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

A new pH capsule telemetry technique was used to measure the pH fluxes in the upper part of the gastrointestinal tract in normal volunteers, symptomatic patients and in those with hiatal herniorrhaphy during the preoperative and postoperative period. The Darvon-sized pH capsule is swallowed with ease and with minimal discomfort by a fasting patient. The pH of the surrounding media activates an FM radio transmitter within the capsule to emit a continuous radio signal which is converted by a receiver to a linear graph on a strip chart recorder. This pH capsule telemetry test is easy to perform on an ambulatory basis and allows an accurate and reproducible determination of the presence or absence of esophageal reflux in patients with and without a hiatal hernia. Its correlation with symptomatic reflux is higher than that found with a conventional gastrointestinal series examination. The technique allows a much clearer distinction to be made between those patients with real symptomatic esophagitis secondary to actual reflux and those with other esophageal, cardiac or pulmonary symptoms existing withour reflux. This study also reveals a consistently lower fasting gastric pH in patients with signs and symptoms of reflux than in normal individuals without reflux. The technique enabled a more accurate assessment of the efficacy of hiatal hernia repair and revealed a reduced degree of esophageal reflux in those patients who had undergone successful repair with fundic plication.
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PMID:A new hyrogen ion telemetry technique for evaluating gastroesophageal reflux. 23 91

We reviewed case histories of 40 pediatric-sized developmentally disabled patients who had previously participated in a study comparing the Nissen fundoplication with the Angelchik prosthesis for the surgical treatment of severe gastroesophageal reflux. Five of these patients had experienced erosions of the prosthesis into the gastrointestinal tract. These erosions were diagnosed between 2 years and 2 years 8 months following surgical insertion of the device. Erosions were associated with a variety of symptoms including vomiting, increasing discomfort, melena, anemia, coffee ground gastric residuals, and repeated small bowel obstructions. In no case was erosion associated with the development of peritonitis. Despite the documented advantages of the Angelchik prosthesis, the 12.5% erosion rate in this patient population is excessive. We recommend that use of the Angelchik prosthesis is not advisable in pediatric-sized developmentally disabled patients.
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PMID:Erosions of the angelchik prosthesis in pediatric-sized developmentally disabled patients. 171 76

A technique of laparoscopic cardiomyotomy is described. The procedure has been performed in a patient with manometrically confirmed classical achalasia with complete relief of episodic total dysphagia and no untoward symptoms including reflux. The procedure was followed by minimal postoperative discomfort and the patient was discharged on the third postoperative day. Laparoscopic cardiomyotomy has the advantage of diminished surgical trauma with accelerated recovery, constitutes definitive therapy comparable to standard myotomy, and by being less disruptive of the lower oesophageal fixation it is prone to precipitate gastro-oesophageal reflux.
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PMID:Laparoscopic cardiomyotomy for achalasia. 183 41

EGD, using 1986 models of either the fiberoptic gastroscope or the videoscope, is a safe and accurate procedure that can be performed by any physician trained in the technique of endoscope passage. It may be performed at large medical centers or small rural hospitals, outpatient clinics, or even private offices. Patients themselves have indicated preference for endoscopic evaluation over the double-contrast barium meal after they have experienced both procedures. The short time of procedure, its accuracy, safety, and its relative lack of discomfort to the patient lend it readily to being an initial component in the primary evaluation of symptoms of abdominal distress, gastrointestinal bleeding, dysphagia, esophageal reflux, persistent vomiting, and odynophagia. It is essential in the evaluation of complications of esophageal reflux and the evaluation of abnormal radiological findings in the upper gastrointestinal tract. It should never be overlooked in evaluating the patient with iron deficiency anemia of unknown etiology. Economic pressures have already moved EGD from the surgery wards to endoscopy labs and to the outpatient setting. These same forces will project more physicians into the role of the diagnostic endoscopist and the patient will benefit by decreased medical costs, quicker diagnosis and treatment, and enhanced continuity of care.
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PMID:Gastroscopy: a primary diagnostic procedure. 304 90

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

During a 15-year period, 62 patients were treated for achalasia of the esophagus. Pneumatic dilation (PD) had been performed initially in 46 and was successful in 23; failures were due to acute perforation of the esophagus, persistent dysphagia, or pathologic gastroesophageal reflux. Esophagomyotomy alone (EM) was performed in 19 individuals resulting in definite improvement in 12; four patients had moderate reflux or dysphagia, and three of these required another surgical procedure. An extended myotomy with an antireflux procedure (M-NF) was performed in 13 patients with symptomatic relief in 12; one patient required reconstruction of a too-tight fundoplication that caused persistent dysphagia. The advantages of pneumatic dilation were the ease of performance, patient acceptability, and an overall efficacy of 50%. Definitive surgical therapy, while more predictably effective in relieving dysphagia, was considerably more expensive in terms of patient discomfort and time. When pathologic reflux was present following a previous procedure, the M-NF was performed; obstruction of the esophagus did not occur if the fundoplication was "floppy." The M-NF deserves consideration as the surgical procedure of choice for achalasia.
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PMID:Achalasia of the esophagus. Treatment controversies and the method of choice. 370 29

