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Query: UMLS:C0432222 (SEM)
 47,337 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Surgical therapy for reflux esophagitis remains controversial. Sixty-five patients who underwent posterior gastropexy between November, 1970 and February, 1976 are presented. Indications for surgery were: esophagitis, 43 patients; esophagitis with stricture, 12 patients; paraesophageal hernia seven patients; incapacitating postfundoplication syndrome, three patients. The average follow-up was 15.6 months. Eighty-two per cent of the patients had a good to excellent result. Twenty-three per cent of the patients developed radiographically recurrent hiatus hernia; however, the incidence of recurrent esophagitis was only nine per cent. Two patients developed postoperative strictures (one de novo, one recurrent). Two patients ultimately required a fundoplication for control of their esophagitis; one patient required a Thal-Nissen procedure. Lower esophageal sphincter pressure on patients with satisfactory results increased from 6.3 +/- 1.3 cm H2O SEM preoperatively, to 17.4 +/- 3.0 cm H2O SEM postoperatively. This increase achieved a statistical significance of p less than 0.001. In patients who had an unsatisfactory result, postoperative sphincter pressures were unchanged from preoperative values. All unsatisfactory results were obtained in patients with complicated esophagitis, i.e., Barrett's ulcer or stricture, alkaline esophagitis, or previous hiatal surgery. Posterior gastropexy appears to constitute effective therapy in the treatment of uncomplicated reflux esophagitis and paraesophageal hiatus hernia without the distressing morbidity associated with the postfundoplication syndrome.
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PMID:An analysis of recurrent esophagitis following posterior gastropexy. 63 76

Luminal and mucosal pH were measured endoscopically in patients with reflux esophagitis and antral gastritis and in control subjects. In all subjects, significant lumen-to-mucosa gradients were observed in the esophagus, stomach and acidified proximal duodenum. In the reflux patients luminal pH was lower in the fundus (mean +/- SEM, control vs. reflux esophagitis: 2.01 +/- 0.17 vs. 1.32 +/- 0.18; p less than 0.02) and antrum (3.51 +/- 0.35 vs. 2.13 +/- 0.24; p less than 0.01) and, in the gastritis patients, in the fundus (2.01 +/- 0.17 vs. 1.3 +/- 0.17; p less than 0.02). In both patient groups, mucosal pH was lower in the fundus (control vs. reflux vs. gastritis: 4.84 +/- 0.37 vs. 3.37 +/- 0.61 vs. 3.12 +/- 0.6; p less than 0.05) and acidified duodenal cap (6.74 +/- 0.13 vs. 6.09 +/- 0.24 vs. 5.73 +/- 0.46; p less than 0.03). Mucosal pH profiles at the various sites showed less resistance of the gradient to a highly acidic environment in both the lower esophagus and antrum than in fundus and duodenum, and this was the case in the patient and control groups. Though associated with a more acid environment, neither esophagitis nor antral gastritis exhibits a specific deficit in the 'mucus-bicarbonate barrier', suggesting that the pathogenesis of these disorders may depend more on abnormal 'attack' rather than impaired defense.
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PMID:Studies of luminal and mucosal pH in reflux esophagitis and antral gastritis. 161 9

Lower esophageal sphincter (LES) pressure was measured in 7 cirrhotic patients with massive ascites, before and after paracentesis. The mean LES pressure was 19.8 +/- 2.2 SEM mm Hg before and 16.3 +/- 1.4 SEM mm Hg after paracentesis (p less than 0.05). It is concluded that cirrhotic patients with massive ascites are protected from reflux esophagitis by having an increased LES pressure.
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PMID:Lower esophageal sphincter pressure before and after paracentesis in cirrhotic patients with intractable ascites. 709 12

In children, excess of gastroesophageal reflux causes lesions of the esophageal mucosa that we have studied by scanning and transmission electron microscopy (SEM and TEM respectively) in 27 grasp biopsies prelevated during endoscopic procedures. Ultrastructural lesions can be graded on the basis of their severity. In grade I, epithelial cells are well preserved in the deepest layers whereas the superficial cells display ultrastructural alterations such as irregular microridges or reduced intercellular junctions. In grade II, the surface is composed of extruding cells and in the intermediate layer, large intercellular spaces containing lympho-monocytic cells are visible. In grade III, the mucosal surface is characterized by crater-like erosions, degenerating cells are visible in all the layers; in two patients columnar epithelium-lined areas (Barrett's esophagus) have been identified. Our results suggest that in patients with reflux esophagitis, ultrastructural examination of grasp biopsies prelevated by pediatric endoscopes allows a grading of the anatomical lesions providing data that can not be obtained by conventional histology.
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PMID:Reflux esophagitis in children: a scanning and transmission electron microscopy study. 826 7

