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

Scintigraphy was used to detect gastroesophageal reflux, determine whether percutaneous gastrostomy (PG) tubes cause reflux, and help in the choice between PG tubes versus percutaneous gastrojejunostomy (PGJ) tubes. During a 2-year period, 46 patients were evaluated with scintigraphy immediately before and 1 week after PG tube placement. Findings in the pre- and postplacement reflux studies were the same in 39 patients (85%). Proof of reflux on either study was considered an indication for conversion to the PGJ tube; at least one study was positive for reflux in 21 patients (46%). All patients were followed up for tube complications, pneumonia, and cause of death. During follow-up, six of 24 patients correctly maintained with PG tubes (25%) and 18 patients with PGJ tubes (39%) developed pneumonia, the cause of death in four of 24 patients with PG tubes (17%) and five of 18 patients with PGJ tubes (28%). The PG tube does not induce reflux, and scintigraphy is useful in selection of patients who can be safely maintained with the PG tube without an increase in the morbidity or mortality associated with reflux and aspiration.
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PMID:Percutaneous enteral alimentation: gastrostomy versus gastrojejunostomy. 845 95

Respiratory morbidity in 334 patients aged 1 to 37 years with repaired oesophageal atresia and tracheo-oesophageal fistula is reported. Just under half the patients were subsequently hospitalised with respiratory illness. Two thirds of admissions were before 5 years of age. Five percent were admitted on more than five occasions. Patients with gastro-oesophageal reflux and low birth weight were more likely to be admitted. Thirty one percent of patients had one or more episodes of pneumonia in the first five years of life and 5% after 15 years. The prevalence of annual bouts of bronchitis in these age groups was 74% and 41% respectively. The prevalence of wheeze was about 40% in all age groups. Patients with symptoms persisting after 15 years were more likely to have had lower respiratory tract illness in early childhood and a history of atopy. In the 12 months before review, weekly episodes of wheezing were present in one third under 5 years and 15% over 15 years. Thirty two percent of patients aged 5-10 years and 8% over 15 years missed two or more weeks of school or work in the previous year with respiratory illness.
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PMID:Respiratory morbidity after repair of oesophageal atresia and tracheo-oesophageal fistula. 848 Oct 36

Gastroesophageal reflux (GER) is one of the most frequent symptomatic clinical disorders affecting the gastrointestinal tract of infants and children. During the past 2 decades, GER has been recognized more frequently because of an increased awareness of the condition and also because of the more sophisticated diagnostic techniques that have been developed for both identifying and quantifying the disorder. Gastroesophageal fundoplication is currently one of the three most common major operations performed on infants and children by pediatric surgeons in the United States. Normal gastroesophageal function is a complex mechanism that depends on effective esophageal motility, timely relaxation and contractility of the lower esophageal sphincter, the mean intraluminal pressure in the stomach, the effectiveness of contractility in emptying of the stomach, and the ease of gastric outflow. More than one of these factors are often abnormal in the same child with symptomatic GER. In addition, in patients with GER disease, and particularly in those patients with neurologic disorders, there appears to be a high prevalence of autonomic neuropathy in which esophagogastric transit and gastric emptying are frequently delayed, producing a somewhat complex foregut motility disorder. GER has a different course and prognosis depending on the age of onset. The incompetent lower esophageal sphincter mechanism present in most newborn infants combined with the increased intraabdominal pressure from crying or straining commonly becomes much less frequent as a cause of vomiting after the age of 4 months. Chalasia and rumination of infancy are self-limited and should be carefully separated from symptomatic GER, which requires treatment. The most frequent complications of recurrent GER in childhood are failure to thrive as a result of caloric deprivation and recurrent bronchitis or pneumonia caused by repeated pulmonary aspiration of gastric fluid. Children with GER disease commonly have more refluxing episodes when in the supine position, particularly during sleep. The reflux of acid into the mid or upper esophagus may stimulate vagal reflexes and produce reflex laryngospasm, bronchospasm, or both, which may accentuate the symptoms of asthma. Reflux may also be a cause of obstructive apnea in infants and possibly a cause of recurrent stridor, acute hypoxia, and even the sudden infant death syndrome. Premature infants with respiratory distress syndrome have a high incidence of GER. Esophagitis and severe dental carries are common manifestations of GER in childhood. Barrett's columnar mucosal changes in the lower esophagus are not infrequent in adolescent children with chronic GER, particularly when Heliobacter pylori is present in the gastric mucosa. Associated disorders include esophageal dysmotility, which has been recognized in approximately one third of children with severe GER. Symptomatic GER is estimated to occur in 30% to 80% of infants who have undergone repair of esophageal atresia malformations. Neurologically impaired children are at high risk for having symptomatic GER, particularly if nasogastric or gastrostomy feedings are necessary. Delayed gastric emptying (DGE) has been documented with increasing frequency in infants and children who have symptoms of GER, particularly those with neurologic disorders. DGE may also be a cause of gas bloat, gagging, and breakdown or slippage of a well-constructed gastroesophageal fundoplication. The most helpful test for diagnosing and quantifying GER in childhood is the 24-hour esophageal pH monitoring study. Miniaturized probes that are small enough to use easily in the newborn infant are available. This study is 100% accurate in diagnosing reflux when the esophageal pH is less than 4.0 for more than 5% of the total monitored time.
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PMID:Gastroesophageal reflux in childhood. 853 88

