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Wang C, Li M, Duan X, Abu-Izneid T, Rauf A, Khan Z, Mitra S, Emran TB, Aljohani ASM, Alhumaydhi FA, Thiruvengadam M, Suleria HAR. Phytochemical and Nutritional Profiling of Tomatoes; Impact of Processing on Bioavailability - A Comprehensive Review. FOOD REVIEWS INTERNATIONAL 2022. [DOI: 10.1080/87559129.2022.2097692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Chuqi Wang
- Faculty of Veterinary and Agricultural Sciences, School of Agriculture and Food, The University of Melbourne, Parkville, Victoria, Australia
| | - Minhao Li
- Faculty of Veterinary and Agricultural Sciences, School of Agriculture and Food, The University of Melbourne, Parkville, Victoria, Australia
| | - Xinyu Duan
- Faculty of Veterinary and Agricultural Sciences, School of Agriculture and Food, The University of Melbourne, Parkville, Victoria, Australia
| | - Tareq Abu-Izneid
- Pharmaceutical Sciences Program, College of Pharmacy, Al Ain University, Al Ain Campus, United Arab Emirates
| | - Abdur Rauf
- Department of Chemistry, University of Swabi, Anbar, Khyber Pakhtunkhwa, Pakistan
| | - Zidan Khan
- Department of Pharmacy, International Islamic University Chittagong, Chittagong, Bangladesh
| | - Saikat Mitra
- Department of Pharmacy, Faculty of Pharmacy, University of Dhaka, Dhaka, Bangladesh
| | - Talha Bin Emran
- Department of Pharmacy, BGC Trust University Bangladesh, Chittagong, Bangladesh
| | - Abdullah S. M. Aljohani
- Department of Veterinary Medicine, College of Agriculture and Veterinary Medicine, Qassim University, Buraydah, Saudi Arabia
| | - Fahad A. Alhumaydhi
- Department of Medical Laboratories, College of Applied Medical Sciences, Qassim University, Buraydah, Saudi Arabia
| | - Muthu Thiruvengadam
- Department of Crop Science, College of Sanghuh Life Science, Konkuk University, Seoul, Republic of Korea
- Department of Microbiology, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences (SIMATS), Chennai, India
| | - Hafiz A. R. Suleria
- Faculty of Veterinary and Agricultural Sciences, School of Agriculture and Food, The University of Melbourne, Parkville, Victoria, Australia
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Salehi B, Sharifi-Rad R, Sharopov F, Namiesnik J, Roointan A, Kamle M, Kumar P, Martins N, Sharifi-Rad J. Beneficial effects and potential risks of tomato consumption for human health: An overview. Nutrition 2019; 62:201-208. [PMID: 30925445 DOI: 10.1016/j.nut.2019.01.012] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 01/04/2019] [Accepted: 01/09/2019] [Indexed: 12/20/2022]
Abstract
Tomato and its derived products have a very interesting nutritional value in addition to prominent antioxidant, anti-inflammatory, and anticancer activities. Tomatoes are generally quite safe to eat. However, overall consumption varies from individual to individual. Indeed, either beneficial or harmful effects of plants or their derived products are closely related to quality, including the presence of biologically active compounds. On the other hand, the synthesis and accumulation of these bioactive molecules depends on many other factors, such as environmental conditions. In this sense, this review briefly highlights the relationship between the chemistry of tomato and its derived products and their beneficial or harmful effects on human health, such as gastroesophageal reflux disease or heartburn, allergies, kidney and cardiovascular disorders, prostate cancer, irritable bowel syndrome, lycopenodermia, body aches, arthritis, and urinary problems.
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Affiliation(s)
- Bahare Salehi
- Student Research Committee, School of Medicine, Bam University of Medical Sciences, Bam, Iran
| | - Razieh Sharifi-Rad
- Zabol Medicinal Plants Research Center, Zabol University of Medical Sciences, Zabol, Iran
| | - Farukh Sharopov
- Department of Pharmaceutical Technology, Avicenna Tajik State Medical University, Dushanbe, Tajikistan
| | - Jacek Namiesnik
- Department of Analytical Chemistry, Faculty of Chemistry, Gdańsk University of Technology, Gdańsk, Poland
| | - Amir Roointan
- Department of Medical Biotechnology, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Science, Shiraz, Iran
| | - Madhu Kamle
- Department of Forestry, North Eastern Regional Institute of Science and Technology, Arunachal Pradesh, India
| | - Pradeep Kumar
- Department of Forestry, North Eastern Regional Institute of Science and Technology, Arunachal Pradesh, India.
| | - Natália Martins
- Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, Porto, Portugal; Institute for Research and Innovation in Health (i3S), University of Porto, Porto, Portugal.
| | - Javad Sharifi-Rad
- Food Safety Research Center (salt), Semnan University of Medical Sciences, Semnan, Iran; Institute for Research and Innovation in Health (i3S), University of Porto, Porto, Portugal.
