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Raza SM, Raza D, Neice M, Kile B, Andrus V, Armstrong E, Okuampa D, Deville A, Dies R, Kawji L, Mubashir M, Rashid S, Ahsan S, Bhuiyan MAN, Cai Q. Short-term symptomatic outcomes of GERD in patients with gastroparesis after gastric per oral endoscopic pyloromyotomy. Dis Esophagus 2024:doae066. [PMID: 39153221 DOI: 10.1093/dote/doae066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 07/09/2024] [Indexed: 08/19/2024]
Abstract
Gastroparesis (Gp) patients often have gastroesophageal reflux disease (GERD). Management of GERD in Gp patients is a challenge. Many studies have shown that gastric peroral endoscopic pyloromyotomy (G-POEM or POP) is moderately effective in reducing nausea and vomiting in patients with Gp. This study aims to determine whether G-POEM can improve GERD in Gp Patients. Patients who underwent G-POEM from July 2021 to October 2022 were enrolled in the study. GERD Health-Related Quality of Life (GERD HRQL) and Reflux Symptom Index (RSI) were used to assess patients' GERD before and after G-POEM. The use of proton pump inhibitors (PPIs) before and after G-POEM were also documented. The Gastroparesis Cardinal Symptom Index (GCSI) was used to assess the severity of Gp before and after G-POEM. A 'Welch two-sample t-test' was used to find differences in GERD HRQL (health-related quality of life) and RSI scores before and after the procedure. Pearson's chi-square test was used to find differences for use of PPI before and after G-POEM. Twenty-three consecutive refractory Gp patients with 30% male (average age 63.2) and 70% female patients (average age 53.9) were enrolled. Of these, 14 had diabetes, 3 had a history of surgery, and 6 had idiopathic Gp. The mean follow-up was 41 days (range 7-61 days). There was a significant decrease in the mean GERD HRQL score from 16.5 to 6.5 after G POEM with a P-value <0.0001 (95% level of significance) and a significant decrease in mean RSI score from 15.3 to 5.2 after G-POEM with P-value <0.0001 (95% level of significance). The proportion of use of PPI before GPOEM was 0.91, and the proportion of PPI use after GPOEM was 0.43 (P = 0.0008). The mean GCSI pre- and post-GPOEM were 3.53 and 1.59, respectively. Eighteen had clinical success in Gp as defined by decreased mean GCSI score greater than 1. In this short-term outcome study, 87% of patients' GERD HRQL scores and RSI scores decreased after G-POEM. These findings indicate that GPOEM not only effectively reduces Gp symptoms but also improves GERD symptoms leading to decreased or more effective use of PPI in these patients. To our knowledge, this is the first study to comprehensively show G-POEM significantly improves GERD. Further studies with a larger patient population and long-term outcomes are needed.
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Affiliation(s)
- Syed Musa Raza
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Louisiana State University Health Science Center at Shreveport, Shreveport, LA, USA
| | - Daniyal Raza
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Louisiana State University Health Science Center at Shreveport, Shreveport, LA, USA
| | - Michelle Neice
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Louisiana State University Health Science Center at Shreveport, Shreveport, LA, USA
| | - Brittany Kile
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Louisiana State University Health Science Center at Shreveport, Shreveport, LA, USA
| | - Victoria Andrus
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Louisiana State University Health Science Center at Shreveport, Shreveport, LA, USA
| | - Elizabeth Armstrong
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Louisiana State University Health Science Center at Shreveport, Shreveport, LA, USA
| | - David Okuampa
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Louisiana State University Health Science Center at Shreveport, Shreveport, LA, USA
| | - Ashely Deville
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Louisiana State University Health Science Center at Shreveport, Shreveport, LA, USA
| | - Ross Dies
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Louisiana State University Health Science Center at Shreveport, Shreveport, LA, USA
| | - Lena Kawji
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Louisiana State University Health Science Center at Shreveport, Shreveport, LA, USA
| | - Maryam Mubashir
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Louisiana State University Health Science Center at Shreveport, Shreveport, LA, USA
| | - Shazia Rashid
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Louisiana State University Health Science Center at Shreveport, Shreveport, LA, USA
| | - Sidra Ahsan
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Louisiana State University Health Science Center at Shreveport, Shreveport, LA, USA
| | - Mohammad Alfrad Nobel Bhuiyan
- Division of Clinical Informatics, Department of Internal Medicine, Louisiana State University Health Science Center at Shreveport, Shreveport, LA, USA
| | - Qiang Cai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Louisiana State University Health Science Center at Shreveport, Shreveport, LA, USA
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Pulvirenti R, IJsselstjin H, Mur S, Morini F. Approaches to nutrition and feeding in congenital diaphragmatic hernia. Semin Pediatr Surg 2024; 33:151442. [PMID: 39004036 DOI: 10.1016/j.sempedsurg.2024.151442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/16/2024]
Abstract
In patients with congenital diaphragmatic hernia1, nutrition can represent a challenge both in the short and long term. Its failure to resolve can have a significant impact on multiple aspects of the lives of patients with congenital diaphragmatic hernia (CDH), ranging from lung function to neurodevelopment. In this review, we will describe the causes of nutritional problems in patients with CDH, their consequences, and possible strategies to address them.
