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)

Sixty-five symptomatic infants and children underwent radionuclide gastroesophagography, acid reflux testing, and barium esophagography with water-siphon testing to evaluate the clinical efficacy of the scintigraphic technique in detecting gastroesophageal reflux. After ingesting 99mTc sulfur colloid in fruit juice, patients rested beneath the gamma camera for 30-60 min while esophageal activity was monitored continuously. By using the acid reflux test as a standard of comparison, the sensitivity of radionuclide gastroesophagography was 75%. Because of its physiologic nature, low radiation exposure, and convenience, radionuclide gastroesophagography warrants further evaluation as a screening test for gastroesophageal reflux.
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PMID:Gastroesophageal reflux in children: radionuclide gastroesophagography. 677 39

A zone of increased intraluminal pressure exists at the gastroesophageal junction in man and is believed to act as a physiologic sphincter. Increasing this lower esophageal sphincter (LES) tone is an accepted and useful method in preventing gastroesophageal reflux. The effects of LES tone were studied in 10 healthy volunteers receiving sequential intravenous injections of atropine, 0.6 mg, or domperidone, 10 mg, followed by domperidone, 10 mg, or atropine, 0.6 mg. The order of drug administration was randomized during the first study. Each volunteer was studied a second time, 1 week later, when the order of drug administration was reversed from the first. Administration of atropine decreased mean LES pressure by 12.6 cm H2O (p < 0.001). Subsequent injection of domperidone restored LES tone to near normal. In contrast, initial injection of domperidone approximately 1 week later in the same subjects, mean LES pressure increased by 18.5 cm H2O (p < 0.001). Intravenous injection of atropine, thereafter, failed to decrease mean LES pressure significantly, LES pressure being sustained at a mean of 14.8 cm H2O above basal control levels (p < 0.005). Results of this study suggest that domperidone given prior to atropine, before induction of general anesthesia, may counteract the potentially deleterious effect of atropine on LES tone, and thereby reduce the chances of regurgitation and pulmonary aspiration of acid gastric contents.
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PMID:Domperidone antagonizes the relaxant effect atropine on the lower esophageal sphincter. 719 11

Increasing the resting lower esophageal sphincter (LES) tone is a useful method of preventing gastroesophageal reflux. The effects of a new antiemetic, domperidone, on LES were studied in 28 subjects. Group I included eight normal nonpregnant control subjects. The remaining 20 pregnant women were divided into two groups, Group II and III--ten parturients without and ten with symptoms of heartburn. Domperidone increased LES pressure by 19, 11 and 10 cm H2O in Groups I, II and III, respectively (P less than 0.05). Domperidone may be a valuable premedicant in some patients to decrease the chance of gastro-esophageal reflux.
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PMID:Effect of domperidone on lower esophageal sphincter tone in late pregnancy. 736 52

The results of Nissen fundoplication operation were evaluated in 12 patients with hiatus hernia and gastroesophageal reflux before and 3, 6, and 12 months after the operation. Excellent clinical results as evidenced by absence of dysphagia, esophagitis, and radiological signs of reflux were obtained in 11 patients. One year after operation one patient developed renewed reflux and slight esophagitis, probably due to sliding of the fundoplication. The resting pressure of the lower esophageal sphincter (LES) increased from 5.4 +/- 5.8 cm H2O (mean +/- S.D.) before the operation to 11.8 +/- 5.0 cm H2O 3 months after operation (p less than 0.01). At 6 and 12 months the mean resting pressure (9.5 +/- 4.6 and 8.0 +/- 3.9 cm H2O, respectively) was not significantly different from the preoperative value. Compared with the preoperative LES pressure after pentagastrin stimulation (10.8 +/- 13.9 cm H2O) the pressure 3 months after operation had increased to 33.6 +/- 11.7 (p less than 0.001), after 6 months to 21.6 +/- 7.0 (0.05 greater than p greater than 0.02, and after 12 months to 22.1 +/- 9.0 cm H2O (0.05 greater than p greater than 0.02). In two patients the stimulated pressure decreased after 6 and 12 months; both are completely free of symptoms. We suggest that assessment of the competence of the LES after fundoplication by pressure measurement is of limited value.
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PMID:Effect of Nissen fundoplication operation on the competence of the lower esophageal sphincter. 738 45

