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

Extended esophageal pH-metering is the best method for GER diagnosis, but it has a certain number of false negatives. In a attempt to judge in which extent we can indicate surgery with a "normal" pH-metering study, we have reviewed our 110 operated children since 1982, and selected 12 in whom pH studies were normal. There where five females and seven males with ages ranging between 18 and 90 months. The clinical course until the diagnosis was accepted was long. Nine patients had vomiting, five respiratory disease, six dysphagia, four anemia and three torticollis. Only two were malnourished. There was radiologic GER in all children (with only one hiatal hernia). In spite of "normal" pH-metering, eight had decreased lower esophageal sphincter, and 11 disturbed motility. Nine had endoscopic esophagitis and eight histologic esophagitis. After operation, indicated only after long periods of medical treatment, vomiting disappeared in all, and so did respiratory disease and torticollis. Five families were very satisfied, six rather satisfied (gas bloat syndrome) and one frankly dissatisfied (dysphagia with severe immotility). Based on this evidence, we believe that some limited indications for surgery in GER are acceptable even in the presence of "normal" pH-studies.
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PMID:[False negatives in pH measurement. A retrospective study of 12 surgical cases]. 207 69

The association between gastroesophageal reflux and respiratory disease is recognized long time ago. We can distinguish two kinds of asthma: asthma caused by a gastroesophageal reflux and asthma complicated by a gastroesophageal reflux. In the clinic evaluation it is important to establish the nature of reflux. It is essential to effect the Bernstein's test.
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PMID:[A case of asthma caused by gastroesophageal reflux. A clinical case]. 215 35

In a 6.5 year period starting January 1982, 121 patients (74 male, 47 female; 1.6:1) with complicated gastroesophageal reflux referred to Alberta Children's Hospital, University of Calgary, required a Nissen fundoplication at a mean age of 35.5 months (range 3 weeks to 18 years). The median age of onset of symptoms was less than 1 month. Symptoms and indications for surgery included regurgitation (88%), failure to thrive (52%), reflux-associated pulmonary symptoms and aspiration (48%), biopsy evidence of esophagitis (35%) with heartburn (17%), dysphagia (18%), hematemesis (17%), anemia (13%), and hypoproteinemia (22%). Sixty-four percent of the patients had a syndrome or chromosomal abnormality, respiratory disease, or neuromuscular disorder. The barium contrast upper-gastrointestinal radiographic series, performed in all patients, identified structural [gastric outlet obstruction (2%), esophageal stricture (11%), erosive esophagitis (9%)], and functional abnormalities [gastroesophageal reflux (90%), barium aspiration (8%), esophageal hypoperistalsis (30%), delayed gastric emptying (4%)]. Barium contrast upper gastrointestinal radiographic series identified gastroesophageal reflux with a sensitivity of 90% (compared to history), was 50% sensitive and 92% specific for erosive esophagitis (compared to biopsy), was 59% sensitive and 74% specific for esophageal dysmotility (compared to esophageal manometry), and there was a significant (p less than 0.01) association between barium aspiration and prior evidence of aspiration pneumonitis. Esophageal manometry demonstrated a significantly (p less than 0.001) lower esophageal sphincter pressure in patients compared with controls, but no significant correlation with failure to thrive, aspiration pneumonia, biopsy evidence of esophagitis, or parameters of the 24-hour esophageal pH study. Twenty-four hour pH monitoring showed significantly (p less than 0.05) more reflux episodes than in asymptomatic controls and there was significant (p less than 0.05) correlation between the percentage of time pH was less than 4 and the presence of hypoalbuminemia, and biopsy-proven erosive esophagitis or Barrett's esophagus. Endoscopic appearance was 91% sensitive and 60% specific for esophagitis when compared to biopsy. Nissen fundoplication was completely effective at resolving gastroesophageal reflux in 83%, and associated with marked improvement in 15%. No patient died as a result of fundoplication. Major complications included: recurrence of symptoms requiring reoperation (2%), subsequent mechanical bowel obstruction (8%), wound infection or pneumonia (12%).
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PMID:Investigation and outcome of 121 infants and children requiring Nissen fundoplication for the management of gastroesophageal reflux. 227 17

Gastroesophageal reflux is a common disorder that can be responsible for respiratory disease and is not considered as an inherited condition. We report five families with several affected members. Other familial cases have been published and some authors have suggested that transmission occurs on an autosomal dominant basis. Only prospective studies could determine whether GER is an inherited disorder, but at present their feasibility is limited since currently available diagnostic investigations are not suitable for screening.
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PMID:[Familial forms of gastro-esophageal reflux]. 236 44

Gastroesophageal reflux is an important cause of chronic respiratory disorders. In at least two common pulmonary conditions, chronic bronchitis and asthma, there may be a ying-yang association between the pulmonary disease and gastroesophageal reflux. Gastroesophageal-provoked disease needs to be evaluated in patients with chronic respiratory disease whose condition is progressing in spite of adequate medical therapy; whose history strongly supports this concept; and whose laboratory tests suggest a causal relationship. Recognition and treatment of gastroesophageal reflux, either medical or surgical, can benefit respiratory problems of many patients.
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PMID:Gastroesophageal reflux and diseases of the respiratory tract: a review. 270 34