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Affiliation(s)
- Rebecca Pulvirenti
- Department of Pediatric Surgery, Erasmus Medical Centre Sophia Children's Hospital, Rotterdam, the Netherlands; Pediatric Surgery Unit, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Hanneke IJsselstjin
- Department of Pediatric Surgery, Erasmus Medical Centre Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Sebastien Mur
- Department of Neonatology, Lille University Hospital, French CDH reference center, Lille, France
| | - Francesco Morini
- Department of Maternal, Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy.
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Reflux Symptoms in Gastroparesis: Correlation With Gastroparesis Symptoms, Gastric Emptying, and Esophageal Function Testing. J Clin Gastroenterol 2020; 54:428-438. [PMID: 30762609 DOI: 10.1097/mcg.0000000000001190] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
GOAL The goal of this study was to determine the relationship of reflux with gastroparesis (Gp), looking both at symptoms and objective testing. BACKGROUND Gp patients often experience gastroesophageal reflux symptoms. How the severity of reflux correlates with the severity of Gp is not known. STUDY Patients referred to our academic center with symptoms of Gp completed the Patient Assessment of Upper Gastrointestinal Symptoms, Hospital Anxiety and Depression Scale, and Patient Health Questionnaire (PHQ)-15. They underwent 4-hour gastric emptying scintigraphy; and, if indicated, high-resolution esophageal manometry and esophageal pH impedance (EpHI). RESULTS Of 755 patients from July 2013 to May 2018, 432 had Gp with Gastroparesis Cardinal Symptom Index (GCSI) total score of 3.2±0.1 (mean±SEM) and heartburn/regurgitation subscore of 2.0±0.1. A fourth (27.1%) of all Gp patients had moderate to very severe heartburn/regurgitation symptoms. Heartburn/regurgitation subscore had strong correlation with GSCI total score (r=0.56, P<0.01), and weak correlation with 4-hour gastric retention (r=0.11, P=0.02). In total, 103 Gp patients underwent EpHI monitoring; time esophageal pH<4 had no correlation with heartburn/regurgitation subscore. Less than half (41.7%) of the patients undergoing EpHI had gastroesophageal reflux disease by EpHI. Gp patients with gastroesophageal reflux disease had more severe 4-hour gastric retention, and more frequently had decreased lower esophageal sphincter resting pressure and esophageal motility disorders. Heartburn/regurgitation subscore had moderate correlation with somatic symptoms, and weak correlations with anxiety and depression. CONCLUSIONS The severity of reflux symptoms in Gp has strong correlation with GCSI total score, weak correlation with gastric retention, and no correlation with esophageal pH monitoring.
