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Theory of gastric CO2 ventilation and its control during respiratory acidosis: Implications for central chemosensitivity, pH regulation, and diseases causing chronic CO2 retention. Respir Physiol Neurobiol 2011; 175:189-209. [DOI: 10.1016/j.resp.2010.12.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Revised: 12/01/2010] [Accepted: 12/01/2010] [Indexed: 01/16/2023]
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2
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Krishnan U, Mitchell JD, Messina I, Day AS, Bohane TD. Assay of tracheal pepsin as a marker of reflux aspiration. J Pediatr Gastroenterol Nutr 2002; 35:303-8. [PMID: 12352517 DOI: 10.1097/00005176-200209000-00012] [Citation(s) in RCA: 85] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES Aspiration of gastric contents is a relatively common cause of acute and chronic pulmonary disease. However, a reliable method of diagnosing recurrent aspiration is currently lacking. The aim of this study was to determine whether the presence of gastric pepsin in tracheal aspirates of infants and children might be used as a reliable marker of the microaspiration of refluxed gastric contents. METHODS Ninety-eight children undergoing general anesthesia and tracheal intubation participated in the study. Sixty-four of 98 children underwent endoscopy for clinically significant gastroesophageal reflux. Thirty-four children from routine operative lists were nonreflux controls. These two groups were further subdivided based on the presence or absence of associated respiratory symptoms. After endotracheal intubation, tracheal aspirates were obtained and subsequently assayed for gastric pepsin using a fluoroscein isothiocyanate casein. RESULTS Pepsin was detected in 7 of 27 children with reflux symptoms alone and in 7 of 8 of those with chronic respiratory symptoms. In addition, pepsin was present in 31 of 37 children with a history of both reflux and chronic respiratory symptoms. Tracheal pepsin was not detected in any of the 26 children without gastroesophageal reflux or respiratory symptoms. Tracheal pepsin was found significantly more frequently in children with reflux symptoms than in those without, particularly in children with both reflux and respiratory problems. CONCLUSION Tracheal pepsin assay as a reliable marker of gastroesophageal reflux aspiration.
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Affiliation(s)
- Usha Krishnan
- Division of Pediatric Gastroenterology, Sydney Children's Hospital, High Street, Randwick, New South Wales, Australia 2031.
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3
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Iwadate K, Doy M, Ito Y. Screening of milk aspiration in 105 infant death cases by immunostaining with anti-human alpha-lactalbumin antibody. Forensic Sci Int 2001; 122:95-100. [PMID: 11672962 DOI: 10.1016/s0379-0738(01)00469-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
To determine the frequency and degree of milk aspiration in infant death cases, immunohistochemical examinations were performed on lung sections from 41 sudden death cases and 64 in-hospital death cases using anti-human alpha-lactalbumin antibody. Milk aspiration to some degree was detected in more than half of the sudden death cases and in about one-third of the in-hospital death cases. A semi-quantitative examination of the amount of aspirated milk was subsequently performed in the positive cases. The amount of aspirated milk in the sudden death cases was significantly higher than that in the in-hospital death cases. The frequency distribution of the amount of aspirated milk was similar in shape in both groups. In most cases, a very small amount of aspirated milk was detected. The aspirated milk was assumed to be a result of occasional gastroesophageal reflux or cardiopulmonary resuscitation. However, in five cases, much larger amounts of aspirated milk were found. In these cases, milk aspiration may have been an important part of the cause of death. We concluded that slight milk aspiration is not rare in infant death cases, and that in a few cases, the aspiration is lethal. An immunohistochemical screening test is available to perform a postmortem diagnosis in these cases.
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Affiliation(s)
- K Iwadate
- Section of Forensic Medicine, Department of International Health Development, Division of Public Health, Graduate School, Tokyo Medical and Dental University, Yushima 1-5-45, Bunkyo-ku, Tokyo 113-8519, Japan.
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4
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Abstract
BACKGROUND The infant with persistent or recurrent wheezing during the first 2 years of life poses a diagnostic dilemma, which can be a source of anxiety to both physicians and parents. A suggested diagnostic approach to the causes of infantile wheezing is outlined. OBJECTIVES 1. To review the physiologic considerations of the infant's airways that predispose to wheezing. 2. To discuss the key physical findings, family history, and risk factors associated with wheezing in infants. 3. To develop a rational approach to the differential diagnosis and management of infantile wheezing. DATA SOURCES The MEDLINE database as well as our clinical experience pertaining to infantile wheezing. CONCLUSIONS This review discusses the diagnostic evaluation and treatment of the wheezing infant. We suggest that infant pulmonary function testing may be used as one diagnostic aid in the workup of the wheezing infant.
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Affiliation(s)
- R L Morton
- Pediatric Pulmonary Medicine, Department of Pediatrics University of Louisville School of Medicine, Kentucky, USA
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5
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Sacco O, Fregonese B, Silvestri M, Sabatini F, Mattioli G, Rossi GA. Bronchoalveolar lavage and esophageal pH monitoring data in children with "difficult to treat" respiratory symptoms. Pediatr Pulmonol 2000; 30:313-9. [PMID: 11015132 DOI: 10.1002/1099-0496(200010)30:4<313::aid-ppul7>3.0.co;2-h] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Gastroesophageal reflux (GER) may be associated with chronic or recurrent asthma-like symptoms secondary to bronchoconstrictor reflexes and/or inhalation of gastric content. The presence of lipid-laden alveolar macrophages has been proposed as an index to establish the degree of gastric aspiration. We evaluated 20 children with "difficult to treat" respiratory symptoms and a clinical history suggestive of GER. All children underwent 24-hr esophageal pH monitoring (pHm) and fiberoptic bronchoscopy with bronchoalveolar lavage (BAL). The amount of lipid per single macrophage was determined by a semiquantitative method, using fluorescence microscopy to detect Nile-Red-stained BAL cells and calculating a lipid-laden macrophage index (LLMI). Eleven children had positive pHm recordings, suggesting the presence of GER (pH-positive patients), and 9 had negative pHm records (pH-negative patients). The pH-positive patients had higher percentages of neutrophils and higher LLMI than the pH-negative children (P < 0.05). There were no correlations between the pHm records and either % BAL neutrophils or LLMI in pH-positive or pH-negative patients (P > 0.05; each correlation). In contrast, a single correlation was found between % BAL neuytrophils and LLMI, both in the pH-positive and in the pH-negative patients (r = 0.72, P = 0.02 and r = 0.71, P = 0.04, respectively). These data demonstrate that a significant proportion of pH-positive patients with respiratory symptoms have BAL abnormalities that suggest airway inflammation and gastric content aspiration. However, the intensity of GER as indicated by pH monitoring does not correspond with BAL data in all patients.
