PubMed · 12394405
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Rochelle Salmore. Practice tips.. https://doi.org/10.1097/00001610-200209000-00015
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Severity of nausea, retching and vomiting was determined using a newly developed nausea and vomiting in pregnancy instrument (NVPI) in two groups of pregnant women at two gestational time periods. Participants at Time 1 (approximately gestational week 9), completed a postal questionnaire (N = 643) and those at Time 2 (approximately 13 weeks) completed the instrument at the clinic (N = 284). The three scale items forming the instrument had acceptable internal reliability (Time 1 alpha = 0.76; Time 2 alpha = 0.82). It was noted that approximately 60% of women did not vomit, approximately 30% experienced no retching, but 30-40% experienced nausea either all the time or more than once a day. The instrument may prove to be useful as a research tool to study nausea and vomiting in pregnancy.
OBJECTIVE: To investigate the relationship between five-year control of reflux and early postoperative oesophageal function after total fundoplication done either laparoscopically or through a laparotomy in severe and mild reflux disease. DESIGN: Prospective open study. SETTING: University hospital, Sweden. PATIENTS: In the group with severe disease 9 patients had a laparotomy and 7 laparoscopy. The corresponding figures for the group with mild disease were 21 and 34 respectively. RESULTS: The increase in lower oesophageal sphincter pressure 6 months after operation in patients with recurrent disease was significantly less than that for patients with good reflux control (p < 0.01). In patients who had laparotomy, including 30% (9/30) with severe reflux disease, good long-term reflux control was found in 93% (27/29). In patients operated on laparoscopically including 17% (7/41) with severe reflux disease good long-term reflux control was found in 90% (35/39). CONCLUSION: The mechanism of recurrence differed between patients with severe disease who had a laparotomy and patients with mild disease operated on laparoscopically. Early postoperative manometry was prognostic for recurrence. Long-term reflux control seems to be similar after laparotomy and laparoscopy. Further randomised studies are needed.
Gastroesophageal reflux disease (GERD) is a common condition with a variety of clinical manifestations and potentially serious complications. This article reviews available methods for diagnosing GERD. A clinical history of the classic symptoms of GERD, heartburn or acid regurgitation, is sensitive enough to establish the diagnosis in patients without other complications. Esophagogastroduodenoscopy is the best way to evaluate suspected complications of GERD, but endoscopic findings are insensitive for the presence of pathological reflux, and therefore they cannot reliably exclude GERD. The "gold standard" study for confirming or excluding the presence of abnormal gastroesophageal reflux is the 24-hour ambulatory esophageal pH monitoring test, and this study should be used for the evaluation of refractory symptoms and extraesophageal manifestations of GERD. A formal acid-suppression test is helpful in the evaluation of the atypical GERD symptom of noncardiac chest pain. Optimal use of currently available tests for GERD may allow for more efficient diagnosis and better characterization of the pathological manifestations associated with GERD.