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Query: UMLS:C0017168 (gastroesophageal reflux disease)
 11,783 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Gastro-oesophageal reflux can lead to peptic oesophagitis and stricture formation. This is particularly true in infants in whom the condition should be suspected if the patient presents with vomiting, anaemia and failure to thrive. The anatomy of the oesophago-gastric junction is described. The inferior oesophageal sphincter is the main barrier to reflux, and marks the functional junction between oesophagus and stomach. It is under nervous and hormonal control. It is weak in the neonate who therefore frequently refluxes. An hiatus hernia can cause problems due to its bulk but the main problem of peptic oesophagitis is due to gastro-oesophageal reflux. The radiological examination should be carried out carefully with the patient swallowing in a prone position. The patient should be put in the Trendenlenberg position and compression applied to the abdomen. Reflux is intermittent and a negative examination should be repeated if the clinical findings suggest a diagnosis of peptic oesophagitis. Associated pyloric stenosis should always be excluded. Radiological examination of the gastro-oesophageal junction remains the quickest, simplest, and most convenient and safe technique as long as its limitations are appreciated.
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PMID:Gastro-oesophageal reflux, hiatus hernia and the radiologist, with special reference to children. 32 Oct 66

Eight severely mentally retarded children with histories of recurrent vomiting, anemia and chest disease are reported. It is suggested that appropriate medical management improves the quality of life for such children and may also reduce the number of hospital admissions for the treatment of this cluster of symptoms. Symptoms of vomiting, anemia and recurrent pneumonia in retarded children should suggest gastro-esophageal reflux. Investigations should include the upper gastrointestinal tract, with specific attention being paid to esophageal reflux.
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PMID:Gastro-esophageal reflux in severely retarded children. 64 Feb 58

Finger clubbing, protein-losing enteropathy, and iron deficiency were documented in three children with severe gastroesophageal reflux. One patient had Sandifer syndrome and the other two had the rumination syndrome. In each case, surgical repair of the gastroesophageal reflux resulted in immediate clearing of signs of the Sandifer syndrome, gastroesophageal reflux, and anemia and the return of serum protein levels to normal. There was definite regression of the finger clubbing during the ensuing year. It is suggested that finger clubbing, protein-losing enteropathy, Sandifer syndrome, and rumination be viewed as parts of an extended syndrome of unusual presentations of gastroesophageal reflux.
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PMID:Gastroesophageal reflux with protein-losing enteropathy and finger clubbing. 98 11

A sliding hiatus hernia is a common radiological finding and is not always relevant to the patient's symptoms. The possibility of an alternative explantation for the complaint of retrosternal pain or dyspepsia should always be considered, and when anaemia is present the site of occult blood loss is often lower in the gastrointestinal tract. The majority of patient's with symptomatic gastro-oesophageal reflux can be controlled with medical measures. Surgical intervention in cases of uncomplicated hiatus hernia should be recommended only after careful preoperative assessment and even then a satisfactory result cannot be absolutely guaranteed.
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PMID:Common gastroenterological problems. II.--Sliding hiatus hernia. 107 40

Two children with the Brachmann-de Lange syndrome and severe gastroesophageal reflux are described. Both had esophagitis, recurrent severe anemia, and one had recurrent episodes of aspiration pneumonia and clubbing. Medical treatment failed in both children. One child responded dramatically to surgery, but the other died before surgery could be attempted. Our experience and a review of the literature suggest that early recognition and surgical treatment of gastroesophageal reflux will reduce morbidity and mortality in children with this syndrome.
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PMID:Gastroesophageal dysfunction in Brachmann-de Lange syndrome. 153 83

Patients with large diaphragmatic hiatal hernias occasionally manifest severe iron deficiency anemia. The etiology is believed to be that of small erosions at the waist of the hernia which bleed slowly. Our study attempts to determine the incidence of this condition in clinical practice, and whether acid plays a role in the pathophysiology. Sixteen such patients were identified prospectively in a series of 5219 consecutive patients (0.31%) accrued over a 5-yr interval. Anemia was the presenting feature, rather than symptoms of gastroesophageal reflux disease. The erosions were endoscopically identified and biopsied. Anemia was treated and recurrence was prevented for a mean of 24.6 months with long-term iron replacement. Of eight patients treated with iron alone, four were willing to undergo follow-up endoscopy. Of these four, none demonstrated healing. Three of these nonhealers and eight additional patients were treated with both iron and H2 antagonists. Thus, 11 patients were treated with H2 antagonists and iron, whereas four patients were treated with iron alone. At 6 wk, reendoscopy showed healing of the erosions in seven of 11 patients on H2 antagonists, but in none of those treated with iron alone (p less than 0.05). The anemia was corrected in all patients with iron therapy. We conclude that 1) gastric acid appears to have some role in the pathogenesis of this lesion; 2) short-term therapy with H2-receptor antagonists promote healing of the erosions; and 3) long-term iron therapy alone is adequate for initial and maintenance therapy of the anemia.
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PMID:Large hiatal hernias, anemia, and linear gastric erosion: studies of etiology and medical therapy. 159 51

