1,721,051 research outputs found
Ruolo dell'imperziometria multicanale nella situazione dei pazienti candidati a laparoscopia
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Terapia endoscopica nella malattia da reflusso gastroesofageo
No full textIn the last decade many endoscopic procedures to treat gastroesophageal reflux disease have been proposed. They can be classified in three main groups: endoscopic suturing and plication procedures, radiofrequency thermal coagulation methods and bulking methods, injection of synthetic substances. Every procedure has been described in details in mechanism of action, technical and clinical data and complications observed
On-demand proton pump inhibitor therapy in patients with gastro-oesophageal reflux disease
No full textOn-demand therapy is an established modality in long-term therapy with histamine-2-receptor antagonists, in cases of mild non-erosive gastro-oesophageal reflux disease. In the literature, only a few studies have specifically addressed the problem of proton pump inhibitors on-demand treatment. The evidence, so far, available suggests that this might be an effective modality of long-term treatment in the majority of patients with non-erosive gastro-oesophageal reflux disease. This treatment modality appears to be the most cost-effective and the best tolerated medical regimen for gastro-oesophageal reflux disease. It also seems to be able to restore the impairment of health-related quality of life due to gastro-oesophageal reflux disease symptoms. Although the current standard of care for patients with non-erosive gastro-oesophageal reflux disease is maintenance therapy with daily administration of a proton pump inhibitor agent, on-demand therapy, with the same drug, may be a reasonable long-term choice. The ideal proton pump inhibitors for such treatment will be those with a more rapid onset of action, more profound acid inhibition, more predictable therapeutic effect and less drug-drug interactions. Newer proton pump inhibitors, like esomeprazole, the S-chiral isomer of omeprazole, are promising drugs for on-demand treatment of gastro-oesophageal reflux disease
Heterogeneity of endoscopy negative heartburn : epidemiology and natural history
No full textIt has now become clear that only about 40% or less of patients with heartburn and/or regurgitation have esophagitis, and that the majority of them lack visible distal esophageal mucosa breaks. These subjects are referred to as non-erosive gastroesophageal reflux disease (NERD) patients. It has been estimated that in the Western world at least one tenth of the general population has at least weekly heartburn. This proportion seems to be lower in Asia, while prevalence is rapidly increasing. Although it would be extremely useful to have prospective information regarding the fate of such patients, the natural history of NERD is largely unknown, and very few studies in the literature have addressed this issue. These studies are for the greater part old, not well conducted, and suffer from methodological drawbacks including ill-defined entry criteria. However, a review of these studies indicates that a consistent minority of NERD patients may develop erosive disease at an approximate rate of about 10% per yea
Nongastroesophageal reflux disease-related infectious, inflammatory and injurious disorders of the esophagus
No full textPurpose of review: To review recently published studies presenting novel and relevant information on some esophageal infectious, inflammatory and injurious diseases. Recent findings: In the treatment of Candida esophagitis, fluconazole remains the treatment of choice, but clinical failures indicate new therapeutic opportunities, like two new echinocandins, micafungin and anidulafungin. Eosinophilic esophagitis is an increasingly recognized entity. New therapeutic insights come from a six-food elimination diet in children and from fluticasone propionate in adults; humanized monoclonal IgG antibody anti-interlukin-5, mepolizumab, has been shown to decrease eosinophilia and ameliorate symptoms. There has been some advance in microscopic characterization of lymphocytic esophagitis. Esophagitis is found to be present in 67% of patients with pemphigo vulgaris, in 32.3% of patients with systemic sclerosis and to be associated with thoracic neoplasias. In the case of caustic ingestion, endoscopic ultrasound with miniprobes has proven not to be better than videoendoscopy. Recent evidence shows that systemic steroids might even be harmful. Mitomycin C applied on fresh wounds is currently being evaluated. Stenting of the stricture has been proposed for contrasting esophageal remodeling. Summary: These recent findings, together with a better understanding of diseases such as eosinophilic or lymphocytic esophagitis, allow new diagnostic and therapeutic approaches
Rabeprazole : a second-generation proton pump inhibitor in the treatment of acid-related disease
No full textRabeprazole is a proton pump inhibitor (PPI) presenting a very advantageous pharmacodynamic and pharmacokinetic profile over older PPIs. In particular, this drug has a very fast onset of action, due to a short activation time and a very high pKa, and may therefore be defined as a 'second generation' PPI. The aim of this article is to provide an update on the pharmacology and clinical profile of rabeprazole and its use in acid-related disorders, with a particular focus on its role in gastroesophageal reflux disease; in the treatment and prevention of duodenal and gastric ulcers and Zollinger-Ellison syndrome; in the therapy of the extraesophageal manifestations of gastroesophageal reflux disease (in particular the respiratory and ear, nose and throat ones); and in the eradication of Helicobacter pylori
L'impedenziometria esofagea multicanale
No full textEsophageal multichannel intraluminal impedance (MII) is a new diagnostic tool for esophageal functional testing. It detects reflux progression by means of the change in segmental electrical impedance that it causes. This method has not pH- or diet-dependent artifacts, doesn't deliver radiations to the patient, is relatively cheap and is usually performed in association with esophageal ambulatory pH-metry, allowing detectiong and analysis also of non-acid or weakly-acid reflux and increasing the symptom index and facilitating correlation of atypical symptoms with reflux. Patients with drug-resistant reflux-like symptoms should undergo impedance-pH-metry during therapy, because many will have non-acid reflux linked symptoms
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