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

1. Gastro-oesophageal reflux of infancy and childhood leads to vomiting and frequently to aspiration pneumonia and failure to thrive. 2. Two thirds of all cases can be cured conservatively. One third has to undergo surgery. 3. According to our present knowledge, the mechanism of the cardia seems to be competent at birth, however, peristaltism and reflex activity undergoes a maturation process. 4. The aetiology of gastro-oesophageal reflux in childhood is variable. There is a distinct difference between primary and secondary reflux. The latter occurs in children with cerebral palsy as well as following operations of the oesophagus or the hiatus. 5. The indication for an operative intervention is not as much depending upon the radiographic findings as upon the existence of oesophagitis, stenosis, anemia and aspiration pneumonia. 6. Nissen's fundoplication is not the operation of choice in childhood since this intervention is followed by a high morbidity. For uncomplicated cases, reconstruction of the angle of His and repositioning of the abdominal oesophagus into the abdominal cavity in combination with a semiplication of the fundus is preferable.
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PMID:[Gastroesophageal reflux in childhood]. 722 23

The technique of 24 hour esophageal pH monitoring (24 hour pH test) is described. Experience with the 24 hour pH test in 393 patients with suspected esophageal disease has shown the clinical usefulness of the test in objectively determining the presence of gastroesophageal reflux. The test was effective in evaluating atypical symptoms of gastroesophageal reflux such as respiratory symptoms and chest pain and, in children, failure to thrive and recurrent pneumonia. The 24 hour pH test was particularly useful in evaluating patients who were referred with other abdominal or thoracic disease and had, in addition, symptoms suggestive of gastroesophageal reflux on history. The test helped to unsnarl the cause of recurrent symptoms after an esophageal myotomy for achalasia or an antireflux procedure. Of 179 patients with typical symptoms of gastroesophageal reflux, 27% had normal 24 hour test results and were subsequently diagnosed as having another cause for their symptoms. Of 146 patients who had normal findings on esophagoscopy, 54% were shown to have abnormal gastroesophageal reflux on 24 hour pH monitoring, indicating lack of sensitivity of endoscopy to detect reflux. In addition, the 24 hour pH test identified patterns of abnormal reflux and indicated those patients most at risk for development of stricture. The test is well tolerated by the patients, simple to use, and dependable when performed and read as described. The clinical use of the 24 hour pH test brings objectivity to the evaluation of exophageal disease that has hitherto not been available.
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PMID:Technique, indications, and clinical use of 24 hour esophageal pH monitoring. 736 33

One hundred children underwent Nissen's fundoplication for complications of gastroesophageal reflux. Indications for fundoplication included refractory pneumonia, apneic spells, intractable vomiting, failure to thrive, esophagitis, esophageal stricture, and Sandifer's syndrome. Except for those with life-threatening complications, fundoplication was performed only in those who had failure with a strict medical antireflux regimen. Four patients were not helped by operation or had a recurrence of symptoms. Of these, three with refractory pneumonia were judged to be failures of selection since reflux was absent postoperatively. The fourth had massive reflux and recurrent vomiting. Eight other patients had radiologic evidence of reflux postoperatively. Six of these were asymptomatic and two had minor symptoms. There was one death and 11 postoperative complications.
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PMID:Surgical treatment of gastroesophageal reflux in children. Results of Nissen's fundoplication in 100 children. 742 52

The clinical features of abnormal gastroesophageal reflux in infants and children extend beyond repeated vomiting and include dysphagia, pain, bleeding, failure to thrive, esophageal stricture, and recurrent respiratory symptoms including aspiration pneumonitis and cyanotic attacks. The unreliability of the traditional barium swallow examination as a diagnostic test is well known. This study reports the results of endoscopic assessment and esophageal biopsy in 100 infants and children and relates them to the clinical findings and the changes in the contrast esophagogram. The results show that further valuable diagnostic information can be gained from endoscopic examination of the esophageal mucosa, especially when there is esophagitis with ulceration, bleeding, or stricture. Endoscopic biopsies are useful to confirm the presence of esophagitis but biopsies alone do not give absolute diagnostic information.
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PMID:Endoscopy and biopsy in gastroesophageal reflux in infants and children. 743 49

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

Laparoscopic surgery for the definitive treatment of gastroesophageal reflux (GOR) has become an accepted alternative to conventional techniques in adults. Although relatively rare, GOR in children represents an important clinical entity with symptoms including failure to thrive, nocturnal dyspnea, and vomiting. This paper details our experience in eight children who have undergone a laparoscopic Nissen fundoplication for failed medical treatment of severe GOR. Particular attention is paid to technical aspects of the procedure and the differences between adult and pediatric techniques are emphasized. The preliminary results suggest that a laparoscopic Nissen fundoplication is a safe procedure which significantly improves reflux symptoms in children and that these results are comparable to those obtained with conventional surgery.
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PMID:Laparoscopic Nissen fundoplication in children. 748 84

Spitting is a common occurrence in infants and is usually of no consequence. When regurgitation is accompanied by the return of gastric acids into the esophagus, however, it is considered to be gastroesophageal reflux. Failure to thrive, esophagitis, aspiration, chronic respiratory disease, and apnea can all be associated with pathologic gastroesophageal reflux. This paper discusses the causes, symptoms, and treatment modalities for pathologic gastroesophageal reflux. Health care practitioners can play a major role in providing direct care as well as coordinating and evaluating treatment interventions for infants with gastroesophageal reflux. In addition, health care providers can supply the families of these infants with the necessary education and emotional support required to care for their infant.
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PMID:Gastroesophageal reflux in infants. 761 22

