RSS Feeds
Update in Gastroenterology
- From the University of Kansas, Kansas City, Kansas. Requests for Reprints: Norton J. Greenberger, MD, Department of Medicine, University of Kansas Medical Center, 39th Street and Rainbow Boulevard, Kansas City, KS 66103. Current Author Addresses: Dr. Greenberger: Department of Medicine, University of Kansas Medical Center, 39th Street and Rainbow Boulevard, Kansas City, KS 66103.
1996-97 Series: John Roberts, MD, Editor
Among the advances made in the field of gastroenterology in the past year, advances in the knowledge and treatment of common upper gastrointestinal symptoms have been the most prominent. The long-term use of proton-pump inhibitors was found to be effective, and various regimens against Helicobacter pylori disease were expanded. The causes of nonulcer dyspepsia were described; even after exhaustive work-ups, however, a third of patients still had “idiopathic” dyspepsia. Advances also took place in the prevention of gallstones, the treatment of ulcerative colitis, the prevention of colon cancer in women, and the use of antibiotics in necrotizing pancreatitis.
Gastroesophageal Reflux Disease
Seven percent of U.S. adults have symptoms of gastroesophageal reflux disease at least once daily. More than half of patients with reflux disease have mild sporadic symptoms and use over-the-counter antacids or histamine blockers. About 20% to 30% of patients frequently have symptoms and consult their primary care physicians about treatment. About 10% to 15% of patients have chronic, persistent symptoms with or without complications and are usually referred to a gastroenterologist.
The major factor contributing to gastroesophageal reflux disease is inappropriate relaxation of the lower esophageal sphincter. Secondary factors include poor esophageal clearance of acid, delayed gastric emptying, and the potency of refluxate. It is not generally appreciated that several medications and foods, such as alcohol, caffeine, chocolate, peppermint, fried foods, onions, and fatty foods, may reduce lower esophageal sphincter pressure and delay gastric emptying, thereby facilitating reflux disease. Several beverages have a very acidic pH and can aggravate symptoms of reflux in patients with underlying esophagitis. Such beverages include Coca Cola and Pepsi Cola (each of which has a pH of 2.5), red wine (pH, 3.25), and orange juice (pH, 3.5).
It is important to keep a detailed drug history of patients with gastroesophageal …
This 100-word excerpt has been provided in the absence of an abstract.
