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

Enteral nutrition must be preferred to parenteral nutrition if case of intact digestive tract. Naso-gastric tubes are frequently used, particularly in enteral feeding. However, the use of naso-enteral tubes, i.e. naso-duodenal and naso-jejunal tubes, is expected to increase in the future. Their efficacy has been demonstrated in two specific cases: intensive care (post-operative or post-traumatic states), acute pancreatitis. A third potential use is in the replacement of a naso-gastric tube by a naso-jejunal tube in cases of frequent aspiration pneumonia related to a gastro-esophageal reflux. Gastro- and jejunostomies have to be indicated when enteral nutrition is thought to be used for more than one month. The insertion of a naso-gastric tube is generally performed by the nurse following medical guidelines and the insertion of a naso-jejunal tube is often done during an endoscopy by the physician. The verification of the correct position of the tube should preferably be done with an X-ray confirmation. However, this is difficult to perform at home and the most frequent method for control is the clinical method by auscultation. Enteral nutrients are generally polymeric and infused with gravity without a peristatic pump excepted in children. In conclusion, technical improvements in enteral nutrition have led to a simple, cost-effective and low risk methods of treatment.
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PMID:[Enteral nutrition: techniques and indications]. 1117 10

Roxatidine acetate hydrochloride capsule is slowly absorbed from the gastrointestinal tract, and its acid suppressive effect on the stomach is long-lasting compared with other H2-blockers. The reduction of gastric juice in perioperative period is considered advantageous for patients not only because it decreases the risk for aspiration pneumonia but also because it reduces the risk of bronchial spasm induced by gastroesophageal reflux of acidic gastric content. The effects of single oral administration of roxatidine acetate hydrochloride 150 mg at night before the operation on the volume and pH of gastric juice were investigated during anesthesia using two types of anesthetic agents (isoflurane and propofol) in 93 patients of three age groups (group Y: age 20-40, group M: age 41-64, group O: age 65 <). The effect of roxatidine on reduction of gastric juice was found at the time of anesthetic induction and 2 hours after the induction in any age group with either anesthetic agent. The serum concentration of roxatidine at the time of induction was much higher in group O. The value of residual concentration of roxatidine 20 hours after oral intake was estimated from the intraoperative measurements of serum concentration. The results suggest that single administration at night before the operation is sufficient for the oldest group, but an additive dose is recommended for the younger groups.
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PMID:[Clinical evaluation of roxatidine acetate hydrochlorides as a preanesthetic medication]. 1124 65

Wasting is a major complication of advanced head and neck cancer and the aim of this study was to compare nasogastric tube feeding (NG) and percutaneous fluoroscopic gastrostomy (PFG) in these patients. The goal of these two methods of nutritional support was to improve or maintain the initial nutritional status during treatment. A total of 90 patients, all stage IV oropharynx or hypopharynx tumor, were reviewed from a prospective databank. All these patients were treated by concomitant chemotherapy and twice-daily continuous radiotherapy with no acceleration. Fifty patients were managed by PFG, and the rest by NG. Mechanical failure, duration of feeding, complications, nutritional evaluation and quality of life were analysed. Mechanical failure occurred in 32 of the 40 NG patients and in seven of the gastrostomy group. In the PFG group, 80% of patients conserved their nutritional support after the end of the radiotherapy, none patient in the NG group. In the PFG group, two presented a wound infection and six had aspiration pneumonia while in the NG group, 21 had aspiration pneumonia probably due to the NG tube (gastroesophageal reflux). The feeding methods were found to be equally effective at maintaining body weight and body mass index at time 1 (3 weeks) and at time 2 (6 weeks). Advantages were associated with PFG cosmesis, mobility and quality of life. PFG is a safe and effective method of providing enteral nutrition during treatment to patients with advanced head and neck cancer and offers important advantages over NG.
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PMID:Comparison between nasogastric tube feeding and percutaneous fluoroscopic gastrostomy in advanced head and neck cancer patients. 1130 12