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Bayerdörffer E, Bigard MA, Weiss W, Mearin F, Rodrigo L, Dominguez Muñoz JE, Grundling H, Persson T, Svedberg LE, Keeling N, Eklund S. Randomized, multicenter study: on-demand versus continuous maintenance treatment with esomeprazole in patients with non-erosive gastroesophageal reflux disease. BMC Gastroenterol 2016; 16:48. [PMID: 27080034 PMCID: PMC4831110 DOI: 10.1186/s12876-016-0448-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 02/25/2016] [Indexed: 12/16/2022] Open
Abstract
Background Most patients with gastroesophageal reflux disease experience symptomatic relapse after stopping acid-suppressive medication. The aim of this study was to compare willingness to continue treatment with esomeprazole on-demand versus continuous maintenance therapy for symptom control in patients with non-erosive reflux disease (NERD) after 6 months. Methods This multicenter, open-label, randomized, parallel-group study enrolled adults with NERD who were heartburn-free after 4 weeks’ treatment with esomeprazole 20 mg daily. Patients received esomeprazole 20 mg daily continuously or on-demand for 6 months. The primary variable was discontinuation due to unsatisfactory treatment. On-demand treatment was considered non-inferior if the upper limit of the one-sided 95 % confidence interval (CI) for the difference between treatments was <10 %. Results Of 877 patients enrolled, 598 were randomized to maintenance treatment (continuous: n = 297; on-demand: n = 301). Discontinuation due to unsatisfactory treatment was 6.3 % for on-demand and 9.8 % for continuous treatment (difference −3.5 % [90 % CI: −7.1 %, 0.2 %]). In total, 82.1 and 86.2 % of patients taking on-demand and continuous therapy, respectively, were satisfied with the treatment of heartburn and regurgitation symptoms, a secondary variable (P = NS). Mean study drug consumption was 0.41 and 0.91 tablets/day, respectively. Overall, 5 % of the on-demand group developed reflux esophagitis versus none in the continuous group (P < 0.0001). The Gastrointestinal Symptom Rating Scale Reflux dimension was also improved for continuous versus on-demand treatment. Esomeprazole was well tolerated. Conclusions In terms of willingness to continue treatment, on-demand treatment with esomeprazole 20 mg was non-inferior to continuous maintenance treatment and reduced medication usage in patients with NERD who had achieved symptom control with initial esomeprazole treatment. Trial registration ClinicalTrials.gov identifier (NCT number): NCT02670642; Date of registration: December 2015.
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Affiliation(s)
| | - Marc-Andre Bigard
- Gastroenterology Unit, University Hospital, Vandoeuvre les Nancy, France
| | - Werner Weiss
- 4th Medical Department, Hospital Rudolfstiftung, Vienna, Austria
| | - Fermín Mearin
- Gastroenterology Service, Centro Médico Teknon, Barcelona, Spain
| | - Luis Rodrigo
- Gastroenterology Service, Hospital Central de Asturias, Oviedo, Spain
| | | | - Hennie Grundling
- Department of Internal Medicine, Universitas Hospital, Bloemfontein, South Africa
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Howden CW, Larsen LM, Perez MC, Palmer R, Atkinson SN. Clinical trial: efficacy and safety of dexlansoprazole MR 60 and 90 mg in healed erosive oesophagitis - maintenance of healing and symptom relief. Aliment Pharmacol Ther 2009; 30:895-907. [PMID: 19681809 DOI: 10.1111/j.1365-2036.2009.04119.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Dexlansoprazole MR, a modified-release formulation of dexlansoprazole, an enantiomer of lansoprazole, effectively heals erosive oesophagitis. AIM To assess dexlansoprazole MR in maintaining healed erosive oesophagitis. METHODS Patients (n = 451) with erosive oesophagitis healed in either of two dexlansoprazole MR healing trials randomly received dexlansoprazole MR 60 or 90 mg or placebo once daily in this double-blind trial. The percentage of patients who maintained healing at month 6 was analysed using life table and crude rate methods. Secondary endpoints were percentages of nights and of 24-h days without heartburn based on daily diaries. RESULTS Dexlansoprazole MR 60 and 90 mg were superior to placebo for maintaining healing (P < 0.0025). Maintenance rates were 87% and 82% for the 60 and 90 mg doses, respectively, vs. 26% for placebo (life table), and 66% and 65% vs. 14%, respectively (crude rate). Both doses were superior to placebo for the percentage of 24-h heartburn-free days (60 mg, 96%; 90 mg, 94%; placebo, 19%) and nights (98%, 97%, and 50%, respectively). Diarrhoea, flatulence, gastritis (symptoms) and abdominal pain occurred more frequently with dexlansoprazole MR than placebo, but were not dose-related. CONCLUSION Dexlansoprazole MR effectively maintained healed erosive oesophagitis and symptom relief compared with placebo, and was well tolerated.
