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

This article reviews the cause and management of respiratory symptoms after repair of esophageal atresia with tracheoesophageal fistula (TEF). Postoperative respiratory symptoms developed in 31 (46%) of 68 patients and included apnea and bradycardia, respiratory arrest, aspiration, and recurrent pneumonia. The respiratory symptoms were initially attributed to gastroesophageal reflux (GER) in 20 patients (64%), tracheomalacia in 4 patients (13%), recurrent TEF in 4 patients (13%), and anastomotic stricture in 3 patients (10%). Three patients with GER and the three patients with a stricture were initially managed nonoperatively. The remaining 25 patients underwent surgical correction of the underlying cause of the respiratory symptoms. Despite aggressive management of this problem, 14 (45%) of these 31 patients had persistent or recurrent respiratory symptoms. Although GER is the most common cause of respiratory complications in patients who have undergone prior TEF repair, other factors are often responsible for these symptoms and should not be overlooked.
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PMID:Etiology and management of respiratory complications after repair of esophageal atresia with tracheoesophageal fistula. 151 68

Of 199 neonates undergoing primary or delayed primary repair of esophageal atresia, 34 (17%) developed anastomotic leakage, 7 of which (3.5%) were major anastomotic disruptions. Infants with major leaks developed signs within 5 days and all required early reoperation, necessitating abandonment of the esophagus in 6. The remaining 27 were minor leaks demonstrated by water-soluble contrast studies and were successfully treated nonoperatively. Gastroesophageal reflux was unassociated with this complication but the use of braided silk sutures was associated with a significantly increased risk of anastomotic leakage when compared with polyglycolic acid (relative risk, 3.2) or polypropylene (relative risk, 2.6) sutures. Following anastomotic leakage there was a significantly increased risk (relative risk, 2.04) of subsequent esophageal stricture formation.
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PMID:Anastomotic leakage following surgery for esophageal atresia. 155 39

Adenocarcinoma arising in Barrett's esophagus has recently been described in two children aged 11 and 14 years. The long-term follow-up of Barrett's esophagus in children is not well described. We evaluated 16 cases of Barrett's esophagus in children treated at this institution during the last 16 years. Ages ranged from 1.2 to 16 years (mean, 10.3 years). There were 11 boys and 5 girls. Barrett's esophagus was documented by endoscopy in 14 instances and at autopsy in 2 patients with secretory diarrhea and tetralogy of Fallot who died of sepsis. Two children had cancer (neuroblastoma, leukemia) and died of their malignant disease. Five patients had cerebral palsy, 1 esophageal atresia, 1 Fanconi's anemia, and 5 were otherwise normal children. Six were treated medically. Eight patients underwent Nissen fundoplication for complications of gastroesophageal reflux (GER). Five patients were available for follow-up endoscopy (mean, 2 years; range, 1.1 to 5.4 years). Endoscopy was performed on a yearly basis, obtaining biopsy specimens from multiple levels of the esophagus. Four children had satisfactory clinical response to an antireflux procedure including the resolution of a stricture in one case. However, in all 5 cases persistent metaplastic epithelium was documented and showed no evidence of regression. Although there has been speculation that Barrett's esophagus in children may be more likely to revert to normal squamous epithelium than in the adult, there has been only one case of regression in 180 cases of Barrett's esophagus occurring in children described in 37 reports in the literature.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Persistence of Barrett's esophagus in children after antireflux surgery: influence on follow-up care. 156 27