Barrett's esophagus, a premalignant condition associated with chronic gastroesophageal reflux, carries an approximate 40-fold increase in the incidence of adenocarcinoma. Between 1975 and 1994, 113 patients with Barrett's esophagus underwent antireflux procedures at the Mayo Clinic. The antireflux procedure was performed more than 3 months after the diagnosis of Barrett's disease in 39 patients (34.5%) and during the initial preoperative evaluation in 74 (65.5%). Uncut Collis-Nissen fundoplication was performed in 69 patients (61.1%), Nissen fundoplication was performed in 16 (14.2%), cut Collis-Nissen fundoplication was performed in 12 (10.6%), Belsey repair was performed in nine (8.0%), Collis-Belsey repair was performed in six (5.3%), and Nissen fundoplication with an anterior gastropexy was performed in one (0.9%). There was one operative death (0.9% mortality). Morbidity occurred in 41 patients (36.3%), including cardiac arrhythmia in eight (7.0%), pneumonia in six (5.3%), empyema in five (4.4%), hemorrhage in four (3.6%), myocardial infarction in two (1.8%), and wound dehiscence, wound infection, perforated duodenal ulcer, and postoperative leak in one each (0.9%). Median follow-up for the 112 survivors of operation was 6.5 years (range 4 months to 18.2 years). Excellent or good alleviation of symptoms was obtained in 92 patients (82.2%). Ninety-nine patients (88.4%) are currently alive and 13 (11.6%) have died. Three patients (2.7%) subsequently had adenocarcinoma of the esophagus after the antireflux procedure at 13, 25, and 39 months; two of these died of cancer. The incidence of esophageal carcinoma in this select group of patients was one in 273.8 patient-years of follow-up. We conclude that although antireflux procedures in patients with Barrett's esophagus result in long-term control of reflux symptoms, the possibility of esophageal cancer still exists. Endoscopic surveillance should therefore be recommended.
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PMID:Barretts's esophagus: does an antireflux procedure reduce the need for endoscopic surveillance? 864 13