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Affiliation(s)
- O Sacco
- Divisione di Pneumologia, G. Gaslini Institute, Genoa, Italy.
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6
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Iwadate K, Doy M, Nishimaki Y, Liang F, Takatori T, Hasekura H. Immunohistochemical examination of the lungs in infant death cases using antibodies against milk components. Forensic Sci Int 2000; 110:19-28. [PMID: 10802197 DOI: 10.1016/s0379-0738(99)00229-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
To examine the use of immunohistochemical staining with antibodies against milk components for detection of aspirated milk on lung sections, eighteen infant death cases were investigated. Immunostaining was performed with anti-human alpha lactalbumin, anti-human IgA, anti-human milk fat globulin 1, and anti-cow whey antibody. Reactivity with each antibody was examined, and semi-quantitative examinations were performed to compare the amount of aspirated milk using anti-human alpha lactalbumin antibody. Materials in the alveoli or bronchioli on lung sections suspected to be aspirated milk showed the most sensitive and clearest reaction with anti-human alpha lactalbumin antibody. Of the eighteen cases, ten cases showed positive reaction with this antibody. The amount of aspirated milk varied widely in each case. In conclusion, immunohistochemical staining with antibodies against human milk components, especially anti-human alpha lactalbumin antibody, can detect small amounts of milk. Using this method, we were able to compare the relative amount of aspirated milk among cases.
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Affiliation(s)
- K Iwadate
- Department of Legal Medicine, Faculty of Medicine, Tokyo Medical and Dental University, Yushima 1-5-45, Bunkyo-ku, Tokyo, Japan.
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7
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Abstract
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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Affiliation(s)
- M L Bauer
- Department of Pediatrics, Section of Pulmonology, Children's Mercy Hospital, Kansas City, Missouri 64108, USA.
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8
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Ahrens P, Noll C, Kitz R, Willigens P, Zielen S, Hofmann D. Lipid-laden alveolar macrophages (LLAM): a useful marker of silent aspiration in children. Pediatr Pulmonol 1999; 28:83-8. [PMID: 10423306 DOI: 10.1002/(sici)1099-0496(199908)28:2<83::aid-ppul2>3.0.co;2-a] [Citation(s) in RCA: 83] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
At present there is no test available which identifies children suffering from silent aspiration due to gastroesophageal reflux (GER). The purpose of this study was to determine whether lipid-laden alveolar macrophage (LLAM) scoring is a useful method to arrive at the diagnosis. We evaluated bronchoalveolar lavage fluid (BALF) from 68 children aged 6 months to 14 years (median 3.75 years) for the presence of lipid-laden alveolar macrophages. We compared children with chronic chest disease (CCD) and GER to healthy surgical controls without known lung disease, and to children with recurrent pneumonia without GER. By grading the amount of intracellular Sudan Red-positive material, we determined a semiquantitative lipid-laden macrophage (LLAM) score for each patient. Patients with chronic chest disease suspected to be caused by silent aspiration secondary to GER had a significantly higher LLAM score (median, 117; range, 10-956) than children with recurrent pneumonia due to other reasons (median, 29; range, 5-127; P < 0.01) and healthy controls (median, 37; range, 5-188; P < 0.01). We believe that simply observing lipid-laden macrophages is nonspecific, but quantitation of these cells is a useful method for diagnosing silent aspiration in children, especially when the score exceeds 200.
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Affiliation(s)
- P Ahrens
- Department of Pediatrics, Johann Wolfgang Goethe-University, Frankfurt am Main, Germany.
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9
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Abstract
Bronchial asthma is a disease that has been recognized for centuries, which is influenced mainly by genetic and environmental factors. The current interest of bronchial asthma is focused to ascertain the causes and the mechanisms that induce bronchoconstriction. Recently, abnormalities of the esophageal and gastric tracts have become important related areas for research. In predisposed individuals, these abnormalities can trigger or worsen the particular syndrome better known as "gastric asthma." In bronchial asthma the disorder of gastroesophageal reflux (GER) occurs more often than would be expected by chance. The neurogenic mechanism is considered to be the main cause of bronchoconstriction. The diagnosis of gastric asthma is particularly difficult and it should be considered also when GER is less evident or not recognized. In asthmatic patients the recognition of gastric abnormalities is very relevant for therapeutic problems also when GER is in a subclinical stage. In fact, many drugs used in the treatment of bronchial asthma can promote or enhance GER and subsequently they can worsen the symptoms of gastric asthma.
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Affiliation(s)
- G Bruno
- Istituto I Clinica Medica, Fondazione A. Cesalpino, Università La Sapienza di Roma, Rome, Italy
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10
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Iwadate K, Sakamoto N, Park SH, Doy M, Iwase H, Nagao M, Takatori T. Immunohistochemical detection of human milk components aspirated in lungs of an infant. Forensic Sci Int 1997; 90:77-84. [PMID: 9438367 DOI: 10.1016/s0379-0738(97)00152-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We examined an autopsy case of an infant whose cause of death was suspected to be asphyxia due to human breast milk aspiration. In order to demonstrate aspirated milk in the lungs, we conducted immunohistochemical staining using eight antibodies against the components of human milk. Seven of the eight antibodies reacted positively with the substances suspected to be aspirated milk. We concluded that immunohistochemical staining with these antibodies is useful to demonstrate human milk aspiration and provide some keys for detecting the causes of unexpected infant deaths.
