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

Asthma is an inflammatory disease of the airways characterized by increased airway reactivity with airflow obstruction. It is exacerbated by multiple triggers, and one common, often overlooked trigger is gastroesophageal reflux (GER). The prevalence of GER in asthmatics is estimated at between 34% and 80%. Up to 24% of asthmatics may have silent GER without the classic reflux symptoms (heartburn, acid regurgitation, and dysphagia). Since most patients are initially seen at the primary care level, it is essential for the primary physicians to recognize the underlying cause of the disease. This review briefly discusses the pathogenesis and clinical features of gastric (reflux-triggered) asthma and provides clues for its diagnosis in primary care practice. The current diagnostic approach to such patients and its management relevant to general practitioners is also discussed.
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PMID:Gastric asthma: a clinical update for the general practitioner. 1460 Jun 41

Gastroesophageal reflux disease (GERD) is generally a lifelong illness that affects many people, but its significance is often underestimated. Chronic abnormal gastric reflux results in erosive esophagitis in up to 60% of patients with GERD. Esophageal stricture, Barrett's esophagus, and esophageal adenocarcinoma are the most serious complications of GERD. Although heartburn and acid regurgitation are the most common complaints, extraesophageal symptoms such as noncardiac chest pain, laryngitis, coughing, and wheezing can be manifestations of GERD. Unfortunately, the severity of symptoms is not a reliable indicator of the severity of erosive esophagitis. Endoscopy is the preferred method to diagnose and grade erosive esophagitis, and various classification systems are used to grade disease severity. The Los Angeles Classification is a valid and widely accepted system to evaluate the severity of erosive esophagitis. The immediate goals of treatment are to provide effective symptomatic relief and to achieve healing in patients with esophageal damage. The treatment regimen often begins by prescribing a therapy to reduce gastric acid secretion. A proton pump inhibitor is the preferred agent for many patients. Because GERD is a chronic, relapsing disease, long-term maintenance therapy is usually necessary to relieve symptoms, prevent complications, and improve the quality of life in patients with GERD.
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PMID:Gastroesophageal reflux disease: clinical manifestations. 1460 78

Gastro-oesophageal reflux disease (GERD) is an increasing health problem in developed countries and is associated with enormous costs in terms of reduced quality of life, loss of productivity, health expenses and mortality. The gastrointestinal disease with the highest annual direct costs in the US (in the year 2000) was GERD (9.3 billion US dollars). GERD is primarily a motility disorder of the oesophagus, however, there are no available promotility drugs on the market. The main symptoms are heartburn and acid regurgitation arising from the reflux of gastric acid, which is the only factor at present suited for pharmacological intervention. The proton pump inhibitors (PPIs) give optimal benefit in the treatment of GERD. The sales of PPIs in the year 2002 amounted to 12 billion US dollars in North America and 4 billion US dollars in Europe and the sales have been increasing by > 10% annually. This paper reviews the use of PPIs in the treatment of GERD with particular focus on one of the newer agents, rabeprazole.
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PMID:Review of rabeprazole in the treatment of gastro-oesophageal reflux disease. 1468 Apr 43

Gastroesophageal reflux disease (GERD) is a specific clinical entity defined by the occurrence of gastroesophageal reflux through the lower esophageal sphincter (LES) into the esophagus or oropharynx to cause symptoms, injury to esophageal tissue, or both. The pathophysiology of GERD is complex and not completely understood. An abnormal LES pressure and increased reflux during transient LES relaxations are believed to be key etiologic factors. Prolonged exposure of the esophagus to acid is another. Heartburn and acid regurgitation are the most common symptoms of GERD, although pathologic reflux can result in a wide variety of clinical presentations. GERD is typically chronic, and while it is generally nonprogressive, some cases are associated with development of complications of increasing severity and significance.
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PMID:GERD pathogenesis, pathophysiology, and clinical manifestations. 1470 78

It is still not known whether there are differences between erosive and nonerosive GERD. The aim of the present study is to evaluate the prevalence of Helicobacter pylori (HP) infection, and other differences between erosive and nonerosive gastroesophageal reflux disease (NERD) patients. One-hundred and four consecutive GERD patients (mean age: 41.6 +/- 12.3 years) were interviewed, endoscoped and tested for HP. Erosive GERD was defined according to the Los Angeles classification. Patients who had no erosions in the esophagus but complained of heartburn or/and acid regurgitation at least twice a week and for whom these symptoms had a negative impact on daily activities were considered to be NERD patients. Erosive GERD was identified in 53 (51%) patients (mean age: 41.0 +/- 12.7 years) and NERD in 51 (49.0%) patients (mean age: 42.2 +/- 11.9 years). HP infection was found in 32 (60.4%) erosive GERD patients, and 41 (80.4%) NERD patients, P < 0.05. Multivariate analysis revealed that there were two statistically significant prediction factors for NERD: female sex with odds ratio (OR) of 6.34 (95% CI: 2.41-16.64; P = 0.0002) and HP infection with odds ratio (OR) of 3.28 (95% CI: 1.26-8.58; P = 0.015). The presence of HP and female sex are found to be statistically significant predictors of NERD.
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PMID:Characteristics of patients with erosive and nonerosive GERD in high-Helicobacter-pylori prevalence region. 1536 Oct 95

