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Pop RS, Pop D, Chiperi LE, Nechita VI, Man SC, Dumitrașcu DL. Utility of the Post-Reflux Swallow-Induced Peristaltic Wave Index and Mean Nocturnal Baseline Impedance for the Diagnosis of Gastroesophageal Reflux Disease Phenotypes in Children. CHILDREN (BASEL, SWITZERLAND) 2024; 11:773. [PMID: 39062223 PMCID: PMC11275132 DOI: 10.3390/children11070773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 06/19/2024] [Accepted: 06/25/2024] [Indexed: 07/28/2024]
Abstract
(1) Objectives: Assessment of novel impedance parameters such as the post-reflux swallow-induced peristaltic wave (PSPW) index and mean nocturnal baseline impedance (MNBI) have been proposed to enhance the accuracy of gastroesophageal reflux disease (GERD) diagnosis. We aimed to evaluate the clinical value of MNBI and the PSPW index in discerning different phenotypes of GERD in children. (2) Methods: We conducted a prospective, observational study that included 49 children aged 5-18 years, referred for MII-pH monitoring due to negative endoscopy and persisting gastroesophageal reflux symptoms despite acid-suppressant treatment. The PSPW index and MNBI were assessed along with conventional metrics. (3) Results: Using a receiver operating characteristic (ROC) curve analysis, MNBI (AUC 0.864) and the PSPW index (AUC 0.83) had very good performance in differentiating between non-erosive reflux disease (NERD) and functional phenotypes. The PSPW index (AUC 0.87) discriminated better between functional heartburn (FH) and reflux hypersensitivity (RH) compared to the MNBI (AUC 0.712). A PSPW cut-off value of 65% provided a sensitivity of 76.9% and a specificity of 90% in distinguishing FH and RH. The PSPW index (AUC 0.87) proved to have better performance than the MNBI (AUC 0.802) in differentiating between FH and non-FH patients. MNBI diagnosed FH with a sensitivity of 84% and a specificity of 80.6% at a cut-off value of 2563 Ω. (4) Conclusions: The PSPW index and MNBI are useful to distinguish between GERD phenotypes in pediatric patients.
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Affiliation(s)
- Radu Samuel Pop
- 3rd Department of Pediatrics, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400217 Cluj-Napoca, Romania; (D.P.); (S.C.M.)
| | - Daniela Pop
- 3rd Department of Pediatrics, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400217 Cluj-Napoca, Romania; (D.P.); (S.C.M.)
- 3rd Pediatric Clinic, Clinical Emergency Hospital for Children, 400217 Cluj-Napoca, Romania
| | - Lăcrămioara Eliza Chiperi
- Department of Pediatrics, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology, 540136 Târgu Mureș, Romania;
| | - Vlad-Ionuț Nechita
- Department of Medical Informatics and Biostatistics, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania;
| | - Sorin Claudiu Man
- 3rd Department of Pediatrics, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400217 Cluj-Napoca, Romania; (D.P.); (S.C.M.)
- 3rd Pediatric Clinic, Clinical Emergency Hospital for Children, 400217 Cluj-Napoca, Romania
| | - Dan Lucian Dumitrașcu
- 2nd Department of Internal Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania;
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Vu JP, Jagannath D, Spielberg DR, Chiou EH, Hosek KE, Lambert EM. Triple endoscopy and recurrent croup in children: A single aerodigestive center experience. Auris Nasus Larynx 2024; 51:125-131. [PMID: 37550113 DOI: 10.1016/j.anl.2023.07.005] [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] [Received: 01/12/2023] [Revised: 04/22/2023] [Accepted: 07/19/2023] [Indexed: 08/09/2023]
Abstract
OBJECTIVE To determine the utility of triple endoscopy (combined direct laryngoscopy, bronchoscopy (DLB), flexible bronchoscopy with bronchoalveolar lavage (FB + BAL), and esophagogastroduodenoscopy (EGD)) in the diagnosis and management of patients with recurrent croup (RC), and to identify predictors of endoscopic findings METHODS: A retrospective chart review was performed of pediatric patients (age <18 years) with RC evaluated by triple endoscopy at a tertiary care pediatric hospital from 2010 to 2021. Data including presenting symptoms, airway findings, BAL and EGD with biopsy findings were collected. RESULTS 42 patients with RC underwent triple endoscopy were included. The mean age was 4.55±2.84 years old. The most common symptom was chronic cough among 19 (45%) patients, while 23 (55%) patients had gastrointestinal (GI) symptoms. Airway findings included tracheomalacia in 19, laryngeal cleft in 17, and subglottic stenosis in 11 patients. On EGD with biopsy, abnormal gross findings were present in 6 and abnormal microscopic findings in 18 patients, including 6 with histologic findings suggestive of gastroesophageal reflux and 5 with eosinophilic esophagitis. Seventeen (40%) patients had positive culture on BAL. No findings in patient histories significantly predicted presence of lower airway malacia, subglottic stenosis, or abnormal EGD findings. CONCLUSIONS Children with recurrent croup presenting to aerodigestive centers may not have any pertinent presenting symptoms that correlate with significant findings on triple endoscopy. Further work is needed to determine which children with recurrent croup may benefit from aerodigestive evaluation. LEVEL OF EVIDENCE Level 3.
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Affiliation(s)
- Jennifer P Vu
- Division of Otolaryngology, Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, 6621 Fannin St, Houston, TX 77030, USA
| | - Deepak Jagannath
- Division of Otolaryngology, Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, 6621 Fannin St, Houston, TX 77030, USA.
| | - David R Spielberg
- Division of Pulmonology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX 77030, USA
| | - Eric H Chiou
- Division of Gastroenterology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX 77030, USA
| | - Kathleen E Hosek
- Department of Surgery, Texas Children's Hospital, Houston, TX 77030, USA
| | - Elton M Lambert
- Division of Otolaryngology, Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, 6621 Fannin St, Houston, TX 77030, USA
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Karabulut M, Kutlu B, Kasim MS. Etiological Evaluation in Children Referred to the Pediatric Cardiology Outpatient Clinic with Chest Pain. SISLI ETFAL HASTANESI TIP BULTENI 2023; 57:397-402. [PMID: 37900330 PMCID: PMC10600598 DOI: 10.14744/semb.2023.22316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/09/2023] [Accepted: 08/10/2023] [Indexed: 10/31/2023]
Abstract
Objectives One of the most common reasons for pediatric cardiology referrals is chest pain in childhood. Although it is mostly innocent in character, it is rarely associated with life-threatening pathologies. In this study, it was aimed to evaluate the etiological causes in children with chest pain. Methods Our study included 1000 children who were referred to the pediatric cardiology clinic with the complaint of chest pain between January 2019 and June 2022. Demographic characteristics, accompanying complaints, echocardiographies, electrocardiographies, 24-h rhythm holters, treadmill exercise test, computed tomography angiography, and non-cardiac findings related to etiology were analyzed retrospectively from the file archives of the patients. Results Five hundred and nine (50.9%) of the patients were female and 491 (49.1%) were male. The mean age of the patients was 11.3 y (range: 3-18 years). Cardiological pathology associated with chest pain was detected in only 6.8% of the patients. Among the etiologies of chest pain, mitral valve prolapse (MVP) was the most common cardiological pathology with a rate of 2.1%. In the non-cardiac etiological evaluation of chest pain, idiopathic causes with a frequency of 48%, musculoskeletal pathologies with a frequency of 22.6%, respiratory pathologies with a frequency of 7.9%, psychiatric pathologies with a frequency of 7.3%, gastrointestinal pathologies with a frequency of 4.1%, and familial Mediterranean fever with a frequency of 2.4%, miscellaneous with a frequency of 1.1% were found, respectively. Conclusion In the study, it was determined that non-cardiac causes were more common among the etiological causes of chest pain in the pediatric age group. In addition, MVP was the most common cause of cardiac chest pain.
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Affiliation(s)
- Muhammed Karabulut
- Department of Pediatric Cardiology, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
| | - Busra Kutlu
- Department of Pediatrics, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
| | - Mustafa Safa Kasim
- Department of Pediatrics, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
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Eiamkulbutr S, Dumrisilp T, Sanpavat A, Sintusek P. Prevalence of gastroesophageal reflux disease in children with extraesophageal manifestations using combined-video, multichannel intraluminal impedance-pH study. World J Clin Pediatr 2023; 12:151-161. [PMID: 37342455 PMCID: PMC10278077 DOI: 10.5409/wjcp.v12.i3.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 04/13/2023] [Accepted: 05/06/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Gastroesophageal reflux disease (GERD) might be either a cause or comorbidity in children with extraesophageal problems especially as refractory respiratory symptoms, without any best methods or criterion for diagnosing it in children.
