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)

Sixteen children, aged 2 to 5 years and ranked ASA 1, were included in this study assessing gastro-oesophageal reflux occurring under halothane anaesthesia, before and during, caudal anaesthesia. They were scheduled for surgery below the umbilicus lasting 1 to 5 h. After premedication with oral hydroxyzine (2 mg.kg-1) and intravenous atropine (10 micrograms.kg-1), induction was carried out with 3% halothane. A gastro-oesophageal pH probe was inserted via the nose after calibration at 37 degrees C. A neutral pH for the oesophageal electrode and an acid pH for the gastric one demonstrated the correct position of the probe. The pH was then registered every 4 s. The probe was left in situ until the patient left the recovery room. The caudal anaesthesia catheter was then inserted with the patient lying on his left side. Caudal anaesthesia was began with 2.5 mg.kg-1 of plain bupivacaine and 5 mg.kg-1 of plain lidocaine. When the patient was lying supine again, narcosis was maintained with 0.5% halothane and 50% nitrous oxide. A dose of 1.5 mg.kg-1 of bupivacaine was injected every 30 to 45 min. None of the children displayed any respiratory signs (coughing, dyspnoea, bronchospasm, cyanosis) during the combined anaesthetic. Two episodes of asymptomatic gastro-oesophageal reflux were revealed by this method, one lasting 7 minutes and occurring during insertion of the caudal catheter, and the other, lasting 4 minutes, during recovery. There were no pulmonary sequels. There was excellent respiratory and haemodynamic stability throughout. The two episodes seemed to have been triggered off by rapid displacement of the patient and too deep an anaesthetic.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Gastroesophageal reflux with combined caudal and halothane anesthesia in children]. 144 13

The preceding discussion has consisted of a review of the technical and clinical aspects of pediatric multichannel recordings, which have become a widely used procedure in the clinical evaluation of infants with various apnea syndromes. It has been shown that multichannel recordings are superior to two-channel pneumocardiograms. Multichannel recordings should therefore be considered in all infants with unexplained episodes of apnea, bradycardia or cyanosis, in order to clarify the type of apnea and to rule out underlying conditions such as gastroesophageal reflux or seizures. The role of multichannel recording in predicting the risk of further apnea and SIDS, however, remains questionable. The clinical introduction of documented monitoring in the home setting with integrated pulse oximetry and a method for monitoring respiratory airflow might help to identify those infants at risk for apnea and SIDS in the future (see article by Weese-Mayer and Silvestri). Nevertheless, multichannel recordings in the hospital have provided a useful tool in the initial evaluation of many infants with infant apnea, and, for SIDS research, they have been useful for evaluating the complex autonomic control mechanisms during sleep and wakefulness.
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PMID:Multichannel polysomnographic recording for evaluation of infant apnea. 146 96

Gastroesophageal reflux (GER) usually presents with digestive symptoms, failure to thrive, and/or respiratory symptoms. During the 8-year period from 1981 to 1989, 1,153 children underwent 20-hour pH monitoring to assess GER. All patients were graded using the scoring system of Euler and Byrne. Patients were classified as severe (score greater than 50), moderate (score 25 to 50), and normal (score less than 25). Five hundred (43.3%) of these patients presented with respiratory symptoms including apnea, cyanosis, or "near miss" sudden infant death syndrome (36%), poorly controlled asthma (28%), recurrent bronchopneumonia (13%), bronchiolitis (9%), and miscellaneous symptoms such as intermittent dyspnea, chronic cough, and stridor (12%). Eight patients (2%) had cystic fibrosis. The ages ranged from 1 month to 20 years (mean, 19.5 months). Twelve patients had technically inadequate studies and were excluded. Severe reflux was present in 156 patients (31%) and moderate reflux in 159 patients (31%). All patients were treated initially by medical therapy for a minimum of 8 weeks. The majority of patients (81%) had resolution of their symptoms with change in position, thickened feedings, and, when indicated, additional therapy with metoclopramide, cisapride, or domperidone. Most of these patients were found to have a specific position, usually prone, which decreased reflux. The remaining 57 patients had documentation of persistent reflux by pH monitoring and underwent an antireflux procedure. Of those patients undergoing surgery 51 had severe reflux and 6 had moderate reflux. Forty-four patients had a posterior 270 degrees wrap (Toupet), 10 had a 360 degrees wrap (Nissen), and 3 had an anterior 180 degrees wrap (Boix-Ochoa).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Diagnosis and treatment of gastroesophageal reflux in 500 children with respiratory symptoms: the value of pH monitoring. 203 Apr 75

