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

Although tracheoesophageal fistula and esophageal atresia (TEF-EA) are surgically correctable, late respiratory complications have been reported. We administered a respiratory and gastrointestinal symptom questionnaire and performed standard pulmonary function tests (PF T's) and methacholine challenge testing on an unselected group of 25 subjects with TEF-EA who underwent surgery at our institution between 1963 and 1985. Results were compared to predicted normals, as well as 10 sibling controls. While the mean values of lung function test results for the TEF-EA group were within the normal range, they were significantly different from their siblings. Thirteen of the 25 TEF-EA group (52%), but none (0%) of the controls, had abnormal pulmonary function. This was classified as restrictive in 9 (36%), obstructive in 3 (12%), and mixed in 1. In addition, airway hyperreactivity [defined as a positive methacholine challenge (PC20 < or = 8 mg/mL)], was found in 6 of 18 TEF-EA subjects and 4 of the 9 controls who were evaluated. Comparison of TEF-EA subjects with normal and abnormal PFTs showed no difference in the incidence of tracheomalacia, esophageal strictures or dilatation, recurrent pneumonias, or gastroesophageal reflux. The respiratory symptom score in the subjects and controls was similar, and did not correlate with abnormal pulmonary function. The cause of the pulmonary function abnormalities remains unexplained.
 ...
PMID:Late pulmonary function following repair of tracheoesophageal fistula or esophageal atresia. 747 77

This article reviews the congenital disorder, esophageal atresia (EA) and tracheoesophageal fistula (TEF), and the acquired problem of gastroesophageal reflux (GER). Each can cause significant morbidity, but if treated appropriately can have gratifying results. EA and TEF anomalies exemplify a congenital disorder which is life threatening, but have been treated with improved success over the past three decades and continue to challenge pediatric surgeons. GER is an abnormal physiologic event which with overt emesis can present pulmonary problems or pathologies involving the esophagus alone. Recognition of GER as part of a foregut motility disorder enhances our understanding of the problem and its treatment.
 ...
PMID:Esophageal disease in the pediatric age group. 785 10

We report two cases of localized tracheomalacia, one associated with esophageal atresia, and one isolated. The pathophysiology explains that the symptoms are more important during or shortly after eating, the alimentary bowl crushing the trachea against the aorta, or the innominate artery. The exact cause of tracheomalacia is unknown. Esophageal atresia is frequently associated. The tracheal compression is more often due to the innominate artery, because its origin is located on the left side of the trachea in infants. The aorta or a vascular anomaly are rarely implicated. The symptoms of tracheomalacia are largely due to airway obstruction during expiration: stridor, baking cough, and the life-threatening "dying spell". For diagnosis, the endoscopy is the most important investigation. Among the many methods of treatment which have been proposed, the aortopexy appears to be the technique giving the best results. A single acute apneic attack is an absolute indication for surgery. It is also important to rule out severe gastroesophageal reflux, which can produce the same symptoms.
 ...
PMID:[Value of aortopexy in infants in the treatment of segmental tracheomalacia]. 801 73

After surgical repair of esophageal atresia (EA), any persistent respiratory distress unexplained by operative complications should lead to performance of tracheoscopy to evaluate the possibility of tracheomalacia. In a review of 46 cases of EA repair, 12 patients developed severe airway problems, manifested mainly by acute apneic episodes. These were related to an anterior extrinsic tracheal compression from vascular structures: the innominate artery alone in 8 patients, and in combination with the aortic arch in 4 patients. Aortopexy, evaluated by intraoperative tracheoscopy, provided good results in 10 patients with a mean follow-up of 2 years. After EA repair, respiratory symptoms, often related to feeding, should be recognized as a possible indication of severe compression of the trachea by the great vessels. The analysis of endoscopic features should allow consideration of patients as candidates for aortopexy, as long as they have resolved their symptoms after conservative therapy, and after investigation of all other possible sources of pulmonary problems. Gastroesophageal reflux must be recognized (7 cases in the series), but does not contraindicate aortopexy if the latter is deemed necessary. In selected cases, the relief of compression, controlled by intraoperative endoscopy, is considered a key component of a comprehensive program to treat children after EA repair.
 ...
PMID:Tracheomalacia caused by arterial compression in esophageal atresia. 802 13

