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)

Persistent gastrointestinal symptoms are common postoperatively in children with intestinal malrotation. We investigated this problem in 14 children with intestinal malrotation who had a Ladd procedure (3 patients), gastroschisis repaired (6 patients), or omphalocele repaired (5 patients) between one month and 15 years prior to study. In 13 patients, gastric emptying was measured at 30 minutes (%GE30) and at 60 minutes (%GE60) following ingestion of 99m-Tc sulfur colloid in apple juice. We estimated the degree of gastric peristalsis using the %GE corrected for immediate postcibal gastroesophageal reflux (corrected %GE). Patients with vomiting exhibited slow gastric emptying compared to patients without vomiting (%GE30: 14.0 +/- 5.5 v 32.5 +/- 4.2, P less than .005). The slow gastric emptying was related to slow gastric peristalsis (corrected %GE30: 20.3 +/- 5.0 v 47.1 +/- 6.0, P less than .005). In all 5 patients with persistent bloating and diarrhea, gastric peristalsis was rapid at 30 minutes (corrected %GE30 = 56.7 +/- 4.2) and at 60 minutes (corrected %GE60 = 69.5 +/- 5.3). To assess the role of gastroesophageal reflux (GER) in persisting symptoms, all children had extended (18 to 24 hours) esophageal pH monitoring. Eleven (79%) of the 14 patients demonstrated GER by esophageal pH monitoring, including four of six patients without reflux symptoms. All ten children under two years of age demonstrated GER regardless of symptoms or congenital anatomic abnormality. In conclusion, GER is common in patients under two years of age with intestinal malrotation, but clinical symptoms seem related more to extreme variations in gastric peristalsis than to GER.
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PMID:The significance of gastric emptying in children with intestinal malrotation. 293 9

Our recent study comparing gastric with jejunal feedings in neonatal piglets demonstrated better weight gain, less diarrhea, and less fat malabsorption in animals fed gastrically. These differences were postulated to be due either to loss of duodenal osmoregulation and absorption, and/or to loss of the combined effects of salivary enzymes, gastric emptying, and gastric secretions on jejunal feedings. The objective of this investigation was to determine the relative contributions of gastric and duodenal function to the differences between gastric and jejunal feedings. Seven piglets (3 to 5 days old, 1.5 to 2.0 kg) underwent operative transgastric insertion of a duodenostomy tube placed just distal to the pylorus. Intravenous fluids and antibiotics were administered for two days postoperatively, then Premature Enfamil Formula (24 kcal/oz; Mead Johnson, Evansville, IN) was administered continuously through the feeding tube. The animals were maintained on 115 kcal/kg/d as in the previous study. Weight, fecal fat analysis, and stool characteristics were determined throughout the 2-week period. The resulting data were compared with data from our previous study comparing gastric with jejunal feedings. These data suggest the vital importance of gastroduodenal contributions of absorption, osmoregulation, and regulation of nutrient concentrations in improving the nutritional status of experimental animals. Duodenal feedings may be preferred to either gastric or jejunal feedings because they provide equivalent nutritional support without the gastroesophageal reflux and aspiration reported with gastric feedings in the neonatal population.
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PMID:Transduodenal feedings: a superior route of enteral nutrition. 311 58

Enteral nutrition is a safe technique but complications may arise. Mechanical problems can occur as a result of tube malposition: regurgitation can induce respiratory distress. Esophagitis is rare and does not seem to be related to acid gastro-oesophageal reflux. Diarrhea, the main gastro-intestinal side effect, has a complex etiology; management requires knowledge of gastro-intestinal physiology during enteral nutrition. Many of the problems encountered with enteral feeding can be avoided by using a fine bore tube, administering the feed by continuous infusion, and careful monitoring of patients for metabolic abnormalities.
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PMID:[Digestive and respiratory complications in enteral nutrition]. 314 96

We studied 14 patients with PSS, 12 females and 2 males with a mean age of 43.6 and a medium of 8 years disease. All of the patients were selected for this study according to updated ARA criteria and were included in a prospective protocol to investigate digestive involvement. This protocol consists of a complete medical history, physical examination, radiologic and endoscopic studies, parasitological and microbial flora investigation. The symptoms more frequently seen were: pyrosis (78%), gastroesophageal regurgitation (50%), flatulence (50%), dysphagia (42%) and chronic diarrhea (21%). The radiologic findings commonly seen were: distal esophageal aperistalsis (78%), gastroesophageal reflux (57%), dilatation of intestinal loops (35%), changes of the mucosal folds (35%). A mild esophagitis was seen endoscopically in 64% of the patients, moderate and severe in 7% respectively. The study of the microbial flora showed contaminations with enterobacteria in 5 patients (35%). After statistical analysis we concluded that the digestive compromise by PSS is frequent, being the esophagus more commonly affected (80%), at the beginning in the form of reflux esophagitis and later in esophageal stenosis, the compromise of the small intestine (40%) is manifested by chronic diarrhea or dyspeptic flatulence, which correlates well the radiologic findings and the bacterial overgrowth in this organ. The colonic compromise generally is asymptomatic, and the common finding is dilatation os the colonic loops. Finally, the bacterial overgrowth in the small intestine is a secondary involvement to the intestinal compromise of Progressive Systemic Sclerosis.
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PMID:[Digestive involvement in progressive systemic sclerosis]. 322 28

