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

Gastroesophageal reflux, common in infants, usually resolves spontaneously by 12 to 18 months. Gastroesophageal reflux disease (GERD) contributes to certain respiratory symptoms, but is reported to be due to other causal diseases, such as tracheolaryngeal anomaly, congenital esophageal hiatal hernia, and cerebral palsy, in pediatric patients. We report 4 pediatric cases with unusual laryngeal disorders, especially posterior glottic lesion, induced by gastroesophageal reflux without other causal disease. Subject 1 was a 1-year-old boy showing severe laryngeal spasm, Subject 2 a 3-year-old boy with life-threatening supraglottic stenosis, Subject 3 a 5-year-old boy whose voice had reached near aphonia with multiple laryngeal granulomatous lesions, and Subject 4 an 8-year-old boy with persistent abnormal throat sensations. Their symptoms were recalcitrant to conventional therapy. Their case histories (much belching and hiccups) and findings for the posterior glottitis, etc., suggested that symptoms might be induced by GERD, but, barium esophagography and esophagoscopy provided no conclusive proof. We could not monitor their ph because of the excessive physical and psychological stress involved. After therapeutic trials with a proton pump inhibitor (lansoprazole 10-15 mg) for 8 weeks, all had recovered almost completely without side effects.
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PMID:[Laryngeal manifestations of gastroesophageal reflux disease (GERD) in pediatric patients: the usefulness of therapeutic (proton pump inhibitor (PPI)) trials]. 1171 Jan 51

Gastrointestinal issues are a major chronic problem in 80 to 90% of children with cerebral palsy and in children with neurodevelopmental disabilities who are at special risk of developing malnutrition because of uncoordinated swallowing, gastroesophageal reflux, and constipation. In addition to poor linear growth, there is a decrease in muscle strength and coordination, impaired cerebral function leading to decreased motivation and energy. Significant neurodevelopmental progress can be achieved with improved nutritional status. A multidisciplinary approach, with input from neurologists, gastroenterologists, nurses, occupational therapists, and dieticians, can make a major contribution to the medical wellbeing and quality of life of these children. Different neurological diseases ( eg, spinal dysraphism, syringomyelia, tethered cord syndromes) can give rise to gastrointestinal dysfunction and symptoms that may need different gastrointestinal or surgical management. The introduction of new drugs, including proton pump inhibitors and innovative endoscopic and surgical techniques in the management of gastroesophageal reflux disease and constipation also may have an impact on the treatment of neurologically handicapped children in the future.
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PMID:Gastrointestinal problems in the handicapped child. 1180 90

Patients with cerebral palsy are known to have a high incidence of feeding difficulties, including problems with swallowing, vomiting, recurrent chest infections, and irritability. Gastroesophageal reflux (GER) is an involuntary passage of the gastric contents into the esophagus. It has been found in a higher prevalence (up to 75 percent) in cerebral palsy patients. Long-term gastric acid attacks teeth and can cause dental erosion. Bargen and Austin first discovered the relationship between GER and dental erosion in 1937 when they concluded that the loss of dental hard tissue could be an indicator and the predominant oral manifestation of GER. The purpose of this study is to investigate the correlation between GER and dental erosion in primary and permanent teeth in cerebral palsy patients. Twenty-one patients participated in this study. Results showed that out of the 21 patients, 15 had erosion and 11 of them had GER history. The chi-square analysis with the p value of less than or equal to 0.025 showed the distribution to be significant. The severity of the erosion was correlated to the duration of the disease, frequency of vomiting, pH of the acid, type of acid, and quantity and quality of saliva. The study revealed that children with cerebral palsy have an increased prevalence of tooth erosion, which may be attributed to the existing gastroesophageal reflux.
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PMID:Gastroesophageal reflux in children with cerebral palsy and its relationship to erosion of primary and permanent teeth. 1288 78