We reviewed case histories of 40 pediatric-sized developmentally disabled patients who had previously participated in a study comparing the Nissen fundoplication with the Angelchik prosthesis for the surgical treatment of severe gastroesophageal reflux. Five of these patients had experienced erosions of the prosthesis into the gastrointestinal tract. These erosions were diagnosed between 2 years and 2 years 8 months following surgical insertion of the device. Erosions were associated with a variety of symptoms including vomiting, increasing discomfort, melena, anemia, coffee ground gastric residuals, and repeated small bowel obstructions. In no case was erosion associated with the development of peritonitis. Despite the documented advantages of the Angelchik prosthesis, the 12.5% erosion rate in this patient population is excessive. We recommend that use of the Angelchik prosthesis is not advisable in pediatric-sized developmentally disabled patients.
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PMID:Erosions of the angelchik prosthesis in pediatric-sized developmentally disabled patients. 171 76

The frequency and the possible age-related characteristics of gastro-oesophageal reflux disease (GORD) were investigated in 195 consecutive elderly subjects (mean age 74 years), referred to endoscopy for abdominal symptoms or sideropenic anaemia. In the 105 of these patients in whom there was any suspicion of GORD, 24-hour pH monitoring was carried out. All the patients were interviewed before the examinations. Erosive or complicated (grade 2-4) oesophagitis was found in 18% of patients. The main symptoms in these patients were dysphagia, respiratory symptoms and vomiting. Chronic cough, hoarseness or wheezing were present in 57% of patients with oesophagitis compared with 33% of those without oesophagitis (p less than 0.001). The occurrence of heartburn and regurgitation did not differ significantly between patients with or without oesophagitis, although the mean symptom scores were higher in those with oesophagitis. Dyspepsia and chest pain were not typical symptoms in oesophagitis. Of patients with oesophagitis 29% had no typical symptoms of GORD; only 24% of patients with regurgitation had oesophagitis. In 24-hour pH monitoring, a significant increase in the occurrence of symptoms was not seen until total reflux time pH less than 4 exceeded 10%. The occurrence of heartburn did not correlate with the extent of reflux in the pH study. In conclusion, typical symptoms of GORD in the aged were regurgitation, dysphagia, respiratory symptoms and vomiting rather than heartburn.
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PMID:Symptoms of gastro-oesophageal reflux disease in elderly people. 175 93

Gastroesophageal reflux (GER) has been known to occur in infants but was thought to be normal. As a result of increased recognition of GER and a clear documentation of GER with extended (18 to 24 hour) esophageal pH monitoring, several severe complications of GER in children have become apparent. An immature cardiorespiratory system is susceptible to some complications of GER such as apnea, choking, recurrent cough or wheezing, and recurrent aspiration pneumonia. Noncardiorespiratory complications include weight loss, esophagitis, anemia, irritability, posturing, malnutrition, and developmental delays. Nursing assessment contributes to a complete clinical picture and the subsequent treatment choice of the physician. To form an accurate assessment of the child with suspected GER, the nurse must be aware of the symptoms and complications of this condition and must precisely execute diagnostic studies, particularly extended esophageal pH monitoring. Nursing responsibilities also include providing a safe yet stimulating environment for the child, teaching parents to participate in the child's care, supporting parents through hospitalization, and preparing both the parents and child for discharge and follow-up care at home.
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PMID:Nursing responsibility in the diagnosis, care, and treatment of the child with gastroesophageal reflux. 176 48

Reflux of gastric contents into the esophagus has for long been accepted as a cause of esophagitis, failure to thrive, and anemia. But, at the same time, gastro-esophageal reflux (GER) is recognized as a physiological phenomenon occurring now and then in every one, especially in the postprandial period. Esophageal pH monitoring is an attractive technique for separating "physiological" from "pathological" GER incidence and duration by measuring incidence and duration. In principle, esophageal pH monitoring is simple, but in practice there are technical and clinical problems. The pH monitoring equipment, the type of electrode, the location of the electrode are examples of equipment and/or methodology related influencing factors. Age, position, duration of the investigation (day/night, fasting/postprandial), feeding and drugs are patient related factors. Despite all these factor, pH data have been shown to be reproducible. The major advantages of pH monitoring are that it evaluates GER in (1) physiological circumstances over (2) a prolonged duration. (3) The investigation can be repeated and can therefore (4) evaluate the efficacy of treatment. (5) The possibility of establishing a relation in time between pH changes and symptoms constitutes another advantage of the technique.
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PMID:Esophageal pH monitoring: methodology, indication and interpretation. 185 12


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