51
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Jones B, Ravich WJ, Donner MW, Kramer SS, Hendrix TR. Pharyngoesophageal interrelationships: observations and working concepts. GASTROINTESTINAL RADIOLOGY 1985; 10:225-33. [PMID: 4029538 DOI: 10.1007/bf01893105] [Citation(s) in RCA: 70] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Simultaneous disorders of the pharynx and esophagus are so frequent that the complete swallowing chain should be examined in all patients with dysphagia. Data are presented to support the concept that such simultaneous disorders represent related phenomena; the mechanism involves changes in cricopharyngeal function seen radiographically as cricopharyngeal prominence. If neurologic disease has been excluded, cricopharyngeal prominence may be the clue to esophageal disease. When cricopharyngeal prominence is found during dynamic imaging of the pharynx, intensive examination of the esophagus and a search for signs of compensation or decompensation in the pharynx should be undertaken.
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52
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Staugas R, Martin AJ, Binns G, Steven IM. The significance of fat-filled macrophages in the diagnosis of aspiration associated with gastro-oesophageal reflux. AUSTRALIAN PAEDIATRIC JOURNAL 1985; 21:275-7. [PMID: 4091769 DOI: 10.1111/j.1440-1754.1985.tb00164.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Tracheal aspirates from 46 children were examined for the presence of fat-filled macrophages. They had no history suggestive of gastro-oesophageal reflux. The number of positive results from this group (46%) was compared with the number of positive results (73%) in a group of 40 children with proven gastro-oesophageal reflux. The difference in proportion of positive results between the two groups was statistically significant (P less than 0.05). In addition, subgroups of subjects, negative for gastro-oesophageal reflux and lower respiratory tract disease, were compared with children who had both conditions. A slightly greater difference, although at a similar level of significance, was found. The fact that 42% of subjects without lower respiratory tract disease or gastro-oesophageal reflux had tracheal aspirates positive for fat-filled macrophages would, however, suggest that this test is of limited clinical value and may need better quantitation before it can be recommended for widespread clinical use.
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53
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Mansfield LE, Yarborough J, Ting S. The effects of acute gastric distension on the pulmonary functions of asthmatic subjects: a preliminary study. J Asthma 1985; 22:191-3. [PMID: 4044472 DOI: 10.3109/02770908509073142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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54
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Vinocur CD, Marmon L, Schidlow DV, Weintraub WH. Gastroesophageal reflux in the infant with cystic fibrosis. Am J Surg 1985; 149:182-6. [PMID: 3966635 DOI: 10.1016/s0002-9610(85)80030-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The association of gastroesophageal reflux and its sequelae in the infant with cystic fibrosis has gone virtually unnoticed. Eight of 40 newly diagnosed infants with cystic fibrosis seen over a 24 month period had significant gastroesophageal reflux, characterized by vomiting (7 infants), recurrent pneumonia (7 infants), and failure to thrive (4 infants). Gastroesophageal reflux was demonstrated by a combination of barium swallow, scintiscan, manometry, and esophagoscopy. Three infants had rapid and permanent alleviation of symptoms after standard medical therapy; in five infants, therapy failed and they required a Nissen fundoplication. Three infants required postoperative ventilatory support for 1, 2, and 5 days. No tracheostomies were required. Postoperative hospital stay averaged 12 days (range 5 to 30 days). There were no complications or perioperative deaths. All children had complete relief of their preoperative symptoms. The group that required surgery presented earlier (mean 7 weeks of age) to the cystic fibrosis center than either the medically treated group (mean 5 months of age) or the group free of gastroesophageal reflux symptoms (5 1/2 months of age). Also, postoperative hospitalization time markedly decreased from 50 percent of 577 combined patient days preoperatively to 4 percent of 1,639 days postoperatively; this 4 percent then paralleled what was seen in the group without gastroesophageal reflux (3 percent of 19,966 combined patient days) and the group controlled medically (5 percent of 1,897 days). The pulmonary manifestations of cystic fibrosis are extremely variable, and evaluation of the effect that any intervention has on the natural history of the disease is difficult. Nonetheless, we believe that even this small series suggests that gastroesophageal reflux and its complications can significantly alter the courses of some children with cystic fibrosis. Gastroesophageal reflux should be managed as aggressively as it is in any child with reflux, and a successful and safe reduction of symptoms can be expected with intensive management.
