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

Inclusion of vagotomy and pyloroplasty in the surgical treatment of gastroesophageal reflux associated with hiatal hernia has long been controversial. To evaluate the morbidity of vagotomy in the treatment of reflux esophagitis, a retrospective study of 311 patients treated by the Hill posterior gastropexy technique of hiatal hernia repair was tabulated. Vagotomy with the anti-reflux operation was performed upon 159 patients (51%). Vagotomy was not included for 152 patients (49%). The incidence of postoperative symptoms with or without vagotomy was almost equally divided--41% without vagotomy and 47% with vagotomy. However, the major postoperative symptoms that occurred in both groups were abdominal cramps and bloating which usually disappeared in the early postoperative period and were attributed to the anti-reflux procedure and not to vagotomy. When vagotomy was included with the anti-reflux operation, the incidence and duration of long term, disabling postoperative symptoms were significantly increased. Diarrhea occurred two times more frequently. Nausea and vomiting occurred ten times more frequently and dumping was present only in vagotomized patients. Long term postoperative symptoms, judged on a basis of symptoms lasting longer than three months duration, occurred in 1% of patients without vagotomy and 26% when vagotomy was included. This study revealed that no additional protection against recurrent symptoms of gastroesophageal reflux or radiographic evidence of recurrent hiatal hernia was provided by inclusion of vagotomy. In conclusion, vagotomy is contraindicated in the treatment of gastroesophageal reflux except in the presence of peptic ulcer disease.
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PMID:Complications of vagotomy in the treatment of hiatal hernia. 97 50

Lower esophageal sphincter pressure has been assessed pre-operatively, intra-operatively,and more than 6 months postoperatively in 34 patients having antireflux surgery for gastro-esophageal reflux disease. The sphincter pressures associated with the outcome in relation to pH measured reflux and the symptoms of recurrent heartburn, gas bloating, and dysphagia have been determined. There was no significant difference between the intra-operative sphincter pressure or the postoperative sphincter pressure and any of these parameters. It is concluded that intra-operative manometry in its present form is not useful in antireflux surgery for primary gastro-esophageal reflux disease.
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PMID:The relationship between intra-operative manometry and clinical outcome in patients operated on for gastro-esophageal reflux disease. 156 20

The effects of the Angelchik prosthesis on esophageal and gastric function were investigated in 17 patients (11 men and six women; median age, 57 years; age range, 36 to 88 years) who underwent surgery for treatment of gastroesophageal reflux disease. All patients demonstrated unequivocal reflux, either at endoscopy or 24-hour pH testing. There was a significant increase in lower esophageal sphincter pressure after surgery, and no patient demonstrated abnormal reflux on pH testing. Gastric emptying of liquids and solids was not altered by surgery. Six months after surgery, all symptoms except dysphagia had significantly improved. Thirty-three months after surgery, six patients described symptoms as severe as or worse than those before surgery. Four patients had the prosthesis removed, two because of dysphagia alone, one because of reflux and dysphagia, and one because of flatulence and bloating. The patients who required removal of the prosthesis because of dysphagia had gross delay of esophageal emptying. We conclude that the Angelchik prosthesis is an effective antireflux device, but it interferes with esophageal function in some patients, requiring removal of the prosthesis. We think the rate of removal of the prosthesis is too high for its routine use in the treatment of gastroesophageal reflux disease.
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PMID:The effect of the Angelchik prosthesis on esophageal and gastric function. 152 90

