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

The fear of aspiration of gastric contents and its life-threatening consequences in patients(aspiration pneumonitis and respiratory failure), has caused many medical practitioners, particularly anaesthetists, to rigidly follow conservative (i.e. prolonged) preoperative fasting standards. This is the nil per os (NPO) order for clear fluids/liquids and solids overnight or six to eight hours preceding the induction of anaesthesia. This practice neither takes into account the differences in the rate of gastric emptying for solid food (which may exceed six hours) and clear liquids (which is one to two hours), nor the differences in scheduled times of surgery. Long-term prospective studies and retrospective reviews have shown that the incidence of significant clinical aspiration is low: 1.4-6.0 per 100,00 anaesthetics for elective general surgery. Risk factors for pulmonary aspiration include: a high American Society of Anaesthesiologists (ASA) physical status score; emergency surgery; difficult airway management; increased gastric volume and acidity; increased intra-abdominal pressure; gastro-oesophageal reflux; oesophageal disease; head injury with impaired consciousness and extremes of age. Experimental studies and reviews have consistently shown the safety of clear liquid ingestion up to two hours before induction of anaesthesia in healthy patients without risk factors, and the fact that a longer fluid fast does not necessarily offer any added protection against pulmonary aspiration. The conservative pre-operative fasting standard causes discomfort and in some cases, suffering of patients and is therefore unnecessary for patients without risk factor(s). Anecdotal reports at the University Hospital of the West Indies (UHWI) have shown that application of the liberalized guidelines for preoperative fasting and fluid intake has not resulted in increased pulmonary aspiration, morbidity or mortality. Instead it has resulted in decreased irritability, anxiety, thirst and hunger in the peri-operative period. Patients, especially children are more comfortable and the perioperative period is better tolerated. It is therefore time that all medical personnel adopt the liberalized guidelines.
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PMID:Preoperative starvation and pulmonary aspiration. New perspectives and guidelines. 1263 41

At present, the ambulatory 24-hr pH test has been used as a diagnostic tool to assess gastroesophageal reflux disease (GERD) in those patients with reflux symptoms and a normal endoscopy. However, patients poorly tolerate the prolonged nature of the 24-hr test. The aim of this study was to determine whether analyzing a 3-hr postprandial period from a full 24-hr study would be as sensitive as the longer test. Data were analyzed from a standard ambulatory 24-hr pH recording. A positive test was determined if the pH was < 4 for more than 4% of the study period with the probe placed 5 cm above the lower esophageal sphincter for both groups. The data were then reanalyzed by determining the percent time of pH < 4 during a 3-hr postprandial period. The results of 50 patients with a positive 24-hr test were compared with 50 patients with normal tests. The meal that was used to study the 3-hr postprandial period occurred in the late afternoon or early evening. The 3-hr postprandial test had a sensitivity of 88% when compared to the 24-hour test and a specificity of 98%. The positive predictive value was 100% for the 3-hr test, and the accuracy of this shorter test when compared with the standard 24-hour test was 95%. In conclusion the 3-hr postprandial analysis is a highly sensitive and specific test for demonstrating GERD. By using the shorter test, patient discomfort may be reduced and compliance enhanced.
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PMID:Streamlining 24-hour pH study for GERD: Use of a 3-hour postprandial test. 1264 84

The prescription of peritoneal dialysis should be individualized based on parameters of tolerance and adequacy. Determination of the intraperitoneal fill volume is essential for optimal patient care. Fill volume enhancement is a factor of exchange surface area recruitment: the wetted, contact peritoneal dialysis membrane. Nevertheless, fill volume enhancement can also lead to patient discomfort, with the potential risk of too high an intraperitoneal pressure (hernia, gastro-esophageal reflux). The perception of the individual patient is also a subjective parameter of fill volume tolerance assessment. In contrast, measurement of the hydrostatic intraperitoneal pressure (IPP, cmH(2)O) allows an objective approach to fill volume tolerance. From our clinical experience of more than 10 years of IPP measurements in child care, we can give a recommendation for normal values in children: less than 18 cm of water, usually between 5 and 15 cm, correlated to the intraperitoneal fill volume (naturally), but individually taking into account age, gender, "accustomization" and overall body mass index.
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PMID:Measurement of hydrostatic intraperitoneal pressure: a useful tool for the improvement of dialysis dose prescription. 1289 79

