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

Of 62 children (1-24 months of age) evaluated for esophageal disease, 22 were found to have pulmonary symptoms of apnea, pneumonia, wheezing, cyanosis, cough and stridor. Upper gastrointestinal series showed free gastroesophageal reflux in 10 of 22 infants; 3 were thought to have stricture. Acid-reflux test was positive in 13 of 15 and correlated with the presence of esophagitis in 12. In addition to esophagitis, endoscopic examination found two foreign bodies and an esophageal stricture unrecognized during fluorescopy. Endoscopic grasp biopsy was inadequate in most infants for the histologic evaluation of esophagitis. However, suction biopsy correlated well with endoscopically diagnosed esophagitis. In infants where medical therapy failed and symptoms were life-threatening, a Nissen fundoplication resulted in excellent resolution of symptoms. In children who present with prolonged and often life-threatening symptoms, esophageal dysfunction should be evaluated by rigorous testing.
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PMID:High incidence of pulmonary symptoms in infants evaluated for esophageal disease. 743 51

Pediatric gastroesophageal reflux is common and its complications may be serious. The diagnosis is being suspected and confirmed with increasing frequency in children because of heightened awareness of the symptoms peculiar to pediatric patients. Thirty-one children who underwent Nissen fundoplication for gastroesophageal reflux are reviewed. Diagnosis was obtained by barium meal, isotope scanning, esophagoscopy and pH monitoring. Failure to thrive, recurrent pneumonia, apnea, feeding difficulty and esophageal stricture unresponsive to medical management were the indications for operation. Children with brain damage or previous repair of esophageal atresia are at high risk for gastroesophageal reflux and its complications. A protective fundoplication is a desirable adjunct to feeding gastrostomy in brain-damaged children. Fundoplication eliminated reflux in 30 of 31 patients, relieved symptoms in 28 and improved symptoms in 2. Nissen fundoplication is a safe and effective surgical procedure for correction of gastroesophageal reflux in children.
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PMID:Pediatric gastroesophageal reflux: age-specific indications for operation. 745

Tracheal compression is one of the many causes of apnea following repair of esophageal atresia with tracheoesophageal fistula. Since May, 1977 we have treated eight patients with "dying spells" usually occurring during and following a feeding. These episodes were characterized by cyanosis and bradycardia, which progressed to apnea. Tracheal compression was documented to be the etiology of the apnea spells. Other possible causes such as aspiration from gastroesophageal reflux, recurrent tracheoesophageal fistula and esophageal stricture were eliminated. Eight infants underwent aortopexy that was successful in terminating the apneic episodes in seven patients with an average follow-up of 20 mo. One patient continued to have symptoms from a previously undiagnosed vascular ring which was successfully divided one month following aortopexy. After being asymptomatic for 1 mo this infant died from a cardiorespiratory arrest at home. An autopsy did not reveal the cause. Intermittant tracheal obstruction leading to apneic spells is a life-threatening entity following tracheosophageal fistula repair, which can be corrected by aortopexy.
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PMID:Tracheal compression as a cause of apnea following repair of tracheoesophageal fistula: treatment by aortopexy. 746 84

There are many options as to the accuracy of a patient's subjective localization of an obstructing esophageal lesion. However, there are few studies specifically examining this issue. Over a 35-month period, all patients evaluated by our gastroenterology service undergoing endoscopy for dysphagia were prospectively identified. The patient's subjective localization for the level of obstruction was evaluated by an investigator blinded to the results of prior barium esophagography and recorded on a schematic of the bony skeleton. At the time of endoscopy, the most proximal level of the obstructing lesion was documented. In all, 139 patients with dysphagia and an esophageal stricture were evaluated. Barium esophagograms were performed prior to endoscopy in all but nine patients (6.5%). The most common lesions causing dysphagia were carcinoma (34.5%), gastroesophageal reflux disease (22.3%), and a Schatzki's ring (15.8%). The level of obstruction was localized exactly in 30 patients (21.6%), within +/- 2 cm in 72 (52%), and within +/- 4 cm in 31 additional patients (74%). Eight patients (15%) with a distal esophageal lesion localized the obstruction to the proximal esophagus, whereas only two patients (5%) with a lesion in the proximal esophagus localized the level of obstruction to the distal esophagus. Overall, patients with distal obstructing lesions were more likely to have referral > 6 cm proximally than proximal lesions with referral to the distal esophagus (P = 0.003). There were no significant differences in accuracy based on the cause of dysphagia. In conclusion, a patient's subjective localization of the level of an esophageal stricture is highly accurate. Patients appear to be most accurate in localizing proximal rather than distal lesions.
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PMID:Localization of an obstructing esophageal lesion. Is the patient accurate? 758 88

Previous studies examining oesophageal acid clearance have employed a variety of techniques to induce or simulate acid reflux. Clearance abnormalities have been deduced from abnormal standard motility studies, barium radiology or from 24-h pH recordings. In this study a 24-h pH and oesophageal motility recording system was used to study naturally occurring acid reflux episodes in control subjects and in two groups of patients with severe acid reflux disease (erosive oesophagitis and oesophageal stricture). Acid clearance was compared between the subject groups. Patients with oesophageal stricture were found to have poor oesophageal peristaltic ability and particularly poor oesophageal acid clearance. Those with erosive oesophagitis had normal peristaltic swallowing but abnormal acid clearance. This study has characterized, for the first time, the abnormalities in acid clearance during naturally occurring acid reflux episodes in patients with severe reflux disease. A more complete understanding of these clearance abnormalities could influence future medical and surgical strategies in the management of severe gastro-oesophageal reflux disease.
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PMID:Oesophageal acid clearance in patients with severe reflux oesophagitis. 779 1

