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

Diagnostic interventions in nuclear medicine may be defined as the coadministration of a nonradioactive drug or application of a physical stimulus or physiologic maneuver to enhance the diagnostic utility of a nuclear medicine test. The rationale for each interventional maneuver follows from the physiology or metabolism of the particular organ or organ system under evaluation. Diagnostic inference is drawn from the pattern of change in the biodistribution of the tracer in response to the intervention-induced change in metabolism or function. In current practice, the most commonly performed interventional maneuvers are aimed at studies of the heart, genitourinary system, hepatobiliary system, and gastrointestinal tract. The single most commonly performed interventional study in the United States is the stress Thallium-201 myocardial perfusion scan aimed at the diagnosis of coronary artery disease. The stress portion of the study is accomplished with dynamic leg exercise on a treadmill and is aimed at increasing myocardial oxygen demands. Areas of myocardium distal to hemodynamically significant lesions in the coronary arteries become ischemic at peak stress due to the inability of the stenotic vessel to respond to the oxygen demand/blood flow needs of the myocardium. Ischemic areas are readily recognized as photopenic defects on scans obtained immediately after exercise, with "normalization" upon delayed imaging. Diuresis renography is aimed at the differential diagnosis of hydroureteronephrosis. By challenging the urinary tract collecting structures with an augmented urine flow, dilated, unobstructed systems can be differentiated from systems with significant mechanical obstruction. Obstructed systems have a low ability to respond even after effective diuresis, resulting in a characteristic prolonged retention of the radiotracer. Hepatobiliary interventions are most commonly employed in the clinical setting of suspected acute cholecystitis. Administering a cholecystogogue before a hepatobiliary tracer promotes visualization of the gallbladder by causing it to go through a contraction/filling cycle in which the filling phase occurs during maximum exposure to the radionuclide. This maneuver can convert a false positive study that suggests the presence of acute cholecystitis to a true negative study. Other gastrointestinal interventions are aimed at enhancing the detection of gastroesophageal reflux and gastrointestinal bleeding. Many new interventions have been developed that are currently aimed at research problems rather than clinical problems.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Diagnostic interventions in nuclear medicine. 264 73

To evaluate relationships between gastroesophageal reflux (GER) and the development and onset of apparent life-threatening event(s) (ALTE), 16 infants presenting with ALTE and 6 control subjects manifesting clinical GER alone were studied using prolonged, esophageal pH monitoring in conjunction with simultaneous pulse oximetry and transthoracic impedance pneumocardiography. Despite the absence of a clinical vomiting history in 14 of 16 patients with ALTE, the incidence of GER was similar in both groups (patients with ALTE vs control subjects, 95% vs 100%). Significant arterial oxygen desaturation (less than 90% for greater than 3 minutes) was monitored during 60 episodes in 14 of 16 infants with ALTE, compared with no episodes of reduced arterial oxygen saturation in control subjects. Fifty-four of 60 of these desaturation events commenced within 3.9 +/- 0.4 minutes (mean +/- SD) of onset of a drop in esophageal pH to less than 4.0. Linear regression analysis indicates a significant correlation between duration of esophageal acidification and length of individual hypoxemic episodes (r = .39). Pneumocardiograms were normal in all patients. These data suggest that unsuspected GER is common in infants presenting with ALTE and, in these patients, GER may be directly associated with reflex hypoxemic episodes. Prolonged intraesophageal pH monitoring, performed simultaneously with evaluation for apnea, should be considered in all infants presenting with ALTE.
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PMID:Gastroesophageal reflux-induced hypoxemia in infants with apparent life-threatening event(s). 275 70

In an effort to delineate the clinical characteristics of respiratory syncytial virus (RSV) infection in the compromised host, we compared children with bronchopulmonary dysplasia (BPD), congenital heart disease (CHD), premature birth, failure to thrive, and gastroesophageal reflux to previously healthy children. During a four-year period, 262 patients were admitted to the hospital with RSV infection diagnosed by a rapid RSV antigen detection test. Children with BPD or CHD had more hospital days and supplemental oxygen days than the previously healthy group (P less than 0.05). Patients with BPD also had more ICU days, ventilator days, and NPO days, as well as a higher physiologic stability index and therapeutic intervention score than the previously healthy group (P less than 0.05). Premature infants were more likely to present with apnea from RSV (P less than 0.001). Patients with underlying illness tended to be older, although significant difference was demonstrated only for the BPD group (7.0 +/- 5.3 vs. 3.5 +/- 3.3, P less than 0.05). Patients with BPD and CHD had more nosocomial infections than the previously healthy group (P less than 0.0001) and death occurred only in patients with underlying illness. We conclude that previously compromised patients are at risk for more severe and prolonged RSV disease. Earlier diagnosis and therapeutic intervention may be necessary in such patients to improve outcome.
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PMID:Clinical characteristics of respiratory syncytial virus infections in healthy versus previously compromised host. 279 31