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

Ninety-two patients with severe gastro-oesophageal reflux submitted to fundoplication from 1979 to 1984 have been studied. Severity of symptoms pre- and postoperatively have been assessed using a symptom score. The mean pre-operative score was 5.39 out of 9. A standard procedure for the fundoplication was used, including a long (5 cm) wrap leaving the wrap in an intrathoracic position when it could not be brought completely into the abdomen. Vagotomy was added in 53 patients. Posterior gastropexy was used in 54 patients. There was a zero incidence of damage to the spleen and a zero mortality. The mean symptom score on follow up was 0.41 out of 9 with 90.5% patients having absent or minimal symptoms. However, only 68% remained satisfied with their overall results. The incidence of sequelae related to the procedure itself including gas bloat (19.6%), dumping (7.6%) diarrhoea (6.5%) and development of gastric ulcer (2.2%) explained this discrepancy. The addition of vagotomy did not improve the results but added its complications especially dumping and diarrhoea. There were no differences in clinical results whether the fundoplication had been left in the chest or in the abdomen but there were two hazardous complications of the intrathoracic fundoplication including a perforated gastric fundus and a gastric ulcer in the thoracic part of the stomach. Posterior gastropexy conferred no benefit to the results. Measures which might improve results include: avoidance of vagotomy, intrathoracic fundoplication and gastropexy; shortening the wrap; and the use of a 50-60 F dilator in the oesophagus during the wrap.
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PMID:Fundoplication for gastro-oesophageal reflux. 387 Jan 65

Since previously reviewed in the Journal (Vol. 12, No. 2), metoclopramide has been confirmed as an effective drug in treating and preventing various types of vomiting and as a useful agent in oesophageal reflux disease, gastroparesis, dyspepsia, and in a variety of functional gastrointestinal disorders. Of considerable importance is the recent evidence of its efficacy when administered intravenously in high dosages in preventing severe vomiting associated with cisplatin. Good results have been achieved in patients not previously treated with cisplatin, but further studies are needed to determine its level of efficacy in patients who have experienced severe vomiting during earlier courses of cytotoxic therapy. Side effects consisting of mild sedation, diarrhoea and reversible extrapyramidal reactions have occurred, but are tolerated by many patients.
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PMID:Metoclopramide. An updated review of its pharmacological properties and clinical use. 634 29

Two cases of infantile dumping syndrome which developed following Nissen fundoplication for gastroesophageal reflux are described. Both infants were fed postoperatively via a gastrostomy and showed the typical clinical picture of dumping with failure to thrive, intermittent diarrhea, lethargy and pallor postprandially. Several glucose tolerance tests were highly pathological with marked hyperglycemia immediately after a gastrostomy meal followed by hypoglycemia two hours later. In one case HbA1c was significantly elevated which is thought to be an expression of recurrent hyperglycemia. In both infants the first and most impressive clinical sign was absolute refusal or oral feeds. Normal oral food intake was slowly re-established after normalization of blood glucose homeostasis.
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PMID:Dumping syndrome following Nissen's fundoplication: a cause for refusal to feed. 642 40

During a 2 year period, 83 patients with gastric motility problems were evaluated using radionuclide imaging. The patients presented with epigastric distress, postprandial fullness, pain, nausea, vomiting, and diarrhea; signs and symptoms suggestive of either gastroparesis or gastric outlet obstruction. Upper gastrointestinal series or endoscopy, or both, demonstrated no mechanical obstruction. After oral administration of a 300 g meal labeled with 600 muCi of technetium-99m sulfur colloid, a gastric emptying study consisting of serial images and data acquisition was performed. Of the patients studied, 52 had had peptic ulcer surgery, 17 were suspected of having gastroesophageal reflux, 8 were diabetic and suspected of having visceral enteropathy, and 6 had a history of irritable bowel syndrome. The normal mean gastric half emptying time was 77 +/- 16 minutes. Of the patients who had had gastric surgery, 90.4 percent had abnormal emptying: 69.2 percent had delayed gastric emptying and 21.2 percent had rapid gastric emptying time; 9.6 percent had normal emptying time. Of the gastroesophageal reflux group, all but two had normal gastric emptying time; 65 percent demonstrated gastroesophageal reflux within 15 minutes. Two of the patients with irritable bowel syndrome had prolonged emptying; the rest had normal emptying. All diabetic patients with gastroparesis had prolonged gastric emptying time, and all responded favorably to metoclopramide. Of the patients who previously had peptic ulcer surgery and had prolonged emptying time, 72 percent also responded favorably to metoclopramide. We conclude that radionuclide gastric imaging is a useful diagnostic test for the measurement of gastric emptying in patients with a variety of gastrointestinal motility disorders and may be helpful in assessing medical therapy and selecting those who may be candidates for surgery.
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PMID:Assessment of gastric motility using meal labeled with technetium-99m sulfur colloid. 665 Jul 70

Proximal gastric vagotomy without drainage for duodenal ulcer was performed in 304 patients between 1969 and 1977. There was one operative death (0.3%) and two patients required secondary drainage (0.6%). Eleven patients died subsequently of unrelated causes. Follow-up 5 to 13 years after operation was conducted on 242 patients (80%). Of these, 141 were asymptomatic and 48 had only trivial symptoms, a success rate of 78%. Thirty-two patients had recurrent ulcer and 2 of them had Zollinger-Ellison syndrome. When these two were excluded, the recurrence rate was 12.4%. Two patients had duodenitis. Seven patients had unexplained pain and some of them may ultimately be shown to have recurrence. Appreciable esophageal reflux was seen in eight patients. Other symptoms, nearly all mild, were dumping in one, diarrhea in seven and bile reflux in six. Recurrent ulcer was treated by cimetidine initially in all 32 cases but ultimately by repeat vagotomy and antrectomy in 27, with no deaths and only one further recurrence (Zollinger-Ellison syndrome). After operative correction, the ultimate success rate (Visick grades I and II) was 90%.
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PMID:Long-term results of proximal gastric vagotomy. 674 38


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