Rationale and efficacy of conservative therapy for gastroesophageal reflux disease

Article Abstract:

Gastroesophageal reflux occurs with regurgitation, or when the contents of the stomach flow backward into the esophagus. It is often associated with an abnormal relaxation of the esophageal sphincter, which is the ring of muscle at the end of the esophagus that controls the flow of food into the stomach. The chief symptoms of reflux are heartburn and regurgitation. It is very common in healthy people, especially following a meal; in one survey of hospital employees, 36 percent reported symptoms of gastroesophageal reflux at least once a month, and 7 percent suffered daily. In past decades, treatment consisted of antacids and lifestyle changes, such as elevating the head of the bed, restricting alcohol use, and avoiding prebedtime meals. Newer modes of treatment include drug therapy and surgery, but there may be some value in the methods of the past, which were based on the known physiology of gastroesophageal reflux. Many foods are known to relax the esophageal sphincter, including chocolate, mint extracts, and fats. Avoidance of these foods may reduce gastroesophageal reflux in those who are susceptible. Alcohol also affects the sphincter. Smoking relaxes the sphincter and has been shown to increase reflux. Commonly used drugs that have the potential for causing gastroesophageal reflux include theophylline, meperidine (Demerol), diazepam (Valium), morphine, calcium channel blockers, and oral contraceptives. Exercise may also cause reflux. The association between obesity and gastroesophageal reflux is less convincing. Sitting upright or elevating the head of the bed has been shown to reduce the number of reflux episodes. Antacids are also beneficial; they buffer the acidity of the stomach contents, and also constrict the esophageal sphincter. Antacids are often combined with alginate, a compound that forms a foam and protects the lining of the esophagus. In fact, this combination has been shown to be as effective in treating gastroesophageal reflux as several anti-ulcer drugs, such as cimetidine (Tagamet), ranitidine (Zantac), and sucralfate (Carafate). It is clear that conservative treatment of gastroesophageal reflux can be effective in the majority of people. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Dosage and administration, Antacids

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The prevalence of abnormal esophageal test results in patients with cardiovascular disease and unexplained chest pain

Article Abstract:

Chest pain resulting from ischemic heart disease, or the lack of adequate oxygen supply to heart muscle, may be indistinguishable from chest pain caused by disorders of the esophagus. However, the two disorders have very different prognoses. Little attention has been paid to the prevalence of esophageal disorders among patients with cardiovascular disease, despite the fact that the chest pain in many such patients might respond to treatment. To investigate the prevalence of esophageal disorders among heart patients, 220 patients with confirmed heart disease and persistent chest pain were examined. A control group of 159 patients with chest pain but without evidence of cardiac disease were also examined. Positive indications for esophageal disorders included abnormal motility and esophageal spasms. Abnormal motility was common, and ranged from 24 to 37 percent among the patients. Negative results occurred in the groups with the following frequencies: noncardiac chest pain, 55 percent; coronary artery disease, 62 percent; mitral valve prolapse, 42 percent; and bypass/angiography patients, 59 percent. There were no distinct differences between the noncardiac chest pain group and the other patient groups. It has been suggested that in some patients esophageal pain may precipitate myocardial ischemia, and there is some suggestion that esophageal disorders may lower the threshold for cardiac chest pain. The relatively high prevalence of esophageal disturbances among the cardiac patients suggests that at least some pain may be effectively treated. It is important to exercise caution, as the results of failing to recognize true cardiac pain when it occurs could be serious. (Consumer Summary produced by Reliance Medical Information, Inc.)

Abnormalities, Heart diseases, Esophagus, Chest pain, Angina pectoris

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Gastroesophageal reflux as a pathogenic factor in the development of symptomatic lower esophageal rings

Article Abstract:

Lower esophageal rings (LER), also referred to as Schatzki rings, represent one of the most common causes of dysphagia, difficulty in swallowing. Gastroesophageal reflux (GER), in which stomach fluids are regurgitated into the esophagus, has been suggested as a cause of these rings. Many patients with symptomatic Schatzki rings have heartburn or associated peptic esophagitis and most are over the age of 40 years. Classically these patients have difficulty swallowing solid foods, and this can worsen over time. An impaction of meat may cause esophageal obstruction and is commonly referred to as steakhouse syndrome. A group of patients with symptomatic Schatzki rings was studied to determine and quantify the presence of GER and reflux injury of the esophagus. Sixty-three percent of patients showed evidence of abnormal GER. Of 20 patients with LER, abnormal GER was documented in 13. Nevertheless, the origin of these rings is not clear. LER is very frequently associated with a hiatal hernia, and therefore many believe that LER is caused by GER. Gastroesophageal reflux disease is considered an important cause of the progressive stricturing in many patients with LER. Therapy should be directed at GER as an adjunct to dilation of the esophagus for patients with symptomatic LER. Flexible fiberoptic and video-endoscopy and other modern techniques that were not available when early studies of these esophageal rings were performed should prove useful in diagnosing GER. (Consumer Summary produced by Reliance Medical Information, Inc.)

Digestive system diseases, Deglutition disorders

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