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

Metoclopramide has wide applications in both clinical and experimental medicine. It is useful in the management of gastro-oesophageal reflux and gastric stasis. It is being used increasingly in the management of nausea and vomiting, and at high doses will significantly relieve the emesis that is induced by cytotoxic agents. Metoclopramide also has an important place in the investigation of the role of dopamine in physiological and pathological processes.
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PMID:Metoclopramide--a review. 351 36

Gastroesophageal reflux (GER) may induce severe complications in infants: besides esophagitis numerous authors have established a relationship between GER and relapsing respiratory infections, between GER and apnea, cyanosis or bradycardia. This required a more precise estimation of the postural treatment than the clinical data of vomiting or the weight curve. Esophageal pH studies are considered to be the most valuable investigational technique in case of GER. It allowed us to study the importance of acid reflux in 43 patients under 1 year of age in different postures: 45 degrees upright in an infant-seat, horizontal prone and 30 degrees prone positions.
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PMID:[Gastroesophageal reflux in infants. Value of orthostatism and ventral decubitus]. 356 41

We describe 9 infants (ranging from 1 to 6 1/2 months) in whom a surgical pathology (gastro-esophageal reflux and/or pyloric stenosis) was associated with cow's milk intolerance (CMI). In all cases vomiting and/or failure to thrive did not disappear after surgery. The patients recovered only after dietary manipulation by cow's milk protein free diet. In 5 out of 9 cases, multiple food intolerances were present (soy and/or casein hydrolysates). In all cases the diagnosis of CMI was confirmed by challenge test. The connections between CMI and abdominal surgery in infancy are discussed.
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PMID:Cow's milk intolerance and abdominal surgery: a puzzling connection. 358 70

A retrospective study was carried out of children undergoing Nissen fundoplication and pyloroplasty for the correction of gastro-oesophageal reflux. Twenty children (thirteen males, seven females) aged 8 months to 12 years underwent surgery over a 10 year period. Forty per cent were mentally retarded. Presentation was failure to thrive in 19 (95 per cent), recurrent vomiting in 18 (90 per cent) and haematemesis in 14 (70 per cent). Four children had Barrett's oesophagus. There were no operative or perioperative mortalities. Follow-up (mean period 3 years, 9 months) revealed no further symptoms of reflux. The 'normal' children gained weight postoperatively whereas the 'retarded' group did not. Adhesion obstruction (10 per cent) was the major late postoperative complication. Regression of Barrett's epithelium was noted endoscopically. 'Gas-bloat' syndrome, a major complication following fundoplication, was not encountered.
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PMID:Nissen fundoplication and pyloroplasty in the management of gastro-oesophageal reflux in children. 360 5

A retrospective study based upon 100 consecutive antireflux operations performed in children for gastroesophageal reflux (GER) in the last 9 years enables the authors to elaborate on indications and their timing. The clinical pictures, often combined in this series, were vomiting (85%), respiratory disease (50%), failure to thrive (47%), haemorrhage (25%), brain damage (16%), rumination (6%), oesophageal stenosis (4%), torticollis (3%) and cricopharyngeal dysphagia (1%). Five children had been previously operated upon for oesophageal atresia. Hiatal hernia was found in only 10 instances. Only 9 children were operated upon before the age of 12 months. Overall operative age was high (52.5 months) and that of patients with neurologic disease was even higher (81.3 months) probably as a result of delayed diagnosis. This experience underlines the limitations of medical treatment beyond the age of 12 months, the poor reliability of disappearance of vomiting as an index of cure during the first year and the need for facing operative indications without prejudgements based on traditional ideas that do not take into consideration clinical manifestations of GER disease which are currently well established.
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PMID:[Indications for the surgery of gastroesophageal reflux in children]. 363 70

Some degree of gastroesophageal reflux is very common in infants and tends to reverse with time. Therefore, the indications for an antireflux operation are not well defined. Furthermore, the complication rate and the ability of the fundoplication to grow remain to be determined. To answer these questions, we reviewed the records of patients 6 months of age or younger who underwent a Nissen fundoplication with gastrostomy tube placement between 1979 and 1985. There were 45 patients (25 boys and 20 girls) with birth weights of 0.65 to 4.3 kg. The consequences of gastroesophageal reflux were more varied than in older children. Severe respiratory problems were common, including recurrent aspiration or bronchopulmonary dysplasia in 60% and frequent apneic and bradycardiac spells in 17%. Failure to gain weight was present in 20% and intractable vomiting in 2.0%. As expected, 78% of these patients had congenital anomalies or acquired problems which, in many cases, were important to the prognosis. The diagnosis was confirmed by barium swallow in all but one patient in whom gross reflux during feedings was present. Initially, medical management was tried for 3 to 4 weeks. In one patient, however, the severity of the respiratory problems precluded trial beyond 12 days. The recommendation for operation was based only on the severity of symptoms attributed to gastroesophageal reflux. All patients underwent Nissen fundoplication with gastrostomy tube placement at 2 weeks to 6 months of age and weighing 1.02 to 6.95 kg. The only surgical complication was one gastrostomy leak. Prematurity or preexisting anomalies led to a 20% incidence of late unrelated deaths between 2 weeks and 23 months postoperatively. Improvement in symptoms occurred in our survivors with follow-up of 5 to 72 months. We conclude: Significant gastroesophageal reflux in infancy most frequently produces respiratory problems that can be life threatening. Nissen fundoplication can be a safe and effective procedure in infants 6 months of age or younger. Fundoplication appears to have good growth potential, and no late complications or feeding problems have occurred. Consequently, surgical correction can be recommended for infants not responding to conservative medical therapy.
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PMID:Nissen fundoplication for gastroesophageal reflux in infants. 363 72