Eight infants with histories of apnea and cyanosis were referred to the Southwest SIDS Research Institute for evaluation of apparent life threatening events (ALTE). All of the infants had been treated for colic with a 1:1 concentration of dimenhydrinate (Dramamine) and phenobarbital, hyoscyamine sulfate, atropine sulfate and scopolamine hydrobromide (Donnatal). The medication was pre-mixed by local pharmacists. A comprehensive work-up failed to reveal a cause for the ALTE in any infant. The Dramamine/Donnatal mixture was withdrawn and polygraphic evaluation was conducted. Cardiorespiratory abnormalities were identified in all eight infants and significant gastroesophageal reflux (GER) was documented in four. The possibility that colic medication contributes to cardiorespiratory instability and GER in vulnerable infants requires serious consideration and further evaluation.
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PMID:Colic medication and apparent life-threatening events. 204 36

From January 1984 through August 1986, 130 infants were referred to our department with a history of apnea, hypotonia, and cyanosis or pallor, suggesting near-miss sudden infant death syndrome. Protocol consisted of medical history, clinical examination, overnight polygraphic recording, and cardiologic, gastrointestinal, metabolic, neurologic, and toxicologic workups. In 49 of these infants who needed vigorous stimulation or mouth to mouth resuscitation, the event occurred shortly after feeding. Combined, continuous esophageal pH monitoring and polygraphic recording in these 49 infants showed pathologic gastroesophageal reflux (GER) in 34 patients. An abnormal overnight polygraphic recording was observed in 8 of 34 infants with pathologic GER. Other investigations led to etiologic diagnoses in 42 of the remaining infants. Severe GER was frequently found in children with apnea after feeding but clearly is not the only mechanism involved. Infants with a history of apnea after a feeding should be investigated for GER and appropriately treated.
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PMID:Gastroesophageal reflux in infants with a history of near-miss sudden infant death. 207 21

In 20 children hospitalized in the age range from 2 months to 7 years the clinical manifestations caused by radiologically demonstrated gastro-oesophageal reflux were analysed. The main symptoms were from the digestive tract and respiratory system. In this group of children this reflux was also the cause of deficient body weight and attacks of apnoea with cyanosis.
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PMID:[Clinical aspects of gastro-esophageal reflux in children]. 208 78

We investigated brainstem auditory evoked potentials (BAEP) in 20 infants at risk of SIDS (age 5 days to 4 months) and in 7 control infants (age 5 days to 4 months). 19 infants were diagnosed as having sleep apnea syndrome (SAS), which we consider to be a possible risk factor for SIDS. The diagnosis of SAS was made in general in the presence of clinical symptoms such as apneas, cyanosis during sleep, poorly coordinated sucking, swallowing and respiration and gastro-oesophageal reflux in combination with an abnormal pneumogramm in a one hour oxycardiorespirography. One infant had the history of a near miss event but a normal pneumogramm, 2 infants, both with SAS, were siblings of SIDS infants. We applied BAEP on 12 infants at risk of SIDS with and on 12 infants at risk of SIDS without aminophyllin treatment. 3 infants at risk of SIDS had two BAEP studies, one before and one during aminophyllin treatment. The time interval between these two studies was 1 week to 16 days. Aminophyllin, given only to infants with SAS was administered orally (therapeutic range 4-10 micrograms/ml). All infants at risk of SIDS and all control infants had normal I-V-IPL (below 2 x SD). There was a tendency to longer I-V IPL in infants at risk of SIDS. When infants at risk of SIDS with and without aminophyllin treatment were compared as a group the I-V-IPL was shorter in the infants with aminophyllin. BAEP can be useful in studying disturbances of the autonomic function of brainstem centers but do not allow the prediction of an individual SIDS risk.
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PMID:[Acoustically evoked brain stem potentials in infants at risk for SIDS with and without aminophylline therapy]. 279 43