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Abstract
Although the definition of gastroparesis in children is the same as in adults, there are key differences between gastroparesis in these two populations in presentation, diagnosis, treatment and outcomes. Infants and younger children with gastroparesis tend to be male, present with vomiting as their primary symptom and are more likely to experience the resolution of their symptoms over time. Adolescents with gastroparesis tend to be female, present with abdominal pain as their primary symptom and have a less favorable short- and medium-term outcome, sharing some similarities with adults with gastroparesis. Despite the fact that validated diagnostic criteria for gastroparesis are lacking in infants and younger children, these age groups make up nearly half of children with gastroparesis in some studies. The diagnosis and treatment of children with gastroparesis has thus far relied heavily on research studies performed in adults, but it is becoming increasingly clear that gastroparesis in children is a distinct entity and there are limitations to the applicability of data obtained from adults to the care of children.
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Kovacic K, Elfar W, Rosen JM, Yacob D, Raynor J, Mostamand S, Punati J, Fortunato JE, Saps M. Update on pediatric gastroparesis: A review of the published literature and recommendations for future research. Neurogastroenterol Motil 2020; 32:e13780. [PMID: 31854057 DOI: 10.1111/nmo.13780] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 11/11/2019] [Accepted: 11/29/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Due to scarcity of scientific literature on pediatric gastroparesis, there is a need to summarize current evidence and identify areas requiring further research. The aim of this study was to provide an evidence-based review of the available literature on the prevalence, pathogenesis, clinical presentation, diagnosis, treatment, and outcomes of pediatric gastroparesis. METHODS A search of the literature was performed using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines with the following databases: PubMed, EMBASE, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, and Web of Science. Two independent reviewers screened abstracts for eligibility. KEY RESULTS Our search yielded 1085 original publications, 135 of which met inclusion criteria. Most articles were of retrospective study design. Only 12 randomized controlled trials were identified, all of which were in infants. The prevalence of pediatric gastroparesis is unknown. Gastroparesis may be suspected based on clinical symptoms although these are often non-specific. The 4-hour nuclear scintigraphy scan remains gold standard for diagnosis despite lack of pediatric normative comparison data. Therapeutic approaches include dietary modifications, prokinetic drugs, and postpyloric enteral tube feeds. For refractory cases, intrapyloric botulinum toxin and surgical interventions such as gastric electrical stimulation may be warranted. Most interventions still lack rigorous supportive data. CONCLUSIONS Diagnosis and treatment of pediatric gastroparesis are challenging due to paucity of published evidence. Larger and more rigorous clinical trials are necessary to improve outcomes.
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Affiliation(s)
- Katja Kovacic
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Walaa Elfar
- Division of Gastroenterology and Nutrition, Department of Pediatrics, The Pennsylvania State Melton S. Hershey Medical Center, Hershey, PA, USA
| | - John M Rosen
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, The Children's Mercy Hospital, Kansas City, MO, USA
| | - Desale Yacob
- Division of Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, Ohio State University, Columbus, OH, USA
| | - Jennifer Raynor
- Edward G. Miner Library, University of Rochester Medical Center, Rochester, NY, USA
| | - Shikib Mostamand
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Jaya Punati
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - John E Fortunato
- Neurointestinal and Motility Program, Section of Pediatric Gastroenterology, Hepatology and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Miguel Saps
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Holtz Children's Hospital, Miller School of Medicine, University of Miami, Miami, FL, USA
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Cao X, Xu X, Drubach L, Fahey FH. Stomach frame-count-based attenuation correction of dynamic posterior view gastric emptying scintigraphy with continuous acquisition in children. Pediatr Radiol 2017; 47:1599-1607. [PMID: 28685191 PMCID: PMC5659918 DOI: 10.1007/s00247-017-3917-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 04/26/2017] [Accepted: 06/02/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND When performing dynamic gastric emptying scintigraphy with continuous acquisition in children, a single posterior view acquisition is preferred because it allows the young patient to more easily interact with a parent or technologist even though this method tends toward overestimating gastric emptying. OBJECTIVES The objective of our study was to develop a new attenuation correction (AC) method to improve the accuracy of the time activity curve and the measurement of residual gastric emptying from 1-h posterior images of gastric emptying scintigraphy with continuous acquisition. MATERIALS AND METHODS We developed a frame-count-based AC for gastric emptying scintigraphy from the posterior view (posterior AC method). We retrospectively reviewed 122 gastric emptying studies performed in children using conjugated posterior and anterior views, and evaluated the statistical differences between posterior only (without AC) and posterior AC using the geometric mean method as a reference standard. RESULTS The residual values obtained using posterior AC were not significantly different (P=0.813) compared to those using the geometric mean while the values using the posterior only were significantly different (P<0.001) from the geometric mean. CONCLUSION The proposed method can replace the geometric mean method to estimate gastric emptying residual fraction using patient-friendly posterior view without a significant difference in 1-h gastric emptying scintigraphy with continuous acquisition.