AIM To evaluate the prevalence of extraesophageal GERD using conventional and combined-video, multichannel intraluminal impedance-pH (MII-pH), and to propose novel diagnostic parameters.
METHODS The study was conducted among children suspected of extraesophageal GERD at King Chulalongkorn Memorial Hospital between 2019 and 2022. The children underwent conventional and/or combined-video MII-pH. The potential parameters were assessed and receiver operating characteristic was used for the significant parameters.
RESULTS Of 51 patients (52.9% males), aged 2.24 years were recruited. The common problems were cough, recurrent pneumonia, and hypersecretion. Using MII-pH, 35.3% of the children were diagnosed with GERD by reflux index (31.4%), total reflux events (3.9%), and symptom indices (9.8%) with higher symptom recorded in the GERD group (94 vs 171, P = 0.033). In the video monitoring group (n = 17), there were more symptoms recorded (120 vs 220, P = 0.062) and more GERD (11.8% vs 29.4%, P = 0.398) by symptom indices. Longest reflux time and mean nocturnal baseline impedance were significant parameters for diagnosis with receiver operating characteristic areas of 0.907 (P = 0.001) and 0.726 (P = 0.014).
CONCLUSION The prevalence of extraesophageal GERD in children was not high as expected. The diagnostic yield of symptom indices increased using video monitoring. Long reflux time and mean nocturnal baseline impedance are novel parameters that should be integrated into the GERD diagnostic criteria in children.
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Affiliation(s)
- Sutha Eiamkulbutr
- Department of Pediatrics, King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
| | - Termpong Dumrisilp
- Department of Pediatrics, Bhumibol Adulyadej Hospital, Bangkok 10220, Thailand
| | - Anapat Sanpavat
- Department of Pathology, Chulalongkorn University, Bangkok 10330, Thailand
| | - Palittiya Sintusek
- Thai Pediatric Gastroenterology, Hepatology and Immunology Research Unit, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
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Li N, Yang WL, Cai MH, Chen X, Zhao R, Li MT, Yan XL, Xue LW, Hong L, Tang MY. Burden of gastroesophageal reflux disease in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of disease study 2019. BMC Public Health 2023; 23:582. [PMID: 36978027 PMCID: PMC10053627 DOI: 10.1186/s12889-023-15272-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 02/14/2023] [Indexed: 03/30/2023] Open
Abstract
INTRODUCTION For effective preventive strategies against GORD (gastro-esophageal reflux disease), we assessed the GORD burden from 1990 to 2019. METHODS The burden of GORD between 1990 and 2019 was evaluated globally, regionally, and nationally. Using ASIR (age-standardized incidence), ASYLDs (age-standardized years lived with disabilitys), we compared them to the GBD world population per 100,000. The estimates were based on 95% uncertainty intervals (UIs). The AAPC (average annual percent change) in incidence, YLDs, along with prevalence rates with associated 95% CIs were estimated. RESULTS Data to estimate the burden of GORD are scarce till now. The global ASIR of GORD in 2019 was 3792.79 per 100,000, an increase AAPC of 0.112% from 1990. The prevalence of GORD increased with a AAPC of 0.096% to 9574.45 per 100,000. Global ASYLDs in 2019 was 73.63, an increase AAPC of 0.105% from 1990. The GORD burden varies greatly depending on the development level and geographical location. USA demonstrated the most obvious decreasing trend in burden of GORD, while Sweden had an increasing trend. That the increase in GORD YLDs was mediated primarily by the growth and aging of population, was revealed by decomposition analyses. There was an inverse relationship between SDI (socio-demographic index) and GORD-burden. Frontier analyses revealed significant scope of improvement in the status of development at all levels. CONCLUSION GORD is a public health challenge, especially in Latin America. Some SDI quintiles had declining rates, while some countries experienced increased rates. Thus, resources should be allocated for preventative measures based on country-specific estimates.
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Affiliation(s)
- Na Li
- Division of Gastroenterology and Hepatology, NHC Key Laboratory of Digestive Disease, Ministry of Health, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, Shanghai, 200125, China
| | - Wan-Li Yang
- State Key Laboratory of Cancer Biology and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, 710032, Shaanxi Province, China
| | - Mei-Hong Cai
- Department of Gastroenterology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
| | - Xiang Chen
- Division of Pulmonary Medicine, Key Laboratory of Heart and Lung, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang Province, China
| | - Ran Zhao
- Department of Gastroenterology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Meng-Ting Li
- Department of Gastroenterology, The Affiliated People's Hospital of Ningbo University, Zhejiang, China
| | - Xia-Lin Yan
- Department of Gastrointestinal Surgery, School of Medicine, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Li-Wei Xue
- Department of Gastroenterology, Ruian People's Hospital, Zhejiang Province, Wenzhou, 325200, China.
| | - Liu Hong
- State Key Laboratory of Cancer Biology and National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, 710032, Shaanxi Province, China.
| | - Ming-Yu Tang
- Division of Gastroenterology and Hepatology, NHC Key Laboratory of Digestive Disease, Ministry of Health, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, Shanghai, 200125, China.
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Pulvirenti G, Sortino V, Manti S, Parisi GF, Papale M, Giallongo A, Leonardi S. Pathogenesis, diagnosis, dietary management, and prevention of gastrointestinal disorders in the paediatric population. Ital J Pediatr 2022; 48:172. [PMID: 36089576 PMCID: PMC9465927 DOI: 10.1186/s13052-022-01366-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 09/04/2022] [Indexed: 11/13/2022] Open
Abstract
Nutrition has a central role in child growth with long-term effects, and nutrition management in gastrointestinal disorders has great importance for child health and disease outcomes. Breast milk is the first choice for infant nutrition. When it is not available, special milk formulas are adopted in specific conditions, as a medical treatment. Moving from the strong guidelines, recommendations and the new possibilities of special diet treatment, this review will analyse the current diet treatment in different gastrointestinal disorders, including food allergy, cystic fibrosis, inflammatory bowel diseases, short-bowel syndrome, gastroesophageal reflux, and eosinophilic esophagitis. The review also aimed at understanding the role of diet and its effects on these diseases. The growth monitoring can prevent malnutrition and improve disease outcomes, particularly in children, and an appropriate dietary management targeted to specific disorders is the best therapeutic choice alone or in combination with pharmacological therapy.
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Dewan T, Turner J, Lethebe BC, Johnson DW. Gastro-oesophageal reflux disease in children with neurological impairment: a retrospective cohort study. BMJ Paediatr Open 2022; 6:10.1136/bmjpo-2022-001577. [PMID: 36645746 PMCID: PMC9490596 DOI: 10.1136/bmjpo-2022-001577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 09/06/2022] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVES To determine the incidence and prevalence of gastro-oesophageal reflux disease (GERD) diagnosis and treatment in children with neurological impairment (NI) along with relationship to key variables. DESIGN This is a population-based retrospective cohort study. SETTING This study takes place in Alberta, Canada. PATIENTS Children with NI were identified by hospital-based International Classification of Diseases (ICD) codes from 2006 to 2018. MAIN OUTCOME MEASURES Incidence and prevalence of a GERD diagnosis identified by: (1) hospital-based ICD-10 codes; (2) specialist claims; (3) dispensation of acid-suppressing medication (ASM). Age, gender, complex chronic conditions (CCC) and technology assistance were covariates. RESULTS Among 10 309 children with NI, 2772 (26.9%) met the GERD definition. The unadjusted incidence rate was 52.1 per 1000 person-years (50.2-54.1). Increasing numbers of CCCs were associated with a higher risk of GERD. The HR for GERD associated with a gastrostomy tube was 4.56 (95% CI 4.15 to 5.00). Overall, 2486 (24.1%) of the children were treated with ASMs of which 1535 (61.7%) met no other GERD criteria. The incidence rate was 16.9 dispensations per year (95% CI 16.73 to 17.07). The prevalence of gastrojejunostomy tubes was 1.1% (n=121), surgical jejunostomy tubes was 0.7% (n=79) and fundoplication was 3.4% (n=351). CONCLUSIONS The incidence of GERD in children with NI greatly exceeds that of the general paediatric population. Similarly, incidence rate of medication dispensations was closer to the rates seen in adults particularly in children with multiple CCCs and gastrostomy tubes. Further research is needed to determine the appropriate use of ASMs balancing the potential for adverse effects in this population.
