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

Gastroesophageal reflux disease (GERD) includes different manifestations of esophageal and extraesophageal affections, such as erosive reflux disease, Barrett's esophagus, laryngitis and even pulmonary diseases. Typical symptoms are heartburn and acid regurgitation, but there are a lot of atypical disturbances like hoarseness or chronic cough. Endoscopy is the most important diagnostic procedure for elderly patients and for those with atypical symptoms. Younger people without alarming symptoms can be tested for GERD by treatment with proton pump inhibitors (PPI). The therapeutic approach depends on the endoscopic findings. PPI are preferred drugs to manage most GERD-related problems. Anti reflux surgery is appropriate for selected patients. Long-term followup data will help to define the benefit of new endoscopic procedures. Barrett's esophagus has to be regarded as a precancerous lesion, therefore surveillance strategy is required.
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PMID:[Gastroesophageal reflux disease]. 1635 87

Dyspepsia itself is not a diagnosis but stands for a constellation of symptoms referable to the upper gastrointestinal tract. It consists of a variable combination of symptoms including abdominal pain or discomfort, postprandial fullness, abdominal bloating, early satiety, nausea, vomiting, heartburn and acid regurgitation. Patients with heartburn and acid regurgitation invariably have gastroesophageal reflux disease and should be distinguished from those with dyspepsia. There is a substantial group of patients who do not have a definite structural or biochemical cause for their symptoms and are considered to be suffering from functional dyspepsia (FD). Gastrointestinal motor abnormalities, altered visceral sensation, dysfunctional central nervous system-enteral nervous system (CNS-ENS) integration and psychosocial factors have all being identified as important pathophysiological correlates. It can be considered as a biopsychosocial disorder with dysregulation of the brain-gut axis being central in origin of disease. FD can be categorized into different subgroups based on the predominant single symptom identified by the patient. This subgroup classification can assist us in deciding the appropriate symptomatic treatment for the patient.
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PMID:Reassessment of functional dyspepsia: a topic review. 1671 48

Gastro-oesophageal reflux disease is one of the most common medical problems in daily practice, with many guidelines on diagnosis and treatment available. The prevalence and incidence of reflux disease are rising. In a period of 10 years, the incidence of reflux oesophagitis has almost doubled, as has the number of pills and tablets of acid-suppressive therapy sold. The decreased number of patients with severe reflux oesophagitis is indicative of increased public awareness. Heartburn and regurgitation are the hallmarks of reflux disease. The symptom score in patients with the mild reflux oesophagitis is significantly higher than it is in patients presenting with severe oesophagitis, NERD or Barrett's oesophagus. Patients with mild oesophagitis also suffer from more reflux. Dysphagia is often the only presenting symptom in severe oesophagitis. Patients with reflux oesophagitis have a significantly higher symptom score than patients with Barrett's oesophagus. The scores for heartburn and acid regurgitation are significantly higher in reflux oesophagitis. The primary goal of treatment is complete clinical remission and prevention of long-term complications. In a study with a follow-up of 4.5 to 7.5 years in patients with reflux oesophagitis it was shown that 85% still used acid-suppressive therapy, mostly on a daily basis. However, the majority were never completely free of reflux. Despite the fact that the degree of reflux oesophagitis correlates with the risk of relapse, also patients in whom initially the most severe grade of reflux oesophagitis (grades III and IV) was diagnosed no longer use medication. Treatment of reflux disease with acid suppressants is a major component in national and international drug budgets, and health-care authorities and insurance companies are eager to reduce these budgets. Since diagnosis and treatment are already discussed in many guidelines, cut-backs could be achieved in patients on maintenance therapy. For this reason, more data have to be assessed on therapy outcome in cases of chronic maintenance therapy. Guidelines for maintenance or on-demand therapy are necessary.
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PMID:Gastro-oesophageal reflux disease--experience in daily practice: symptoms and symptom assessment. 1678 15