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Affiliation(s)
- C W Howden
- Division of Gastroenterology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Sharma P, Shaheen NJ, Perez MC, Pilmer BL, Lee M, Atkinson SN, Peura D. Clinical trials: healing of erosive oesophagitis with dexlansoprazole MR, a proton pump inhibitor with a novel dual delayed-release formulation--results from two randomized controlled studies. Aliment Pharmacol Ther 2009; 29:731-41. [PMID: 19183157 DOI: 10.1111/j.1365-2036.2009.03933.x] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Dexlansoprazole MR employs a dual delayed-release delivery system that extends drug exposure and prolongs pH control compared with lansoprazole. AIM To assess the efficacy and safety of dexlansoprazole MR in healing erosive oesophagitis (EO). METHODS Patients in two identical double-blind, randomized controlled trials (n = 4092) received dexlansoprazole MR 60 or 90 mg or lansoprazole 30 mg once daily. Week 8 healing was assessed using a closed testing procedure--first for non-inferiority, then superiority, vs. lansoprazole. Secondary endpoints included week 4 healing and week 8 healing in patients with moderate-to-severe disease (Los Angeles Classification grades C and D). Life-table and crude rate analyses were performed. Symptoms and tolerability were assessed. RESULTS Dexlansoprazole MR achieved non-inferiority to lansoprazole, allowing testing for superiority. Using life-table analysis, dexlansoprazole MR healed 92-95% of patients in individual studies vs. 86-92% for lansoprazole; the differences were not statistically significant (P > 0.025). Using crude rate analysis, dexlansoprazole MR 90 mg was superior to lansoprazole in both studies and 60 mg was superior in one study. Week 4 healing was > 64% with all treatments in both studies. In an integrated analysis of 8-week healing in patients with moderate-to-severe EO, dexlansoprazole MR 90 mg was superior to lansoprazole. All treatments effectively relieved symptoms and were well tolerated. CONCLUSION Dexlansoprazole MR is highly effective in healing EO and offers benefits over lansoprazole, particularly in moderate-to-severe disease.
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Affiliation(s)
- P Sharma
- Department of Veterans Affairs Medical Center and University of Kansas School of Medicine, Kansas City, MO, USA.
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Labenz J, Armstrong D, Lauritsen K, Katelaris P, Schmidt S, Schütze K, Wallner G, Juergens H, Preiksaitis H, Keeling N, Nauclér E, Adler J, Eklund S. Esomeprazole 20 mg vs. pantoprazole 20 mg for maintenance therapy of healed erosive oesophagitis: results from the EXPO study. Aliment Pharmacol Ther 2005; 22:803-11. [PMID: 16225489 DOI: 10.1111/j.1365-2036.2005.02643.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Following initial healing of erosive oesophagitis, most patients require maintenance therapy to prevent relapse. AIM To compare endoscopic and symptomatic remission rates over 6 months' maintenance therapy with esomeprazole or pantoprazole (both 20 mg once daily) in patients with healed erosive oesophagitis. METHODS Patients with symptoms of gastro-oesophageal reflux disease and endoscopically confirmed erosive oesophagitis at baseline were randomized to receive esomeprazole 40 mg or pantoprazole 40 mg for up to 8 weeks. Patients with healed erosive oesophagitis and free of moderate/severe heartburn and acid regurgitation at 4 weeks or, if necessary, 8 weeks entered the 6-month maintenance therapy phase of the study. RESULTS A total of 2766 patients (63% men; mean age 50 years) received esomeprazole 20 mg (n = 1377) or pantoprazole 20 mg (n = 1389) and comprised the intention-to-treat population. Following 6 months of treatment, the proportion of patients in endoscopic and symptomatic remission was significantly greater for those receiving esomeprazole 20 mg (87.0%) than pantoprazole 20 mg (74.9%, log-rank test P < 0.0001). Esomeprazole 20 mg produced a higher proportion of patients free of moderate to severe gastro-oesophageal reflux disease symptoms and fewer discontinuations because of symptoms than pantoprazole 20 mg (92.2% vs. 88.5%, P < 0.001). CONCLUSIONS Esomeprazole 20 mg is more effective than pantoprazole 20 mg for maintenance therapy following initial healing of erosive oesophagitis and relief of gastro-oesophageal reflux disease symptoms.
