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

Drug-induced esophagitis is being recognized increasingly in the past few years. We have reviewed 175 cases with a view to classifying this disease based on pathology. Drug-induced esophageal injury tends to occur at the anatomical site of narrowing, with the middle third behind the left atrium predominating. The disease is classified broadly into two groups. The first group is transient and self-limiting, as exemplified by tetracycline- and emepronium-induced injury (57.3%). The second is the persistent esophagitis group, often with stricture with two distinct entities: 1) patients on nonsteroidal antiinflammatory agents whose injury is aggravated by gastroesophageal reflux (26.2%) (reflux aggravated), and 2) patients with potassium chloride and quinidine sulfate-induced injury (16.2%) (persisting drug injury). We report a case that highlights the pathophysiology (delayed transit, persisting potassium within the stricture) of this type of injury which is not reflux aggravated.
Am J Gastroenterol 1991 Sep
PMID:Drug-induced esophagitis. 188 89

Two questions were examined, namely, 1) whether pH 4 is really the optimal threshold for the definition of acid gastroesophageal reflux, and 2) to what extent shifting of the upper limits of normal affects sensitivity and specificity of 24-h pH monitoring. To answer these questions, we studied 74 patients with proven reflux disease and 37 asymptomatic volunteers, using ambulatory 24-h esophageal pH monitoring. Gastroesophageal reflux was defined as episodes with esophageal pH of less than the threshold values 3.0, 3.5, 4.0, 4.5, or 5.0, respectively. For each of these pH thresholds, the percentage time with esophageal pH below the threshold was calculated separately for periods of upright and supine body position. Two-dimensional receiver-operating-characteristic (ROC) analysis was used to define upper limits of normal. A maximum of sensitivity, specificity, and rate of correct decisions (all 89%) was obtained using pH 4 for the definition of gastroesophageal reflux, although other pH thresholds were not much worse. On the basis of pH 4, the upper limits of normal could be shifted around the "optimal upper limit of normal" within a certain limit without considerable loss of accuracy of pH monitoring. This may explain the divergences between upper limits of normal obtained by different laboratories. In conclusion, 1) the threshold pH 4 should further be used for the definition of acid gastroesophageal reflux, and, 2) within certain limits, shifting of the upper limits of normal has little effect on the accuracy of pH monitoring in gastroesophageal reflux disease.
Am J Gastroenterol 1991 Sep
PMID:Which pH threshold is best in esophageal pH monitoring? 188 91

Patients with recurrent chest pain free of significant coronary artery disease account for 10% to 30% of patients undergoing coronary angiography. Recent studies suggest that gastroesophageal reflux disease may be very common in these patients. The cause of this chest pain seems to be related primarily to an acid-sensitive mucosa regardless of the presence of esophagitis. Unfortunately, a careful history will not distinguish chest pain arising from a cardiac versus an esophageal source. Therefore, all patients must undergo a thorough cardiac evaluation before assuming that acid reflux is the cause of their complaints. Initial gastroenterology evaluation will usually include upper GI endoscopy or barium studies, possibly with acid perfusion (Bernstein) testing, or both. However, the more sensitive and specific test for acid-related disease is prolonged esophageal pH monitoring. This study quantifies the amount of acid reflux but, more importantly, identifies the relationship between chest pain and acid reflux episodes. Patients should be studied in the outpatient setting with emphasis placed on performing activities that replicate their chest pain. Although we presume that acid-induced chest pain responds as well as heartburn to vigorous antireflux regimens, there are few studies to address this issue. Nevertheless, I have had great success in treating these patients with either high-dose H2 blockers or omeprazole therapy.
Med Clin North Am 1991 Sep
PMID:Gastroesophageal reflux disease as a cause of chest pain. 189 6

In a prospective study of the frequency and clinical importance of heterotopic gastric mucosa in the upper oesophagus, 634 consecutive veteran patients (98% male), undergoing endoscopy for various gastrointestinal complaints, were evaluated. Sixty four patients (10%) had heterotopic gastric mucosal patches varying in size from 0.2-0.3 cm to 3 x 4-5 cm often immediately below the upper oesophageal sphincter. Biopsies of these patches showed fundic type gastric mucosa with chief and parietal cells. The 10% prevalence is more than twice the highest reported prevalence rate of endoscopically detected patches in the upper oesophagus. The characteristic location of these patches at the sphincter area, their uniformly fundic type gastric mucosa, and their poor correlation with clinical and endoscopic evidence of gastro-oesophageal reflux support the hypothesis that they are congenital in nature.
Gut 1991 Sep
PMID:Incidence of heterotopic gastric mucosa in the upper oesophagus. 191 99

Postoperative manometry was carried out in 12 patients with gastro-oesophageal reflux associated with hypomotility of the oesophageal body. A Nissen fundoplication was carried out in all patients. After a median follow-up of 3.5 years, patients underwent clinical, endoscopic, radiological, manometric and pH-metric evaluation. Manometric results revealed an overall improvement in oesophageal motor function with an increase in the amplitude of deglutition waves and a decrease in the percentage of deglutitions without response. Six of the patients (one with complete motor failure) recovered normal peristaltic function. Non-specific oesophageal motor disorders may be secondary to gastro-oesophageal reflux and are reversible in nature.
Br J Surg 1991 Sep
PMID:Surgery improves defective oesophageal peristalsis in patients with gastro-oesophageal reflux. 193 94

