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

Gastric and esophageal dysfunction are components of familial dysautonomia. The limited success of various medical management programs, has led to two types of surgical intervention. Experience with nine patients who had gastrostomy alone and 12 patients who had gastroesophageal fundoplication is reviewed. Both surgical procedures decreased frequency of vomiting and pneumonias and had positive effects on weight gain. Although "dysautonomic crises" are not eliminated, sufficient modification in character occurs so that associated risks are lessened. It is suggested that if medical management cannot control recurrent pneumonia, postprandial vomiting, esophageal bleeding, and/or inadequate weight gain, then the patient should be evaluated for fundoplication and/or gastrostomy.
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PMID:Gastroesophageal fundoplication and gastrostomy in familial dysautonomia. 705 37

Gastroesophageal reflux in infants and children is a complex disease. The diagnosis in 14 operative patients was made utilizing a careful history, barium swallow, technetium radionuclide milk scan, and endoscopy with esophageal biopsy. Symptoms were intractable vomiting, failure to thrive, recurrent pneumonia, apnea, asthma and bronchitis, esophagitis, and esophageal stricture. The pernicious aspects of this disease include a potentially significant mortality in children with severe apnea episodes, increased morbidity with esophagitis, and psychosocial disruption for those children that progress to the teenage years with recurrent vomiting, rumination, heartburn and stricture formation. A high incidence of gastroesophageal reflux unresponsive to medical management was noted with esophageal atresia and neurologic disease. The Nissen fundoplication was used in all patients and proved an effective procedure with a low morbidity and recurrence rate.
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PMID:Gastroesophageal reflux in children: an underrated disease. 707 8

To evaluate the clinical significance of suspected symptoms of GER, 24-hour esophageal pH monitoring was performedin 55 children (mean age of 23.9 months). We used 24-hour esophageal pH monitoring as a gold standard for the diagnosis of pathological GER. The primary indication for the study included frequent vomiting, dysphagia and respiratory diseases (recurrent pneumonia, aspiration pneumonia, hyperreactive airway, apnea and stridor). Forty-seven per cent of these 55 children had pathological GER and 61.5 per cent of them were less than 1-year-old. The sensitivity of frequent vomiting, dysphagia and aspiration pneumonia as symptoms of GER was lowest (7.7%) Recurrent pneumonia had highest sensitivity (50%) but had lowest specificity (31%) among other presenting symptoms. All the other symptoms had high specificity (82.8-100%). Dysphagia, hyperreactive airway and apnea were the presenting symptoms with high positive predictability (100%, 80%, and 75% respectively). We suggest that all children who have a history of dysphagia, hyperreactive airway and apnea should be evaluated for GER.
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PMID:Gastroesophageal reflux in children: correlation of symptoms with 24-hour esophageal pH monitoring. 782 6

Chronic pulmonary aspiration (CPA) causes significant morbidity, but is underdiagnosed because of difficulties in establishing a diagnosis. The lipid-laden macrophage index (LLMI) is said to differentiate between those with and without CPA. Records of 113 patients were reviewed to determine specificity and sensitivity of the LLMI for CPA. Diagnostic accuracy was inferred from treatment outcome. Mean LLMI for aspirators was 104 +/- 62 (range, 20-233), and for nonaspirators, 44 +/- 39 (range, 0-170) (P < 0.05). Sensitivity and specificity were 0.69 and 0.79, respectively. While the LLMI provides clinically helpful information, it does not stand alone as the gold standard for the diagnosis of CPA. Failure to thrive and neurological impairment correlated with CPA, using Fisher's exact test. CPA was not diagnosed in any patient with normal growth, normal neurological development, and an LLMI <86. No other clinical observation (cough, wheeze, vomiting, difficulty feeding, choking with feeding, recurrent pneumonia, bronchopulmonary dysplasia, chronic chest X-ray changes, endotracheal tube, tracheostomy tube, nasogastric feeding tube, or transpyloric feeding tube) or diagnostic study (upper gastrointestinal series, gastroesophageal scintigraphy, modified barium swallow, or pH probe) correlated with the diagnosis of CPA.
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PMID:Chronic aspiration in children: evaluation of the lipid-laden macrophage index. 1042 5

Gastroesophageal reflux disease (GORD) is more frequent among people with intellectual disability than among the intellectually normal population. Also GORD is more serious in this population. The diagnosis is often missed, because most intellectually disabled cannot express their complaints of GORD. For that reason a multidisciplinary working group of the Dutch Association of physicians active in the care of persons with a mental handicap has developed guidelines. The working group recommends endoscopy in case of a (alarm) symptoms: haematemesis, prolonged vomiting, irondeficiency anaemia e.c.i., and a 24 hour oesophageal pH test in case of b (aspecific) symptoms: recurrent pneumonia, refusal of food, regurgitation, rumination, dental erosions. In general most patients are cured with drug treatment (omeprazol or another proton pump inhibitor). If symptoms are not improved after 6 months of optimal treatment, surgical treatment may be considered.
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PMID:[Diagnosis and treatment of gastroesophageal reflux disease in the mentally retarded: guidelines of a multidisciplinary consensus work group. Dutch Association of Physicians in Care of Mentally Handicapped]. 1087 95

An 85-year-old woman was receiving enteral feeding via percutaneous endoscopic gastrostomy (PEG). The patient exhibited symptoms of gastro-esophageal reflux, leakage of nutrient from the PEG insertion point, vomiting, pyrexia, dyspnea when given nutrients and recurrent pneumonia. We therefore gave a half-solid nutrient, which was made by a mixture of agar powder and conventional liquid nutrient Immediately after starting the half-solid nutrient feeding via PEG, the patients no longer exhibited the above symptoms apart from mild pyrexia, which also vanished two weeks later. This case suggested that simply changing the fluidity of nutrients can contribute to a reduction of complications expected to occur in patients on PEG tube feeding.
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PMID:[Half-solid enteral nutrient prevents chronic complications of percutaneous endoscopic gastrostomy tube feeding]. 1218 12