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Affiliation(s)
- Tammie Dewan
- Pediatrics, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Justine Turner
- Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | | | - David W Johnson
- Pediatrics, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
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McGovern PE, Crowley TB, Zackai EH, Burrows E, McDonald-McGinn DM, Nance ML. Surgical insights and management in patients with the 22q11.2 deletion syndrome. Pediatr Surg Int 2022; 38:899-905. [PMID: 35411495 DOI: 10.1007/s00383-022-05123-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/30/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE 22q11.2 deletion syndrome (22q11.2DS) can present with a variety challenges to patients and their caregivers, many of which require surgical evaluation and intervention. Surgical needs can also extend long into adulthood, prompting evaluation and intervention throughout development and beyond. Here, we identify common concerns and patient needs associated with the 22q11.2DS from a general surgery perspective, their management, and typical management based on our institution's experience with 1263 patients. METHODS 1263 patients evaluated and treated at the 22q And You Center at the Children's Hospital of Philadelphia were enrolled and included in the study, from January 1992 to May 2017 Co-morbidities, procedures, and imaging studies performed were quantified and assessed via descriptive analysis. RESULTS Gastroesophageal reflux disease (GERD) and feeding difficulties were the most common surgical issues identified, while gastrostomy tube placement, anorectal procedures, and hernia repairs were the most common surgical interventions performed by general surgeons. CONCLUSIONS General surgical procedures are commonly needed in this population and are part of the complex needs these patients and their surgeons may encounter in the setting of a 22q11.2DS diagnosis. These findings will help to inform a well-coordinated, multidisciplinary approach to care.
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Affiliation(s)
- Patrick E McGovern
- Division of General, Thoracic, and Fetal Surgery, The Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.
| | - T Blaine Crowley
- Division of Human Genetics - 22q and You Center, The Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Elaine H Zackai
- Division of Human Genetics - 22q and You Center, The Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Evanette Burrows
- Roberts Center for Pediatric Research, The Children's Hospital of Philadelphia, 2716 South St, Philadelphia, PA, 19146, USA
| | - Donna M McDonald-McGinn
- Division of Human Genetics - 22q and You Center, The Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Michael L Nance
- Division of General, Thoracic, and Fetal Surgery, The Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
- Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce St # 4, Philadelphia, PA, 19104, USA
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McLoughlin VZY, Suaini NHA, Siah K, Loo EXL, Pang WW, Chong YS, Godfrey KM, Tan KH, Chan JKY, Goh AEN, Lee BW, Shek LP, Eriksson JG, Aw MM, Tham EH. Prevalence, risk factors and parental perceptions of gastroesophageal reflux disease in Asian infants in Singapore. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2022; 51:263-271. [PMID: 35658149 DOI: 10.47102/annals-acadmedsg.2021411] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Infant gastroesophageal reflux disease (GERD) is a significant cause of concern to parents. This study seeks to describe GERD prevalence in infants, evaluate possible risk factors and assess common beliefs influencing management of GERD among Asian parents. METHODS Mother-infant dyads in the Singapore PREconception Study of long-Term maternal and child Outcomes (S-PRESTO) cohort were prospectively followed from preconception to 12 months post-delivery. GERD diagnosis was ascertained through the revised Infant Gastroesophageal Reflux Questionnaire (I-GERQ-R) administered at 4 time points during infancy. Data on parental perceptions and lifestyle modifications were also collected. RESULTS The prevalence of infant GERD peaked at 26.5% at age 6 weeks, decreasing to 1.1% by 12 months. Infants exclusively breastfed at 3 weeks of life had reduced odds of GERD by 1 year (adjusted odds ratio 0.43, 95% confidence interval 0.19-0.97, P=0.04). Elimination of "cold or heaty food" and "gas producing" vegetables, massaging the infant's abdomen and application of medicated oil to the infant's abdomen were quoted as major lifestyle modifications in response to GERD symptoms. CONCLUSION Prevalence of GERD in infants is highest in the first 3 months of life, and the majority outgrow it by 1 year of age. Infants exclusively breastfed at 3 weeks had reduced odds of GERD. Cultural-based changes such as elimination of "heaty or cold" food influence parental perceptions in GERD, which are unique to the Asian population. Understanding the cultural basis for parental perceptions and health-seeking behaviours is crucial in tailoring patient education appropriately for optimal management of infant GERD.
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Affiliation(s)
- Vanessa Z Y McLoughlin
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore
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Fukahori S, Yagi M, Kawahara H, Masui D, Hashizume N, Taguchi T. Current status of intractable pediatric gastroesophageal reflux disease in Japan: a nationwide survey. Surg Today 2022; 52:1153-1159. [PMID: 34982227 DOI: 10.1007/s00595-021-02444-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 11/15/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE A nationwide survey was conducted to investigate the current status of pediatric gastroesophageal reflux disease (GERD) in Japan, with special reference to the characteristics of intractable GERD. METHODS Data were collected using a questionnaire from facilities specializing in the treatment of pediatric GERD in Japan. Intractable GERD was defined as follows: I, no symptomatic improvement after 8 weeks of optimal medical treatment (OMT) plus fundoplication; II, no symptomatic improvement after 8 weeks of OMT and with no indications for fundoplication; and III, no symptomatic improvement after surgery without OMT. RESULTS We collected data from 3,463 pediatric patients with GERD from 91 institutions, and 81 satisfied the definition of intractable GERD. Additional clinical information was obtained from 56 patients, and 41 represented cases of definite intractable GERD. The main underlying disorders included neurological impairment (NI), esophageal atresia (EA), and congenital heart disease (CHD), which altogether accounted for 85% of patients. Of the 41 patients, 33 received fundoplication, and the remaining 8 received medical treatment alone because surgery was considered unsuitable. CONCLUSIONS The nationwide survey revealed that pediatric intractable GERD is rare in Japan. Three main underlying disorders-NI, EA, and CHD-were implicated in the majority of cases of intractable GERD.
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Affiliation(s)
- Suguru Fukahori
- Department of Pediatric Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan.
| | - Minoru Yagi
- Department of Pediatric Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Hisayoshi Kawahara
- Department of Pediatric Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Daisuke Masui
- Department of Pediatric Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Naoki Hashizume
- Department of Pediatric Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Tomoaki Taguchi
- Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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Jackson R, Lewis P, Brown SD. Comparative Stability of Compounded Omeprazole Suspension Versus Commercial Omeprazole Kit When Stored in Oral Syringes Under Refrigerated Conditions. J Pharm Technol 2021; 36:179-186. [PMID: 34752549 DOI: 10.1177/8755122520935532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Omeprazole is a proton pump inhibitor used to manage gastrointestinal disorders. Special populations may require omeprazole to be given as an oral suspension. Objective: The purpose of this project was to compare the stability of omeprazole in the FIRST kit product to a traditionally compounded omeprazole suspension, when stored in refrigerated unit-dosed syringes. NG tube delivery of the 2 products was also investigated. Methods: Five batches of compounded omeprazole oral suspension and 5 kits of FIRST-Omeprazole were prepared to an initial concentration of 2 mg/mL. Suspensions were aliquoted into 5-mL doses in clear plastic oral syringes, and stored at 2-8 °C. Syringes from each batch were analyzed at baseline and after 7, 14, 21, and 30 days for omeprazole potency using HPLC. To assess suitability for NG tube administration, 20 mL of each suspension were administered through NG tubes (8Fr, 10Fr, and 18Fr), and percent omeprazole recovery assessed. Results: The chemical potency remained within 90-110% for 14 days and 30 days for compounded samples and FIRST-Omeprazole samples, respectively. There was a statistically significant difference in initial concentration; 1.89 mg/mL versus 1.98 mg/mL for compounded and FIRST-Omeprazole, respectively. After 30 days, FIRST-Omeprazole demonstrated 97.20% API recovery. Neither suspension experienced statistically significant loss of potency following NG tube passage. Conclusion: FIRST-Omeprazole suspension may be stored in refrigerated clear luer-lock oral syringes for 30 days. Traditionally compounded omeprazole suspension should be used within 14 days. Both suspensions are suitable for NG tube administration.