The natural history of fundoplication in young children with gastroesophageal reflux (GER) had not been analyzed previously. The authors reviewed the charts of 160 children who underwent gastric fundoplication (GF) before the age of 2 years (mean age [+/- SD], 9 +/- 7 months; range, 1 week to 2 years), from 1974 to 1992. Reflux was documented by upper gastrointestinal series in 124 patients, by 24-hour pH probe monitor in 98 patients, and by both in 68 patients. Clinical indications for GF included failure to thrive (FTT) in 68%, emesis (Ems) in 58%, and aspiration pneumonia (Asp) in 53%. Neurological impairment (NI) was present in 47% of all patients, and 13% had esophageal atresia (EA). The type of GF used was a Nissen fundoplication in 79% and an anterior fundoplication (AF) in 21%. Of the 160 patients, 24 (15%) died of unrelated causes. Of the remaining 136, follow-up of at least 2 years was obtained for 96 (mean follow-up period, 5.3 +/- 3.0 years; range, 2 to 15 years). Clinical resolution of symptoms/findings after GF occurred in 87% of children with FTT, 92% with Ems, 70% with Asp, and 71% overall. A second fundoplication was required for 15 children (16%) because of documented recurrent reflux. The type of GF, the age of the patient, and the presence of EA or NI did not significantly affect the success of GF.(ABSTRACT TRUNCATED AT 250 WORDS)
 ...
PMID:Fundoplication in 160 children under 2 years of age. 803 82

To assess the predictive value of preoperative esophageal manometric study in the outcome of antireflux surgery, 14 children with severe gastroesophageal reflux (GER) who underwent surgery were studied retrospectively. Five patients had neuromuscular disease; one had been operated on for esophageal atresia. After extended (> 20 h) esophageal pH monitoring and/or barium swallow study, all patients underwent preoperative manometric study. After surgery, the patients were followed for 4 months to 4 years. Functional complications were noted after mechanical complications were eliminated. All patients had normal upper esophageal sphincter pressure (UESp); the resting lower esophageal sphincter pressure (LESp) was decreased in four patients, and seven had esophageal body motility trouble. Functional complications occurred in two patients. One was a neurologically involved patient who had had a normal preoperative manometric study; the other was the patient who had been operated on for esophageal atresia. No complications occurred in four patients who had had abnormal preoperative manometric studies. We conclude that, in this group of patients, esophageal manometric study has no predictive value in the outcome of the surgical procedure; however, it still would be interesting to elucidate the mechanisms of GER, especially in congenital abnormalities such as esophageal atresia.
 ...
PMID:Prognostic value of esophageal manometry in antireflux surgery in childhood. 805 13

Helicobacter pylori is an important factor in the pathogenesis of chronic gastritis and gastroduodenal ulcer disease. However, the basic causal mechanisms of H pylori colonization on the gastric mucosa are still unclear. The authors evaluated the prevalence of H pylori colonization in 266 children who underwent upper gastrointestinal endoscopy during a 12-month period. The indications for endoscopy were follow-up of esophagitis related to gastroesophageal reflux (n = 17), suspicion of gastroesophageal reflux (n = 51), abdominal pain (n = 28), vomiting (n = 30), follow-up of esophageal atresia (n = 46) and duodenal atresia (n = 28), inflammatory bowel disease (n = 28), and miscellaneous (n = 38). The methods used to detect H pylori colonization were histology and the rapid urease test. H pylori colonization was demonstrated in 31 (11.6%) of the 266 patients. In two patient groups, a high prevalence of colonization was identified. In patients with an operated duodenal atresia, 36% (10 of 28) had H pylori on the gastric mucosa. The organism was demonstrated on the gastric mucosa in 47% (8 of 17) of the patients with gastroesophageal reflux-related esophagitis; five of the eight patients had neurological impairment. In the other patient groups, the prevalence of H pylori infection ranged from 2% to 14%. The present study suggests that, in children, the disturbed esophagogastroduodenal motility, which is commonly associated with gastroesophageal reflux and duodenal atresia, predisposes to H pylori infection.
 ...
PMID:Does disordered upper gastrointestinal motility predispose to Helicobacter pylori colonization of the stomach in children? 807 8

