Etiology and importance of alkaline esophageal reflux

Article Abstract:

Reflux of stomach contents into the esophagus is a common complaint. Acidic gastroesophageal reflux is well understood. When acidic stomach contents flow back into the esophagus the pH in the esophagus falls to below 4 (very acidic) and causes heartburn, difficulty swallowing and regurgitation. Occasionally, patients will experience a rise in the pH of the esophagus above 7 (the normal esophageal pH ranges from 4 to 7). The causes of this rise in pH are not known. At certain times during digestion the stomach has alkaline periods; these are associated with reflux of duodenal contents into the stomach. It is possible that the increased pH in the esophagus may result from the reflux of a mixture of both stomach and duodenal contents. A study was undertaken of 81 patients with upper GI symptoms in which 24-hour esophageal pH monitoring was performed. The effectiveness of the lower esophageal sphincter was also evaluated. It was found that heartburn, difficulty swallowing and dysphagia occurred more often in patients who had a defective esophageal sphincter; epigastric pain was found in patients who had reflux of both stomach and duodenal contents. Patients with a defective sphincter had more episodes of inflammation of the esophagus, and these were more severe. A pH of less than 4 occurred in 40.5 percent of patients without duodenal gastric reflux, compared with only 10.2 percent of patients with duodenal gastric reflux. Episodes of pH elevation lasting more than one minute were identified in 45 patients. Patients with duodenal gastric reflux had higher pH readings after these episodes, suggesting a gastroduodenal origin of alkalinization. Evaluation of patients with gastroesophageal reflux should consider the alkaline component, so that appropriate treatment can be planned. (Consumer Summary produced by Reliance Medical Information, Inc.)

Measurement, Causes of, Complications and side effects, Digestion, Hydrogen-ion concentration, Heartburn, pH measurement

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Minimal access surgery and the future of interventional laparoscopy

Article Abstract:

The main goal of minimal access surgery is to reduce the trauma caused by a major incision into a body cavity, without compromising the ability of the surgeons to see the field of operation. This type of surgery is performed using long instruments introduced into the body through tubes, often less than 1/2 inch in diameter, and under the visual control of a laparoscope (an instrument which visualizes the internal organs and transmits images to a television monitor). Use of this type of surgery reduces the cost of treatment through reduction of time spent in the hospital and a speedy convalescence with quicker return to full activity. Additionally, wound infections are virtually eliminated and surgery on obese patients is easier to perform. The list of laparoscopic procedures already being performed on patients includes: appendectomy, removal of the appendix; cholecystectomy, removal of the gallbladder; lysis (cutting) of adhesions; vagotomy (cutting into the vagus nerve) and other procedures for peptic ulcer disease; aspiration of liver cysts; hernia repair; varicocelectomy (removal of swollen veins in the scrotum, the male external genital area), and gynecologic procedures. Improvements need to be made in the light-delivery system, surgical instrumentation, ultrasound, and portable lasers. Additionally, adequate prospective evaluation of these procedures must be undertaken. Possible, but not yet documented, benefits of these procedures include reduction in the common postoperative complications of chest infection and blood clots, and reduced risk of transmission of viral disease due to reduced contact with the patient's blood. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Equipment and supplies, Surgery, Abdomen, Laparotomy, Laparoscopy, Therapeutics, Surgical, Surgical therapeutics

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Abnormal esophageal transit in patients with typical reflux symptoms but normal endoscopic and pH profiles

Article Abstract:

Symptoms of gastroesophageal reflux (heartburn, regurgitation, and dysphagia, or painful swallowing) are frequently reported; however, symptoms do not correlate well with severity or presence of disease. There is a small subgroup of patients who have these symptoms but have normal acid levels in the esophagus and normal findings upon evaluation of the upper gastrointestinal tract. These patients are difficult to treat. A study was undertaken to evaluate the transit time of food (in this case, radioactively labeled egg white) through the esophagus in 58 patients; these patients had symptoms but no diagnostic evidence of gastroesophageal reflux. There were 33 women and 25 men in the study and the average age was 39.5 years. Over half the patients (53.3 percent) had normal motility. In the remaining 27 patients a specific abnormal transit pattern was identified: 59 percent had delay in the middle or far end of the esophagus; 22.2 percent showed a nonspecific delay; 11.1 percent showed an oscillatory pattern, and 7.4 percent showed total nonclearance during the period of the study. The patients with abnormal transit patterns were similar to patients with normal transit patterns when compared on the basis of age, sex and severity of symptoms. The authors suggest that patients in this study might benefit from prokinetic drugs in an effort to improve esophageal transit; the effectiveness of this treatment needs to be evaluated. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Esophagus, Diffuse esophageal spasm

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