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

Episodic apnea leading to asphyxia is a relatively common disorder of young children. Important apnea syndromes include apnea of prematurity, "narrow upper airway syndrome," congenital hypoventilation syndrome, breath-holding spells, and "near-miss" sudden infant death syndrome. More recently described syndromes include apnea associated with feedings, regurgitation or gastroesophageal reflux, and apnea initiated by epileptic seizures. Apnea occurring during wakefulness is common and may be related to that occurring during sleep. Knowledge of the clinical features and pathophysiology of these various kinds of apnea is important in their management.
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PMID:Sleep apnea in infancy and childhood. 390 4

An evident coincidence exists between increased and extended apneas during sleep and frequent gastroesophageal reflux as well as disturbances of propulsive esophageal peristalsis. The tendency to develop apnea and disturbed esophageal function are related to the degree of the maturity of the patient. This indicates that in some infants, a combined regulatory immaturity of the autonomic centers persists. Moreover, the gastroesophageal reflux fosters the clinical manifestation of sleep apneas. The risk of a reflex apnea accompanied by gastroesophageal reflux increases in proportion to the disturbance in the central respiratory regulation present at the same time. This pathomechanism can be considered one of the causes of the sudden infant death syndrome. The possibility of effective prophylaxis consists in treating the apneic tendency with aminophylline and the treatment of reflux by elevating the upper body and thickening the nourishment given.
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PMID:Combined disturbance of respiratory regulation and esophageal function in early infancy. 392 31

The examination of the respiratory function in 184 sleeping infants gave evidence of a significant difference in several parameters between the so-called SIDS risk group and the control group. The risk group (97 babies) consists of 60 infants with frequent prolonged apneas, 30 infants with postnarcotic apneas and 7 near miss infants. Polygraphic registration during sleep showed significantly more apneas in the risk group. These apneas often appeared more frequently during certain periods. The average respiratory deficit expressed as the MA-value (MA = average apnea duration) in the risk group was significantly higher than in control infants. Besides that we were able to prove a more frequent pathological gastroesophageal reflux in the risk infants than in control infants.
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PMID:[Sleep apnea in infants and the risk of SIDS]. 395 42

Sudden infant death syndrome (SIDS) probably represents a number of specific processes rather than one disease, the causes of which have so far eluded scientists. Various hypotheses as to cause are discussed, as is the role of the emergency physician. Also considered are apparently life-threatening events such as prolonged sleep apnea, laryngeal-induced apnea, gastroesophageal reflux-induced apnea, and seizure-associated apnea.
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PMID:Sudden infant death syndrome (SIDS), apnea, and near miss for SIDS. 639 85

Knowledge regarding the etiology and optimal management of prolonged apnea and its relationship to SIDS is still limited. The majority of infants with prolonged apnea do not die of SIDS, although the risk of SIDS in this group is greater than in the general population. Many infants with prolonged apnea who are perceived by parents and physicians as having had a "life-threatening" event may be at risk for another. Appropriate assessment following this event includes a careful history and physical examination to determine cause and severity. Etiologies to be considered include infections, metabolic aberrations, seizure problems, cardiac arrhythmias or congenital heart disease, anatomic airway abnormalities, gastroesophageal reflux and impaired regulation of breathing. If a specific cause has been identified for the infant's apnea, appropriate treatment often will lead to resolution of the apnea problem. If a specific etiology has not been identified or if the risk of "life-threatening" prolonged apnea seems to persist, electronic cardiorespiratory monitoring may be considered. Appropriate treatment for asymptomatic infants who are at increased statistical risk of SIDS is controversial. Asymptomatic infants may be candidates for home monitoring, but as yet, there are no reliable tests to predict which infants are at risk for prolonged apnea. Monitoring at home must be prescribed by the physician and should be continued until judged no longer appropriate by the attending physician. Skilled caregivers are crucial to the continuous observation and management of these patients in the hospital and at home. Therefore parents should be taught monitor use and also CPR.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Evaluation and management of infantile apnea. 670 8

We have compared barium swallow with a radionuclide gastro-oesophageal scintigraphy (milk scan) method of detecting gastro-oesophageal reflux in 26 infants. In 17 cases, presenting as near miss sudden infant death syndrome, reflux was detected in 2 by barium swallow and in 8 by scintigraphy. In the remaining 9 infants with suspected pulmonary aspiration, reflux was demonstrated by barium swallow in 2 and by scintigraphy in four. Aspiration after gastro-oesophageal reflux was demonstrated only by the radionuclide scan. The feasibility of recording physiological variables during periods of reflux was confirmed.
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PMID:Gastro-oesophageal reflux in near-miss sudden infant death syndrome or suspected recurrent aspiration. 683 Mar 3

