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)

One hundred ten infants with congenital diaphragmatic hernia (CDH) developed life-threatening respiratory distress in the first 6 hours of life. Associated anomalies were present in 33%. Twenty-eight of 65 infants (43%) treated before 1987 (pre-extracorporeal membrane oxygenation [ECMO] era) survived after immediate CDH repair, and mechanical ventilation with or without pharmacologic support. Only two of 16 (12.5%) infants requiring a prosthetic diaphragmatic patch survived. Since 1987, 31 of 46 (67.4%) infants with birth weight, gestational age, and severity of illness similar to the pre-1987 group survived. All patients were immediately intubated and ventilated. Seven (four with lethal chromosomal anomalies) infants died before treatment, and 30 stabilized (partial pressure of carbon dioxide [PCO2] < 50; partial pressure of oxygen [PO2] > 100; pH > 7.3) and underwent delayed CDH repair at 5 to 72 hours. Fifteen did well on conventional support and survived. Fifteen infants deteriorated after operation: 11 were placed on ECMO with eight survivors, and four infants were not considered ECMO candidates. Nine babies failed to stabilize initially and were placed on ECMO before CDH repair (alveolar-arterial gradient > 600 and oxygenation index > 40), and seven survived. The overall survival rate was 80% at 3 months in this ECMO-treated group. Early mortality was due to inability to wean from ECMO (one), intracranial hemorrhage (one), liver injury (one), and pulmonary hypoplasia (one). Nine of 11 babies requiring a prosthetic patch in the post-1987 ECMO group survived (81.8%). There were three late post-ECMO deaths (3 to 18 months) of right heart failure (two) and sepsis (one). Symptomatic gastroesophageal reflux occurred in nine cases, six requiring a fundoplication in the bypass babies. Recurrent diaphragmatic hernia occurred in nine cases (five ECMO). The overall survival rate was significantly improved in the delayed repair/ECMO group (67% versus 43%; p < 0.05) and was most noticeable in infants requiring a prosthetic diaphragm (81.2% versus 12.5%; p < 0.005). These data indicate that early stabilization, delayed repair, and ECMO improve survival in high-risk CDH. Early deaths are related to pulmonary hypertension and can be reversed by ECMO.
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PMID:Delayed surgical repair and ECMO improves survival in congenital diaphragmatic hernia. 141 95

Availability of extracorporeal membrane oxygenation (ECMO) support and the potential advantages of delayed repair of congenital diaphragmatic hernia (CDH) have led several centers to delay CDH repair, using ECMO support if necessary. This study reviews the combined experience of five ECMO centers with infants who underwent stabilization with ECMO and repair of CDH while still on ECMO. All infants were symptomatic at birth, with a mean arterial oxygen pressure (PaO2) of 34 mmHg on institution of bypass despite maximal ventilatory support. A total of 42 infants were repaired on ECMO, with 18 (43%) surviving. Seven infants had total absence of the diaphragm, and 28 required a prosthetic patch to close the defect. Only five infants ever achieved a best postductal PaO2 over 100 mmHg before institution of ECMO. Prematurity was a significant risk factor, with no infants younger than 37 weeks of age surviving. Significant hemorrhage on bypass was also a hallmark of a poor outcome, with 10 of the 24 nonsurvivors requiring five thoracotomies and six laparotomies to control bleeding, whereas only one survivor required a thoracotomy to control bleeding. In follow-up, nine of the 18 survivors (50%) have developed recurrent herniation and seven (43%) have significant gastroesophageal reflux. Importantly, five of the 18 survivors were in the extremely high-risk group who never achieved a PaO2 over 100 mmHg or an arterial carbon dioxide pressure (PaCO2) less than 40 mmHg before the institution of ECMO. In conclusion, preoperative stabilization with ECMO and repair on bypass may allow some high-risk infants to survive. Surviving infants will require long-term follow-up because many will require secondary operations.
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PMID:Congenital diaphragmatic hernia. Stabilization and repair on ECMO. 144 48

Upper oesophageal sphincter pressure was recorded with a Dent sleeve in 30 patients breathing nitrous oxide, oxygen and halothane. Twenty-three patients, after thiopentone induction, received suxamethonium and had their trachea intubated either before (group A, n = 11), or after (group B, n = 11), a study period of inhalational anaesthesia. Group C (n = 8) received an inhalational induction. Mean (SD) sphincter pressure after loss of consciousness was 8 (7) mmHg (group A), 6 (5) mmHg (group B) and 24 (13) mmHg (group C) increasing to 19 (7) mmHg in group A immediately after intubation. With an end-tidal halothane concentration of 1.5%, mean sphincter pressure in group B, 16 (7) mmHg, was significantly lower than in group A, 45 (21) mmHg (p < 0.001) and group C, 27 (14) mmHg (p < 0.05). Halothane had no dose-related effect on sphincter pressure. Insertion of a laryngeal mask in group C (n = 7) had no significant effect on sphincter pressure. Induction and maintenance of anaesthesia with halothane, unlike thiopentone or suxamethonium, maintained a degree of upper oesophageal sphincter tone, although three patients in this study had sphincter pressures of less than 10 mmHg and would therefore have been at risk of regurgitation in the presence of gastro-oesophageal reflux.
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PMID:Upper oesophageal sphincter pressure during inhalational anaesthesia. 146 34