Nasogastric (NG) tubes are routinely used in patients undergoing cardiac surgery. This randomized study was designed to assess gastroesophageal reflux (GER) without a NG tube (control) compared with a NG tube managed either by gravity drainage (gravity) or continuous low-grade suction (suction). Antimony pH probes were placed in the lower esophagus and trachea after induction of anesthesia in 51 patients, and pH was recorded every 5 s until the time of tracheal extubation. GER was defined as reversible decrease in esophageal pH to less than 4.0. No significant difference was found between groups in age, weight, gender, duration of postoperative ventilation, morphine use, or antiemetic use. All indicators of GER were seen more frequently in the gravity group compared with the two other groups (P < 0.001). One episode of sudden decrease in tracheal pH was observed in a patient in the gravity group, indicating tracheal aspiration, which was associated with delayed extubation and postoperative pneumonia. The absence of a NG tube is not associated with reflux, probably since the gastroesophageal sphincter remains competent. NG tubes are not routinely necessary for cardiac surgery in patients without risk factors for GER, and increase reflux risk if managed without low-grade suction.
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PMID:Gastroesophageal reflux and tracheobronchial contamination after cardiac surgery: should a nasogastric tube be routine? 869 97

Percutaneous endoscopic placement of feeding gastrostomies (PEG) was pioneered by Gauderer et. al. in 1980 [1]. Since then, it has become the preferred method of providing enteral nutritional support in children and adults because of advantages in morbidity and cost [2,3]. Pneumonia is a known sequel of this procedure, occurring at different rates, depending on the length of follow-up. Some series have shown an incidence of 10% at 30 days and others 56% at 11 months [4,5]. It does not appear that PEG feeding offers an advantage over the more traditional naso-enteric tube feeding methods in this respect. To study the prevalence of gastroesophageal reflux (GER) in PEG-fed patients, we quantitated GER by 24-hour intraesophageal pH monitoring in a group of patients who developed post-PEG pneumonia and compared it with a control group. Our study demonstrates an increased prevalence of GER in the pneumonia group compared with the control group. However, the exact contribution of this observed increased GER to the development of pneumonia needs to be determined.
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PMID:Prevalence of gastroesophageal reflux in patients who develop pneumonia following percutaneous endoscopic gastrostomy: a 24-hour pH monitoring study. 872 Oct 64

The objective has been to identify the different etiologies and elaborate a diagnostic and therapeutical methodology for patients with chronic cough. During one year we studied prospectively 83 patients with persistent cough of daily appearance with an evolution of four or more weeks and no previous etiologic diagnosis. We worked on three diagnostic (D) levels. D1: Based on the anamnesis and physical examination. D2: Sequential incorporation of complementary exams. D3: Evaluation of the response to the specific treatment. We divided the population into 2 groups: G1 healthy children, G2 children followed in our hospital for different conditions. The mean age was 4.7 years (range, 3 months to 15 years), and the average duration of cough was 4.9 months (range, 1 to 36 months). In G1 the following causes were identified in 78 children: cough variant asthma 41 (52%), asthma+upper respiratory tract infections 8 (10%), asthma+lower respiratory tract infections 6 (7%), postnasal drip syndrome (sinusitis, adenoiditis) 5 (6%), psychogenic 6 (7%), undetermined 4 (5%), gastroesophageal reflux 2, asthma+cigarette 2, AIDS 1, Sjogren syndrome 1, vascular ring 1, cricopharyngeal foreign body 1. In G2 out of 5 children we have found: 2 children with chronic encephalopathies who had swallowing disorders and gastroesophageal reflux, 1 patient with Down syndrome presenting hypogammaglobulinemia and bronchiectasis, 1 tracheaesophageal fistula in H in a child with recurrent pneumonia, 1 lymphocytic pneumonia in an AIDS patient. The D1 was correct in 92% of the cases. The specific therapy has proved useful for achieving the remission of the symptoms. Although asthma is the most frequent cause of chronic cough, other etiologies exist and must be ruled out.
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PMID:[Chronic cough in pediatrics]. 872 72

This paper deals with the indications, techniques and results of laparoscopic total or partial posterior fundoplications (Nissen and Toupet procedures, respectively) performed in 41 patients with gastroesophageal reflux disease (GERD) failing to respond to medical treatment. Stationary manometry and 24-hour esophageal pH monitoring established the indications for surgery. Laparoscopy was attempted in all patients, even when giant mixed or para-esophageal herniations were present. The rate of conversion to laparotomy amounted to 12.2%. There were no intraoperative complications. Major complications were observed in 3 patients (8%) and included 2 cases of slipped Nissen and 1 of pneumonia. Four patients had persistent postoperative dysphagia; two of them were re-operated and two were treated with pneumatic dilatation. Reflux only recurred in 1 patient. Functional follow-p demonstrated an overall increase in LES resting pressure and length, with no abnormal gastro-esophageal reflux episodes, findings which tended to persist in the long term.
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PMID:Laparoscopic treatment of gastro-esophageal reflux disease: indications and results. 874 Jun 90