A wide range of clinical findings was present in 58 near-miss sudden infant death syndrome (SIDS) infants and 6 surviving twins of SIDS siblings. Specific investigations included: studies of gastro-oesophageal reflux and aspiration (24-hour oesophageal pH recordings, barium swallow, radionuclide 'milk-scan'); polygraphic studies of breathing, reflux, and sleep state; studies of upper airways disease (lateral airways radiography and endoscopy); detection of seizure activity by electroencephalography; evaluation of thiamine status by erythrocyte transketolase activity of venous blood. Thiamine deficiency was found in 12 of 43 tested infants; 5 of the deficient infants had a familial history of SIDS. Many potential mechanisms for asphyxia were found: idiopathic central apnoea (7 infants), tracheal obstruction from minimal tracheomalacia or aberrant innominate artery (4 infants), temporal lobe or generalised seizures (6 infants), gastro-oesophageal reflux (55 infants) with intrapulmonary aspiration (11 infants). The high incidence, severity, and timing of reflux were new findings. Reflux occurred in active and indeterminate sleep, but not in quiet sleep. The depression of respiratory reflexes by active sleep stresses the vulnerability to asphyxia. Two factors suggest that near-miss episodes are related to SIDS: the similar age distribution but earlier occurrence of near-miss episodes compared with age at death of SIDS infants, and the subsequent sudden death of 2 infants whose necropsies were consistent with SIDS.
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PMID:Multiple causes of asphyxia in infants at high risk for sudden infant death. 683 Mar 4

Barium esophagrams of 160 infants who were being examined for apneic episodes were obtained at a referral center for the investigation of sudden infant death syndrome (SIDS). The studies were standardized as closely as possible to evaluate swallowing, esophageal function and anatomy, and the gastroduodenal regions. The level and frequency of gastroesophageal reflux were carefully assessed. The most common abnormality identified was gastroesophageal reflux (54%). Other abnormalities included nasopharyngeal reflux (27%), aberrant right subclavian artery (3%), and aspiration into the airway (3%). Swallowing dysfunction, esophageal dysmotility, antral dysmotility, chalasia, and tracheoesophageal fistula were each found in less than 1% of the infants.
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PMID:Infant apnea: findings on the barium esophagram. 686 35

Forty-five term infants who had a "near miss" for SIDS were studied with a continuous overnight polygraphic recording of endoesophageal pH, respiration, and ECG. Recordings were examined for occurrences of GER and for central apnea of 10 seconds or greater duration. There were 341 apneic events greater than or equal to 10 seconds recorded in 46 studies, with a mean of 7 +/- 7. In 91% of the infants, no apneas exceeded 15 seconds. Only 31 episodes of apnea greater than or equal to 10 seconds occurred during GER: in two of these episodes the apneic event was greater than or equal to 15 seconds. Twenty-four of the 31 apneas greater than or equal to 10 seconds during periods of pH less than 4 occurred in one infant. A total of 356 precipitous pH drops was recorded (mean 8.7 +/- 7.4). The pH drops occurred most frequently when the patient appeared to be awake (73%), and in 84% of events there was movement before and during the pH change. We conclude that the majority of these near miss SIDS infants had GER associated with movement during awake periods, without any temporal relationship to apnea. Although reflex apnea following GER may be seen in some term infants, this problem may be more significant for the immature infant.
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PMID:Movement and gastroesophageal reflux in awake term infants with "near miss" SIDS, unrelated to apnea. 708 88

Although prior to 1950 esophageal hiatal hernia (EHH) in children was a seldom recognized entity, it has since then become well known. The symptoms in children are considerably different from those in adults. The cause of EHH is still somewhat in doubt. The term gastroesophageal reflux (GER) is often applied as a diagnosis where the diagnosis is uncertain. The authors have reviewed case histories of 56 patients admitted to the Hospital for Sick Children, Toronto, from 1972 to 1980. A comparison is made with 101 cases admitted between 1952 and 1960. It is our firm belief that all patients with symptoms of GER should be esophagoscoped for definitive diagnosis as well as for assessment of the esophagus. Because there is a high rate of respiratory complications in infants and children with GER, bronchoscopy should be carried out concurrently with the esophagoscopy. Infants with GER are at risk from the possibility of aspiration and it is possible that an unknown number of sudden infant death syndrome is due to this factor. The majority of patients with EHH can be managed by a medical regime. Those with esophageal strictures are treated by dilatation but many require surgical correction.
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PMID:Esophageal hiatal hernia in infants and children. 727 Nov 53


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