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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 (GER) may induce severe complications in infants: besides esophagitis numerous authors have established a relationship between GER and relapsing respiratory infections, between GER and apnea, cyanosis or bradycardia. This required a more precise estimation of the postural treatment than the clinical data of vomiting or the weight curve. Esophageal pH studies are considered to be the most valuable investigational technique in case of GER. It allowed us to study the importance of acid reflux in 43 patients under 1 year of age in different postures: 45 degrees upright in an infant-seat, horizontal prone and 30 degrees prone positions.
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PMID:[Gastroesophageal reflux in infants. Value of orthostatism and ventral decubitus]. 356 41

Esophageal pH monitoring is now the most reliable test in the diagnosis of gastroesophageal reflux (GER) in infants and children. A 18-24 hr esophageal pH monitoring is undertaken in 26 newborns to validate this test for this age group where GER is frequent with fair correlation of clinical presentation. In 19 infants with suspicion of GER, this test give a positive diagnosis in 12 of them. Seven out of these 12 infants have another investigations (barium- esophagram - scintigraphy - esophagoscopy) with only a positive diagnosis of GER in 4 cases. Esophageal pH monitoring in 7 control infants show that the percent of monitoring time with pH below 4.0 is one of the best discriminative values (upper limit: 4.2%) for the diagnosis of GER. Unusual symptoms of GER in the neonatal period as apneic spells, dyspnea, cyanosis or neurological signs are indications for esophageal pH monitoring.
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PMID:[Esophageal pH measurements in newborn infants. Value and indications]. 364 8

127 cases of tracheal dyskinesia were seen in infants and children out of which 87 were 1 to 12 months of age. The diagnosis was based on the existence of a collapse reducing the tracheal diameter of more than 50% on endoscopy. Endoscopic examination was performed without general anesthesia. This material represents 5,8% of the patients submitted to this procedure. 85 patients had "primitive" dyskinesia and 42 had major associated abnormalities. Uni or bilateral bronchial dyskinesia was associated in 43% of the cases. The four commonest presenting symptoms were a stridulous or wheezing respiration, recurrent bronchitis, chronic cough, cyanosis. The frequency of associated digestive troubles: gastroesophageal reflux aspiration was noteworthy. Several functional consequences were encountered: hypoxemia, hypercapnia, abnormalities of FRC, increased RL, lowering of dynamic compliance, alterations of perfusion and ventilation on scintiscans. The prognosis was good in primitive cases. Two deaths occurred, in the group with associated abnormalities. The pattern of the patient with primitive dyskinesia and that of the patient with dyskinesia and associated abnormalities are outlined. Some features remarkable in this series of patients are pointed out in a discussion of the pathophysiology of the syndrome. Increased transmural pressure is not a common cause of tracheal dyskinesia and infection as well. The possibility of a temporary intrinsic anomaly of the tracheal wall is suggested. Even if its exact mechanism remains unknown, tracheal dyskinesia is a distinct entity observed in infants and children. It appears as a common cause of recurrent bronchopulmonary disease in the young.
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PMID:[Tracheal dyskinesia (tracheomalacia) in infants and children. Study of 127 cases diagnosed through endoscopic examination (author's transl)]. 626 18

Because nonepileptic disorders may cause episodic and paroxysmal symptoms that resemble epilepsy, these conditions and syndromes must be considered in the differential diagnosis or when antiepileptic drugs are ineffective. Gastroesophageal reflux usually presents as recurrent vomiting in infants and young children. A small subgroup of infants develop apnea and cyanosis accompanied by posturing of the limbs, deviation of the eyes, or opisthotonos, which leads to the incorrect diagnosis of epilepsy. Breathholding spells and pallid infantile syncope, common in infants and young children, may also be mistaken for epileptic attacks. The parasomnias, including pavor nocturnus and somnambulism, are frequently mistaken for epilepsy, since these nocturnal episodes are paroxysmal in nature, may be associated with automatic behavioral mannerisms, and tend to be recurrent. Migraine is especially difficult to differentiate from epilepsy because its manifestations, particularly in children, are so diverse. Other disorders that may superficially mimic epilepsy include transient ischemic attacks, syncope, and transient global amnesia.
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PMID:Differential diagnosis of episodic symptoms. 661 95