We reviewed our experience in the diagnosis and management of esophageal achalasia in 33 children over a 25-year period at a single center by a retrospective chart review of all patients diagnosed with achalasia between December 1, 1975 and January 30, 2001. There were 33 cases ranging from 5 months to 16 years of age at the time of presentation (17 boys and 16 girls). Although dysphagia and vomiting were the commonest presenting symptoms, weight loss, chest pain, coughing, and recurrent pneumonia also occurred in many patients. Barium contrast study of the esophagus was the initial diagnostic modality followed by esophageal manometry. An upper endoscopy was also performed in 78.7% of cases. Management was predominantly surgical; however, seven recently diagnosed patients opted for botulinum toxin (botox) injection as the first line of treatment. The follow-up duration varied from 10 months to 10 years (mean 4.71 +/- 3.2 years). Postsurgical complications included gastroesophageal reflux disease in five patients who had not received a simultaneous antireflux procedure and "residual achalasia" in two patients, who both responded to a single botox injection.
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PMID:A review of achalasia in 33 children. 1245 92

Gastroesophageal reflux (GER) occurs throughout the day in healthy infants, children, and adolescents, as well as in adults. However, regurgitation into the pharynx and vomiting are more common in infants than in adults. This places the infant at particular risk for supraesophageal complications of GER. Despite recognition of this risk, a lack of good control data in children and an absence of placebo-controlled treatment trials provide only marginal evidence to support GER as a cause of any supraesophageal disorder in infants or children. An association of GER with "awake apnea," reactive airway disease, and recurrent pneumonia has been demonstrated. Although there is no good evidence to support the efficacy of medical therapy, surgical therapy for GER has been demonstrated to improve symptoms in selected cases with each of these symptom presentations. Although clinical experience and case series suggest that GER may possibly contribute to laryngeal disorders, sinusitis, and otitis media, convincing data are lacking. No studies have definitively demonstrated symptom improvement with medical or surgical therapy for the latter symptom presentations.
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PMID:Supraesophageal complications of gastroesophageal reflux in children: challenges in diagnosis and treatment. 1292 92

The aim of this study was to investigate the presence of gastroesophageal reflux with 24-hour pH monitoring in children with cerebral palsy. In the second part of the study, we started cisapride with the children with documented gastroesophageal reflux and evaluated the efficacy of cisapride with the second 24-hour pH monitoring. This study was performed before discontinuation of cisapride with US Food and Drug Administration reports in Turkish markets. Twenty-eight children who had been followed up in the Department of Pediatric Neurology between 1999 and 2000 were enrolled in the study. Twenty-four-hour pH monitoring was performed on all patients. Two parameters were evaluated as pathologic: a reflux index (percentage of time the pH value was <4) over 4.5% and reflux longer than 15 minutes even when the reflux index was below 4.5%. Cisapride treatment was assigned to the patients with pathologic monitoring results at a dose of 0.2 mg/kg/day for 3 months. Electrocardiograms (ECGs) were analyzed before and after cisapride treatment. Symptoms suggestive of gastroesophageal dysfunction were dysphagia in 18 cases (64.3%), constipation in 8 cases (28.6%), vomiting in 6 (14.2%) cases, and recurrent pneumonia in 2 cases (8.5%). The reflux index was > or =4.5% in 13 (46.4%) of the 28 cases. Reflux was longer than 15 minutes in 2 (7.1%) cases. Cisapride was started in 15 cases with pathologic monitoring results. Appetite improved in 6 cases and dysphagia disappeared in 8 cases after cisapride therapy (P < .05). pH monitoring was repeated in 12 cases after 3 months and was normal in 8 of them. Improvement in the reflux index and total reflux episodes was statistically significant after therapy (P = .008). No adverse effects occurred. Even though the drug is no longer marketed, we concluded that it improved the symptoms and quality of life in spastic children with gastroesophageal reflux.
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PMID:Gastroesophageal reflux in children with cerebral palsy: efficacy of cisapride. 1570 73

Children with neurological disorders may suffer from gastroesophageal reflux disease (GERD). Typical symptoms are vomiting, regurgitation and hematemesis. Patients present with respiratory symptoms only in cases with swallowing disorders causing chronic airway aspiration. We report the case of a patient affected by chromosome 8 p deletion syndrome with mental retardation, referred to our unit for suspected GERD. Chest X-ray, performed at admission for coexisting respiratory complaints, showed left lower lobe pneumonia; esophageal pH monitoring and upper endoscopy were normal for GERD. To rule out chronic airway aspiration, gastroesophageal 99 mTc scintigraphy with lung scan 18 to 24 h after a test meal and video fluoroscopy swallowing study were performed, both negative. Two months later, a second episode of left lower lobe pneumonia occurred. A chest CT scan was performed and showed an endobronchial mass; the biopsy taken during the broncoscopy was not conclusive. Surgical excision resulted in a diagnosis of pulmonary carcinoid. Bronchial carcinoids, although rare, should be taken into consideration as a potential cause of recurrent pneumonia even in the presence of demonstrated GERD where severe respiratory infections only occur with coexisting chronic pulmonary aspiration, even in neurologically impaired people.
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PMID:Association between gastroesophageal reflux and endobronchial carcinoid: a case report. 2148 Jan 46


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