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)

Some patients undergoing ambulatory oesophageal pH monitoring to investigate symptoms suggestive of gastro-oesophageal reflux disease (GORD) are found to have oesophageal acid exposure within the physiological range but show a close correlation between their symptoms and individual reflux episodes. It is suggested that these patients might exhibit enhanced oesophageal sensation, akin to the heightened perception of both physiological and provocative stimuli in the gut that has been described in patients with functional gastrointestinal disorders. This study tested the hypothesis by measuring the sensory thresholds for oesophageal balloon distension and discomfort in 20 patients with symptoms of GORD, in whom ambulatory pH monitoring had shown normal acid exposure times, but in whom the symptom index for reflux events was 50% or greater, and compared these with 15 healthy volunteer controls, and with control groups with confirmed excess reflux. The study group showed lower thresholds both for initial perception of oesophageal distension, and for discomfort, compared with healthy controls (median ml (range)); 7.5 (2-19) v 12 (6-30) (p = 0.002) and 10 (5-20) v 16 (8-30) (p < 0.0001), respectively. Sensory thresholds in the study group were also significantly lower than in patients with excess reflux, and than patients with Barrett's oesophagus, who also exhibited significantly higher sensory thresholds than healthy controls. No differences in sensory thresholds for somatic nerve stimulation were found between the study group and health controls. The results show a spectrum of visceral sensitivity in GORD, with enhanced oesophageal sensation in patients with symptomatic but not excess gastro-oesophageal reflux, suggesting that their symptoms result from a heightened perception of normal reflux events.
 ...
PMID:Lowered oesophageal sensory thresholds in patients with symptomatic but not excess gastro-oesophageal reflux: evidence for a spectrum of visceral sensitivity in GORD. 767 84

Laparoscopic Nissen fundoplication is an effective treatment for gastroesophageal reflux. The procedure involves wrapping the gastric fundus around the lower end of the esophagus to augment the lower esophageal sphincter. The procedure offers several advantages over open laparotomy, including smaller abdominal incisions, reduced postoperative discomfort, and shortened postoperative recovery and hospital stays. The laparoscopic approach also reduces the length of time a patient has an ileus.
 ...
PMID:Laparoscopic Nissen fundoplication to treat gastroesophageal reflux. 777 2

180 patients suffering from frequent heartburn and endoscopically normal oesophageal mucosa or mild non-erosive oesophagitis entered an open, multicentre study to evaluate the 6-week safety profile and efficacy on symptom relief of famotidine (CAS 76824-35-6, Pepdul mite), a potent and long-acting H2-receptor antagonist. By week 6 the cumulative percentage of patients with defined response, that is complete relief of heartburn in 5 days and only mild discomfort in the remaining 2 days of a week, reached 68.9%, whereas the cumulative percentage of patients with complete relief of heartburn within a week reached 52.7%. Throughout the evaluation period famotidine relieved nighttime heartburn better than daytime heartburn. More than 75% of the responders remained without recurrence. Even the non-responders experienced a 60-70% reduction of heartburn severity assessed using scores. Antacid consumption was reduced from 18 tablets (median) in week 0 to 5 tablets in week 6. 90% of the patients reported at week 6 excellent (67.2%) or moderate (22.8%) symptomatic improvement. No serious adverse events attributable to famotidine occurred. It is concluded that in patients with non-erosive gastro-oesophageal reflux disease famotidine therapy, 20 mg twice daily, is highly effective in reducing reflux disease symptoms.
 ...
PMID:[Symptomatic therapy with famotidine in non-erosive gastro-esophageal reflux. Results of an open multicenter study]. 777 50

The preferred treatment of gastroesophageal reflux has traditionally been Nissen fundoplication. This involves an extensive abdominal or thoracic incision and subsequently results in patient discomfort, an extended recovery period, and increased overall costs. In the advent of laparoscopic advances surgical correction of symptoms of gastroesophageal reflux are now being offered through minimal access surgery. Increased patient satisfaction, decreased costs, and a quicker return to activities of daily living, suggest why laparoscopic Nissen fundoplication, (LNF) is fast becoming the preferred alternative to correction of gastroesophageal reflux disease. This article will review gastroesophageal reflux and describe one surgical method of laparoscopic correction. The role of the perioperative nurse and implementation of the nursing process regarding this surgical procedure will be highlighted.
 ...
PMID:Laparoscopic Nissen Fundoplication: a minimal access alternative. 781 96

To identify behaviors associated with the onset of gastroesophageal reflux episodes in infants both systematically and prospectively, each of 10 patients (aged 2 to 32 weeks) was studied during 2 hours of intraluminal esophageal pH probe monitoring, using a split-screen audiovisual recording technique. Videotape analysis of eight infants who had scoreable reflux events revealed six discrete behaviors closely associated temporally (P < .001 to < .05) with the onset of reflux events: "discomfort" (crying or frowning), "emission" (of liquid or gas, i.e., regurgitation, drooling, or burping), yawning, stridor, stretching, and mouthing. Three behaviors (hiccuping, sneezing, and thumb-sucking) were infrequent but were significantly associated with onset of reflux events in one or two patients each. A tenth behavior, coughing or gagging, was significantly associated with onset of reflux events in two patients, but not in the rest, despite relatively frequent occurrence. Exploration of temporal relations between reflux and each behavior suggested that discomfort, emission, mouthing, and cough-gag may have caused reflux episodes, and that all 10 of the behaviors may have been caused by reflux episodes. These findings and a "quiet period" immediately preceding episodes in six of the infants suggest interesting pathophysiologic mechanisms in infants which require further evaluation.
 ...
PMID:Behaviors associated with onset of gastroesophageal reflux episodes in infants. Prospective study using split-screen video and pH probe. 785 24

