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[Gastro-esophageal reflux esophagitis in infants].

On the basis of their clinical experience the authors consider the main cause of gastro-esophageal reflux-esophagitis in children up to three months of age to be dysfunction of the autonomic nervous system against the background of underdeveloped zone of cardia. Maximum conservative treatment is recommended and a complex of pathogenetic therapeutic measures is proposed. The remote results confirm the rightness of the tactics proposed.

Esophageal Atresia↗

[New trends in diagnosis of reflux esophagitis].

Reflux esophagitis is acid peptic disorder at the lower part of the esophageal mucosa. Acid reflux into the esophagus also induces typical and atypical reflux symptoms. Endoscopy is the definitive diagnostic procedure for reflux esophagitis, the consequence of acid reflux. Evaluation of pathophysiology of acid reflux is also important for the diagnosis of gastroesophageal reflux disease. 24hr esophageal pH monitoring measures acid reflux semiquantitatively. Fluoroscopic and ultrasonographic observation of reflux, esophageal manometery and gastric emptying study are useful for evaluation of pathophysiological state of gastroesophageal reflux disease, particularly in patients lacking evident endoscopic esophagitis. Symptom evaluation, either by acid suppression or acid load, shows relationship analysis is also the important diagnostic approach to acid reflux. Changes in symptoms by acid suppression and acid perfusion of the esophagus suggest the link between acid irritation and symptomatogenesis. Health-related quality of life evaluation seems to be another important diagnostic toll in near future.

Esophagitis, Peptic↗

[Recent topics in the medical treatment of reflux esophagitis].

Reflux esophagitis is one of the most common disorders of the upper gastrointestinal tract. It can lead to obstruction through stricture formation, in more severe form to bleeding through ulceration, and to cancer development through the association of Barrett's esophagus. The vast majority of esophagitis can be managed medically. Medical management is separated into two categories: (1) life style modification and (2) drug therapy. Drug therapy includes antacids, prokinetics, sucralfate, H2 receptor antagonists (H2-RAs) and proton pump inhibitors (PPIs). Among these, antisecretory therapy is the mainstay for the treatment. PPIs are shown to be superior to H2-RAs in healing of esophagitis and symptom relief. Recurrence, particularly of erosive esophagitis, is common without maintenance therapy. PPIs are also consistently superior to H2-RAs in maintenance of esophagitis healing. Interestingly, a recent report has suggested that curing Helicobacter pylori infection may provoke reflux esophagitis, raising the possibility that the gastroesophageal reflux diseases become more common in the future. Therefore, treatment strategy for reflux esophagitis needs to be re-established in terms of the future cost-effectiveness evaluation and quality-of-life assessments.

Antacids↗

Ornithine decarboxylase (ODC) levels in children with reflux esophagitis.

Reflux esophagitis is a common disease in infants and can be diagnosed largely by esophageal biopsy. In adults, chronic esophagitis may lead to Barrett's esophagus, a premalignant condition for esophageal cancer development. Ornithine decarboxylase (ODC) is used as an early marker for colon cancer development. No data are available on the role of ODC in reflux esophagitis in the pediatric population. In this study we retrospectively analyzed ODC activity in esophageal biopsies of children who underwent upper endoscopy. According to the esophageal histology, patients were divided into three groups: normal mucosa, mild, and moderate/severe esophagitis. None of our patients had esophageal metaplasia or cancer. ODC level was significantly higher in the moderate/severe esophagitis group compared to mild and normal mucosa group. We conclude that ODC activity is directly proportional to the severity of the esophageal inflammation/regenerative process in children with reflux esophagitis.

Biopsy↗

[The clinical evaluation of structured questionnaire for reflux esophagitis].

Reflux esophagitis is suspected on clinical grounds and confirmed by a variety of endoscopical, roentgenological and physiological investigations, which are obviously inapplicable to an epidemiological survey. Questionnaire for the diagnosis of reflux disease(QUEST) can reduce bias introduced by observer variability, is practical, inexpensive, and noninvasive. QUEST also has good sensitivity and specificity for reflux esophagitis, so it's one of the useful diagnostic tools for reflux esophagitis. It, however, needs to be modified for the diagnosis of gastroesophageal reflux disease (GERD). Questionnaires to measure Quality of Life(QOL) quantitatively can be applied to the assessment of the severity of diseases or drug efficacy, and they are useful especially for the evaluation of endoscopy-negative GERD.

