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

The respiratory symptoms of gastro-oesophageal reflux, which sometimes includes massive and fatal inhalation, are well-known in infants. In older children the digestive signs are not clinically evident and the reflux mainly, if not exclusively, can be translated by recurring respiratory symptoms. The series of 36 cases presented in this work concerns children between 3 months and 15 years old, for whom the first signs were respiratory, with often a silent gastro-oesophageal reflux for several months, and even several years in some cases. The physiopathology of the respiratory symptoms concerns principally the repeated alimentary aspiration and/or gastric content during nocturnal decubitus. The pulmonary lesions caused by the reflux can be either localized, with atelectasis, obstructive emphysema or bronchiectasis, or generalized with granulomatous reactions around the food particles. Other respiratory conditions such as asthma or cystic fibrosis can be also associated with gastro-oesophageal reflux. The diagnostic criteria are discussed.
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PMID:[Recurrent bronchopneumopathies caused by gastroesophageal reflux in children. Clinical, x-ray and histologic studies of 36 cases]. 61 80

With the aim of suggesting incision of peptic esophageal strictures, as an alternative to bougienage, we report the results of the first 20 patients so treated. We included as candidates for this treatment all those patients with moderate or severe dysphagia in whom a stricture of the distal esophagus was confirmed on esophagoscopy that could not be negotiated despite continuous and vigorous pressure with the tip of the fiberscope. On the basis of radiological films, the minimum diameter of the stenotic ring (+/- SD) was 4.4 +/- 2.2 mm, increasing up to 10.05 +/- 1.5 mm once the endoscopic procedure was made. Dysphagia was initially relieved in all the cases. Four patients had recurrence within a few days after the incision. Later, another 4 patients had recurrence. Finally, a further 4 cases were lost by non-compliance. The remaining 8 patients who underwent a 6-months' follow-up did not show a later tendency to re-stenosis. In total, 5 patients were surgically treated for hiatal hernia. One case of emphysema in the mediastinum was noted and treated conservatively. We conclude that endoscopic incision is an alternative to esophageal dilatation as initial treatment for peptic esophageal stricture, despite the fact that a significant number of patients will require additional surgical correction for gastro-esophageal reflux.
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PMID:Endoscopic incision as an alternative to bougienage in the treatment of peptic esophageal stricture. 235 32

An alcoholic man with known reflux esophagitis and Barrett's esophagus developed fever, epigastric pain, subcutaneous crepitus, and leukocytosis from an esophageal perforation at a Barrett's ulcer. Possible risk factors for perforation in this patient included alcoholism, severe gastroesophageal reflux, corticosteroid therapy, noncompliance with antacid and H2 blocker therapy, and the presence of acid-secreting parietal cells in the Barrett's epithelium. Five cases of this complication have previously been reported in a review of the literature, which included 536 cases of Barrett's esophagus or esophageal perforation. This entity may present with a clinical triad of a patient (a) in acute distress with fever and epigastric or noncardiac chest pain and without signs of peritonitis, (b) with symptoms of or known gastroesophageal reflux, and (c) with chest examination revealing subcutaneous crepitus, or chest roentgenogram revealing subcutaneous emphysema, pneumomediastinum, or hydropneumothorax.
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PMID:Esophageal perforation at a Barrett's ulcer. 258 67

In an effort to explore the utility of classic Nissen fundoplication performed laparoscopically, 16 adult patients with well documented gastroesophageal reflux underwent laparoscopic Nissen fundoplication. A full gastric fundal dissection was performed, with division of at least 2 short gastric vessels. The crura were approximated with 1-3 sutures, and a loose fundoplication was performed over an esophageal dilator (minimum 46 F) with three stitches, encompassing the esophageal wall (2.5 cm in length). All patients had symptoms of reflux refractory to medical therapy, and four had an esophageal stricture requiring preoperative dilatation. Fifteen of 16 procedures were completed laparoscopically; one patient required conversion to an open procedure to control bleeding from a posterior gastric vein. There were no other operative complications. The average operative time was 180 minutes (range 120-285). Clear liquids were begun at the passage of flatus (average 2.7 days postop), and patients were discharged an average of 4.1 days postoperatively. Postoperative complications included ileus (1 patient for 6 days), severe subcutaneous emphysema (1 patient), and dysphagia requiring dilatation (5 patients). In short follow-up (mean 4.43 mo., range 1-12 mo.) 14 of 15 patients had complete abolition of reflux symptoms, but one patient with persistent heartburn had reflux demonstrated on a postoperative upper GI series. Thirteen of 16 patients returned to full function within 14 days of surgery. We conclude that standard Nissen fundoplication is possible laparoscopically, and allows a rapid recovery from surgery. However, it is difficult, time consuming, and associated with a significant rate of recurrence in the short term (6%).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Initial experience with laparoscopic Nissen fundoplication. 783 76

Gastro-oesophageal reflux disease (GORD) is a chronic disorder requiring lifelong medical therapy or surgery. In the present study we evaluated the postoperative course and effect of laparoscopic fundoplication on GORD in 27 patients with a median age of 44 (range 27-73) years. Fifteen were operated on with a Watson procedure, and 12 patients had a Nissen procedure. Median stay and convalescence after surgery was one and 10 days respectively. Three patients had to be converted into open surgery (bleeding: two, unclear anatomy: one). No major complications were seen, but four patients had postoperative complications (stenosis requiring dilatation: one, subcutaneous emphysema: one, wound sepsis: one, hernia: one. The two latter complications were seen in converted patients). Two patients had prolonged dysphagia, and two patients needed slight dietetic advice for gasbloat syndrome. In 25 of 27 patients good control of GORD was accomplished as judged by symptomatology, endoscopy and 24-hour pH measurements. It is concluded that laparoscopic fundoplication offers good control of GORD with few complications, and short hospital stay and convalescence.
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PMID:[Laparoscopic fundoplication in gastroesophageal reflux]. 904 46