The effect of proximal selective vagotomy on the lower esophageal sphincter was studied in 13 dogs by manometry and cinefluorography. The studies, done under resting conditions and during abdominal compression, were repeated 8 weeks after proximal selective vagotomy in seven animals and after truncal vagotomy in six animals. Proximal selective vagotomy had no significant effect on the pressures in the lower esophageal sphincter; the resting pressures were 32.1 +/- 4.1 cm H2O before and 28.9 +/- 3.7 after operation, and the pressures on abdominal compression were 50.6 +/- 6.5 and 41.6 +/- 3.8 cm H2O, respectively (p < 0.05). Truncal vagotomy decreased the lower esophageal sphincter pressures at rest from 28.2 +/- 4.0 to 18.0 +/- 2.2 cm H2O (p = 0.1) and those during abdominal compression from 44.7 +/- 5.6 to 15.5 +/- 2.6 cm H2O (p < 0.01). Gastroesophageal reflux was not seen after proximal selective vagotomy but was seen in one animal in the truncal vagotomy group. Since proximal selective vagotomy does not decrease lower esophageal sphincter function, it offers an advantage over truncal vagotomy in the treatment of duodenal ulcer. The data also indicate that vagal afferents from the proximal stomach are not important in reflex control of lower esophageal sphincter activity.
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PMID:Effect of proximal selective vagotomy on the canine lower esophageal sphincter. 745 41

A healthy neonatal piglet model was developed to investigate the effects of simulated gastro-esophageal reflux (GER) on airway protective mechanisms in different sleep states. Piglets were chosen for the model because there are similarities in esophageal morphology, development of the cardiorespiratory system and sleep-wakefulness cycle between the piglet and the human infant. Unanesthetized piglets were instrumented and trained to sleep in a radiolucent, temperature-controlled box. Physiologic recordings of sleep (electroencephalogram, 'ear-o-gram', behavioral observations), cardiorespiratory function (end-tidal CO2, O2 saturation, heart rate, respiratory movements), swallowing (pharyngeal or esophageal pressures) and GER (signaled by a fall in esophageal pH) were displayed and stored on a computer. An image intensifier was used for radiographic observations. The outputs from the computer and image intensifier were synchronized and recorded on videotape. The method enabled simultaneous physiologic and radiographic observations to be made during the simulation of GER by the injection of normal NaCl, distilled water or HCl (pH 2 and 3) into either the pharynx or different sites in the esophagus. The piglet model appears to accurately reflect the normal physiologic responses of the healthy sleeping neonate.
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PMID:A method for simultaneous physiological and radiographic recordings from sleeping neonatal piglets. 767 62

Secondary peristalsis contributes to oesophageal acid clearance. The aim of the study was to evaluate the integrity and characteristics of secondary peristalsis in patients with gastro-oesophageal reflux disease. Studies were performed in 22 patients with reflux disease and 20 age matched controls. Oesophageal motility was recorded at 3 cm intervals along the oesophageal body. Primary peristalsis was tested with 5 ml water swallows. Secondary peristalsis was stimulated with 10 ml boluses of air and water injected in the mid-oesophagus and by 5 second distensions with a 3 cm balloon at the same level. It was found that primary peristalsis was normal in 19 of 20 control subjects and in 14 of 22 patients with reflux disease. In patients with reflux disease, intact secondary peristalsis was triggered infrequently by air and water distension (median success rate of 0% for both stimuli) and occurred significantly less frequently than in control subjects (50% and 30% respectively). The frequency of balloon induced secondary peristalsis, however, was similar in the two groups (0% controls, 20% reflux disease). The major pattern of failure of secondary peristalsis was the complete absence of any oesophageal secondary peristaltic response. The amplitudes of the intact secondary peristaltic responses were not significantly different for the two groups. Peristaltic velocity for air and balloon induced secondary peristalsis was also similar in control subjects and patients with reflux disease whereas water induced secondary peristalsis was slower in the reflux patients. In conclusion, patients with reflux disease exhibit a pronounced defect in the triggering of secondary peristalsis.
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PMID:Integrity and characteristics of secondary oesophageal peristalsis in patients with gastro-oesophageal reflux disease. 773 53

