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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 1977 we started treating babies with isolated esophageal atresia by delayed primary anastomosis and in 1981 reported our early experience in five cases treated between 1977 and 1979. Since 1979, 11 further consecutive cases have been managed by initial gastrostomy followed by delayed primary esophageal anastomosis. Their mean gestation was 35 weeks (range, 28 to 40 weeks) and mean birth weight was 2,040 g (range, 1,140 to 2,720 g). The esophageal gap between the two ends when assessed initially at fluoroscopy ranged from 2.2 to 4.5 cm (mean, 3.2 cm). Age at delayed primary anastomosis ranged from 6 to 20 weeks. Anastomotic leak occurred in three babies in the immediate postoperative period and all were successfully managed conservatively. Eight of the 11 patients developed anastomotic strictures; seven cases required 1 to 5 esophageal dilatations. One patient who did not respond to multiple esophageal dilatations required resection of an esophageal stricture. One patient died at 15 months of age of unrelated causes. The 10 surviving patients have been followed-up from 18 months to 11 years. At follow-up, seven patients were eating normally. Three patients had swallowing difficulties and all three were found to have esophageal strictures on barium swallow, two of them also had gross esophageal reflux and hiatus hernia. The height and weight in the 10 patients varied from 3rd centile to 75th centile. Delayed primary anastomosis is feasible in cases of isolated esophageal atresia and the patient's own esophagus is the best. A more aggressive approach should be applied to gastroesophageal reflux in these patients.
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PMID:Delayed primary anastomosis for esophageal atresia: 18 months' to 11 years' follow-up. 140 48

Benign esophageal strictures may be caused by numerous disorders, but more than 90% of them are due to severe gastroesophageal reflux or ingestion of lye. A new classification of the severity of the stricture is proposed, based on the endoscopic and radiological evaluation of three parameters: internal diameter, length of the stricture and ease or difficulty of dilatation. In patients with strictures secondary to reflux, initial treatment includes periodic dilatation. Grade I and II strictures require esophageal resection. In grade III patients, bile diversion or esophageal resection should be performed. Caustic ingestion produces a wide spectrum of tissue damage in the upper digestive tract ranging from minimal chemical burn to an extensive and massive necrotic lesion. The basic and main treatment in patients with an established esophageal stricture is periodic dilatation avoiding, if at all possible, any kind of surgery. In patients with grade III stricture, colonic interposition between cervical esophagus and stomach or duodenum is preferred, treating the damaged esophagus by resection or leaving it "in situ". Psychiatric evaluation is mandatory in these cases.
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PMID:Surgical management of esophageal strictures. 148 61

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

Anatomical and physiological considerations specific to newborn infants with congenital thoracic abnormalities directly affect the timing and nature of surgical intervention during the neonatal period. This paper uses oesophageal atresia as an example of a common neonatal thoracic condition to highlight the way in which these considerations have influenced the approach to their surgical management. The type of surgical approach employed during thoracotomy determines the likelihood of subsequent chest wall deformity: an intercostal approach is preferable to rib resection. Multiple thoracotomies adversely affect the chest wall appearance and lung function. In premature infants with respiratory distress syndrome early surgical closure of the tracheo-oesophageal fistula is advantageous, and gastrostomy alone often prolongs the ventilatory difficulties. The upper oesophagus can be extensively mobilized with little danger to its blood supply, whereas the lower oesophagus, because it receives a segmental supply, is more vulnerable to ischaemia. The severity and distribution of tracheomalacia is reflected in its symptomatology. Tracheomalacia often coexists with gastro-oesophageal reflux, which should be corrected by a fundoplication if respiratory symptoms persist or an oesophageal stricture develops. The numerous factors producing heat loss in the newborn during thoracotomy are discussed. It is clear that an understanding of the anatomy and physiological changes which occur in the neonate is required if these infants are to be treated effectively and safely.
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PMID:Influence of anatomy and physiology on the management of oesophageal atresia. 190 89