Aspiration pneumonia due to gastroesophageal reflux is a frequent complication in ICU. The most commonly chosen method for long-term enteral access is gastrostomy and this method also reduces the risk of aspiration and shortens the hospital stay. We evaluated 31 patients in whom PEG was performed between 1997-98 in our unit. Indication of PEG was long-term ICU stay and coma which necessitate long term enteral nutrition. Mean age of our patients were 60.5((19.4). We evaluated the aspiration by clinical inspection. Aspiration and interruption of feeding was observed 1.57 ((1.43) times before PEG and 0.67 ((0.73) times after PEG. Further more positive tracheal aspirate culture were seen 3.14 ((1.95) times before PEG and 1.52 ((1.47) times after PEG.
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PMID:[Percutaneous endoscopic gastrostomy in the ICU]. 1181 87

Rumination is a syndrome characterized by the effortless regurgitation of recently ingested food. It has been linked to severe medical and psychosocial conditions including malnutrition, aspiration pneumonia, and complete social withdrawal. Psychotherapy, the current treatment modality for rumination, may improve symptoms but requires significant motivation and is rarely curative. We hypothesized that a complete fundoplication would eliminate, or at least impair, the ability to regurgitate gastric contents through the esophagogastric junction. We performed a Nissen fundoplication in five patients with a classic history of rumination. In all cases, symptoms had been resistant to medical and psychiatric intervention prior to fundoplication. Formal preoperative testing included esophageal manometry, 24-hour pH monitoring, endoscopy, and upper gastrointestinal barium swallow studies. All patients reported their primary symptom to be effortless recurrent postprandial regurgitation for 1 to 2 hours after meals consistent with rumination. Four (80%) of the five patients had low resting lower esophageal sphincter pressures with evidence of gastroesophageal reflux disease on 24-hour pH monitoring. All patients reported complete cessation of ruminating behavior after Nissen fundoplication. We report, for the first time, complete elimination of rumination symptoms after a Nissen fundoplication. Although further trials are needed to confirm our results, we recommend considering a Nissen fundoplication for treatment of rumination refractory to behavioral and medical interventions.
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PMID:Effective treatment of rumination with Nissen fundoplication. 1212 34

Aicardi syndrome is an X-linked-dominant condition characterized by infantile spasms, agenesis of the corpus callosum, and chorioretinal lacunae. We reviewed the Aicardi Syndrome Foundation's compilation of family-based, self-reported questionnaires for the year 2000. Information was obtained from 77 females with Aicardi syndrome regarding developmental milestones, seizure frequency, seizure classification, antiepileptic drug use, and medical problems. Patient ages ranged from 1 to 25 years (mean = 7.2 years). All patients were significantly developmentally delayed with milestones ranging from 2 to 36 months. Of the patients, 91% attained milestones no higher than 12 months. Seizures were reported in 92% of patients and occurred daily in 67%. Infantile spasms were the most common seizure type observed in 17%, although a variety of other seizure types were also reported. Multiple antiepileptic drugs were used in these patients with 73% of patients taking two or more antiepileptic drugs. Five patients had a vagal nerve stimulator implanted, and one patient underwent a hemispherectomy. The most common medical problems cited included scoliosis, constipation, gastroesophageal reflux, aspiration pneumonia, and otitis media, but overall health was perceived to be good. Our review demonstrates the spectrum of developmental disabilities, epilepsy severity, and prognosis in a large group of Aicardi patients.
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PMID:Aicardi syndrome: spectrum of disease and long-term prognosis in 77 females. 1250 1