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55
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Abstract
By better understanding the intrinsic and extrinsic factors that predispose children to chronic lung disease, strategies to prevent its development can be proposed. This article addresses conditions, such as bronchiolitis, croup, hyaline membrane disease, hydrocarbon ingestion, and near-drowning, that have been found to result in long-term changes in lung physiology. Also considered are the possible relationships of common respiratory infection, asthma, smoking, and air pollution to the development of chronic respiratory infection.
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56
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Fernandez Sanchez-Alarcos J, Lopez Encuentra A. Reflujo gastroesofagico y patologia broncopulmonar. Arch Bronconeumol 1983. [DOI: 10.1016/s0300-2896(15)32286-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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57
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Abstract
We describe an infant with stridor associated with gastroesophageal reflux (GER). This is the first report in which there is clear documentation by pH probe of a temporal association between individual episodes of GER and stridor. We review the literature and speculate on the relationship between these two phenomena. GER should be considered in patients with stridor.
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58
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Abstract
The clinical course of 19 infants with severe respiratory symptoms associated with the presence of both congenital heart disease and gastroesophageal reflux is described. Down Syndrome or central nervous system disease was present in 12 of the 19 infants. The identification of reflux as a major or additional cause of the respiratory complications was often overlooked. Medical therapy alone was successful in only one of the 19 patients. Early repair or palliation of the cardiac malformation with or without subsequent antireflux surgical procedure was associated with relief of the symptoms in 13 patients.
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59
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Abstract
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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60
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Shapiro GG, Christie DL. Gastroesophageal reflux and asthma. CLINICAL REVIEWS IN ALLERGY 1983; 1:39-56. [PMID: 6142759 DOI: 10.1007/bf02991316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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61
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Couriel JM, Hibbert M, Olinsky A, Phelan PD. Long term pulmonary consequences of oesophageal atresia with tracheo-oesophageal fistula. ACTA PAEDIATRICA SCANDINAVICA 1982; 71:973-8. [PMID: 7158336 DOI: 10.1111/j.1651-2227.1982.tb09559.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Lung function was studied in 20 children, aged 8-17 years, who had successfully repaired oesophageal atresia with tracheo-oesophageal fistula. Spirometry and plethysmography showed mild restrictive lung disease. Airways obstruction was assessed using maximal expiratory and inspiratory flow-volume loops in air and after breathing a helium-oxygen mixture. Analysis of the flow-volume data demonstrated significant obstruction at the level of the trachea and little evidence of small airways disease. Bronchial hyperreactivity, as assessed by histamine challenge, was present in 22% of subjects. Respiratory and oesophageal symptoms were common, but decreased in frequency with increasing age. The mechanisms involved in the frequent respiratory symptoms these children suffer are discussed in the light of the physiological findings.
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62
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Abstract
Radionuclide techniques are currently used to fully evaluate many congenital and acquired abnormalities of the gastrointestinal tract of children. Frequently, the anatomic and functional data provided by the nuclear examination are definitive. In the study of many disease entities, tracer techniques have replaced more cumbersome or invasive procedures. Although the radiopharmaceuticals and instrumentation are similar as applied to both children and adults, the uniqueness of children and their disease entities requires special consideration when performing and interpreting their studies. In this review, the principle radionuclide examinations used in the evaluation of pediatric gastrointestinal disorders are detailed and examples are illustrated.
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63
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64
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Johnson LF. New concepts and methods in the study and treatment of gastroesophageal reflux disease. Med Clin North Am 1981; 65:1195-222. [PMID: 7035765 DOI: 10.1016/s0025-7125(16)31469-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
This paper reviews progress in the use of 24-hour distal esophageal pH monitoring in the study of gastroesophageal reflux. This technique records acid exposure as numbers of reflux episodes and time required by the esophagus to return this acid juice to the stomach. These data afford an opportunity to conceptualize the pathophysiology of gastroesophageal reflux disease in relation to physiologic activities such as alimentation, sleep, and postural change. This knowledge will enable the clinician to critically focus attention on important issues of patient management and therapy as they relate to the pathophysiology of this disease.
