Stress reflux

Second, reflux may occur after transient increases in intraabdominal pressure (stress reflux).3 An increase in intraabdominal pressure such as that occurring during straining, bending over, coughing, eating, or a Valsalva maneuver may overcome a weak lower esophageal sphincter, and thus may lead to reflux. 

Instances of free reflux only occur when the resting LES pressure is within 0 to 4 mm Hg of intragastric pressure. Nevertheless, it is likely that a substantial number of individuals with mild or moderate GERD are susceptible to stress reflux when their LES pressure has been temporarily diminished by specific foods (chocolate, onion, coffee), drugs, or personal habits. 

New Jersey 08360. A Dimroth condenser is recommended for use with refluxing liquids that boil up to 160°. Since the points of sealing are situated above the zone with a high temoerature gradient, the risk of cracking from thermal stress is minimized. The a-chlorination of aliphatic acids by this procedure is usually carried out at 110-140° (see Table I). The submitters circulated ice-cold water through the condenser. 

Unlabeled Uses Prevention and treatment of stress-related mucosal damage, especially in acutely or critically ill patients treatment of gastric ulcer and rheumatoid arthritis relief of Gl symptoms associated with NSAlDs treatment of gastroesophageal reflux disease... 

Drug Relative Potency Dose to Achieve > 50% Acid Inhibition for 10 Hours Usual Dose for Acute Duodenal or Gastric Ulcer Usual Dose for Gastroesophageal Reflux Disease Usual Dose for Prevention of Stress-Related Bleeding... 

We stress that this equation dictates the minimum reflux ratio based purely on thermodynamic arguments. As a1 3 = 1.11 in our case, the value of rmin = 12.28. In general, the mixture will not be equimolar, and if the products are not pure but satisfy a less strict specification, the value of rmin will be smaller. Now, a column operated under these conditions will have an efficiency of 100% since it is using the minimum amount of work necessary to separate the components. 

Xanthines have been given to infants at the risk of sudden infant death sjmdrome or idiopathic apnea of prematurity (see monograph on Theophylline). About 50% of 30 infants treated with caffeine (and 12 of 18 infants treated with theophylline) had significant increases in episodes of gastroesophageal reflux (36). The authors stressed that screening for reflux should precede the administration of caffeine (and theophylline) to infants at the risk of sudden infant death syndrome. As expected, the frequency of adverse effects such as tachycardia and gastroesophageal reflux is lower with lower doses of caffeine for example 2.5 mg/kg qds (SEDA-17,1). 

Refluxing ureters can be treated endoscopically with sub-ureteric injection of polytetrafluoroethylene paste (Polytef), the STING procedure. However, ureteric obstruction has been described as a complication (8). Urinary incontinence has also been treated by periurethral or submucosal injections of Polytef, but reports of urinary obstruction (9,10) and poor long-term success (11,12) have limited the range of indications for this treatment. Other reported complications of Teflon injection for stress urinary incontinence include periurethral abscess, urethral diverticulum. Teflon granuloma with urethral wall prolapse (13), and microembolization (14). 

In more elaborate electrolytic experiments it is often desirable to use a closed cell [37] with accessories for working under an inert atmosphere, or in vacuum [38], at elevated pressure, with reflux, or to allow the identification of gaseous products a stirrer and a thermometer are also conveniently added. For the performance of controlled potential electrolyses with external control of the working electrode potential by a potentiostat, it is necessary to include a reference electrode, which should then be placed as near the working electrode surface [39] as possible. However, reference electrodes are not so much used in undivided cells, and it must be stressed that CPE may be realized without the use of a... 

To avoid putting undue stress on the column walls, equipment such as reflux condensers and overhead receiving drums is usually not attached to the top of a column, but is instead located adjacent to the column in the plant structure. Condensers and receiving vessels are often placed above grade level to provide net positive suction head for reflux and overhead pumps sited at grade. 

THERAPEUTIC USES Because increased gastric pH may be a factor in the development of nosocomial pneumonia in critically iU patients, sucralfate may offer an advantage over proton pump inhibitors and H receptor antagonists for the prophylaxis of stress ulcers (see below). Due to its unique mechanism of action, sucralfate also has been used in several other conditions associated with mucosal inffammation/ulceration that may not respond to acid suppression, including oral mucositis (radiation and aphthous ulcers) and bile reflux gastropathy. Administered by rectal enema, sucralfate also has been used for radiation proctitis and solitary rectal ulcers. 

FIGURE 36-4 Adapted from Wolfe MM, Sachs G Acid suppression optimizing therapy for gastroesophageal ulcer healing, gastroesopageal reflux disease, and stress-related syndrome. Gastroenterology. 118 S9-S31, 2000. Copyright 2000 with permission from Elsevier. 

Indications Duodenal ulcer, gastric ulcer, hypersecretory states, acid reflux, esophagitis, stress ulcer prophylaxis Common drug examples ... 

---