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Query: UMLS:C0042963 (vomiting)
 31,883 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Gastric emptying was measured using a modification of the double-sampling dye dilution technique in 16 children with gastroesophageal reflux and partial thoracic stomach (hiatal hernia), 13 with reflux per se, and 12 controls with nonspecific vomiting. No differences could be demonstrated between the rate of emptying in these groups. Our study failed to provide a rational explanation for the copious projectile vomiting that is a frequent manifestation of these disorders.
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PMID:Children with gastroesophageal reflux with or without partial thoracic stomach (hiatal hernia) have normal gastric emptying. 273 62

Seventy-five infants and children presenting during the period December 1984 to December, 1987 with the clinical features of vomiting, failure to thrive, chronic cough, recurrent pneumonia and atypical asthma were evaluated for gastroesophageal reflux by standard barium esophagram. Fifty six cases (74.7%) and as many as 80% of the infants studied had gastroesophageal reflux; Grade II reflux was seen in 12 cases, Grade III in 30 and Grade IV in 14 cases. The patients with gastroesophageal reflux were put on medical treatment. All the patients had subjective improvement after 6 weeks to 6 months of conservative treatment and none of them developed further complications of gastroesophageal reflux during a follow-up period varying from two months to fifteen months. Anti-reflux surgery was not considered owing to the subjective improvement in all the patients on conservative treatment. We conclude that gastroesophageal reflux is very common in infants and children and urge the need to evaluate the patients presenting with the symptoms suggesting gastroesophageal reflux by barium esophagram; conservative treatment is the mainstay in the management of these children.
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PMID:Gastroesophageal reflux in infants and children. 275 28

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

We study 22 children with clinical symptoms of gastroesophageal reflux. The main manifestations were: frequent vomiting, failure to thrive and repetitive pneumonia. In all of them we perform barium esophagogram (SEGD) with fluoroscopy, esophageal manometry (EM) and a four hours intraesophageal pH measurement. Thirteen of the twenty two children present a pathologic reflux (ERGE); in 16 we found SEGD that show reflux; three of them had an abnormal EM, the other 13 were normal. Seven patients showed alteration of the intraesophageal pH measurement. In conclusion the intraesophageal pH measurement in short period of time (4 hours) is a good method in the diagnosis of patients with ERGE.
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PMID:[Intraesophageal pH in children with suspected reflux]. 275 73

We report our experience with 90 neurologically impaired children treated with gastrostomy and Nissen fundoplication. Malnutrition was the main problem, followed by aspiration, recurrent pneumonia, and vomiting. The symptomatology was caused by swallowing incoordination and gastroesophageal reflux. The diagnosis of gastroesophageal reflux was confirmed by upper gastrointestinal series and pH probe. Nissen fundoplication was performed following a standard technique with preservation of the vagus nerves and its branches, repair of the diaphragmatic crura, reconstruction of the angle of His, and a 360 degree wrap. A gastrostomy and pyloroplasty or pyloric dilatation were part of the operative procedure. There were no deaths and few complications related to the surgical procedure. Marked nutritional improvement was seen in most cases with an average weight gain of 3.2 kg/patient 3 months following surgery. There was also improvement in milestones and seizure control. The majority of parents were very satisfied and would recommend the procedure to other parents with similar problems.
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PMID:Gastrostomy and Nissen fundoplication in neurologically impaired children. 280 49

Clinical signs of esophageal hiatal hernia in four dogs and one cat included regurgitation, vomiting, hematemesis, hypersalivation, dysphagia, and dyspnea. Thoracic radiographs, esophagram, and fluoroscopy were used to demonstrate cranial displacement of the esophagogastric junction and part of the stomach through the esophageal hiatus. Other findings included megaesophagus, esophageal hypomotility, gastroesophageal reflux, and pneumonia. Medical therapy failed to resolve the clinical signs. Reduction in size of the esophageal hiatus, fixation of the esophagus to the diaphragmatic crus (esophagopexy), and a left fundic gastropexy were performed. Surgical results were considered good to excellent.
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PMID:Hiatal hernia repair by restoration and stabilization of normal anatomy. An evaluation in four dogs and one cat. 281 56

Vomiting, hematemesis, and esophagitis resulting from gastroesophageal reflux or hiatal hernia are frequently observed in severely handicapped children. This study was conducted to determine whether the use of a new H2-antagonist, famotidine, could prevent recurrence of reflux esophagitis among such children. Seventeen severely handicapped, bedridden children admitted to a children's medical center between April 1985 and September 1986 were studied. All had vomiting or hematemesis as a main symptom, and the cause of esophagitis was suggested to be gastroesophageal reflux in 13 cases and hiatal hernia in four. Six had been previously treated with cimetidine or other drugs or a combination thereof without relief. Famotidine was administered at about 1 to 2 mg/kg/day, two times daily to patients weighing more than 10 kg and three times daily to those weighing less than 10 kg. In 13 cases, famotidine was administered intravenously for between seven and ten days and then given orally, while the rest were given the drug orally from the outset. The following results were obtained: (1) improvement was seen within seven days after start of famotidine treatment, and reduction of vomiting or hematemesis or both was reached within two weeks in 70% of cases and within three weeks in 94%; (2) famotidine was markedly effective in 29% and moderately effective in 41%; in no case was the drug ineffective; (3) no side effects were observed; five patients had transient, mild elevation of SGOT . SGPT, but this was not attributable to the drug.
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PMID:Effect of a new H2-blocker, famotidine, in reflux esophagitis among severely handicapped children. 288 29