Low birthweight and associated anomalies are important risk factors in patients with esophageal atresia. Gastroesophageal reflux is also a common problem in these patients and can lead to serious complications. The aim of this retrospective study was to analyse complications and mortality in 110 patients treated for esophageal atresia between January 1971-December 1987, in order to determine what role reflux may play. Symptoms of reflux were common in most patients during the first years of life. In some cases the symptoms were serious and even caused some late deaths by aspiration. The overall mortality was 12% (13/110). Early mortality (six patients) was caused by prematurity and associated anomalies, whereas late mortality often was caused by aspiration or other respiratory complications. Patients who had been operated with a circular myotomy showed more complications, but did not show a higher mortality rate than the remainder. This study confirms the importance of identifying patients with reflux at an early stage in order to prevent serious complications and mortality.
 ...
PMID:Esophageal atresia: mortality and complications related to gastroesophageal reflux. 811 Jul 13

Ultra-long-gap esophageal atresia, defined as a gap length of 3.5 cm or greater, has proved difficult to repair. When primary repair has been attempted, even with bougienage, circular myotomy, or intraabdominal esophageal mobilization to lessen anastomotic tension, leaks, anastomotic disruptions, and recurrent tracheoesophageal fistulas are frequent. Consequently, interposition grafts are commonly used. For long-term function the intact native esophagus should be preferable to an interposition graft or the consequences of circular myotomy. Therefore, even when an ultra-long gap is present, we have carried out a primary repair using our single-layer technique without myotomies. Since 1979, 8 of 58 infants (14%) with esophageal atresia had gaps ranging from 3.5 to 6 cm. All had a primary repair with follow-up from 1 to 11 years. Despite severe anastomotic tension in all cases, there were no anastomotic leaks, disruptions, recurrent tracheoesophageal fistulas, or deaths. The tension, however, may have led to major gastroesophageal reflux in 5 of 8 patients (62.5%), all treated by a Nissen fundoplication, and a stricture in 4 of 8 infants (50%). Three strictures responded to dilation and one was resected. Now, all children are eating a normal diet for age. In conclusion, this technique has allowed primary repair of ultra-long-gap esophageal atresia. Although the severe tension may contribute to strictures needing dilation and gastroesophageal reflux requiring fundoplication, primary repair resulted in a clinically functional native esophagus.
 ...
PMID:Primary repair of ultra-long-gap esophageal atresia: results without a lengthening procedure. 814 24

The risk of postoperative reflux and pulmonary aspiration with straight colon or gastric tube esophageal replacement in children prompted us to reevaluate the presumed antireflux role of the ileocecal valve with retrosternal ileocolic interposition. This operation was done in eight patients with esophageal atresia (six) and lye stricture (two) from 19 to 50 months of age between 1983 and 1992. There were no operative deaths. The duration of follow-up ranged from 4 to 115 months. Barium swallow obtained in all patients showed unobstructed esophagoileocolic transit without reflux. Two patients with esophageal atresia had localized proximal anastomotic leaks, which healed spontaneously without stricture. In the two patients with lye ingestion ileoesophageal strictures developed that necessitated revision. None of the patients had postoperative respiratory complications or symptomatic gastroesophageal reflux. All eight children have had their gastrostomy tubes removed, are eating a regular diet, and are growing well. In conclusion, the retrosternal ileocolic conduit provides an excellent substitute esophagus in selected pediatric patients, with potential advantages over delayed primary anastomosis or the straight colon or gastric tube interposition because of the antireflux role of the ileocecal valve.
 ...
PMID:Retrosternal ileocolic esophageal replacement in children revisited. Antireflux role of the ileocecal valve. 815 28


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>