In a material of 25 patients with gastro-oesophageal reflux (GER), 11 had cerebral damage, 15 had symptoms of oesophagitis and 18 had respiratory problems including here six cases of apnoea with cyanosis and bradycardia resembling near-miss sudden infant death syndrome (SIDS). Only two of the children recovered acceptably on conservative treatment and the remainder were submitted to operation. Operation had insufficient effect in 30%. Cerebral damage or atresia of the oesophagus were present in all of the patients in whom operation was without effect. All children with symptom-producing GER should first be submitted to conservative treatment for at least three months and operation should be offered in cases where this treatment fails. Children with chronic or recurrent respiratory symptoms without other explanation and all children with episodes of apnoea and near-miss SIDS should be examined for the presence of GER.
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PMID:[Gastroesophageal reflux in children. An overlooked disease]. 280 4

Pneumograms of 33 fullterm infants (age 1-16 weeks) with idiopathic sleep apnea syndrome (SAS), treated with aminophyllin administered orally, were compared with pneumograms of 12 age-matched infants without aminophyllin treatment. In a one hour oxycardiorespirography (OCRG) all infants had pneumogram abnormalities defined as apneas greater than or equal to 15 s, greater than or equal to 3 apneas lasting 10 s, MA-value (mean duration of all apneas during sleep time) greater than or equal to 7 s/min, and greater than or equal to 3 episodes of periodic breathing. The diagnosis of an SAS, discussed as a possible risk factor of SIDS, was made in general in the presence of clinical symptoms such as apneas, cyanosis during sleep, poorly coordinated sucking, swallowing and respiration, and gastro-esophageal reflux (GER) in combination with an abnormal pneumogram. Of the 33 infants 12 with a history of an SIDS sibling were clinically asymptomatic. We found that after one week of aminophyllin treatment in 88% the pneumograms were normal. The mean plasma concentration of aminophyllin at this time was 8.3 micrograms/ml (range 4-19 micrograms/ml). All abnormalities showed a statistically significant reduction. In the infants without aminophyllin the pneumogram was still abnormal and no abnormality was significantly reduced. After at least 6 weeks we discontinued aminophyllin and one week later we monitored the OCRG. In 83% of the infants we found a normal pneumogram and compared to the initial pneumogram there was again a statistically significant difference.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Effect of aminophylline therapy in mature infants with sleep apnea syndrome]. 321 Nov 67

The case of a 3-week-old male infant is described. After receiving an iatrogenic overdose of metoclopramide (1.0 mg/kg every six hours) throughout a 36-hour period for the treatment of suspected gastroesophageal reflux, he became cyanotic, lethargic, and irritable, he fed poorly, and he had diarrhea and respiratory distress. Methemoglobinemia (20.5%) and reduced oxyhemoglobin saturation (79%) were identified. The patient had an excellent clinical response following a single IV dose of methylene blue. Subsequently, methemoglobin reductase activity was normal and there was no measurable hemoglobin M. The diagnosis of methemoglobinemia should be considered in any infant receiving large doses of metoclopramide who has clinical findings of cyanosis, ashen color, or a history of lethargy and/or motor restlessness.
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PMID:Metoclopramide-induced methemoglobinemia. 340 65


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