Gastroesophageal reflux disease (GERD) is a common condition that affects about 20-30% of the adult population, presenting with a broad spectrum of symptoms and varying degrees of severity and frequency. Other manifestations are being increasingly recognized: the so-called ''extraesophageal'' manifestations, such as laryngitis, hoarseness, chronic cough, asthma, or non-cardiac chest pain. Epidemiological studies consistently demonstrate significant associations between pulmonary manifestations and GERD. Up to 50% of patients with an endoscopically proven esophagitis suffer from symptoms other than heartburn or acid regurgitation. However, the published estimates of extraesophageal disorders in patients with GERD vary widely, which may be a result of referral bias. The most effective initial approach in suspected reflux-related extraesophageal symptoms is empiric proton pump inhibitor (PPI) therapy. However, studies demonstrated that the advantage of long-term PPI treatment over placebo could have been overestimated.
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PMID:Extraesophageal manifestations in gastroesophageal reflux disease. 1697 71

The aims of the present study were to compare effects of sodium alginate and the antacid magaldrate anhydrous in adults with gastroesophageal reflux (GOR) symptoms. Patients with heartburn and/or acid regurgitation for at least 3 days in the week before the study started (n=203) were randomized to receive a single dose of sodium alginate or magaldrate anhydrous at the onset of symptoms during a 3-day run-in period. Patients with symptoms during the run-in (n=191) were rerandomized to receive a 14-day treatment with either drug given as four daily doses. A speed of action < or =30 min was significantly more frequent among patients in the alginate group (49.4% vs. 40.4%; P=0.0074). A trend toward a more prolonged duration of action (median: 16.5 vs. 12.7 hr) and a greater sum of the symptom intensity difference (median: 40.0 vs. 31.0) was observed in the sodium alginate group. Total disappearance of symptoms was reported in 81.6% and 73.9% of patients in the sodium alginate group and magaldrate group, respectively. We conclude that sodium alginate was faster than magaldrate in relieving GRO symptoms and showed a tendency toward a more prolonged duration of action and a higher level of efficacy.
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PMID:A comparison between sodium alginate and magaldrate anhydrous in the treatment of patients with gastroesophageal reflux symptoms. 1697 7

Excess alcohol consumption has been associated with multiple pathologies of the gastrointestinal tract. The consumption of large amounts of alcohol (hazardous drinking) facilitates acid regurgitation by reducing the pressure of the lower oesophageal sphincter and slowing both oesophageal motility and gastric emptying. Regardless of the type of alcoholic beverage involved lower alcohol doses also have been shown to induce decreased pressure in lower oesophageal, decrease in oesophageal motility and enhanced risk of gastroesophageal reflux disease (GERD). GERD can be important risk factor for oesophageal adenocarcinoma. For identification of hazardous drinking patients we can use AUDIT (Alcohol Use Disorder Identification Test). AUDIT has been created by World Health Organization experts as a simple screening test looking for hazardous drinking people.
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PMID:[Gastroesophageal reflux disease in hazardous drinkers]. 1700 4

There is a perception that the prevalence of gastroesophageal reflux disease (GERD) is increasing, but few studies have directly tackled this issue. By using a systematic approach, this review aimed to assess objectively whether the prevalence of GERD is changing with time. First, population-based studies that reported the prevalence of at least weekly heartburn and/or acid regurgitation were subjected to a time-trend analysis with a Poisson regression model. Second, population-based studies reporting the prevalence of GERD symptoms at 2 time points in the same source population were reviewed. Third, longitudinal studies that charted the prevalence of GERD symptoms and esophagitis in primary and secondary care were examined. The Poisson model revealed a significant (P < .0001) trend for an increase in the prevalence of reflux symptoms in the general population over time. Separately, significant increases with time were found for North America (P = .0005) and Europe (P < .0001) but not Asia (P = .49). Studies of the same source population over time indicated an increase in the prevalence of GERD in the U.S., Singapore, and China but not Sweden. An increase in the prevalence of GERD or esophagitis was found in the majority of longitudinal studies. There is evidence that the prevalence of GERD has increased during the past 2 decades. If this trend continues, it could contribute to the rapidly increasing incidence of more serious complications associated with GERD, such as esophageal adenocarcinoma, as well as costs to healthcare systems and employers.
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PMID:Time trends of gastroesophageal reflux disease: a systematic review. 1714 9