Of 62 children (1-24 months of age) evaluated for esophageal disease, 22 were found to have pulmonary symptoms of apnea, pneumonia, wheezing, cyanosis, cough and stridor. Upper gastrointestinal series showed free gastroesophageal reflux in 10 of 22 infants; 3 were thought to have stricture. Acid-reflux test was positive in 13 of 15 and correlated with the presence of esophagitis in 12. In addition to esophagitis, endoscopic examination found two foreign bodies and an esophageal stricture unrecognized during fluorescopy. Endoscopic grasp biopsy was inadequate in most infants for the histologic evaluation of esophagitis. However, suction biopsy correlated well with endoscopically diagnosed esophagitis. In infants where medical therapy failed and symptoms were life-threatening, a Nissen fundoplication resulted in excellent resolution of symptoms. In children who present with prolonged and often life-threatening symptoms, esophageal dysfunction should be evaluated by rigorous testing.
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PMID:High incidence of pulmonary symptoms in infants evaluated for esophageal disease. 743 51

Tracheal compression is one of the many causes of apnea following repair of esophageal atresia with tracheoesophageal fistula. Since May, 1977 we have treated eight patients with "dying spells" usually occurring during and following a feeding. These episodes were characterized by cyanosis and bradycardia, which progressed to apnea. Tracheal compression was documented to be the etiology of the apnea spells. Other possible causes such as aspiration from gastroesophageal reflux, recurrent tracheoesophageal fistula and esophageal stricture were eliminated. Eight infants underwent aortopexy that was successful in terminating the apneic episodes in seven patients with an average follow-up of 20 mo. One patient continued to have symptoms from a previously undiagnosed vascular ring which was successfully divided one month following aortopexy. After being asymptomatic for 1 mo this infant died from a cardiorespiratory arrest at home. An autopsy did not reveal the cause. Intermittant tracheal obstruction leading to apneic spells is a life-threatening entity following tracheosophageal fistula repair, which can be corrected by aortopexy.
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PMID:Tracheal compression as a cause of apnea following repair of tracheoesophageal fistula: treatment by aortopexy. 746 84

Gastroesophageal reflux (GER) in infants is most commonly thought of as repeated excessive vomiting and failure to thrive, with most infants responding favorably to medical therapy. However, GER may also manifest exclusively with a variety of respiratory symptoms that, if not detected and treated early, may lead to life-threatening complications. During the period of 1987 to 1992, 39 neonates and infants underwent Nissen fundoplication for the treatment of respiratory symptoms attributed to GER. Symptoms included apnea and bradycardia (64%), pneumonia (31%), cyanosis (28%), cough (18%), and stridor (15%). Most patients were ascribed at least one incorrect diagnosis to explain respiratory symptoms. These include apnea of prematurity (38%), bronchopulmonary dysplasia (31%), asthma (8%), and subglottic stenosis (8%). All patients underwent a variety of investigations and medical treatments without noticeable clinical improvement. These included bronchoscopy, esophagoscopy, and polysomnograms. Treatment such as antibiotics, theophylline, bronchodilators, steroids, and oxygen were directed at presumed primary respiratory disease. On the other hand, H2 blockers, metoclopramide, positioning, and thickened feeds were prescribed to treat GER without objective evidence of disease. Ultimately, GER was demonstrated by upper gastrointestinal series in 64%, pH probe in 61%, and both studies in 38%. All patients underwent Nissen fundoplication after failed attempts at medical therapy. A total of 95% of patients had resolution or substantial improvement of respiratory symptoms postoperatively. Preoperative hospitalization averaged 37.0 days, and postoperative stay averaged only 14.2 days. We present a series of patients with GER, all of whom presented with respiratory symptoms.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Diagnosis and treatment of respiratory symptoms of initially unsuspected gastroesophageal reflux in infants. 794 42