Antimony electrodes are widely used for gastro-oesophageal pH monitoring. They are also sensitive to oxygen, however, especially at low PO2 levels, which are known to shift recorded values in the alkaline direction. This study, which compares antimony and glass electrodes for oesophageal pH monitoring in six adults, shows that values recorded by antimony electrodes are 2.1 +/- 0.8 pH units (mean +/- SD) higher than by glass electrodes (p < 0.001; n = 7642). A further 52 patients with suspected gastro-oesophageal reflux were investigated by 24-h pH monitoring by means of antimony electrodes. In these patients the oesophageal pH was higher than 8.0 for 7% of the time (range, 0-60%). The alkaline periods recorded with antimony electrodes were all protracted in time, smoothly increasing from a neutral pH, and did not correspond to a sudden increase in pH, which would be expected if alkaline reflux had occurred. It is concluded that high pH values obtained by antimony electrodes are due to the oxygen sensitivity of the electrodes. The diagnosis of alkaline reflux seems to be valid only when pH monitoring is performed with glass electrodes or when values obtained with antimony electrodes are adjusted for the influence of the oxygen tension in the oesophagus.
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PMID:Alkaline oesophageal reflux--an artefact due to oxygen corrosion of antimony pH electrodes. 147 27

From 1977 to 1991, 136 neonates have had corrective surgery for diaphragmatic hernia at Children's Hospital of Los Angeles. A retrospective study was performed to determine how many of the 136 neonates had defects large enough to require the use of a prosthetic patch to repair the defect. Twelve were found. All 12 were symptomatic at birth for respiratory distress. Mean arterial blood gas values at birth were pH 6.95, PCO2 94.8, and PO2 47.2. The mean oxygen index (n = 10) was 61.8. Six of these patients were repaired without extracorporeal membrane oxygenation (ECMO) support while the other six received ECMO bypass perioperatively. All six of the patients who did not receive ECMO support died despite successful diaphragmatic repair. Five of six patients who received ECMO perioperatively survived (83%). These surviving infants are now between 1 month and 4 years of age. In the survivors, four of five required subsequent repair and patch enlargement for a recurrent diaphragmatic hernia. Gastroesophageal reflux, requiring a Nissen fundoplication in two infants, complicated the course of three survivors. Four survivors were discharged with supplemental oxygen therapy lasting less than 13 months. Patch disruption is predicted to occur at approximately 18 months of age in all patients, especially if little or no muscle was available at primary repair for prosthetic attachment. These children should be followed closely for feeding or respiratory symptoms. Diagnosis of patch disruption can be made by chest x-rays and confirmed by contrast studies. Patch expansion by laparotomy and careful search for additional musculature for patch attachment is recommended when reherniation occurs.
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PMID:ECMO and the management of congenital diaphragmatic hernia with large diaphragmatic defects requiring a prosthetic patch. 150 Oct 39

Because it offers high sensitivity and specificity, esophageal pH monitoring has become the reference method for the diagnosis of gastroesophageal reflux. This review was undertaken to evaluate methodologic problems raised by this method, involving selection of the electrode, selection of equipment, and criteria of normality according to the patient's symptoms. In some instances, multiple recordings are needed to detect correlations between clinical symptoms and esophageal pH, cardiac and respiratory tracings and esophageal pH, or oxygen saturation and esophageal pH. These studies allow improved qualitative interpretation of results. Emphasis is put on the value of esophageal pH recordings for the evaluation of medical or surgical therapies.
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PMID:[Esophageal pH monitoring in children. Methodological aspects and a review of the literature related to indications]. 153 27