Esophagitis, Peptic↗

[Pathophysiology of reflux esophagitis].

Reflux esophagitis is more frequent in developed countries, and its prevalence increased in Japan in these 1/4 centuries. These increase might be based on the increase in the population of the elderly, advances in endoscopic technology, increase in the interest on esophagitis, and declined prevalence of Helicobacter pylori infection. Main pathogenesis on the reflux esophagitis are classified as 2 components. One is the motility factor of the stomach and the esophagus. Distention of the stomach causes transient LES relaxation(TLESR), leading acid reflux into the esophagus. Delayed gastric emptying enhances gastric distention, causing TLESR. Resting LES pressure might be lower than normal. Hiatal hernia is also an exaggerating factor, causing repeated reflux from the hernia sac. The other main cause is the intact acid secretion causing enough to injure the esophageal mucosa. Gastric atrophy due to Helicobacter pylori infection would be protective factor for reflux esophagitis.

Aged↗

[Long-term results of conservative management of reflux esophagitis].

Reflux esophagitis is a frequent and chronic disease. Impairment of the quality of life by the reflux symptoms and the risk of complications are the most important indications for a long-term treatment. The base of the treatment of reflux esophagitis is the inhibition of the gastric acid secretion with proton pump inhibitors (PPI) or by H2-receptor antagonist. In general, PPI's are more efficient in the treatment of refluxesophagitis as compared to H2-receptor antagonists blockers regarding the relieve of symptoms and the healing of erosive esophageal lesions. The use of an antacids and procinetics in the long-term treatment is not indicated. The treatment strategy depends on the severity of the symptoms and the esophageal lesions. Patient with mild esophagitis can be treated either with H2-receptor antagonists or with PPI's on demand or continuous. In the case of severe esophagitis, a long-term treatment with PPI's is indicated to avoid complications. Recurrence of esophagitis during a long-term therapy should be treated by PPI's. After healing the long-term treatment should be adapted either by increasing the given dose of the medicament or by a switch to more effective medicaments in acid suppression.

Age Factors↗

The rationale for continuous maintenance treatment of reflux esophagitis.

Reflux esophagitis is a chronic process associated with frequent episodes of relapse in many patients. In addition, the disease may be progressive in at least some patients. Erosion of the esophageal mucosa precedes the development of some of the complications of the condition. There is accumulating evidence that continuous treatment of patients with erosive esophagitis effectively maintains symptomatic remission and absence of esophageal erosions. Whether such treatment will prevent the development of complications has not yet been demonstrated. We investigated a number of questions concerning the natural history and complications of erosive esophagitis and the need for maintenance treatment for patients with severe manifestations of disease as well as the impact of continuous maintenance treatment on the natural history of reflux esophagitis and its complications.

Chronic Disease↗

Severe reflux esophagitis.

Reflux esophagitis, usually the mild to moderate form, is found endoscopically in less than 50% of patients with classic symptoms of gastroesophageal reflux disease (GERD). These patients tend to have low lower esophageal sphincter pressures, poor esophageal clearance, and hiatal hernias. The endoscopic findings of distal esophageal erosions and ulcerations are a specific, but not very sensitive, marker of GERD. Treatment of reflux esophagitis usually requires H2 antagonists, omeprazole, or antireflux surgery.

Aged↗

Gastro-esophageal reflux and esophageal motility disorders in morbidly obese patients.

