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

In recent years, there has been increasing interest in how gastrointestinal symptoms relate to and impact on patients' health-related quality of life. This is particularly the case for functional gastrointestinal disorders that are characterized by a lack of biological markers for disease activity. There is only a slight variation in the type of gastrointestinal symptoms reported with different gastrointestinal disorders, and patients with dyspepsia or irritable bowel syndrome, for example, often describe a variety of gastrointestinal symptoms with considerable overlap between them. The same pattern has been observed in patients with gastroesophageal reflux disease, even though heartburn and acid regurgitation are easier to distinguish from other gastrointestinal symptoms, particularly in patients in whom objective reflux is verified. Most aspects of health-related quality of life in patients with gastrointestinal disorders are compromised, irrespective of diagnosis. Patients with functional disorders seem, if anything, to display more emotional distress than those with organic disorders. Given the considerable overlap between different gastrointestinal symptom clusters, it is not surprising that these conditions have a similar impact in terms of perceived health status and quality of life. The key factors associated with the degree of perceived distress and dysfunction relate to disease severity and the presence of abdominal pain symptoms.
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PMID:Quality of life in different gastrointestinal conditions. 1002 66

The authors studied the relationship of endoscopic esophagitis and gastroesophageal flap valve (GEFV) in patients with symptomatic gastroesophageal reflux (GER). On endoscopy, the GEFV was graded as I to IV in 138 patients with acid regurgitation and heartburn relieved by antacids, and in 54 control subjects without symptoms suggestive of GER. Grade of GEFV was correlated with the grade of esophagitis, response to medical treatment, duration of symptoms, obesity, smoking, sex, and age of the patient. Abnormal GEFV (grades III and IV) was more frequent in patients with symptomatic GER, both with and without esophagitis, compared with control subjects (p = 0.000001. p = 0.03). Abnormal GEFV was significantly more common in patients with GER with esophagitis compared with those without (p < 0.00001). There was no significant difference in the distribution of normal and abnormal GEFV in patients with grade I esophagitis. However, grade 2 and grade 3 esophagitis were associated more commonly with an abnormal GEFV (p < 0.00001, p < 0.02 respectively). Hiatal hernia is always associated with an abnormal GEFV. Abnormal GEFV correlated significantly with age (more frequent when older than 40 years). Sex, duration of symptoms (>3 years), response to medical therapy, smoking, and obesity (body mass index > 30 kg/m2) did not correlate significantly with abnormal GEFV. We conclude that endoscopic esophagitis is usually associated with abnormal GEFV. It is more frequent in grades 2 and 3 but not grade 1 esophagitis. It is also encountered more commonly after the age of 40 years.
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PMID:Endoscopic esophagitis and gastroesophageal flap valve. 1019 2

The meaning and definition of dyspepsia continues to challenge clinical investigators and has led to the setting up of several international working teams. However, confusion continues to reign around this term. The effort to classify patients with dyspepsia into subgroups according to their most predominant symptoms has failed to provide clues to the underlying disease, or even to discriminate between functional and organic dyspepsia. With these limitations in mind, the question arises: is there any reason for putting further effort into developing a world-wide definition of dyspepsia when, in addition to the aforementioned shortcomings, further variables such as geographical region, ethnic background, culture and sanitary resources come into play? The answer is that only by establishing a reproducible methodology for individual symptom assessment using a well-defined protocol will comparisons of the prevalence of dyspepsia and the impact of different therapeutic interventions become possible around the world. The data on dyspepsia prevalence, nearly all arising from studies in a few developed geographical areas and countries, are of the order of 1-4% of all consultations in all primary care medicine. However, estimates of adults affected by dyspepsia are as high as 20-40%. The magnitude of these statistics underlines the necessity for further work on the concept of dyspepsia and its major functional subgroups, following the exclusion of any organic causes. Issues such as 'investigate dyspepsia before starting with any kind of treatment or treat dyspepsia before further investigation' or the debate about whether to 'eradicate or ignore Helicobacter pylori in functional dyspepsia' will remain unresolved unless studies performed throughout the world use widely comparable and acceptable definitions and criteria for these conditions. Since the first international working party report in 1988, definitions of dyspepsia have included the description of 'upper abdominal pain or discomfort' and, more recently, have specified 'pain or discomfort centered in the upper abdomen' in order to emphasise further the site of origin as the upper alimentary tract (stomach-duodenum). However, a major change was evident in the more recent Rome I and Rome II reports, in which the symptoms heartburn, acid regurgitation, and belching were excluded from the definition of dyspepsia because of their relation to gastroesophageal reflux disease (GERD) and aerophagia. The intention to define a set of symptoms for dyspepsia is good, but we continue to be faced with overlaps. How should the patient with epigastric pain and heartburn after endoscopic exclusion of duodenal ulcer and reflux esophagitis be classified: dyspepsia or GERD? In cases of abnormal gastroesophageal reflux, 24-h pH monitoring could help to resolve this dilemma, but what if this investigation turns out to be normal? In this field, we need to perform careful studies. In addition, we need to consider the lifestyle and cultural habits of people around the world when translating upper gastrointestinal symptoms into dyspepsia. A step forward in the definition of dyspepsia was attempted by the recent working party for the Rome II consensus on functional gastrointestinal disorders (N. Talley et al.). In this project, the symptoms of dyspepsia were individually described not by a single term, but by painting a 'word picture', to make it easier for patients to express their symptoms, and give doctors and clinical investigators a better understanding of the 'dyspeptic problem' of each individual. It is advisable to follow this approach, since a clear picture of a patient's symptoms, including their duration and intensity, in association with the modern technical approaches that allow investigation beyond organic causes of dyspepsia, will lead to progress in our understanding and better communication about this problem within the medical community, and ultimately to better treatment.
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PMID:Current concepts in dyspepsia: a world perspective. 1044 9

