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

Gastro-oesophageal reflux can lead to peptic oesophagitis and stricture formation. This is particularly true in infants in whom the condition should be suspected if the patient presents with vomiting, anaemia and failure to thrive. The anatomy of the oesophago-gastric junction is described. The inferior oesophageal sphincter is the main barrier to reflux, and marks the functional junction between oesophagus and stomach. It is under nervous and hormonal control. It is weak in the neonate who therefore frequently refluxes. An hiatus hernia can cause problems due to its bulk but the main problem of peptic oesophagitis is due to gastro-oesophageal reflux. The radiological examination should be carried out carefully with the patient swallowing in a prone position. The patient should be put in the Trendenlenberg position and compression applied to the abdomen. Reflux is intermittent and a negative examination should be repeated if the clinical findings suggest a diagnosis of peptic oesophagitis. Associated pyloric stenosis should always be excluded. Radiological examination of the gastro-oesophageal junction remains the quickest, simplest, and most convenient and safe technique as long as its limitations are appreciated.
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PMID:Gastro-oesophageal reflux, hiatus hernia and the radiologist, with special reference to children. 32 Oct 66

Eighty-three infants and children underwent surgical correction of gastroesophageal reflux (GER) from 1973 to 1978. Fifty-four patients had coexistent brain damage (most commonly due to cerebral palsy), eight were previously treated for esophageal atresia, and four had gastroschisis or omphalocele repair. Clinical presentation included failure to thrive in 64 patients, vomiting in 59, and recurrent bouts of aspiration pneumonitis in 43. Barium roentgenography showed GER in 61 patients, whereas additional tests (particularly pH monitoring) were required for detection of GER in 22 patients. After failure of medical management, transabdominal Nissen fundoplication was performed in 80 cases and a Hill repair in three cases. The surgical mortality was zero, but there were five late deaths. Results were considered excellent in 54 patients, good in 22 patients, and poor in seven. Ten of 12 patients with preoperative stricture responded to dilation after fundoplication. Nissen fundoplication was a safe and effective antireflux procedure in 76 of the 83 cases.
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PMID:Gastroesophageal reflux in infants and children. Diagnosis and management. 43 65

Gastroesophageal reflux (GER) has been recognized with increasing frequency as the source of a wide variety of symptoms in infants and children. During the past 8 years at the UCLA Hospital, 74 patients under 18 years of age have been identified as having sufficiently severe symptomatic reflux to warrant gastroesophageal fundoplication. Although repeated emesis was the most common primary symptom, failure to thrive was a major symptom in 20 patients, repeated pneumonia in 18, asthma in five, and dysphagia owing to stricture in 12. Nine patients with previously repaired esophageal atresia had severe reflux. Serious neurologic disorders were present in 14 children. The diagnosis of reflux in the majority of symptomatic children was established by combining the findings of an abnormal esophagogram, Tuttle test, esophageal manometry, and esophagoscopy with biopsy. Six infants experienced repeated symptomatic GER although results of all diagnostic studies were normal. Each of the patients had undergone an unsuccessful trial of medical management before the decision to operate was made. Transabdominal Nissen fundoplication with gastrostomy was performed on each of the 74 children (28 under 1 year of age). Each of the strictures was successfully managed by postoperative dilatations. No death and no major complications occurred, but six patients experienced transient dysphagia and four had delayed gastric emptying. Every patient has been relieved of clinical reflux, and the pulmonary status in each, including the asthmatic children, has been markedly improved. On the basis of this favorable experience with 74 patients, we believe that an aggressive surgical approach should be taken in the management of symptomatic GER in infants and children who fail to respond to an adequate trial of medical management.
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PMID:Gastroesophageal fundoplication for the management of reflux in infants and children. 70 70

Twelve patients with gastroesophageal reflux following repair of esophageal atresia are presented. Reflux produced recurrent stricture, failure to thrive, repeated pneumonitis, and in one patient, respiratory arrest and nearly death. Treatment consists of positional therapy or fundoplication operation both of which seem less successful in this combination of lesions than with GER and a normal esophagus. There was one death as a late postoperative complication of fundoplication.
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PMID:Early recognition and aggressive treatment of gastroesophageal reflux following repair of esophageal atresia. 87 20

Hiatal hernia should be included in the differential diagnosis of all children with emesis and failure to thrive, since early diagnosis is imperative to prevent the irreversible esophageal damage from long-standing peptic esophagitis. The Nissen fundoplication as described in this paper appears to be far superior to gastropexy in preventing recurrence of gastroesophageal reflux. Colon interposition should be reserved for those cases in which hiatal herniorrhaphy is technically impossible. Successful repair of the hiatal hernia results in rapid improvement in the nutritional status of these children.
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PMID:Surgical management of hiatal hernia in children. 118 64

One hundred and fifty three patients had repair of tracheo-oesophageal fistula in a 15 year period of observation. Of these 55 had associated gastro-oesophageal reflux and of these 12 (8%) underwent a Nissen fundoplication. All patients manifested significant failure to thrive but weight-gain was documented in all patients following their fundoplication. Twenty five percent of patients demonstrated recurrent reflux in this study and emphasises the difficulty of treating gastro-oesophageal reflux in repaired tracheo-oesophageal fistula patients. Careful selection is important.
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PMID:Nissen fundoplication for gastro-esophageal reflux in repaired tracheo-esophageal fistula. 147 58

