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

A new computerized telemetry system for extended esophageal pH monitoring is prospectively evaluated and compared with other diagnostic modalities in 38 pediatric patients suspected of having gastroesophageal reflux (GER). Unique circuitry allows connection of 1.5 mm diameter antimony electrodes to a patient-worn digital recorder that continuously samples pH at four levels from pharynx to distal esophagus. Ambulatory studies in a "physiologic" environment are possible and data is teletransmitted by the satellite computer to the central laboratory for analysis. Of 41 studies completed, four were lost to interpretation because of battery, electrode, or computer failure. Thirty-seven studies could be analyzed in five clinical groups: emesis and failure to thrive; status post esophageal atresia repair; apnea/bradycardia; central nervous system damage; and status post antireflux procedure. Pathologic GER was noted 14 times and an antireflux procedure was clinically required in 13 instances. In five cases the upper GI series failed to detect the GER. Twenty-three studies showed no GER, and the clinical symptoms resolved with appropriate medical therapy in 21 cases. The upper GI series demonstrated GER five times in this group. In the nine instances that esophagoscopy/biopsy was employed, the pH study findings were uniformly confirmed. This computerized system provided a technically complete and interpretable study 90% of the time. Based on patient outcome, the extended pH monitoring was 92% accurate in detecting clinically important GER with a sensitivity of 87% and specificity of 93%. The upper GI series demonstrated a 69% accuracy with a 60% sensitivity and 64% specificity (P = .01).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:A unique teletransmission system for extended four-channel esophageal pH monitoring in infants and children. 381 98

One hundred forty-eight infants with abnormalities of the esophagus treated over a 5-year period were reviewed: 87% comprised esophageal atresia with distal tracheoesophageal fistula. The survival rate for infants in risk group A was 100%, for risk group B, 86%, and for risk group C, 73%. There were six infants with associated anomalies incompatible with survival. Anastomotic leaks occurred in 21% of cases, strictures in 18% and recurrent tracheoesophageal fistula in 12%. The use of braided silk for the repair was associated with a high complication rate. There was a distinct advantage in delaying surgery pending improvement in aspiration pneumonia. Low birth weight was not considered a contraindication for primary repair. Emergency ligation of the fistula was considered a more appropriate procedure than gastrostomy for the infant with associated severe respiratory distress syndrome in whom mechanical ventilation was providing difficult. Congenital cardiac anomalies were the single most common cause of mortality and correction of these anomalies should be pursued aggressively. There were definite advantages of preoperative endoscopy, particularly in identifying proximal fistulae. Elective postoperative ventilatory support for infants with a very tense anastomosis was successful in preventing leaks in five infants. There were no advantages to routine gastrostomy. Severe gastroesophageal reflux and tracheomalacia demand aggressive management. Mortality was directly related to the severity of associated congenital anomalies.
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PMID:Esophageal atresia: five year experience with 148 cases. 382 1

Gastroesophageal reflux (GER) in the pediatric patient is a frequently recognized problem. Unlike the adult, in whom symptoms relating to esophagitis predominate, the infant and child may present with a variety of respiratory problems, vomiting and/or growth failure. GER is often seen in association with other conditions and must be considered in the evaluation of any pediatric patient with chronic recurring respiratory problems, vomiting or failure to thrive (FTT). Thirty-eight pediatric patients have been surgically managed at West Virginia University from 1977-1983 for GER. The patients fall into several different patterns of presentation and associated problems. Nine premature infants all with bronchopulmonary dysplasia (BPD) have undergone fundoplication for FTT, worsening BPD, and pneumonia. Seven infants and two older children had GER associated with previous esophageal atresia repairs. Esophagitis, vomiting and growth failure were the predominant complaints in this group, though all nine patients had recurring respiratory symptoms as well. Syndromes involving mental retardation and neurologic dysfunction affected another group of five patients, all of whom presented with the complications of long-term esophagitis. The remaining 15 children were otherwise healthy infants who had predominantly respiratory symptoms due to GER. The benefits of fundoplication in these severely affected infants and children far outweigh the relatively few complications. In the carefully selected patient, surgical management of GER is dramatically successful.
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PMID:Patterns of pediatric gastroesophageal reflux. 398 87

From 1976 to 1981 six patients with esophageal atresia types 1 and 2 underwent a successful delayed primary anastomosis. At birth a gap between the upper and lower pouch (5 to 7 vertebras) was present. 9 to 14 weeks later, at surgery, the mean gap was 3 vertebras and the anastomosis was carried out without excessive tension. No upper pouch elongation was done before surgery and end-to-end esophageal anastomosis was accomplished without the need of circular myotomy. All patients are alive and well after a follow up period from 6 months to 6 years. We have to mention post-operative complications; 3 anastomotic extrapleural leaks were managed conservatively by peripheric parenteral nutrition, 1 post operative tracheo-esophageal fistula required a closure and 2 patients with a symptomatic gastro-esophageal reflux were managed by antireflux fundoplication. No anastomotic stricture was observed. The functional results are excellent.
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PMID:[Cure of esophageal atresia types 1 and 2. Deferred primary anastomosis. Apropos of 6 cases]. 622 24