The development of esophageal stricture is common following endoscopic variceal sclerotherapy (EVS). Gastroesophageal reflux may be at least partly responsible. Twelve randomly selected male patients underwent chronic EVS for the management of bleeding esophageal varices. Six patients developed strictures during or after EVS, six did not. There were no significant differences between stricture and nonstricture patients during 24 hour esophageal pH monitoring. Three of the six stricture patients and four of the six nonstricture patients had an abnormal amount of reflux. Gastroesophageal reflux occurs frequently in patients undergoing EVS, and it is not likely to play a major role in EVS stricture formation.
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PMID:Gastroesophageal reflux and sclerotherapy strictures. 224 Aug 56

Eight patients with esophageal reflux strictures and brachioesophagus were treated by endoscopic dilatation and the Collis-Nissen procedure between 1986 and 1990 at the Institute of Digestive Diseases, Belgrade University Clinical Center. Dilatation of the esophageal stricture was performed by the Eder-Puestow system. All strictures were dilated preoperatively to in average 45 Fr without any complications recorded. The average duration of the Collis-Nissen operation was 3.5 hours and it was hastened by the usage of GIA surgical stapler for construction of the Collis gastroplasty tube. Postoperative course was uneventrful in all eight patients and by dismissal all of them had satisfactory relief of dysphagia and barium esophagogram. Postoperative hospital stay averaged 13.0 days. Satisfactory symptomatic control of gastroesophageal reflux (no symptoms, no treatment) was achieved in 5 patients at a long-term follow-up. Two patients required periodic dilatations and antireflux therapy during the first postoperative year to achieve resolution of the dysphagia and no need for medical therapy. One patient had objective failure of reflux control and progression of stricture formation requiring reoperation. This patient underwent esophagectomy and esophagocoloplasty with a subsequent good result. The combined Collis gastroplasty-Nissen funduplication has become the operation of choice in patients with dilatable reflux stricture and esophageal shortening and a reasonable alternative to a formidable resectional procedures. This report evaluates the first experiences with a Collis-Nissen procedure in our country.
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PMID:[The Collis-Nissen operation in the treatment of reflux due to esophageal stenoses associated with brachioesophagus]. 224 10

In a 6.5 year period starting January 1982, 121 patients (74 male, 47 female; 1.6:1) with complicated gastroesophageal reflux referred to Alberta Children's Hospital, University of Calgary, required a Nissen fundoplication at a mean age of 35.5 months (range 3 weeks to 18 years). The median age of onset of symptoms was less than 1 month. Symptoms and indications for surgery included regurgitation (88%), failure to thrive (52%), reflux-associated pulmonary symptoms and aspiration (48%), biopsy evidence of esophagitis (35%) with heartburn (17%), dysphagia (18%), hematemesis (17%), anemia (13%), and hypoproteinemia (22%). Sixty-four percent of the patients had a syndrome or chromosomal abnormality, respiratory disease, or neuromuscular disorder. The barium contrast upper-gastrointestinal radiographic series, performed in all patients, identified structural [gastric outlet obstruction (2%), esophageal stricture (11%), erosive esophagitis (9%)], and functional abnormalities [gastroesophageal reflux (90%), barium aspiration (8%), esophageal hypoperistalsis (30%), delayed gastric emptying (4%)]. Barium contrast upper gastrointestinal radiographic series identified gastroesophageal reflux with a sensitivity of 90% (compared to history), was 50% sensitive and 92% specific for erosive esophagitis (compared to biopsy), was 59% sensitive and 74% specific for esophageal dysmotility (compared to esophageal manometry), and there was a significant (p less than 0.01) association between barium aspiration and prior evidence of aspiration pneumonitis. Esophageal manometry demonstrated a significantly (p less than 0.001) lower esophageal sphincter pressure in patients compared with controls, but no significant correlation with failure to thrive, aspiration pneumonia, biopsy evidence of esophagitis, or parameters of the 24-hour esophageal pH study. Twenty-four hour pH monitoring showed significantly (p less than 0.05) more reflux episodes than in asymptomatic controls and there was significant (p less than 0.05) correlation between the percentage of time pH was less than 4 and the presence of hypoalbuminemia, and biopsy-proven erosive esophagitis or Barrett's esophagus. Endoscopic appearance was 91% sensitive and 60% specific for esophagitis when compared to biopsy. Nissen fundoplication was completely effective at resolving gastroesophageal reflux in 83%, and associated with marked improvement in 15%. No patient died as a result of fundoplication. Major complications included: recurrence of symptoms requiring reoperation (2%), subsequent mechanical bowel obstruction (8%), wound infection or pneumonia (12%).
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PMID:Investigation and outcome of 121 infants and children requiring Nissen fundoplication for the management of gastroesophageal reflux. 227 17