BACKGROUND: Morbid obesity has long been considered as a contributing factor to gastro-esophageal reflux, but the literature contains conflicting data on the subject. The authors studied a large number of morbidly obese candidates for bariatric surgery with objective means, in order to better define the incidence of gastro-esophageal reflux disease (GERD) and esophageal motility disorders in this population. METHODS: Morbidly obese patients, in whom indication for bariatric surgery was confirmed after complete evaluation, were included consecutively during a 4-year period. The evaluation included history of reflux symptoms, upper GI endoscopy, 24-hour pH monitoring, and stationary esophageal manometry. RESULTS: 345 patients were studied, of whom 35.8% reported reflux symptoms. Endoscopy showed a hiatus hernia in 181 patients (52.6%), and reflux esophagitis in 108 (31.4%). 24-hour pH monitoring revealed an elevated De Meester score in 163 patients (51.7%). Manometry was normal in 247 patients (74.4%), and showed a decreased lower esophageal sphincter pressure in 59 (17.7%). Esophagitis and abnormal pH testing were more common in patients with symptoms or hiatus hernia, and the incidence of esophagitis was higher with abnormal pH testing. Esophagitis was associated with increased weight and abdominal obesity. CONCLUSIONS: This study confirms the increased prevalence of GERD in the morbidly obese population. Upper GI endoscopy should be performed routinely during evaluation of morbidly obese patients for bariatric surgery. When both conditions coexist, effective treatment is probably best provided by Roux-en-Y gastric bypass, which produces effective weight loss and correction of pathological reflux.

Adult↗

Reflux esophagitis.

Reflux esophagitis and its complications are not only common clinical problems but also problems that can be accurately defined by careful history taking and a knowledge of the pathophysiology of the various manifestations. An element of objective assessment, however, is required to define and substantiate fully an individual patient's problem. Only when disabling subjective and intractable objective complications persist after good medical treatment should surgical intervention be considered. Various antireflux procedures are currently available and all can be effective. Surgeons should review their own experiences and make alterations that they perceive will correct the types of problems encountered. In our current technique for the surgical management of gastroesophageal reflux in the common clinical setting, normal esophageal peristalsis is present, the fundus is adequate for plication, and sufficient esophageal mobilization can be effected to permit reduction of the entire stomach and fundoplication below the diaphragm. In addition, the procedure should be restricted to patients who do not have stenosis or have stenosis that can be readily dilated to 50 French.

Esophageal Stenosis↗

Gastroesophageal scintigraphy and endoscopy in the diagnosis of esophageal reflux and esophagitis.

The value of gastroesophageal (G/E) scintigraphy in the diagnosis of gastroesophageal reflux was assessed in 51 subjects, who presented with heartburn and had endoscopic evidence of reflux esophagitis. G/E scintigraphy was done using 99mTc sulfur-colloid in acidified orange juice. The G/E reflux index was calculated according to previous reports. The mean (+/- SD) G/E reflux index in 18 patients with severe esophagitis and 30 patients with moderate esophagitis were 1.6% (+/- 1.5) and 3.2% (+/- 5.0), respectively. The mean G/E reflux index in 14 control subjects was 2.4% (+/- 1.1). There was no significant difference between the esophagitis and control groups. Furthermore, if 4% was taken as upper limit of normal, this will include almost all the esophagitis patients and controls. It is concluded that the G/E reflux index based on G/E scintigraphy is of little value in the diagnosis of G/E reflux.

Adolescent↗

[Reflux esophagitis].

Chronic Esophageal reflux induces reflux esophagitis, which is a common finding in gastroenterological practice. Reflux esophagitis produce symptoms like pirosis, regurgitation and in some cases respiratory complains resembling asthma or angina-like chest pain. The pathophysiology of this disease is based on a multifactorial origin, which usually results in the chronic evolution of the disease. In recent years, there have appeared new evidences pointing out to alterations in the relaxing mechanisms of the lower esophageal sphincter; however, some patients having reflux esophagitis show normal shincteric pressure. The sweep action of esophageal smooth muscle is a key point for sending back to stomach the eventually refluxed material; it has been demonstrated that this sweeping action is impaired in many patients having reflux esophagitis. Incompetence of lower esophageal sphincter seems to be related a local to neural alteration rather than to smooth muscle functional disturbance. Recent findings stablis a link between local nitric oxide release and relaxation of the lower esophageal sphincter. Esophageal mucosaldisplay an intrinsic resistance to HCL, pepsin, bilis and enzymes deleterious action by a blockade of back-defusion of hydrogen ions contained in the refluxed material. Nevertheless, some other luminal and non-luminal factors are involved in this mucosalprotection. When these intrinsic resistance factors are abated, tisular lesions like ersion, ulcer and Barret's mucosal changes can occur; is of particular interest because its potential malignant evolution. Esophageal reflux usually resolves with medical treatmen, but in some particular cases surgical correction is indicated for improving the antireflux barrier.

Esophagitis, Peptic↗