Long-term oesophageal pH monitoring has become the preferred technique for detection and quantification of gastro-oesophageal reflux (GOR). The most obvious advantages of pH monitoring are the duration of the investigation, the possibility of being able to relate "events" (emesis, heartburn, apnoea) to pH changes (and to study "occult GOR"), the physiological conditions in which the data are recorded (sleep, work), and the possibility of repeating the investigation in treatment conditions. However, it has been reported that the accuracy of pH monitoring is no higher than 90%, because the intermittent presence of acid in the oesophagus is only one of the various abnormalities in the syndrome of GOR. A tremendous number of technique- (pH monitoring system, type of electrode, location of the electrode) and patient-related factors influence pH data. Age, position (both for adults and for infants), duration of the investigation (day/night), feeding and drugs are patient-related factors. Finally, the question arises (which is still unanswered) whether the indication for pH monitoring should be considered in the interpretation of the data: are the same criteria valid for GOR in children presenting with emesis and oesophagitis as for children with GOR resulting in chronic respiratory disease or "near-miss sudden infant death syndrome".
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PMID:PH monitoring in children. 272 3

Gastro-oesophageal reflux was demonstrated in 5 cases of bronchiolitis obliterans with apparently cryptogenetic organizing pneumonia. In addition, one patient had hiatus hernia and another, oesophageal diverticulum. In 4 patients, after failure of prolonged antibiotic therapy, medical or surgical treatment of the gastro-oesophageal reflux resulted in regression of the clinical and radiological signs of pulmonary lesions. The cure thus obtained persisted throughout a follow-up period of 2 months to 8 years. Gastro-oesophageal reflux therefore could be one of the causes of apparently cryptogenetic bronchiolitis obliterans with organizing pneumonia, and all patients with this respiratory disease should be investigated for gastro-oesophageal reflux.
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PMID:[Bronchiolitis obliterans with cryptogenetic-like organizing pneumonia. Demonstration of gastro-esophageal reflux in 5 cases]. 297 80

Choice of therapeutic approach remains difficult in patients with gastro-oesophageal reflux and respiratory symptoms. Except in children in whom microaspiration has been demonstrated it is very difficult to predict which ones are going to be relieved from their respiratory disease after GER treatment. In 1981 Jolley and coll. found that the mean duration of nocturnal episodes of reflux (MDNR) in extended pH-metering excluding post-cibal hours could differentiate not only patients with and without respiratory manifestations, but also those in whom respiratory tract disease will disappear after GER treatment from those in whom this will be useless. Only some references on this topic have been published ever since. We have reviewed the charts and pH tracings of the 70 patients with respiratory disease and GER treated in our service aiming at assessing the real value of this parameter in our hands. Fifty-two cases could be evaluated: 41/52 were either improved or completely relieved from their respiratory manifestations (79%) where has the remaining 21% were unchanged by GER treatment. In the first group MDNR was 13.1 +/- 9.7 min and in the second one it was 6.3 +/- 4.6 (p less than 0.05). Our results confirm that MDNR is a valid parameter in order to make prognosis in this particular group of patients.
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PMID:[The average duration of nocturnal reflux in the prognosis of respiratory problems associated with gastroesophageal reflux]. 344 66

A retrospective study based upon 100 consecutive antireflux operations performed in children for gastroesophageal reflux (GER) in the last 9 years enables the authors to elaborate on indications and their timing. The clinical pictures, often combined in this series, were vomiting (85%), respiratory disease (50%), failure to thrive (47%), haemorrhage (25%), brain damage (16%), rumination (6%), oesophageal stenosis (4%), torticollis (3%) and cricopharyngeal dysphagia (1%). Five children had been previously operated upon for oesophageal atresia. Hiatal hernia was found in only 10 instances. Only 9 children were operated upon before the age of 12 months. Overall operative age was high (52.5 months) and that of patients with neurologic disease was even higher (81.3 months) probably as a result of delayed diagnosis. This experience underlines the limitations of medical treatment beyond the age of 12 months, the poor reliability of disappearance of vomiting as an index of cure during the first year and the need for facing operative indications without prejudgements based on traditional ideas that do not take into consideration clinical manifestations of GER disease which are currently well established.
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PMID:[Indications for the surgery of gastroesophageal reflux in children]. 363 70

Thirty-eight children, aged from a few weeks to 7 years, with severe chronic pulmonary disease and without gastrointestinal symptoms, were investigated for gastroesophageal reflux (GER), using prolonged pH probe monitoring and gastroesophageal scintiscanning. All treatments were discontinued before testing. GER was found in 24 patients (63%) (group I) and it was not observed in 14 patients (group II). All patients of group I received antireflux treatment, consisting of cisapride; in 22 of 24 patients, GER was controlled, as indicated by improvement of either pH monitoring or scintiscanning, or both. Eighteen of these 22 (82%) had remission of their pulmonary disease, and only two patients of group II (14%) had spontaneous remission of the respiratory symptoms. We concluded that GER was probably the cause of the respiratory disease in 63% of our patients, since treatment of GER was followed by disappearance of the respiratory complaints in most of them. The combination of gastroesophageal scintiscanning and pH probe study improved the diagnostic accuracy.
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PMID:Gastroesophageal reflux and unexplained chronic respiratory disease in infants and children. 365 24


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