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65
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Abstract
It is now widely recognized that gastroesophageal reflux causes a number of symptoms in children. Numerous tests have been developed and document the presence of GER, but none is infallible, partially because some reflux is a normal phenomenon. A carefully obtained history and esophagram are the two most useful and available clinical tools. Other tests are useful if there is no agreement between history and esophagram, if specific problems need to be documented (esophagitis), or if more certain documentation is desired because of atypical disease or in anticipation of surgery. If two tests of esophageal function agree, presence or absence of GER is diagnosed with a high degree of accuracy. At present, there is no test that will consistently demonstrate that reflux is causing respiratory symptoms. Most cases of GER in infants will respond to therapy or benign neglect by the time the babies are 18 months of age. This is in contrast to the adult situation, where reflux exists for decades and therapy is directed at the chief symptom, heartburn. Unless there are life-threatening complications or strictures, an intensive course of medical therapy is indicated. Positional therapy is presently the keystone of medical therapy, but is less effective and harder to institute in older patients. Use of thickened feedings may have some benefit. If heartburn or esophagitis is present, attempts to neutralize gastric contents are indicated. Some experience is developing in the use of drugs to control reflux, and a trial of bethanechol is warranted in difficult cases. Since most cases will improve by 18 months of age, therapy is required for only a limited time. At present, surgery is quite safe and is very effective in controlling reflux, although there is no clear consensus on how prolonged and severe symptoms must be to justify surgery in the absence of life-threatening complications.
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66
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Hillemeier AC, Lange R, McCallum R, Seashore J, Gryboski J. Delayed gastric emptying in infants with gastroesophageal reflux. J Pediatr 1981; 98:190-3. [PMID: 6894002 DOI: 10.1016/s0022-3476(81)80633-6] [Citation(s) in RCA: 123] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The purpose of this study was to investigate the rate of gastric emptying of a liquid meal in young children with symptomatic gastroesophageal reflux of varying intensity. Twenty-three infants (mean age 7.0 +/- 1.4 [SEM] months, range 2 to 14 months) were evaluated for reflux by esophageal manometry, a five-hour pH probe study, and barium swallow. The rate of gastric emptying was determined by using a liquid meal of 4 ounces of cow milk formula labeled with 99mTc sulfur colloid. In seven infants with failure to thrive and objective criteria for severe reflux, the mean gastric emptying was 21.3 +/- 6.4% at one hour. In six infants with reflux and recurrent pulmonary disease, the mean gastric emptying was 19.8 +/- 5.4%. Ten infants with mild reflux, adequate weight gain, and no pulmonary symptoms emptied 44.3 +/- 6.0% of formula at one hour, and six normal adults (mean age 28.3 +/- 2 years) emptied 56.2 +/- 6.5% of formula at one hour. These data suggest that infants with severe GER have significantly delayed gastric emptying, that gastric retention may contribute to the FTT and pulmonary symptoms in these infants, and that abnormal motor function of the gastric fundus may be a significant factor in the pathogenesis of gastroesophageal reflux of infancy.
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67
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Abstract
Gastroesophageal reflux (GER) may produce vomiting, failure to gain weight, esophagitis, heartburn, or pulmonary symptoms. Medical or surgical management depends on the severity of the symptoms. Newer diagnostic procedures such as esophageal manometry, esophageal pH probes, and nuclear scans may confirm the presence of GER. The mechanism by which GER produces different symptoms is not well understood.
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68
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Rothstein FC, Halpin TC. High incidence of pulmonary symptoms in infants evaluated for esophageal disease. Ann Otol Rhinol Laryngol 1980; 89:450-3. [PMID: 7436251 DOI: 10.1177/000348948008900516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Of 62 children (1-24 months of age) evaluated for esophageal disease, 22 were found to have pulmonary symptoms of apnea, pneumonia, wheezing, cyanosis, cough and stridor. Upper gastrointestinal series showed free gastroesophageal reflux in 10 of 22 infants; 3 were thought to have stricture. Acid-reflux test was positive in 13 of 15 and correlated with the presence of esophagitis in 12. In addition to esophagitis, endoscopic examination found two foreign bodies and an esophageal stricture unrecognized during fluorescopy. Endoscopic grasp biopsy was inadequate in most infants for the histologic evaluation of esophagitis. However, suction biopsy correlated well with endoscopically diagnosed esophagitis. In infants where medical therapy failed and symptoms were life-threatening, a Nissen fundoplication resulted in excellent resolution of symptoms. In children who present with prolonged and often life-threatening symptoms, esophageal dysfunction should be evaluated by rigorous testing.