Some children with cerebral palsy and severe feeding impairment experience pulmonary complications from aspiration and gastroesophageal reflux. This exploratory study examined whether pulmonary function would improve following one year of intervention with optimal positioning for feeding, control of gastroesophageal reflux and use of food textures that would minimize aspiration from swallowing. Two children showed a 28% and 45% improvement, respectively, in functional residual capacity. One child experienced a 37% improvement in total respiratory resistance and a 284% improvement in respiratory compliance. All children gained sufficient weight to maintain their growth trajectories but only one who was changed from oral to tube feeding due to aspiration showed catch-up growth in length. One child showed pathological gastroesophageal reflux that was controlled medically throughout the study period. Although all children experienced pulmonary illnesses during the one year of follow up, control of aspiration permitted a clinically significant improvement of their pulmonary obstructive syndrome Further study is needed to more fully determine the effect of this treatment approach on pulmonary function.
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PMID:Feeding management of children with severe cerebral palsy and eating impairment: an exploratory study. 1295 86

Gastric emptying time is considered a factor in the increased frequency of gastroesophageal reflux in children with cerebral palsy. It is unknown if emptying time influences the severity of reflux. In this study, 76 cerebral palsy patients with reflux indicative symptoms were investigated by 24-hour pH monitoring. Reflux complications were also studied. Emptying time in children with reflux was investigated using gastric scintigraphy. Twenty-eight children with resistant asthma scanned for pulmonary aspiration were studied as control subjects for emptying time. Reflux was diagnosed in 51.3%; it was severe in 53.8%, moderate in 38.5%, and mild in 7.7%. Occurrence of reflux did not differ significantly among different forms of cerebral palsy or between males and females. The most frequent complications in reflux-positive patients were iron deficiency (51.3%), anemia (41.0%), malnutrition (33.3%), recurrent upper respiratory tract infections (28.2%), and low body weight (28.2%). Patients without reflux had less frequent complications. Gastric emptying time measured by gastric scintigraphy in 28 patients with reflux manifested no difference in comparison to the control group (P > 0.05). No relationship was found between emptying time and reflux severity (P > 0.05). In conclusion, reflux (moderate or severe) is common in children with cerebral palsy, frequently leading to complications but no delayed emptying time. The patients described in this report had no delayed emptying time. There was also no relationship between emptying time and severity of reflux.
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PMID:Gastric emptying in children with cerebral palsy and gastroesophageal reflux. 1535 Oct 16

The aim of this study was to investigate the presence of gastroesophageal reflux with 24-hour pH monitoring in children with cerebral palsy. In the second part of the study, we started cisapride with the children with documented gastroesophageal reflux and evaluated the efficacy of cisapride with the second 24-hour pH monitoring. This study was performed before discontinuation of cisapride with US Food and Drug Administration reports in Turkish markets. Twenty-eight children who had been followed up in the Department of Pediatric Neurology between 1999 and 2000 were enrolled in the study. Twenty-four-hour pH monitoring was performed on all patients. Two parameters were evaluated as pathologic: a reflux index (percentage of time the pH value was <4) over 4.5% and reflux longer than 15 minutes even when the reflux index was below 4.5%. Cisapride treatment was assigned to the patients with pathologic monitoring results at a dose of 0.2 mg/kg/day for 3 months. Electrocardiograms (ECGs) were analyzed before and after cisapride treatment. Symptoms suggestive of gastroesophageal dysfunction were dysphagia in 18 cases (64.3%), constipation in 8 cases (28.6%), vomiting in 6 (14.2%) cases, and recurrent pneumonia in 2 cases (8.5%). The reflux index was > or =4.5% in 13 (46.4%) of the 28 cases. Reflux was longer than 15 minutes in 2 (7.1%) cases. Cisapride was started in 15 cases with pathologic monitoring results. Appetite improved in 6 cases and dysphagia disappeared in 8 cases after cisapride therapy (P < .05). pH monitoring was repeated in 12 cases after 3 months and was normal in 8 of them. Improvement in the reflux index and total reflux episodes was statistically significant after therapy (P = .008). No adverse effects occurred. Even though the drug is no longer marketed, we concluded that it improved the symptoms and quality of life in spastic children with gastroesophageal reflux.
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PMID:Gastroesophageal reflux in children with cerebral palsy: efficacy of cisapride. 1570 73