Forty-eight patients with repaired congenital oesophageal anomaly underwent aortopexy for significant tracheomalacia between 1980 and 1990. Indications for aortopexy included recurrent apnoea/cyanosis in 31, near fatal episodes in 16, recurrent respiratory distress and infection in 20 and worsening stridor in 15. Gastro-oesophageal reflux was noted in 30 patients, recurrent fistula in 6 and oesophageal stricture in 14. Aortopexy cured near fatal episodes in all patients and resulted in improvement of airway obstruction in 95%. The procedure failed in 2 patients due to unrecognised bronchomalacia and phrenic nerve palsy respectively. Aortopexy is the primary procedure of choice for significant tracheomalacia when associated with near fatal episodes and significant airway obstruction.
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PMID:Aortopexy for tracheomalacia in oesophageal anomalies. 829 76

A relationship between neurovegetative symptoms and an increased risk of sudden infant death (SID) has been frequently described. Such symptoms are vomiting because of gastroesophageal reflux, breathing disorders while nutritive sucking, excessive sweating during sleep, prolonged apneas and apneas with associated symptoms, further unexplained episodes of cyanosis, pallor and loss of muscle tone. An acute decompensation of the cardiorespiratory autonomic system during sleep is currently discussed to be one of the causes of SID. Polysomnographic investigations are used to diagnose sleep related cardiorespiratory autonomic dysfunction. In this study, infants up to the age of 5 months were examined using polysomnography throughout their entire nocturnal sleep. The findings from 79 infants with neurovegetative symptoms were compared with the results from 163 healthy control children. Indications of an impaired respiratory regulation during sleep were shown to be significantly more frequent in infants with neurovegetative symptoms. In particular the occurrence of periodic breathing with a high frequency of periodic apnea plus a large number of acute decreases in oxygen saturation could be shown in infants with neurovegetative symptoms. The findings were most pronounced during the first 1.5 months after birth. The results of this investigations lead to the conclusion that, in the case of young infants with breathing abnormalities, neurovegetative symptoms can frequently be observed. The occurrence of such symptoms should therefore be a reason for a polysomnographic examination.
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PMID:[Neurovegetative symptoms in infants with sleep-related respiratory disorders]. 919 72

We reviewed the 9 year experience at the Children's Hospital of Philadelphia with patients requiring tracheotomy for a diagnosis of congenital airway abnormalities. Of the 56 patients, 28 (50%) had cardiovascular, or chromosomal abnormalities, neurologic conditions, or congenital syndromes, 24 (43%) were born prematurely, and 13 (23%) were found to have gastroesophageal reflux. Only 18 (32%) went on to eventual decannulation of their tracheotomy with a mean tracheotomy duration of 1.75 years. The majority of patients (75%) had multiple presenting signs. Stridor was the most common (54%), followed by accessory respiratory effort (39%), cyanosis (30%), apnea (29%), and failure to thrive (23%). Twenty eight patients (50%) had multiple airway abnormalities contributing to their need of a tracheotomy for airway protection orr ventilator dependence. Laryngeal abnormalities were found in 71% of patients, tracheal abnormalities in 48% of patients, bronchial abnormalities in 11%, and upper airway obstruction in 14%. Of the laryngeal abnormalities, laryngomalacia was the most common, followed by subglottic stenosis, glottic web, and vocal cord paralysis. Tracheomalacia was the most common tracheal abnormality. The relatively large percentage of patients with cardiovascular or other major malformations, and prematurity, accounts for comorbid factors in the need for prolonged tracheotomy (and low early decannulation rate). Although gastroesophageal reflux was found in a recognizable portion off the patients, it is unclear whether this represents a comorbid condition.
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PMID:Congenital airway abnormalities requiring tracheotomy: a profile of 56 patients and their diagnoses over a 9 year period. 966 53


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