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Affiliation(s)
- K Iwadate
- Department of Forensic Medicine, Faculty of Medicine, University of Tokyo, Japan
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11
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Affiliation(s)
- Y Vandenplas
- Academic Children's Hospital, Free University of Brussels, Belgium
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12
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Meer S, Groothuis JR, Harbeck R, Liu S, Leung DY. The potential role of gastroesophageal reflux in the pathogenesis of food-induced wheezing. Pediatr Allergy Immunol 1996; 7:167-70. [PMID: 9151336 DOI: 10.1111/j.1399-3038.1996.tb00127.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Severe reactive airways disease (RAD) in children is frequently associated with gastroesophageal reflux or food allergy. However a relationship between these two confounding factors has yet to be investigated. We postulate that, in certain patients with micro-aspiration of gastric contents into the airways, food allergens sensitize T cells in the peribronchial lymphoid tissue and induce the production of food-specific IgE antibodies that sensitize airway cells. Subsequent exposure to these food allergens might then induce IgE dependent mediator release from mast cells as well as T cell and eosinophil activation, thus contributing to airway inflammation and RAD. In the current report, we describe the case of a patient with severe asthma who had food allergy and gastroesophageal reflux whose clinical findings support this hypothesis. We also provide additional evidence for a high rate of food sensitization in patients with bronchopulmonary dysplasia (BPD), RAD and GER. We conclude that additional studies are warranted to examine the possibility that patients who have RAD and GER require an evaluation for food allergy.
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Affiliation(s)
- S Meer
- Department of Pediatrics, National Jewish Center for Immunology and Respiratory Medicine, University of Colorado, Health Sciences Center, Denver, USA
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13
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Santorelli FM, Schlessel JS, Slonim AE, DiMauro S. Novel mutation in the mitochondrial DNA tRNA glycine gene associated with sudden unexpected death. Pediatr Neurol 1996; 15:145-9. [PMID: 8888049 DOI: 10.1016/0887-8994(96)00163-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We describe an A-to-G transition at nucleotide 10044 in the tRNA(Gly) gene of mitochondrial DNA in a sibship in which the proband died at age 8 years after a severe encephalopathy, a brother died of sudden and unexpected death, and the other six siblings had a combination of symptoms, including apparent life-threatening events and gastroesophageal reflux. This novel mutation was very abundant (> 90%) in liver and muscle of the proband and in several tissues, including blood, from his affected siblings (range 91-99%) but was less abundant in blood from the asymptomatic mother (88%) and maternal grandmother (85%). Our findings further enlarge the spectrum of clinical presentations associated with mitochondrial DNA mutations.
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Affiliation(s)
- F M Santorelli
- H. Houston Merritt Clinical Research Center for Muscular Dystrophy and Related Diseases, Department of Neurology, Columbia University, New York, USA
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14
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Abstract
The literature on dental erosion is made up of a number of areas, some of which are reviewed here: there are anecdotal case reports, linking a small number of clinical cases with a possible etiological factor. The second area of evidence concentrates on case control studies in which there is a strong association with dental erosion, for example, patients with bulimia. The final piece of epidemiological evidence is beginning to emerge as prevalence studies, but the information from prevalence data worldwide is scanty. It is difficult to compare prevalence studies because of the different indices used in the various studies and also because of the different teeth assessed in the sample. Standardization of indices used would overcome some of these differences as would the reporting of results in a comparable way. However, identifying the true prevalence of erosion per se is fraught with difficulty because there may be more than one etiological factor operating and attrition and or abrasion may complicate the picture, especially in older populations. Case reports frequently associate evidence of erosion with excessive use of particular drinks or foodstuffs so they must be viewed with caution. There is an increasing awareness, amongst the dental profession, of the potential for this particular form of tooth wear to occur. It is important that the dental team is vigilant and instigates preventive measures before tooth tissue loss becomes clinically significant. The importance of erosion in dental health promotion should not be overlooked.
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Affiliation(s)
- J H Nunn
- Dental School, University of Newcastle upon Tyne, U.K.
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15
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Hietanen E, Raitakari OT, Backman H. Validity of ambulatory 24-h oesophageal pH measurement in the diagnosis of reflux disease. CLINICAL PHYSIOLOGY (OXFORD, ENGLAND) 1995; 15:491-8. [PMID: 8846669 DOI: 10.1111/j.1475-097x.1995.tb00538.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The validity of 24-h oesophageal pH recording was studied in 100 consecutive patients who had gastro-oesophageal reflux (GER) symptoms and had indications for a 24-h pH recording. The aim was to explore the relationship of patient symptoms, endoscopic findings and histopathological analysis of oesophageal mucosa with the findings in pH recording. Among these patients with typical GER symptoms, the multiplicity of symptoms or their nature did not differentiate them, but in all groups abnormal amounts of reflux were present, as compared with usual reference pH recording values. Yet, among these symptomatic patients, the macroscopic severity of oesophagitis and histologically defined oesophagitis were related to increased abnormality of 24-h pH recording. The results suggest that 24-h pH recording of the oesophagus gives a good indication of the severity of gastro-oesophageal reflux disease and, as such, superior to patient symptoms.
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Affiliation(s)
- E Hietanen
- Department of Clinical Physiology, Turku University Hospital, Finland
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16
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Robertson DF, Mobaireek K, Davis GM, Coates AL. Late pulmonary function following repair of tracheoesophageal fistula or esophageal atresia. Pediatr Pulmonol 1995; 20:21-6. [PMID: 7478777 DOI: 10.1002/ppul.1950200105] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Although tracheoesophageal fistula and esophageal atresia (TEF-EA) are surgically correctable, late respiratory complications have been reported. We administered a respiratory and gastrointestinal symptom questionnaire and performed standard pulmonary function tests (PF T's) and methacholine challenge testing on an unselected group of 25 subjects with TEF-EA who underwent surgery at our institution between 1963 and 1985. Results were compared to predicted normals, as well as 10 sibling controls. While the mean values of lung function test results for the TEF-EA group were within the normal range, they were significantly different from their siblings. Thirteen of the 25 TEF-EA group (52%), but none (0%) of the controls, had abnormal pulmonary function. This was classified as restrictive in 9 (36%), obstructive in 3 (12%), and mixed in 1. In addition, airway hyperreactivity [defined as a positive methacholine challenge (PC20 < or = 8 mg/mL)], was found in 6 of 18 TEF-EA subjects and 4 of the 9 controls who were evaluated. Comparison of TEF-EA subjects with normal and abnormal PFTs showed no difference in the incidence of tracheomalacia, esophageal strictures or dilatation, recurrent pneumonias, or gastroesophageal reflux. The respiratory symptom score in the subjects and controls was similar, and did not correlate with abnormal pulmonary function. The cause of the pulmonary function abnormalities remains unexplained.
