Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0017168 (gastroesophageal reflux disease)
 11,783 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Chronic cough is a common symptom presenting to all clinicians. Every effort should be made to determine the cause(s) of cough because specific therapy has a higher likelihood of success than empiric therapy. Evaluation begins with a complete history, physical examination, routine health screen laboratory testing, chest film, and pulmonary function testing. Further investigation should be guided by the response to treatment of the most likely diagnostic possibilities: postnasal drip, cough-variant asthma, gastroesophageal reflux, chronic bronchitis, bronchiectasis, and ACE inhibitor induced. The majority of each patient's workup can be performed and ordered by the primary care physician.
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PMID:Chronic cough. 787 96

A total of 3409 patients with gastro-oesophageal reflux disease were treated with roxatidine acetate. 60.7% of the patients received a daily dose of 2 x 75 mg roxatidine acetate, and the median duration of treatment was 5 weeks. Symptoms improved in about 90% of patients. For 1687 patients, endoscopic findings were available at the beginning and end of the treatment period. The overall endoscopic healing rate was 65.3%, and, depending on the initial finding (if), decreased from 92.9% (if: Savary-Miller stage I) to 67.5% (if: stage II), 40.7% (if: stage III), and to 22.5% (if: stage IV). Twenty-one patients experienced adverse events during the course of treatment, which, however, were either only minor or not related to the use of roxatidine acetate.
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PMID:[Roxatidine acetate in therapy of reflux esophagitis]. 876 33

Refractory cough in a patient with a normal chest X-ray usually falls into one of five categories: drug-induced (especially by ACE inhibitors), secondary to postnasal discharge, gastroesophageal reflux, or hyperactive airway disease, and idiopathic but responsive to nebulized lidocaine. The history may point to the most likely cause, and empiric therapy may confirm the diagnosis.
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PMID:Persistent cough: causes and cures. 907 71

H1 antihistamines have been shown to have antitussive effects in patients with asthma and postnasal drip. In Japan, no study has been performed to determine whether orally administered oxatomide, H1 antihistamine, can reduce the chronic cough seen in patients with post-upper-airway infection (postinfection). Patients who had chronic cough of more than three weeks' duration and a history of post-upper-airway infection took part in the study. None had any history of nasal disease, gastroesophageal reflux, bronchial asthma, or other chronic pulmonary disease. All patients were non-smokers, and none used ACE inhibitors. They had normal CRP concentrations, peripheral white blood cell and eosinophil counts, serum IgE concentrations, titers of cold agglutinins and antibodies to Mycoplasma pneumoniae, chest roentgenograms, and respiratory function tests. A prospective randomized, open design was used. The effect of one week of treatment with dextromethorphan (D) or with D plus oxatomide (D + O) on the severity of cough, as estimated by cough diary, were examined. Twenty-two patients entered the study, and 20 were eligible for efficacy and side-effect analyses. Nine patients receiving D and 11 receiving D + O completed the protocol. Patients' characteristics before the start of the study, such as severity and duration of cough, and laboratory data, were not significantly different between the two groups. From trial day 5 to 7, improved rates of cough were significantly higher with D + O than with D alone (p < 0.05). Combination therapy with oxatomide and dextromethorphan reduces subjective perception of cough as estimated by cough diary. These results suggest that oxatomide, H1 antihistamine may improve chronic cough in patients with post-upper-airway infection.
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PMID:[Effects of oxatomide, H1-antagonist, on postinfectious chronic cough; a comparison of oxatomide combined with dextromethorphan versus dextromethorphan alone]. 952 65

The cause can almost always be identified. Postnasal drip syndrome, asthma, or gastroesophageal reflux disease account for most cases. The differential diagnosis also includes ACE inhibitor therapy, pertussis, and, in up to 80% of patients, multiple causes. Response to treatment may offer diagnostic confirmation but can be slow in coming.
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PMID:Silencing chronic cough. 1023 42

