Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0017168 (gastroesophageal reflux disease)
 11,783 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Nissen fundoplication is a frequently performed procedure by pediatric surgeons for the treatment of gastroesophageal reflux. Reoperation for failed fundoplication is necessary in 10 per cent of children and in 25 per cent of neurologically impaired children. In an attempt to reduce the postoperative recurrence of gastroesophageal reflux and wrap herniation, we have modified our Nissen fundoplication by reinforcing the crural repair with a horseshoe-shaped prosthetic patch. Between 1993 and 1995, 38 children underwent a Nissen fundoplication with prosthetic patch crural repair. Tension-free crural repair was performed over an esophageal dilator by suturing a horseshoe-shaped Dacron patch posterior to the esophagus. After crural repair, the standard Nissen 360 degrees wrap was constructed. Of the 38 children, 56 per cent (n = 21) were neurologically impaired. In 18 per cent of patients, the operation was performed for recurrent reflux due to wrap herniation after a Nissen fundoplication without prosthetic patch repair. One child required esophageal dilatation postoperatively for dysphagia related to esophageal stenosis. After a mean follow-up of 15 months, all patients were without symptomatic reflux or had no radiographic evidence of recurrent reflux or wrap herniation. Tension-free crural repair with a prosthetic patch may decrease postoperative reflux and wrap herniation, particularly in neurologically impaired children and in children requiring reoperation for recurrent reflux.
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PMID:Prosthetic patch stabilization of crural repair in antireflux surgery in children. 945 40

Knowledge of the competence of the oesophago-gastric junction (OGJ) is fundamental to the understanding of gastro-oesophageal reflux disease (GORD), a disorder with a high incidence among the general population. A catheter with a bag 9.5 cms long mounted towards the distal end was swallowed by three volunteers. Using manometry readings and the point of respiratory inversion as a guide the probe was placed in the OGJ. The bag was distended with saline at a fixed rate volume before and after the administration of butylscopolamine to block cholinergic-mediated contractile smooth muscle activity. Using impedance planimetry three cross-sectional areas (CSA) measurements were made between three pairs of electrodes with 4 mm between each electrode on the catheter placed inside the ballon. Using the law of Laplace, CSA and pressure data could be calculated to give wall tension. Tension rose in all volunteers as the radius increased and it was higher towards the proximal end of the OGJ indicating that this measurement can be used to show the distensibility of the OGJ at different degrees of opening. This technique could be useful in identifying changes in the competence of the lower oesophageal sphincter in some patients with GORD.
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PMID:A new measurement of oesophago-gastric junction competence. 1550 May 10