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Affiliation(s)
- D F Robertson
- Department of Pediatrics, McGill University, Faculty of Medicine, Montreal, Quebec, Canada
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17
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Abstract
There are at least eight mechanisms identified that result either in volume clearance of the pharynx and esophagus (secondary peristalsis and pharyngeal swallow) or prevent entry of the gastric content into the esophagus and pharynx (LES and UES), accentuate these barriers (esophago-UES and pharyngo-UES contractile reflexes), or induce closure of the vocal cords and introitus to the trachea (esophagoglottal and pharyngoglottal reflexes). The sum effect of various combinations of these mechanisms is suggested to help prevent retrograde aspiration. In other words, airway protective mechanisms against retrograde aspiration are multifactorial and involve delicate interaction between upper GI and upper airway tracts. Although the existence of these mechanisms in normal volunteers has been documented, their function in patients with retrograde aspiration and supraesophageal complications of gastroesophageal reflux disease currently awaits investigation.
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Affiliation(s)
- R Shaker
- Medical College, Wisconsin Dysphagia Institute, Department of Medicine, USA
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18
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Abstract
The purpose of this study was to study the relationship of aspiration with ongoing respiratory difficulties in infants with bronchopulmonary dysplasia (BPD). Twelve infants with BPD were identified out of 314 children who had flexible bronchoscopy between 1987 and 1990; 11 of 12 had bronchoalveolar lavage (BAL). The lipid index (LI) was used to quantify the degree of lipid-laden macrophages in the BAL fluid as a marker of aspiration. The age range at the time of bronchoscopy was 3 months to 5 years. The LI was considered positive in 6 of 11 subjects. A pH probe study was done on seven subjects with concordant findings in five. Other findings included dynamic or structural airway abnormalities in 10 of the 12 subjects. These data suggest that aspiration frequently is associated with BPD in addition to the previously recognized dynamic and structural airway problems. The predisposition to gastroesophageal reflux and laryngeal injury probably accounts for the increased aspiration risk in children with BPD.
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Chetcuti P, Phelan PD. Respiratory morbidity after repair of oesophageal atresia and tracheo-oesophageal fistula. Arch Dis Child 1993; 68:167-70. [PMID: 8481036 PMCID: PMC1029227 DOI: 10.1136/adc.68.2.167] [Citation(s) in RCA: 76] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Respiratory morbidity in 334 patients aged 1 to 37 years with repaired oesophageal atresia and tracheo-oesophageal fistula is reported. Just under half the patients were subsequently hospitalised with respiratory illness. Two thirds of admissions were before 5 years of age. Five percent were admitted on more than five occasions. Patients with gastro-oesophageal reflux and low birth weight were more likely to be admitted. Thirty one percent of patients had one or more episodes of pneumonia in the first five years of life and 5% after 15 years. The prevalence of annual bouts of bronchitis in these age groups was 74% and 41% respectively. The prevalence of wheeze was about 40% in all age groups. Patients with symptoms persisting after 15 years were more likely to have had lower respiratory tract illness in early childhood and a history of atopy. In the 12 months before review, weekly episodes of wheezing were present in one third under 5 years and 15% over 15 years. Thirty two percent of patients aged 5-10 years and 8% over 15 years missed two or more weeks of school or work in the previous year with respiratory illness.
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Affiliation(s)
- P Chetcuti
- Department of Thoracic Medicine, Royal Children's Hospital, Australia
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Chetcuti P, Phelan PD, Greenwood R. Lung function abnormalities in repaired oesophageal atresia and tracheo-oesophageal fistula. Thorax 1992; 47:1030-4. [PMID: 1494766 PMCID: PMC1021095 DOI: 10.1136/thx.47.12.1030] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Respiratory complications are common after neonatal repair of oesophageal atresia and tracheo-oesophageal fistula. The prevalence of lung function abnormalities and the relation between gastrointestinal complications and lung function has not been studied in a large number of patients. METHODS Lung volumes and flow-volume loops were measured in 155 patients without spinal curvature aged 6-37 years who had undergone surgery for oesophageal atresia and tracheo-oesophageal fistula. RESULTS Sixty four of the 155 patients had evidence of mild lower airways disease, with values for FEV1 more than two standardised scores below the predicted value in 39 (25%) and above 2 standardised scores for the residual volume (RV)/total lung capacity (TLC) ratio in 64 (41%). Restrictive lung disease (TLC more than 2 standardised scores below predicted) was present in 28 (18%). Severe lung function abnormalities were present in under 10% of the 155. Half the subjects had some evidence of extra-thoracic tracheal obstruction, with a high ratio of expiratory to inspiratory flow for peak flow in 76 (50%) and at 50% of vital capacity in 59 (38%). Patients with radiological gastro-oesophageal reflux in early childhood had more airways obstruction and smaller lung volumes. Patients with current gastrointestinal symptoms were similar in their lung function to symptom free patients. CONCLUSIONS Minor lung function abnormalities are common in patients after repair of oesophageal atresia. Early diagnosis and management of gastro-oesophageal reflux may help to minimise these lung function abnormalities.
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Affiliation(s)
- P Chetcuti
- Department of Thoracic Medicine, Royal Children's Hospital, Parkville, Victoria, Australia
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21
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Abstract
Gastro-esophageal reflux disease encompasses a spectrum of disorders in which gastric reflux leads to symptoms and/or damage to the esophageal mucosa. Although a common problem in clinical practice, our understanding of the pathophysiology of the condition has not been matched by our knowledge of its epidemiology and natural history. This review examines some of the difficulties inherent in epidemiological studies with particular emphasis on the nature and variety of reflux symptoms and their relationship to esophagitis, the natural history and complications of reflux disease, Barrett's esophagus, and the possible role of gastroesophageal reflux in lung disease, especially asthma.
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Affiliation(s)
- P J Howard
- Department of Medicine, Royal Infirmary, Edinburgh, Scotland
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22
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Abstract
In this study we investigated the presence of gastroesophageal reflux in children with recurrent abdominal pain and its possible relationship to food intolerance-associated duodenal inflammation. Twenty-four-hour intra-esophageal pH monitoring, an endoscopic duodenal biopsy and a small bowel 51Cr-EDTA permeability test were performed in 25 children with recurrent abdominal pain. In 14 cases (56%) the pH monitoring was abnormal, pointing to the presence of pathological gastroesophageal reflux. Treatment of gastroesophageal reflux in the latter patients resulted in resolution or improvement of abdominal pain in 10 cases (71%). Gastroesophageal reflux did not appear to be associated with either intestinal permeability to 51Cr-EDTA or duodenal biopsy findings. We conclude that pathological gastroesophageal reflex is a frequent finding in children with recurrent abdominal pain, that it is unrelated to duodenal inflammation and that there might be a causal relationship between pathological gastroesophageal reflux and recurrent abdominal pain in children.