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Affiliation(s)
- Xinhua Cao
- Department of Radiology, Division of Nuclear Medicine and Molecular Imaging, Boston Children's Hospital and Harvard Medical School, 300 Longwood Ave., Boston, MA, 02115, USA.
| | - Xiaoyin Xu
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Laura Drubach
- Department of Radiology, Division of Nuclear Medicine and Molecular Imaging, Boston Children's Hospital and Harvard Medical School, 300 Longwood Ave., Boston, MA, 02115, USA
| | - Frederic H Fahey
- Department of Radiology, Division of Nuclear Medicine and Molecular Imaging, Boston Children's Hospital and Harvard Medical School, 300 Longwood Ave., Boston, MA, 02115, USA
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Knatten CK, Fjeld JG, Medhus AW, Pripp AH, Fyhn TJ, Aabakken L, Kjosbakken H, Edwin B, Emblem R, Bjørnland K. Preoperative liquid gastric emptying rate does not predict outcome after fundoplication. J Pediatr Surg 2017; 52:540-543. [PMID: 28277299 DOI: 10.1016/j.jpedsurg.2016.09.068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 09/08/2016] [Accepted: 09/30/2016] [Indexed: 12/12/2022]
Abstract
AIM OF THE STUDY Preoperative gastric emptying (GE) rate in patients with gastrointestinal reflux disease (GERD) was evaluated as a predictor of outcome after antireflux surgery. METHODS AND PATIENTS GE was assessed using radionuclide scintigraphy and a standardized meal with cow's milk. GE half time (T1/2), patient demographics and GERD symptoms including vomiting (>4days/week), retching (>4days/week), prolonged feeding time (>3h/day), and discomfort after meals were recorded pre- and postoperatively. A standardized follow-up included a 24-h pH-monitoring and an upper gastrointestinal contrast study. Of 74 patients undergoing Nissen fundoplication between 2003 and 2009, 35 underwent a preoperative GE study. The remaining 39 patients were not examined owing to volume intolerance, cow's milk intolerance or allergy, inability to lie still, or parents refusing participation. MAIN RESULTS Median age at fundoplication was 4.9 [range 1.1-15.4] years, and follow-up time was median 4.3 [1.9-8.9] years. GERD recurred in 7 (20%) patients. Preoperative T1/2 in the seven patients with recurrent GERD was median 45 [21-87] min compared to 44 [16-121] min in the 28 patients without recurrent GERD (p=0.92). There was no significant difference between the one third of patients with the slowest GE [T1/2 54-121min] and the remaining patients [T1/2 16-49min] regarding GERD recurrence or postoperative vomiting, retching, prolonged feeding time, or discomfort after meals. CONCLUSION Preoperative GE rate did not predict outcome after antireflux surgery, as slow GE was not associated with recurrent GERD or postoperative troublesome symptoms such as vomiting, retching, or meal discomfort.
