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) is a common problem which can manifest as vomiting, failure to thrive, recurrent pneumonias, asthma, sinusitus, or subglottic stenosis. The medical management plan should be individualized. A "happy spitter" who has no complications of GER may respond well to conservative management, including positioning and thickening of feedings. A child with complications may require treatment with H-2 antagonists or proton pump inhibitors in conjunction with prokinetic agents. Children with gastrointestinal symptoms suggestive of GER who do not respond to antireflux management may need to be treated for eosinophilic esophagitis. Recent studies that assess the effect of medications on recognized complications of GER are reviewed.
 ...
PMID:Medical management of gastroesophageal reflux. 1083 61

Gastrooesophageal reflux disease has a variety of symptoms in children. 24-hour pH monitoring in the lower oesophagus is the gold standard for documenting gastrooesophageal reflux. We present our experience with 24-hour pH monitoring in children. 150 pH recordings in 120 children were performed. Clinical background and results from pH monitoring were recorded, in addition to supplementary examinations and treatment. No complications were recorded, but ten recordings (8.3%) were unsuccessful. Mean age was 3.5 years (median 13 months; range one month to 15 years). 44% had a pathological reflux index. Indications for pH monitoring were dominated by regurgitation/vomiting (63%), failure to thrive (45%) and respiratory symptoms (32%). Of the supplementary examinations performed, upper gastrointestinal contrast series provided no additional information (34 children), while endoscopy (20 children) showed oesophagitis in 11. Medical treatment was prescribed in 66% of the cases based on the pH monitoring results and clinical evaluation. Five patients were given anti-reflux surgery, and ten received gastrostomy. Our experience with this recording technique is good. pH monitoring should be available in paediatric departments, as a large number of the recordings had clinical consequences for the patient.
 ...
PMID:[Reflux disease and 24-hour esophageal pH monitoring in children]. 1085 12

Gastroesophageal reflux (GOR) is a major cause of morbidity and failure to thrive particularly in neurologically impaired children. Clinical manifestations of GOR in children range from regurgitation, food refusal, irritability, failure to thrive, hematemesis, wheezing and aspiration pneumonia, apnoea and apparent life threatening events in infants to clinically silent reflux. Although, no one test is always best to diagnose GOR, 24 hour esophageal pH monitoring remains the 'gold standard' for diagnosis. Barium radiography is useful for the diagnosis of associated anatomical abnormalities and endoscopy enables a histological diagnosis of esophagitis. Therapy for gastroesophageal reflux disease is now well established. Proper positioning of the baby and thickening of feeds is beneficial in uncomplicated GOR. Prokinetic agents like cisapride should be tried if dietary management and antacids are ineffective. Metoclopramide or domperidone may be tried in neurologically impaired children. H2-receptor antagonists are indicated in GOR complicated by esophagitis. Ranitidine is regarded to be more potent. Cimetidine has additional spectrum of adverse effects and sufficient information is not available on famotidine. Omeprazole has been shown to be effective in treating GOR-esophagitis resistant to H2 antagonist therapy even in high risk patients.
 ...
PMID:Gastroesophageal reflux in children. 1113 70

Laryngeal respiratory obstruction associated with Chiari malformations was first described in 1932. We studied this type of obstruction in six children with one or several disorders pointing to brainstem dysfunction (failure to thrive, velopharyngeal incompetence, gastroesophageal reflux, or vagal hypertonia). The nature of the laryngeal obstruction was highly variable (vocal cord paralysis, paradoxical vocal cord motion, laryngomalacia) as were the frequency and severity of associated disorders. Chiari malformations should be routinely sought in a child with laryngeal respiratory obstruction occurring at birth or later, whatever the endoscopic diagnosis, especially when signs of brainstem dysfunction are present. The best tool for diagnosing the Chiari malformation is T1- and T2-weighted MRI. Signs of brainstem dysfunction must be treated symptomatically, before treating Chiari malformations by decompressive surgery. This latter approach led to full functional recovery in all five children who underwent the procedure. Palliative surgical treatment should be reserved for patients in whom this procedure is unsuccessful.
 ...
PMID:Respiratory obstruction as a sign of brainstem dysfunction in infants with Chiari malformations. 1122 51