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69
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Foglia RP, Fonkalsrud EW, Ament ME, Byrne WJ, Berquist W, Siegel SC, Katz RM, Rachelefsky GS. Gastroesophageal fundoplication for the management of chronic pulmonary disease in children. Am J Surg 1980; 140:72-9. [PMID: 7396089 DOI: 10.1016/0002-9610(80)90420-1] [Citation(s) in RCA: 60] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Gastroesophageal reflux is a common cause of chronic pulmonary disease in children. Forty-two children with recurrent pneumonia or severe asthma were evaluated and shown to have signicant reflux. Esophagography and esophageal pH testing proved the best diagnostic tests for determining reflux. Although the pulmonary symptoms were often due to repeated aspiration, they appeared in several cases to be related to bronchospasm caused by acid in the upper esophagus. All of the children underwent Nissen fundoplication and gastrostomy an average of 30 months after the onset of pulmonary symptoms. Of the children who had preoperative pneumonia, 87 percent had no recurrence after operation. In 13 of the 14 asthmatic children who underwent operation, symptoms improved and less bronchodilator medication was required. Morbidity and mortality were closely related to the duration and severity of pulmonary disease.
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70
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Arasu TS, Wyllie R, Fitzgerald JF, Franken EA, Siddiqui AR, Lehman GA, Eigen H, Grosfeld JL. Gastroesophageal reflux in infants and children comparative accuracy of diagnostic methods. J Pediatr 1980; 96:798-803. [PMID: 7365577 DOI: 10.1016/s0022-3476(80)80545-2] [Citation(s) in RCA: 110] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
To assess the diagnostic accuracy of methods employed for detection of gastroesophageal reflux, 30 infants and children with symptoms of GER were evaluated by upper gastrointestinal series, gastroesophageal scintiscan, measurement of mean resting lower esophageal sphincter pressure, esophageal intraluminal PH measurement (acid reflux test), and endoscopy. Fifteen control patients were also evaluated by the above studies. GER was demonstrated by UGI in 15 and by GE scintiscan in 17 study patients. LESP less than 15 mm Hg was noted in 12 and a positive acid reflux test was obtained in 29 study patients. Esophagitis was detected in two (of 30) study patients radiographically and in 15 (of 21) study patients by upper gastrointestinal endoscopy. Pulmonary aspiration of gastric contents was not detected by the radionuclide method. None of the 15 control patients had GER demonstrated with any of the above methods. These studies indicate that (1) the acid reflux test correlates most closely with symptoms of GER; (2) THE GE scintiscan is complementary to the UGI in the diagnosis of GER, i.e., the combination increases sensitivity; (3) normal LESP does not necessarily exclude GER; and (4) endoscopy is superior to the UGI in detecting the presence of esophagitis.
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71
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Page-Goertz SS, Stewart DR. Is the baby just spitting? Consideration of the gastroesophageal reflux. ISSUES IN COMPREHENSIVE PEDIATRIC NURSING 1980; 4:53-66. [PMID: 6900622 DOI: 10.3109/01460868009040495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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72
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Jolley SG, Herbst JJ, Johnson DG, Matlak ME, Book LS. Surgery in children with gastroesophageal reflux and respiratory symptoms. J Pediatr 1980; 96:194-8. [PMID: 7351578 DOI: 10.1016/s0022-3476(80)80801-8] [Citation(s) in RCA: 68] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
We reviewed our seven-year experience in 63 children with an operation to control gastroesophageal reflux and respiratory symptoms. The age at operation, sex, major associated disorders, and control of vomiting in this group of children were compared with another group of 72 children without respiratory symptoms who also had an antireflux operation during the same period. Associated central nervous system, pharyngeal, or esophageal disorders were common in both groups. Vomiting was controlled in 96% of patients. Fifty-six of 61 (92%) children had at least partial relief of respiratory symptoms postoperatively. The complete relief of these symptoms was more likely in patients without major associated disorders (97% vs 59% P = 0.0009). Central nervous system disorders were present in most children with incomplete resolution of respiratory symptoms. It appears that a significant number of affected infants and children may have respiratory difficulties unrelated to the presence of GER.