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Affiliation(s)
- C K Knatten
- Department of Gastrointestinal and Pediatric Surgery, Oslo University Hospital, Norway; Department of Pediatrics, Oslo University Hospital, Norway.
| | - J G Fjeld
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Norway; Oslo and Akershus University College of Applied Sciences
| | - A W Medhus
- Department of Gastroenterology, Oslo University Hospital, Norway
| | - A H Pripp
- Oslo Centre of Biostatistics and Epidemiology, Oslo University Hospital, Norway
| | - T J Fyhn
- Department of Gastrointestinal and Pediatric Surgery, Oslo University Hospital, Norway
| | - L Aabakken
- Department of Gastroenterology, Oslo University Hospital, Rikshospitalet, Norway; Institute of Clinical Medicine, University of Oslo, Norway
| | - H Kjosbakken
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Norway
| | - B Edwin
- Institute of Clinical Medicine, University of Oslo, Norway; Intervention Centre, Oslo University Hospital, Rikshospitalet, Norway; Department of HPB Surgery, Oslo University Hospital, Rikshospitalet, Norway
| | - R Emblem
- Department of Gastrointestinal and Pediatric Surgery, Oslo University Hospital, Norway; Institute of Clinical Medicine, University of Oslo, Norway
| | - K Bjørnland
- Department of Gastrointestinal and Pediatric Surgery, Oslo University Hospital, Norway; Institute of Clinical Medicine, University of Oslo, Norway
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Choi YJ, Ha EK, Jeong SJ. Dietary habits and gastroesophageal reflux disease in preschool children. KOREAN JOURNAL OF PEDIATRICS 2016; 59:303-7. [PMID: 27588031 PMCID: PMC5007426 DOI: 10.3345/kjp.2016.59.7.303] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 05/01/2016] [Accepted: 05/04/2016] [Indexed: 01/10/2023]
Abstract
Purpose To identify the relationship between dietary habits and childhood gastroesophageal reflux disease (GERD) in preschool children. Methods We performed a questionnaire study to analyze the relationship between dietary habits and GERD in 85 preschool children with GERD and 117 healthy children of the same age. Results Irregular and picky eating were more p–revalent in the GERD group than in the control group (odds ratio [OR], 4.14; 95% confidence interval [CI], 1.37–12.54 and OR, 4.96; 95% CI, 1.88–13.14, respectively). The snack preferences and the late night eating habits were significantly more prevalent in the GERD group than in the control group (OR, 3.83; 95% CI, 1.23–11.87 and OR, 9.51; 95% CI, 2.55–35.49, respectively). A preference for liquid foods was significantly more prevalent in the GERD group (OR, 9.51; 95% CI, 2.548–35.485). The dinner-to-bedtime interval was significantly shorter in the GERD group than in the control group (157.06±48.47 vs. 174.62±55.10, P=0.020). In addition, the time between dinner and bedtime was shorter than 3 hours in 47 children (55.3%) of the GERD group and 44 (37.6%) of the control group. This difference was statistical significance (P=0.015). Conclusion Dietary habits such as picky and irregular eating, snack preference, a preference of liquid foods, late night eating, and a shorter dinner-to-bedtime interval had a significant correlation with GERD. Further large-scale studies are necessary to confirm our results.
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Affiliation(s)
- You Jin Choi
- Department of Pediatrics, Bundang CHA Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Eun Kyo Ha
- Department of Pediatrics, Bundang CHA Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Su Jin Jeong
- Department of Pediatrics, Bundang CHA Medical Center, CHA University School of Medicine, Seongnam, Korea
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Shlomovitz E, Pescarus R, Cassera MA, Sharata AM, Reavis KM, Dunst CM, Swanström LL. Early human experience with per-oral endoscopic pyloromyotomy (POP). Surg Endosc 2014; 29:543-51. [PMID: 25106716 DOI: 10.1007/s00464-014-3720-6] [Citation(s) in RCA: 121] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Accepted: 06/22/2014] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Gastroparesis is a condition characterized by delayed gastric emptying, and a constellation of symptoms, including nausea, vomiting, early satiety, and bloating. Although current surgical options such as pyloroplasty have been shown to be effective, an endoscopic submucosal myotomy technique may be applied to divide the pyloric sphincter without surgical access. Such endoscopic technique may provide the benefits of a natural orifice procedure, and improve gastric emptying in gastroparetic patients. METHODS AND PROCEDURES Per-oral pyloromyotomy (POP) was performed in seven female patients aged 33-65 years (mean 51 years). All patients had a pre-operative work-up that included upper endoscopy, and a gastric emptying study. A pH study, and esophageal manometry were also performed when a concomitant fundoplication was considered. RESULTS POP was technically successful in all seven cases. There were no immediate procedural complications. Perioperative, complications included: one patient with an upper GI bleed 2 weeks post-procedure, necessitating transfusions, and endoscopic clipping of a pyloric channel ulcer; one patient who experienced difficulty swallowing post operatively, delaying discharge by 1 day; and one patient who developed a hospital-acquired pneumonia, delaying discharge by several days. Six of the seven patients experienced significant symptomatic improvement following the procedure. Three month follow-up nuclear medicine solid-phase gastric emptying studies are currently available for 5 of the 7 patients. Normal gastric emptying at 4 h was noted in four of five patients (80 %). One patient did not respond to endoscopic management subsequently underwent an uneventful laparoscopic pyloroplasty, which also failed to significantly improve her symptoms. CONCLUSION POP is a technically safe and feasible endoscopic procedure. Early follow-up suggests promising symptomatic improvement as well as objective improvement in gastric emptying. Additional clinical experience is required to establish the role of this technique in the management of gastroparesis.