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Affiliation(s)
- S B van der Meer
- Department of Pediatrics, Academic Hospital Maastricht, The Netherlands
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23
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Hampton FJ, MacFadyen UM, Beardsmore CS, Simpson H. Gastro-oesophageal reflux and respiratory function in infants with respiratory symptoms. Arch Dis Child 1991; 66:848-53. [PMID: 1863098 PMCID: PMC1793256 DOI: 10.1136/adc.66.7.848] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
This study aimed to define the incidence and severity of gastro-oesophageal reflux (GOR), as measured using 24 hour oesophageal pH monitoring, in 38 infants with recurrent respiratory symptoms and to relate these findings to measures of respiratory function. Twenty one infants had a pH under 4 for more than 5% of the time (one definition of abnormal GOR) and nine had GOR exceeding age related normal values. Maximum expiratory flow at functional residual capacity was reduced in 37 infants, airways resistance was raised in 19 infants, and thoracic gas volume was abnormal in 11 infants. There was no association between indices of GOR and measures of lung function whether assessed by correlation or by chi 2 analysis for normal versus abnormal values. However, individual infants appeared to have respiratory symptoms produced by GOR. This suggests that host responsiveness to GOR may be of greater relevance than the amount of GOR.
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Affiliation(s)
- F J Hampton
- Department of Child Health, University of Leicester
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24
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Larrain A, Carrasco E, Galleguillos F, Sepulveda R, Pope CE. Medical and surgical treatment of nonallergic asthma associated with gastroesophageal reflux. Chest 1991; 99:1330-5. [PMID: 2036812 DOI: 10.1378/chest.99.6.1330] [Citation(s) in RCA: 178] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Patients presenting to a chest clinic because of adult-onset wheezing with no history of allergy had a 90 percent prevalence of gastroesophageal reflux, even though reflux symptoms were mild or absent. Ninety patients were randomly assigned to receive cimetidine or an identical placebo or to undergo antireflux surgery. During a six-month period, all groups improved clinically; the cimetidine and surgical groups improved more than the placebo group. The intake of pulmonary medication decreased significantly in both cimetidine and surgical groups. Pulmonary function test results improved in the cimetidine- and surgically treated patients; improvement was not statistically significant. At long-term follow-up, the surgical group maintained clinical improvement and decreased pulmonary medication intake, whereas the placebo group worsened. We conclude that gastroesophageal reflux can play a significant role in some patients with nonallergic pulmonary disease and that its treatment can improve pulmonary symptoms and objective measurements of pulmonary function.
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Affiliation(s)
- A Larrain
- Department of Medicine, Instituto Nacional de Enfermedades Respiratorias y Chirugia Toraxica, Santiago, Chile
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25
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Jolley SG, Halpern LM, Tunell WP, Johnson DG, Sterling CE. The risk of sudden infant death from gastroesophageal reflux. J Pediatr Surg 1991; 26:691-6. [PMID: 1941459 DOI: 10.1016/0022-3468(91)90012-i] [Citation(s) in RCA: 54] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Gastroesophageal reflux (GER) has been a suspected cause of infant deaths and sudden infant death syndrome (SIDS). We examined our 10-year experience with 499 consecutive infants 6 months of age or less who had extended (18 to 24 hours) esophageal pH monitoring performed to evaluate for GER. The data extracted from the esophageal pH records included the pH score, the pattern of GER (type I, II, or III), and the mean duration of reflux during sleep (ZMD). All infants were followed to determine the occurrence and cause of death during the first year of life. Of the 19 deaths found in the series, three were classified as SIDS and two were in-hospital deaths caused by reflux-induced aspiration. All five of these infants who died had a prolonged ZMD (greater than 3.8 minutes) and received either basic medical (n = 4) or no (n = 1) antireflux therapy. Four infants also had the type I pattern of GER. There was a 9.1% (4/44; 95% confidence limits, 2.5% to 21.7%) incidence of reflux-related or SIDS deaths in infants with type I GER and a prolonged ZMD who were treated nonoperatively, compared with none (0/83, P = .03) in the same group of infants treated with antireflux surgery. The incidence of SIDS was higher in infants with type I GER and a prolonged ZMD who were treated nonoperatively (3/44, 6.8%) compared with all other infants treated nonoperatively (0/265, 0%; P = .003).(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- S G Jolley
- Department of Surgery, Humana Children's Hospital, Las Vegas, NV
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26
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27
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28
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Abstract
Gastroesophageal reflux is a common disorder in infants and children worldwide. This paper is intended to provide updated information on various aspects of the disease. It is hoped that this review will increase awareness and stimulate research in this field.
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Affiliation(s)
- M I El-Mouzan
- Department of Pediatrics, King Faisal University, College of Medicine, and King Fahd Hospital of the University, Al-Khobar and Dammam, Saudi Arabia
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29
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Gustafsson PM, Kjellman NI, Tibbling L. Bronchial asthma and acid reflux into the distal and proximal oesophagus. Arch Dis Child 1990; 65:1255-8. [PMID: 2248539 PMCID: PMC1792619 DOI: 10.1136/adc.65.11.1255] [Citation(s) in RCA: 63] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The prevalence of pathological gastro-oesophageal reflux in children and adolescents with asthma was studied by 24 hour two level oesophageal pH monitoring in 42 subjects aged 9-20 years with moderate or severe bronchial asthma. The importance of oesophagobronchial nerve reflexes and of aspiration of gastric acid as triggers in asthma was assessed by studying whether episodes of reflux into the distal and into the proximal oesophagus were followed by asthma attacks. Twenty-one subjects (50%) had a pathological total reflux time in the distal oesophagus and six (16%) in the proximal oesophagus. Nine patients had pathological gastro-oesophageal reflux into the distal oesophagus together with symptoms of asthma during the day on which the recording took place. In three of them the episodes of asthma symptoms were significantly correlated with preceding episodes of reflux into the distal oesophagus, and in one subject to reflux into the proximal oesophagus. We conclude that pathological gastro-oesophageal reflux is common in children and adolescents with asthma, but it seems to provoke symptoms of asthma in only a few. Symptoms of asthma were more often elicited by exposure of the distal oesophagus to gastric acid, possibly by a vagal reflex, than by aspiration of gastric juice.
