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 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Around 10-20% of the population suffer from the hallmark symptoms of heartburn, regurgitation, sour burping and retrosternal pain. Based on their characteristic medical history alone, such patients can usually be presumed to have gastroesophageal reflux disease (GERD). In around 30-50% of them, the endoscopic examination will reveal the typical erosions and ulcerations in the esophagus. In addition to the clinical symptoms, endoscopy plays a central role in diagnosing GERD. An endoscopy is always indicated whenever these warnings symptoms are present. In patients with persistent reflux problems, endoscopy is indicated to diagnose erosive reflux esophagitis. This procedure should include a routine biopsy taken distal to the Z-line to enable histological detection of the metaplasia associated with Barrett's esophagus. Although the majority of patients exhibit the classical symptoms and respond to acid suppression therapy, endoscopy may not find erosions (non-erosive reflux disease NERD). In these cases, further diagnostic steps must be taken to verify the diagnosis of gastroesophageal reflux disease. There are patients, moreover, who exhibit unclear, uncharacteristic reflux symptoms, such as respiratory diseases with bronchial asthma, chronic bronchitis, chronic cough or ENT problems like posterior laryngitis and globus sensation (a lump in the throat). In these uncertain cases and in patients with NERD, 24-hour pH monitoring can verify and objectify and acid gastroesophageal reflux. An association can then be made between acid reflux and symptomatology. As an alternative, trial therapy with a proton pump inhibitor can help identify patients who have acid-related problems and symptoms. Other functional tests such as radiographic examination, manometry or scintigraphy are less well suited, if at all, for primary diagnostics of gastroesophageal reflux disease.
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PMID:[Diagnosis of gastroesophageal reflux]. 1207 Oct 79

Neurotoxicological profile of actoprotector bromantane was studied on rats using S. Irwin's protocol of multi-test observation. The drug in doses of 30-300 mg/kg stimulated and in doses of 600-9,600 mg/kg suppressed behavioral activity. Spontaneous motor activity increased after single treatment with bromantane in doses of 30-300 mg/kg, did not change after treatment in doses of 600 mg/kg, and was inhibited after treatment in doses above 600 mg/kg. In doses of 300-600 mg/kg the drug reduced pain sensitivity threshold and in doses above 600 mg/kg elevated the pain threshold and tactile sensitivity and reaction to knock. Bromantane induced mydriasis in all studied doses; in doses above 10 g/kg the preparation induced blepharoptosis. In doses above 5 g/kg bromantane slightly increased respiration rate and depth (Kussmaul-like respiration). In some animals bromantane in high doses induced regurgitation, diarrhea, and polyuria. Rectal temperature decreased by 0.5-1 degrees C after virtually all doses. Behavioral effects of bromantane in doses of 30 and 600 mg/kg were associated with stimulation of the central dopamine and suppression of muscarinic and nicotinic cholinergic structures, n-cholinolytic effects of bromantane was more pronounced at a dose of 30 mg/kg than at a dose of 600 mg/kg.
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PMID:Toxic effect of single treatment with bromantane on neurological status of experimental animals. 1212 51

A questionnaire to diagnose dyspepsia was created. The questionnaire consists in 9 items written in very clear and understandable language and related to the cardinal symptoms of dyspepsia (easy sensation of fullness, postprandial epigastric fullness, heartburn, regurgitation, nausea, vomiting, postprandial epigastric pain, excessive belching and hunger pain). The questionnaire also includes a system of quantification levels for each symptom, taking into account its frequency and intensity of presentation in the previous two weeks: 1 point, if the symptom did not bother at all or only infrequently; 2 points, if it bothered only a little; 3 points, if it bothered moderately; and 4 points, if it bothered a lot. The questionnaire was applied to 40 patients with dyspepsia and 20 healthy control subjects, and their answers were compared with data obtained by anamnesis. For the comparison, three criteria were considered to define, with the questionnaire, the existence of dyspepsia: A) Presence of a minimum of 2 symptoms, and at least one of them with a quantification level of 2 points or more; B) Presence of a minimum of 2 symptoms, and at least one of them with a quantification level of 3 points or more; and C) Presence of a minimum of 2 symptoms with a quantification level of 3 points or more. Of these three criteria, criterion B was found to be the best, and following it, the sensitivity and specificity of the questionnaire were, respectively, 95% and 100%. The new questionnaire will be, for sure, a useful instrument to accurately investigate dyspepsia, specially in large population groups.
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PMID:A new questionnaire for the diagnosis of dyspepsia. 1213 88