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Affiliation(s)
- Eran Shlomovitz
- Gastrointestinal and Minimally Invasive Surgery Division, The Oregon Clinic, Portland, OR, USA,
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Thomas PG, Sharp NE, St. Peter SD. Laparoscopic pyloromyotomy: comparing the arthrotomy knife to the Bovie blade. J Surg Res 2014; 190:251-4. [DOI: 10.1016/j.jss.2014.03.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Revised: 03/06/2014] [Accepted: 03/12/2014] [Indexed: 12/01/2022]
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Caldaro T, Alghisi F, De Angelis P, Garganese MC, Rea F, Pizzoferro M, Villani MF, Romeo EF, Torroni F, Foschia F, Gambitta RA, Federici G, Lucidi V, Dall'Oglio L. Cystic fibrosis: a surgical matter? J Pediatr Surg 2014; 49:753-8. [PMID: 24851763 DOI: 10.1016/j.jpedsurg.2014.02.089] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Accepted: 02/13/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Gastroesophageal reflux disease (GERD) is very common in patients with chronic lung diseases. We evaluated the incidence of GERD in young patients with cystic fibrosis (CF) and defined the characteristics of gastroesophageal reflux episodes analyzed by pH-multichannel intraluminal impedance (pH-MII) and esophagogastric scintigraphy. PATIENTS AND METHODS Since 2010, 31 patients with CF underwent pH-MII. Scintigraphy and upper endoscopy were performed in positive GERD patients. Forced expiratory volume in 1 second (FEV1%) predicted was detected. RESULTS pH-MII was positive in 17/31 (54.8%) patients (mean age: 12.4 years; range: 4-17 years). pH monitoring detected an average of 64.6 acid reflux events 4.4 episodes >5 minutes in duration. The DeMeester score was 38.5. Impedance identified a mean number of reflux episodes of 66 (65.2% acid; 32% weakly acidic; 2.8% nonacidic), 28% of which reached the proximal esophagus. Esophageal transit and gastric emptying were delayed in 6/13 (46.1%) and in 5/15 (33.3%) cases, respectively. No differences were found in lung function between positive and negative GERD patients (P=0.88). CONCLUSIONS Pediatric patients with CF have a high incidence of GERD with acidic events. These patients should be investigated with pH-MII and scintigraphy in order to make an early diagnosis and determine the most appropriate follow-up.