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Affiliation(s)
- P M Gustafsson
- Department of Paediatrics, University Hospital, Linköping, Sweden
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30
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Gonzalez ER, Bahal N, Johnson LF. Gastroesophageal reflux and respiratory symptoms: is there an association? Proposed mechanisms and treatment. DICP : THE ANNALS OF PHARMACOTHERAPY 1990; 24:1064-9. [PMID: 2275231 DOI: 10.1177/106002809002401110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Gastroesophageal reflux (GER) is a dysfunction of the distal esophagus causing movement of stomach contents into the esophagus. Patients may develop heartburn, regurgitation, dysphagia, odynophagia, and hemorrhage. Respiratory symptoms occur in 10-60 percent of patients with GER or hiatal hernia. Although there is evidence associating pulmonary symptoms and GER, causality has not been proven. The appropriate use of antireflux therapy or surgery to treat GER may consequently alleviate respiratory symptoms.
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Affiliation(s)
- E R Gonzalez
- Department of Internal Medicine, Virginia Commonwealth University, Medical College of Virginia, Richmond
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31
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Mattox HE, Richter JE. Prolonged ambulatory esophageal pH monitoring in the evaluation of gastroesophageal reflux disease. Am J Med 1990; 89:345-56. [PMID: 2203264 DOI: 10.1016/0002-9343(90)90348-h] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Gastroesophageal reflux disease is a common problem that frequently presents with atypical complaints including nausea, hiccups, globus sensation, chest pain, hoarseness, coughing, or various pulmonary complaints. Diagnosis may be difficult, as these patients often do not have radiographic or endoscopic evidence of esophagitis. In these difficult cases, prolonged esophageal pH monitoring provides an accurate method of quantitating acid reflux parameters and correlating symptoms with reflux episodes in an outpatient setting. Current equipment is compact, durable, and not difficult to use or extremely expensive. Data analysis, with a particular emphasis on acid-exposure time (total, upright, supine), reliably discriminates between abnormal and normal subjects but it is not a perfect "gold standard" for gastroesophageal reflux disease. Indications for esophageal pH monitoring include: (1) atypical symptoms of acid reflux with normal endoscopy, (2) typical reflux symptoms unresponsive to medical therapy, and (3) the follow-up of reflux disease after either medical or surgical therapy. This test is currently performed primarily by gastroenterologists, but we believe many other groups may find this technology helpful. To meet these expanding applications, test refinements are necessary, particularly easier methods of placing the pH probe and better standards for defining abnormal pH parameters in older patients. The future for esophageal pH monitoring is bright. This technology has the potential to do for the diagnosis of gastroesophageal reflux disease what endoscopy has done for the diagnosis of peptic ulcer disease.
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Affiliation(s)
- H E Mattox
- Gastroenterology Division, Bowman Gray School of Medicine, Winston-Salem, North Carolina
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32
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Jolley SG, Halpern CT, Sterling CE, Feldman BH. The relationship of respiratory complications from gastroesophageal reflux to prematurity in infants. J Pediatr Surg 1990; 25:755-7. [PMID: 2380892 DOI: 10.1016/s0022-3468(05)80012-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The association between respiratory complications of gastroesophageal reflux (GER) and prematurity in infants has not been described completely. We studied 82 consecutive infants less than 6 months of age with major respiratory symptoms suspected to be caused by GER. Twenty-eight patients had bronchopulmonary dysplasia (BPD). Extended (18 to 24 hours) esophageal pH monitoring was used to document GER with a pH score. Respiratory complications were considered to be caused by GER if a prolonged mean duration of sleep reflux (ZMD) was found. Seventy-five of the 82 (91%) infants had documented GER, but only 45 (55%) had a prolonged ZMD. The incidence of GER was high regardless of the gestational age at birth, postconceptual age at time of study, and the presence of BPD. The incidence of a prolonged ZMD was higher in infants who were 34 to 39 weeks' gestation (10/12, 83%) than in infants who were less than 34 weeks' gestation at birth (15/37, 41%; P = .01). The incidence of a prolonged ZMD was lowest in infants 39 weeks or less postconceptual age at the time of study (4/14, 29%; P = .017). Most infants with BPD did not have a prolonged ZMD (12/28, 43%). However, 11 of the 12 (92%) infants with BPD and a prolonged ZMD showed dramatic improvement after effective antireflux therapy compared with 0 of 16 infants with BPD and normal ZMD (P less than .001).(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- S G Jolley
- Department of Surgery, Humana Hospital Sunrise, Las Vegas
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33
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Padhy AK, Gopinath PG, Sharma SK, Prasad AK, Arora NK, Tiwari DC, Gupta K, Chetty A. Radionuclide detection of gastroesophageal reflux in children suffering from recurrent lower respiratory tract infection. Indian J Pediatr 1990; 57:517-25. [PMID: 2286404 DOI: 10.1007/bf02726761] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Radionuclide gastro-esophageal scintigraphy was performed on 25 control and 183 children suffering from recurrent lower respiratory tract infection. Gastro-esophageal reflux (GER) of varying grades was observed in 135 patients. The severity of clinical symptoms in the patients was found to be directly related to the severity of reflux observed in the radionuclide study. In some patients an attempt was also made to quantitate GER by calculating the Gastro-esophageal reflux index. The results of the scintigraphic study were correlated with the results of the other commonly used and more conventional Barium swallow and fluoroscopy study. Gastro-esophageal scintigraphy was found to be much superior in terms of sensitivity, specificity and accuracy in detecting GER. It was also possible to objectively evaluate and monitor response to treatment following conservative or corrective surgical therapy using the radionuclide technique. The results of the study demonstrated a remarkably high incidence of GER in the patients. Whether GER is the cause of recurrent lower respiratory tract infection or not is difficult to establish firmly. But within the preview of the study the association seems to be very strong and cannot be easily ignored.