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Affiliation(s)
| | - Paul Lewis
- Johnson City Medical Center, Johnson City, TN, USA
| | - Stacy D Brown
- East Tennessee State University, Johnson City, TN, USA
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12
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Diagnosis and Management of Gastroesophageal Reflux Disease in Children: Recommendations of Pediatric Gastroenterology Chapter of Indian Academy of Pediatrics, Indian Society of Pediatric Gastroenterology, Hepatology and Nutrition (ISPGHAN). Indian Pediatr 2021. [DOI: 10.1007/s13312-021-2400-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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13
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Curtius K, Rubenstein JH, Chak A, Inadomi JM. Computational modelling suggests that Barrett's oesophagus may be the precursor of all oesophageal adenocarcinomas. Gut 2020; 70:gutjnl-2020-321598. [PMID: 33234525 PMCID: PMC8292551 DOI: 10.1136/gutjnl-2020-321598] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 10/13/2020] [Accepted: 10/14/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Barrett's oesophagus (BE) is a known precursor to oesophageal adenocarcinoma (OAC) but current clinical data have not been consolidated to address whether BE is the origin of all incident OAC, which would reinforce evidence for BE screening efforts. We aimed to answer whether all expected prevalent BE, diagnosed and undiagnosed, could account for all incident OACs in the US cancer registry data. DESIGN We used a multiscale computational model of OAC that includes the evolutionary process from normal oesophagus through BE in individuals from the US population. The model was previously calibrated to fit Surveillance, Epidemiology and End Results cancer incidence curves. Here, we also utilised age-specific and sex-specific US census data for numbers at-risk. The primary outcome for model validation was the expected number of OAC cases for a given calendar year. Secondary outcomes included the comparisons of resulting model-predicted prevalence of BE and BE-to-OAC progression to the observed prevalence and progression rates. RESULTS The model estimated the total number of OAC cases from BE in 2010 was 9970 (95% CI: 9140 to 11 980), which recapitulates nearly all OAC cases from population data. The model simultaneously predicted 8%-9% BE prevalence in high-risk males age 45-55, and 0.1%-0.2% non-dysplastic BE-to-OAC annual progression in males, consistent with clinical studies. CONCLUSION There are likely few additional OAC cases arising in the US population outside those expected from individuals with BE. Effective screening of high-risk patients could capture the majority of population destined for OAC progression and potentially decrease mortality through early detection and curative removal of small (pre)cancers during surveillance.
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Affiliation(s)
- Kit Curtius
- Centre for Genomics and Computational Biology, Barts Cancer Institute, School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Division of Biomedical Informatics, Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Joel H Rubenstein
- Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, USA
- Center for Clinical Management Research, Ann Arbor Veterans Affairs Medical Center, Ann Arbor, Michigan, USA
| | - Amitabh Chak
- Division of Gastroenterology and Liver Disease, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - John M Inadomi
- Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
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14
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Lynch MK, Thompson KA, Dimmitt RA, Barnes MJ, Goodin BR. Pain and internalizing symptoms in youth with gastrointestinal conditions including recurrent abdominal pain, eosinophilic esophagitis, and gastroesophageal reflux disease. CHILDRENS HEALTH CARE 2020. [DOI: 10.1080/02739615.2020.1810575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Mary K. Lynch
- Department of Psychiatry, Section of Psychology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Kathryn A. Thompson
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Reed A. Dimmitt
- Department of Pediatrics, Division of Gastroenterology Hepatology, & Nutrition, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Margaux J. Barnes
- Department of Pediatrics, Division of Gastroenterology Hepatology, & Nutrition, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Burel R. Goodin
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
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15
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Borodina G, Morozov S. Children With Gastroesophageal Reflux Disease Consume More Calories and Fat Compared to Controls of Same Weight and Age. J Pediatr Gastroenterol Nutr 2020; 70:808-814. [PMID: 32443037 DOI: 10.1097/mpg.0000000000002652] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The aim of the study was to compare the rates of nutrients consumption in children and adolescents with gastroesophageal reflux disease (GERD) compared to the control group without the disease. METHODS Based on symptom evaluation and esophageal pH-impedance recordings patients were allocated on to GERD and control groups. All patients underwent esophagogastroscopy. Levels of nutrients consumption were assessed with the use of food frequency questionnaire in the regard to the presence of the disease, esophagitis, and z score body mass index (BMI). RESULTS Data of 219 children and adolescents were available for the final analysis. Risks to have GERD were higher in groups with obesity (risk ratio 1.2 [95% confidence interval 0.8-1.7]) and excessive weight (1.1 [0.9-1.4]). Energy values of the rations and amount of fat consumption were higher in the GERD group compared to the control when rations were compared according to z score BMI. In contrast to nonerosive form of GERD, patients with erosive esophagitis consumed more protein (percentage deviation from the recommended daily allowance Me [25%;75%]): 14.3 (11.07; 19.1) % versus 8.5 (6.71; 14.1) %, total fat 36.8 (12.5; 75.5) % versus 16.9 (10.1; 17.9) %, and less polyunsaturated fats -54.3 (-73.4; -47.7) % versus -45.6 (-56.2; -33.1) %, P < 0.05. CONCLUSIONS The rations of children with GERD are characterized by higher calorie values and larger amounts of fat intake compared to the control group in the regard to z score BMI. Low dietary fiber consumption is additional factor associated with GERD in children with excessive weight and obesity. Compared to nonerosive GERD, higher intake of energy, protein, and total fat and lower of polyunsaturated fats revealed in patients with GERD with erosive esophagitis.
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Affiliation(s)
- Galina Borodina
- Department of Pediatric Gastroenterology, Hepatology and Dietology, Federal Research Center of Nutrition, Biotechnology and Food Safety
- Department of Propaedeutics of Children's Diseases, I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - Sergey Morozov
- Department of Gastroenterology and Hepatology, Federal Research Center of Nutrition, Biotechnology and Food Safety, Moscow, Russia
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16
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Walls E. Understanding reflux problems in infants, children and young people. ACTA ACUST UNITED AC 2019; 28:920-923. [DOI: 10.12968/bjon.2019.28.14.920] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Elaine Walls
- Senior Lecturer, Department of Health and Life Sciences, Northumbria University
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17
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Leung AK, Hon KL. Gastroesophageal reflux in children: an updated review. Drugs Context 2019; 8:212591. [PMID: 31258618 PMCID: PMC6586172 DOI: 10.7573/dic.212591] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 05/17/2019] [Accepted: 05/21/2019] [Indexed: 12/14/2022] Open
Abstract
Background Gastroesophageal reflux is a common disorder in pediatrics. Clinicians should be familiar with the proper evaluation and management of this condition. Objective To provide an update on the current understanding, evaluation, and management of gastroesophageal reflux in children. Methods A PubMed search was performed with Clinical Queries using the key term ‘gastroesophageal reflux’. The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews. The search was restricted to the English literature and the pediatric age group. Results Regurgitation is the most frequent symptom of gastroesophageal reflux and is present in nearly all cases. Gastroesophageal reflux occurs normally in infants, is often physiological, peaks at 4 months of age, and tends to resolve with time. Gastroesophageal reflux disease occurs when gastric contents reflux into the esophagus or oropharynx and produce troublesome symptom(s) and/or complication(s). A thorough clinical history and a thorough physical examination are usually adequate for diagnosis. When the diagnosis is ambiguous, diagnostic studies may be warranted. A combined esophageal pH monitoring and multichannel intraluminal esophageal electrical impedance device is the gold standard for the diagnosis of gastroesophageal reflux disease if the diagnosis is in doubt. In the majority of cases, no treatment is necessary for gastroesophageal reflux apart from reassurance of the benign nature of the condition. Treatment options for gastroesophageal reflux disease are discussed. Conclusion In most cases, no treatment is necessary for gastroesophageal reflux apart from reassurance because the condition is benign and self-limiting. Thickened feedings, postural therapy, and lifestyle changes should be considered if the regurgitation is frequent and problematic. Pharmacotherapy should be considered in the treatment of more severe gastroesophageal reflux disease for patients who do not respond to conservative measures. Proton pump inhibitors are favored over H2-receptor antagonists because of their superior efficacy. Antireflux surgery is indicated for patients with significant gastroesophageal reflux disease who are resistant to medical therapy.
