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

To evaluate the diagnostic value of different tests for gastroesophageal reflux disease, a test population was constructed from 45 patients with symptoms of heartburn and regurgitation with or without esophagitis and 45 healthy subjects, who never experienced heartburn, regurgitation, or swallowing discomfort. The test population underwent esophagoscopy, standard acid reflux test, 24-hour pH monitoring, and manometry of the lower esophageal sphincter. Sensitivity, specificity, positive predictive value, negative predictive value, and the accuracy of the tests and test combinations were calculated. Esophagoscopy had a sensitivity of 62%, that is, only 62% of patients with the disease have evidence of mucosal damage on endoscopy. Manometric measurements of the lower esophageal sphincter had a sensitivity of 84%, a specificity of 89%, and an accuracy of 87%. Twenty-four hour esophageal pH monitoring had a sensitivity, specificity, and accuracy of 96%. The results show that 24-hour pH monitoring can detect gastroesophageal reflux disease with an accuracy of 96% by measuring an increase in esophageal acid exposure. Manometry of the lower esophageal sphincter can detect a mechanically deficient sphincter as a cause of the disease with an accuracy of 87%. The test combination of 24-hour monitoring and motility studies can select patients with an accuracy of 91% who have an increase in esophageal exposure to gastric juice because of a deficient cardia. Antireflux surgery is designed to reduce esophageal exposure to gastric juice in patients with a deficient sphincter by creating a mechanical antireflux mechanism at the cardia. Therefore it is necessary to determine the mechanical status of the sphincter with manometry before surgery in such patients. Thus the indications for antireflux surgery are (1) uncontrolled symptoms of increased esophageal exposure to gastric juice; (2) a documented increase in esophageal exposure to gastric juice by 24-hour pH monitoring; and (3) a mechanically defective sphincter on motility with a pressure of 6 mm Hg or less, an overall length of 2 cm or less, and an abdominal length of 1 cm or less.
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PMID:Specificity and sensitivity of objective diagnosis of gastroesophageal reflux disease. 366 Feb 34

Gastro-oesophageal reflux (GER) in children, causes sometimes aspecific symptoms in children. Not only in the case of regurgitation but also in respiratory problems or even in the 'near missed' - Sudden Infant Death Syndrome GER is to be considered. The most important method of investigation is pH-monitoring during 24 hours preceded by a barium meal and followed by endoscopy, in most cases. Operative treatment is necessary for a hiatal hernia, or after failure of conservative treatment of an oesophagitis. In mentally retarded children, who continue to vomit, a fundoplication can be necessary to improve general care.
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PMID:[Gastroesophageal reflux]. 367 86

Pulmonary aspiration of gastric contents during induction of, or emergence from, anaesthesia poses hazards for both surgical and obstetric patients requiring urgent operations. Little emphasis has been placed on the importance of the lower oesophageal sphincter in relation to regurgitation and aspiration. This is especially important since anaesthetic drugs have been known to both decrease and increase lower oesophageal sphincter (LOS) tone. Any drug that will decrease tone will increase the incidence of gastric oesophageal reflux while drugs that increase tone may decrease this hazard. This review outlines the problem of acid aspiration in relation to the LOS and the various drugs which may influence LOS pressure.
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PMID:The lower oesophageal sphincter and the anaesthetist. 373 46

In a study comprising 100 patients referred to a surgical clinic with symptoms suggestive of gastro-oesophageal reflux disease the value of different diagnostic procedures was investigated. Positive acid perfusion and 24-h pH tests were the commonest findings. Forty-nine per cent showed a normal oesophageal mucosa or diffuse oesophagitis at endoscopy. The severity of heartburn and regurgitation did not differ between patients with normal oesophageal mucosa and oesophagitis of various severities. The severity of macroscopic oesophagitis was significantly correlated to the total reflux time, the presence of reflux or a hiatal hernia at radiology, an open cardia or reflux at endoscopy, pressure transmission or reflux and low lower oesophageal sphincter pressure at manometry. Gastric hypersecretion was found in 66% of the patients. Gastric acid secretion was not correlated to the severity of oesophagitis or to the findings at 24-h pH test. In patients with severe oesophagitis the sensitivity for radiologic, manometric, and endoscopic signs of incompetence of the gastro-oesophageal junction was 94%.
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PMID:Oesophagitis, signs of reflux, and gastric acid secretion in patients with symptoms of gastro-oesophageal reflux disease. 377 50

Owing to the inherent difficulties of recording upper esophageal sphincter pressure, little is known about normal upper esophageal sphincter physiology. In this study we used a modified sleeve device to record upper esophageal sphincter pressure continuously in 8 normal volunteers. Intraesophageal pH and electroencephalogram activity were also recorded to document the occurrence of spontaneous gastroesophageal reflux and sleep. After an hour of baseline recording, the subjects ate a meal. Recording was then resumed for an additional 7 h during which period the subjects slept part of the time. The mean upper esophageal sphincter pressure was measured for each 10-min epoch. Electroencephalogram recordings were read blindly for the presence and stage of sleep. Periods of sleep were then correlated with the manometric tracings. Mean upper esophageal sphincter pressure during wakefulness, stage 1 sleep, and deeper sleep was 40 +/- 17 (SD), 20 +/- 17, and 8 +/- 3 mmHg, respectively. A significant change in upper esophageal sphincter pressure did not occur postprandially or during episodes of spontaneous gastroesophageal reflux. Upper esophageal sphincter pressure was observed to increase transiently with each inspiration during periods of restfulness and sleep, a response consistent with the hypothesis that one function of the upper esophageal sphincter is to exclude air from the esophagus during respiration. The demonstration that upper esophageal sphincter pressure falls markedly during sleep may have significance in that this diminishes the barrier to nocturnal regurgitation and potential aspiration.
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PMID:Effect of sleep, spontaneous gastroesophageal reflux, and a meal on upper esophageal sphincter pressure in normal human volunteers. 379 82

