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

Liquid esophageal transit and gastric emptying, mouth-to-cecum transit, and whole gut transit of a solid-liquid meal were measured in 14 patients with PSS, 16 control subjects (esophageal transit), and 20 control subjects (gastrointestinal transit), respectively, by using scintigraphic techniques, the hydrogen breath test, and stool markers. In patients with PSS, the glucose hydrogen breath test for detection of small intestinal overgrowth was performed and various gastrointestinal symptoms were determined. Esophageal transit and gastric emptying were significantly prolonged in PSS patients with 11 of 14 PSS patients (79%) disclosing delayed esophageal transit and eight of 14 PSS patients (57%) disclosing delayed gastric emptying. All PSS patients with prolonged gastric emptying also had delayed esophageal transit and there was a significant positive correlation between esophageal transit and gastric emptying (r = 0.696, P < 0.01). No significant differences between PSS patients and controls were detected concerning mouth-to-cecum transit and whole gut transit, but abnormally delayed mouth-to-cecum transit was found in four of 10 PSS patients (40%) and abnormally prolonged whole gut transit was detected in three of 13 PSS patients (23%). Small bacterial overgrowth was diagnosed in three of 14 PSS patients (21%). Delayed esophageal transit and gastric emptying were associated with dysphagia, retrosternal pain, and epigastric fullness, while prolonged whole gut transit was associated with constipation. It is concluded that delayed gastric emptying is frequently associated with esophageal transit disorders in PSS patients and may be one important factor for the development of gastroesophageal reflux disease in these patients.
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PMID:Gastrointestinal transit through esophagus, stomach, small and large intestine in patients with progressive systemic sclerosis. 792 44

Ultrasound is a new test proven to be sensitive in the demonstration of gastroesophageal reflux (GER). Following reflux seen with ultrasound various symptoms can be observed in physiological circumstances, and thereby a causal relationship between reflux and these symptoms can be observed in physiological circumstances, and thereby a causal relationship between reflux and these symptoms can be proven. We performed a study in 220 children suspected of GER to determine the incidence of sonographically demonstrated "symptomatic reflux" in different clinical groups: children with (1) vomiting only, (2) respiratory symptoms, (3) attack-like symptoms, and (4) pain and irritability. Overall, GER was demonstrated in 78% of all 209 children in whom technically satisfactory studies could be performed. This reflux was associated with symptoms in 32% of the cases. Symptomatic reflux was most frequent in group 3, which included children investigated for near-miss sudden infant death syndrome. The symptoms that were noted most frequently were vomiting, motor unrest, coughing, and wheezing. Apnea, bradycardia and attacks of unusual posturing could incidentally be related to reflux. Ultrasound is a cheap, simple, noninvasive, and physiological test to show clinically significant reflux.
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PMID:Symptomatic gastroesophageal reflux: diagnosis with ultrasound. 796 78

The explantation of the cause of recurrent chest pain may be a considerable problem. In the first place coronary heart disease should be excluded. classical anginal pain features do not determine unequivocally its cause. One third of patients with anginal pain have normal coronarograms. Patients with chest pain of unexplained origin are a serious clinical problem. Recently, more attention has been paid to the possible role of functional oesophageal disturbances in such symptoms. Gastro-oesophageal reflux and abnormalities in motor function such as "nutcracker oesophagus", diffuse oesophageal oontraction, conditions of increased lower oesophageal sphincter tonus, or non-specific disturbances of motor function may be the cause of pain even of anginal character. However, both reflux and oesophageal motor function disturbances are frequently observed in healthy persons without could be the cause of chest pain. Confirmation of the connection between the symptoms and oesophageal disturbances may require the application not only of X-ray examinations and endoscopy but also manometric and pH-metric examinations and challenge tests (intraoesophageal balloon inflation, test with edrophonium, Bernstein test). Simultaneous monitoring of pH and pressures in the oesophagus during many hours seems to be particularly useful. An important role in the pathophysiology of chest pain may be played by abnormal perception of visceral stimuli ("irritable oesophagus")-so it is useful to supplement the studies with psychological tests.
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PMID:[Role of functional esophageal disturbances in the development of chest pain]. 797 38