In several areas of clinical medicine, electrical impedance tomography could offer significant advantages over existing methods. These advantages have been supported by preliminary studies or by validation studies, which are described. The suggested applications are reviewed in this section. They mainly concern developments in impedance variations on brain, lung (neonatal, edema, emphysema), and heart; changes in blood volume, gastrointestinal system (gastric emptying, gastroesophageal reflux, pharyngeal transit time); pelvis (pelvis congestion); and thermal mapping in hyperthermia and breast (tissue characterization). The conductivity information at one frequency in a pixel is insufficient to take into account the very complex physiological mechanisms that underlie the observed impedance changes. To gain a better understanding of these mechanisms, research is currently being carried out on imaging of the imaginary part, parametric imaging, spectroscopic imaging, and 3D imaging, which are developed at the end of this section.
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PMID:Bioelectrical impedance techniques in medicine. Part III: Impedance imaging. Third section: medical applications. 919 88

Esophageal perforation is a serious complication of pneumatic dilatation. We studied the cases of 4 patients (2 men and 2 women, mean age 58 years, range 56-62) who had surgical treatment for achalasia, two of which had had previous dilatation. The main symptoms were pain and dyspnea. Pneumomediastinum was present in all patients, pleural effusion in 2 and cervical emphysema in 1. Esophagographic results showed evidence of perforation in all four cases and gastric patches were surgically placed on the esophageal tear within 12 hours. Three patients received enteral nutrition for an average of 13 days. Mean hospital stay was 14 days. No post-operative complications were exhibited although one patient did develop gastroesophageal reflux 3 months later and underwent surgery to repair a hernia in the thorax 5 years later. Early and aggressive treatment is considered the best therapy and the gastric patch, in our opinion, is an effective and reliable technique for esophageal perforation repair in achalasia patients.
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PMID:[Perforation of the esophagus during pneumatic dilatation in achalasia]. 1051 19

Percutaneous endoscopic gastrostomy (PEG) insertion became the preferred technique for facilitating enteral nutrition in children unable to take adequate caloric intake orally once its advantages over the standard Stamm gastrostomy became apparent. It has taken longer for some of its limitations and shortcomings to be recognized. Problems encountered during PEG insertion include: inability to enter the stomach with the trocar, oesophageal laceration, colonic perforation, gastro-colo-cutaneous fistula, peritonitis, subcutaneous emphysema, external migration of inner flange, wound infection, peristomal excoriation, symptomatic gastro-oesophageal reflux requiring later fundoplication, intestinal obstruction and haemorrhage. Many of these complications can be avoided by attention to technique.
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PMID:Limitations of percutaneous endoscopic gastrostomy in facilitating enteral nutrition in children: review of the shortcomings of a new technique. 1057 51

The usefulness of radiologic examination in the diagnosis of aspiration pneumonia in infants. The aim of the study was to estimate whether the connection between the localisation and radiological findings on the plain X-ray chest examination exists in the group of 121 infants and young children, age 1 to 24 month (77 boys and 44 girls), treated for pneumonia and gastroesophageal reflux disease (GERD), established by 24-hour esophageal pH-monitoring. In all children the diagnosis of pneumonia were made on admission to hospital by physical and X-ray chest examinations. GERD, in accordance with consensus ESPAGAN, was diagnosed in the group of 65 children. Children with abnormal results of pH-monitoring had significantly more changes in the lower parts of the right lung and in the intermediate and the lower parts of the left lung. There were no difference in radiological appearance between the changes suspected to the aspiration etiology and other pneumonic changes in the group of 56 children with normal pH-investigation. Additionally, there was no significant difference in the frequency of atelectasis, emphysema and/or enlargement of the thymus between both groups.
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PMID:[Effect of gastroesophageal reflux in children on x-ray imaging of the lungs]. 1599 46

While most patients respond well to conventional antiasthmatic therapy as outlined in current guidelines, a small percentage, however, have severe disease which is relatively or completely unresponsive to inhaled as well as oral medications. These patients who often have a long-standing "career" in asthma are frequently labeled steroid-resistant or difficult-to-control but this group of patients is not well defined. It is likely that a number of mechanisms contribute to therapy-resistant asthma such as socioeconomic status, mental disturbances but also characteristics of the individual subgroups within the syndrome of asthma such as aspirin-exacerbated airway disease or intrinsic asthma. A thorough and systematic approach is required in the work-up of these patients which sometimes involves repeated evaluations to determine that asthma and not other diseases such as chronic obstructive pulmonary disease (COPD), emphysema, gastroesophageal reflux, congestive heart failure and many others which can mimic asthma are present. Issues relating to compliance with prior or future therapies are warranted and doctor-patient communication should be checked. A meticulous search for possible triggers such as cigarette smoking, occupational allergens and comorbid conditions should be included in the work-up. High-dose combination therapy including frequent bursts or maintenance therapy with systemic corticosteroids is often necessary. Alternative therapies such as methotrexate and other immunosuppressants should be avoided based on current data but recent evidence from controlled studies suggests that anti-IgE or anti-tumor necrosis factor-(TNF-)alpha strategies might be of benefit in these patients. There is data that different phenotypes of therapy-resistant asthma might exist but little if any evidence to suggest a single phenotype of therapy-resistant asthma.
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PMID:[Therapy-resistant asthma--a distinct phenotype?]. 1660 86


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