Little is known about the relationship between hiatus hernia (HH) and gastroesophageal reflux symptoms (GERS). Nine hundred and thirty patients submitted to gastroscopy because of symptoms completed a self-administered questionnaire. Fourteen per cent showed esophagitis (ES) and 17% HH. Forty-nine per cent of the patients with HH had endoscopic ES, and 60% of those with ES had HH. The severity of ES was dependent (p less than 0.05) on both the presence and the size of HH. After exclusion of patients with peptic ulcer and malignancy, patients with and without HH and ES were compared with regard to the presence of single symptoms and a weighted GERS score based on symptoms proven to be typical for ES. Only borderline differences were found between patients with ES and HH and those with ES and no HH. The former group, however, presented with significantly (p less than 0.001) more GERS than the patients with HH only. Nevertheless, the patients with HH as the only pathologic finding had significantly (p less than 0.01) more GERS than the patients with no major endoscopic abnormality. This study indicates a close association between HH and gastroesophageal reflux disease and supports the clinical significance of an endoscopically detected HH.
Scand J Gastroenterol 1991 Sep
PMID:Relationship between endoscopic hiatus hernia and gastroesophageal reflux symptoms. 194 83

The author discusses the role of prokinetic agents, such as bethanechol, metoclopramide, domperidone, and cisipride in the management of gastroesophageal reflux disease. These agents address the upper gastrointestinal motility disturbances that contribute to this disease and therefore have an important role in the acute and long-term medical management of reflux esophagitis.
Gastroenterol Clin North Am 1990 Sep
PMID:Gastric emptying in gastroesophageal reflux and the therapeutic role of prokinetic agents. 197 2

Of the more than 60 million adult Americans who have heartburn at least once a month, 60% choose over-the-counter medication rather than consulting their physician. Those individuals who do seek medical advice for reflux symptoms will probably receive a prescription for an H2-receptor antagonist, although in many instances simple life-style changes and occasional use of antacids may provide effective therapy. Patients who have severe esophagitis or reflux symptoms unresponsive to H2-receptor antagonists may be treated with a more potent antisecretory agent (proton pump inhibitor). The author discusses the role of antacids and acid inhibition in the treatment of gastroesophageal reflux disease. The results of the clinical trials with the H2-receptor antagonists, cimetidine, ranitidine, famotidine, and nizatidine, and the proton pump inhibitor omeprazole, are compared and contrasted.
Gastroenterol Clin North Am 1990 Sep
PMID:The medical management of reflux esophagitis. Role of antacids and acid inhibition. 197 3

Fifty symptomatic patients with GERD, 20 each of non ulcer dyspepsia (NUD) & duodenal ulcer (DU) and 10 healthy controls were subjected to various tests employed for diagnosis of GERD. Among these endoscopy and histology had highest sensitivities (92% & 91% respectively) followed by Bernstein's test (overall 88%; early positivity 72%) and oesophagography (70%). The specificities of various tests were: endoscopy (86%), histology (82%) and Bernstein's test (overall 80%; early positive 94%). The false positivity was mainly in DU subjects where majority (greater than 84%) had two or more of these tests offitive. Any two of the three tests (endoscopy, histology & Bernstein's test) in combination had a sensitivity of 80-91% and a specificity of 90-92%. Our observations suggest that these tests, particularly in combination, are useful in establishing the diagnosis of GERD and that subclinical oesophagitis in DU might be responsible for the false positivity of these tests.
J Assoc Physicians India 1990 Sep
PMID:Gastro-esophageal reflux disease (GERD): an appraisal of different tests for diagnosis. 209 23

Gastroesophageal reflux disease is a common problem that frequently presents with atypical complaints including nausea, hiccups, globus sensation, chest pain, hoarseness, coughing, or various pulmonary complaints. Diagnosis may be difficult, as these patients often do not have radiographic or endoscopic evidence of esophagitis. In these difficult cases, prolonged esophageal pH monitoring provides an accurate method of quantitating acid reflux parameters and correlating symptoms with reflux episodes in an outpatient setting. Current equipment is compact, durable, and not difficult to use or extremely expensive. Data analysis, with a particular emphasis on acid-exposure time (total, upright, supine), reliably discriminates between abnormal and normal subjects but it is not a perfect "gold standard" for gastroesophageal reflux disease. Indications for esophageal pH monitoring include: (1) atypical symptoms of acid reflux with normal endoscopy, (2) typical reflux symptoms unresponsive to medical therapy, and (3) the follow-up of reflux disease after either medical or surgical therapy. This test is currently performed primarily by gastroenterologists, but we believe many other groups may find this technology helpful. To meet these expanding applications, test refinements are necessary, particularly easier methods of placing the pH probe and better standards for defining abnormal pH parameters in older patients. The future for esophageal pH monitoring is bright. This technology has the potential to do for the diagnosis of gastroesophageal reflux disease what endoscopy has done for the diagnosis of peptic ulcer disease.
Am J Med 1990 Sep
PMID:Prolonged ambulatory esophageal pH monitoring in the evaluation of gastroesophageal reflux disease. 220 64


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>