Respiratory function undergoes sleep-associated changes which in normal subjects leave it unaffected. However in some cases they may be more marked than usual or may be superimposed on a pre-existing disease, thus giving rise to sleep-related ventilation disorders. These include obstructive sleep apnea syndrome (OSAS), nocturnal desaturation events of chronic obstructive pulmonary disease (COPD) and restrictive syndromes, as well as nocturnal asthmatic attacks. OSAS is a condition characterized by the frequent recurrence of interruptions of oronasal flow (greater than 10 s.) due to upper airway occlusion induced by a reduction in pharyngeal muscle tone. This phenomenon, particularly prominent in REM sleep, results in oxyhemoglobin desaturation and marked cardiovascular consequences (arrhythmias, increases in pulmonary and systemic arterial pressure), as well as symptoms (loud intermittent snoring, daytime sleepiness, intellectual deterioration etc.). Obesity is often associated with OSAS or may lead to a sleep-related hypoventilation syndrome. Treatment is based on weight loss, surgery of upper airway abnormalities, if present, and on splinting of the upper airway by the application of nasal continuous positive airway pressure. In COPD and restrictive disorders, nocturnal hypoxemia is mainly due to REM-associated loss of respiratory muscle tone, as well as in the sleep-related exaggeration of functional defects due to COPD (low chemoreceptor sensitivity, high closing volume etc.). Treatment is based on oxygen administration, provided that possible side-effects are carefully monitored. Nocturnal asthma is due to circadian changes in hormonal secretion (catecholamines, cortisol), as well as supine posture, reduced muco-ciliary clearance, gastro-esophageal reflux etc. Sleep itself plays some role through a depressed arousal reaction in slow wave sleep, resulting in more marked and prolonged attacks in this stage. Slow-release theophylline or beta-mimetic medications, as well as new chromones and antimuscarinic drugs are therapeutic alternatives.
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PMID:Cardio-respiratory function during sleep. 174 49

Gastro-oesophageal reflux in preterm infants may result in recurrent pulmonary insult due to aspiration of gastric contents, and intractable obstructive apnoea. Fundoplication is effective in controlling reflux when medical management has failed. Our experience between 1981 and 1990 was reviewed to assess the efficacy of early surgery in the management of 11 such infants. The infants had a median gestational age of 29 weeks and a median birthweight of 1032 g. Nine infants had fundoplication for recurrent aspiration pneumonitis and two for intractable apnoea. The median age at the time of surgery was 100 days and the median weight of the infants was 2640 g. Nine infants were oxygen dependent and two were still ventilated at the time of surgery. The operative procedure was well tolerated by 10 of the 11 infants. Surgery failed to control reflux in two infants, although good control was obtained in the one who had subsequent surgery. Three infants required prolonged ventilation postoperatively; two of them died later from pulmonary failure. The median time to discharge was 24 days (8-113 days). All infants with intractable apnoea were cured by surgery. Fundoplication is an effective method of management when used early in the treatment of chronic gastro-oesophageal reflux in preterm infants. There is minimal morbidity from the surgical procedure.
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PMID:Fundoplication in preterm infants with gastro-oesophageal reflux. 195 26

We studied the relation of gastro-oesophageal reflux with apnoea during sleep in 24 infants with antecedent respiratory abnormalities and/or proven gastrooesophageal reflux (GOR), by combined lower oesophageal pH and polygraphic monitoring. GOR, indicated by pH less than 4, was confirmed in 24 infants. There were no episodes of prolonged (greater than 20 s) central apnoea (CA). Fifty-six mixed or obstructive breathing episodes were identified in 12 infants (14 studies), of which 28 lasted between 3 and 6 s. Bradycardia (heart rate less than less than 80 beats/min for 10 s was not observed. There were 80 falls in transcutaneous oxygen (PtcO2 greater than 5 mmHg) but only 6 exceeded 10 mmHg and one 20 mmHg. There was no relationship between GOR and obstructive episodes in terms of frequency, duration or temporal occurrence, except in one infant. There were 1276 gross body movements, mainly during active or indeterminate sleep and, of these, 7% were associated with decreases in pH to less than 4. Movements occurred during the 60 s period preceding 83% of pH decreases greater than 1 pH unit compared to only 30% in the 60 s succeeding a pH drop. We conclude that, while GOR and obstructive episodes may co-exist in the patient groups studied, decreases in pH in the lower oesophagus do not usually induce either central or obstructive apnoea, and vice versa. Of the variables monitored, only gross body movements were temporally associated with pH drops, and usually preceded them.
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PMID:Gastro-oesophageal reflux and apnoeic pauses during sleep in infancy--no direct relation. 220 58

We report 30 patients with exogenous lipoid pneumonia due to vegetal oil. This was employed in most of the cases during the first month of life for digestive tube symptomatology; clinical manifestations began three months following administrations, as a pneumonia or bronchopneumonia with a respiratory distress syndrome of variable severity. 60% of the thorax x-ray studies were abnormal, the main finding was opacity. One patient has alterations of the mechanics of deglutition; seven had gastroesophageal reflux. Arterial gasometry showed hypoxaemia and increase of alveolo-arterial gradient of oxygen in all. Ten patients died and all the survivors were reevaluated in september, 1988; 18 had normal physical findings. Thorax x-ray studies in 13 patients had right reticulate infiltration and 6 right apical opacity; ECG showed right ventricular hypertrophy in 3. Perfusion pulmonary gamagram with technetium 99 was abnormal in 5. Gastroesophageal reflux was evident in 2. Five were under treatment for several causes. Diagnosis and treatment is discussed.
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PMID:[Exogenous lipoid pneumonia]. 260 74


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