Gastroesophageal reflux disease (GERD) is the most common esophageal disease. Besides the typical presentation of heartburn and acid regurgitation, either alone or in combination, GERD can cause atypical symptoms. An estimated 20 to 60 percent of patients with GERD have head and neck symptoms without any appreciable heartburn. While the most common head and neck symptom is a globus sensation (a lump in the throat), the head and neck manifestations can be diverse and may be misleading in the initial work-up. Thus, a high index of suspicion is required. Laryngoscopy can confirm the diagnosis of laryngopharyngeal reflux. Erythema of the posterior larynx may be seen, and the true vocal cords may be edematous. Treatment should be initiated with a histamine H2 receptor blocker or proton pump inhibitor. Lifestyle changes are also beneficial. Untreated, GERD can lead to chronic laryngitis, dysphonia, chronic sore throat, chronic cough, constant throat clearing, granuloma of the true vocal cords and other problems.
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PMID:Head and neck manifestations of gastroesophageal reflux disease. 1075 Aug 74

Few studies have focused on the impact of gastroesophageal reflux disease on general health and on work absenteeism. Our aim was to evaluate the prevalence and severity of symptoms suggestive of gastroesophageal reflux disease in two samples of Italian employees. We interviewed 424 subjects of S. Matteo Hospital staff and 344 subjects of the Military Factory of Pavia regarding the frequency and severity of heartburn and acid regurgitation during the last 12 months. Subjects were specifically asked whether symptoms interfered with the quality of work activities or determined work absenteeism. In all, 91% of eligible subjects responded. The prevalence rate per 100 of any heartburn or regurgitation experienced at least monthly was 21. This value increased to 45% taking into consideration symptoms experienced occasionally. Mild or moderate symptoms were more frequent than severe symptoms (P < 0.001). Only 2.6% of subjects answered that symptoms have a negative influence on the quality of their work. No work absenteeism was recorded. The study confirms that typical gastroesophageal reflux symptoms are common conditions, but mainly of mild or moderate degree.
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PMID:Prevalence and impact of symptoms suggestive of gastroesophageal reflux disease. 1050 24

The recently reported increase in seroprevalence of Helicobacter pylori, the causative pathogen in peptic ulceration, in bronchiectasis is unexplained. Therefore, the association of antibodies directed against cytotoxin-associated gene A(CagA), whose expression indicates virulence of H. pylori, and upper gastrointestinal symptoms in patients with stable bronchiectasis and healthy volunteers evaluated. One hundred patients (mean +/- SD age 55.1+/-16.7 yrs) and 94 healthy asymptomatic subjects (54.6+/-7.6 yrs) underwent clinical and physiological assessment and serum levels of anti-H. pylori CagA were determined using standard clinical and enzyme-linked immunosorbent assay techniques. Samples were positive for anti-H. pylori CagA in 11.7% of controls and 24% of bronchiectatic subjects (p = 0.03). There was, however, no association between serum H. pylori CagA immunoglobulin G level and forced expiratory volume in one second (FEV1), forced vital capacity (FVC), sputum volume, respiratory symptoms or upper respiratory gastrointestinal symptoms (p>0.05). Patients who suffered from acid regurgitation or upper abdominal distension had significantly lower FEV1 and FVC (as a percentage of the predicted value) compared to their counterparts. The results of anticytotoxin-associated gene A measurements in this study contrasted with the previous finding that anti-Helicobacter pylori immunoglobulin G correlated with sputum volume. These findings, therefore, suggest that Helicobacter pylori, should it have a pathogenic role in bronchiectasis, could act via noncytotoxin-associated gene A-mediated mechanisms, and, in this context, gastro-oesophageal reflux might be of importance in bronchiectasis.
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PMID:Helicobacter pylori and upper gastrointestinal symptoms in bronchiectasis. 1062 65