The general health of a German shepherd dog had deteriorated slightly when it was found after being loose for one hour. After 10 hours of observation, the dog showed signs of pain for the first time and signs of poisoning, such as tenseness of muscles, slight opisthotonus, regurgitation, salivation, mydriasis, dyspnoea and cyanosis, were observed; it died 15 minutes after showing the first clinical signs but it had no seizures or tetanic spasms at any time. A postmortem examination did not reveal any pathological changes. A screening test for alkaloids was positive for strychnine (strychnidin-10-one). The presence of strychnine was confirmed and its concentration was determined by gas chromatography/mass spectrometry in urine (728.5 ng/ml) and in the stomach contents (44.6m microg/g). No strychnine was detected in the dog's serum, but traces of brucine (2,3-dimethoxystrychnidin-10-one), the dimethoxy derivative of strychnine, were detected. This case was compared with other strychnine poisonings recorded in the authors' laboratory over the previous six years, taking into account the species, type of samples, the clinical signs and their duration, the postmortem findings, and the concentrations of strychnine. This was the only case to show such an atypical time course of clinical signs.
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PMID:Atypical time course of clinical signs in a dog poisoned by strychnine. 1213 20

This study reports the reliability and validity of the distress subscale of the GERD Symptom Assessment Scale (GSAS) and the acute SF-36 Health Survey in a clinical trial setting. Patients with moderately severe GERD completed the GSAS and SF-36 at baseline and four weeks following treatment. The age (mean +/- SD) of the 187 patients was 45.5 +/- 11.1 years and most were female (63%) and Caucasian (78%). All scales met the 0.70 reliability criterion except for the SF-36 bodily pain scale. Mean baseline GSAS scores were significantly (P < 0.001) poorer by 10-17% among patients reporting more severe levels of all symptoms. Mean baseline SF-36 physical component summary scores were significantly (P < 0.02) poorer among patients reporting more severe levels of regurgitation, early satiety, bloating, and nausea. Patients reporting complete and satisfactory heartburn relief reported improvements in GSAS scores that were 13% and 10% greater, respectively, than patients who did not experience these levels of relief (P < 0.001). In conclusion, the GSAS and SF-36 scales were reliable and valid measures in this clinical trial. Differences of 10% in GSAS distress scores correspond to differences in symptom severity at a point in time and to changes in symptom severity over time. The SF-36 was not as useful in detecting differences in symptom severity over time.
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PMID:Measuring symptom distress and health-related quality of life in clinical trials of gastroesophageal reflux disease treatment: further validation of the Gastroesophageal Reflux Disease Symptom Assessment Scale (GSAS). 1214 13

Symptomatic gastroesophageal reflux disease (GERD) is characterized by a wide spectrum of symptoms. The variance of GERD symptoms may be due to a decreased threshold for symptom elicitation/perception described as "visceral sensitivity." In this study GERD symptoms were scored for presence/frequency. The symptom score was weighted for the presence/frequency of typical reflux symptoms: heartburn, retrosternal pain, and regurgitation. The weighted GERD symptom score was used to assess symptom expansion and the hypothesis of GERD visceral sensitivity. One hundred five subjects with heartburn/retrosternal pain underwent esophageal pH studies. Subjects with abnormal esophageal pH studies reported more GERD-related symptoms, occurring more frequently, compared to subjects with normal esophageal pH studies. Symptom scores correlated with the number of reflux episodes but not with the length of time of mucosal exposure to acid. Therefore, aggregation of symptoms in gastroesophageal reflux is associated with frequent alternation between low and normal pH values in the distal esophagus.
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PMID:Visceral sensitivity in gastroesophageal reflux. 1245 95

