Prolonged ambulatory esophageal pH monitoring in the evaluation of gastroesophageal reflux disease
Article Abstract:
Gastroesophageal reflux (GR), in which acid flows backward from the stomach to the esophagus, is the most common esophageal disorder. Heartburn is the most frequent symptom, but atypical symptoms such as nausea, chest pain, hoarseness, coughing, or asthma can also occur. GR may be diagnosed by barium X-rays or visual inspection of the esophagus in some cases, but these methods are ineffective if inflammation is not present. Measurement of acid levels using a glass pH probe placed in the esophagus has been very effective in diagnosing GR. The methods for and results from such monitoring are reviewed in this article. A background of GR and esophageal pH monitoring is reviewed. Technical aspects are discussed, including equipment, placement of the pH electrode, standardization of patient diet and activities, duration and timing of pH testing, patient tolerance of the study, and technical problems. The results expected from healthy subjects are discussed, as are ways of distinguishing normal from abnormal subjects and the reproducibility of the technique. Correlation of symptoms with pH events is an important consideration. For purposes of screening patients for GR, esophageal pH monitoring is highly effective, but no single test has been able to provide a definitive diagnosis; this issue is discussed. Esophageal monitoring has been increasingly applied to cases in which symptoms may relate to GR or to other diseases, including non-cardiac chest pain, lung disorders, and disorders of the larynx. It is also useful for evaluating atypical patients with heartburn, or in patients before and after anti-reflux surgery. Research to improve the use and applications of esophageal pH monitoring is needed. This technique is likely to become a standard method for diagnosing gastroesophageal reflux. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1990
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Coronary flow reserve, esophageal motility, and chest pain in patients with angiographically normal coronary arteries
Article Abstract:
Eighty-seven patients with chest pain were tested for abnormalities in blood flow within the coronary arteries which supply the heart, and abnormal function of the esophagus, the tube that carries food from the mouth to the stomach. These patients all had normal X-rays of their coronary arteries, indicating that the arteries were not blocked. Further testing showed that 63 of 87 patients had disorders of coronary flow reserve, indicated by increased resistance of the coronary arteries to blood flow. Resistance occurred during stress from rapid atrial pacing, the setting of a rapid heart rate within the atria, and after administration of the drug ergonovine, which constricts blood vessels. This resistance developed without narrowing of the coronary arteries. Chest pain occurred during testing in 57 of 63 patients with coronary flow abnormalities and six of 24 patients without coronary flow disorders. Twenty of the 87 patients had abnormalities of esophageal function; this group included 16 patients who also had abnormalities of coronary flow reserve. Twenty-four patients experienced chest pain during esophageal function testing, although only five of these patients showed abnormalities of esophageal motility or activity. The results show that 71 of 87 patients with angina-like chest pain and normal blood vessels according to coronary angiography had abnormalities of coronary flow reserve and/or esophageal motility. Chest pain was common during testing of the heart or esophagus, regardless of evidence for abnormalities of coronary flow reserve or esophageal function. Thus, chest pain may result from either one, or a combination of, the following: abnormalities in coronary blood flow, abnormal esophageal function, and nociception, which is internal organ pain. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1990
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Pill-induced esophageal strictures: clinical features and risk factors for development
Article Abstract:
Ingestion of pills can sometimes cause damage to the esophagus, although pill-induced narrowing of the esophagus has been studied less extensively. The characteristic risk factors of pill-induced constricture of the esophagus were assessed by review of the literature and five recent cases of pill-induced esophageal stricture. There have been 195 cases of pill-induced damage to the esophagus and 39 cases of pill-induced esophageal constricture reported in the literature to date. Strictures were located within the initial portion or midway along the esophagus in 78 percent of cases. Sixty percent of stricture cases were due to potassium chloride or quinidine preparations, which were more likely to produce stricture than other agents known to cause damage to the esophagus. Some factors associated with an increased risk of esophageal stricture included older age, male sex, enlargement of the left atrium of the heart, ingestion of sustained-release formulations, and prior abnormalities in the esophagus. The most significant factors associated with stricture development were older age and ingestion of sustained-release formulations. The results show that the development of esophageal stricture depends on patient characteristics in addition to the irritant nature of the pills. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1990
User Contributions:
Comment about this article or add new information about this topic:
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