A clinical profile and the course and outcome with therapy of 126 infants and children with gastroesophageal reflux (GER), diagnosed at a median age of 2.5 months and followed for 1.5 to 3.5 years is presented. Features included repeated regurgitation or rumination (99%), signs suggesting esophageal pain (49%, excessive crying "colic," sleep disturbance, Sutcliffe-Sandifer syndrome, respiratory symptoms 42%), failure to thrive (18%), and minor hematemesis (18%). Feeding problems and maternal distress were common, associated with child abuse in four cases. Therapy was initially conservative (posture, thickening of feeds, antacids, bethanechol), augmented by cimetidine in those with proven esophagitis (n = 34, 0.27%). Most (81%) were symptom-free by 18 months of age (55% by 10 months of age); 17 percent had fundoplication with good results; 2 percent have persisting symptoms beyond 2 years of age (1% failed surgery). No deaths were recorded. Surgery was performed for recurrent apneas/aspiration (6%), refractory esophagitis or stricture (5%), and failed medical management (7%). Esophagitis was a significant determinant to outcome, and the importance of selective early endoscopy is emphasized. GER is a cause of considerable morbidity in infants but, with active therapy, is self-limiting in the majority. Certain distinctive clinical signs indicate those patients who require detailed investigation and to whom more aggressive therapeutic efforts should be directed.
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PMID:Gastroesophageal reflux in children. Clinical profile, course and outcome with active therapy in 126 cases. 380 92

Diagnosis of pulmonary disease due to inhalation (PDI) is based on the assumption that not all paediatric pulmonary disease is attributable to infection. Moreover, an accurate investigation of all typical signs of PDI is necessary: drooling, pouring of food from the nose, choking, frequent vomiting and regurgitation. Specific aetiological diagnosis is not difficult when PDI represents only the epiphenomenon of well defined diseases which have disturbed deglutition (e.g. premature birth, cerebral palsy, muscle disease). It is difficult but more important to find the cause of dysphagia when dysphagia itself represents the first sign of dysfunction of the autonomic nervous system (e.g. familial dysautonomy). There are different PDI due to oesophageal dysphagia, e.g. the anomalous artery which presses the oesophagus against the trachea, oesophageal duplication, achalasia. The most frequent cause is gastro-oesophageal reflux, although recently its role in producing symptoms at night in the asthmatic child in much less. Gastro-oesophageal reflux is increased by the Beta2, agonists, the corticosteroids and theophylline. Therefore these drugs, especially theophylline, have to be used with discretion, also if gastro-oesophageal reflux is only suspected (e.g. frequent vomiting by the infant). Anomalous communication between the oesophagus and airways, particularly the laryngotracheo-oesophageal cleft and the isolated tracheoesophageal fistula, are rare diseases and difficult to diagnose. Therefore diagnosis can be delayed for months or even years. Prognosis is extremely variable: repeated inhalation will, however, cause diffuse interstitial fibrosis or, more rarely, a bronchiectasic lesion.
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PMID:[Aspiration bronchopneumopathies]. 383 99

Gastroesophageal reflux has been well described in children as the cause of a variety of symptoms from nutritional to respiratory problems. If the regurgitation and vomiting are very common symptoms in newborns, their persistence after the first months of life will result in pathological entity leading to complications as esophagitis, failure to thrive, respiratory problems. The purpose of this article is to point out the functional and anatomical implications maintaining gastroesophageal reflux in children and the correct indications for surgery.
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PMID:[Gastro-esophageal reflux in childhood. When to operate?]. 383 21

The liquid antacid Novaluzid (10 ml seven times daily) was compared with ranitidine (150 mg twice daily) and with placebo in 57 patients with symptoms and endoscopic signs of oesophagitis and gastro-oesophageal reflux. A randomized three-period change-over design with the double-dummy technique was used. Each treatment period lasted 6 weeks. Only 37 patients (64.9%) completed the entire trial. In retrospect, five patients receiving placebo were withdrawn because of insufficient effect, six patients because of side effects while taking Novaluzid and two while taking ranitidine. The remaining seven dropouts/withdrawals were for reasons without evident relationship to the treatment given. Statistical analyses based both on the 37 completers and on the 43 patients who had at least two treatment periods showed that ranitidine and Novaluzid were superior to placebo with regard to pain score (p less than 0.005) but not with regard to regurgitation, dysphagia, histology, and appearance on endoscopy (p greater than 0.05). It was impossible to distinguish statistically between ranitidine and Novaluzid. In conclusion, ranitidine and high-dose antacids are of equal effectiveness in the short-term treatment of reflux oesophagitis, and both are superior to placebo with regard to symptomatic relief.
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PMID:Ranitidine and high-dose antacid in reflux oesophagitis. A randomized, placebo-controlled trial. 389 81

Episodic apnea leading to asphyxia is a relatively common disorder of young children. Important apnea syndromes include apnea of prematurity, "narrow upper airway syndrome," congenital hypoventilation syndrome, breath-holding spells, and "near-miss" sudden infant death syndrome. More recently described syndromes include apnea associated with feedings, regurgitation or gastroesophageal reflux, and apnea initiated by epileptic seizures. Apnea occurring during wakefulness is common and may be related to that occurring during sleep. Knowledge of the clinical features and pathophysiology of these various kinds of apnea is important in their management.
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PMID:Sleep apnea in infancy and childhood. 390 4


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