A paediatric dietitian, occupational therapist and speech and language therapist describe how they jointly run a feeding clinic for infants and children with feeding difficulties. Conditions treated include cerebral palsy, autism, learned aversion following severe gastro-oesophageal reflux, and delayed oral development that affects feeding. The therapists' co-ordinated approach enables parents to receive clear guidance on feeding at one combined appointment, without the inconvenience of having to attend three separate appointments. The article outlines the role of each therapist, with examples of how they assess and alleviate the children's problems. The need for safety, nutrition and hydration is balanced against the desire for developmental progress in a holistic approach involving all three therapy disciplines. The aim of the feeding clinic is to provide advice, support and intervention plans to help make feeding a pleasurable and safe experience for all the children who attend.
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PMID:A multiprofessional children's feeding clinic. 1609

Cerebral palsy (CP) is a group of nonprogressive, motor impairment patterns due to an insult to the developing encephalon. Clinical manifestations vary by the specific motor deformity, anatomically affected region, and location of the brain injury. Spasticity is common, resulting in skeletal muscle weakness and loss of fine motor control. Spasticity in a child undergoing skeletal maturation may precipitate joint contractures and dislocation. Long-term medical care is interventional. The therapeutic goals are to increase the person's independence and improve the caretaker's ability to provide daily care. Early medical intervention to control spasticity and prevent contractures may reduce the need for future orthopedic surgical intervention. Centrally acting, tone-reducing medications may decrease spasticity but cause central nervous system side effects. Orthopedic surgical procedures may be necessary to remedy the chronic effects of increased tone on the muscles and bones of the extremities and spine. Anesthetic care of children and adolescents with CP is increasing. Thorough preoperative assessment facilitates preparation of an intraoperative care plan. Intellectual disability may attend CP and limit the person's ability to participate in preoperative preparation. Perioperative complications include hypothermia, intravascular depletion, muscle spasm, limb contracture, and seizure control. Gastroesophageal reflux and poor respiratory function might complicate anesthetic management.
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PMID:Update for nurse anesthetists--part 6--Perioperative care of patients with cerebral palsy. 1730 86

Children with neurodevelopmental disabilities such as cerebral palsy (CP), spina bifida, or inborn errors of metabolism frequently have associated gastrointestinal problems. These include oral motor dysfunction leading to feeding difficulties, risk of aspiration, prolonged feeding times, and malnutrition with its attendant physical compromise. Gastrostomy tube feeding is increasingly being used in these children to circumvent oral motor dysfunction and prevent malnutrition. Foregut dysmotility causes several problems such as dysphagia from oesophageal dysmotility, gastro-oesophageal reflux disease, and delayed gastric emptying. Gastro-oesophageal reflux disease is common in these children but often fails to respond to medical management and may require surgical treatment. Finally, constipation is often a problem that may be overlooked in this population. This article focuses on these associated gastrointestinal manifestations and discusses the current diagnostic and therapeutic options available.
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PMID:Gastrointestinal disorders in children with neurodevelopmental disabilities. 1864 21

The ketogenic diet for the treatment of refractory epileptic encephalopathies has been suggested as an early treatment option in very young children. The aim of the present study was to assess the efficacy and tolerability of the ketogenic diet in children younger than 5 years, all affected by different types of catastrophic childhood encephalopathies. The study group is composed of 38 children (22 males and 16 females), aged between 3 months and 5 years, affected by symptomatic partial epilepsy (6) and cryptogenic-symptomatic epileptic encephalopathies (32). Psychomotor delay-mental retardation was present in all of the patients: mild to moderate (9), severe (7), and profound (22). Cerebral palsy was present in 74% of the cases. Children were started on a 4:1 ketogenic diet as ketocal formula alone or supporting about the 80% of the daily caloric amount. Children poorly complying with ketocal milk were shifted to a classic 4:1 ketogenic diet. The average time (months +/- S.D.) on the diet was 10.3 +/- 7.4. All the children initiating the diet remained on it at 1 month and 35 of them (92%) at 3 months, 28 (73.7%) remained on it at 6 months, and 20 (52.7%) at 1 year. At 12-month follow-up, 11 children (28.9%) had a greater than 50% reduction of seizures and the other 9 (23.7%) were seizure-free. Adverse side effects were recorded in 25 of 38 patients (65.8%), including drowsiness, constipation, weight loss, vomiting, gastroesophageal reflux, fever, and hyperlipidemia. This report confirms that severe epileptic encephalopathies are much suitable for the ketogenic diet.
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PMID:Ketogenic diet for the treatment of catastrophic epileptic encephalopathies in childhood. 1963 70


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