The Dor-Gavriliu procedure was utilized in six children with achalasia of the cardia from 1983 to 1991. Four boys and two girls (mean age, 10.1 years; range, 3 months to 16 years) presented with symptoms of weight loss (83%), emesis (83%), dysphagia (67%), recurrent respiratory infections (67%), and nocturnal regurgitation (33%). The diagnosis of achalasia was established by barium swallow in all patients; esophageal manometry was used in four patients to confirm the diagnosis. Follow-up ranged from 10 months to 8 years (mean, 3.5 years). Four neurologically normal patients had excellent results with complete resolution of their preoperative symptoms. Two neurologically impaired children, both afflicted with Down's syndrome, had less than excellent results. One moderately impaired child had a good result (required three postoperative bougie dilations over 8 years without demonstration of gastroesophageal reflux); the second, more severely impaired child, had only a fair result (persistent failure to thrive with the development of grade II gastroesophageal reflux). The Dor-Gavriliu procedure uses a transabdominal, anterior esophageal myotomy with incorporation of an effective, nonobstructing, antireflux mechanism that should prevent myotomy reapposition.
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PMID:Surgery for achalasia of the cardia in children: the Dor-Gavriliu procedure. 147 2

Reflux of gastric contents into the esophagus has for long been accepted as a cause of esophagitis, failure to thrive, and anemia. But, at the same time, gastro-esophageal reflux (GER) is recognized as a physiological phenomenon occurring now and then in every one, especially in the postprandial period. Esophageal pH monitoring is an attractive technique for separating "physiological" from "pathological" GER incidence and duration by measuring incidence and duration. In principle, esophageal pH monitoring is simple, but in practice there are technical and clinical problems. The pH monitoring equipment, the type of electrode, the location of the electrode are examples of equipment and/or methodology related influencing factors. Age, position, duration of the investigation (day/night, fasting/postprandial), feeding and drugs are patient related factors. Despite all these factor, pH data have been shown to be reproducible. The major advantages of pH monitoring are that it evaluates GER in (1) physiological circumstances over (2) a prolonged duration. (3) The investigation can be repeated and can therefore (4) evaluate the efficacy of treatment. (5) The possibility of establishing a relation in time between pH changes and symptoms constitutes another advantage of the technique.
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PMID:Esophageal pH monitoring: methodology, indication and interpretation. 185 12

The value of performing Nissen fundoplication in neurologically impaired children is a controversial issue. To evaluate the benefit of fundoplication in these children, hospital records were reviewed for 77 children who underwent fundoplication for gastroesophageal reflux (GER). Fifty-two children were neurologically impaired; 25 children had no neurological impairment. Impaired children had significantly fewer hospital admissions (1.8 v 0.7; P less than .005) and total days of hospitalization (36 v 14; P less than .005) during the first postoperative 6 months, compared with the immediate preoperative 6-month period. Normal children had fewer hospital admissions and days postoperatively, but the difference was not significant. Impaired children with preoperative failure to thrive (FTT had significantly increased average monthly weight gain over the first 6-month period postoperatively, compared with preoperative growth rate (3.0% v 0.9% of total body weight; P less than .05). Average monthly weight gain at 1 and 2 years postoperatively was not significantly different from preoperative values for impaired children. Growth rate of normal children with FTT did not change significantly postoperatively. Symptomatic relief was comparable in the normal and impaired children. Perioperative mortality was 0% in the normal children and 6% in the impaired children. This study demonstrates that Nissen fundoplication in neurologically impaired children with GER can be performed safely, reduces the frequency of hospitalization, and improves short-term weight gain.
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PMID:Evaluation of Nissen fundoplication in neurologically impaired children. 194 60

Gastroesophageal reflux (GER) usually presents with digestive symptoms, failure to thrive, and/or respiratory symptoms. During the 8-year period from 1981 to 1989, 1,153 children underwent 20-hour pH monitoring to assess GER. All patients were graded using the scoring system of Euler and Byrne. Patients were classified as severe (score greater than 50), moderate (score 25 to 50), and normal (score less than 25). Five hundred (43.3%) of these patients presented with respiratory symptoms including apnea, cyanosis, or "near miss" sudden infant death syndrome (36%), poorly controlled asthma (28%), recurrent bronchopneumonia (13%), bronchiolitis (9%), and miscellaneous symptoms such as intermittent dyspnea, chronic cough, and stridor (12%). Eight patients (2%) had cystic fibrosis. The ages ranged from 1 month to 20 years (mean, 19.5 months). Twelve patients had technically inadequate studies and were excluded. Severe reflux was present in 156 patients (31%) and moderate reflux in 159 patients (31%). All patients were treated initially by medical therapy for a minimum of 8 weeks. The majority of patients (81%) had resolution of their symptoms with change in position, thickened feedings, and, when indicated, additional therapy with metoclopramide, cisapride, or domperidone. Most of these patients were found to have a specific position, usually prone, which decreased reflux. The remaining 57 patients had documentation of persistent reflux by pH monitoring and underwent an antireflux procedure. Of those patients undergoing surgery 51 had severe reflux and 6 had moderate reflux. Forty-four patients had a posterior 270 degrees wrap (Toupet), 10 had a 360 degrees wrap (Nissen), and 3 had an anterior 180 degrees wrap (Boix-Ochoa).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Diagnosis and treatment of gastroesophageal reflux in 500 children with respiratory symptoms: the value of pH monitoring. 203 Apr 75


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