Gastroesophageal reflux (GER) in infants is most commonly thought of as repeated excessive vomiting and failure to thrive, with most infants responding favorably to medical therapy. However, GER may also manifest exclusively with a variety of respiratory symptoms that, if not detected and treated early, may lead to life-threatening complications. During the period of 1987 to 1992, 39 neonates and infants underwent Nissen fundoplication for the treatment of respiratory symptoms attributed to GER. Symptoms included apnea and bradycardia (64%), pneumonia (31%), cyanosis (28%), cough (18%), and stridor (15%). Most patients were ascribed at least one incorrect diagnosis to explain respiratory symptoms. These include apnea of prematurity (38%), bronchopulmonary dysplasia (31%), asthma (8%), and subglottic stenosis (8%). All patients underwent a variety of investigations and medical treatments without noticeable clinical improvement. These included bronchoscopy, esophagoscopy, and polysomnograms. Treatment such as antibiotics, theophylline, bronchodilators, steroids, and oxygen were directed at presumed primary respiratory disease. On the other hand, H2 blockers, metoclopramide, positioning, and thickened feeds were prescribed to treat GER without objective evidence of disease. Ultimately, GER was demonstrated by upper gastrointestinal series in 64%, pH probe in 61%, and both studies in 38%. All patients underwent Nissen fundoplication after failed attempts at medical therapy. A total of 95% of patients had resolution or substantial improvement of respiratory symptoms postoperatively. Preoperative hospitalization averaged 37.0 days, and postoperative stay averaged only 14.2 days. We present a series of patients with GER, all of whom presented with respiratory symptoms.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Diagnosis and treatment of respiratory symptoms of initially unsuspected gastroesophageal reflux in infants. 794 42

Gastroesophageal reflux (GER) is the movement of gastric contents retrograde into the esophagus. Sometimes the refluxate is seen as emesis, but often reflux is "silent," meaning that there are no discrete symptoms during an episode. In adults, the most common symptom of GER is heartburn, whereas in infancy excessive crying and malaise are symptoms that prompt investigation for GER, with or without esophagitis. Symptoms of esophagitis in infancy may include arching (hyperextension) of the torso and refusal of feedings. Tube feedings may be required to treat infants with failure to thrive who refuse oral feedings. Paradoxically, tube feedings increase the number of GER episodes. A hypothetical explanation for refusal of food in infancy is that pain with swallowing (odynophagia) or heartburn are consequences of peptic esophagitis. As a result, infants will learn to refuse food if it hurts or if they fear that it will hurt to eat. Another possible mechanism is visceral hyperalgesia, a neuropathic condition in which prior experience changes sensory nerves so that previously innocuous stimuli are perceived as painful. Some infants may have especially sensitive sensory nerves in the upper gastrointestinal tract, which predisposes visceral hyperalgesia to develop. Thus pain occurs from luminal distension or acid reflux in the absence of tissue damage. The evaluation of babies who won't eat includes a careful history and physical examination to exclude the possibility of chronic systemic illness. Refusal to feed is an unusual manifestation of a common condition: GER disease. The initial tests for GER usually include a barium swallow study to assess the upper gastrointestinal anatomy, endoscopy and esophageal biopsy to assess esophagitis, and an intraesophageal pH study, which is useful in "silent" reflux to quantitate the duration of esophageal acid exposure and to correlate discrete symptom episodes with periods of reflux. The treatment of infants and toddlers who refuse to eat because of pain resulting from visceral hyperalgesia or reflux esophagitis involves removing the pain associated with eating and making eating a pleasurable experience. Treatment for esophagitis may include maintaining an upright posture after meals and thickened feeds, medication to improve gastrointestinal motility or to decrease acid secretion, or fundoplication.
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PMID:Gastroesophageal reflux: one reason why baby won't eat. 798 64

Pediatric gastroenterologists have tended to view gastroesophageal reflux (GER) as a disease in and of itself--a disease that can be diagnosed "objectively" with use of numerical data from esophageal pH monitoring and cured with pharmacologic or surgical treatment. What is often forgotten is that the data derived from esophageal pH monitoring and other techniques may identify the presence of abnormal GER but tell nothing about its pathogenesis. The usual approach to infants who feed poorly, vomit, or fail to gain weight is to identify the presence of abnormal GER, rule out underlying organic causes of vomiting, and then diagnosis primary GER disease. The baby is then treated with pharmacologic, dietary, or positional therapy and, ultimately, if these therapies fail to eradicate the symptoms attributed to GER, surgical fundoplication, which stops vomiting regardless of its causes. The pediatric literature on infant vomiting and GER is almost devoid of research into the nature and possible relationships among infant stress, vomiting, feeding difficulties, and failure to grow. Clinically, the quality of the maternal-infant relationship is frequently approached superficially, with psychosocial aspects treated as less important in infants considered to have primary organic disease amenable to medical or surgical treatment. Psychosocial factors in the pathogenesis of the infant's symptoms are often not pursued beyond assessment for possible abuse or neglect. It has been known for centuries that stress or excitement affects gastrointestinal function and symptoms. Although the field of infant psychiatry has produced a substantial literature on the nature of stresses that affect both infants and mothers, the pediatric literature on vomiting and failure to thrive seldom acknowledges the existence or importance of these contributions. In clinical practice, failure to explore psychosocial aspects that may contribute to vomiting, feeding difficulties, or failure to thrive may result in missed opportunities for less invasive, more effective therapy at best, and countertherapeutic treatment at worst. This article describes three functional vomiting disorders of infancy, their distinguishing characteristics, hypotheses regarding their pathogenesis, and principles of comprehensive management.
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PMID:Functional vomiting disorders in infancy: innocent vomiting, nervous vomiting, and infant rumination syndrome. 798 67


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