Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0042963 (vomiting)
 31,883 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Aiming at developing a model of experimental gastro-esophageal reflux (GER) in the rodent we have tested three surgical procedures (distal esophageal myectomy (EM), esophago-gastrostomy (EG) and end-to-side esophago-jejunostomy (EJ) in three groups of 12 Wistar rats weighting 175 to 225 g. We have used for comparison a control group of unoperated rats. We have checked radiologically and by lower esophageal pH-monitoring that all three procedures induced GER and that this was absent in control animals. Six individuals in each group were sacrificed at the 7th day and the remaining six at the 14th day. At that time blood was drawn and esophageal tissue was collected for histological studies. Animals in the EM group were healthy after operation, had little vomiting and conserved their initial weight. Those in the EG and EJ groups had frequent vomiting, and lost weight. These symptoms were particularly severe in the EJ group. Animals in the control, EM and EG groups had histologically normal esophageal mucosa at the 7th and at the 14th days whereas those in the EJ group had grade 2-3 esophagitis at the 7th and grade 3 esophagitis at the 14th days. Esophageal epithelium in the rat is keratinized and therefore highly resistant to acid GER as attested by its excellent tolerance to reflux in the EM and EG groups. On the contrary, the presence of gastric and pancreatic juices and bile in the refluxate, like in the EJ group, digests the superficial layers of the epithelium and induces severe esophagitis.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Experimental gastro-esophageal reflux in rats]. 208 61

In the 25 years since it was first described, prolonged esophageal pH monitoring has gained increasing acceptance and popularity as a diagnostic and research technique in GER disease. Some recent developments that have contributed to its attraction include compact portable recorders, computerized analysis, short monitoring periods, the good discriminant value of the simple measurement of percent monitoring time that pH is less than 4, and the symptom index, allowing correlation of symptoms with reflux events. Nevertheless, there remain areas of uncertainty with regard to reproducibility and the conditions of monitoring, in particular whether strict dietary control and controlled activity and posture are necessary. There is no universally accepted normal range of values, but it is now apparent that normal and abnormal GER are not appropriately differentiated by simply defining the upper limit of normal using a formula of the mean plus two standard deviations, so other statistical techniques have emerged. Indications for the technique include atypical symptoms, particularly noncardiac chest pain, respiratory symptoms, and, in young children, apneic attacks and recurrent vomiting associated with failure to thrive. The technique is having an impact on the assessment prior to, during, and after medical and surgical therapy for GER, as well as in helping to unravel the complexities of the pathogenesis of esophagitis.
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PMID:Esophageal pH monitoring. 222 68

Domperidone is useful in the treatment of vomiting and gastroesophageal reflux in children. Its efficaciousness is due to the antagonist effect on gastrointestinal dopaminergic receptors. Contrary to the initial expectations, domperidone is able to penetrate into the hematoencephalic barrier and to cause adverse neurologic reactions. We report a case of extrapyramidal reaction in a child after moderate overdosage of domperidone.
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PMID:[Extrapyramidal syndrome caused by moderate overdosage of domperidone. Description of a case]. 223 67

The authors postulated that volumetric measurement of residual gastric aspirate in neonates and infants with nonbilious projectile vomiting could enable differentiation between patients with hypertrophic pyloric stenosis (HPS) and those with gastroesophageal reflux (GER) and help to determine whether ultrasound (US) or fluoroscopy of the upper gastrointestinal tract would best confirm the diagnosis. In the 38 patients (all but two of whom had been fasting for 3-4 hours), 10 mL or more of nasogastric aspirate was considered indicative of obstruction. HPS occurred in 91.7% of patients with 10 mL of aspirate or more, whereas GER occurred in 85.7% of patients with less than 10 mL. The differences between the two groups were statistically significant. Solely on the basis of residual volume (greater than or equal to 10 mL), the cause of vomiting could be differentiated, prior to standard radiologic studies, 89.4% of the time. It is concluded that patients with projectile vomiting who have 10 mL or more of residual aspirate in the stomach should undergo US for confirmation of HPS; those with less than 10 mL should undergo fluoroscopy for confirmation of GER.
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PMID:Hypertrophic pyloric stenosis: volumetric measurement of nasogastric aspirate to determine the imaging modality. 202 13

The need for feeding gastrostomy seems to be increasing in children with neurological impairment and swallowing incoordination. Because gastrostomy can cause or increase gastroesophageal reflux, an antireflux procedure has been advocated at the time of gastrostomy placement in neurologically impaired children. A gastrostomy in the lesser gastric curvature with antirefluxing properties was performed in nine neurologically impaired children. All had severe swallowing incoordination with aspiration and malnutrition. Postoperatively none of the nine patients have demonstrated clinical evidence of vomiting or gastroesophageal reflux. This type of gastrostomy prevents the developement of gastroesophageal reflux by increasing the length of the intraabdominal esophagus and by increasing the acuity of the gastroesophageal angle of His. When compared with an antireflux procedure, it has less complications, shorter postoperative recovery, and is more economical.
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PMID:Gastrostomy with antireflux properties. 226 50