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73
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74
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Abstract
Lung function and bronchial reactivity by methacholine challenge were studied in 24 patients seven to 18 years after repair of type I tracheoesophageal fistula. Only one patient had no abnormalities of the variables tested. Thirteen patients had obstructive airways disease, five had a restrictive defect, and 15 had a positive methacholine challenge. It is postulated that continuing subclinical aspiration of esophageal contents causes lung damage and renders the airways hyperreactive.
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75
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Fonkalsrud EW, Ament ME, Byrne WJ, Rachelefsky GS. Gastroesophageal fundoplication for the management of reflux in infants and children. J Thorac Cardiovasc Surg 1978. [DOI: 10.1016/s0022-5223(19)41013-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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76
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Christie DL, O'Grady LR, Mack DV. Incompetent lower esophageal sphincter and gastroesophageal reflux in recurrent acute pulmonary disease of infancy and childhood. J Pediatr 1978; 93:23-7. [PMID: 650341 DOI: 10.1016/s0022-3476(78)80593-9] [Citation(s) in RCA: 79] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Fifteen patients with recurrent acute respiratory symptoms were evaluated for gastroesophageal reflux. All 15 had barium esophagrams. Ten of 15 had acid reflux tests performed and lower esophageal sphincter pressures measured. The data were compared to those in 23 patients with no acid reflux and 23 patients with positive acid reflux but no respiratory symptoms. Ten of ten patients with respiratory symptoms who were evaluated by the acid reflux test had positive results. The remaining five demonstrated GER by barium esophagram. LES pressure measurements in the ten patients were 11.3 +/- 1.5 mm Hg, which was significantly lower than the pressures in the acid reflux-negative group (20.3 +/- 1.3 mm Hg, P less than 0.001) but not different than in the patients with GER but no respiratory symptoms (13.9 +/- 1.5 mm Hg, P greater than 0.05). GER secondary to an incompetent lower esophageal sphincter may be one cause of recurrent acute respiratory disease in infants and children.
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77
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Girardi G, Fritis E, Vial L, Hevia E. Diagnosis of gastro-oesophageal reflux in infants and children by methylene-blue test. Lancet 1978; 1:1236. [PMID: 77998 DOI: 10.1016/s0140-6736(78)92468-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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78
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79
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Wells JK. GER and failure to thrive. Hosp Pract (1995) 1978; 13:23. [PMID: 621080 DOI: 10.1080/21548331.1978.11707252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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80
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Shermeta DW, Whitington PF, Seto DS, Haller JA. Lower esophageal sphincter dysfunction in esophageal atresia: nocturnal regurgitation and aspiration pneumonia. J Pediatr Surg 1977; 12:871-6. [PMID: 592067 DOI: 10.1016/0022-3468(77)90596-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The association between lower esophageal sphincter (LES) incompetence, gastroesophageal reflux, and recurrent pneumonia in patients who have undergone successful repair of esophageal atresia (EA) and tracheoesophageal fistula is demonstrated in this study. The efficacy of esophageal manometric examination in the evaluation of the LES in young children after EA repair is documented. This study also provides evidence that infants and children with LES incompetence associated with EA may have LES responsiveness to bethanechol. Once established by manometry, this responsiveness may be used to manage the patient until surgical repair would be advantageous.
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81
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Whitington PF, Shermeta DW, Seto DS, Jones L, Hendrix TR. Role of lower esophageal sphincter incompetence in recurrent pneumonia after repair of esophageal atresia. J Pediatr 1977; 91:550-4. [PMID: 908973 DOI: 10.1016/s0022-3476(77)80500-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The etiology of recurrent aspiration pneumonitis after the successful repair of esophageal atresia has not been defined. In order to explain this occurrence, we performed esophageal manometric examinations on eight patients who had undergone repair of EA and tracheoesophageal fistula. Two patients who had had recurrent pneumonia had subnormal pressure of the lower esophageal sphincter; they also had a history of severe regurgitation, and a barium esophagram demonstrated free gastroesophageal reflux. The LES incompetence in these patients was apparently corrected by administration of bethanechol.
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