Dysfunction of the upper esophageal sphincter was found in five out of 44 children with gastroesophageal reflux. Three of the five children had mental retardation associated with Silver Russell syndrome, 5p syndrome, or minimal change myopathy. The five patients had swallowing disorders, vomiting, and failure to thrive; four also had pulmonary aspiration. Esophageal manometry showed incomplete upper esophageal sphincter relaxation in two patients, upper esophageal sphincter relaxation incoordinated with pharyngeal contractions in two other patients, and both incomplete and incoordinated upper esophageal sphincter relaxation in the last patient. Intensive and successful treatment of gastroesophageal reflux did not improve swallowing or symptoms of pulmonary aspiration in four children. The fifth patient underwent cricopharyngeal myotomy, with complete resolution of respiratory and swallowing symptoms. It is suggested that a dysfunction of the upper esophageal sphincter, either primary or secondary to neuromuscular disorders, may play a role in the swallowing disorders and respiratory symptoms of pediatric patients.
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PMID:Disorders of upper esophageal sphincter motility in children. 368 74

Exercise-induced gastroesophageal reflux (GER) is described in an athletic child with chronic abdominal pain and vomiting in conjunction with strenuous exercise. Although continuous 24-h pH probe monitoring was negative for GER, simultaneous pH probe and exercise stress testing (treadmill) showed a prolonged, continuous episode of acid reflux throughout exercise and the 30-min recovery phase. The authors are unaware of other cases of exercise-induced GER in children and suggest that simultaneous pH probe and exercise stress testing may be a useful technique to evaluate exercise-induced symptoms in children. Moreover, the presence of acid reflux during stress may warrant exercise restriction during the early management of reflux esophagitis.
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PMID:Exercise-induced gastroesophageal reflux in an athletic child. 368 87

Esophageal motility was studied in 26 children with gastroesophageal reflux. In 11 patients (group A), esophagitis was severe; in the remaining 15 (group B), either mild or no microscopic changes were found. Lower esophageal sphincter pressure and amplitude, as well as velocity and duration of esophageal pressure waves, were manometrically measured. All patients underwent a 12-week intensive antacid course. Manometric tracings, blindly read, were compared with those of 16 age-matched children with emesis without proven reflux (group C). Among the variables analyzed, amplitude of the motor waves was significantly lower in patients with severe esophagitis than in group B and C patients (P less than 0.01). Nonspecific motor defects (simultaneous, broad-based, double-peaked waves) were more commonly present in group A. At the end of therapy, symptoms had either disappeared or significantly improved. Endoscopic and histologic studies showed disappearance of the severe inflammatory changes. Manometry, repeated in patients with cured severe esophagitis, showed normalization of the amplitude and significant decrease of the nonspecific motility abnormalities. We conclude that severe gastroesophageal reflux disease in children causes esophageal motor dysfunction, resulting from esophageal inflammation. The occurrence of esophageal motility disorders only in patients with severe esophagitis and its disappearance after therapy may account for the favorable course of reflux disease in infancy.
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PMID:Esophageal motor abnormalities in children with gastroesophageal reflux and peptic esophagitis. 371 55

Several studies concerning the relationships between gastroesophageal reflux (GOR), gastric emptying and esophageal motility are available. So far, results have been contradictory. The purpose of this work was to study gastric emptying in patients with GOR; to search for simultaneous esophageal motility disorders and to specify their type and frequency; to establish a potential relationship between motor disorders of the esophagus and the stomach in these patients. Thirty-two consecutive patients were selected according to clinical criteria, i.e. presence of at least two of the three characteristic symptoms of GOR, and the data of a three-hour post-prandial pH-metry. Gastric stasis related clinical manifestations (nausea, post-prandial vomiting, sensation of abdominal distension or of post-prandial epigastric fullness) were also searched for in all patients. A gastroscopy allowed to score esophagitis in each case. All patients, including adult controls underwent an esophageal manometry as well as a radionuclide determination of gastric emptying, after isotopic labelling of the solid (S) and liquid (L) phases of a test meal. The results showed that there was no significant modification of gastric emptying of the S and L phases of the meal in the group of patients with GOR whatever the intensity of the reflux, judged on the pH-metry results and the endoscopic data. Thus the average time of gastric half-emptying of S and L was respectively 115 and 52 min for the patients vs 111 and 51 min for the control group. As well, no correlation was found between the gastric emptying parameters and the presence or absence of clinical signs of gastric stasis or the amplitude of esophageal contraction waves. On an individual basis, two patients showed a significant decrease in gastric emptying of either the S or L phases without any attendant modification in the kinetics of the other. These results suggest that, in the adult, gastric emptying cannot be considered to be a determining factor of GOR and there are no diffuse motility disorders of the upper digestive tract during this illness.
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PMID:[Gastric emptying of a solid-liquid meal in gastroesophageal reflux in adults]. 372 Nov 14


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