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Affiliation(s)
- Alexander Kc Leung
- Department of Pediatrics, The University of Calgary, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Kam Lun Hon
- Department of Paediatrics, The Chinese University of Hong Kong, Shatin, Hong Kong.,PICU, The Hong Kong Children's Hospital, Kowloon, Hong Kong
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18
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Prevalence of Gastroesophageal Reflux Disease Symptoms in Infants and Children: A Systematic Review. J Pediatr Gastroenterol Nutr 2019; 68:811-817. [PMID: 31124988 DOI: 10.1097/mpg.0000000000002280] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Gastroesophageal reflux disease (GERD) is defined as gastroesophageal reflux causing troublesome symptoms or complications. In this study we reviewed the literature regarding the prevalence of GERD symptoms in infants and children. METHODS Databases of PubMed, EMBASE, and Cochrane were systematically searched from inception to June 26, 2018. English-written studies based on birth cohort, school-based, or general population samples of ≥50 children aged 0 to 21 years were included. Convenience samples were excluded. RESULTS In total, 3581 unique studies were found, of which 25 studies (11 in infants and 14 in children) were included with data on the prevalence of GERD symptoms comprising a total population of 487,969 children. In infants (0-18 months), GERD symptoms are present in more than a quarter of infants on a daily basis and show a steady decline in frequency with almost complete disappearance of symptoms at the age of 12 months. In children older than 18 months, GERD symptoms show large variation in prevalence between studies (range 0%-38% of study population) and overall, are present in >10% and in 25% on respectively a weekly and monthly basis. Of the risk factors assessed, higher body mass index and the use of alcohol and tobacco were associated with higher GERD symptom prevalence. CONCLUSIONS This systematic review demonstrates that the reported prevalence of GERD symptoms varies considerably, depending on method of data collection and criteria used to define symptoms. Nevertheless, the high reported prevalence rates support better investment of resources and educational campaigns focused on prevention.
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Goldman-Yassen AE, Gross J, Novak I, Poletto E, Kim JS, Son JK, Levin TL. Identification of clinical parameters to increase the diagnostic yield of the non-emergent upper gastrointestinal series in pediatric outpatients. Pediatr Radiol 2019; 49:162-167. [PMID: 30357445 DOI: 10.1007/s00247-018-4286-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 09/18/2018] [Accepted: 10/09/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Outpatient, non-emergent upper gastrointestinal (GI) series are frequently requested in children with no surgical history who have nonspecific symptoms such as abdominal pain, failure to thrive and vomiting. The positive yield of an upper GI series in these patients, and, thus, its utility, has not been studied. OBJECTIVES We evaluated the incidence of positive upper GI findings in children without a history of GI pathology or abdominal surgery in order to identify clinical indications associated with a greater diagnostic yield. MATERIALS AND METHODS Findings of upper GI series performed between October 2015 and October 2017 in three institutions in children younger than 18 years of age were retrospectively reviewed. The upper GI series protocol for each institution was also reviewed. Children with a medical or surgical GI history, children with insufficient history in the chart and those with an incomplete upper GI series were excluded from the study. Exam indications, patient demographics and clinical history were obtained from the electronic medical records. RESULTS Of 1,267 children who underwent outpatient upper GI series, 720 (median age: 2 years) had no GI history and were included in the study. The most common indications were non-bilious vomiting (62%), reflux symptoms (28%) and abdominal pain (20%). Upper GI series were normal in 605/720 cases (84%), including 25/26 children with reported bilious emesis. Of the 115 positive studies, 78 (68%) showed only gastroesophageal reflux (GER) (median age: 11 months). Of the remaining 37 studies, 19 demonstrated esophageal findings. One case of malrotation without midgut volvulus was identified in a patient who presented with dysphagia and reflux symptoms. Using a multinomial logistic regression model and adjusting for other variables, reflux symptoms and younger patient age were independent predictors of GER on upper GI series (relative risk ratios of 2.2 and 0.9, respectively). Dysphagia and/or foreign body sensation and older patient age were independent predictors of the presence of esophageal findings (relative risk ratios of 3.3 and 1.1, respectively). CONCLUSION The yield of routine upper GI series in children with nonspecific symptoms, such as abdominal pain and vomiting, and no surgical history is low. Diagnostic yield was improved in older children and in those complaining of dysphagia and/or foreign body sensation. Routine upper GI series should be avoided in clinically well children with symptoms only of uncomplicated GER and no significant GI history. In children with a history of dysphagia and/or foreign body sensation, an esophagram/barium swallow can suffice.
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Affiliation(s)
- Adam E Goldman-Yassen
- Department of Radiology, Montefiore Medical Center, 111 East 210th St, Bronx, NY, 10467, USA
| | - Jordana Gross
- Department of Radiology, Montefiore Medical Center, 111 East 210th St, Bronx, NY, 10467, USA
| | - Inna Novak
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Children's Hospital at Montefiore, Bronx, NY, USA
| | - Erica Poletto
- Department of Radiology, St. Christopher's Hospital for Children, Philadelphia, PA, USA
| | - Jane S Kim
- Department of Diagnostic Radiology & Nuclear Medicine, University of Maryland Medical Center, Baltimore, MD, USA
| | - Jennifer K Son
- Department of Diagnostic Radiology & Nuclear Medicine, University of Maryland Medical Center, Baltimore, MD, USA
| | - Terry L Levin
- Department of Radiology, Montefiore Medical Center, 111 East 210th St, Bronx, NY, 10467, USA.
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DIAGNOSTIC VALUE OF MORPHOLOGICAL CHANGES IN GASTROESOPHAGEAL REFLUX DISEASE IN BIOPSY MATERIAL OF THE DISTAL ESOPHAGUS IN ADOLESCENTS SICKLY WITH ACUTE RESPIRATORY DISEASES. EUREKA: HEALTH SCIENCES 2019. [DOI: 10.21303/2504-5679.2019.00847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The article dedicated to the problem of the diagnostic value of morphological changes in gastroesophageal reflux disease in the biopsy of the distal esophagus in pubertal children of childbearing age.
Aim of the research is to investigate the diagnostic value of morphological changes in gastroesophageal reflux disease in esophageal biopsy material in adolescents sickly with acute respiratory diseases.
Methodology. The objective of the study was achieved through examination of 90 adolescents (10 to 16 years old, average age 13.1±3.54 years) kept under observation at the Children’s Clinical Hospital No. 9 of Kyiv and on the basis of the Department of Pediatrics No. 1 Center of Primary Health Care No. 4 of the Desnianskyi district of Kyiv. All adolescents belonged to the group of sickly with a number of respiratory diseases averaging 6-8 times a year, lasting from 8 to 18 days (on average 12.8±5.41 days). All children have undergone endoscopic examination of the esophagus, stomach and duodenum with the esophagus mucosa biopsy using the OLYMPUS GIF-P3 flexible fiberscope.
Results. It was found that the least valuable diagnostic feature in the morphological examination of the mucous membrane of the distal esophagus in the pain-causing children with GERD was thickening of the epithelium with a sensitivity of 13,0 %, a specificity of 96.0 %, and total value of 65.0 %. It has been proved that hyperplasia of cells of the basal layer of the mucous membrane of the distal esophagus at the GERD in the infected children is 46.7 % (specificity – 93.3 %, the total value is 75.6 %). Increase in the number of papillae and their prolongation in 33.3 % cases (sensitivity – 33.3 %, specificity – 93.3 %, overall diagnostic value – 70.8 %).
Conclusion. The peculiarity of the morphological manifestations of GERD in childbearing children is dystrophic changes in keratocytes in the superficial parts of the multilayer squamous epithelium, which are detected at 100.0 % of patients (specificity is 93.3 %, total value is 96.8 %), with parakeratosis centers at 13.3 % of cases. It has been shown that a frequent and diagnostically valuable indication is inflammatory infiltration of the esophageal mucosa, which are verified in all cases (100.0 %, with dilatation and hyperemia in 46.7 % of patients (specificity – 40.0 %, total value – 81.3 %).