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Affiliation(s)
- A K Padhy
- Department of Nuclear Medicine, Internal Medicine and Pediatrics, All India Institute of Medical Sciences, New Delhi
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34
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van Aalderen WM, Hoekstra MO, Hess J, Gerritsen J, Knol K. Respiratory infections and vascular rings. ACTA PAEDIATRICA SCANDINAVICA 1990; 79:477-80. [PMID: 2349887 DOI: 10.1111/j.1651-2227.1990.tb11500.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Recurrent respiratory infections after the first years of life are not easily related to vascular rings as the cause of these infections. Therefore six cases of older children are presented in whom a vascular ring was the cause of their respiratory problems. None of them ever had stridor or swallowing problems in early infancy, and recurrent respiratory infections occurred later in life as a symptom of a vascular ring. Unfamiliarity with this association caused a delay in diagnosis and treatment in two patients and persistent lung damage in one child. Five of the 6 children recovered well after operation. The diagnosis can be made at an early stage if close inspection of the outline of the trachea on the chest radiograph shows an impression from the right side.
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Affiliation(s)
- W M van Aalderen
- Department of Pediatrics, University Hospital, Groningen, The Netherlands
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35
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36
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Wienbeck M, Barnert J. Epidemiology of reflux disease and reflux esophagitis. SCANDINAVIAN JOURNAL OF GASTROENTEROLOGY. SUPPLEMENT 1989; 156:7-13. [PMID: 2662390 DOI: 10.3109/00365528909091032] [Citation(s) in RCA: 135] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Symptomatic gastroesophageal reflux is a common medical problem. But only few data exist on the epidemiology of reflux disease (without inflammation) and reflux esophagitis. The literature is critically reviewed and ecological causes of gastroesophageal reflux are discussed. The prevalence of reflux esophagitis in Western countries is estimated to be 2% and that of reflux disease 5%. Sparse reports exist on the natural history of both diseases. They appear to have little if any effect on life expectancy. The main complications of reflux esophagitis are Barrett's esophagus, peptic stricture, ulceration and bleeding.
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Affiliation(s)
- M Wienbeck
- Zentralklinikum Augsburg, Department of Internal Medicine III, FRG
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37
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Abstract
Gastroesophageal reflux is an important cause of chronic respiratory disorders. In at least two common pulmonary conditions, chronic bronchitis and asthma, there may be a ying-yang association between the pulmonary disease and gastroesophageal reflux. Gastroesophageal-provoked disease needs to be evaluated in patients with chronic respiratory disease whose condition is progressing in spite of adequate medical therapy; whose history strongly supports this concept; and whose laboratory tests suggest a causal relationship. Recognition and treatment of gastroesophageal reflux, either medical or surgical, can benefit respiratory problems of many patients.
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38
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Affiliation(s)
- S R Orenstein
- Department of Pediatrics, University of Pittsburgh School of Medicine, PA
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39
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Crump WJ. Reflux Esophagitis. Prim Care 1988. [DOI: 10.1016/s0095-4543(21)01055-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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40
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Crausaz FM, Favez G. Aspiration of solid food particles into lungs of patients with gastroesophageal reflux and chronic bronchial disease. Chest 1988; 93:376-8. [PMID: 3338306 DOI: 10.1378/chest.93.2.376] [Citation(s) in RCA: 80] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
The existence of a relationship between upper digestive tract impairment and respiratory disturbance is generally accepted. The aim of this study was to determine whether pulmonary aspiration, documented by labeled meal and lung scans, could be a contributory factor. Thirty-two patients with chronic respiratory complaints (19 men, 13 women, mean age: 57.8 yr), 29 of whom had an FEV1 below 80 percent of predicted values, and 13 healthy subjects (six men, seven women, mean age 50.9 yr) took part in a prospective study. Scintiscans showed gastroesophageal reflux (GER) in 27 patients (84 percent) and in five control subjects (38 percent). Lung contamination was ascertained in 24 patients (75 percent) and in two control subjects (15 percent) (p less than 0.001) 15 hours after a labeled solid meal. Vegetal fibers were found in sputum smears after mouth rinsing the day after ingestion of 8.5 g wheat bran in 72 percent of patients and in 77 percent of control subjects. Although two associated phenomena are not necessarily causally related, pulmonary aspiration documented by pulmonary scintigraphy did significantly correlate with gastroesophageal reflux, suggesting that aspiration resulting from reflux may perpetuate, if not initiate, chronic bronchial disease.
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Affiliation(s)
- F M Crausaz
- Out-patient Department, University Medical School of Lausanne, Switzerland
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41
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Gustafsson PM, Tibbling L. 24-hour oesophageal two-level pH monitoring in healthy children and adolescents. Scand J Gastroenterol 1988; 23:91-4. [PMID: 3344404 DOI: 10.3109/00365528809093854] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Two-level pH recording in the oesophagus was performed for 24 h in 28 healthy schoolchildren between 9.3 and 17.3 years of age, to obtain reference values for reflux studies. The pH probes were placed 5 and 15 cm above the lower oesophageal sphincter by means of the manometric technique. A standardized acid-free diet was given on the day of recording. A drop in pH to 4.0 or below was regarded as reflux. The normal upper limit of total reflux time was 1.0% at the lower oesophageal level. Mean reflux time was about three times shorter at the upper level than at the lower, which indicates the importance of exact positioning of the pH probe.
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Affiliation(s)
- P M Gustafsson
- Dept. of Paediatrics, Faculty of Health Sciences, University Hospital, Linköping, Sweden
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42
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Fawcett HD, Hayden CK, Adams JC, Swischuk LE. How useful is gastroesophageal reflux scintigraphy in suspected childhood aspiration? Pediatr Radiol 1988; 18:311-3. [PMID: 3387152 DOI: 10.1007/bf02388999] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
It has been suggested that gastroesophageal reflux scintigraphy (GRS) might be useful in assisting one in determining therapy for patients suspected of aspirating or becoming apneic secondary to gastroesophageal reflux. This, however, has not been our experience and in reviewing 23 patients with recurrent pneumonia and/or apnea who had GRS, we were able to detect aspiration in only one. This was especially significant since 13 (59%) of these patients had demonstrable reflux, and of these, eight were treated successfully for suspected aspiration even though none was demonstrated isotopically. To be sure, the demonstration of pulmonary aspiration with GRS had little influence on patient selection and response to therapy. For this reason we feel there is little justification in depending on the GRS for the specific purpose of trying to document pulmonary aspiration in infants and children who are refluxing.