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Affiliation(s)
- J Labenz
- Medical Department, Ev.Jung-Stilling Hospital, Siegen, Germany
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Abstract
BACKGROUND Laparoscopic Nissen fundoplication is increasingly being performed on a day-case basis. The aim of the present paper was to systematically review published data on day-case or ambulatory laparoscopic fundoplication and discuss the differing criteria for patient selection, postoperative management and patient outcomes presented in each series. METHODS An optimally sensitive search strategy of subject headings and text words were used and the databases used included MEDLINE, PubMed and the Cochrane Library. All databases were searched from 1 January 1994 onwards. RESULTS A total of seven papers were included in the present review, of which six were prospective single-cohort studies. Overall, there was large heterogeneity among the studies but with similar complication and readmission rates. CONCLUSIONS Short-term outcomes for laparoscopic Nissen fundoplication in terms of complications and readmission rates are comparable to inpatient procedures. However there is a paucity of published data.
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Affiliation(s)
- Raphael Ng
- University of Adelaide Department of Surgery, The Queen Elizabeth Hospital, Woodville, South Australia, Australia
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Miner P. Review article: relief of symptoms in gastric acid-related diseases--correlation with acid suppression in rabeprazole treatment. Aliment Pharmacol Ther 2004; 20 Suppl 6:20-9. [PMID: 15496215 DOI: 10.1111/j.1365-2036.2004.02162.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Symptom relief is one of the key goals in the management of gastric acid-related disorders such as gastro-oesophageal reflux disease (GERD), including nonerosive reflux disease (NERD), and duodenal and gastric ulcer. Whereas heartburn and regurgitation are classic symptoms of GERD, duodenal and gastric ulcers are associated with epigastric pain. The relationship between gastric acid and the presence of symptoms correlates well in GERD and duodenal ulcer, but not in gastric ulcer and NERD. Nevertheless, in all these disorders, gastric acid is considered a key pathogenic element, and acid suppression remains central to therapy. With their profound, prolonged effect on acid inhibition, proton pump inhibitors are considered the first-choice therapy for these disorders. Rabeprazole is a newer generation proton pump inhibitor that suppresses the gastric proton pump and acid secretion more rapidly than does omeprazole, lansoprazole or pantoprazole. In clinical trial settings, rabeprazole provided fast and sustained symptom relief, which can help ensure patient acceptance of therapy and aid in patient compliance.
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Affiliation(s)
- P Miner
- Oklahoma Foundation for Digestive Research, Oklahoma City, OK 73104, USA.
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van Rossum LGM, Laheij RJF, Vlemmix F, Jansen JBMJ, Verheugt FWA. Health-related quality of life in patients with cardiovascular disease--the effect of upper gastrointestinal symptom treatment. Aliment Pharmacol Ther 2004; 19:1099-104. [PMID: 15142199 DOI: 10.1111/j.1365-2036.2004.01937.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Upper gastrointestinal discomfort decreases the already impaired health status of patients with cardiovascular disease. AIM To evaluate whether acid suppressive therapy improves health-related quality of life in patients who developed upper gastrointestinal symptoms after starting low-dose acetylsalicylic acid. METHODS In a double-blind, placebo-controlled randomized trail, cardiac patients using low-dose (80 mg) acetylsalicylic acid with (n = 142) and without (n = 90) upper gastrointestinal symptoms were included. Patients with symptoms were treated with rabeprazole or placebo for 4 weeks. At baseline and 4 weeks information about gastrointestinal symptoms and health-related quality of life was assessed. RESULTS The 73 patients assigned to rabeprazole when compared with 69 patients given placebo reported the same quality of life scores 4 weeks after randomization. The differences in quality of life scores between patients with and without symptoms at baseline remained after 4 weeks. Patients in whom treatment led to complete symptom relief or those who remained symptom-free reported significantly higher scores for Physical Component Summary (P < 0.01) and Mental Component Summary (P < 0.01), when compared to those with persistent symptoms or new onset symptoms. CONCLUSION Proton-pump inhibitor therapy did not improve quality of life. Upper gastrointestinal symptom relief in itself considerably increased quality of life.