The short term prognosis of the esophageal atresia has been improved by the progress of diagnosis and surgical techniques. The long term prognosis still depends upon the occurrence of bronchopulmonary complications. Having investigated fourteen cases and a review of the literature, the authors studied the cause of these respiratory complication. Two factors seem to play an important role: the gastroesophageal reflux and the tracheomalacia. This has important therapeutical implications: treatment of the gastro-esophageal reflux and long term respiratory kinesitherapy. The authors suggest for these patients a management plan over several years.
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PMID:[Broncho-pulmonary complications in survivors of esophageal atresia. (author's transl)]. 626 19

The experience of the authors concerns 100 neonates treated for esophageal atresia between 1968 and 1980. A retrospective study of the sequelae observed in 73 survivors (age 3 to 15 years) found 26 cases of gastroesophageal reflux. This study demonstrates a high incidence of reflux in children who initially presented with a fistula and long gap esophageal atresia. It also shows that chronic respiratory disorders are more frequent in these patients and that esophagitis is the principal factor leading to stricture of the anastomosis stubborn to dilatation. In 14 patients, the severity of the clinical and endoscopic symptoms justified a surgical antireflux procedure, the only guarantee of clinical and radiologic recovery, with long term confirmation in 9 patients.
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PMID:[Gastroesophageal reflux after the surgical treatment of esophageal atresia]. 638 22

Severe gastroesophageal reflux was found in 9 out of 18 infants with congenital esophageal atresia studied radiographically shortly after primary reconstruction. Pulmonary complications were recorded in 18 out of 32 similar patients in long-term follow-up. Strictures at the level of the anastomosis were detectable in 18 out of 32 patients; eleven strictures were severe enough to require dilation or surgical revision. These findings suggest that early evaluation for gastroesophageal reflux may be useful in management of infants with esophageal atresia. The precautions taken preoperatively to prevent complications of gastroesophageal reflux should be continued in the postoperative interval unless a competent lower esophageal sphincter is demonstrated.
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PMID:Surgical treatment of congenital esophageal atresia. 650 16

To prevent the reflux of gastric contents into the bronchial tree through the tracheoesophageal fistula in patients with esophageal atresia with tracheoesophageal fistula, Nissen fundoplication was performed in the first-stage repair of staged operations. After elimination of the pulmonary complication, a correction of esophageal atresia and tracheoesophageal fistula was successfully performed through the extrapleural route at the age of 16 days. Thus, because Nissen fundoplication is simple to perform and effective in preventing gastroesophageal reflux, this procedure is considered to be useful in the staged repair of esophageal atresia with tracheoesophageal fistula.
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PMID:Prevention of gastroesophageal reflux using Nissen fundoplication in the staged repair of esophageal atresia with distal tracheoesophageal fistula. 667 89

The results of this study demonstrate that there is abnormal esophageal function in patients who have undergone repair of esophageal atresia. The diagnostic tests used may be too sensitive as the abnormalities demonstrated have little clinical relevance. In addition, there was an inverse relationship between signs and symptoms of esophageal dysfunction and the age of the child. The abnormalities are probably intrinsic and only secondarily affected by surgical treatment. Increased tension at the gastroesophageal junction is a likely factor in the production of gastroesophageal reflux. Esophageal dysfunction does not necessarily lead to detrimental gastroesophageal reflux with the sequela of repeated respiratory infections, failure to gain weight or esophageal stricture. Only patients who have such signs or symptoms need to undergo evaluation of esophageal function to determine if there is an abnormality. The results of the studies then document the need for an antireflux procedure.
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PMID:Esophageal function after repair of esophageal atresia. 671 Feb 97

Gastroesophageal reflux in infants and children is a complex disease. The diagnosis in 14 operative patients was made utilizing a careful history, barium swallow, technetium radionuclide milk scan, and endoscopy with esophageal biopsy. Symptoms were intractable vomiting, failure to thrive, recurrent pneumonia, apnea, asthma and bronchitis, esophagitis, and esophageal stricture. The pernicious aspects of this disease include a potentially significant mortality in children with severe apnea episodes, increased morbidity with esophagitis, and psychosocial disruption for those children that progress to the teenage years with recurrent vomiting, rumination, heartburn and stricture formation. A high incidence of gastroesophageal reflux unresponsive to medical management was noted with esophageal atresia and neurologic disease. The Nissen fundoplication was used in all patients and proved an effective procedure with a low morbidity and recurrence rate.
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PMID:Gastroesophageal reflux in children: an underrated disease. 707 8


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