Gastroesophageal Reflux

Fisher, Robert S.; Cohen, Sidney

doi:10.1016/s0025-7125(16)31818-1

Cited by 21 publications

(6 citation statements)

References 105 publications

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“…The lower oesophageal sphincter (LOS) is believed to be the main antireflux barrier [ 1,2]. A competent sphincter maintains a high pressure zone between the stomach and the oesophagus, and responds to increasing gas tric pressure with an excess pressure [3,4], In oesophagitis patients, reflux occurs by tran sient complete relaxation of the LOS, tran sient increase in intra-abdominal pressure, and spontaneous reflux associated with low resting LOS pressure [5,6], Clearing of refluxed material by primary or secondary oesophageal peristaltic waves is the second defense mechanism.…”

mentioning

confidence: 99%

“…The third defense line is commonly re ferred to as 'tissue resistance' to noxious sub stances, such as acid and pepsin [8], bile salts [9] and possibly pancreatic enzymes [10], It has long been thought that the origin of reflux disease is an incompetent LOS (11,12], However, experiments in cats and ba boons have shown that exogenous acid-in duced oesophagitis results in decreases in LOS pressure and oesophageal peristalsis [13,14], which thus explain reflux oesopha gitis as a self-propagating destructive mecha nism [2]: acute injury affects oesophageal defense resulting in continuing reflux and more damage.…”

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confidence: 99%

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Healing of Grade-II and III Oesophagitis through Motility Stimulation with Cisapride

et al. 1990

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The clinical relevance of cispride’s stimulating effects on lower oesophageal motility was studied in 19 patients with documented (endoscopy, biopsy) grade II or III oesophagitis. Patients were treated for 8 or 16 weeks (depending essentially on whether the result was cure or failure) with 10 mg of cisapride four times a day (n = 11) or placebo (n = 8). Cisapride was superior to placebo with regard to mucosal healing (p < 0.001) and symptomatic improvement (p < 0.05): at the end of treatment, healing (grade 0) was observed in 8 cisapride patients, against 1 placebo patient, and reflux symptoms had disappeared in 7 and 1 patients, respectively. In conclusion, cisapride was of significant benefit to oesophagitis patients and was well tolerated.

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Healing of Grade-II and III Oesophagitis through Motility Stimulation with Cisapride

et al. 1990

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“…Although the basic principal of the test remained similar, many investigators have tried different acid perfusion rates, concentrations, and durations in the hope of increasing the sensitivity of the test. [27][28][29][30][31][32][33][34] Furthermore, some have even suggested the addition of bile salts to the acid solution. 35 Many attempts were made to change the test from a qualitative to a quantitative tool.…”

Section: Acid Perfusion Test (Bernstein Test)mentioning

confidence: 99%

Sensory Testing of the Esophagus

Fass

2004

Journal of Clinical Gastroenterology

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Originally, sensory testing of the esophagus included the acid perfusion test and the edrophonium test, which were developed to assess patients with non-cardiac chest pain. In the last 2 decades interest in functional esophageal disorders has increased and thus further understanding of the underlying mechanisms of esophageal pain required development of new sensory testing techniques. Balloon distension using a computerized electronic device, electrical stimulation and impedance planimetry have generated important information about esophageal sensory thresholds for pain in different disease states. Intraluminal ultrasonography has been used to determine the physiologic changes of the muscle wall of the esophagus during perception of typical esophageal symptoms. Central evaluation of patients undergoing esophageal stimulation has recently been introduced to assess cerebral activation in different esophageal disorders. However, many studies using esophageal sensory testing are afflicted with significant design flaws, making interpretation of the results very difficult. This is primarily due to lack of recognition of factors that can modulate esophageal sensation.

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“…Mechanical factors that have been proposed to play a role in protection include: the cardioesophageal angle; a diaphragmatic pinchcock mechanism; the phrenoesophageal ligament; a mucosal rosette formed by gastric folds; and distal paraesophageal pressure. 16,17 There is also a zone of elevated intraluminal pressure in the distal esophagus that has been termed the "lower esophageal sphincter." The resting pressure within this zone in normal subjects is 12 to 30 mmHg above the intra-abdominal pressure and acts as another effective barrier against reflux.…”

Section: Pathogenesis Of Gastroesophageal Refluxmentioning

confidence: 99%