Intraesophageal stenting using a self-expandable metallic stent is currently the first choice for patients with unresectable malignant stricture of the esophagus to improve their quality of life because of its efficacy and less invasiveness. Two types of stent are commercially available in Japan. The Ultraflex stent (Boston Scientific Co. Ltd.) is more flexible and less expandable than the Cook-Z stent (Wilson-Cook Co. Ltd.). Care should be taken based on the position of the stricture. Stenting in the cervical esophagus may cause discomfort. Stenting for a lesion adjacent to the airway may cause airway obstruction. Therefore airway stenting or provision for emergency intratracheal intubation is necessary. A stent with an antireflux mechanism would be effective in preventing gastroesophageal reflux following stenting at the esophagogastric junction. The development and legal approval of a stent with antireflux mechanism are expected. Some reported that anticancer treatment after stenting was effective, and some radiologists cautioned against the risk of radiation after stenting. The safety and efficacy of anticancer treatment after stenting remain to be clarified.
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PMID:[Self-expandable metallic stent for unresectable malignant esophageal stricture]. 1293 24

Fifteen cases of intractable chronic esophagitis due to gastroesophageal reflux were treated with a continuous intraesophageal antacid drip. A proprietary antacid preparation, Gelusil or monalium hydrate (Riopan), in a concentration of one part of antacid to nine parts of water, was infused into the mid-esophagus through a polyethylene tube with an internal diameter which admits a No. 18 blunted needle. Patients are not confined to bed while the drip is in progress. If the flow is constant and the end of the tube is below the cricopharyngeal sphincter, patients do not experience discomfort even if the drip is administered continuously for several days.Results indicate that remission of symptoms can be achieved in almost every patient, even those who have previously failed to respond to oral antacid therapy.
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PMID:CONSTANT INTRAESOPHAGEAL ANTACID DRIP AS A METHOD OF TREATMENT OF REFLUX ESOPHAGITIS. 1411

This report describes the cases of two patients who underwent laparoscopic repair for treatment of Morgagni-Larrey hernia at United Hospital Center in Clarksburg. The first patient was a 40-year-old woman complaining of epigastric discomfort and tenderness. Her chest X-ray revealed an anterior cardiophrenic mass, and a CT scan showed a characteristic Morgagni hernia with incarcerated colon and omentum. After reduction of the incarcerated bowel and omentum, autosuture repair was carried out laparoscopically In the second case, a 22-year-old man with severe GERD was found to have a large Morgagni hernia with incarcerated transverse colon and omentum, which was discovered while he was undergoing an elective laparoscopic Nissen fundoplication. Laparoscopic repair of Morgagni hernia was carried out, in addition to Nissen fundoplication. Both patients did very well postoperatively. Minimally invasive laparoscopic repair can be successfully carried out, and mesh implantation is performed only in some cases. In order to avoid pleural injury, we prefer not to remove the hernia sac before a Morgagni hernia is repaired. Laparoscopic repair should be considered the standard and safest procedure for the treatment of a Morgagni hernia.
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PMID:Laparoscopic treatment of Morgagni-Larrey hernia. 1511 91

Up to 20% of parents report a problem with infant crying or irritability in the first 3 months of life. Crying usually peaks at 6 weeks and abates by 12-16 weeks. For most irritable infants, there is no underlying medical cause. In a minority, the cause is cow's milk and other food allergy. Only if frequent vomiting (about five times a day) occurs is gastro-oesophageal reflux a likely cause. It is important to assess the mother-infant relationship and maternal fatigue, anxiety and depression. Management of excessive crying includes: explaining babies' normal crying and sleeping patterns; helping parents help their baby deal with discomfort and distress through a baby-centred approach; helping parents recognise when their baby is tired and apply a consistent approach to settling their baby; encouraging parents to accept help from friends and family, and to simplify household tasks. If they are unable to manage their baby's crying, admission to a parenting centre (day stay or overnight stay) or local hospital should be arranged.
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PMID:1. Problem crying in infancy. 1551 99

