-week healing rates were 38.5% for nizatidine 300 mg, 41.1% for nizatidine 150 mg, and 25.8% for placebo. The nizatidine 150 mg treatment group had significantly greater improvement in daytime and nighttime heartburn severity after 1 day of therapy versus placebo. Twice-daily administration of nizatidine 150 mg or 300 mg provides prompt relief from the major symptom of GORD, heartburn, and complete healing of oesophagitis is seen in many patients.
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PMID:Nizatidine versus placebo in gastro-oesophageal reflux disease: a 6-week, multicentre, randomised, double-blind comparison. Nizatidine Gastroesophageal Reflux Disease Study Group. 779

Two doses of nizatidine (150 mg twice daily and 300 mg at bedtime), an H2-receptor antagonist, were compared with placebo in a 12-week, multicentre, randomised, double-blind, parallel study in 466 patients with endoscopically documented gastro-oesophageal reflux disease. Antacid tablets were given concomitantly as needed for pain. Compared with placebo, nizatidine 150 mg twice daily was highly effective in rapidly reducing the severity of heartburn, regardless of oesophagitis severity at entry. Significantly greater complete mucosal healing of oesophagitis occurred after 6 weeks of therapy with nizatidine 150 mg bid (vs nizatidine 300 mg at bedtime or placebo) only in patients with erosive oesophagitis [16/68 (24%) vs 8/65 (12%)] and erosive and ulcerative oesophagitis combined [21/99 (21%) vs 10/94 (11%)]. At week 12, healing with nizatidine 150 mg bid was also significantly greater than placebo in erosive [19/68 (28%) vs 9/65 (14%)], ulcerative [10/31 (32%) vs 3/29 (10%)], and erosive and ulcerative oesophagitis combined [29/99 (29%) vs 12/94 (13%)]. These results show that twice-daily therapy with nizatidine 150 mg is very effective at relieving heartburn, and can also heal erosive and ulcerative oesophagitis. Nizatidine 300 mg at bedtime was not effective at healing oesophagitis, compared with placebo.
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PMID:Nizatidine versus placebo in gastro-oesophageal reflux disease: a 12-week, multicentre, randomised, double-blind study. 779 1

Leiomyomas are the common est benign tumors of the esophagus and most of them are located in the lower third. Dysphagia and vague pain are the most frequent symptoms. However, 50% of the patients remain asymptomatic and the tumor is often discovered incidentally. Operative management by transthoracic enucleation is the procedure of choice but for asymptomatic forms, this remains controversial. In addition, gastro-esophageal reflux frequently coexists with an esophageal leiomyoma and the therapeutic indications are not well defined for such situations. We report 3 cases of esophageal leiomyoma situated in the lower third, with emphasis on the operative management by transhiatal enucleation, particularly in case of coexisting gastro-esophageal reflux. This procedure avoids thoracotomy and the surgical treatment of the associated gastro-esophageal reflux is much easier by this approach than with thoracotomy.
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PMID:[Leiomyomas of the lower third of the esophagus. Value of transhiatal enucleation]. 781 Sep 78

What are some take-home lessons on the syndrome of unexplained chest pain? Carefully exclude heart disease, which--unlike esophageally caused chest pain--may be life-threatening. Noncardiac chest pain is a common problem: at least 25% of chest pain patients in coronary care units or emergency rooms "rule out" for heart disease. It is a problem that has been vexing physicians for at least 100 years. The pain patterns in ischemic heart disease and in the unexplained pain syndromes, particularly reflux, may be identical. The mechanism may be an "irritable" esophagus, in which the visceral pain threshold is lowered. Look carefully for gastroesophageal reflux, and treat it aggressively. Finally, in all cases, try to establish a diagnosis if at all possible. When patients are told they don't have heart disease and no further workup is pursued, more than half of them continue to have significant morbidity from their chest pain, utilizing health care facilities and visiting doctors (34,35). Research over the past two decades has enlightened us about many patients with unexplained chest pain, but unfortunately we are still confused about many others, and for this group of patients a conservative therapeutic approach may be best.
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PMID:Approach to the patient with unexplained chest pain. 783 62

The relation between symptom severity in gastro-oesophageal reflux disease (GORD) and quantitated oesophageal acid reflux is variable. Furthermore, when oesophageal acid exposure lies within the conventional normal range, the cause of the symptoms is unknown. This prospective study evaluated 24 hour ambulatory oesophageal pH profiles in relation to objective symptom scores in 100 dyspeptic patients who were free from ulcer and gall stones. Twenty patients had raised oesophageal acid exposure and reflux symptoms consistent with GORD, and 80 had oesophageal pH profiles within the conventional normal range. Forty four of the 80 had severe or moderate reflux symptoms and were classified as having reflux like functional dyspepsia (RFD); 36 had minimal or absent reflux symptoms, and were categorised as having non-reflux dyspepsia (NFD). While oesophageal pH profiles lay within the conventional normal range in both functional dyspepsia subgroups, patients with RFD had consistently greater acid exposure values as follows: mean (SEM) total oesophageal acid exposure time, RFD 16.2 (2.56) min v NFD 9.05 (2.0) min (p < 0.03); percentage of time with pH < 4, RFD 1.4 (0.2) v NFD 0.8 (0.2) (p < 0.03); DeMeester scores, RFD 12.8 (0.5) v NFD 11.4 (0.4) (p < 0.03). The RFD group had a pain/reflux event correlation of 23.8 (5.3)% v 8.1 (3.7)% for the NFD group (p < 0.01). This study shows that patients with RFD have oesophageal acid exposure that lies below the diagnostic threshold for GORD, but exceeds that of patients with NFD. The high pain/reflux event correlation in RFD, suggests that subthreshold oesophageal acid exposure may be associated with troublesome reflux symptoms.
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PMID:Importance of reflux symptoms in functional dyspepsia. 788 15

Widespread us of laparoscopic surgery adds a new element to the debate over the choice between medical or surgical treatment for gastro-oesophageal reflux. Patients and gastroenterologists often favour medical management to avoid post-operative pain, a long recovery period, an abdominal scar or the risk of eventration but at the cost of long-term drug therapy and the need for repeated check-ups and endoscopy examinations. Yet surgery was found to give better long-term results in the only study comparing surgery and medical treatment. The question of cost and insurance coverage must also be considered. Although the indications for laparoscopic surgery would be identical to those for laparotomy it is probably possible that a wider population could benefit from this technique as laparoscopic cure can be indicated as an alternative in patients highly dependent on drug therapy. Relapse in patients with a long-term medical regimen is another recent indication. We should however always keep in mind that good outcome after laparoscopic surgery depends not only on a correct indication and evaluation of the oesophageal motricity but also on the skill and experience of the surgical team. Laparoscopic cure should certainly play a major role in the treatment of gastro-oesophageal reflux and will undoubtedly soon be the second most frequent laparoscopic technique performed after laparoscopic cholecystectomy.
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PMID:[Gastroesophageal reflux. 2nd indication for digestive celioscopic surgery?]. 789 64


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