A 81-year-old man, who had been diagnosed in multiple cerebral infarction and Alzheimer's disease, was followed up in his local clinic since 1997. He had been bedridden before admission, but could eat. He was admitted with severe aspiration pneumonia in December 1999. Since severe dementia and dysphagia were noted after admission, he was examined to find out whether or not he could swallow while the treatment of his pneumonia was conducted at the same time. The water swallowing test indicated a risk of aspiration, thus, percutaneous endoscopic gastrostomy was performed on January 26, 2000 after the completion of the treatment for pneumonia. Although the patient's condition was complicated by aspiration pneumonia, enteral feeding through the gastric fistula gradually became successful, and he was discharged in June 2000. His family physician followed him up by visiting at home to examine and observe his general physical condition including consciousness, vital signs, skin and respiration, while taking measures in cooperation with the local health care visiting nurse. The patient, thereafter, was repeatedly admitted and discharged because of exacerbation and remission of symptoms, including coughing, sputum and fever, probably caused by aspiration pneumonia. When he was admitted in December 2001, which was his sixth admission, since there were troubles with the infusion tube and frequent gastroesophageal reflux, the gastric fistula management was judged to be a great burden on the patient. In January 2002, the gastrostomy tube was removed and the patients, whose alimentation was managed using intra-venous hyperalimentation (IVH), was discharged. Besides periodic visits by his family physician, a 24-hour house visit system was introduced to control his IVH and deal with his family members' anxiety. His general condition, thereafter, has not markedly changed. The patient has continuously received medical treatment for 14 months after being discharged and his condition is stable.
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PMID:[A case of serious aspiration pneumonia associated with multiple cerebral infarctions and Alzheimer's disease followed by hospital and home care service team]. 1468 57

Gastroparesis is a serious complication of lung and heart-lung transplantation that can lead to malnutrition, gastroesophageal reflux, aspiration pneumonia and deteriorating lung function. Some patients with severe gastroparesis have symptoms that are refractory to dietary modifications and gastric promotility agents and require surgery. We describe the successful use of gastric pacing for the management of intractable gastroparesis, malnutrition and recurrent aspiration in a heart-lung allograft recipient. Lung transplant recipients with severe gastroparesis may benefit from gastric pacing.
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PMID:Gastric pacing for severe gastroparesis in a heart-lung transplant recipient. 1501 48

This clinical paper discusses the role of the pediatric nurse in the evaluation and management of gastroesophageal reflux (GER) in infants. During an infant's first year of life, GER is a common occurrence and concern of families. The infant with uncomplicated GER may be managed conservatively with feeding schedule modifications, thickened feeds, changes in positioning, or a trial of formula change. Gastroesophageal reflux disease (GERD) is a pathological process in infants manifested by poor weight gain, signs of esophagitis, persistent respiratory symptoms or complications, and changes in neurobehavior. Management of the infant with GERD, in addition to non-pharmacological interventions, involves further diagnostic evaluation and pharmacologic therapy, depending upon the child's history and clinical presentation. While most cases of GER are self-limiting, complications include esophagitis, bronchospasm, apnea, aspiration pneumonia and other otolaryngologic disorders. The pediatric health care provider should offer an ongoing, comprehensive clinical approach to the family based on considerations of growth and development, and the quality of interactions between the caregivers and child.
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PMID:Gastroesophageal reflux in infants: a primary care perspective. 1502 52

Gastroesophageal reflux is a condition that causes lung complications by gastric content aspiration in both adults and children. The most common complications are asthma, chronic bronchitis or chronic cough, recurrent pneumonia, pulmonary fibrosis and in children apnea as a result of regurgitation of large amount of gastric content suddenly. The reason of recurrent aspiration pneumonia is the aspiration of gastric content or microorganisms in upper gastrointestinal system. Barrett's esophagus characterized by the conversion of the epithelium of esophagus from squamous to columnar is a histological consequence of gastroesophageal reflux. We are presenting a case of Barrett's esophagus and recurrent pneumonia who had respiratory symptoms and difficulty in swallowing but no symptoms of gastroesophageal reflux. As it has been shown in our case it is difficult to cure the respiratory disease caused by nontreated asymptomatic gastroesophageal reflux.
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PMID:[Recurrent aspiration pneumonia and Barrett's esophagus: a case report]. 1510 Sep 5


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