Gastroesophageal reflux (GER) is the movement of gastric contents retrograde into the esophagus. Sometimes the refluxate is seen as emesis, but often reflux is "silent," meaning that there are no discrete symptoms during an episode. In adults, the most common symptom of GER is heartburn, whereas in infancy excessive crying and malaise are symptoms that prompt investigation for GER, with or without esophagitis. Symptoms of esophagitis in infancy may include arching (hyperextension) of the torso and refusal of feedings. Tube feedings may be required to treat infants with failure to thrive who refuse oral feedings. Paradoxically, tube feedings increase the number of GER episodes. A hypothetical explanation for refusal of food in infancy is that pain with swallowing (odynophagia) or heartburn are consequences of peptic esophagitis. As a result, infants will learn to refuse food if it hurts or if they fear that it will hurt to eat. Another possible mechanism is visceral hyperalgesia, a neuropathic condition in which prior experience changes sensory nerves so that previously innocuous stimuli are perceived as painful. Some infants may have especially sensitive sensory nerves in the upper gastrointestinal tract, which predisposes visceral hyperalgesia to develop. Thus pain occurs from luminal distension or acid reflux in the absence of tissue damage. The evaluation of babies who won't eat includes a careful history and physical examination to exclude the possibility of chronic systemic illness. Refusal to feed is an unusual manifestation of a common condition: GER disease. The initial tests for GER usually include a barium swallow study to assess the upper gastrointestinal anatomy, endoscopy and esophageal biopsy to assess esophagitis, and an intraesophageal pH study, which is useful in "silent" reflux to quantitate the duration of esophageal acid exposure and to correlate discrete symptom episodes with periods of reflux. The treatment of infants and toddlers who refuse to eat because of pain resulting from visceral hyperalgesia or reflux esophagitis involves removing the pain associated with eating and making eating a pleasurable experience. Treatment for esophagitis may include maintaining an upright posture after meals and thickened feeds, medication to improve gastrointestinal motility or to decrease acid secretion, or fundoplication.
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PMID:Gastroesophageal reflux: one reason why baby won't eat. 798 64

This report describes our preliminary experience with two surgical laparoscopic fundoplication procedures, the Nissen technique and the Toupet operation, in which the fundal wrap is reduced from 360 degrees to 180-200 degrees. Fourteen patients with symptomatic gastroesophageal reflux disease who were refractory to pharmacologic and medical therapy underwent a laparoscopic Nissen fundoplication; in an additional 14 patients, we performed a laparoscopic Toupet partial fundoplication. Our laparoscopic approach to the two procedures does not differ significantly from the traditional open methods and the effectiveness of the laparoscopic fundoplication procedures appears similar to that of the same conventional techniques. Oral feedings can be resumed on the first postoperative day and patients typically are discharged on the second day after surgery. Operative time for performing the Toupet procedure averaged just approximately 1.6 h and was shorter than that for the Nissen fundoplication, due to the use of a stapler to secure the fundal wrap. Confirming earlier observations, the laparoscopic Toupet 180-200 degrees fundoplication was associated with a lower incidence of postoperative digestive complications, such as dysphagia, than was the laparoscopic Nissen operation. The laparoscopic fundoplication approach offers the advantages of clear visualization, adequate dissection and precise repair, along with the benefits associated with endoscopic surgery: diminished postoperative pain and discomfort, reduced hospitalization, and quicker return to normal activities. Our experience indicates that the Toupet fundoplication may be preferable to the Nissen technique for many patients requiring surgical treatment of their reflux disease.
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PMID:Laparoscopic repair of gastroesophageal reflux disease. Toupet partial fundoplication versus Nissen fundoplication. 799 49

Analysis of the association between symptoms and abnormal oesophageal function is a central part of 24 hour oesophageal pressure and pH recording in patients with non-cardiac chest pain. Such studies have used different time windows including a period after the onset of pain. Since stress and pain can induce oesophageal motor abnormalities and transient lower oesophageal sphincter relaxations, a proportion of the motor abnormalities and the reflux episodes observed after the onset of pain may be a consequence rather than the cause of that pain. This study aimed to assess this possibility in patients with chest pain that was presumed to be of oesophageal origin by comparing the results of analysis using time windows before and after the onset of pain. Forty eight patients experienced a total of 166 spontaneous chest pain episodes during 24 hour ambulatory monitoring. A time window beginning two minutes before and ending at the onset of pain (-2/0) was compared with a window beginning at the onset of pain and ending two minutes afterwards (0/+2). The percentage of episodes related to reflux, abnormal oesophageal motility, or neither were 22.9%, 24.7%, and 52.4% in the -2/0 time window and 9.0%, 22.3%, and 68.7% in the 0/+2 time window, respectively. However, 11 of the 37 episodes associated with abnormal motility in the 0/+2 time window were preceded by a reflux episode, and 19 of these 37 episodes had abnormal motility in the -2/0 time window. Consequently, in only seven of the 166 chest pain episodes (4.2%) in two patients were the findings consistent with secondary oesophageal motor disorders provoked by pain. Likewise, only six of the 166 chest pain episodes (3.6%) were consistent with reflux provoked by pain. These findings indicate that in patients with non-cardiac chest pain, gastro-oesophageal reflux and oesophageal motor abnormalities are rarely a consequence of the pain.
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PMID:Temporal relationships between episodes of non-cardiac chest pain and abnormal oesophageal function. 802 Jul 94

