Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0017168 (gastroesophageal reflux disease)
 11,783 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In 196 cases of gastro-oesophageal reflux, simple or connected to a hiatal hernia or to a cardio-tuberous misplacement, the respiratory signs that are found in 1 patient out of 4, are analyzed. The nocturnal fits of coughing (39 cases, 20% of the reflux) is the most frequent sign of laryngo-tracheal aspiration of stomach content. This symptom of great diagnostic value, though neglected, should be looked for systematically. Other troubles are less frequent: bouts of recurring broncho-pulmonary infections, asthma attack, Mendelson's syndrome, pulmonary fibrosis. In absence of a patent cause, the symptoms should lead to suspect a reflux of stomach content in the airways. Similarly to oesophagitis, respiratory signs represent a complication sometimes serious, of gastro-oesophageal reflux, needing more frequently a surgical treatment of hiatal herniae or of the cardiac inefficiency.
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PMID:[Broncho-pulmonary manifestations and gastroesophageal reflux]. 61 79

Investigation of 340 babies who suffered from apparent life threatening episodes (ALTE) was performed using pneumographic studies and a variety of medical investigations. A number of medical abnormalities were demonstrated by history or investigation, including gastro-oesophageal reflux (211), airways pathology (17), evidence of fits (25), brain-stem tumour (2), hypoglycaemia (2), respiratory syncytial virus (8) and possible Munchausen by proxy (5). Pneumographic abnormalities were detected in 27 of the 340 infants. Home monitors were used for 135 infants. Future central apnoeas occurred in 20 of the 26 infants on home monitors that had had an abnormal pneumogram, compared with one of the 109 infants on home monitors after a normal pneumogram. Thus pneumograms have a sensitivity and specificity of 95% for predicting central apnoeas in babies who have already suffered an ALTE. The effect of eyeball pressure on the heart rate was measured in 65 babies and was found to cause a brisk drop in heart rate in 32 babies. Twenty-two of the 32 babies had future white apnoeas (usually associated with gastro-oesophageal reflux), compared with five of the 33 babies who had no drop in heart rate in response to eyeball pressure. Thus this test has a sensitivity of 81% and a specificity of 74% at predicting white apnoeas in babies who have already suffered an ALTE.
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PMID:The pneumographic and medical investigation of infants suffering apparent life threatening episodes. 175 76

Clinical evaluation and prolonged esophageal pH monitoring were performed before and during treatment with cisapride (0.3 mg/kg t.i.d.) for 1 month in 19 children with reflux-associated bronchopulmonary disease. Results (mean +/- SEM) show that cisapride significantly decreases the frequency of long duration (greater than 5 min) reflux episodes (from 9.7 +/- 0.7 to 5.7 +/- 1.2), the percentage of total time pH was less than 4 (from 15.9 +/- 2.5 to 7.7 +/- 1.1%), the percentage of time pH was less than 4 at night (from 18.0 +/- 3.9 to 4.9 +/- 1.5%), the duration of the longest reflux episodes (from 44.5 +/- 6.4 to 19.7 +/- 2.7 min), as well as the duration of reflux at night (from 100.1 +/- 28.0 to 28.2 +/- 10.1 min). The frequency of reflux episodes, however, remains unaffected by cisapride. Cough fits at night disappeared completely in 12 out of 13 children. We conclude that cisapride given for 1 month significantly decreased gastroesophageal reflux as well as cough episodes at night.
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PMID:Effect of cisapride on esophageal pH monitoring in children with reflux-associated bronchopulmonary disease. 270 65

A four-month-old boy with pseudo-seizures was extensively investigated for fits and gastro-oesophageal reflux and subsequently treated for presumed epilepsy. It was finally established that his mother was inducing the "seizures" by asphyxiation and subsequent interviews established that information concerning the parents had been falsified.
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PMID:SIDS, seizures or 'sophageal reflux? Another manifestation of Munchausen syndrome by proxy. 404 52

Formerly, for gastrostomy, we passed a No. 18 French red rubber catheter through the antrum of the stomach with the tip directed toward the fundus. We used this method with great success, both for decompression and feeding. Recently, a tube made of silicone rubber and thus resistant to gastric secretions was manufactured for us by the Medical Innovations Corporation of Milpitas, Calif. The tip of the tube is long enough to reach to within 3 cm of the fundus. A doughnut-shaped inflatable balloon fits nicely against the gastric mucosa, and a "Secur-Lok" ring external to the abdominal wall slides down to the skin, allowing the tube to be held in position without the use of sutures. We believe that the tube placed using the above technique is effective, comfortable, and reliable. This study was done to evaluate its efficacy. We report a series of 90 patients in whom this new gastrostomy tube was placed. We discuss the lasting qualities of the tube, the function of the doughnut-shaped balloon, the hypothesis we have developed to explain why there has been no esophageal reflux with this tube, and the efficacy of the Secur-Lok ring in holding the tube in position without the use of sutures.
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PMID:Gastrostomy: evaluation of a new tube using an old technique. 815 77