Electromanometry and electromyography were used to study gastro-oesophageal motility in two planes of halothane anaesthesia in sheep. Gastro-oesophageal motility when present was greater in light than in deep anaesthesia. The caudal thoracic oesophagus contracted more frequently and for longer than the rostral thoracic oesophagus. In light anaesthesia oesophageal movements were peristaltic in direction with a propagation velocity of 26-29 cm sec-1. Rumen pressures increased throughout anaesthesia and the rate of increase was greatest when the plane of anaesthesia was deep at the start. Gastro-oesophageal reflux (GOR) occurred in both planes of anaesthesia and must occur by passive mechanisms during deep anaesthesia because gastro-oesophageal motility was inhibited. A high pressure zone (HPZ) was demonstrated for a length of 2.9 cm at the gastro-oesophageal junction with a balloon-tipped catheter and a 'pull through' technique. Open-tipped catheters could detect the HPZ but were less sensitive. The pressure in the HPZ was not significantly influenced by the depth of anaesthesia used. In 80% of cases of light anaesthesia an increase in HPZ pressure preceeded the contraction of the cranial sac of the rumen. In deep anaesthesia the HPZ continued to have rhythmic changes in tone. Spontaneous GOR coincided with a maximum gastro-oesophageal pressure gradient in 24% of cases. Rumen insufflation with oxygen provoked GOR at a rumen pressure above 33 mmHg compared with 7.2 mmHg during spontaneous reflux. The study demonstrates that a gastro-oesophageal pressure gradient was not primarily responsible for the initiation of GOR during anaesthesia and that the HPZ at the gastro-oesophageal junction of sheep had some of the properties of a lower oesophageal sphincter and played an important role in the initiation of GOR during anaesthesia.
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PMID:Motility of the oesophagus and gastro-oesophageal junction during halothane anaesthesia in sheep. 319 53

This article reviews the current data available on the most frequently used drugs in bronchopulmonary dysplasia. Oxygen, diuretics, bronchodilators, steroids, ribavirin, and antioxidants, as well as medication available for pulmonary hypertension, systemic hypertension, and gastroesophageal reflux are discussed, with emphasis on known advantages, side effects, and current dosage.
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PMID:Pharmacotherapy in bronchopulmonary dysplasia. 332 29

We reviewed the medical records of nine infants with severe bronchopulmonary dysplasia and gastroesophageal reflux who underwent fundoplication-gastrostomy surgery. All the infants were born prematurely, required preoperative mechanical ventilation, and were failing to thrive. The operative procedure was well tolerated by all the infants. Seven patients were extubated by day 11, and two patients required long-term ventilation. There were two postoperative deaths, both attributed to acute respiratory deterioration followed by cardiorespiratory failure. The postsurgical respiratory response was observed to be a rapid decrease in oxygen requirements and an absence of further aspiration episodes. A mean decrease of 0.14 in fractional inspired oxygen concentration was noted by 30 days postoperatively, and by 180 days the decrease in fractional inspired oxygen concentration was 0.22. All infants were fed by gastrostomy by postoperative day 4, with no evidence of clinical reflux. The nutritional response was noted to be an increase in growth velocity with increasing age (ie, catch-up growth) and ease of feeding. At both 30 and 180 days postoperatively, the mean growth velocity was more than double the preoperative growth velocity. In addition, ease of postoperative feeding reduced the nursing care requirements and allowed earlier discharge from hospital. Fundoplication and gastrostomy is effective in facilitating growth and feeding in addition to decreasing oxygen requirements in infants with severe bronchopulmonary dysplasia and gastroesophageal reflux.
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PMID:Antireflux surgery in infants with bronchopulmonary dysplasia. 357 89