A 13-yr-old boy was scheduled for emergency appendicectomy because of abdominal pain. His preoperative medical history was complicated by a recent hospital admission for management of asthma. He had presented to hospital seven days earlier because of dyspnoea, tachypnoea and oxygen desaturation to 77% on room air. Following admission, he required intensive nonventilatory management of his asthma, including intravenous salbutamol, methylprednisolone, and aminophylline, as well as use of an ipratroprium bromide inhaler and 100% oxygen by mask. He was discharged to the ward, and continued on prednisone (delta-cortisone), beclomethasone inhaler, ipratroprium inhaler, and salbutamol inhaler. During his ICU stay, he complained of nonspecific abdominal pain, interpreted as gastro-oesophageal reflux. After four days, he was discharged to the ward. On his sixth hospital day, he began to experience right-sided lower abdominal pain and right shoulder pain. A surgeon was consulted, and the patient was found to have a very tender right lower quadrant with guarding and rebound pain. He was therefore scheduled for appendicectomy; antibiotic therapy with ampicillin, gentamicin, and metronidazole was initiated.
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PMID:Anaesthetic management of an asthmatic child for appendicectomy. 806 95

Gut motility disorders and altered pain perception were reported in patients with irritable bowel syndrome (IBS). To verify foregut involvement in IBS, we studied 30 patients using esophageal manometry and 24-hr pH monitoring of the distal esophagus. Two subgroups of patients underwent esophageal provocative tests (bethanechol 50 micrograms/kg subcutaneously and esophageal balloon distension test). Twelve healthy volunteers formed a control group. A pain threshold on esophageal distension significantly lower than in healthy subjects (11.5 +/- 1 ml vs 22.2 +/- 1.7 ml, P < 0.01) was found in IBS patients. On the other hand, no differences between patients and controls were detected in lower esophageal sphincter pressure and length, esophageal body motility, or GER pattern; furthermore, bethanechol stimulation elicited similar esophageal body motility changes. Our study could confirm no detectable basal or bethanechol-induced esophageal motility disorders in IBS patients, nor enhanced GER. Esophageal involvement in IBS consists of a lower pain threshold on esophageal distension, possibly reflecting an altered visceral receptor sensitivity or modulation throughout the gut.
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PMID:Altered esophageal pain threshold in irritable bowel syndrome. 809 69

The phases of therapy for gastroesophageal reflux disease (GERD) and the efficacy, safety, and cost of the various drugs used are discussed. The therapeutic goals for patients with GERD are to relieve pain, promote healing, avoid complications, and prevent recurrence. Sustained inhibition of gastric acid secretion is necessary to facilitate healing of eroded esophageal mucosa. Phase 1 treatment involves lifestyle changes to remove factors that may help to precipitate reflux, such as overeating, alcohol, and tobacco. Phase 2 involves pharmacologic manipulation of the secretion, concentration, and transport of gastric acid. The drugs used are antacids, alginic acid, the histamine H2-receptor antagonists, the prokinetic agents, sucralfate, and omeprazole. While all of these agents may provide symptomatic relief, only the H2 antagonists and omeprazole have been convincingly shown to relieve symptoms and promote healing. The H2 antagonists differ in potency, pharmacodynamic effect, pharmacokinetics in certain patient groups, drug interactions, and adverse effects. The H2 antagonists may not be effective at standard dosages in patients who secrete especially large quantities of gastric acid. Because of its mechanism of action, omeprazole provides greater inhibition of gastric acid than any other antisecretory drug. Omeprazole may also be the most cost-effective treatment. The availability of omeprazole may reduce the number of patients for whom clinicians must resort to phase 3 treatment, surgery. Although many drugs provide symptomatic relief in patients with GERD, the healing that is necessary to break the cycle of damage and symptoms is promoted only by the H2 antagonists and omeprazole.
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PMID:Efficacy, safety, and cost issues in managing patients with gastroesophageal reflux disease. 809 63

This multicenter, double-blind, randomized, placebo-controlled trial investigated QID and BID regimens of cimetidine (total daily dosage of 1600 mg) in adult patients with moderate or severe gastroesophageal reflux disease. Healing of endoscopically documented lesions and heartburn pain relief were compared among three treatment groups: placebo (n = 82), cimetidine 800 mg BID (n = 85), and cimetidine 400 mg QID (n = 83). To maintain the double-blind conditions, all groups received two tablets QID (a combination of placebo and drug). Healing and improvement were evaluated with repeat endoscopy at 6 and 12 weeks, and pain severity for daytime and nighttime heartburn was recorded separately on diary cards and was rated on a four-point scale (severe = 3, moderate = 2, mild = 1, or none = 0). Efficacy results for the three treatment groups are presented in the following order: placebo, cimetidine 800 mg BID, and cimetidine 400 mg QID. Cumulative healing at week 12, using life-table methods, was 42%, 60% (P < 0.05 vs placebo), and 66% (P < 0.01 vs placebo), respectively. Cumulative improvement was 49%, 66% (P < 0.05 vs placebo), and 75% (P < 0.01 vs placebo), respectively. Median time in days to achieve 24 hours of complete freedom from heartburn was 18, 9, and 4 (P < 0.01 vs placebo), respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Cimetidine QID and BID in rapid heartburn relief and healing of lesions in gastroesophageal reflux disease. 811 19


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