Fifty-seven of 101 Nissen fundoplications during the 4-year period, July 1979 to July 1983, were performed on neurologically impaired children. Mean age at the time of surgery was 5.9 years (range 1 month to 22 years). Indications for operation included: persistent vomiting, 57 patients (100%); failure to thrive, 49 patients (86%); repeated episodes of pneumonia, 49 patients (86%); esophagitis, 18 patients (32%); hiatal hernia, 14 patients (25%); episodes of apnea, 10 patients (18%); and esophageal stricture, six patients (10%). Forty-six of the 57 patients had previously failed a standard trial of nonsurgical management. Gastroesophageal reflux was documented by barium esophagograms in 51/56 patients (91%), chalasia scans in 28/32 patients (88%), esophagitis or stricture at endoscopy in 21/23 patients (91%), and acid reflux on pH monitoring in 13/16 patients (80%). Operative management included gastrostomy in 55 of the 57 patients and this was permanent in 50. Gastrostomies had previously been performed in nine patients but had failed to provide a reliable method of enteral feeding because of chronic reflux and aspiration. The surgical complication rate was 12%. Intraoperative esophageal perforation occurred in two patients, splenic tear in one, hepatic vein laceration in one, and a tight wrap in one. After surgery, bowel obstruction from adhesions developed in one patient and a midgut volvulus in another. Five of the children have died, none from causes related to the surgical procedure. Clinical and radiologic follow-up evaluations of all survivors have been done, with a mean follow-up of 3 years. In four patients the repair was felt to be inadequate. One patient had an esophageal stricture and three had recurring episodes of pneumonia. Three children showed radiologic evidence of persistent reflux, but only two were symptomatic. Two patients required a second antireflux procedure for reflux and are now free of symptoms. Nissen fundoplication appears to be a safe and beneficial procedure in neurological impaired children. Long-term follow-up evaluation of these patients showed satisfactory growth as well as a significant decrease in pulmonary disease associated with aspiration.
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PMID:The effectiveness of Nissen fundoplication in neurologically impaired children with gastroesophageal reflux. 2325 71

In order to compare the standard Nissen fundoplication with the more recent Angelchik antireflux prosthesis, 47 pediatric-sized, developmentally disabled patients were prospectively randomized to receive either of these gastroesophageal antireflux procedures. The two groups were comparable at the time of surgery with regard to age, weight, surface area, emesis, number of chest radiographs, medications, lower esophageal sphincter pressure, and number and duration of reflux episodes during standard acid reflux testing. The Angelchik group required significantly less anesthesia time than the Nissen group: 107.4 +/- 22.6 min (mean +/- SD) versus 156.5 +/- 42.4 min (p less than 0.001). There was no difference in length of postsurgical hospital stay. Six months after surgery, both groups showed improvement. There was no significant difference between the Angelchik and Nissen groups in mean subjective assessment score, increased weight gain, decreases in emesis, numbers of chest radiographs, hospital days, or medications, increased lower esophageal sphincter pressure, or decreased numbers and duration of reflux during acid reflux testing. Long-term follow-up of eight Angelchik and 10 Nissen patients 12-30 months postsurgery (Angelchik 21.6 +/- 6.0 months, Nissen 21.9 +/- 5.0 months) demonstrated no significant difference in the percent of time the distal esophageal pH was below 4.0. Significant complications potentially related to the type of procedure developed in 1/21 patients in the Angelchik group and 1/17 patients in the Nissen group. We conclude that both procedures are usually effective for the surgical treatment of gastroesophageal reflux. Further study is indicated in order to establish the long-term superiority of one procedure.
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PMID:A prospective randomized double-blind study of gastroesophageal reflux surgery in pediatric-sized developmentally disabled patients: Nissen fundoplication versus Angelchik prosthesis. 293 8

Persistent gastrointestinal symptoms are common postoperatively in children with intestinal malrotation. We investigated this problem in 14 children with intestinal malrotation who had a Ladd procedure (3 patients), gastroschisis repaired (6 patients), or omphalocele repaired (5 patients) between one month and 15 years prior to study. In 13 patients, gastric emptying was measured at 30 minutes (%GE30) and at 60 minutes (%GE60) following ingestion of 99m-Tc sulfur colloid in apple juice. We estimated the degree of gastric peristalsis using the %GE corrected for immediate postcibal gastroesophageal reflux (corrected %GE). Patients with vomiting exhibited slow gastric emptying compared to patients without vomiting (%GE30: 14.0 +/- 5.5 v 32.5 +/- 4.2, P less than .005). The slow gastric emptying was related to slow gastric peristalsis (corrected %GE30: 20.3 +/- 5.0 v 47.1 +/- 6.0, P less than .005). In all 5 patients with persistent bloating and diarrhea, gastric peristalsis was rapid at 30 minutes (corrected %GE30 = 56.7 +/- 4.2) and at 60 minutes (corrected %GE60 = 69.5 +/- 5.3). To assess the role of gastroesophageal reflux (GER) in persisting symptoms, all children had extended (18 to 24 hours) esophageal pH monitoring. Eleven (79%) of the 14 patients demonstrated GER by esophageal pH monitoring, including four of six patients without reflux symptoms. All ten children under two years of age demonstrated GER regardless of symptoms or congenital anatomic abnormality. In conclusion, GER is common in patients under two years of age with intestinal malrotation, but clinical symptoms seem related more to extreme variations in gastric peristalsis than to GER.
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PMID:The significance of gastric emptying in children with intestinal malrotation. 293 9


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