From January 1979 to May 1995, 18 patients (4 men, 14 women) with a mean age of 75.4 +/- 12.5 yr underwent surgery for a complicated paraesophageal hiatus hernia. In 5 patients, the complication was the first sign of the diagnosis. Thirteen patients had a history of digestive, respiratory, or cardiac symptoms (mean duration of symptoms 74 mo.; range 2-240 mo.); 9 of them were aware that they had a hiatus hernia. Ten patients presented with acute obstruction (associated with a perforation in 1 case, jaundice in 1 case, and righy lower lobe pneumonia in 1 case). Hemorrhage occurred in 6 patients (hematemesis 4 cases, melena 2 cases). One patient had a perforation and another had an abscess of the lower right lobe. Surgery was performed via a transabdominal approach in all cases (5 times as an emergency, 12 times as a delayed emergency procedure, and once as an elective procedure). The procedure was delayed in 13 cases because of successful nasogastric decompression. All patients underwent reintegration of the stomach, diaphragmatic repair and gastropexy. An antireflux procedure was performed in 14 cases. Seven patients had an ancillary procedure (including one splenectomy following decapsulation). There were no postoperative deaths. Two patients who underwent emergency surgery developed a benign complication. The outcome of 17 patients is known; none of them developed a recurrence. One patient who did not undergo an antireflux procedure presented with gastroesophageal reflux; another experienced pain during eructation. In conclusion, nearly two-thirds of all patients who present with an acute complication can benefit from medical preparation before surgery, a strategy that improves results.
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PMID:[Results of surgical treatment of complicated paraesophageal hernias]. 875 21

A nationwide retrospective study of exogenous lipid pneumonia (ELP) was carried out to update the data on this disease, with emphasis on thoracic computed tomography (CT) scan and bronchoalveolar lavage (BAL) findings. The inclusion criteria were: 1) presence of abnormal imaging features compatible with the diagnosis of ELP; 2) presence of intrapulmonary lipids; and 3) exogenous origin of the lipid pneumonia. Forty four cases were included (20 males and 24 females; mean age 62 +/- 11 yrs), of which four were occupational (chronic inhalation of cutting mist or oily vapour in an industrial environment). Thirty of the 40 nonoccupational cases were related to aspiration of liquid paraffin used for the treatment of constipation. A condition possibly favouring oil aspiration or inhalation was present in 34 patients (77%), most commonly gastro-oesophageal reflux (n = 20) and neurological or psychiatric illness (n = 14). Fever (39%), weight loss (34%), cough (64%), dyspnoea (50%) and crepitations (45%) were the most frequent symptoms. BAL was performed in 39 cases: 23% had a lymphocytic alveolitis; 14% neutrophilic alveolitis; and 31% a mixed alveolitis (lymphocytic and neutrophilic). Alveolar consolidations (57%), ground glass opacities (39%), and alveolar nodules (23%) were the most common radiological abnormalities. The changes were bilateral (79%), predominant in the posterior and lower zones of the lobes concerned (74%), hypodense (71%), and spared the subpleural zones (52%). In 13 cases, hypodensity was retrospectively established on CT scan by the presence of a "positive angiogram". This sign may be of diagnostic value when the density measurement is either not possible or not reliable. In conclusion, this study provides an update of the clinical, biological and radiological profile of exogenous lipid pneumonia and, in particular, confirms the diagnostic benefit of computed tomography scan, which revealed bilateral and hypodense changes in a large majority of cases.
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PMID:Exogenous lipid pneumonia: a retrospective multicentre study of 44 cases in France. 883 60


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