Severe feeding troubles were recorded in five babies with long-gap esophageal atresia who underwent, between 1985 and 1990, a delayed primary anastomosis after spontaneous growth of their esophageal stumps. A comparison with 20 cases of direct esophageal anastomosis, operated on in the same period, was carried out by means of recorded esophagrams, pH monitoring and questionnaires charting the growth pattern and feeding habits of the patients. Bottle feeding, and, later on, the introduction of semi-solid foods was significantly retarded in the group of children with delayed primary anastomosis (labeled as group B) as well as height and weight parameters. Failure to complete feeds, dysphagia, vomiting, coughing, choking and recurrent respiratory symptoms were also significantly more common in this group than in the primary anastomosis group (labeled as group A) even in the absence of stricture. Variable degrees of disordered esophageal motility were present in all patients but pooling of the contrast medium, retrograde flow and delayed clearing of the esophagus were more frequent in group B. No patient was shown to have associated hiatal hernia. A 24 hour pH recording showed severe gastroesophageal reflux in 4 out of 13 cases of group A and in 3 out of 5 cases of group B. Clearing times were significantly delayed in all refluxing children. Our data suggest that the retarded start of oral feeding and swallowing coordination in patients with delayed primary anastomosis add further negative factors to their congenitally impaired esophageal motility, causing protracted dysphagia which represents a major problem for both family and hospital staff.
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PMID:Feeding troubles following delayed primary repair of esophageal atresia. 161 Jul 54

End-to-side anastomosis (ES) and ligation of the tracheoesophageal fistula (TEF) has been the procedure of choice for esophageal atresia at our institution since 1967. This report summarizes our operative and long-term results with the ES operation in 68 babies, including 33 in Waterston group A (50%), 23 in group B (35%), and 12 in group C (15%). An additional 10 patients had a primary end-to-end (EE) anastomosis, while 14 others required either staged EE repair or an esophageal replacement procedure. Overall survival rate with ES was 93% including two deaths attributed to major anastomotic leaks and sepsis, and three others in group C from cardiac anomalies. Six (9%) of those having ES anastomosis developed a recurrent TEF between 40 days and 21 months of age, necessitating reoperation. Predisposing factors to recurrent TEF were surgical inexperience (three cases; first operation for each surgeon), forceful vomiting secondary to gastroesophageal reflux (GER) in two, and drug overdose in one. Anastomotic leak occurred in seven (10%) following end-to-side repair and was implicated in two deaths. Three patients developed minor anastomotic stricture requiring less than three dilatations, while one with a tight stricture needed as many as five dilatations over the first 14 months of life. Mild dysphagia and respiratory symptoms were uniformly observed during the first year, but only five patients (7%), including the two with recurrent TEF, required fundoplication for persistent GER. All patients were eating table foods after 1 year of age, while 10 (15%) have required periodic endoscopic removal of solid food lodged at the radiographically unobstructed anastomosis.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Reassessment of the end-to-side operation for esophageal atresia with distal tracheoesophageal fistula: 22-year experience with 68 cases. 162 21

Between 1985 and 1990, we treated 46 cases of esophageal atresia in the pediatric surgery department in Marseille. In 17 of these patients atresia was associated with tracheomalacia. The most common respiratory manifestations were acute apneic attacks, cyanotic spells and recurring pneumopathy. The underlying cause was arterial compression of the airways by the innominate artery in 6 cases, the aortic arch in 2 cases, and a common origin of the innominate and left carotid arteries in 2 cases. Eleven patients underwent surgery to relieve arterial compression: suspension of the aorta from the under surface of the sternum (10 cases) and reimplantation of the innominate artery (1 case). Results in terms of tracheal caliber and symptomatic relief were excellent in 10 cases including 1 case requiring redo, and poor in 1 case. For diagnosis, our experience shows the importance of endoscopy, nuclear magnetic resonance and recognition of gastroesophageal reflux which is often associated (9/11). The role of tracheomalacia is discussed. On the basis of our results and those previously reported, aortopexy appears to be an effective surgical technique in patients with esophageal atresia presenting respiratory complications due to arterial compression.
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PMID:Esophageal atresia, tracheomalacia and arterial compression: role of aortopexy. 174 56