With the aim of suggesting incision of peptic esophageal strictures, as an alternative to bougienage, we report the results of the first 20 patients so treated. We included as candidates for this treatment all those patients with moderate or severe dysphagia in whom a stricture of the distal esophagus was confirmed on esophagoscopy that could not be negotiated despite continuous and vigorous pressure with the tip of the fiberscope. On the basis of radiological films, the minimum diameter of the stenotic ring (+/- SD) was 4.4 +/- 2.2 mm, increasing up to 10.05 +/- 1.5 mm once the endoscopic procedure was made. Dysphagia was initially relieved in all the cases. Four patients had recurrence within a few days after the incision. Later, another 4 patients had recurrence. Finally, a further 4 cases were lost by non-compliance. The remaining 8 patients who underwent a 6-months' follow-up did not show a later tendency to re-stenosis. In total, 5 patients were surgically treated for hiatal hernia. One case of emphysema in the mediastinum was noted and treated conservatively. We conclude that endoscopic incision is an alternative to esophageal dilatation as initial treatment for peptic esophageal stricture, despite the fact that a significant number of patients will require additional surgical correction for gastro-esophageal reflux.
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PMID:Endoscopic incision as an alternative to bougienage in the treatment of peptic esophageal stricture. 235 32

Thirty-two patients with proximal oesophageal stricture who were treated under one surgeon (K.M.) during a 17-year period are reviewed. The cause of the stricture in these cases was widely varied and included: gastro-oesophageal reflux (Barrett-type oesophagus), radiotherapy and post-surgical anastomosis following oesophageal reconstruction. Seventeen patients were treated by repeated endoscopic dilatation. Of the remaining 15, 3 patients only (1 with suspected malignancy and 2 with occult cancer) needed resection and reconstruction of the oesophagus. Twelve patients underwent simple conservative operations. There was no hospital or treatment related mortality in this series. We concluded that the majority of such strictures respond to repeated endoscopic dilatation or conservative surgical operation. It is mandatory to exclude malignancy in obstructive lesions of the proximal oesophagus and it is important to establish the aetiology of the lesion in order to undertake the most appropriate treatment.
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PMID:Management of proximal oesophageal stricture. 262 74

Esophageal function was evaluated in 53 patients with increasing severity of esophageal injury caused by gastroesophageal reflux disease (study 1), and the findings were applied to the treatment of 28 patients with reflux-induced strictures (study 2). Fifty asymptomatic volunteers served as controls for both studies. In study 1 there were 14 patients without reflux complications, 14 with esophagitis grade I to III, 13 with esophageal stricture, and 12 with Barrett's epithelium (6 of whom had a stricture). The prevalence of a mechanically defective sphincter increased with the progression of the esophageal injury; 50% in the patients without complications to 84% and 92% in those with stricture or Barrett's epithelium, respectively. Similarly, a decrease in amplitude of contractions in the distal esophagus was observed in patients with stricture and patients with Barrett's epithelium. In study 2, these findings were applied in the surgical management of 28 consecutive patients with a reflux-induced stricture. Preoperative motility studies were performed after patients were dilated to 60F. Control of reflux by a Nissen fundoplication gave excellent (86%) to good (14%) results in patients who had relief of dysphagia after dilation or adequate motility, or both. Four patients with both persistent dysphagia after dilation and inadequate motility underwent resection. Transmural presented are helpful in the selection of the optimal surgical procedure for the treatment of dilatable reflux-induced strictures.
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PMID:Esophageal function in patients with reflux-induced strictures and its relevance to surgical treatment. 293 Mar 1


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