Gastroesophageal

On the pathophysiological side, hyperactive nNOS has been implicated in A/-methyl-D-aspartate (NMDA)-receptor-mediated neuronal death in cerebrovascular-stroke. Some disturbances of smooth muscle tone within the gastrointestinal tract (e.g., gastroesophageal reflux disease) may also be related to an overproduction of NO by nNOS in peripheral nitrergic nerves. 

Gastrin Releasing Peptide Gastroesophageal Reflux Disease (GERD)... 

XANTHINE DERIVATIVES. The patient taking theophylline may report heartburn because the drug relaxes the lower esophageal sphincter, allowing gastroesophageal reflux. Heartburn is minimized if the patient remains in an upright position and sleeps with the head of die bed elevated. 

Gastroesophageal reflux has been associated with increased asthma symptoms, especially nighttime symptoms. 

Other complications may include gastroesophageal reflux, dysmotility, intussusception, volvulus, atresia, rectal prolapse, and complications related to corrective surgery for meconium ileus.6... 

Explain the underlying causes of gastroesophageal reflux disease (GERD). 

Adapted from Williams DB, Schade RR. Gastroesophageal reflux disease. In DiPiro JT, Talbert RL, Yee GC, et al, eds. Pharmacotherapy A Pathophysiologic Approach. 6th ed. McGraw-Hill, New York McGraw-Hill 2005 615, with permission. 

The pathophysiology of GERD is a complex process. It is difficult to determine which occurs first gastroesophageal reflux leading to defective peristalsis with delayed clearing, or an incompetent lower esophageal sphincter pressure leading... 

Gastroesophageal reflux occurs in approximately 18% of infants. As in adults, transient lower esophageal sphincter relaxations appear to be the most common cause of GERD.26 This is due to developmental immaturity of the lower esophageal sphincter.27 Other causes include impaired luminal clearance of gastric acid, neurologic impairment, and type of infant formula. 

GERD gastroesophageal reflux disease H2RA histamine2-receptor antagonist LES lower esophageal sphincter... 

DeVault KR, Castell DO. Updated guidelines for the diagnosis and treatment of gastroesophageal reflux disease. Am J Gastroenterol 2005 100 190-200. 

Lagergren J, Bergstrom R, Lindgren A, Nyren O. Symptomatic gastroesophageal reflux as a risk factor for esophageal adenocarcinoma. N Engl J Med 1999 340 825-831. 

Wong WM, Wong BCY. Definition and diagnosis of gastroesophageal reflux disease. J Gastroenterol Hepatol 2004 19 S26-S32. 

FIGURE 15-2. Approach to the patient presenting with ulcer-like symptoms. GERD, gastroesophageal reflux disease HP Helicobacter pylori ... 

Refer to Chapter 14 on gastroesophageal reflux disease for more information on the PPIs. The PPI omeprazole is superior to both ranitidine and misoprostol for preventing recurrence of NSAID-associated PUD. In one study, omeprazole 20 mg daily was compared to misoprostol 200 meg twice daily for NSAID-associated PUD prevention. At 6 months, the omeprazole-treated group had significantly fewer ulcers than those taking misoprostol. Furthermore, more patients discontinued ulcer prophylaxis in the misoprostol group due to adverse events.26... 

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