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Aznar‐Lou I, Reilev M, Lødrup AB, Rubio‐Valera M, Haastrup PF, Pottegård A. Use of proton pump inhibitors among Danish children: A 16‐year register‐based nationwide study. Basic Clin Pharmacol Toxicol 2019; 124:704-710. [DOI: 10.1111/bcpt.13191] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 12/03/2018] [Indexed: 01/10/2023]
Affiliation(s)
- Ignacio Aznar‐Lou
- Teaching, Research & Innovation Unit Institut de Recerca Sant Joan de Déu Barcelona Spain
- Epidemiology and Public Health Networking Biomedical Research Centre (CIBERESP) Madrid Spain
- Clinical Pharmacology and Pharmacy, Department of Public Health University of Southern Denmark Odense Denmark
| | - Mette Reilev
- Clinical Pharmacology and Pharmacy, Department of Public Health University of Southern Denmark Odense Denmark
- Research Unit of General Practice, Department of Public Health University of Southern Denmark Odense Denmark
| | - Anders Bergh Lødrup
- Department of Hepatology and Gastroenterology Aarhus University Hospital Aarhus Denmark
- Diagnostic Centre Silkeborg Hospital Silkeborg Denmark
| | - Maria Rubio‐Valera
- Teaching, Research & Innovation Unit Institut de Recerca Sant Joan de Déu Barcelona Spain
- Epidemiology and Public Health Networking Biomedical Research Centre (CIBERESP) Madrid Spain
- School of Pharmacy University of Barcelona Barcelona Spain
| | - Peter Fentz Haastrup
- Research Unit of General Practice, Department of Public Health University of Southern Denmark Odense Denmark
| | - Anton Pottegård
- Clinical Pharmacology and Pharmacy, Department of Public Health University of Southern Denmark Odense Denmark
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Cystic Fibrosis and gastroesophageal reflux disease. J Cyst Fibros 2018; 16 Suppl 2:S2-S13. [PMID: 28986024 DOI: 10.1016/j.jcf.2017.07.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 07/06/2017] [Accepted: 07/06/2017] [Indexed: 12/19/2022]
Abstract
Gastroesophageal reflux is common in children and adults with cystic fibrosis (CF). Pathological gastroesophageal reflux disease (GERD) is also frequent in patients of all ages with CF. This article reviews the pathophysiology, diagnostic work-up, management options, complications, and future directions in the evaluation and management of GERD - unique to and pertinent for - patients with CF in particular.
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Houben E, Johansson S, Nagy P, Penning-van Beest FJA, Kuipers EJ, Herings RMC. Observational cohort study: safety outcomes in children using proton pump inhibitors or histamine-2 receptor antagonists. Curr Med Res Opin 2018; 34:577-583. [PMID: 29149805 DOI: 10.1080/03007995.2017.1407302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Acid suppression with histamine-2 receptor antagonists (H2RAs) or proton pump inhibitors (PPIs) is recommended for children with persistent gastroesophageal reflux disease symptoms. In this retrospective, observational postauthorization study, we aimed to assess and compare safety outcomes in pediatric first-time users of esomeprazole, other PPIs or H2RAs. METHODS Data on children (aged 0-18 years) first dispensed esomeprazole, other PPIs or H2RAs between September 2008 and August 2011 was obtained from the Dutch PHARMO Database Network. Hospitalizations for seven predefined safety outcomes were evaluated (maximum follow-up: 18 months). Rate ratios were calculated using Poisson regression adjusted for baseline imbalances. Discharge letters were reviewed for event occurrence confirmation. RESULTS Of 23,470 included children, 2820 (median age: 3 years) were prescribed esomeprazole, 13,818 (median age: 15 years) other PPIs and 6832 (median age: 5 years) H2RAs. In total, 504 (2%) children were hospitalized for 762 predefined events: gastroenteritis (246); convulsion/seizure (200); pneumonia (154); failure to thrive (119); acute interstitial nephritis (19); thrombocytopenia (23); and angioneurotic edema (1). Significant differences between cohorts were observed only for failure to thrive, with adjusted rate ratios (95% confidence interval) for esomeprazole of 6.1 (2.4-15.7) vs. other PPIs and 6.1 (2.9-12.8) vs. H2RAs among current users. Occurrence was confirmed for 74% of assessable events. Confirmation rates were highest for pneumonia (81%) and lowest for failure to thrive (40%). CONCLUSIONS Hospitalization rates for predefined outcomes were low and mostly similar in pediatric first-time users of PPIs and of H2RAs. TRIAL REGISTRATION NCT01338363.
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Affiliation(s)
- Eline Houben
- a PHARMO Institute for Drug Outcomes Research , Utrecht , Netherlands
| | - Saga Johansson
- b Global Medical Affairs, Medical Evidence and Observational Research Centre, AstraZeneca Gothenburg , Mölndal , Sweden (at the time of the study)
| | - Péter Nagy
- c AstraZeneca Gothenburg , Mölndal , Sweden (at the time of the study)
| | | | - Ernst J Kuipers
- d Department of Gastroenterology and Hepatology , Erasmus MC University Medical Center , Rotterdam , Netherlands
| | - Ron M C Herings
- a PHARMO Institute for Drug Outcomes Research , Utrecht , Netherlands
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Abstract
This relationship between gastroesophageal reflux and airway disorders is complex, possibly bidirectional, and not clearly defined. The tools used to investigate gastroesophageal reflux are mostly informative about involvement of gastroesophageal reflux within the gastrointestinal tract, although they are often utilized to study the relationship between gastroesophageal reflux and airway issues with are suspected to occur in relation to reflux. These modalities often lack specificity for reflux-related airway disorders. Co-incidence of gastroesophageal reflux and airway disorders does not necessarily infer causality. While much of our focus has been on managing acidity, controlling refluxate is an area that has not been traditionally aggressively pursued. Our management approach is based on some of the evidence presented, but also often from a lack of adequate study to provide further guidance.
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Affiliation(s)
- Asim Maqbool
- Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA.
| | - Matthew J Ryan
- Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA
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Ruigómez A, Kool-Houweling LMA, García Rodríguez LA, Penning-van Beest FJA, Herings RMC. Characteristics of children and adolescents first prescribed proton pump inhibitors or histamine-2-receptor antagonists: an observational cohort study. Curr Med Res Opin 2017; 33:2251-2259. [PMID: 28562108 DOI: 10.1080/03007995.2017.1336083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To describe the characteristics of pediatric patients prescribed proton pump inhibitors (PPIs) vs those of pediatric patients prescribed histamine-2-receptor antagonists (H2RAs). METHODS Observational studies were conducted using The Health Improvement Network (THIN) and the PHARMO Database Network. Patients aged 0-18 years who were first prescribed a PPI or H2RA between October 1, 2009 and September 30, 2012 (THIN) or between September 1, 2008 and August 31, 2011 (PHARMO) were included. Patient characteristics were identified and compared between the PPI and H2RA cohorts using odds ratios (ORs) and 95% confidence intervals (CIs) adjusted for age and sex. RESULTS The mean age (years) was higher in the PPI than in the H2RA cohorts (THIN 12.3 [n = 8204] vs 5.4 [n = 7937], PHARMO 11.0 [n = 15 362] vs 7.1 [n = 6168]). Previous respiratory disease was more common in the PPI than in the H2RA cohort in THIN (OR = 1.19, 95% CI = 1.08-1.30), as were asthma and respiratory medication use in PHARMO (OR = 1.27, 95% CI = 1.12-1.45 and OR = 1.23, 95% CI = 1.10-1.38, respectively) and oral corticosteroid use in both databases (OR = 1.45, 95% CI = 1.10-1.92 [THIN]; OR = 2.80, 95% CI = 2.11-3.71 [PHARMO]). Non-steroidal anti-inflammatory drugs, antibiotics, and oral contraceptives were also more common in PPI than in H2RA cohorts in both databases. CONCLUSIONS Pediatric patients receiving PPIs and those receiving H2RAs may represent different patient populations. PPIs may be more commonly prescribed than H2RAs among patients with respiratory diseases.