Gastrointestinal and liver disorders are often observed in high performance athletes, especially those training for the increasingly popular endurance sports including the marathon and the triathlon. The disorders often start with stress before competition or training, followed by dehydration during the event. Insufficient training is an aggravating factor as are certain environmental factors including hot climate, irregular terrain and high altitude. Athletes may also consume non-steroid anti-inflammatory drugs, for example after a minor bone lesion or joint sprain, in an attempt to maintain their highest level of performance. Gastric signs include epigastric pain known to be caused by ischaemic gastritis resulting from decreased splanchnic flow and increased vasoconstriction in the gastric mucosa. Gastrooesophageal reflux results from modifications in sphincter tone and gastric emptying. Drinking hyperosmolar liquids also plays a role. Abdominal pain, diarrhoea, melena and uncommonly ischaemic colitis are the main signs of colic disorders. Mesenteric ischaemia may occur due to lowered splanchnic blood supply (by as much as 80% in some cases). Mechanical trauma is another mechanism; in marathon runners the "caecal slap syndrome" is a repeated microtrauma of the caecum against a hypertrophied muscular wall. Waterborne infectious agents may also lead to colic lesions. Exertion heat stroke is an emergency situation which can cause multiple organ damage and usually occurs after long intense exercise, often, but not always in a hot environment. Uncompensated thermogenesis and excessive loss of water by perspiration leads to central hyperthermia and ischaemic hepatic necrosis. Fatal liver failure has been observed. More or less severe symptoms of gastrointestinal or hepatic disorders are observed in 30% of high performance athletes and the incidence may reach 40% in those who have trained insufficiently. Such disorders lead to reduced performance in 10% of these athletes.
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PMID:[Hepato-digestive disorders in athletic practice]. 802 25

Gastroesophageal reflux (GER) often occurs in babies receiving respiratory assistance for neonatal distress. The authors examined the lower esophageal sphincter and the thoracic and abdominal pressure conditions in rats under progressively higher continuous positive airway pressure (CPAP) to test the efficacy of the antireflux barrier under such conditions. Intrathoracic and intraabdominal pressures were recorded within the esophagus and within the inferior vena cava in 10 anaesthesized 250-g male rats. Pull-through techniques were used for lower esophageal sphincter pressure (LESP) and length (LESL) studies, and the length of the intraabdominal segment of the esophagus (LIASE) was also determined. Measurements were performed in baseline conditions and at CPAP levels of 0, 1, 3, 5, and 7 cm H2O. The respiratory effort progressively increased with prolonged expiration and decreased frequency. LESP and LESL did not change significantly, but the antireflux barrier was weakened by a progressive shortening of LIASE. Successive CPAP increases led to increasingly negative thoracic pressures during inspiration, and increasingly positive abdominal pressures during expiration yielded progressively greater transdiaphragmatic pressure gradients. The authors suggest that CPAP weakens the antireflux barrier and, at the same time, increases the gastroesophageal pressure gradient, thus increasing the risk of GER. Although transpolation of experimental data to the clinical setting is always hazardous, the authors believe this issue should be investigated in infants.
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PMID:Continuous positive airway pressure and gastroesophageal reflux: an experimental study. 807 7

Contraction of the crural diaphragm increases the lower esophageal sphincter (LES) pressure, which is important for preventing gastroesophageal reflux. Our objective in this study was to compare the influence of diaphragmatic contraction on LES pressure of Chagas' disease patients with dysphagia, and control volunteers. We studied 17 patients with positive serologic reactions for Chagas' disease, dysphagia and slow transit of barium sulphate through the esophagus. Two also had esophageal dilatation. Twelve healthy volunteers were the control group. LES pressure was measured by the station pull-through (SPT) method with a round manometric catheter with four side holes opened at the same level, 10 cm from the end of the catheter, infused with water at a flow of 0.5 ml/minute. The catheter was introduced through the nose until the four side holes reached the stomach. After five minutes of stabilization it was withdrawn 1 cm every 15 seconds while the patient or volunteer breathed normally. We measured the difference in LES pressure recorded at inspiration and expiration, which is the contribution of the diaphragmatic contraction to LES pressure. There was no difference in this value between controls (18.5 +/- 9.6 mmHg, mean +/- SD) and patients (17.9 +/- 7.6 mmHg, P > 0.05). The value increased with LES pressure, suggesting that the diaphragm may participate in LES pressure asymmetry. We conclude that the diaphragmatic contribution to LES pressure in Chagas' disease patients is the same as that of normal subjects.
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PMID:[Diaphragmatic contraction in the lower esophageal sphincter pressure in Chagas disease patients]. 808 49


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