Russell-Silver syndrome (RSS) is a genetic syndrome with clinical manifestations of intrauterine and postnatal growth retardation, normal head circumference, body asymmetry, and distinctive facial appearance. We followed an infant diagnosed with RSS who had occurrence of multiple gastrointestinal complications. Although there are a number of published reports describing gastrointestinal problems associated with RSS, specific gastrointestinal diseases have not been recognized as major features. We hypothesize that gastrointestinal complications may be more frequent in RSS cases than previously reported. To address our hypothesis, we developed a pilot study of RSS cases to identify and characterize associated gastrointestinal complications. Surveys were distributed by MAGIC, a support group for individuals with RSS. Surveys included information on the objective and subjective characteristics used to diagnose RSS, as well as descriptions of gastrointestinal problems. Completed surveys were returned on 135 individuals. We used strict diagnostic guidelines to determine affected status of children reported in our survey. Of the 135 surveys completed, 65 were determined to have clear-cut RSS. The diagnoses were made without knowledge of the gastrointestinal symptoms of any of the subjects. Of the 65 subjects with "clear cut" RSS, 50 (77%) had gastrointestinal symptoms. Major specific symptoms included gastroesophageal reflux disease (34%), esophagitis (25%), food aversion (32%), and failure to thrive (63%). A common theme in gastrointestinal complications of RSS is significant gastroesophageal reflux that includes esophagitis and food aversion. Results of this survey suggest that there is an association of gastrointestinal complications with RSS that should be addressed in diagnosis as well as management protocols for children with this condition.
 ...
PMID:Gastrointestinal complications of Russell-Silver syndrome: a pilot study. 1240 60

The decision for antireflux surgery is often made on an individual basis. How symptom patterns and therapeutic suggestions relate is debatable. There is a long list of differential diagnoses for vomiting not caused by disturbances of the lower esophageal sphincter. Guidelines for the clinical practice in gastroesophageal reflux have been established for children and for adult patients by the Genval Workshop Report and the Trondheim Consensus statement. Endoscopy is indicated if macroscopically visible lesions are to be expected. Routine endoscopic biopsy is not used in the diagnosis of gastroesophageal reflux disease (GERD). pH monitoring is performed in 33 to 77% of patients. If the most prominent symptoms are respiratory, radiographic studies and pH monitoring prove that the symptoms are really related to GERD. Best results with drugs are achieved by effective initial therapy. The effects of long-term treatment are little known. Failed long-term therapy, complications of esophagitis, recurrent aspiration, apnea or "near miss" sudden infant death syndrome, failure to thrive and anatomical abnormalities are indications for surgery. The superiority of laparoscopic antireflux surgery over open surgery depends on the experience of the surgeon. Some surgeons choose a "tailored approach", ie, perform a partial wrap in children with normal peristalsis, an extrashort "floppy" Nissen or a partial wrap for those with impaired peristalsis, and a slightly tighter 360-degree wrap in neurologically impaired children. Partial wraps allow vomiting, which is considered risky in neurologically impaired children.
 ...
PMID:Indications for laparoscopic antireflux procedures in children. 1240 21

Although laparoscopic fundoplication is now performed commonly in children, its long-term results in neurologically impaired (NI) children is unknown. We present a single surgeon's experience. During an 8.5 year period, 54 consecutive NI children (age 5 months to 16 years; weight 2.7 to 42 kg) who had failed medical treatment for severe gastroesophageal reflux (GER) underwent laparoscopic Nissen fundoplication without (7) or with (47) gastrostomy. Indications for surgery included failure to thrive and feeding difficulties in all, major vomiting in 42, recurrent chest infections in 44, and inability to take oral medication in 14. Hiatus hernia was present in 14 and delayed gastric emptying in 6 patients. Eight (15%) had undergone previous abdominal surgery. Access was modified according to individual anatomy and 4 or 5 cannulae were used in each patient. Postoperative epidural/morphine analgesia was used in the first 12 to 24 hours, and fluid intake and feeding were started on day 1 and 2, respectively. The average operating time for fundoplication was 2.2 hours (range 1.05 to 3) and for fundoplication and gastrostomy 2.3 hours (range 1.22 to 4.10). Three patients had conversion to open surgery (1 perforated esophagus, 1 hypercarbia and hepatomegaly, 1 camera failure). There were no other operative complications or mortality. One child with Down syndrome developed a food bolus obstruction 3 days postoperatively. The vast majority of patients were discharged home 3 to 4 days following fundoplication and 5 to 7 days following fundoplication and gastrostomy. Postoperative gas bloat was common, diarrhea developed in 4, dumping in 3, and major gastrostomy infection in 1 case. During follow-up (median 5.2, range 3 months to 8.6 years), 9 (16%) children showed signs of persistent/recurrent problems. Investigations showed a recurrent hiatus hernia in 1 (requiring re-operation) and minor reflux in 3 patients. To date 6 (11%) children have died of their background conditions. In NI children, laparoscopic fundoplication is safe and successful. Awareness of the differences in access and risks for NI and normal children is important. Compared with historical data for open technique, laparoscopic fundoplication produces lower mortality and morbidity and similar intermediate and long-term results.
 ...
PMID:Results of laparoscopic antireflux procedures in neurologically impaired children. 1240 29