Laparoscopic Nissen, Nissen-Rossetti, cardial calibration with gastropexy, and other modifications are the procedures commonly used for surgical treatment of gastroesophageal reflux disease. Postoperative failures have been reported ranging from 10% to 15% associated with postoperative symptoms or recurrent gastroesophageal reflux. In this paper, we present 38 patients submitted to different procedures in which different "abnormal" deformities were found during the postoperative radiological evaluation with barium swallow. The symptoms associated with these deformities were pain (62%), dysphagia (43%), early satiety (37%), postprandial discomfort (35%), and recurrent postoperative reflux (30%). Dysphagia and pain were frequently observed after the Nissen-Rossetti technique, in which a bilobed stomach and stricture (46%) were confirmed. Hiatal hernia was observed in two patients, and slipped Nissen in one patient associated to pain and early satiety. Patients were submitted to conservative treatment (endoscopic dilatation, proton pump inhibitors, and prokinetics), but 10 patients were submitted to redo surgery. There were no complications, and good results were obtained after redo operations.
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PMID:Anatomical deformities after laparoscopic antireflux surgery. 1573 Jan 5

Idiopathic dyspepsia refers to pain and/or discomfort perceived in the epigastrium that is not secondary to organic, systemic, or metabolic diseases. Symptoms may overlap with those of gastroesophageal reflux disease and irritable bowel syndrome. Gastrointestinal motor disorders, hypersensitivity to mechanical or chemical stimuli, and psychosocial factors can act individually or in concert to induce the symptoms of dyspepsia. Accordingly, there is no single therapy, and treatment must be individualized. Eradication of Helicobacter pylori infection rarely achieves symptom improvement. Treatment of idiopathic dyspepsia should begin by reassuring the patient about the benign nature of the syndrome and educating them on the knowledge that has been achieved in recent years regarding potential causes of the syndrome. Both prokinetic and antisecretory drugs have been reported to improve dyspeptic symptoms, but results are not completely convincing. Although well-designed studies demonstrate superiority of proton pump inhibitors over placebo, it should be noted that patients with nonerosive gastroesophageal reflux disease were invariably included; when these patients are excluded, the benefit of antisecretory medications is questionable. We suggest that patients with idiopathic dyspepsia be initially treated according to the predominant symptom. Those with epigastric pain/burning should receive a trial with standard doses of proton pump inhibitors for 4 to 8 weeks, whereas prokinetic patients should be prescribed at recommended doses for similar periods of time to patients with nonpainful dyspeptic symptoms such as posprandial fullness, early satiety, nausea, or vomiting. Nonresponders may benefit from combination therapies or short trials with higher doses of drugs. Visceral analgesics and antidepressants can also be prescribed alone or in combinations with other therapeutic strategies. Recent studies demonstrate utility for psychologic therapy and hypnotherapy, although truly controlled studies are difficult in this area. Herbal medicines deserve further evaluation.
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PMID:Idiopathic Dyspepsia. 1576 39

Gastroesophageal Reflux disease (GERD) has a common clinical presentation of a burning discomfort in the retroesternal area, regurgitation and dysphagia. Yet, an estimated of 20 to 60 percent of patients with GERD have head and neck symptoms without any appreciable heartburn. Careful history and a meticulous physical exam can guide us to have a correct diagnosis and give adequate treatment. Other methods, such as gastroscopy and gastric pH monitoring, as well as other diagnostic studies can help us to confirm the diagnosis. Once we have the correct diagnosis stabilized, life style modification should be the first step in the management of GERD, aided with antacids, H2 receptors antagonists and/or Proton pump inhibitors. Family physicians should be aware that helping patients to understand the cause of their symptoms and reinforcing the life style modifications will bring better control of the disease and patients can have improvement of their symptoms leading to possible cure of the disease. Gastroesophageal Reflux Disease (GERD) is defined as the movement of gastric contents into the esophagus without presence of vomiting. It is frequently associated with heartburn, the sensation of burning discomfort in retrosternal area, that moves upward, toward the throat. GERD is a chronic, relapsing condition with associated morbidity and adverse impact on quality of life. The purpose of this article is to give an overall look at the clinical presentations of GERD with typical and atypical symptoms, the various presentations of this disease in all of the age groups, and to identify all of the aspects that contribute to the progression and solution of this problem.
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PMID:Typical and atypical presentations of gastroesophageal reflux disease and its management. 1580 87


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