Diagnosis and initial management of Gastroesophageal complications

Kamal, A. N.; Vaezi, Michael F.

doi:10.1016/j.bpg.2010.09.008

Cited by 9 publications

(3 citation statements)

References 96 publications

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“…Untreated GERD, however, is associated with serious complications such as esophageal ulcerations, peptic stricture, Barrett's esophagus, adenocarcinoma and extraesophageal disease 19 . Thus, it is important to know the extent to which dyspeptic symptoms and use of acid suppression persist beyond childhood, with the ultimate goal to develop treatment strategies that can minimize both complications of GERD and long term use of acid suppression 20 .…”

Section: Introductionmentioning

confidence: 99%

Pediatric Patients With Dyspepsia Have Chronic Symptoms, Anxiety, and Lower Quality of Life as Adolescents and Adults

et al. 2012

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Background & Aims Little is known about long-term health outcomes of children with dyspeptic symptoms. We studied the natural history of pediatric patients with dyspeptic symptoms, with and without histologic reflux, compared to healthy controls. Methods We performed a prospective study of consecutive new patients, ages 8–16 years, who underwent evaluation for dyspepsia, including upper endoscopy. Patients were assigned to groups with histologic evidence of reflux esophagitis (n=50), or normal histology results (n=53). Healthy children were followed as controls (n=143). Patients and controls were evaluated 5–15 years later. They provided self reports on severity of dyspeptic symptoms, use of acid suppression, quality of life, anxiety, and depression. Results When the study began, the groups with histologic evidence for esophagitis and normal histologies did not differ in severity of dyspeptic symptoms, functional disability, or depression. After a mean 7.6-year follow-up period, each group had significantly lower quality of life scores and more severe dyspeptic symptoms and functional disability than controls, but did not differ significantly from each other; both groups were significantly more likely than controls to meet criteria for an anxiety disorder. At time of follow-up, use of acid suppression medication was significantly greater in the group with histologic evidence for esophagitis, compared with patients that had normal histology findings when the study began. Conclusion Among pediatric patients with dyspepsia evaluated by endoscopy and biopsy, those with histologic evidence for esophagitis or normal histology findings are at increased risk for chronic dyspeptic symptoms, anxiety disorder, and reduced quality of life in adolescence and young adulthood.

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Section: Introductionmentioning

confidence: 99%

Pediatric Patients With Dyspepsia Have Chronic Symptoms, Anxiety, and Lower Quality of Life as Adolescents and Adults

et al. 2012

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“…Our findings suggest that the recommendation to perform pH monitoring only after a failed eight-week empiric trial of twice-daily PPIs and a negative EGD [16, 17] may require reconsideration. We found that the response to empiric trials of acid-reducing medication had no correlation with the results of the pH monitoring studies.…”

Section: Discussionmentioning

confidence: 99%

Early referral for 24-h esophageal pH monitoring may prevent unnecessary treatment with acid-reducing medications

Kleiman¹,

Sporn²,

Beninato³

et al. 2012

Surg Endosc

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BACKGROUND Gastroesophageal reflux disease (GERD) affects nearly 25% of adults, however an objective diagnosis is rarely established. We hypothesized that patients’ symptoms and response to acid-reducing therapy are poor predictors of the outcome of 24-hour esophageal pH monitoring. METHODS A review of 24-hour esophageal pH monitoring studies performed at an ambulatory tertiary care center between 2004 and 2011 was performed. Demographics, type of GERD symptoms, and duration and response to acid-reducing medications prior to referral for pH monitoring were collected. DeMeester score, symptom sensitivity index (SSI), and symptom index (SI) were tabulated and compared to the patients’ symptoms and response to medical therapy. RESULTS One hundred patients were included. Of all reported symptoms, only heartburn was more common in patients with positive DeMeester scores, but there were no correlations between any symptoms and SSI or SI scores. Sixty-nine percent of patients with esophageal symptoms had a positive DeMeester score compared to only 29% of patients with extraesophageal symptoms (p<0.01). Esophageal symptoms and endoscopic evidence of GERD significantly increased the likelihood of having a positive DeMeester score, but they had no influence on SSI or SI scores. There was no correlation between response to acid-reducing medications and DeMeester, SSI or SI scores. A total of 536 person-years of acid-reducing medications were prescribed to the study population, of which 151 (28%) were prescribed to patients who had a negative pH study. CONCLUSION Extraesophageal symptoms and response to empiric trials of acid-reducing medications are poor predictors of the presence of GERD and the DeMeester score is more likely to identify GERD in patients who met other empiric diagnostic criteria than either SSI or SI. Early referral for 24-hour esophageal pH monitoring may avoid lengthy periods of unnecessary medical therapy.

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“…GERD is caused by failure of the barrier between the esophagus and stomach, resulting in backflow of stomach content to the esophagus ( Malfertheiner and Hallerback, 2005 ). Heartburn, dysphasia, and chronic cough are common symptoms ( Malfertheiner and Hallerback, 2005 , Kamal and Vaezi, 2010 ). Chronic tissue injury due to GERD can cause Barrett’s esophagus, in which the squamous epithelium of the esophagus is replaced with metaplastic columnar epithelium ( Velanovich, 2012 ).…”

Section: Gastroesophageal Reflux Diseasementioning

confidence: 99%

Clinical manifestations of gastrointestinal diseases in the oral cavity

Al-Zahrani

Alhassani

Zawawi

2021

The Saudi Dental Journal

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Aim In this review, several gastrointestinal diseases that dentists may encounter in practice are highlighted and discussed. Materials and methods Using MEDLINE (PubMed), a comprehensive review of gastrointestinal diseases and their oral cavity manifestations was performed. Results Many gastrointestinal diseases present with oral symptoms that are detectable by dentists and dental hygienists. Often, oral manifestations of the disease may appear before systemic signs and symptoms. Managing patients with these conditions requires dentists to adjust their treatment and/or involve other health professionals. Conclusion Care must be taken when providing periodontal therapy or dental implants to patients suffering gastrointestinal diseases who are at high risk of bleeding, infection, or malnutrition, for example. Also, pharmacological therapy for these patients may need to be customized.

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Diagnosis and initial management of Gastroesophageal complications

Cited by 9 publications

References 96 publications

Pediatric Patients With Dyspepsia Have Chronic Symptoms, Anxiety, and Lower Quality of Life as Adolescents and Adults

Pediatric Patients With Dyspepsia Have Chronic Symptoms, Anxiety, and Lower Quality of Life as Adolescents and Adults

Early referral for 24-h esophageal pH monitoring may prevent unnecessary treatment with acid-reducing medications

Clinical manifestations of gastrointestinal diseases in the oral cavity

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