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)

Gastroesophageal reflux (GER) frequently complicates the clinical course of children suffering from conditions leading to upper airway obstruction (UAO) (choanal atresia, tracheomalacia, esophageal atresia, vascular rings, etc). In an attempt to explore whether partial airway obstruction causes changes in the normal thoracoabdominal pressure gradients, we measured end-inspiratory intrathoracic and intraabdominal pressures in anesthetized rats under spontaneous breathing conditions, after tracheostomy, and under upper airway obstruction induced by tracheal intubation with three progressively narrower cannulae (inner diameters 1.0 mm, 0.5 mm, and 0.2 mm). We also measured the lower esophageal sphincter pressure (LESP) and length (LESL) and calculated the thoracoabdominal end-inspiratory pressure gradient (TAEIPG). Neither LESP nor LESL changed significantly before or after maximal tracheal obstruction (14.3 +/- 6.2 v 18 +/- 7.6 cm H2O [P > .05] and 0.34 +/- 0.09 v 0.41 +/- 0.1 cm H2O [P > .05] respectively) but TAEIPG significantly increased from 5.58 +/- 1.34 cm H2O to 17.62 +/- 4.27 cm H2O (P < .01) under the same conditions, mainly as a result of progressively increasing negative intrathoracic pressures during inspiration. These experiments prove that the powerful thoracoabdominal pressure gradients developed after partial UAO may contribute to the pathogenesis of GER by overcoming the antireflux barrier function. This study points out the convenience of routinely screening for GER all children with airway obstructive conditions, bearing in mind that the reestablishment of normal respiratory conditions should be the primary goal of treatment.
 ...
PMID:Airway obstruction and gastroesophageal reflux: an experimental study on the pathogenesis of this association. 822 6

A preliminary report is presented regarding the 24 hours continuous pH monitoring of 40 patients from 1 month to 19 years of age with clinical features of gastro-esophageal reflux confirmed by at least one of the diagnostic methods utilized (radiology, endoscopy, esophageal biopsy). The equipment used was a MIC GASTROGRAPH with 1.2 and 3 mm catheters according to age and using the methodology suggested by ESPGAN. Patients with reflux index of more than 10% had all other pH indexes and other diagnostic methods abnormal. The area of the curve below pH 4 correlated directly with the presence of esophagitis. Patients with post history of esophageal atresia and caustic esophagitis had marked alterations of pH. PH monitoring with the modern methodology currently available is of great help to quantify severity of acid reflux, to distinguish between physiologic pathologic reflux and to decide treatment.
 ...
PMID:[Measurement of esophageal pH during 24 hours in children. Preliminary report]. 824 66

Although the esophagus functions simply as a conduit between the mouth and the more distal gastrointestinal tract, its physiology and pathophysiology display a complexity that contrasts with that simple function. Thus there are still mysteries about this "tube" and its disorders, and each year brings new revelations. Most attention continues to focus on gastroesophageal reflux, its emerging pathophysiology, multiple manifestations, various diagnostic techniques, and improving methods of treatment. Complications of gastroesophageal reflux, including optimal ways of preventing and treating them, have been explored further. Other aspects of esophageal motility and dysmotility and other causes of inflammation and injury of the esophagus have also been studied during the past year. The surgical literature, especially, continues to struggle with congenital esophageal lesions, particularly esophageal atresia and stenoses.
 ...
PMID:Esophageal disorders in infants and children. 828 82

Long-term follow-up examination with esophagogastroduodenoscopy was performed on 39 esophageal atresia patients 2 to 11 years (mean, 7.6) after the anastomotic operation. Nine of these patients had undergone fundoplication for symptomatic gastroesophageal reflux. The subjective results at the last follow-up were as follows: excellent in 25, good in 10, and fair in 4 patients. The endoscopic findings were normal in 17 patients. Endoscopy of the remaining 22 patients showed esophagitis in 20, 5 associated with Barrett's change. Hiatal hernia was found in 10 patients. The fundoplication was totally or partially disrupted in 3 patients. Esophageal biopsies were obtained from 37 patients. The histological findings were as follows: esophagitis in 21, gastric metaplasia in 3, and normal esophageal mucosa in 13 patients. The endoscopic and histological findings correlated poorly with subjective results as more than half of the patients with excellent subjective results had esophagitis, one of them with gastric metaplasia. Therefore, long-term endoscopic follow-up of all esophageal atresia patients is warranted.
 ...
PMID:Chronic esophagitis and gastric metaplasia are frequent late complications of esophageal atresia. 830 87