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Affiliation(s)
- Tamara Caldaro
- Digestive Surgery and Endoscopy Unit, Bambino Gesù Children's Hospital, Rome, Italy.
| | - Federico Alghisi
- Cystic Fibrosis Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | - Paola De Angelis
- Digestive Surgery and Endoscopy Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | | | - Francesca Rea
- Digestive Surgery and Endoscopy Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | - Milena Pizzoferro
- Nuclear Medicine Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | | | | | - Filippo Torroni
- Digestive Surgery and Endoscopy Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | - Francesca Foschia
- Digestive Surgery and Endoscopy Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | - Rosa Alba Gambitta
- Digestive Surgery and Endoscopy Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | - Giovanni Federici
- Digestive Surgery and Endoscopy Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | | | - Luigi Dall'Oglio
- Digestive Surgery and Endoscopy Unit, Bambino Gesù Children's Hospital, Rome, Italy
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Omür O, Erdoğan M, Ozkılıç H, Yılmaz C. Scintigraphic methods to evaluate alterations of gastric and esophageal functions in female obesity. Mol Imaging Radionucl Ther 2014; 23:5-11. [PMID: 24653928 PMCID: PMC3957973 DOI: 10.4274/mirt.14633] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 10/04/2013] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE Altered gastrointestinal function has frequently been observed in obese patients. The aim of this study was to investigate the frequency of gastro-esophageal reflux (GER) and to determine the alterations of gastric emptying and esophageal transit by scintigraphic methods in obese patients. METHODS Scintigraphic studies of 50 obese female non-diabetic patients who had not received any treatment for weight control were retrospectively reviewed. Mean Body Mass Index (BMI) was 34.96±3.04 kg/m(2) (range:32-39 kg/m(2)). All subjects were submitted to scintigraphic evaluation of esophageal transit, gastro-esophageal reflux, gastric emptying and presence of Helicobacter pylori infection. The data of obese patients were compared with those of sex-age matched 30 non-obese cases who were selected from our clinical archive. RESULTS In obese group, seventeen (34%) patients were found to be GER positive scintigraphically; mean gastric emptying time (t½) was 59.18±30.8 min and the mean esophageal transit time was 8.9±7.2 s. Frequency of positive GER scintigraphy and the mean value of esophageal transit time were significantly higher in obese patients than non-obese control subjects. Gastric emptying time and esophageal transit time values were significantly longer in GER positive obese patients than GER negative ones. There was no statistically significant difference in the frequency of positive C14 urea breath test between obese and non-obese subjects and there were also no statistically significant correlations between BMI, GER, esophageal transit time and gastric emptying time. CONCLUSION In our study, 42 of the 50 obese patients had esophago-gastric motility alterations. The significance of these alterations in obesity is not fully understood, but it is believed that these changes could be because of potential contributing factors in the development or maintenance of obesity or changes in eating habits. CONFLICT OF INTEREST None declared.
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Affiliation(s)
- Ozgür Omür
- Ege University Faculty of Medicine, Department of Nuclear Medicine, İzmir, Turkey
| | - Mehmet Erdoğan
- Ege University Faculty of Medicine, Department of Endocrinology and Metabolism, İzmir, Turkey
| | - Hayal Ozkılıç
- Ege University Faculty of Medicine, Department of Nuclear Medicine, İzmir, Turkey
| | - Candeğer Yılmaz
- Ege University Faculty of Medicine, Department of Endocrinology and Metabolism, İzmir, Turkey
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Gastric emptying in children with gastroesophageal reflux and in healthy children. J Pediatr Surg 2013; 48:1856-61. [PMID: 24074657 DOI: 10.1016/j.jpedsurg.2013.03.076] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Revised: 03/04/2013] [Accepted: 03/14/2013] [Indexed: 11/21/2022]
Abstract
PURPOSE The aim of this report is to examine whether children with gastroesophageal reflux (GER) have delayed gastric emptying compared to healthy children. METHODS All patients had GER verified by 24-hour pH monitoring. Gastric emptying of cow's milk was examined by radionuclide scintigraphy in 51 patients with GER and in 24 controls. Gastric emptying rate was expressed as exponential half time (T1/2). RESULTS Median age was 4.4 years [range 0.1-15.4] in patients and 6.1 years [range 2.5-10.0] in controls (p=.10). A wide range of gastric emptying rates was observed both in GER patients [range 16-121] and controls [range 29-94]. One GER patient (2%) had slower gastric emptying (T1/2=121 min) than the healthy child with the longest T1/2 (94 min). Mean T1/2 was 49 minutes (SD 20.1) and 46 minutes (SD 14.2) in GER patients and controls, respectively (p=.51). CONCLUSIONS Gastric emptying rate of milk was not significantly different between children with GER and healthy children. A wide range of gastric emptying rates was observed in both groups.