Persistent gastrointestinal symptoms are common postoperatively in children with intestinal malrotation. We investigated this problem in 14 children with intestinal malrotation who had a Ladd procedure (3 patients), gastroschisis repaired (6 patients), or omphalocele repaired (5 patients) between one month and 15 years prior to study. In 13 patients, gastric emptying was measured at 30 minutes (%GE30) and at 60 minutes (%GE60) following ingestion of 99m-Tc sulfur colloid in apple juice. We estimated the degree of gastric peristalsis using the %GE corrected for immediate postcibal gastroesophageal reflux (corrected %GE). Patients with vomiting exhibited slow gastric emptying compared to patients without vomiting (%GE30: 14.0 +/- 5.5 v 32.5 +/- 4.2, P less than .005). The slow gastric emptying was related to slow gastric peristalsis (corrected %GE30: 20.3 +/- 5.0 v 47.1 +/- 6.0, P less than .005). In all 5 patients with persistent bloating and diarrhea, gastric peristalsis was rapid at 30 minutes (corrected %GE30 = 56.7 +/- 4.2) and at 60 minutes (corrected %GE60 = 69.5 +/- 5.3). To assess the role of gastroesophageal reflux (GER) in persisting symptoms, all children had extended (18 to 24 hours) esophageal pH monitoring. Eleven (79%) of the 14 patients demonstrated GER by esophageal pH monitoring, including four of six patients without reflux symptoms. All ten children under two years of age demonstrated GER regardless of symptoms or congenital anatomic abnormality. In conclusion, GER is common in patients under two years of age with intestinal malrotation, but clinical symptoms seem related more to extreme variations in gastric peristalsis than to GER.
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PMID:The significance of gastric emptying in children with intestinal malrotation. 293 9

Gastroesophageal reflux is common in infants and children and is associated with a broad spectrum of symptoms and disease. The majority of young patients with reflux can be managed nonoperatively because growth and time usually bring maturation of the antireflux mechanisms. We feel that operation is justified and indicated for the child with complications of reflux that are not reversed by a six-week medical trial, and children with stricture or infants with reflux-related apnea should have operation without delay. In our experience, analysis of the 24-hour esophageal pH tracing has proved most useful to correlate respiratory symptoms with reflux. The Nissen fundoplication is the most effective and the most reliable antireflux procedure, but it must be constructed loosely to minimize the side effects of dysphagia and gas bloating. Because the population at risk for reflux disease has approximately a 50 per cent incidence of significant associated medical problems, morbidity and mortality from some of these problems is inevitable. There should be little or no mortality associated with the antireflux operation itself.
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PMID:Gastroesophageal reflux in infants and children. Recognition and treatment. 731 26

Several studies, using pH monitoring with event markers, have identified patients with normal oesophageal exposure to acid despite an apparent relation between symptoms and reflux episodes. In this series of 771 consecutive patients referred for 24 hour oesophageal pH monitoring, a probability calculation was used to evaluate the relation between symptoms and reflux episodes. Oesophageal exposure to acid was normal in 462 of 771 recordings (59.9%); despite this, 70.8% (327 of 462) of these patients used at least once the event marker. In 96 patients (12.5% of total patients) with normal oesophageal exposure to acid, there was a statistically significant association between symptoms and reflux episodes. The symptom cluster of such patients was similar to that usually seen in patients with gastro-oesophageal reflux disease, but symptoms like belching, bloating, and nausea were common thus overlapping with the symptom pattern of functional dyspepsia. In these patients both the duration and the minimum pH of reflux episodes (either symptom related or asymptomatic) were significantly shorter and higher, respectively, when compared with those of patients with gastro-oesophageal reflux disease. These results are consistent with the idea that oesophageal hypersensitivity to acid is the underlying pathophysiological feature of this syndrome.
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PMID:Reflux related symptoms in patients with normal oesophageal exposure to acid. 888 28

Since its introduction by Rudolph Nissen in 1956, fundoplication has become the most commonly used antireflux procedure. Following fundoplication the majority (80 to 90%) of the patients become symptomfree or have only mild and occasional reflux symptoms in the long run. With a short and loose fundic wrap postoperative dysphagia is not a clinical problem, providing that preoperative manometry shows adequate peristalsis. Flatus is increased after fundoplication, but rarely to a disturbing extent. Patients who have problems with flatus preoperatively are also prone to have complaints postoperatively. Bloating is decreased rather than increased after fundoplication. At endoscopy as intact seen fundic wrap (the main determinant of the long-term outcome) is observed in 70% to 80% of the cases 10 to 20 years after the operation. Oesophageal 24-hour pH-recording is normal and oesophagitis cured in similar number of patients. In conclusion, Nissen fundoplication gives effective cure of symptoms of gastro-oesophageal reflux disease and reliably corrects reflux oesophagitis. Postoperative adverse effects are rare and well tolerable and do not detract from the success of the operation in correctly selected patients.
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PMID:Nissen fundoplication for gastro-oesophageal reflux disease: long-term results. 757 68