Between 1976 and 1988 an antireflux procedure (ARP) was performed in 364 infants and children (Nissen, 358; Thal, 6). Recurrent gastroesophageal reflux (GER) necessitating reoperation occurred in 21 patients, a failure rate of 6%. Recurrent GER developed within 28 months of primary ARP in 18 (86%) children. The symptoms of GER became apparent following an episode of forceful emesis in 29% of patients, half of whom had a malpositioned gastrostomy tube. Recurrent GER developed in 28% of children with corrected esophageal atresia. A definitive etiology of ARP failure was identified in 18 (86%) cases: "slipped" fundoplication (15), no fundoplication visualized (2), and paraesophageal hernia (1). Perioperative morbidity, intraoperative blood loss, and length of surgery were significantly increased for secondary ARP. Mortality following reoperation was zero, but three late deaths occurred. Long-term control of GER has been achieved in 78% of children following the second operation.
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PMID:The failed antireflux procedure: analysis of risk factors and morbidity. 226 51

We report a case of Sandifer syndrome with chronic torticollis and gastroesophageal reflux (GER). The infant exhibited regurgitations and vomiting from birth. Torticollis with a permanent tilt of the head towards the right developed at age six months. At 16 months, persistence of the vomiting and abnormal attitude of the head and neck led to a CT scan that outruled a brain tumor. Esophageal pH recordings disclosed severe gastroesophageal reflux (pH less than 4 for 46% of the time over 24 hours) and endoscopy showed ulcerated peptic esophagitis. Surgical treatment of the GER ensured both resolution of the reflux and disappearance of the torticollis, establishing the causal relationship between the former and latter manifestations.
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PMID:[Torticollis in children: do not forget the Sandifer syndrome]. 231 62

An open, three-day trial was carried out in 49 infants and children with vomiting related to an acute gastrointestinal or ENT infection (63.3% of cases), a gastroesophageal reflux (20.4%), or an attack of malaria (14.3%). Mean age of patients was 21.9 months. Number of episodes of vomiting exceeded six per day in 89.8% of patients. Alizapride (Plitican) was given as oral drops in a dosage of 3 mg/kg/d. Five patients were prematurely withdrawn from the trial for clinical deterioration requiring discontinuation of enteral nutrition. Under treatment, vomiting resolved completely in 35 patients, i.e. 71.4% of the initial study group. Six patients exhibited incomplete improvement of vomiting and eight (including the 5 dropouts) continued to have a significant number of episodes of vomiting. Overall effectiveness evaluated on the frequency of episodes of vomiting, weight changes, and the investigator's clinical judgement was considered as excellent or good in 81.6% of cases. No significant adverse effects were recorded but the product's bitter taste was involved in the persistence of vomiting in one of the dropouts and in the development of moderate nausea in another patient who was able to continue treatment. The therapeutic value of alizapride, evaluated using an analog scale, proved significant in this indication.
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PMID:[The value of alizapride in the treatment of vomiting in infants and children]. 232 4

Clinical experience shows that episodes of apnea can occur during regurgitations or vomiting. We questioned whether sleep apneas could be related temporally to documented falls in esophageal pH, when no clinical symptoms of emesis are witnessed. Twenty infants admitted after an apparently life-threatening event ('ALTE') during sleep, but with no clinical symptoms of vomiting or regurgitations at the time of the event, and ten control infants were studied. All infants had occasional episodes of regurgitations. Polygraphic monitoring of state of alertness, cardiorespiratory activity and low esophageal pH was performed continuously during 1 night. The data were analyzed blindly. A total of 334 central and 36 obstructive apneas were monitored, mainly in the ALTE group, during NREM sleep. A total of 116 falls in esophageal pH below 4 units were seen in 18 infants; 50% occurred during wakefulness, and 31% in REM sleep. Arousals or body movements preceded the pH fall in 50% of the cases. Within 5 min following the reflux onset, 18 central apneas (7.2% of the apneas) were seen. There was no correlation between the duration, or the lowest values of esophageal pH measured, and the number or duration of apneas. No obstructive apnea, bradycardia or arousal followed the falls in esophageal pH. Acid esophageal reflux did not play a significant role in the development of apnea in our population.
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PMID:Sleep apneas and acid esophageal reflux in control infants and in infants with an apparent life-threatening event. 232 98

A relation was found between persistent stridor and gastroesophageal reflux in seven infants, aged 6 weeks to 6 months. Stridor began at 11 days to 2 months of age, and four of the seven infants had transient hypercarbia on at least one occasion before study. Only one had a history of frequent vomiting; three had recurrent pneumonia. Midesophageal pH, chest and abdominal movement, exhaled carbon dioxide partial pressure, and heart rate of six of the infants were recorded for 4 to 12 hours as they slept. Esophageal pH of the seventh infant was recorded for 24 hours. In the six completely studied infants, there were persistent increases of greater than 10 mm Hg in exhaled carbon dioxide level (three infants), of greater than 10 breaths per minute in respiratory rate (four infants), and in retractions and stridor (six infants) 5 to 20 minutes after onset of reflux. Stridor improved with medical management in 48 hours (five of five infants) and disappeared in 3 weeks (three of five infants) to 2 months (one of five infants). One of these medically treated infants subsequently was treated by Nissen gastric fundoplication because of a recurrence of persistent and severe stridor. Three infants had antireflux surgery, and in two of these stridor disappeared in 48 hours. In the third infant stridor disappeared 3 weeks after surgery. Based on this experience, reflux occasionally causes stridor, probably because of acute inflammation of the upper airway. If structural anomalies are ruled out, infants with severe stridor should be examined for gastroesophageal reflux.
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PMID:Stridor and gastroesophageal reflux in infants. 233 26


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