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Query: UMLS:C0017168 (gastroesophageal reflux disease)
 11,783 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This article reviews the cause and management of respiratory symptoms after repair of esophageal atresia with tracheoesophageal fistula (TEF). Postoperative respiratory symptoms developed in 31 (46%) of 68 patients and included apnea and bradycardia, respiratory arrest, aspiration, and recurrent pneumonia. The respiratory symptoms were initially attributed to gastroesophageal reflux (GER) in 20 patients (64%), tracheomalacia in 4 patients (13%), recurrent TEF in 4 patients (13%), and anastomotic stricture in 3 patients (10%). Three patients with GER and the three patients with a stricture were initially managed nonoperatively. The remaining 25 patients underwent surgical correction of the underlying cause of the respiratory symptoms. Despite aggressive management of this problem, 14 (45%) of these 31 patients had persistent or recurrent respiratory symptoms. Although GER is the most common cause of respiratory complications in patients who have undergone prior TEF repair, other factors are often responsible for these symptoms and should not be overlooked.
Surgery 1992 Sep
PMID:Etiology and management of respiratory complications after repair of esophageal atresia with tracheoesophageal fistula. 151 68

We compared scintigraphy to other reflux tests in 45 symptomatic patients. Sensitivity of 24-h pH score was 82%, endoscopy 64%, and LESp 33%. Scintigraphy was insensitive (36%), although 50% of patients with esophagitis had a positive test. Specificity and positive predictive value were good (all greater than or equal to 88%) in discerning patients with an abnormal 24-h pH score and esophagitis. We suggest scintigraphy as the first diagnostic test to confirm frequent reflux events (REs) and normal clearance in the subgroup of patients with severe endoscopic esophagitis, and manometry and 24-h pH monitoring when scintigraphy is negative. We also compared scintigraphy to simultaneously performed pH monitoring in detecting individual postprandial REs and their clearance. The two methods agreed in only 25% of total reflux events. Scintigraphy was superior at detection of reflux of buffered gastric contents and detection of additional REs during acid clearing intervals, whereas only the pH probe detected REs after gastric emptying. We conclude that scintigraphy has a limited role as a diagnostic test in gastroesophageal reflux disease, and much potential as a research tool, especially in combination with the pH probe.
Am J Gastroenterol 1992 Sep
PMID:Scintigraphy in gastroesophageal reflux disease: a comparison to endoscopy, LESp, and 24-h pH score, as well as to simultaneous pH monitoring. 151 65

Ambulatory 24-h esophageal pH monitoring is increasing in popularity as the means to measure esophageal exposure to gastric juice and document the presence of gastroesophageal reflux disease, particularly before surgical therapy. Normal values for pH exposure were obtained from 50 asymptomatic healthy subjects. Receiver operating characteristic curves constructed from another 25 asymptomatic healthy subjects and 25 selected patients with other markers of increased esophageal acid exposure showed that a composite score and the percent total time pH less than 4 provide the most efficient interpretation of the test with a sensitivity of 96%, a specificity of 100% and an accuracy of 98% for the composite score, and a sensitivity, specificity, and accuracy of 96% for the percent total time pH less than 4. Repeat monitoring of healthy volunteers and symptomatic subjects in the inpatient and outpatient environment showed no significant difference, with the exception that the number of reflux episodes was significantly greater during the outpatient recording in volunteers. This did not affect the clinical accuracy of the test. Esophageal pH probes were well tolerated, but caused belching and coughing during the early part of the monitored period. We conclude that computerized ambulatory 24-h esophageal pH monitoring in the outpatient setting provides accurate and reproducible results.
Am J Gastroenterol 1992 Sep
PMID:Ambulatory 24-h esophageal pH monitoring: normal values, optimal thresholds, specificity, sensitivity, and reproducibility. 151 62

Twelve patients presenting with symptomatic esophagitis associated with hiatal hernia and gastroesophageal reflux underwent operative management under laparoscopic guidance. The antireflux procedure employed was the Nissen fundoplication. The authors completed the operation laparoscopically in nine patients. Postoperatively, patients were evaluated with repeat fiberoptic endoscopy, esophageal manometry, and barium contrast studies. Postoperative results were considered excellent on the basis of these studies and complete control of symptoms. The mortality rate was 0%. The only major operative complication was a pneumonia that occurred in one patient. At 1 month follow-up, six patients were totally asymptomatic. The authors conclude that laparoscopic treatment of gastroesophageal reflux associated with a hiatal hernia is feasible by a procedure that has already proven its value during open surgery.
Surg Laparosc Endosc 1991 Sep
PMID:Laparoscopic Nissen fundoplication: preliminary report. 166 93

Prolonged esophageal pH monitoring is considered to be the most sensitive and specific test for the diagnosis of gastroesophageal reflux disease (GERD). However, the role of pH monitoring in predicting the clinical and endoscopic response of reflux esophagitis is not well defined. In this study, 106 patients with moderate to severe symptoms of GERD and esophagitis (grades 0-IV) by endoscopy were initially studied by ambulatory esophageal pH monitoring, and their clinical response to standard H2 antagonist therapy was monitored at 8 wk. Refractory patients were defined as those who failed to heal and/or had intractable reflux symptoms after 8 wk of H2 antagonist therapy, and who required continuous therapy with higher doses of H2 antagonists, addition of prokinetic agents, or omeprazole. There was a positive correlation (r = 0.89) between endoscopic severity of esophagitis upon entry into the study and refractoriness to standard medical therapy. However, there were no differences in the various pH parameters analyzed between the 58 patients who responded and the 48 patients who were refractory to medical therapy, regardless of the endoscopic grading of their esophagitis. We conclude that 24-h ambulatory esophageal pH monitoring does not predict refractoriness of reflux esophagitis to standard therapy. The decision for more aggressive methods of treatment probably requires assessment of symptomatic and endoscopic response after 8 week standard H2 antagonist therapy.
Am J Gastroenterol 1991 Sep
PMID:Failure of initial 24-hour esophageal pH monitoring to predict refractoriness and intractability in reflux esophagitis. 167 86