The effect of associated congenital abnormalities, particularly cardiac malformations, on the survival rate of infants with esophageal atresia is emphasized in a number of publications. In infants with non-duct-dependent cardiac anomalies, repair of the esophagus takes precedence whereas in duct-dependent lesions, temporary control can usually be achieved with prostaglandin E. In rare instances, a palliative shunt may have to be constructed prior to the esophageal surgery. The role of gastroesophageal reflux and tracheomalacia in the long-term follow-up is also stressed. Controversy regarding the choice of the ideal method of esophageal replacement continues: one publication compares the outcome of colonic interposition with gastric tube esophagoplasty, whereas the results and short-term follow-up of gastric transposition are detailed in another.
 ...
PMID:Esophageal atresia and tracheoesophageal fistula in children. 837 55

Two cases of coarctation complex (CoA + VSD + PDA) associated with congenital esophageal atresia (Gross type C) were successfully treated with esophageal and two-staged cardiac surgery. The perioperative management of the two cases is discussed with special reference to circulatory, respiratory and nutritional problems. Case 1; A newborn was diagnosed as esophageal and cardiac anomalies and gastrostomy was performed followed by end to end anastomosis of the esophagus under receiving Prostaglandin E1 infusion. Although subclavian flap angioplasty (SFA) and pulmonary artery banding (PAB) were performed 1 month later, she had recurrent respiratory complications and malnutrition postoperatively due to bronchomalacia and gastroesophageal reflux (GER). Case 2; A newborn was diagnosed as esophageal atresia and underwent corrective surgery of it on the 1st day of life. After esophageal surgery congestive heart failure (CHF) developed progressively and CoA complex was evident by echocardiography 5 days later. SFA and PAB were performed 26th day of life. In spite of the palliative surgery for cardiac lesions, both patients had growth failure because of CHF, respiratory complications and malnutrition. As soon as the circulatory and respiratory condition improved, corrective surgery was performed and resulted in full recovery.
 ...
PMID:[Two cases of coarctation complex associated with congenital esophageal atresia (Gross type C)]. 837 2

From January 1974 to December 1988, 80 patients with esophageal atresia (EA) and tracheoesophageal fistula (TEF) were treated at the C.S. Mott Children's Hospital with division of their TEF and esophagoesophagostomy. Thirty-four in this group developed gastroesophageal reflux (GER). After an unsuccessful trial of medical management, 21 underwent Nissen fundoplication, and an additional child with refractory GER died intraoperatively before completion of her fundoplication. Following fundoplication, only eight patients had an uncomplicated course with elimination of reflux and no postoperative dysphagia. Wrap disruption and recurrent reflux occurred in 7 of the 21 (33%), a markedly higher incidence than the 10% figure seen in 220 children without EA who have undergone fundoplication at this institution. Upward tension on the wrap due to the presence of a shortened esophagus probably predisposes to an increased frequency of fundoplication failure in the EA child. In addition, postoperative dysphagia requiring prolonged gastrostomy feedings complicated eight otherwise successful initial or redo-fundoplications. Prolonged dysphagia in this group is likely related to the inability of the dyskinetic esophagus, common in EA, to overcome the increased resistance caused by the Nissen fundoplication. Three deaths (14%) from complications related to antireflux surgery occurred in the series. Although 15 of the 21 children (71%) eventually had excellent long-term results following initial or redo-fundoplication with elimination of reflux and normalization of oral intake, morbidity and mortality were clearly significant. Due to the high incidence of postoperative dysphagia and recurrent reflux, the transabdominal Nissen fundoplication may not be appropriate in EA patients.
 ...
PMID:Efficacy of the Nissen fundoplication in the management of gastroesophageal reflux following esophageal atresia repair. 842 73

A retrospective review from 1981 to 1986 was made of 51 neonates who were treated for congenital esophageal atresia at the Royal Alexandra Hospital for Children, Sydney, Australia. Thirty of the 51 had primary repair and 15 (50%) developed esophageal stricture requiring one or more dilations. Stricture dilations were performed with open-tube rigid esophagoscopes, rigid telescopes, and Jackson dilators. The number of dilations performed until the patient was asymptomatic ranged from 1 to 12 (mean 4.5). The minimal follow-up time was 4 years. There was one esophageal perforation with full recovery following conservative management. One child died of septicemia caused by continued aspiration of unknown cause. A surprising finding, contrary to other reports, was the stricture formation did not appear to be related to the size of the "gap" found at the time of esophageal repair. Gastroesophageal reflux, however, was an important factor. We conclude that esophageal stricture following repair of tracheoesophageal atresia can be satisfactorily and relatively safely managed by direct vision antegrade endoscopic dilation using graduated dilators, although treatment may be prolonged and repeated. New esophagoscopes and dilators, in graduated sizes and designed for pediatric use, are recommended. The technique of esophageal dilation in infants is described in detail. Pediatric laryngobronchoesophagologists will become more involved in the care of infants born with esophageal atresia with or without tracheoesophageal fistula.
 ...
PMID:Esophageal stricture following esophageal atresia repair: endoscopic assessment and dilation. 848 61