The effects of fundic mobilization in Nissen fundoplication on belching ability, abdominal gas volume, bloating and flatus were assessed in a prospective, randomized study of 25 patients with refractory gastro-oesophageal reflux disease. Reflux was cured regardless of fundic mobilization. Subjective ability to belch was restored to preoperative in 73% of the patients with fundic mobilization, compared to 50% without. About 10% in both groups totally lost their ability to belch. Disturbance from flatus increased postoperatively slightly in both groups, but from bloating it remained the same or even diminished. The residual intra-abdominal radioactivity (median (interquartile range)) after provoked belching was preoperatively 8.9% (4.4-12.0) with and 13.2% (6.8-15.2) without fundic mobilization, compared to 36.7% (31.1-40.9) of the controls (P < 0.05). After fundoplication this residual activity was normalized in both study groups. Disturbance from postoperative bloating or flatus were not related to the ability of belching. Preoperatively symptomatic patients tended to have more complaints postoperatively. In conclusion, fundic mobilization restored belching ability slightly more effectively without compromising antireflux efficacy, but there did not seem to be any advantage regarding flatus or bloating.
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PMID:Two antireflux operations: floppy versus standard Nissen fundoplication. 763 14

Patients are often referred for evaluation of a wide range of GI complaints including dysphagia, abdominal pain, bloating, nausea, constipation or diarrhoea. Many are diagnosed with 'functional' disease when endoscopy or conventional radiological studies fail to identify an anatomic cause for the patient's symptoms. In such cases nuclear medicine offers non-invasive methods for objectively demonstrating disease involving different areas of the gastrointestinal tract. Increasingly scintigraphy is playing a primary role in the evaluation of patients with suspected acute cholecystitis, active gastrointestinal bleeding, gastroparesis, and small and large bowel motility disorders. In addition, it supplements other studies when results are inconclusive in diagnosing oesophageal dysmotility, gastro-oesophageal reflux, acalculous cholecystitis, and postoperative complications of gastrointestinal surgery.
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PMID:Current applicability of scintigraphic methods in gastroenterology. 777 16

Surgery is indicated when gastro-oesophageal reflux disease (GORD) is resistant to medical treatment. Manometry, upper GI series, pH-metry, gastric emptying studies and gastric acid sampling are performed in order to demonstrate that GORD is caused by a deficient gastro-oesophageal valve mechanism, and hence that surgical treatment will be beneficial. The surgical principle is restoring an anti-reflux barrier by recreating a sufficient pressure gradient in the distal oesophagus, and by correcting the gastro-oesophageal Hiss. Nissen' fundoplication is probably the most efficient anti-reflux procedure. However, it can cause dysphagia, gas bloating and inability to burp. One hundred and fifty-six laparoscopic Nissen fundoplications have been performed by the author. Operating time average 120 min. No perioperative death was observed. There were 3 conversions to laparotomy and 4 peroperative complications: 1 gastric perforation, 2 lesions of the pleura and 1 liver laceration. Four postoperative complications occurred: 1 pneumonia, 1 necrosis of the wrap, 1 small bowel perforation and 1 obstruction due to migration of the entire stomach into the chest. Hospitalisation time ranged between 2 and 14 days (median 2), with a follow up of a median of 10 months. Long-term postoperative complications were: 1 recurrent heartburn 6 months postoperatively and 2 severe dysphagia.
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PMID:[Anti-reflux surgery: indications, principles and contribution of laparoscopy]. 819 Nov 68


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