Gastroesophageal reflux disease in diabetic patients

Esophageal dysfunctions occur frequently in patients with diabetic autonomic neuropathy, and the complication of gastroesophageal reflux disease (GERD) has also been reported. However, the characteristics of the GERD complicated with diabetes are obscure, because no detail assessment was performed. We recorded esophageal motility and acid reflux simultaneously in diabetic patients, and the correlation between esophageal dysfunction and diabetic neuropathy was examined. Esophageal dysfunctions including GERD were significantly related to diabetic motor neuropathy. Although the GERD is frequently complicated with diabetes, the symptoms are not apparent in diabetic patients. Therefore, physicians treating diabetic patients should have GERD in mind regardless of the symptoms. We also examined the effect of aldose reductase inhibitor (ARI) on the esophageal dysfunction in diabetic patients. Significant improvement of gastroesophageal reflux and esophageal motility were observed in diabetic patients by ARI treatment. ARI may be useful for the treatment of GERD complicated with diabetes.     

Gastroesophageal reflux disease

Gastroesophageal reflux disease, usually manifested by frequent heartburn, occurs in approximately 10% of our adult population. The presence of a hiatal hernia is usually associated with, but does not necessarily cause, LES dysfunction, allowing acid reflux to produce esophageal and aerodigestive symptoms. The mucosa can be extensively damaged and, ultimately, a columnar lining, termed Barrett's esophagus, a premalignant condition, can develop. Treatment with H2-antagonists has been nirvana to some patients, but has proved only partially helpful to others. Adjunctive agents may increase relief and may help heal erosive esophagitis in some patients, but side effects and cost limit their use. Maintenance therapy with full doses is required, as the relapse rate for this chronic condition is high. Omeprazole temporarily heals almost everyone with otherwise resistant GERD, but it is currently used only on a short-term basis unless surgery, eminently successful in well-selected patients, is contraindicated.     

Gastroesophageal reflux disease

In this age of fast food, overeating, and busy schedules, many people frequently complain of heartburn or indigestion. Meal times are rarely consistent, so meal planning appears out of the question. What are the consequences of this lifestyle? Gastroesophageal reflux disease (GERD) is a common disorder that affects every population. This article defines this condition and provides a history, literature review, and pathophysiology for the disorder. Recommendations for diagnosis and guidelines for treatment and nursing care interventions also are given.     

Gastroesophageal reflux disease.

This article examines the diagnostic and treatment options available to people who have gastroesophageal reflux disease. The role of nurses in advising and educating patients about lifestyle modifications, which reduce the severity of symptoms and increase the quality of life, is emphasised.     

Gastroesophageal reflux disease. Medical aspects

Symptomatic gastroesophageal reflux is one of the most common complaints encountered by clinicians. The pathogenesis of reflux remains unclear, but multiple factors are involved. Heartburn is the most common clinical manifestation. The history and barium esophagram provide sufficient diagnostic information in most cases. Other studies, including ambulatory pH monitoring, the Bernstein test, endoscopy with biopsy, and esophageal manometry, are warranted if the patient has atypical symptoms, an incomplete response to therapy, dysphagia, or abnormalities on the esophagram. Proper utilization of these studies requires an understanding of the questions each test answers. Reflux disease is often a chronic problem. Many patients can be treated symptomatically by a combination of life-style modifications and use of antacids. Patients who do not respond adequately to these simple measures or who have documented erosive esophagitis usually require further drug therapy.     

Gastroesophageal reflux disease and Barrett's esophagus

GERD has emerged as an important medical issue by virtue not only of its high prevalence, but also by the concern that it may predispose to adenocarcinoma of the esophagus. It generally is classified into erosive and nonerosive forms. Nonerosive GERD tends to remain as such in most patients, and treatment is based on symptom relief. In contrast, erosive GERD mandates aggressive lifelong treatment based on its inevitable relapse without appropriate treatment. Two excellent therapies are available for GERD. Proton-pump inhibitors are highly efficacious and have an excellent long-term (> 10 years) safety profile. Laparoscopic fundoplication offers a new and easier method of delivering a standard reliable procedure also with excellent long-term efficacy. The occurrence of Barrett's esophagus among reflux patients has emerged as an important problem mostly because of the rapidly rising incidence of adenocarcinoma of the esophagus in the population. All patients with long-standing reflux symptoms should be screened for Barrett's and subsequently followed regularly with surveillance endoscopy if Barrett's is detected. Although there are no data to show that aggressive medical or surgical treatment alters the malignant potential of this disease, patients need lifelong therapy.     

Gastroesophageal reflux disease and Barrett's esophagus

Gastroesophageal reflux disease (GERD) is a common clinical problem. Circumstantial evidence continues to suggest that infection with Helicobacter pylori may protect some patients from developing GERD and its complications. An empirical trial of a proton-pump inhibitor may now be a reasonable alternative to endoscopy or 24-hour pH testing for the diagnosis of GERD. Long-term follow-up data covering more than over a decade indicate that proton-pump inhibitors are effective and safe agents for the treatment of GERD. Furthermore, a strategy of proton-pump inhibitors first may be the most cost-effective approach to GERD. It remains unclear why some patients with GERD develop Barrett's esophagus, whereas others do not. Recent studies demonstrate the importance of pulses of acid or bile in increasing cell proliferation and cyclooxygenase-2 expression in Barrett's epithelium cell cultures. Short-segment Barrett's esophagus is now clearly associated with an increased risk of dysplasia or cancer compared to intestinal metaplasia of the cardia, and the cancer risk in this condition is similar to that with long-segment Barrett's esophagus. However, the overall cancer risk in patients with Barrett's esophagus is lower than previously estimated, at approximately 0.5% annually. Ablation techniques continue to show promise, but are not yet ready for routine clinical use. Endoscopic mucosal resection is a new treatment option for selected patients with high-grade dysplasia or superficial esophageal adenocarcinoma.     

