1,721,029 research outputs found
Oesophageal sensitivity to acid in patients with non-cardiac chest pain: is the oesophagus hypersensitive?
No full textDuring the past decade, gastro-oesophageal reflux disease has been shown to be the most common identifiable cause of non-cardiac chest pain of oesophageal origin. The development of combined pH-pressures recording systems has also contributed to a better understanding of the underlying mechanisms of pain perception. Beside typical gastro-oesophageal reflux disease, many patients with non-cardiac chest pain appear to have an hypersensitivity to acid or mechanical stimuli, or both. Despite new insights into the pathophysiology of gastro-oesophageal reflux disease, therapy is limited to the suppression of noxious stimuli by antisecretory drugs or surgery. New therapeutic approaches using drugs affecting visceral perception, and well-controlled placebo trials are urgently needed
Modern diagnosis of gastroesophageal reflux disease (GERD).
No full textTypical dominant symptoms such as heartburn and regurgitation are very specific for the diagnosis of GERD. Unfortunately they are relatively insensitive. The diagnosis can be made reliably if mucosal breaks are present at endoscopy. In endoscopy-negative patients with atypical symtoms, the most accurate investigation is 24-hour pH-monitoring with symptom analysis. Another alternative which may prove more cost-effective is to start with a PPI-test (e.g. omeprazole 20 or 40 mg bid for one or two weeks) and to use the symptomatic response as a diagnostic test
Simultaneous measurement and recording of gastric potential difference and intragastric pH in man.
No full textGastric potential difference (GPD) is used increasingly as an index of mucosal integrity. The technique for GPD measurement currently employed is however laborious due to the preparation and check of KCl-agarose bridges prior to each experiment. In addition, calculations - usually handmade - are time-consuming and inaccurate. Therefore, a new apparatus allowing continuous recording of basal and drug-induced changes in GPD values was developed. A commercially available 24-hour pH monitor (Proxima Light, Synectics Medical) was modified in order to allow GPD measurement and recording with subsequent elaboration of data. Furthermore, simultaneous measurement of GPD and intragastric pH through the use of a single stomach probe was made possible. The new method was checked towards the classical PD measuring system employing KCl-agarose bridges. The readings obtained with both systems, either in basal conditions or after aspirin, correlated in a highly significant way. Readings proved to be quite stable with a variation, for 150 consecutive values, of less than 2 mV. With this system the effect of pH modifications, obtained through H2 receptor stimulation and inhibition, on the behaviour of GPD values was investigated in healthy volunteers. Analysis of paired data obtained from these experiments showed an inverse relationship between these two parameters. This suggests that GPD and pH should be measured together, especially during experiments aiming to study drug effects on gastric mucosa. Although the apparatus described was developed for PD measurement and recording in the stomach, it can be used easily for PD measurement across the mucosa of the entire digestive tract, for example in the esophagus, colon or rectum
Pharmacodynamic assessment of drugs in gastro-oesophageal reflux disease (GORD): An overview.
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Treatment of gastro-oesophageal reflux disease in adults.
No full textMost patients with dominant heartburn have no signs of oesophagitis at endoscopy. However, chronic relapsing gastro-oesophageal reflux disease can severely affect quality of life
In primary care many patients can be successfully treated by intermittent courses of drugs on demand. Alginate-antacids and H2 receptor antagonists are useful in patients with mild disease
Cisapride is as effective as H2 receptor antagonists in short term treatment and can prevent relapse in mild oesophagitis
Proton pump inhibitors relieve symptoms and heal oesophagitis more completely and faster than other drugs. They are effective throughout the disease spectrum, and maintenance therapy prevents recurrences. The principles of laparoscopic and open antireflux surgery are the same. In skilled hands, similarly good results have been reported up to two years after both approaches
In young fit patients laparoscopic surgery may be a cost effective alternative to a lifetime of drug treatment
Transmucosal potential difference as an index of esophageal mucosal integrity.
No full textAll the epithelia lining the gastrointestinal (GI) tract, including that of the esophagus, exhibit a transmucosal electrical potential difference (PD). The luminal surface of the GI mucosa is indeed electrically negative when compared with the serosal one. Although it was initially felt that the body of the esophagus exhibits a PD near 0 or slightly positive, recent studies, using parenteral reference electrodes, have shown a negative PD of around -15 mV. Measurement of esophageal PD has been mainly used to locate both the lower and the upper esophageal sphincters but very rarely to evaluate esophageal mucosal integrity in clinical settings, most probably due to the difficulties encountered during measurement of mucosal PD. Reliable techniques to measure esophageal PD simultaneously with esophageal pressure or mucosal pH are now available. Application of these recently developed methodologies showed that measurement of esophageal PD during either manometry or endoscopy provides meaningful information about mucosal integrity. Indeed, tissue injury, either neoplastic of inflammatory, usually results in a less negative PD. In contrast, an abnormally high negative PD is very often observed in patients with columnar-lined lower esophagus. In patients with microscopic reflux esophagitis, PD exhibits less negative values which are significantly correlated with the degree of the mucosal damage. Normalization of the altered PD after either medical or surgical treatment makes it an additional parameter to evaluate the effect of a given therapy
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