We have studied for periods averaging 111 months 16 survivors out of a series of 20 children treated for oesophageal atresia (EA) by neonatal end-to-end anastomosis. Twelve of them had gastroesophageal reflux (GER) manifested by either digestive (vomiting, dysphagia, pyrosis, haemorrhage or foreign body impaction) or respiratory symptoms (repeated neumoniae or frequent u.r.i.). pH-studies decealed very increased acid exposure in these patients. Manometric studies showed disorganized peristalsis with near-absence of propulsive waves and predominance of mass-contractions. Interestingly both lower esophageal sphincter pressure and length were normal. Five children had histological esophagitis and 2 had Barrett's esophagus. Seven patients have had an anti-reflux procedure and two more should be operated in the near future. Our experience reveals that GER incidence in EA is very high, that esophageal function is severely impaired in this condition, that mucosal lesions can be serious and that funduplication is effective. Since it has been demonstrated that esophageal dysfunction in EA patients is due to structural anomalies, spontaneous improvement should not be expected in them and surgical treatment should be largely indicated. EA patients require long-term gastro-enterologic follow-up.
An Esp Pediatr 1991 Sep
PMID:[Motor function of the esophagus following surgery for atresia]. 174 78

Asthma is a multifactorial syndrome with different etiologies, both allergic and non-allergic. Response to an allergen may be moderate and may often be shown only by provocation tests, not by skin tests or RAST. Food allergy is a significant cause of asthma. There are many non-allergic causes, from gastro-oesophageal reflux to aspirin-intolerant asthma, to sulphites...the list is far from exhaustive. Often there is an association of allergic and non-allergic causes.
Allerg Immunol (Paris) 1991 Sep
PMID:Intrinsic asthma: myth or reality? 174 28

The frequency and the possible age-related characteristics of gastro-oesophageal reflux disease (GORD) were investigated in 195 consecutive elderly subjects (mean age 74 years), referred to endoscopy for abdominal symptoms or sideropenic anaemia. In the 105 of these patients in whom there was any suspicion of GORD, 24-hour pH monitoring was carried out. All the patients were interviewed before the examinations. Erosive or complicated (grade 2-4) oesophagitis was found in 18% of patients. The main symptoms in these patients were dysphagia, respiratory symptoms and vomiting. Chronic cough, hoarseness or wheezing were present in 57% of patients with oesophagitis compared with 33% of those without oesophagitis (p less than 0.001). The occurrence of heartburn and regurgitation did not differ significantly between patients with or without oesophagitis, although the mean symptom scores were higher in those with oesophagitis. Dyspepsia and chest pain were not typical symptoms in oesophagitis. Of patients with oesophagitis 29% had no typical symptoms of GORD; only 24% of patients with regurgitation had oesophagitis. In 24-hour pH monitoring, a significant increase in the occurrence of symptoms was not seen until total reflux time pH less than 4 exceeded 10%. The occurrence of heartburn did not correlate with the extent of reflux in the pH study. In conclusion, typical symptoms of GORD in the aged were regurgitation, dysphagia, respiratory symptoms and vomiting rather than heartburn.
Age Ageing 1991 Sep
PMID:Symptoms of gastro-oesophageal reflux disease in elderly people. 175 93

Sixteen infants who presented with symptoms suggestive of gastroesophageal reflux (GER)-associated apnea were evaluated at the Breathing Disorder Center of the Children's Hospital of Philadelphia. These neonates had a history of occasional emesis and an apparent life-threatening event (ALTE) that occurred while awake which was similar to the presentation of a group of infants previously described. Evaluation of the present group of infants however, revealed increased periodic breathing (12.1 +/- 1.8 SEM% of total sleep time) as opposed to the obstructive apnea that was typically seen with GER. Pathologic gastroesophageal reflux could not be diagnosed in relationship to apneic events. Infants who present during the first month of life with symptoms suggestive of GER-associated apnea should have careful evaluation of reflux and respiratory patterns to confirm the correct diagnosis. Because of the similarities of these infants to the GER group, we have called their disorder pseudoreflux.
Clin Pediatr (Phila) 1991 Sep
PMID:Pseudoreflux syndrome-increased periodic breathing during the neonatal period presenting as feeding-related difficulties. 180 85

In 1948-1990 the authors operated 112 patients with paraoesophageal and mixed hiatus hernias. 100 patients operated in 1988 were followed up on a long-term basis. Gastroesophageal reflux was recorded before operation in 52%, haemorrhage in 18%, an ulcer in the neck in 7% an incarceration and obstruction in 9%. Before the onset of the seventies hiatorrhaphy and gastropexy were performed. During check-up examinations in these patients relapses were recorded in 47%, reflux in 43%, subjective complaints in 26%. This made the authors change the surgical procedure and in subsequent years they performed hiatorrhaphy, fundoplication, fundophrenopexy and anterior gastropexy. The incidence of relapses of hernia during check-up examinations declined to 21%, of gastroesophageal reflux to 9% and subjective complaints to 10%. The follow-up period varied between 1 and 19 years. The surgical lethality was 2%.
Rozhl Chir 1991 Sep
PMID:[Surgical treatment of patients with paraesophageal and mixed hiatal hernias]. 182 44


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