The proton pump inhibitors have consistently been shown to be far more effective than the others are in gastro-oesophageal reflux disease (GERD) as proton pump inhibitors (PPIs) block the final and rate-limiting step of parietal acid production. The primary objective of the study was to assess the efficacy and tolerability of esomeprazole 40 mg given once a day for 4 weeks in patients with reflux oesophagitis. An open, non-comparative study was done with 103 patients in 4 centres with endoscopic erosive oesophagitis. Symptoms of reflux oesophagitis such as heartburn/retrosternal pain and regurgitation recorded on a 4-point scale, dysphagia being marked as present or absent. Oesophagitis was graded as 5-point scale. There was a significant decrease in mean score of heartburn (60.8% and 86%), retrosternal pain (60.84% and 86.75%), mean score of regurgitation (65% and 90%) at second and fourth week respectively. Global assessment of overall symptoms by patients showed complete resolution of symptoms in 86.4% patients at week 4. At the end of treatment 93 out of 103 patients showed complete healing, 13.6% of total cases had side effects. Esomeprazole was found effective and safe in the treatment of GERD.
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PMID:An open non-comparative clinical study for the evaluation of safety and efficacy of esomeprazole in patients of reflux oesophagitis in Indian population. 1245 20

Rapid-sequence induction with cricoid pressure is a standard procedure for inducing anesthesia in patients with a potentially full stomach. During the induction period, if the patient develops generalized movements of the body, the pressure level of the cricoid may change unexpectedly. As a result, the increase in intragastric pressure may cause gastric regurgitation and consequent pulmonary aspiration. Rocuronium has been widely used as an alternative to succinylcholine during the induction of anesthesia. However, most patients who received rocuronium complained of severe burning pain in their arm during intravenous injection. Even after the administration of the induction agents, rocuronium injection can also cause withdrawal of the hand or other generalized movements of the body. We describe a case of gastric regurgitation with pulmonary aspiration following generalized spontaneous movements associated with rocuronium injection in a girl who received pediatric emergent surgery.
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PMID:Rocuronium-induced generalized spontaneous movements cause pulmonary aspiration. 1247 24

Goals of gastroesophageal reflux disease (GERD) treatment are symptom relief, healing of esophagitis, prevention of complications, and prevention of relapses. The aims of the current study were to evaluate a selected group of patients referred to our Department of General Surgery for presurgical examination (N = 70: 41 males and 29 females) for their expectations about laparoscopic antireflux surgery and to compare these expectations with the official medical treatment goals. The leading expectations for laparoscopic antireflux surgery were as follows: (1) for 92.8%, abatement of GERD-related symptoms, especially heartburn, regurgitation, and pain; (2) for 84.3%, a return to normal daily activities and life such as eating and drinking habits, sleeping habits, or work-related aspects; (3) for 72.9%, an improvement in quality of life; (4) for 52.9%, a successful surgical intervention without any complications or side effects; and (5) for 48.6%, protection from a Barrett esophagus and cancer risk. In contrast, only two patients answered that they would expect normalization of pH values and healing of esophagitis. The data show that the majority of patients have clear expectations about laparoscopic antireflux surgery. These expectations are partly related to official medical treatment goals. In general, patient-related aspects of outcome concerning expectations should be included as a standard in all official goals of GERD treatment and also in medical outcome studies. One of these aspects should absolutely be patients' quality of life.
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PMID:Expectations of patients with gastroesophageal reflux disease for the outcome of laparoscopic antireflux surgery. 1249 43

We experienced a case of bronchospasm during upper gastrointestinal endoscopy under sedation. An 80-year-old man came to our hospital with abdominal distension with pain, nausea and vomiting. He has the history of splenectomy, cholecystectomy for hemolytic anemia and thyroidectomy for thyroid cancer, surgery for bilateral shoulder joints and diabetes. Abdominal X-ray suggested obstruction of the small intestine. On the third hospital day, gastrointestinal endoscopy was scheduled for insertion of a long ileus tube. Under sedation with diazepam 10 mg and local anesthesia of the pharynx with lidocaine spray 24 mg, the endoscope was inserted and when it reached the esophageal-gastrojunction, respiratory rate increased to 30 breaths.min-1 with expiratory stridor. The endoscope was removed immediately. He was oro-tracheally intubated and artificially ventilated. On the fourth hospital day, he was extubated under bronchoscopy. No abnormalities were observed in the trachea, vocal cord, pharynx and larynx. Later, it was revealed that he had a history of hoarseness and dysphasia. His left recurrent nerve and cervical nerve had been resected with thyroid and right cervical nerve anastomosed to the rest of the left recurrent nerve. The insertion of upper gastrointestinal endoscope might have induced bronchospasm stimulating distal esophageal afferent vagal reflex partly by regurgitation of gastric acid under sedation.
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PMID:[Bronchospasm during upper gastrointestinal endoscopy under sedation]. 1264 76


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