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Update in Gastroenterology
- Gastroenterology
- Gastroesophageal reflux
- Helicobacter infections
- Dyspepsia
- Gastrointestinal hemorrhage
- Inflammatory bowel disease
- Pancreatitis
1999-2000 Series: Update Sessions from ACP-ASIM's 1999 Annual Session
Margaret Ring Gillock, Editor, and David Cramer, MD, Co-Editor
Among the most important topics attracting investigators' attention in 1998 were gastroesophageal reflux disease (GERD), the diagnosis and treatment of Helicobacter pylori infection, and how best to manage patients with nonulcer dyspepsia. Also worthy of note are reports on the treatment of gastrointestinal bleeding, several aspects of inflammatory bowel disease, chronic pancreatitis, and colonic gas.
Gastroesophageal Reflux Disease
Gastroesophageal reflux disease is widely prevalent, affecting roughly 7% of the U.S. population on a daily basis. Many other people are bothered by heartburn every week or month. Perhaps one fourth of all Americans use antacids at least twice a month. Relatively few patients with GERD reach the point of consulting their primary care physician or a gastroenterologist. About 2% of all patients with symptoms of GERD but 10% to 15% of those who do see a specialist have endoscopically documented esophagitis. These represent only the tip of this “iceberg” disease; most symptomatic patients medicate themselves.
Experience with several thousand patients suggests that esophagitis will heal in about one quarter of those given placebo and that symptoms will improve in about the same number. With an H2-receptor blocker, 60% of patients will feel better and half will be healed; with a prokinetic drug such as cisapride, the percentages are 50% and 40%. When a proton-pump inhibitor such as omeprazole is used, the percentages go up to 80%. Some patients with typical symptoms of reflux do not respond to treatment, even after esophagogastroduodenoscopy, 24-hour pH monitoring, and manometric studies. The problem may be an abnormally sensitive esophageal mucosa, a condition documented in studies in which inflating an esophageal balloon reproduces patients' symptoms; this effect was not observed in healthy controls. In many cases, this “visceral hyperalgesia” …