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Affiliation(s)
- Ana Ruigómez
- a Spanish Centre for Pharmacoepidemiologic Research (CEIFE) , Madrid , Spain
| | | | | | | | - Ron M C Herings
- b PHARMO Institute for Drug Outcomes Research , Utrecht , The Netherlands
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Ruigómez A, Johansson S, Nagy P, García Rodríguez LA. Utilization and safety of proton-pump inhibitors and histamine-2 receptor antagonists in children and adolescents: an observational cohort study. Curr Med Res Opin 2017; 33:2201-2209. [PMID: 28699796 DOI: 10.1080/03007995.2017.1354830] [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] [Indexed: 10/19/2022]
Abstract
BACKGROUND Little is known about the use of acid-suppressing treatments and related safety events in children. OBJECTIVE This study compared patient characteristics and safety outcomes among children prescribed acid-suppressing drugs for the first time. METHODS The Health Improvement Network was used to determine the characteristics of children prescribed a proton pump inhibitor (PPI; esomeprazole or another PPI) or a histamine-2 receptor antagonist (H2RA) by UK primary care physicians between October 2009 and September 2012. Pre-defined safety outcomes were compared among the treatment groups in up to 18 months of follow-up. RESULTS The cohorts comprised 8,172 patients on PPIs (including 24 patients on esomeprazole) and 7,905 on H2RAs. The baseline characteristics were similar between cohorts, although the children in the PPI cohorts tended to be older. No safety outcomes occurred in the esomeprazole cohort. In the other-PPIs cohort, 92 safety outcomes occurred, most commonly gastroenteritis (n = 36; 39.1%). In the H2RAs cohort, 193 safety outcomes occurred, most commonly gastroenteritis (n = 62; 32.1%). The incidence of most safety outcomes was higher in the H2RAs cohort than in the other-PPIs cohort, including failure to thrive (3.11 [95% confidence interval (CI) = 2.25-4.28] vs 0.49 per 1,000 person-years [95% CI = 0.22-1.07]) and gastroenteritis (5.27 [95% CI = 4.11-6.75] vs 3.04 per 1,000 person-years [95% CI = 2.20-4.20]). CONCLUSION Esomeprazole is rarely prescribed to children when they first require acid-suppressing medication, compared with other PPIs/H2RAs. Overall, more safety outcomes occurred in the H2RAs cohort than in the PPI cohorts.
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Affiliation(s)
- A Ruigómez
- a Spanish Centre for Pharmacoepidemiologic Research (CEIFE) , Madrid , Spain
| | | | - P Nagy
- c Former employee of AstraZeneca Gothenburg , Mölndal , Sweden
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Abstract
Gastroesophageal reflux (GER) is a normal physiologic process. It is important to distinguish GER from GER disease (GERD) since GER does not require treatment. Although a diagnosis of GERD can largely be based on history and physical alone, endoscopy and pH impedance studies can help make the diagnosis when there in atypical presentation. In children and adolescents, lifestyle changes and acid suppression are first-line treatments for GERD. In infants, acid suppression is not effective, but a trial of hydrolyzed formula can be considered, as milk protein sensitivity can be difficult to differentiate from GER symptoms.
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Affiliation(s)
- Hayat Mousa
- University of California, San Diego, 3020 Children's Way, MOB 211, MC 5030, San Diego, CA 92123, USA; Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Rady Children's Hospital, 7960 Birmingham Way, Room 2110, MC 5030, San Diego, CA 92123, USA.
| | - Maheen Hassan
- University of California, San Diego, 3020 Children’s Way, MOB 211,
MC 5030, San Diego, CA 92123,
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Why we need a higher suspicion index of urolithiasis in children. J Pediatr Urol 2017; 13:164-171. [PMID: 28185760 DOI: 10.1016/j.jpurol.2016.12.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 12/13/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Most children with symptoms of urolithiasis and urinary solute excretion abnormalities leading to stone formation have no calculi revealed by ultrasound or X-ray plain film ("occult urolithiasis"). This covers a large group of children presenting with common symptoms such as abdominal pain, hematuria, and dysuria, often faced by general practitioners and pediatricians. However, half or more of children with urolithiasis could present with abdominal/flank pain without specific urinary symptoms. STUDY DESIGN We review the current evidence about prevalence, clinical presentation, and radiological detection of overt and "occult" urolithiasis in children, aiming to give readers the instruments to suspect and diagnose urolithiasis while avoiding cost-ineffective and undue diagnostic procedures. CONCLUSIONS It is important to investigate for urolithiasis first by ultrasound and, in specific cases, by urinary metabolic and different imaging studies in the following groups: 1) in children with non-glomerular hematuria or/and dysuria not presenting inflammation of external genitalia; 2) in children with acute/sub-acute or infrequent recurrent abdominal pain and family history of urolithiasis in first or second degree relatives or being at higher risk of developing stones although hematuria and dysuria are lacking; 3) in children under 8 years old, even though pain is central or diffuse to the whole abdomen; and 4) in children presenting risk factors or conditions predisposing to urolithiasis. Finally, it seems reasonable to repeat ultrasound 1-2 years later also in children with "occult" urolithiasis and high risk of developing stones to detect any (re-)appearance of calculi.
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Polonini HC, Silva SL, Loures S, Almy R, Balland A, Brandão MAF, Ferreira AO. Compatibility of proton pump inhibitors in a preservative-free suspending vehicle. Eur J Hosp Pharm 2016; 25:150-156. [PMID: 31157010 DOI: 10.1136/ejhpharm-2016-001034] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 11/03/2016] [Accepted: 11/08/2016] [Indexed: 01/24/2023] Open
Abstract
Objectives To evaluate the microbiological and physicochemical compatibility of commonly used proton pump inhibitors (PPIs) esomeprazole, lansoprazole, omeprazole and pantoprazole compounded at a single concentration using SyrSpend SF Alka and stored at refrigerated temperatures (omeprazole was also stored at room temperature because it has the most widespread use). Methods Compatibility was assessed by measuring the per cent recovery at varying time points throughout a 90-day period. Quantification of the APIs was performed by a validated high performance liquid chromatography (HPLC-UV) method. This same assay was also used to determine the dosage content uniformity of the suspensions. Microbiological stability ('test in use') was assessed during 60 days and total aerobic microbial count (TAMC), total combined yeasts and moulds count (TYMC), detection of Escherichia coli and pH determination were performed. Antimicrobial effectiveness testing was determined following European Pharmacopoeia guidelines. Results Beyond-use dates of maximum 60 days for omeprazole (5 mg/mL), pantoprazole (3 mg/mL) and esomeprazole (3 mg/mL) were established. All suspensions that met the physicochemical criteria for stability also met the content uniformity criteria. The suspensions showed no antimicrobial efficiency against bacteria, yeasts and moulds as SyrSpend SF Alka is an unpreserved vehicle, but the 'test in use' showed that the suspensions can remain microbiologically stable for up to 60 days. Conclusions SyrSpend SF Alka can be used to compound palatable (taste-masking properties) preservative-free oral suspensions with almost all commonly used PPIs.
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Affiliation(s)
| | - Sharlene L Silva
- Ortofarma-Quality Control Laboratories, Matias Barbosa, MG, Brazil
| | - Shirley Loures
- Ortofarma-Quality Control Laboratories, Matias Barbosa, MG, Brazil
| | - Rachel Almy
- Eurofins-Pharma Quality Control, Sainte Croix en Plaine, France
| | - Antoine Balland
- Eurofins-Pharma Quality Control, Sainte Croix en Plaine, France
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Papachrisanthou MM, Davis RL. Clinical Practice Guidelines for the Management of Gastroesophageal Reflux and Gastroesophageal Reflux Disease: 1 Year to 18 Years of Age. J Pediatr Health Care 2016; 30:289-94. [PMID: 26432163 DOI: 10.1016/j.pedhc.2015.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 08/31/2015] [Accepted: 08/31/2015] [Indexed: 12/19/2022]
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Bayram AK, Canpolat M, Karacabey N, Gumus H, Kumandas S, Doğanay S, Arslan D, Per H. Misdiagnosis of gastroesophageal reflux disease as epileptic seizures in children. Brain Dev 2016; 38:274-9. [PMID: 26443628 DOI: 10.1016/j.braindev.2015.09.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 08/15/2015] [Accepted: 09/18/2015] [Indexed: 12/16/2022]
Abstract
BACKGROUND Gastroesophageal reflux disease (GERD) can mimic epileptic seizure, and may be misdiagnosed as epilepsy. On the other hand, GERD can be more commonly seen in children with neurological disorders such as cerebral palsy (CP); this co-incidence may complicate the management of patients by mimicking refractory seizures. OBJECTIVE The purpose of our study was to evaluate the clinical features, definite diagnoses and treatment approaches of the patients with clinically suspected GERD who were referred to the division of pediatric neurology with a suspected diagnosis of epileptic seizure. We also aimed to investigate the occurrence of GERD in children with epilepsy and/or CP. METHODS Fifty-seven children who had a final diagnosis of GERD but were initially suspected of having epileptic seizures were assessed prospectively. RESULTS All patients were assigned to 3 groups according to definite diagnoses as follows: patients with only GERD who were misdiagnosed as having epileptic seizure (group 1: n=16; 28.1%), those with comorbidity of epilepsy and GERD (group 2: n=21; 36.8%), and those with the coexistence of GERD with epilepsy and CP (group 3: n=20; 35.1%). Five patients (8.8%) did not respond to anti-reflux treatment and laparoscopic reflux surgery was performed. The positive effect of GERD therapy on paroxysmal nonepileptic events was observed in 51/57 (89.5%) patients. CONCLUSIONS GERD is one of the important causes of paroxysmal nonepileptic events. In addition, GERD must be kept in mind at the initial diagnosis and also in the long-term management of patients with neurological disorders such as epilepsy and CP.