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.
 ...
PMID:Laparoscopic repair of gastroesophageal reflux disease. Toupet partial fundoplication versus Nissen fundoplication. 799 49

The impact of stress on gastroesophageal reflux and antireflux mechanisms remains largely unexplored. To a major extent, reflux depends on a balance between gastroesophageal junction resistance to flow and gastric tone. We hypothesized that these two forces could be differently affected by stress, and to test the hypothesis we quantified in 10 healthy volunteers the effect of an acute stressful stimulus (cold pain) upon both gastroesophageal junction resistance (measured by a pneumatic resistometer) and gastric tone (measured by an electronic barostat). Such measurements were performed both under basal conditions and during stress stimulation (hand immersion in cold water for 5 min), on two separate days. The cardiovascular autonomic response was simultaneously monitored as changes in blood pressure and pulse rate. We found that, taken as a whole, cold stress significantly decreased gastroesophageal resistance (flow increase from 347 +/- 29 ml/min to 526 +/- 58 ml/min) as well as gastric tone (volume increase from 147 +/- 10 ml to 218 +/- 17 ml) (P < 0.02 for both). However, responses showed marked intra- and interindividual variation. Moreover, we found no relationship between changes in resistance to flow at the junction and either the cardiovascular autonomic response or the discomfort produced by cold stress. Changes in gastric tone were similarly unrelated to autonomic and perceptive responses. We conclude that in man experimental stress induced by cold pain tends to disrupt each of two opposite mechanisms that control gastroesophageal reflux: gastroesophageal resistance to flow and gastric tone. However, since both are decreased by stress, gastroesophageal function is largely maintained.
 ...
PMID:Effect of experimental cold pain stress on gastroesophageal junction. 813 3

Forty patients with gastro-oesophageal reflux disease and oesophagitis, documented by endoscopy (grades I to III by the Savary-Miller classification) were randomized to participate in a comparative double-blind trial to receive cisapride (10 mg q.d.s.) or ranitidine (150 mg b.d.) for an 8-week period. Upper gastrointestinal endoscopy was performed immediately before the entry to the trial and after the 8-week period at the completion of the trial. The evaluable cohort included 37 patients who completed the trial, 18 in the cisapride group and 19 in the ranitidine group. Three patients were withdrawn from the trial; one on ranitidine developed severe anaphylactic reaction, one on cisapride severe dizziness and one on cisapride did not wish to continue on the trial. The results of the trial, regarding symptomatic and endoscopic improvement were comparable in the two groups. Both drugs were effective in controlling symptoms, such as acid regurgitation, retrosternal pain, retrosternal burning, epigastric fullness and discomfort (pain, burning, sense of pressure) and resulted in endoscopic healing of oesophagitis. With few exceptions, symptoms remained in remission 1 month after treatment in the majority of patients. Globally, both drugs were tolerated comparably, and adverse effects other than those which resulted in the withdrawal from the trial were minimal in both groups. The results of this trial indicate that cisapride and ranitidine, although of different pharmacological action, are comparable in their therapeutic effect in symptomatic improvement and endoscopic healing in patients with mild to moderate gastro-oesophageal reflux disease.
 ...
PMID:Cisapride and ranitidine in the treatment of gastro-oesophageal reflux disease--a comparative randomized double-blind trial. 816 70

The diagnosis of alkaline gastroesophageal reflux (AGER) by esophageal pH-monitoring is elusive because several other causes may raise esophageal pH above 7. This study approaches the issue by simultaneously recording esophageal and gastric pH with a 2.1 mm assembly of two antimony electrodes in refluxing (n = 69) and nonrefluxing (n = 40) children. On the basis of the information gathered, patients were divided into four groups: acid refluxers (GER, n = 40 or 57%), alkaline refluxers (AGER, n = 8 or 11%), alkalacid refluxers (AAGER, n = 15 or 22%), and silent refluxers or false negatives (SGER, n = 6 or 9%). Children with AGER could not be differentiated from other refluxers nor from controls by esophageal pH information alone. Prolonged gastric buffering or alkalinization could be documented in both AGER and AAGER children, indicating extended duodenogastric reflux (DGR) in them. The incidence of esophagitis was not significantly different between the groups of refluxers: 75% for AGER and AAGER, 73% for GER, and 67% for SGER. AGER, a disorder involving both pyloric and gastroesophageal barriers, is as significant a problem in children as in adults and may lead to severe complications even in the absence of excessive acid exposure. Monitoring esophageal pH alone is insufficient for making the diagnosis of AGER. The diagnosis can be made with little more expense and similar patient discomfort using the two-probe test. We suggest the need for a critical reassessment of the current antacid and prokinetic GER treatments and of antireflux operations which leave DGR intact while correcting GER.
 ...
PMID:Simultaneous gastroesophageal pH monitoring and the diagnosis of alkaline reflux. 826 6

Gastro-oesophageal reflux and pneumonia are complications of enteral feeding. We report our experience of a scintigraphic technique in 51 patients fed by percutaneous endoscopic gastrostomy. The technique was very well tolerated; only one patient (2 percent) had vagal discomfort. A quantitative isotopic study using Tc 99 m labelled enteral infusion demonstrated episodes of reflux in 26 patients (51 percent). The reflux was greater than 6 percent of recording time in 15 patients. All patients with pneumonia had positive scintigraphy. Our study suggests that reflux is frequent after percutaneous endoscopic gastrostomy and constant in patients with pneumonia.
 ...
PMID:[Gastroesophageal reflux after percutaneous endoscopic gastrostomy. Scintigraphic study in 51 patients]. 830 78


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