Gastroesophageal reflux disease (GERD) is one of the most common diagnoses in a gastroenterologist's practice. Gastroesophageal reflux describes the retrograde movement of gastric contents through the lower esophageal sphincter (LES) to the esophagus. It is a common, normal phenomenon which may occur with or without accompanying symptoms. Symptoms associated with GERD include heartburn, acid regurgitation, noncardiac chest pain, dysphagia, globus pharyngitis, chronic cough, asthma, hoarseness, laryngitis, chronic sinusitis and dental erosions. The introduction of fiberoptic instruments and ambulatory devices for continuous monitoring of esophageal pH (24-hour pH monitoring) has led to great improvement in the ability to diagnose reflux disease and reflux-associated complications. The development of pathological reflux and GERD can be attributed to many factors. Pathophysiology of GERD includes incompetent LES because of a decreased LES pressure, transient lower esophageal sphincter relaxations (TLESRs) and deficient or delayed esophageal acid clearance. Uncomplicated GER may be treated by modification of life style and eating habits in an early stage of GERD. The various agents currently used for treatment of GERD include mucoprotective substances, antacids, H(2) blockers, prokinetics and proton pump inhibitors. Although these drugs are effective, they do not necessarily influence the underlying causes of the disease by improving the esophageal clearance, increasing the LESP or reducing the frequency of TLESRs. The following article gives an overview regarding current concepts of the pathophysiology and pharmacological treatment of GERD.
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PMID:Pathophysiology and pharmacological treatment of gastroesophageal reflux disease. 1106 Apr 72

Gastroesophageal reflux disease (GERD) is a common condition with a variety of clinical manifestations and potentially serious complications. This article reviews available methods for diagnosing GERD. A clinical history of the classic symptoms of GERD, heartburn or acid regurgitation, is sensitive enough to establish the diagnosis in patients without other complications. Esophagogastroduodenoscopy is the best way to evaluate suspected complications of GERD, but endoscopic findings are insensitive for the presence of pathological reflux, and therefore they cannot reliably exclude GERD. The "gold standard" study for confirming or excluding the presence of abnormal gastroesophageal reflux is the 24-hour ambulatory esophageal pH monitoring test, and this study should be used for the evaluation of refractory symptoms and extraesophageal manifestations of GERD. A formal acid-suppression test is helpful in the evaluation of the atypical GERD symptom of noncardiac chest pain. Optimal use of currently available tests for GERD may allow for more efficient diagnosis and better characterization of the pathological manifestations associated with GERD.
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PMID:Diagnosing gastroesophageal reflux disease. 1115 24

Usual gastroesophageal reflux (GER) presentations are heartburn and acid regurgitation. The prevalence in occidental population ranges from 5 to 45% according to symptoms frequency. Oesophagitis is observed in 30 to 50% of examined patients and only erosive and ulcerative lesions must be considered. Distinction is made between non-severe oesophagitis (isolated loss of substance), severe oesophagitis (circonferential loss of substance) and complicated oesophagitis (stenosis, ulcerations, brachyoesophagus). 24-hour pH-monitoring analyses reflux duration and relations between symptoms and reflux specially in unusual extraoesophageal presentations. Symptoms and quality of life are the main criteria for staging. In few patients, oesophagitis is severe. Complications (stenosis, ulcerations, bleeding, endobrachyoesophagus) are observed in 10 to 15% of cases. Endobrachyoesophagus with intestinal metaplasia is a risk for neoplasia. The consensus conference proposes this initial therapeutic strategy. In cases of time-spaced symptoms: antiacids, alginic acid or low doses of anti-H2 with life style changes. In cases of typical frequent symptoms, in patients younger than 50 years: 4-weeks treatment with half dosed proton pump inhibitors (PPI) or standard doses of anti-H2 or prokinetics. Nowadays, the majority of the experts propose empiric full-dose treatment. This attitude is more logical as total symptoms suppression with full dose PPI brings positive clues for exact GOR diagnostic without endoscopy. In patients older than 50 years or with alarming symptoms (weight loss, dysplagia, bleeding, anemia): endoscopy must be performed. Patients with non severe oesophagitis: PPI without checking endoscopy. In patients with severe or complicated oesophagitis: 8-weeks treatment following by endoscopy; in non relieved patients: doses are increased. In cases of extraoesophageal presentations: standard PPI treatment during 4 to 8 weeks if GER is well established. In long term strategy, if recidives are rare: intermittent treatment. In early and frequent recidives: long term adapted PPI or surgery. Stenosis are treated by PPI, pneumatic dilatation or surgery if unsuccessful. Brachyoesophagus must be checked by endoscopy every 2 years (malignancy risk).
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PMID:[Diagnosis and treatment of gastroesophageal reflux in the adult: guidelines recommended by French and Belgian consensus]. 1125 2

Gastroesophageal reflux disease (GERD) is highly prevalent in the general population. Heartburn and acid regurgitation are considered the typical presentation of GERD, that however might represent a major pathogenic mechanism in patients with chest pain without coronary artery disease. Chest pain in this instance is often successfully treated with high-dose antisecretory drugs, but the pathogenetic mechanism remains unclear. Further research is needed to clarify the role of GERD on the pathogenesis of chest pain and to ascertain whether a medical or surgical anti-secretory treatment could represent a possible approach. Patients with non-cardiac chest pain of unknown origin should be carefully screened for the occurrence of GERD.
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PMID:[Gastroesophageal reflux disease and chest pain]. 1138 36


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