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Affiliation(s)
- L G M van Rossum
- Department of Gastroenterology, Heart Center, University Medical Center St Radboud, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
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Caum LC, Bizinelli SL, Pisani JC, Amarantes HMBDS, Ioshii SO, Carmes ER. Metaplasia intestinal especializada de esôfago distal na doença do refluxo gastroesofágico: prevalência e aspectos clínico-epidemiológicos. ARQUIVOS DE GASTROENTEROLOGIA 2003; 40:220-6. [PMID: 15264043 DOI: 10.1590/s0004-28032003000400005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
RACIONAL: A metaplasia intestinal especializada pode ser classificada, de acordo com os achados endoscópicos e histológicos, em Barrett longo, Barrett curto e metaplasia intestinal da cárdia. O esôfago de Barrett é doença adquirida que ocorre em aproximadamente 10% a 13% dos indivíduos com doença do refluxo gastroesofágico e representa uma condição pré-neoplásica. É caracterizado por substituição do epitélio escamoso estratificado pelo metaplásico colunar especializado, contendo células caliciformes. OBJETIVOS: Determinar, prospectivamente, a prevalência e as características clínico-epidemiológicas da metaplasia intestinal especializada de esôfago distal na doença do refluxo gastroesofágico. MÉTODOS: Entre abril e outubro de 2002, 402 pacientes com sintomas da doença do refluxo gastroesofágico foram avaliados através de questionário padronizado que abordava as variáveis demográficas e foram submetidos a exame endoscópico com biopsias 1 cm abaixo da junção escamocolunar, nos quatro quadrantes. RESULTADOS: Metaplasia intestinal especializada foi encontrada em 18,4% dos pacientes: 0,5% Barrett longo, 3,2% Barrett curto e 14,7% metaplasia intestinal da cárdia. Houve tendência de maior número de homens apresentando esôfago de Barrett e mulheres com metaplasia intestinal da cárdia. Todos com esôfago de Barrett eram da raça branca. Não houve relação entre a intensidade dos sintomas da doença do refluxo gastroesofágico e a presença de metaplasia intestinal especializada. O tempo de duração de sintomas superior a 5 anos foi uma tendência nos portadores de esôfago de Barrett. Este grupo também apresentou mais hérnia de hiato e esofagite mais intensa do que aqueles com metaplasia intestinal da cárdia. Não houve relação entre uso de tabaco ou álcool e metaplasia intestinal especializada. CONCLUSÕES: Esôfago de Barrett foi mais relacionado ao sexo masculino, com sintomas de longa cronicidade, esofagite mais intensa e sem associação com tabaco ou álcool.
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Affiliation(s)
- Leiber C Caum
- Hospital de Clínicas, Universidade Federal do Paraná.
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Redmond MC. Perianesthesia care of the patient with gastroesophageal reflux disease. J Perianesth Nurs 2003; 18:335-44; quiz 345-7. [PMID: 14569544 DOI: 10.1016/s1089-9472(03)00182-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Every day millions of people suffer heartburn and other related symptoms of gastroesophageal reflux disease (GERD). Because symptoms can lead to a reduced quality of life, GERD sufferers are desperate for relief. This article explores the definition and pathophysiology, clinical manifestations, diagnostic procedures, and treatment options for GERD, including lifestyle modifications, medications, surgery, and alternative procedures. It also discusses preoperative, anesthesia/intraoperative, and postoperative special care considerations for the surgical patient with GERD.
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Affiliation(s)
- Mary C Redmond
- Alegent Health Bergan Mercy Medical Center, Omaha, NE, USA
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Dunmore F. Care modes for the older adult with gastroesophageal reflux disease. Geriatr Nurs 2002; 23:212-6. [PMID: 12183747 DOI: 10.1067/mgn.2002.127996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Gastroesophageal reflux disease is a common chronic disease in the older population. Because of the cumulative effects of acid reflux and delayed gastric emptying, the older adult is at risk for such complications as peptic strictures, esophagitis, and Barrett's esophagus. Providing information on the current care modes (lifestyle, dietary, pharmacologic, and surgical interventions) will help identify relevant solutions and help the older adult generate alternative safe and effective solutions to manage the disease. Many people struggle to change their lives and may need assistance to break old habits.
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