In an effort to explore the utility of classic Nissen fundoplication performed laparoscopically, 16 adult patients with well documented gastroesophageal reflux underwent laparoscopic Nissen fundoplication. A full gastric fundal dissection was performed, with division of at least 2 short gastric vessels. The crura were approximated with 1-3 sutures, and a loose fundoplication was performed over an esophageal dilator (minimum 46 F) with three stitches, encompassing the esophageal wall (2.5 cm in length). All patients had symptoms of reflux refractory to medical therapy, and four had an esophageal stricture requiring preoperative dilatation. Fifteen of 16 procedures were completed laparoscopically; one patient required conversion to an open procedure to control bleeding from a posterior gastric vein. There were no other operative complications. The average operative time was 180 minutes (range 120-285). Clear liquids were begun at the passage of flatus (average 2.7 days postop), and patients were discharged an average of 4.1 days postoperatively. Postoperative complications included ileus (1 patient for 6 days), severe subcutaneous emphysema (1 patient), and dysphagia requiring dilatation (5 patients). In short follow-up (mean 4.43 mo., range 1-12 mo.) 14 of 15 patients had complete abolition of reflux symptoms, but one patient with persistent heartburn had reflux demonstrated on a postoperative upper GI series. Thirteen of 16 patients returned to full function within 14 days of surgery. We conclude that standard Nissen fundoplication is possible laparoscopically, and allows a rapid recovery from surgery. However, it is difficult, time consuming, and associated with a significant rate of recurrence in the short term (6%).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Initial experience with laparoscopic Nissen fundoplication. 783 76

Acid gastro-oesophageal reflux occurs when the lower oesophageal sphincter is incompetent, but oesophagitis caused by reflux of duodenal content implies incompetence of both the pyloric and gastro-oesophageal sphincters. The term 'alkaline' reflux oesophagitis was coined long before objective analysis was made of bile in the stomach and oesophagus, and well before pH monitoring was introduced. Surgical procedures to divert bile from the stomach and oesophagus were developed on a clinical basis and gave encouraging results in the management of peptic oesophageal stricture. Alkaline oesophagitis is well recognized after gastric surgery and the entity 'primary pathological duodenogastric reflux', although contested by some, attracts growing support. Recent evidence suggests that the complications of Barrett's oesophagus may be related to duodenogastro-oesophageal reflux. Probes designed to measure gastric and oesophageal bile salts have recently been developed and may give more information in the future.
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PMID:'Bile' in the oesophagus. 825 39

Despite the frequent occurrence of gastroesophageal reflux disease, until now only very few studies have dealt with the epidemiology of this common disorder. The Health Care Financing Administration complies annually 10 million records of all hospital discharges among Medicare beneficiaries distributed throughout the United States. The purpose of the present study was to take advantage of this large data set and analyze the demographic characteristics of patients discharged with esophagitis, esophageal ulcer, or esophageal stricture. The hospital discharge rates of all three diagnoses showed an age-related rise, the rise being most pronounced for esophageal stricture and, less significant, esophageal ulcer. The marked age dependency of esophageal stricture and ulcer may reflect the time necessary for complications to develop. While simple esophagitis affected women more frequently than men, significantly more men contracted its severe forms involving ulcers and strictures. All forms were more common in whites than blacks, and living in the southern parts of the United States was associated with an increased risk for esophagitis and strictures. The data suggest that besides varying exposure to environmental risk factors, differences in the pathophysiology among demographically stratified groups contribute to the occurrence of esophagitis.
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PMID:Hospital discharges resulting from esophagitis among Medicare beneficiaries. 828 55

Forty-eight patients with repaired congenital oesophageal anomaly underwent aortopexy for significant tracheomalacia between 1980 and 1990. Indications for aortopexy included recurrent apnoea/cyanosis in 31, near fatal episodes in 16, recurrent respiratory distress and infection in 20 and worsening stridor in 15. Gastro-oesophageal reflux was noted in 30 patients, recurrent fistula in 6 and oesophageal stricture in 14. Aortopexy cured near fatal episodes in all patients and resulted in improvement of airway obstruction in 95%. The procedure failed in 2 patients due to unrecognised bronchomalacia and phrenic nerve palsy respectively. Aortopexy is the primary procedure of choice for significant tracheomalacia when associated with near fatal episodes and significant airway obstruction.
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PMID:Aortopexy for tracheomalacia in oesophageal anomalies. 829 76

Esophageal stenosis due to an intrinsic congenital factor is uncommon in infancy. We report a case of a male newborn infant, who was well at birth and presented with foamy sputum from the third day of life and vomiting at 18 days of age. Esophagogram revealed a narrowed segment, about 1 cm in length, at the level of the seventh and eighth cervical vertebral bodies, with proximal dilatation. There was no sign of gastroesophageal reflux. Operative findings: There was no external compression, foreign body or fistula, but a 1 cm length of esophageal stenosis was found. The stenosed segment was hard on palpation. Segmental resection of the stenosed region, with direct anastomosis of the esophagus was performed. Pathological examination of the narrowed segment revealed fibrosis of the submucosa without any tracheobronchial remnent components.
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PMID:[Congenital esophageal stenosis with submucosal fibrosis: report of one case]. 833 88


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