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Rea F, Caldaro T, Tambucci R, Romeo EF, Caloisi C, Torroni F, di Abriola GF, Foschia F, Francalanci P, Dall'Oglio L, De Angelis P. Eosinophilic esophagitis: is it also a surgical disease? J Pediatr Surg 2013; 48:304-8. [PMID: 23414856 DOI: 10.1016/j.jpedsurg.2012.11.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2012] [Accepted: 11/12/2012] [Indexed: 01/07/2023]
Abstract
BACKGROUND Eosinophilic esophagitis (EoE) is a chronic immune/antigen-mediated disease with esophageal dysfunction and eosinophil-predominant inflammation. An association between EoE and gastro-esophageal reflux disease (GERD) has not been well established. AIMS The aim was to evaluate patients with EoE who underwent pH-Multichannel Intraluminal Impedance (pH-MII), investigating proton-pump-inhibitors (PPI) therapy/anti-reflux surgery requirement. METHODS Twenty-five patients [mean age 7.6 (range 1-17 years)] with EoE underwent pH-MII. The children were then divided into Group 1 (pathological pH-MII) and Group 2 (normal pH-MII). PPI was administered for two months in Group 1 and in those children in Group 2 unresponsive to standard EoE therapy (diet and corticosteroids). All patients underwent endoscopy and clinical follow-up. Data are described as mean (range). RESULTS Group 1 (n=16, M:F=14:2) had mean reflux index (RI) 13.9% (0.8%-53.4%) with a mean number of total reflux episodes (RE) of 65.8 (14-341). Group 2 (n=9, M:F=6:3) had a mean RI 1.2% (0.2%-2.7%) with a mean number of total RE of 27.4 (14-39). There was a histological response to repeated cycles of PPI in 11/16 (69%) children in Group 1 and 4/9 (44%) children in Group 2. Fundoplication, because of dependence on PPI, was required in 4/11 PPI-responders in Group 1, allowing discontinuation without relapse of EoE. CONCLUSIONS The use of PPI is suggested in EoE at time of diagnosis in addition to standard treatment and may even have benefit in children who do not appear to have significant GERD but are unresponsive to standard therapy.
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Affiliation(s)
- Francesca Rea
- Digestive Surgery and Endoscopy Unit, Pediatric Hospital and Research Institute Bambino Gesù-IRCCS, Rome, 00165, Rome, Italy.
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Okada T, Honda S, Miyagi H, Minato M. Nissen fundoplication for gastroesophageal reflux: No deterioration of gastric emptying measured by C-acetate breath test. J Indian Assoc Pediatr Surg 2011; 16:137-41. [PMID: 22121311 PMCID: PMC3221155 DOI: 10.4103/0971-9261.86866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim: To study the gastric emptying 30 days after laparoscopic Nissen fundoplication (NF) in gastroesophageal reflux. Materials and Methods: Three patients were evaluated with 13C-acetate breath test (ABT) performed pre and post-NF. The liquid test meal consisted of Racol™ mixed with 13C-acetate. Results: In the patient without neurological impairment (NI), the preoperative t½ex and t lag were 0.900 and 0.510 hours, respectively. The postoperative t½ex and t lag were 0.959 and 0.586 hours, respectively. In one patient with NI, the preoperative t½ex and t lag were 1.828 and 1.092 hours, respectively. The postoperative t½ex and t lag were 2.081 and 1.025 hours, respectively. In the other patient with NI, the preoperative t½ex and t lag were 2.110 and 0.980 hours, respectively. The postoperative t½ex and t lag were 1.118 and 0.415 hours, respectively. Conclusions: Our findings suggest that 13C-ABT parameters did not worsen in any of the children after laparoscopic NF.
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Affiliation(s)
- Tadao Okada
- Department of Pediatric Surgery, Hokkaido University Hospital, Sapporo, Japan
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