Numerous studies have been performed on the effects of omeprazole, a powerful inhibitor of gastric acid secretion, on the various morphotypes of oxyntic mucosa, whilst scant attention has been paid to modifications induced by this drug on surface epithelial mucosa. The authors carried out a SEM study on bioptic fragments removed at gastric level from 15 patients receiving omeprazole treatment for duodenal ulcer and/or reflux esophagitis, but apparently free from lesions to the mucosa of the body of the stomach. Biopsies were performed before the start, after two months and after seven-ten months of treatment. The results of basal biopsies showed an hypersecretive trend in surface epithelial cells, with frequent dissolution of the apical plasmalemma and emptying of cell bodies. After two months of treatment the hypersecretive phenomena regressed, whereas the mucosa appeared hypertrophic and presented typical cell polymorphism in some areas. After seventeen months of treatment the mucosa showed normal characteristics, except in one case in which there was a trend towards atrophy. In conclusion, the authors attribute the hypertrophic-dysplastic modifications observed after medium-term treatment to hypergastrinemia, secondary to treatment, and suggest careful morphological control follow-up during the course of treatment so as to obtain an early diagnosis of a possible deviation towards intestinal metaplasia.
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PMID:[Morphological variations of the human gastric mucosa after omeprazole treatment: a scanning electron microscopic study]. 896 7

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT Reflux oesophagitis is a common clinical disorder associated with significant morbidity. Proton pump inhibitors are the current pharmacotherapy of choice, but not all treated patients achieve symptom relief. Little is known about the efficacy of mosapride, a prokinetic agent which decreases episodes of gastro-oesophageal reflux, as an adjunct to proton pump inhibitors in improving the symptoms of reflux oesophagitis. WHAT THIS STUDY ADDS Mosapride was generally not more effective than placebo as an adjunct therapy to a standard dose of lansoprazole in decreasing the symptom burden of patients with reflux oesophagitis. However, in a subgroup with more severe symptoms, combination therapy with lansoprazole and mosapride was possibly superior to monotherapy with lansoprazole. AIMS To investigate if mosapride, a prokinetic agent, was an effective adjunct to acid suppression in improving the symptoms of reflux oesophagitis. METHODS Patients (n= 96) with reflux oesophagitis were randomly assigned to either mosapride (5 mg three times daily) or placebo for 4 weeks. Symptom severity was assessed by a validated questionnaire at enrolment, 4 and 8 weeks after medication. The primary outcome for the first 4 weeks was decrease in symptom scores. After a 3 day washout period, patients initially allocated to mosapride crossed over to placebo and vice versa for the next 4 weeks. The outcome of the second phase was maintenance of symptom control. All patients received lansoprazole (30 mg once daily) throughout study. RESULTS The decreased symptom score after 4 weeks of treatment with lansoprazole and mosapride (n= 50) was 13.42 +/- 1.16 (mean +/- SEM), similar to that of lansoprazole plus placebo (10.85 +/- 1.03, n= 46), with an insignificant difference of 2.57 (95% CI -0.53, 5.67, P= 0.103). However, a sub-group analysis for patients with pre-treatment scores of >18 points (n= 48) revealed that lansoprazole plus mosapride achieved a greater reduction of symptom score than lansoprazole plus placebo (18.22 +/- 1.91 vs. 12.88 +/- 1.65; mean difference of 5.34, 95% CI 0.28, 10.40, P= 0.039). In the second phase, there was no difference between lansoprazole with mosapride or placebo in maintaining symptom control (39/44 or 86.64% vs. 41/50 or 82%, P= 0.401). Subgroup analysis for those with substantial residual symptoms revealed similar results. CONCLUSION Compared with placebo, mosapride generally does not provide additional benefit to a standard dose of lansoprazole in patients with reflux oesophagitis, except possibly in the subgroup of severely symptomatic patients.
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PMID:Mosapride as an adjunct to lansoprazole for symptom relief of reflux oesophagitis. 2065 70