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Title: A study of the pathophysiology of gastro-oesophageal reflux disease
Author: Singh, Pradip
ISNI:       0000 0001 3415 7469
Awarding Body: University of Southampton
Current Institution: University of Southampton
Date of Award: 1992
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This thesis traces the history of the gastro-oesophageal reflux disease and the changing concepts of its pathogenesis. The literature on the pathophysiology of this disease is reviewed. The various methods of investigation of the disease have been discussed. The prevalence of oesophageal motor dysfunction in reflux oesophagitis is investigated and compared with healthy controls using oesophageal scintigraphy, manometry, acid clearance test and 24 hour oesophageal pH monitoring. A high prevalence of oesophageal motor dysfunction in patients with oesophagitis has been found. Patients with Barrett's oesophagus appear to have particularly severe oesophageal motor dysfunction and consequently more severe acid reflux. The effect of endoscopically confirmed complete healing of oesophagitis on oesophageal motor function has been examined. It has been shown that abnormalities of motor function are not reversed after healing of oesophagitis. The effect of a long period of remission on oesophageal acid exposure has been examined in a subset of patients and again found not to affect the magnitude of acid exposure on cessation of antisecretory medication. The results from these studies suggest that oesophageal motor dysfunction in reflux oesophagitis (and probable gastro-oesophageal reflux disease in general) is a primary phenomenon and not a consequence of inflammation. An alternative, but less likely explanation could be that oesophagitis causes irreversible motor dysfunction. The usefulness of 24 hour pH monitoring as a diagnostic tool for this disease is examined with particular regard to the importance of the position of the pH electrode in the oesophagus. It has been shown that there is a gradient of the degree of acid reflux along the length of the oesophagus in patients as well as the controls and therefore the precise position of the probe is an important factor for the reliability of the test. The discriminatory value of the test was slightly better if the probe was at 5 cm above the lower oesophageal sphincter than at 10 cm above the LOS.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: Oesophagitis; Gastroenterology