In the present study we have examined the hypothesis that transient lower esophageal sphincter relaxations are under vagal control. Fasting esophageal motor function was monitored with a manometric sleeve catheter passed via a cervical esophagostomy. Gastric insufflation with oxygen resulted in intermittent venting of gas into the esophagus during transient lower esophageal sphincter relaxations. Such venting of gas was associated with the occurrence of esophageal body common cavities and gas venting from the esophageal stoma, all of which increased with increasing rates of gastric insufflation. The optimal insufflation rate, 80 ml/min, produced stomal gas venting at a rate of 10.3 +/- 1.1/h (mean +/- SE). The time and pressure profiles of transient lower esophageal sphincter relaxations induced by gastric insufflation were similar to those relaxations seen with spontaneous postprandial gastroesophageal reflux and belching in dogs. Sphincteric relaxation started 10 s before the onset of common cavities. In all 4 dogs, cooling of cervical subcutaneous vagosympathetic loops abolished transient lower esophageal sphincter relaxations, common cavities, and stomal gas venting. Within 1-4 min of cessation of vagal cooling, all three markers of gastroesophageal gas venting returned. Atropine, 50 and 200 micrograms/kg i.v., did not block transient lower esophageal sphincter relaxations or gas reflux. Gastric gaseous distention is a potent and consistent trigger of transient lower esophageal sphincter relaxations in the dog. This effect can be used as a model for study of control mechanisms of transient sphincter relaxation-dependent gastroesophageal reflux. Our observations with this model indicate that transient lower esophageal sphincter relaxations are under vagosympathetic control, but that muscarinic mechanisms are not important mediators of this control.
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PMID:Abolition of gas reflux and transient lower esophageal sphincter relaxation by vagal blockade in the dog. 374 65

A wide variety of types of pulmonary diseases and respiratory symptoms have been associated with gastroesophageal reflux (GER). Asthma, chronic bronchitis, bronchiectasis, and pulmonary fibrosis have all been linked to GER, but causal mechanisms have been difficult to establish. To characterize pulmonary function abnormalities in older children and young adults (age 7-23 years) with GER, lung function was evaluated in 22 patients being treated for reflux. The patients were divided into two groups: nine subjects (Group 1) had no history of pulmonary symptoms. Thirteen subjects (Group 2) had known pulmonary disease; all had diagnosed asthma, and five had a history of recurrent pneumonia. Lung volumes and spirometry were measured. Airway reactivity was assessed by measuring change in flows following isocapneic hyperventilation of subfreezing air. The presence of "small airway" disease was assessed by air-helium flow volume curves and the single breath oxygen test. Lung size, as indicated by measurement of total lung capacity, was normal in all patients. Flow rates, density dependence of maximal expiratory flow, single breath oxygen test, and tests of airway reactivity were abnormal only in Group 2 patients and were normal in the Group 1 patients. That not all children with GER have abnormal pulmonary function suggests that, if there is a causal relationship between GER and lung disease, it is multi-factorial in nature. Children with GER who do have lung disease have evidence of airway obstruction, maldistribution of ventilation, and increased airway reactivity, but do not have restricted lung volumes.
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PMID:Pulmonary function in older children and young adults with gastroesophageal reflux. 376 70

Pierre Robin's syndrome, a disorder apparently constituted by peripheral signs, is in fact the result of early major disturbances of ontogenesis of motor and regulatory organization of the fetal rhombencephalon. This is confirmed by the presenting signs in neonates with Pierre Robin's syndrome: --electrophysiological deglutition and sucking disorders as demonstrated on electromyography; --disorders in tone of tongue, pharyngeal and laryngeal muscles; --cardiac and respiratory regulatory disorders as shown by central and obstructive apneas with diminished oxygen pressure and bradycardia of central origin during sleep; and gastro-esophageal reflux. Associated signs indicating that Pierre Robin's syndrome is a separate disease entity are: --evidence of a rhomboencephalic neurocristopathy (malformation of 3rd and 4th aortic arch arteries, thymic and parathyroid hypoplasia) associated with a central rhomboencephalic lesion and resulting in dysneurulation; --mesencephalic lesion as seen in Stickler's syndrome and prosencephalic lesion as in Binder's syndrome, indicating more diffuse cephalic dysneurulation. The common origin of Di George's and Pierre Robin's syndromes is emphasized, the neonatal microretrognathism of the latter syndrome being a bulbar sign. Pierre Robin's syndrome has a poor prognosis, as there is a fatal outcome in one out of four neonates affected, and it appears to be an affection that is the clinical expression of an early major anomaly of cephalic neurulation.
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PMID:[A new concept of Pierre Robin syndrome and disease: dysneurulation of the rhombencephalon]. 657 97

To determine what relationship might exist between gastroesophageal reflux and nocturnal asthma, we studied nine patients with asthma and seven control subjects overnight in the sleep laboratory, monitoring sleep state, esophageal pH, tidal volume (including the relative contribution of rib cage and abdomen), and oxygen saturation. There were 15 episodes of gastroesophageal reflux, in three patients with asthma and four control subjects. There were no significant differences between the two groups in the number of reflux episodes, duration of the longest episode, and the percentage of reflux time. Thirteen of the 15 episodes occurred during the awake state or after movement arousal. None of the episodes caused coughing, wheezing, or changes in oxygen saturation in any of the subjects. These patients with chronic asthma did not have an increased incidence of gastroesophageal reflux at night, and reflux did not play any role in the production of their nighttime symptoms.
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PMID:Gastroesophageal reflux during sleep in asthmatic patients. 684 21


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