The effect of non steroidal anti-inflammatory drugs (NSAIDs) on esophageal mucosa is not well known. NSAIDs do not provoke gastro-esophageal reflux disease in healthy subjects but can worsen a preexistant non symptomatic reflux. Mechanism of action is not determined; NSAIDs do not modify the motility of lower esophagus sphincter or of esophageal body. A significant increase of symptoms of GERD (hearthburn and acid regurgitation) is observed in patients treated with NSAIDs. Relative risk of GERD symptoms with NSAIDs is about 2. Erosive esophagitis is common in elderly patients taking NSAIDs but it is not proven that an increased risk of esophagitis exists with NSAID therapy. Case-control studies favored an association between NSAIDs consumption and benign esophageal stricture. NSAIDs can provoke a pill-induced esophagitis, specially if the drugs are absorbed without water and in case of preexistant acid reflux.
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PMID:[Esophageal complications of non steroidal antiinflammatory drugs]. 1536 75

Gastroesophageal reflux disease (GERD) is associated with a range of symptoms (typically heartburn, acid regurgitation and dysphagia), which may or may not be accompanied by endoscopically evident esophagitis. A number of studies have demonstrated that health-related quality of life (HRQoL) in reflux disease patients is significantly impaired in comparison to the general population, regardless of the endoscopic findings. Furthermore, this impairment is comparable to or greater than that observed in other chronic conditions, such as diabetes, arthritis or congestive heart failure. Impaired HRQoL in GERD patients is a result of features such as disturbed sleep, reduced vitality, generalized body pain, an impaired sex life and anxiety about the underlying cause of the symptoms. Nocturnal symptoms of reflux disease appear to have a particularly marked impact on HRQoL. The burden of illness imposed by reflux disease on HRQoL also has an impact on productivity, both at and outside work. The impact of reflux disease on productivity is significant and comparable to that caused by headache or back pain. Effective treatment is available for reflux disease, and there is evidence that this can quickly restore HRQoL to levels observed in the general population. However, poor communication between physicians and patients is contributing to unacceptable levels of patient dissatisfaction. Understanding patients' experience of GERD and its treatment through the study of HRQoL is one way to address this problem.
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PMID:Review of the quality of life and burden of illness in gastroesophageal reflux disease. 1538 50

Gastroesophageal reflux disease (GERD) is a common condition that effects about 10% of the adult population comprising a broad spectrum of symptoms and varying degrees of severity and frequency. Extra-esophageal manifestations are increasingly being recognized. Up to 50% of patients with an endoscopically proven or negative esophagitis suffer from symptoms other than heartburn or acid regurgitation such as laryngitis, hoarseness, chronic cough, asthma, or non-cardiac chest pain. The therapy of choice is proton pump inhibitors.
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PMID:Extra-esophageal disorders in gastroesophageal reflux disease. 1538 51

Gastro-oesophageal reflux disease (GERD) encompasses a wide range of disorders defined by either reflux-related symptoms or by complications of gastro-oesophageal reflux. The most characteristic GERD symptoms are heartburn and acid regurgitation. Patients with these symptoms are in most cases easily identifiable and diagnosis is made on the basis of symptoms alone. For patients with a decreased frequency of heartburn, diagnosis is more difficult, and endoscopy is the single best test for diagnosis of GERD. A major difference between the West and Asia is the frequency of endoscopic investigation. In Japan, the earlier high prevalence of stomach cancers resulted in the increased use of endoscopy as an investigational tool for dyspeptic symptoms and today endoscopy continues to be widely available as a diagnostic tool. However, the overall sensitivity of endoscopy for the diagnosis of GERD is less than 50% since not all patients will have oesophagitis at the time of endoscopy. Ambulatory pH monitoring is therefore a frequently used diagnostic tool as it allows correlation between reflux events and symptoms, and is especially useful in patients with atypical or extraoesophageal symptoms. Oesophageal manometry is also an excellent test to evaluate oesophageal function and to measure sphincter pressure and while it may not provide an unequivocal diagnosis of GERD it is a useful tool with which to evaluate oesophageal function.
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PMID:Review article: diagnosis and investigation of gastro-oesophageal reflux disease in Japanese patients. 1557 66

Gastroesophageal reflux (GOR) disease is one of the 3 commonest causes of chronic cough. It can be difficult to diagnose as the traditionally recognised symptoms of GOR, such as heartburn and acid regurgitation, are often absent. More subtle indicators of a link between the cough and the oesophagus should therefore be sought. These include cough which occurs in relation to eating or phonation, cough which settles at night and does not tend to wake the patient from sleep and symptoms suggestive of laryngopharyngeal reflux. Investigations such as oesophageal manometry and 24 hour pH monitoring can be useful in characterising any underlying oesophageal abnormality, but may underestimate the problem since non-acid reflux can precipitate cough. Empirical trials of treatment are therefore often employed, but should be continued for at least 2 months, as symptoms can be slow to improve due to plasticity of the cough reflex. Pharmacologic treatment options include proton pump inhibitors, H2 receptor antagonists, pro-motility agents and liquid alginate preparations. Surgical fundoplication can also be effective when performed in appropriately selected individuals.
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PMID:Gastroesophageal reflux and chronic cough. 1572 96


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