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Affiliation(s)
- H D Fawcett
- Department of Pediatrics, University of Texas Medical Branch, Galveston
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43
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Gadol CL, Joshi VV, Lee EY. Bronchiolar obstruction associated with repeated aspiration of vegetable material in two children with cerebral palsy. Pediatr Pulmonol 1987; 3:437-9. [PMID: 3320918 DOI: 10.1002/ppul.1950030611] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Chronic reactive bronchiolar obstruction has not been noted to occur with repeated aspiration of food materials. In this report, we describe two autopsy cases of children aged 8 years and 22 months with cerebral palsy, one with documented and treated esophageal reflux, and both with histories of repeated aspiration pneumonia. In each case, the lungs showed multiple nodules of hyalinized tissue and organized exudate obstructing the bronchiolar lumina, with multinucleated foreign body-type giant cells surrounding intraluminal vegetable particles. It is suggested that chronic bronchiolar obstruction was a significant contributing cause of respiratory insufficiency and consequent morbidity in these patients with cerebral palsy.
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Affiliation(s)
- C L Gadol
- Children's Hospital of New Jersey, Newark 07107
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44
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45
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46
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Abstract
Esophageal dysfunction has been reported after successful repair of esophageal atresia but its nature has not been clearly defined. We studied esophageal motility in 20 newborns with esophageal atresia by recording intraluminal pressure of both proximal and distal segments. The investigation was made by pressure monitoring of the upper pouch via the mouth and of the distal segment via the gastrostomy. In all cases we found motility disorders. Two patients (12.5%) showed incomplete relaxation of the upper esophageal sphincter. The resting pressure of the esophageal body in both segments was constantly positive in all cases. Lower esophageal sphincter (LES) function was normal in all but two patients (16.7%) in whom the LES pressure was reduced and one case (8.4%) with incomplete relaxation of the LES. These studies suggest that motility disorders are also present in esophageal atresia before surgery.
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47
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Nussbaum E, Maggi JC, Mathis R, Galant SP. Association of lipid-laden alveolar macrophages and gastroesophageal reflux in children. J Pediatr 1987; 110:190-4. [PMID: 3806289 DOI: 10.1016/s0022-3476(87)80152-x] [Citation(s) in RCA: 80] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The association of lipid-laden alveolar macrophages (LLAM) and gastroesophageal reflux (GER) was investigated prospectively in 115 patients in two groups. Group 1 included 74 children with chronic respiratory tract disorders and documented GER by prolonged esophageal pH monitoring, barium esophagram, and esophagoscopy; group 2 included 41 children with chronic respiratory tract disorders without GER. LLAM were present in 63 (85%) and eight (19%) children from groups 1 and 2, respectively (P less than 0.0001). Thus a strong association between the presence of LLAM and GER in children with chronic respiratory tract disorders was established. We suggest that LLAM from bronchial lavage may be a useful marker for tracheal aspiration in children with GER in whom chronic lung disease may subsequently develop.
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48
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Abstract
A wide variety of types of pulmonary diseases and respiratory symptoms have been associated with gastroesophageal reflux (GER). Asthma, chronic bronchitis, bronchiectasis, and pulmonary fibrosis have all been linked to GER, but causal mechanisms have been difficult to establish. To characterize pulmonary function abnormalities in older children and young adults (age 7-23 years) with GER, lung function was evaluated in 22 patients being treated for reflux. The patients were divided into two groups: nine subjects (Group 1) had no history of pulmonary symptoms. Thirteen subjects (Group 2) had known pulmonary disease; all had diagnosed asthma, and five had a history of recurrent pneumonia. Lung volumes and spirometry were measured. Airway reactivity was assessed by measuring change in flows following isocapneic hyperventilation of subfreezing air. The presence of "small airway" disease was assessed by air-helium flow volume curves and the single breath oxygen test. Lung size, as indicated by measurement of total lung capacity, was normal in all patients. Flow rates, density dependence of maximal expiratory flow, single breath oxygen test, and tests of airway reactivity were abnormal only in Group 2 patients and were normal in the Group 1 patients. That not all children with GER have abnormal pulmonary function suggests that, if there is a causal relationship between GER and lung disease, it is multi-factorial in nature. Children with GER who do have lung disease have evidence of airway obstruction, maldistribution of ventilation, and increased airway reactivity, but do not have restricted lung volumes.
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49
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Buts JP, Barudi C, Moulin D, Claus D, Cornu G, Otte JB. Prevalence and treatment of silent gastro-oesophageal reflux in children with recurrent respiratory disorders. Eur J Pediatr 1986; 145:396-400. [PMID: 3792384 DOI: 10.1007/bf00439246] [Citation(s) in RCA: 63] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Thirty-six infants and children presenting with recurrent respiratory disorders (RRD) as the sole clinical symptom including bronchial asthma (6), recurrent obstructive bronchitis with or without wheezing (18), chronic nocturnal cough (3), recurrent episodes of pneumonia (3), recurrent pharyngitis (3) and recurrent laryngitis (3) were investigated for associated gastro-oesophageal reflux (GER) by oesophagram, endoscopy and continuous 24 h pH monitoring of the distal oesophagus. The pH monitoring criteria were selected on the basis of a preliminary study comparing statistically measurements of 32 variables recorded in 15 patients who all had clinical, radiological and endoscopic evidence of GER and in 8 asymptomatic controls. Although patients with symptomatic GER differed significantly from the asymptomatic ones for 27 variables examined, 6 variables emerged as having the highest value for discrimination (overlap score 0-1). Among these, the Euler-Byrne index (number of reflux pH less than 4 + 4 times the number of reflux episodes of more than 5 min), the percentage of total reflux time and the number of reflux episodes 1 h post-cibal scored 0 (no overlap). GER was considered to be present when at least five of these six parameters were abnormal. The overall incidence of GER in children with RRD was 41% (15) when detected by oesophagram and 61% (22) when diagnosed by pH monitoring criteria. In the children with bronchial asthma or with recurrent laryngitis, the percentage of reflux time during sleep was about 40 times higher than in asymptomatic controls and 2 times higher than in those with symptomatic GER.(ABSTRACT TRUNCATED AT 250 WORDS)
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50
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Abstract
Bronchopulmonary dysplasia has become the most common pulmonary sequelae in neonates receiving mechanical ventilation. The pathogenesis of BPD is multifactorial, but prematurity, positive pressure ventilation, oxygen toxicity and pulmonary edema are some of the most important factors in its development. By minimizing these factors, it is possible to reduce the incidence and severity of BPD.
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