Hypertension is a significant and prevalent risk factor for the development of cardiovascular disease and target organ damage. The urgency of treatment of high blood pressure depends on the level of blood pressure elevation and the presence of coexistent risk factors for cardiovascular disease. Likewise, the level to which blood pressure is reduced is not restricted to the definition of high blood pressure but instead depends on the underlying disease. Diabetes and renal insufficiency, for example, require blood pressure goals below those that are traditionally defined. In the absence of contraindications, beta-blockers and diuretics are still recommended as first-line agents for treatment of uncomplicated hypertension. Calcium channel antagonists also may reduce mortality. In patients with diabetes, ACE inhibitors are effective first-line agents in type 1 and type 2 diabetic patients who are hypertensive or have microalbuminuria. ACE inhibitors may be beneficial in patients with nondiabetic renal insufficiency as well. Calcium channel antagonists may have some effect in retarding progression of diabetic nephropathy although a recent trial found a higher incidence of death as a secondary endpoint in hypertensive diabetic patients who were treated with calcium channel antagonists. Beta-blockers seem to be safe and well tolerated in patients with mild to moderate intermittent claudication, although patients with rest pain or limb ischemia have not been studied. Beta-blockers should not be used in patients with asthma. Dihydropyridine calcium channel antagonists are the preferred treatment of hypertension in patients with Raynaud's but should be avoided in patients with severe gastroesophageal reflux disease. NSAIDs, particularly piroxicam and indomethacin, raise mean blood pressure by approximately 5 mm Hg, enough to consider a change of either NSAID or antihypertensive to one that is not as affected by NSAIDs. Cyclosporine A can induce hypertension by its vasoconstrictive effects, particularly on the kidney. Calcium channel antagonists may antagonize this vasoconstriction while allowing the clinician to reduce the dose of cyclosporine A required to achieve its immunosuppressive effect.
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PMID:Evaluation and treatment of hypertension. 1046 27

Exercise decreases splanchnic bloodflow. Therefore exercise may induce alterations in gastrointestinal (GI) function. In the present study we investigated the effect of high-intensity exercise on oesophageal motility, gastro-oesophageal reflux, gastric pH, gastric emptying, orocaecal transit time (OCTT), intestinal permeability and glucose absorption simultaneously, using an ambulatory protocol. Ten healthy well-trained male subjects underwent a rest-cycling-rest, and a rest-rest-rest protocol (60-90-210 min). Oesophageal motility, gastro-oesophageal reflux and intragastric pH was measured using a trans-nasal catheter. OCTT was measured via breath H2 measurement. A sugar absorption test was applied to determine intestinal permeability and glucose absorption. Gastric emptying was measured using the 13C-acetate breath test. Peristaltic velocity was increased during cycling, compared to rest (4.92 (2.86) vs. 4.03 (1. 48) cm s-1, P = 0.015). Peristaltic contraction pressure at the mid-oesophagus and the duration of the peristaltic contractions at the mid- and distal oesophagus was lower during cycling. There were no differences between the pre-exercise, the exercise and the post-exercise episodes for gastric pH or for both the number and duration of reflux episodes, in both the rest and cycling trials. Neither gastric emptying nor OCTT showed differences between rest and cycling. The lactulose/rhamnose ratio and intestinal glucose absorption were significantly decreased in the cycling trial. Our model enables multiple GI-measurements during exercise. Cycling at 70% Wmax does not lead to differences in reflux, gastric pH or gastrointestinal transit in healthy trained individuals. The distal oesophageal pressure decreases and peristaltic velocity increases. The lactulose/rhamnose ratio and jejunal glucose absorption are decreased during exercise.
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PMID:The effect of physical exercise on parameters of gastrointestinal function. 1058 50