Gastroesophageal reflux disease and Barrett's esophagus

Gastroesophageal reflux disease (GERD) is a common clinical problem. More frequent and extended acidic reflux episodes are characteristic of GERD, although substantial (nonacid) reflux per se is also observed in control individuals. Helicobacter pylori may protect some people from reflux disease, but others do not experience deterioration of GERD as a result of H. pylori eradication, for reasons so far unknown. Medical treatment, preferably with proton-pump inhibitors, is well established and is also recommended in endoscopy-negative forms of the disease, although the efficacy is less marked in comparison with erosive esophagitis. Surgery has emerged as an alternative to medical therapy, but the long-term results do not now appear to be as promising as was initially claimed. A number of new endoscopic techniques for the treatment of GERD have been developed, but the future for these is unclear. Barrett's esophagus develops in some patients with GERD for unknown reasons, and surveillance should be carried out in these patients due to the risk of subsequent malignant transformation. Several new approaches have been developed for detecting premalignant conditions, but these need to be investigated further. Ablative techniques are still under intensive investigation, and appear to be promising, at least in a subset of patients, although they are not devoid of major complications. Whether antireflux therapy, irrespective of the method used, can slow down the development of cancer is still an intriguing and clinically important question.     

Gastroesophageal reflux disease and Barrett's esophagus

Gastroesophageal reflux disease (GERD) is a very common disorder, mainly occurring in Western countries. The nonerosive form of GERD, which occurs in more than half of the patients affected, deserves particular attention. Administering symptomatic therapy without a prior endoscopic examination has become an attractive option, since it also provides diagnostic information. Proton-pump inhibitors (PPIs) have become established as the standard therapy, but new insights into the pathophysiology of the condition may lead to new treatment options using gamma-aminobutyric acid (GABA) agonists. Endoscopic therapy is still at the experimental stage and has yet to prove its value as an alternative to PPI and surgery. However, it is questionable whether antireflux surgery is more cost-effective in the longer term.[nl]Gastroenterologists are now much more aware of Barrett's esophagus than was the case a few years ago. Barrett's esophagus is a frequent finding in patients with reflux symptoms, but is a rare cause of death in affected patients. For several reasons, there is a large gap between recommendations regarding surveillance, on the one hand, and everyday practice on the other. New diagnostic procedures such as chromoendoscopy may allow better detection of premalignant and malignant alterations in metaplastic mucosa, but the safety of such techniques has been questioned. Prophylactic ablation is a debatable approach, whereas endoscopic interventions in patients with high-grade dysplasia and early adenocarcinoma are continuing to develop as attractive alternatives to esophagectomy in selected patients. It remains to be seen whether chemoprevention using cyclooxygenase-2 (COX-2) inhibitors should be carried out in high-risk patients with Barrett's esophagus, in order to prevent malignant transformation to esophageal cancer.     

Gastroesophageal reflux disease and Barrett's esophagus

Several articles have been published during the last year that may affect the management of patients with gastroesophageal reflux disease (GERD) and/or Barrett's esophagus in the near future. A new method of measuring esophageal pH has been introduced that does not require an indwelling transnasal catheter and may allow a more physiological assessment of esophageal acid exposure. Several articles discussed the use of endoscopic antireflux procedures, and a sham-controlled randomized study was published concerning the Stretta procedure. A long-term follow-up study and a decision analysis study have again fueled the debate concerning the relevance of surveillance of Barrett's patients, whereas other studies focused on techniques that may improve the detection of specialized intestinal metaplasia and dysplasia within the Barrett's segment. Finally, several studies have reported promising results with the endoscopic treatment of Barrett's metaplasia and early neoplasia using ablation techniques or endoscopic resection modalities. This review summarizes the most important articles in the field of GERD and Barrett's esophagus that have been published in peer-reviewed journals during the last year that are relevant to the practicing endoscopist.     

中年人非糜烂性胃食道反流病的影响因素分析

目的分析中年人非糜烂性胃食道反流病患者的影响因素,以预防该疾病的发生。方法分别观察了118例患者的性别、体重指数、进食种类等与症状的关系及本组患者的反流方式。结果女性患者比男性患者高,习惯进食刺激性食物的(如浓茶、咖啡、辣椒、油炸食物等)患者比间断进食刺激性食物者高,体重指数超标患者比体重指数正常者高。进食后即有反流症状者115例,占95%。结论中年女性内分泌功能紊乱,增加了反流症状。刺激性大、高脂食物对食管下段括约肌压力及胃排空的影响,使反流症状加重。体重指数超标使腹压增高并加重反流,反流方式以餐后为主。对患者进行心理干预及健康生活指导,可有效预防此类症状的发生。