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

Gastroesophageal reflux was looked for in 51 children with chronic obstructive respiratory disease (CORD) using prolonged pH monitoring. An index of reflux aggressivity dependent on both duration and acidity of refluxed material was calculated. This index was significantly related to the macroscopic endoscopic findings, patients with an elevated acidity index having more severe "endoscopic esophagitis" than patients with a normal acidity index. We conclude that the finding of normal, erythematous or destructive esophagitis at endoscopy has at least some clinical relevance.
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PMID:Is the macroscopic aspect of the esophagus at endoscopy indicative of reflux esophagitis? 394 7

The association between gastro-oesophageal reflux (GER) and respiratory disease is well studied and established. A causal relationship, except in the case of clear cut aspiration, continues to elude proof but is supported by an increasing body of clinical experience. Barium oesophagram is the logical first test to demonstrate reflux, to rule out distal obstruction, and to provide good imaging of the oesophagus. Extended (24 h) oesophageal pH monitoring has proven to be the most reliable test in our hands for the identification of abnormal reflux. The false negative rate with this test was 12%, and false positives were seen only 6% of the time. Radionuclide scintigraphy offers the theoretical possibility for absolute correlation between reflux and aspiration, but in practice the results have been disappointing. Where other treatment measures have failed and where objective tests and clinical evidence point to the probability that respiratory disease is reflux-induced, anti reflux surgery is justified and most often strikingly successful. A Nissen fundoplication with a loose wrap and a short cuff is still the standard treatment for antireflux surgery. Long term follow-up suggests the benefits of antireflux surgery outweigh the occasional complications and side effects where operation is performed to control otherwise intractable reflux-associated symptoms.
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PMID:Gastro-oesophageal reflux and respiratory disease: the place of the surgeon. 659 62

Recent advances in technology have made it possible to detect gastroesophageal reflux (GER) through monitoring of esophageal pH, lower esophageal sphincter pressure, and esophageal motility for prolonged periods, including sleep. When these methods are applied to patients with chronic respiratory disease, as many as 65% have GER; improvement in respiratory status has often been reported after treatment of the GER. This article reviews the evidence for the association between GER and chronic respiratory disease, the possible physiologic mechanisms underlying this association, and the implications for therapy.
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PMID:Gastroesophageal reflux and chronic respiratory disease. 671 6

The therapeutic effects of positioning and state of alertness were evaluated in 79 patients with gastroesophageal reflux (GER) and 49 nonreflux patients by extended esophageal pH monitoring during the two-hour postprandial period. The amount of GER in nonreflux patients was not significantly affected by changes in position or state or alertness whereas patients with GER demonstrated consistent decreases in the percent time and frequency of reflux episodes while asleep compared wtih being awake. In patients with GER, less reflux occurred while upright than supine during awake but not during asleep periods. The 30-degree elevated prone position was superior to the supine or upright positions while patients were awake or asleep. A beneficial effect of the 30-degree elevated supine position was not noted. Patients with respiratory disease, with severe esophagitis, or who required surgical correction of GER all responded to positioning or alertness changes in the same manner.
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PMID:Effectiveness of positioning therapy for gastroesophageal reflux. 707 42

Twenty children with respiratory disease ingested 500 muCi of Tc-99m sulfur colloid orally, and scintigrams of the thorax were obtained to determine whether pulmonary aspiration of gastric contents could be detected. The children ranged in age from 1 mo to 14 yr; 13 were 8 mo of age or younger. Children were studied at 5 min and 4 hr after ingestion of Tc-99m sulfur colloid using a high sensitivity computer oscilloscope to record 100K-count images. Additional images were obtained after the children had slept overnight. Five children (25%) showed definite pulmonary accumulation of activity; four of these also had a barium swallow and three showed either pulmonary aspiration of barium or moderately severe gastroesophageal reflux. Oral ingestion of Tc-99m sulfur colloid provides a noninvasive means for diagnosing pulmonary aspiration under physiologic conditions in infants and children.
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PMID:Detection of pulmonary aspiration in infants and children with respiratory disease: concise communication. 738 59

Respiratory diseases are frequently related to gastroesophageal reflux (GER). In the absence of classic symptoms like vomiting, silent GER can only be ruled out by further studies. Esophageal pH monitoring of long duration (18 to 24 hr) is now recommended as the technique of choice in infants and children with atypical presentation of GER. Mechanisms of GER pathway are complex and may provoke chronic pneumonia or wheezing; pH monitoring cannot be considered an "all or nothing" exam. Several esophageal pH profiles have been described in various respiratory diseases.
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PMID:Diagnostic procedures of GER in childhood lung disease. 754 23

In cases of severe gastroesophageal reflux with failed medical management over a period of 3 to 6 months and/or extreme aggravation of respiratory disease, surgical intervention is necessary. The operative choice in infants and the most commonly used and successful surgery for the control of gastroesophageal reflux is the Nissen fundoplication. Care of the infant with a Nissen fundoplication should be focused on meeting the needs of the infant and the family. An understanding of the disease process, effects of fundoplication, and family process are essential for the nurse practitioner in planning care for these infants and their families.
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PMID:Care of the infant with gastroesophageal reflux and respiratory disease: after the Nissen fundoplication. 756 9

Cystic fibrosis is an autosomal recessive disorder which affects one in 2500 live births. It is a multisystem disease and has a variety of presentations. The major clinical features affect the gastrointestinal and respiratory tracts. Severe respiratory disease, diabetes and gastroesophageal reflux are common features of concern to anaesthetists. Improved care of young patients has allowed many to survive into adulthood. Lung transplantation has significantly improved the outlook for many patients. At Alfred Hospital, 74 patients with cystic fibrosis underwent 149 procedures from January 1978 to January 1994, with a mortality of 0.6% (95% CI 0.4%-0.8%). This retrospective cohort study describes the anaesthetic management and perioperative care of these patients. Most of the anaesthetics were for procedures related to cystic fibrosis but 12% were for unrelated conditions. Cystic fibrosis related procedures include diagnostic, venous access, enteral feeding procedures, treatment of complications of cystic fibrosis and lung transplantation. Despite extremely poor respiratory function, these patients can be managed with acceptably low postoperative mortality (1%). Pre- and postoperative care must be directed towards optimal clearance of viscous respiratory secretions. Procedures need to be planned so that optimal care can be given by each member of the team caring for cystic fibrosis patients.
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PMID:Anaesthesia for adults with cystic fibrosis. 757 20

Spitting is a common occurrence in infants and is usually of no consequence. When regurgitation is accompanied by the return of gastric acids into the esophagus, however, it is considered to be gastroesophageal reflux. Failure to thrive, esophagitis, aspiration, chronic respiratory disease, and apnea can all be associated with pathologic gastroesophageal reflux. This paper discusses the causes, symptoms, and treatment modalities for pathologic gastroesophageal reflux. Health care practitioners can play a major role in providing direct care as well as coordinating and evaluating treatment interventions for infants with gastroesophageal reflux. In addition, health care providers can supply the families of these infants with the necessary education and emotional support required to care for their infant.
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PMID:Gastroesophageal reflux in infants. 761 22

Gastroesophageal reflux is often overlooked as both a cause and a complication of respiratory disease in children. The manifestations may be protean and may bear little clinical relationship to the gastrointestinal tract. However, a high index of suspicion for its potential role in unexplained respiratory symptoms may yield large benefits for the physician and patient alike.
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PMID:Respiratory manifestations of gastroesophageal reflux in children. 775 56


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