A total of 17 patients, ages 3 weeks to 14 1/2 years, had 20 esophageal strictures develop after repair of esophageal atresia (9 strictures); primary gastroesophageal reflux (3 strictures); Nissen fundoplication (4 strictures); epidermolysis bullosa congenita dystrophica (1 stricture); congenital esophageal stenosis (2 strictures); or colonic interposition (1 stricture). These strictures were treated with 132 endoscopic balloon catheter dilations (average, 6.6/patient, range, 1 to 24) during a period of 42 months (average, 8 months; range, 2 to 42 months). Fifteen of the 17 patients are now asymptomatic. Thirteen of the 17 patients had documented reflux esophagitis and were also medically treated. The two residually symptomatic patients included a patient with severe proximal esophagitis secondary to epidermolysis bullosa congenita dystrophica who had only a temporary response to dilations and another patient with a tight Nissen fundoplication who did not improve after dilation but is now asymptomatic after corrective surgery. The 10 patients with tracheoesophageal fistula repair were asymptomatic within 3 to 21 months (average, 10.8 months). Only one patient had perforation develop as a result of the procedure. Sixteen of 17 patients had the procedures performed as outpatients. All patients were given oral feedings throughout the course of dilation and had normal growth.
 ...
PMID:Endoscopic balloon dilation of esophageal strictures in children. 849 35

Gastroesophageal reflux (GER) is one of the most frequent symptomatic clinical disorders affecting the gastrointestinal tract of infants and children. During the past 2 decades, GER has been recognized more frequently because of an increased awareness of the condition and also because of the more sophisticated diagnostic techniques that have been developed for both identifying and quantifying the disorder. Gastroesophageal fundoplication is currently one of the three most common major operations performed on infants and children by pediatric surgeons in the United States. Normal gastroesophageal function is a complex mechanism that depends on effective esophageal motility, timely relaxation and contractility of the lower esophageal sphincter, the mean intraluminal pressure in the stomach, the effectiveness of contractility in emptying of the stomach, and the ease of gastric outflow. More than one of these factors are often abnormal in the same child with symptomatic GER. In addition, in patients with GER disease, and particularly in those patients with neurologic disorders, there appears to be a high prevalence of autonomic neuropathy in which esophagogastric transit and gastric emptying are frequently delayed, producing a somewhat complex foregut motility disorder. GER has a different course and prognosis depending on the age of onset. The incompetent lower esophageal sphincter mechanism present in most newborn infants combined with the increased intraabdominal pressure from crying or straining commonly becomes much less frequent as a cause of vomiting after the age of 4 months. Chalasia and rumination of infancy are self-limited and should be carefully separated from symptomatic GER, which requires treatment. The most frequent complications of recurrent GER in childhood are failure to thrive as a result of caloric deprivation and recurrent bronchitis or pneumonia caused by repeated pulmonary aspiration of gastric fluid. Children with GER disease commonly have more refluxing episodes when in the supine position, particularly during sleep. The reflux of acid into the mid or upper esophagus may stimulate vagal reflexes and produce reflex laryngospasm, bronchospasm, or both, which may accentuate the symptoms of asthma. Reflux may also be a cause of obstructive apnea in infants and possibly a cause of recurrent stridor, acute hypoxia, and even the sudden infant death syndrome. Premature infants with respiratory distress syndrome have a high incidence of GER. Esophagitis and severe dental carries are common manifestations of GER in childhood. Barrett's columnar mucosal changes in the lower esophagus are not infrequent in adolescent children with chronic GER, particularly when Heliobacter pylori is present in the gastric mucosa. Associated disorders include esophageal dysmotility, which has been recognized in approximately one third of children with severe GER. Symptomatic GER is estimated to occur in 30% to 80% of infants who have undergone repair of esophageal atresia malformations. Neurologically impaired children are at high risk for having symptomatic GER, particularly if nasogastric or gastrostomy feedings are necessary. Delayed gastric emptying (DGE) has been documented with increasing frequency in infants and children who have symptoms of GER, particularly those with neurologic disorders. DGE may also be a cause of gas bloat, gagging, and breakdown or slippage of a well-constructed gastroesophageal fundoplication. The most helpful test for diagnosing and quantifying GER in childhood is the 24-hour esophageal pH monitoring study. Miniaturized probes that are small enough to use easily in the newborn infant are available. This study is 100% accurate in diagnosing reflux when the esophageal pH is less than 4.0 for more than 5% of the total monitored time.
 ...
PMID:Gastroesophageal reflux in childhood. 853 88


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