Caffeine is suspected to affect gastrointestinal function. We therefore investigated whether supplementation of a carbohydrate-electrolyte solution (CES) sports drink with 150 mg/l caffeine leads to alterations in gastrointestinal variables compared with a normal CES and water using a standardized rest-exercise-rest protocol. Ten well-trained subjects underwent a rest-cycling-rest protocol three times. Esophageal motility, gastroesophageal reflux, and intragastric pH were measured by use of a transnasal catheter. Orocecal transit time was measured using breath-H(2) measurements. A sugar absorption test was applied to determine intestinal permeability and glucose absorption. Gastric emptying was measured via the (13)C-acetate breath test. In the postexercise episode, midesophageal pressure was significantly lower in the CES + caffeine trial compared with the water trial (P = 0.017). There were no significant differences between the three drinks for gastric pH and reflux during the preexercise, the cycling, and the postexercise episode, respectively. Gastric emptying, orocecal transit time, and intestinal permeability showed no significant differences between the three trials. However, glucose absorption was significantly increased in the CES + caffeine trial compared with the CES trial (P = 0.017). No significant differences in gastroesophageal reflux, gastric pH, or gastrointestinal transit could be observed between the CES, the CES + caffeine, and the water trials. However, intestinal glucose uptake was increased in the CES + caffeine trial.
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PMID:Gastrointestinal function during exercise: comparison of water, sports drink, and sports drink with caffeine. 1095 54

Roxatidine acetate hydrochloride capsule is slowly absorbed from the gastrointestinal tract, and its acid suppressive effect on the stomach is long-lasting compared with other H2-blockers. The reduction of gastric juice in perioperative period is considered advantageous for patients not only because it decreases the risk for aspiration pneumonia but also because it reduces the risk of bronchial spasm induced by gastroesophageal reflux of acidic gastric content. The effects of single oral administration of roxatidine acetate hydrochloride 150 mg at night before the operation on the volume and pH of gastric juice were investigated during anesthesia using two types of anesthetic agents (isoflurane and propofol) in 93 patients of three age groups (group Y: age 20-40, group M: age 41-64, group O: age 65 <). The effect of roxatidine on reduction of gastric juice was found at the time of anesthetic induction and 2 hours after the induction in any age group with either anesthetic agent. The serum concentration of roxatidine at the time of induction was much higher in group O. The value of residual concentration of roxatidine 20 hours after oral intake was estimated from the intraoperative measurements of serum concentration. The results suggest that single administration at night before the operation is sufficient for the oldest group, but an additive dose is recommended for the younger groups.
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PMID:[Clinical evaluation of roxatidine acetate hydrochlorides as a preanesthetic medication]. 1124 65

Systemic sclerosis is an extremely variable disease in its manifestations and consequently, treatment needs to be individualized depending on the specific problems that each patient has. Limited scleroderma patients have a prolonged duration of Raynaud's phenomenon and puffy fingers before they develop any skin thickening, digital ulcers or gastrointestinal symptoms. They are likely to present with all the classic manifestations of scleroderma. Diffuse scleroderma patients have a much more acute systemic onset with marked whole hand swelling and may initially have only subtle skin thickening. A good understanding of the differences between the natural history of limited and diffuse scleroderma will enable the physician to treat present problems and anticipate future ones more effectively. One should determine which major subset and organ systems are involved before deciding on the appropriate therapy. Advances in organ-specific therapy, particularly calcium channel antagonists in Raynaud's phenomenon, proton pump inhibitors in esophageal reflux, intravenous iloprost and endothelin receptor antagonists in pulmonary hypertension, and ACE inhibitors in renal crisis, have decreased morbidity and mortality in patients with scleroderma. Studies of aggressive therapies to prevent or improve pulmonary fibrosis are in progress. Further clinical experience in wound healing, gastrointestinal malabsorption and physical therapy for loss of motion has helped patients to have a more comfortable life. In recent years, a significant number of controlled clinical trials have been performed and there has been improved understanding of the best way to perform studies and of which patients are most likely to respond to therapy. Penicillamine, methotrexate, photopheresis, relaxin, interferons, and cyclosporine have all been studied in controlled trials with variable outcomes. Although an overall remittive therapy has not yet been determined, new, potentially useful agents are being investigated.
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PMID:Treatment of systemic sclerosis. 1172 50


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