Gastroesophageal reflux (GER) occurs frequently in infants with esophageal atresia (EA). The definitive management is primary repair and often includes tube gastrostomy. The recent finding of lower esophageal sphincter (LES) pressure changes with tube gastrostomy suggests that GER might be related to gastrostomy rather than EA per se. To evaluate this thesis, two populations of patients from different children's hospitals were reviewed: EA with and without routine gastrostomy. The two populations were similar with respect to number of infants, associated anomalies, distribution in the Waterston classification, morbidity, and mortality. One hundred sixteen patients were studied. Of the 66 survivors who underwent gastrostomy and repair of EA, 30 were found to have GER (45.5%) and 12 required fundoplication (18.2%). Of 31 surviving patients who underwent repair of EA without gastrostomy, 11 had GER (35.5%) and four required fundoplication (12.9%). These data suggest that tube gastrostomy does not significantly contribute to the GER associated with EA.
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PMID:The effect of tube gastrostomy on gastroesophageal reflux in patients with esophageal atresia. 202 75

End-to-end anastomosis has become the standard technique for repair of esophageal atresia with distal tracheoesophageal fistula. End-to-side anastomosis with ligation of the fistula in continuity has also been advocated. For over 25 years both methods have been used in this hospital. The purpose of this report is to compare retrospectively the results obtained with these two techniques. Between 1962 and 1988, 111 neonates underwent repair of esophageal atresia and distal tracheoesophageal fistula. 74 patients had an end-to-end repair and 37 had end-to-side anastomosis with fistula ligation, according to the surgeons' preference. There were no significant differences between the two groups with respect to preoperative variables and Waterston classification. There was a significantly increased incidence of fistula recanalization (22% v 3%, P = .003) and mortality directly related to the esophageal atresia (16% v 3%, P = .03) in the end-to-side group versus the end-to-end group. The end-to-end group had a significantly higher incidence of gastroesophageal reflux. Logistic regression analysis showed that the end-to-side repair was associated with a greater overall mortality. We conclude that the end-to-end repair appears to be a safer procedure than the end-to-side technique.
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PMID:A more than 25-year experience with end-to-end versus end-to-side repair for esophageal atresia. 205 10

A series of six patients with congenital esophageal stenosis associated with esophageal atresia (EA) and distal tracheoesophageal fistula is presented. Three patients required only repeated dilatations, and have had good results. Two patients required limited resections of the distal esophagus, with excellent results. One patient died following a Heller myotomy. Tracheobronchial rests were present in the distal esophagus in the latter three patients. Diagnosis of congenital distal esophageal stenosis following repair of EA requires a high index of suspicion and a careful review of previous esophagrams. It is important to exclude anastomotic stricture and stenosis associated with gastroesophageal reflux. This requires barium esophagram, esophagoscopy with biopsy, and esophageal pH monitoring. Once a congenital basis for distal esophageal stenosis is suspected, management consists of dilatation by bouginage followed by balloon dilatation. Resection is reserved for persistent stenoses from tracheobronchial rests, which usually do not respond to dilatations.
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PMID:Distal congenital esophageal stenosis associated with esophageal atresia. 205 11

Between 1976 and 1988 an antireflux procedure (ARP) was performed in 364 infants and children (Nissen, 358; Thal, 6). Recurrent gastroesophageal reflux (GER) necessitating reoperation occurred in 21 patients, a failure rate of 6%. Recurrent GER developed within 28 months of primary ARP in 18 (86%) children. The symptoms of GER became apparent following an episode of forceful emesis in 29% of patients, half of whom had a malpositioned gastrostomy tube. Recurrent GER developed in 28% of children with corrected esophageal atresia. A definitive etiology of ARP failure was identified in 18 (86%) cases: "slipped" fundoplication (15), no fundoplication visualized (2), and paraesophageal hernia (1). Perioperative morbidity, intraoperative blood loss, and length of surgery were significantly increased for secondary ARP. Mortality following reoperation was zero, but three late deaths occurred. Long-term control of GER has been achieved in 78% of children following the second operation.
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PMID:The failed antireflux procedure: analysis of risk factors and morbidity. 226 51


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