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)

Twenty-four-hour continuous esophageal pH monitoring has become the preferred test to quantify acid gastroesophageal reflux. Agreement has been achieved that acid gastric content reflux into the esophagus constitutes a major cause of reflux esophagitis; we therefore calculated the "area under pH 4" (A) in 560 consecutive pH monitorings in infants 1-12 months old and related this parameter (A) to the reflux index (RI): RI less than 10%: A 185 +/- 295 (mean +/- 1 SD); RI 10-19%: A 1,046 +/- 1,206; RI 20-29%: A 1,967 +/- 2,038; RI 30-39%: A 3,307 +/- 2,955; RI greater than 40%: A 7,977 +/- 7,227. A higher RI is associated with a greater area under pH 4 (p less than 0.001); the high SD obtained in each group, however, illustrates the great variability in surface (or acidity of the reflux episodes) in all groups. Esophagoscopy and biopsy were performed in 112 infants (20%). Specificity in the prediction of (mild) esophagitis was higher for the area under pH 4 (88%) compared with the RI (50%). The sensitivity of both parameters was comparable (96 versus 93%). Our results strongly suggest that in young infants, the acidity of the reflux episodes (the area under pH 4) is a determining factor in the prediction of esophagitis. These data need to be confirmed by more studies before general application of this parameter can be advised.
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PMID:Area under pH 4: advantages of a new parameter in the interpretation of esophageal pH monitoring data in infants. 277 67

A 1 month-old girl presented with severe asphyxia during sleep. Her weight was the same as at birth. The day before the accident she had cried a great deal and had vomited her feeds. Small bowel volvulus was diagnosed. Surgical cure led to the disappearance of all symptoms with a one year follow-up. Episodes of asphyxia require detailed histories. Alkaline esophageal reflux may reveal an anatomic intestinal obstruction and lead to laryngospasm, identical to the one induced by acid reflux.
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PMID:[An unusual cause of near-miss sudden death in infants: intermittent volvulus of the small intestine on the mesenterium commune]. 380 May 62

Although fiberoptic, upper gastrointestinal (UGI) endoscopy has become an accepted diagnostic technique in the older child and adult, concerns about safety have limited the use of this procedure in infants. A 1-year experience with 49 upper gastrointestinal endoscopies in infants less than 25 months of age is reported. There were varied indications for the procedures, including upper gastrointestinal hemorrhage and obstruction, but evaluation for esophagitis secondary to gastroesophageal reflux was most common. Procedures were performed without sedation in 45% of all infants studied, including 87% of infants less than 3 months of age; procedures were well tolerated. General anesthesia was used on only three occasions. A thorough examination was always possible, and biopsies were taken whenever indicated. Only one complication, transient bradycardia, occurred in a critically ill infant. This experience demonstrates that upper gastrointestinal endoscopy is a safe and effective diagnostic aid in infants, and it can often be performed with little or no sedation.
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PMID:Upper gastrointestinal endoscopy in infants: diagnostic usefulness and safety. 649 78

We performed 12 simultaneous scintigraphic and pH probe studies in children being evaluated for reflux to determine the ability of scintigraphic images in comparison to pH probe data to quantify gastroesophageal reflux in children and to identify an optimal scintigraphic framing interval. We used a multiplexor to synchronize exactly the scintigraphy and pH probe and an acid meal to avoid missing postprandial episodes with the pH probe. We reformatted the studies in both 60-sec and 10-sec images to compare the two framing intervals. The 60-sec images produced better agreement between pH probe and scintigraphy than the 10-sec images for both the number of reflux episodes and the duration of reflux. Of the 64 reflux episodes detected by either method at this coarser framing interval, scintigraphy detected 80%, the pH probe detected 63% and both methods concurrently detected 42%. Of the 681 60-sec images aggregated across patients, scintigraphy detected 55% of those with intraesophageal refluxate, the pH probe detected 96% and both tests concurrently detected 51%. Within patients, the number of positive scintigraphic images in the postprandial hour correlated with the number of images with pH < 4 during the same hour (p = 0.008, and p < 0.0001 if two patients with very rapid gastric emptying are excluded), but not with the results of the 24-hr pH probe study. A 1-hr scintigraphic study formatted in 60-sec frames provides a quantitative representation of postprandial gastroesophageal reflux for children, particularly if they do not have rapid gastric emptying.
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PMID:Scintigraphy versus pH probe for quantification of pediatric gastroesophageal reflux: a study using concurrent multiplexed data and acid feedings. 832 76