In a prospective study, 180 infants, mean age 2-6 months, hospitalized for apparent life threatening events between October 1985 and September 1988 (for 7,261 infants admitted into the pediatric unit during the same period), were submitted to the following investigations: careful anamnesis, complete clinical examination, systematic paraclinical investigations (standard biological studies, infectious and metabolic tests, investigations for gastro esophageal reflux (GER) and vagal hyper-reflectivity (VHR), polysomnography) or adapted to the clinical situation (toxic tests, brain computed scan, laryngoscopy, etc). Pathologies were mainly functional with neuro-vegetative immaturity (67.5%): gastro esophageal reflux (49%), vagal hyper-reflectivity (8.5%) or both (10%). An incidental pathological factor (breath holding spell, convulsion, intoxication, infection) was found in 18.5% of the infants, and 14% had normal results. Diphemanil 10 mg/kg/24h corrected the VHR and Metoclopramide 1 mg/kg/24h controlled 52% of the GER. The recurrence rate of illness in the GER and VHR groups was statistically lower with efficient therapy (12% vs 48%); no recurrence occurred in other groups.
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PMID:[Study of risk factors for recurrence in severe life-threatening conditions in infants]. 839 95

A 3-year-old boy was found to have a mixed tubulopathy with hypokalemia (1.9 mmol/l), alkalosis (blood pH 7.51, plasma carbon dioxide pressure 46 mm Hg, plasma bicarbonate 35.7 mmol/l) and hypophosphatemia (1.21 mmol/l). An electrocardiogram disclosed a prolonged heart rate corrected QT interval of 490 ms. The boy was put on potassium chloride, phosphate and nonsteroidal anti-inflammatory agents. With this treatment plasma phosphate normalized and plasma potassium increased up to 3.0-3.3 mmol/l. Three years later the child, who did not have history of gastroesophageal reflux or epileptic convulsions, suddenly died during sleep. The cause of death could not be determined through gross examination of the body. The history of hypokalemia, the QT-prolongation, the sudden death and the failure to assess the cause of death through gross examination of the body suggest that death was caused by an arrhythmia secondary to hypokalemia.
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PMID:Electrocardiographic QT prolongation and sudden death in renal hypokalemic alkalosis. 1213 87

Cervical inlet patch (CIP) is defined by the presence of gastric mucosa within the first few centimeters of the esophagus. Several endoscopic series have demonstrated a frequent association of CIP with Barrett's esophagus (BE) suggesting a pathogenetic link. A histochemical study reporting the presence of acid mucin in CIP, including sulfomucin, supports this hypothesis. We evaluated mucin core protein expression and cytokeratins 7 and 20 (CK7/CK20) pattern in biopsies of CIP, normal antrum, and BE to comment on a possible relationship of CIP with BE. We observed that both lesions have similar cytokeratin patterns with mixed CK7/CK20 reactivity on the surface and pits and lone CK7 positivity in the glands. MUC5AC was strongly expressed on the surface and pits but not in the glands of CIP and antral mucosa. Within BE, MUC5AC positivity was noted not only on the surface and pits but also in the glands. MUC6 similarly decorated the glands of CIP and BE. MUC2 was expressed rarely in CIP with goblet cells but conspicuously on the surface and pits of BE. MUC5B was seen in both CIP and BE and rarely in the antral mucosa. The similarities between CIP and BE but not with normal antral mucosa fits with the hypothesis that both lesions may originate from submucosal esophageal mucous glands. Two pathogenetic pathways can be entertained: focal upper esophageal mucosal misdevelopment in pediatric population and patchy metaplastic replacement of squamous mucosa in adults with gastroesophageal reflux disease.
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PMID:Cytokeratins 7 and 20 and mucin core protein expression in esophageal cervical inlet patch. 1576 95

A 12-month-old boy diagnosed with propionic acidemia underwent gastrostomy. The patient's general state was good and he was alert, but with reduced muscular tone (unstable when seated with support, floppy head) and with dystonic movements in all extremities. An electroencephalogram showed slightly slowed brain activity. The patient was being treated with a low protein diet, phenobarbital, L-carnitine, L-isoleucine, and biotin. Surgery was carried out in satisfactory conditions with general anesthesia without opioids combined with infiltration of the surgical wound with local anesthetic. Recovery from anesthesia was rapid and free of complications. Propionic acidemia is caused by mitochondrial propionyl coenzyme carboxylase deficiency. Most patients have episodes of severe metabolic ketoacidosis as a result of excessive protein intake, delayed development, vomiting, gastroesophageal reflux, lethargy, hypotonia, and convulsions. The anesthetic approach involves avoiding triggers of metabolic acidosis (such as fasting, dehydration, hypoxemia, and hypotension) and preventing airway complications. Agents that metabolize propionic acid (such as succinylcholine, benzylisoquinoline neuromuscular blocking agents, and propofol) are not used, as they can exacerbate acidemia. We also believe that using local or regional anesthesia in combination with general anesthesia without opiates is safe and effective for controlling pain during surgery and postoperative recovery, as that combination avoids respiratory depression in these patients, who are highly sensitive to opiates.
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PMID:[Infant boy with propionic acidemia: anesthetic implications]. 1620 Sep 24

The functional gastrointestinal disorders are defined by the Rome criteria as a heterogeneous group of symptom-based conditions that have no structural or biochemical explanation. However, this definition now seems outdated, because structural and molecular abnormalities have begun to be recognized in subsets of patients with the irritable bowel syndrome (IBS), the prototypic functional bowel disease. A complex classification system based arbitrarily on symptom criteria does not fit in with a number of emerging facts. For example, the symptom overlap of IBS with gastroesophageal reflux disease is not due to chance, and the emergence of post-infectious IBS, dyspepsia, or both after Salmonella gastroenteritis fits better with a 1-disease model. A new paradigm seems to be needed. All of these disorders may arise after infection or gut inflammation, but the phenotype depends on localized neuromuscular dysfunction in the predisposed human host (the "irritable gut").
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PMID:A unifying hypothesis for the functional gastrointestinal disorders: really multiple diseases or one irritable gut? 1669 76


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