Diabetes mellitus and cystic fibrosis (CF) have been reported before in the literature, but they have never been reported in the same patient in the Middle East. We present the first reported case of insulin dependent diabetes mellitus (IDDM) and CF in 2 siblings of the same family. Both siblings were diagnosed early in life with IDDM, and their diabetes was well controlled on insulin. Cystic fibrosis was diagnosed in the first case one year after IDDM was diagnosed due to history of chronic cough and in the 2nd case by family screening. Both had severe failure to thrive, recurrent chest infections and gastro-esophageal reflux. With treatment both showed clinical improvement, but continued to have moderate lung disease radiologically and by pulmonary function test.
 ...
PMID:Diabetes mellitus and cystic fibrosis in 2 Saudi siblings. 1251 10

Gastro-oesophageal reflux (GOR) disease is very common and, in the majority of infants, is physiological. However, untreated GOR disease in infants and children is associated with a decrease in quality of life for the child and their parents. It may also cause sometimes more severe complications, such as oesophagitis, and causing, in rare cases, failure to thrive, oesophageal stricture, apnoea and even death. Every therapeutic intervention (non-drug treatment, medical treatment and surgery) is associated with morbidity and even mortality. Moreover, efficacy data of many medications in children are non-existing, limited or disappointing. The safety profile of cisapride is comparable to that of other therapeutic interventions or to the risk of non-treatment. Therefore, the therapeutic approach of GOR disease in infants and children needs to be well-balanced, considering therapeutic efficacy and side effects. This review will focus on the side effects of the different therapeutic options.
 ...
PMID:Pharmacotherapy of gastro-oesophageal reflux disease in children: focus on safety. 1290 35

About 50% of children with chronic respiratory diseases (RD) have "silent" gastroesophageal reflux (GER). Our purpose was to evaluate the possibility that RD in patients with GER reflects the presence of more severe acid reflux. We compared the severity of parameters from pH studies in children with chronic RD and "silent" GER, to children with signs of symptomatic gastrointestinal (GI) GER with and without RD. This study included 236 children (aged 1 month to 15 years) with abnormal 24-hr pH monitoring among 718 patients studied for suspected diagnosis of GER. Patients were divided into three groups. Group 1 consisted of children with chronic RD but without any GI symptoms of GER. Group 2 was comprised of children with symptomatic GI presentation of GER such as regurgitation, vomiting, heartburn, and failure to thrive, but without any signs or symptoms of RD. Group 3 included children with prevalent RD and concomitant signs of symptomatic GER. Patients with predominant GI manifestations (group 2) had a significantly higher fraction of time with pH <4 (P < 0.01), total time value of pH <4 (P < 0.05), and longest episode with pH <4 (P < 0.05). Esophageal clearance was significantly longer in group 1 patients than in the other two groups (P < 0.05). Patients with mixed disease (group 3) were similar to patients in group 2. Patients with GI symptoms had significantly worse scores for all parameters evaluated except esophageal clearance score, compared to patients without GI symptoms. Longer esophageal clearance was the only parameter associated with respiratory signs in patients with respiratory symptoms compared to those without. In conclusion, the presence of RD in pediatric patients with silent GER is related to longer esophageal clearance, but is not related to severity of reflux.
 ...
PMID:Severity of acid gastroesophageal reflux assessed by pH metry: is it associated with respiratory disease? 1295 47


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