A 1.5-month-old boy with Sandifer's syndrome is described. After an uneventful delivery, he presented torticollis, seizure-like dystonic neck movements usually associated with feeding, episodic vomiting, inspiratory stridor and hand tremor in the first month of life. Barium esophagogram demonstrated gastroesophageal reflux, for which medical therapy was started. Children with torticollis and dystonic movements should be evaluated for Sandifer's syndrome. Early diagnosis and treatment of gastroesophageal reflux may prevent complications.
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PMID:A case of Sandifer's syndrome with hand tremor. 1176 69

Studies of the pharmacokinetics of omeprazole in children with gastroesophageal reflux disease (GERD) remain scarce despite the vast number of reports on its efficacy. The objectives of this study were to assess the pharmacokinetics of omeprazole in healthy adults and in children with GERD. Omeprazole (Losec, delayed-release capsules) was administered orally to 18 healthy adults (mean age 36.8 years) and 12 children with GERD (mean age 6.1 years). Blood samples were collected over 5 hours, and plasma concentrations were assessed using liquid chromatography. Population pharmacokinetic parameters were calculated using NONMEM. A 1-compartment model with zero-order absorption and a lag time was used. The population approach was well suited to the limited number of samples available, and residual variability was low. Oral clearance (CL/F) and apparent volume of distribution (V(ss)/F) in healthy adults (Mean +/- SD: 0.62 +/- 0.27 L/h/kg and 0.76 +/- 0.26 L/kg, respectively) were not significantly different than those in children with GERD (0.51 +/- 0.34 L/h/kg and 0.66 +/- 0.25 L/kg, respectively). Healthy adults displayed a statistically significantly longer delay in drug absorption (Lag time: 0.62 +/- 0.15 hours) as compared with that observed in children with GERD (0.12 +/- 0.03 hours, P < 0.05). On the basis of these findings, omeprazole dosings on a milligram-per-kilogram basis are recommended with no further adjustments for the treatment of GERD in children.
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PMID:Pharmacokinetics of omeprazole in healthy adults and in children with gastroesophageal reflux disease. 1474 42

In recent years, the focus of Helicobacter pylori clinical research has been mainly on gastric malignancy. However, the role of H. pylori in non-malignant diseases, such as peptic ulcer, gastroesophageal reflux disease (GERD) and non-ulcer dyspepsia, as well as non-steroidal anti-inflammatory drug consumption, is still of great interest. A 1- to 2-week course of H. pylori eradication therapy is an effective treatment for H. pylori-positive peptic ulcer disease and a positive CagA status is a predictor for successful eradication of H. pylori. Antral prostaglandin-E2-basal levels appear to be critical for the development of aspirin-induced gastric damage in subjects without H. pylori infection. In clinical practice, among patients treated with proton-pump inhibitors, H. pylori status has no effect on the speed or degree of GERD symptom relief. For the management of dyspepsia in primary care, antisecretory therapy confers a small insignificant benefit compared to strategies based on H. pylori testing while these latter strategies may be cost-effective. H. pylori eradication therapy has a small but statistically significant effect on H. pylori-positive non-ulcer dyspepsia. An economic model suggests that this modest benefit may still be cost-effective but more research is needed.
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PMID:Helicobacter pylori and non-malignant diseases. 1772 56