Gastroesophageal reflux disease (GERD) is a common condition, managed mostly in primary care practice. Heartburn and acid regurgitation are considered primary symptoms, and are usually highly specific. However, the symptom spectrum is much wider and in many cases it is difficult to determine whether the patient has GERD or dyspepsia from another origin. The aim of this study is to develop a symptom score and rule for the diagnosis of GERD, using data mining techniques, to provide a clinical diagnostic tool for primary care practitioners in the evaluation and management of upper gastrointestinal symptoms. A diagnostic symptom questionnaire consisting of 15 items and based on the current literature was designed to measure the presence and severity of reflux and dyspepsia symptoms using a 5-point Likert-type scale. A total of 132 subjects with uninvestigated upper abdominal symptoms were prospectively recruited for symptom evaluation. All patients were interviewed and examined, underwent upper gastrointestinal endoscopy, and completed the questionnaire. Based on endoscopic findings as well as the medical interview, the subjects were classified as having reflux disease (GERD) or non-reflux disease (non-GERD). Data mining models and algorithms (neural networks, decision trees, and logistic regression) were used to build a short and simple new discriminative questionnaire. The most relevant variables discriminating GERD from non-GERD patients were heartburn, regurgitation, clinical response to antacids, sour taste, and aggravation of symptoms after a heavy meal. The sensitivity and specificity of the new symptom score were 70%-75% and 63%-78%, respectively. The area under the ROC curve for logistic regression and neural networks were 0.783 and 0.787, respectively. We present a new validated discriminative GERD questionnaire using data mining techniques. The questionnaire is useful, friendly, and short, and therefore can be easily applied in clinical practice for choosing the appropriate diagnostic workup for patients with upper gastrointestinal complaints.
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PMID:Applying data mining techniques in the development of a diagnostics questionnaire for GERD. 1742 Sep 44

In the past there has been reliance on heartburn and acid regurgitation as the cardinal symptoms of gastro-esophageal reflux. Now it is recognized that diverse additional symptoms including extraesophageal manifestations are essential components of gastroesophageal reflux disease (GERD). Furthermore, previous reliance in mucosal damage at endoscopy as evidence of therapeutic success in the management of GERD has proven of only limited value in the diverse world of GERD symptoms. Indeed is now apparent that the relationship between symptoms and lesions is modest at best. Most patients with GERD have no overt erosions or ulceration at endoscopy and they frequently suffer from a wide array of complaints other than heartburn that contribute to their diminished perception of life's quality. To address these problems, multidimensional questionnaires designed to encompass the diverse symptomatology of GERD have been investigated, principally, to provide a reproducible metric of change in the subjective response to pharmacologic therapy during trials for patients with nonerosive reflux disease. The most promising of these instruments is The ReQuest questionnaire, because it has been extensively validated in multiple patient groups and cultures, appears highly promising in this regard and for erosive disease too and may ultimately prove to be of value for the initial evaluation of patients with GERD. We propose that accurate symptom delineation complemented with endoscopy performed in selected groups of patients will become the mainstay in diagnosis of GERD and the assessment of therapy efficacy.
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PMID:GERD evaluation: time for a new paradigm? 1742 60

The prevalence of the symptoms of reflux (hearthburn and acid regurgitation) and of gastro-esophageal reflux disease is high. Numerous lifestyle modifications have been advocated in the prognosis of reflux. Obesity, the decubitus, eating rapidly, tobacco, alcohol and exercise provoke symptoms of the reflux (hearthburn and acid regurgitation). The proportion of fat in the food and stress aren't factors associated with reflux. Some works point at the chocolate, at the acid juices, at the carbonated beverages and at the onions as factors that unleash symptoms of reflux. Nevertheless larger prospective controlled trials are warranted. Gum-chewing after eating, keep standing up and to go to bed 4 h after dinner improves the symptoms of the reflux and the gastro-esophageal reflux disease.
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PMID:[Influence of lifestyle in patients with gastroesophageal reflux disease]. 1743 11


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