One hundred consecutive patients had a primary Nissen fundoplication for gastroesophageal reflux disease. None of the patients had previous gastric or esophageal surgery or evidence of esophageal stricture or motility disorder. The primary symptom was persistent heartburn in 89 patients and aspiration in 11. An abnormal pattern of esophageal acid exposure was documented in all patients with 24-hour esophageal pH monitoring. By actuarial analysis, the operation was 91% effective in the control of reflux symptoms over a 10-year period. The incidence of postoperative symptomatic gas bloat and increased flatus was lower in patients with preoperative abnormal manometric measurements of the distal esophageal sphincter (p less than 0.05). Three modifications in operative technique were made during the course of the study to minimize the side effects of the operation. First, enlarging the caliber of the bougie to size the fundoplication reduced the incidence of temporary swallowing discomfort from 83 to 39% (p less than 0.01). Second, shortening the length of the fundoplication decreased the incidence of persistent dysphagia from 21 to 3% (p less than 0.01). Third, mobilizing the gastric fundus for construction of the fundoplication increased the incidence of complete distal esophageal sphincter relaxation on swallowing from 31 to 71% (p less than 0.05). This was done to prevent the delayed esophageal acid clearance secondary to incomplete sphincter relaxation observed after operation in five of 36 studied patients. It is concluded that by proper patient selection and the incorporation of the above surgical techniques, the Nissen fundoplication can re-establish a competent cardia and provide relief of reflux symptoms with minimal side effects.
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PMID:Nissen fundoplication for gastroesophageal reflux disease. Evaluation of primary repair in 100 consecutive patients. 372 89

The origin of chest discomfort in patients with mitral valve prolapse is controversial. We performed esophageal manometry in 18 patients with mitral valve prolapse, chest pain, and no significant coronary artery disease at cardiac catheterization. Fourteen of the 18 had esophageal disorders: five had diffuse esophageal spasm and two had hypertensive lower esophageal sphincter-motility disorders associated with chest pain syndromes; five mitral valve prolapse patients had hypotensive lower esophageal sphincters, a finding that increases the probability of symptomatic gastroesophageal reflux; and two had nonspecific motor abnormalities. Esophageal disorders may provide an explanation for chest discomfort experienced by certain patients with mitral valve prolapse.
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PMID:Esophageal disorders in patients with chest pain and mitral valve prolapse. 376 96

An increased risk of esophageal carcinoma has been reported in systemic sclerosis (scleroderma). Periodic endoscopic or radiologic surveillance, or both, of systemic sclerosis patients with gastroesophageal reflux symptoms has been recommended for early detection of Barrett's mucosa and esophageal adenocarcinoma. A review of 680 closely followed systemic sclerosis patients for esophageal carcinoma of all types, and of a 22-yr experience with esophageal and esophagogastric junction adenocarcinoma and undifferentiated carcinoma, did not reveal a significant increase in the frequency of esophageal carcinoma in systemic sclerosis. Regular surveillance for Barrett's esophagus and esophageal adenocarcinoma would not appear to be cost-effective because of the rarity of carcinoma, increased patient discomfort and expense, and the questionable benefit for long-term survival.
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PMID:Systemic sclerosis (scleroderma) and esophageal adenocarcinoma: Is increased patient screening necessary? 392 90

Controversy exists regarding the appropriate method for biopsy confirmation of esophageal reflux injury. We have compared endoscopic pinch biopsy (PB) with endoscopically directed Rubin tube suction biopsy (SB) in 40 patients with symptomatic gastroesophageal reflux disease (GERD). Utilizing a plastic tube attached alongside the endoscope, SB at specific sites in the esophagus can be easily obtained. Suction biopsy was rated superior to PB for adequacy of tissue, ability to make an interpretation, and certainty in diagnosis. These differences were most pronounced in patients with endoscopic grades 0 and 1 + esophagitis in which 59% of PBs were uninterpretable compared to 23% of SBs. The passage of the Rubin tube was easily done and could be performed repeatedly. Six of 40 patients (15%) developed substernal chest discomfort in the 24 hr following SB. We conclude that SB is the most appropriate way to evaluate histologic changes related to reflux injury and that this method is mandatory in symptomatic patients with minimal endoscopic evidence of esophagitis (0-1 +).
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PMID:Histologic evaluation of chronic gastroesophageal reflux. An evaluation of biopsy methods and diagnostic criteria. 669 59


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