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Affiliation(s)
- Ayşe Kaçar Bayram
- Department of Pediatrics, Division of Pediatric Neurology, Erciyes University, Faculty of Medicine, Kayseri, Turkey.
| | - Mehmet Canpolat
- Department of Pediatrics, Division of Pediatric Neurology, Erciyes University, Faculty of Medicine, Kayseri, Turkey.
| | - Neslihan Karacabey
- Department of Pediatrics, Division of Pediatric Gastroenterology, Erciyes University, Faculty of Medicine, Kayseri, Turkey.
| | - Hakan Gumus
- Department of Pediatrics, Division of Pediatric Neurology, Erciyes University, Faculty of Medicine, Kayseri, Turkey.
| | - Sefer Kumandas
- Department of Pediatrics, Division of Pediatric Neurology, Erciyes University, Faculty of Medicine, Kayseri, Turkey.
| | - Selim Doğanay
- Department of Radiology, Division of Pediatric Radiology, Erciyes University, Faculty of Medicine, Kayseri, Turkey.
| | - Duran Arslan
- Department of Pediatrics, Division of Pediatric Gastroenterology, Erciyes University, Faculty of Medicine, Kayseri, Turkey.
| | - Hüseyin Per
- Department of Pediatrics, Division of Pediatric Neurology, Erciyes University, Faculty of Medicine, Kayseri, Turkey.
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Prävalenz und natürlicher Verlauf der gastroösophagealen Refluxkrankheit. GASTROENTEROLOGE 2016. [DOI: 10.1007/s11377-016-0045-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Kirby CN, Segal AY, Hinds R, Jones KM, Piterman L. Infant gastro-oesophageal reflux disease (GORD): Australian GP attitudes and practices. J Paediatr Child Health 2016; 52:47-53. [PMID: 26257315 DOI: 10.1111/jpc.12983] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/29/2015] [Indexed: 12/29/2022]
Abstract
AIM The aim of this study was to evaluate the attitudes and practices of Australian general practitioners (GPs) regarding infant gastro-oesophageal reflux disease (GORD) diagnosis and management. METHODS A national cross-sectional survey, involving a random sample of currently practising Australian GPs (n = 2319) was undertaken between July and September 2011. GPs attitudes and management of infant GORD were surveyed via an online and paper-based 41-item questionnaire. RESULTS In total, 400 responses were analysed (17.24% response rate). The majority of GPs employed empirical trials of acid-suppression medication and/or lifestyle modifications to diagnose infant GORD. GPs frequently recommended dietary modification despite the belief that they were only moderately effective at best. In addition, GPs frequently prescribed acid-suppression medication, despite concerns regarding their safety in the infant population. Other GP concerns included the lack of clinical guidelines and education for GPs about infant GORD, as well as the level of evidence available for the safety and efficacy of diagnostic tests and treatments. CONCLUSION Despite the important role Australian GPs play in the diagnosis and management of infant GORD, high-level evidence-based guidelines for GPs are lacking. Consequently, GPs engage in diagnostic and management practices despite their concerns regarding the safety and effectiveness.
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Affiliation(s)
- Catherine N Kirby
- Office of the Pro Vice-Chancellor, Berwick and Peninsula Campuses, Monash University, Melbourne, Victoria, Australia
| | - Ahuva Y Segal
- Office of the Pro Vice-Chancellor, Berwick and Peninsula Campuses, Monash University, Melbourne, Victoria, Australia
| | - Rupert Hinds
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - Kay M Jones
- Office of the Pro Vice-Chancellor, Berwick and Peninsula Campuses, Monash University, Melbourne, Victoria, Australia
| | - Leon Piterman
- Office of the Pro Vice-Chancellor, Berwick and Peninsula Campuses, Monash University, Melbourne, Victoria, Australia
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Klinische Symptome und Differenzialdiagnosen des Hustens. Monatsschr Kinderheilkd 2015. [DOI: 10.1007/s00112-015-3383-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Straughan DM, Azoury SC, Bennett RD, Pimiento JM, Fontaine JP, Toloza EM. Robotic-Assisted Esophageal Surgery. Cancer Control 2015; 22:335-9. [DOI: 10.1177/107327481502200312] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Affiliation(s)
- David M. Straughan
- Departments of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Saïd C. Azoury
- Department of Surgery, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Robert D. Bennett
- Departments of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Jose M. Pimiento
- Departments of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida
- Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, Florida
- Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Jacques P. Fontaine
- Departments of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida
- Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, Florida
- Departments of Thoracic Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
- Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Eric M. Toloza
- Departments of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida
- Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, Florida
- Departments of Thoracic Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
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Hazelton WD, Curtius K, Inadomi JM, Vaughan TL, Meza R, Rubenstein JH, Hur C, Luebeck EG. The Role of Gastroesophageal Reflux and Other Factors during Progression to Esophageal Adenocarcinoma. Cancer Epidemiol Biomarkers Prev 2015; 24:1012-23. [PMID: 25931440 DOI: 10.1158/1055-9965.epi-15-0323-t] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 04/10/2015] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND U.S. esophageal adenocarcinoma (EAC) incidence increased over 5-fold between 1975 and 2009. Symptomatic gastroesophageal reflux disease (sGERD) elevates the risk for EAC. However, a simple calculation suggests that changes in sGERD prevalence can explain at most approximately 16% of this trend. Importantly, a mechanistic understanding of the influence of sGERD and other factors (OF) on EAC is lacking. METHODS A multiscale model was developed to estimate temporal trends for sGERD and OF, and their mechanistic role during carcinogenesis. Model calibration was to Surveillance, Epidemiology, and End Results (SEER) incidence and age-dependent sGERD data using maximum likelihood and Markov chain Monte Carlo (MCMC) methods. RESULTS Among men, 77.8% [95% credibility interval (CI), 64.9%-85.6%] of the incidence trend is attributable to OF, 13.4% (95% CI, 11.4%-17.3%) to sGERD, and 8.8% (95% CI, 4.2%-13.7%) to sGERD-OF interactions. Among women, 32.6% (95% CI, 27.0%-39.9%) of the trend is attributable to OF, 13.6% (95% CI, 12.5%-15.9%) to sGERD, and 47.4% (95% CI, 30.7%-64.6%) to interactions. The predicted trends were compared with historical trends for obesity, smoking, and proton pump inhibitor use. Interestingly, predicted OF cohort trends correlated most highly with median body mass index (BMI) at age 50 (r = 0.988 for men; r = 0.998 for women). CONCLUSIONS sGERD and OF mechanistically increase premalignant cell promotion, which increases EAC risk exponentially with exposure duration. IMPACT Surveillance should target individuals with long-duration sGERD and OF exposures.
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Affiliation(s)
- William D Hazelton
- Program in Computational Biology, Fred Hutchinson Cancer Research Center, Seattle, Washington. Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington.
| | - Kit Curtius
- Department of Applied Mathematics, University of Washington, Seattle, Washington
| | - John M Inadomi
- Division of Gastroenterology, University of Washington, Seattle, Washington
| | - Thomas L Vaughan
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington. Department of Epidemiology, School of Medicine, University of Washington, Seattle, Washington
| | - Rafael Meza
- Department of Epidemiology, School of Public Health, University of Michigan Medical School, Ann Arbor, Michigan
| | - Joel H Rubenstein
- Division of Gastroenterology, University of Michigan Medical School, Ann Arbor, Michigan. Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan
| | - Chin Hur
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts. Gastrointestinal Unit, Massachusetts General Hospital, Boston, Massachusetts. Harvard Medical School, Boston, Massachusetts
| | - E Georg Luebeck
- Program in Computational Biology, Fred Hutchinson Cancer Research Center, Seattle, Washington. Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
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Abstract
OBJECTIVES Hiatal hernia (HH) affects from 10% to 50% of adult population. The correlation between HH, gastroesophageal reflux disease, dyspeptic symptoms, and esophagitis has long been known in adults. The primary objective of our prospective observational study was to estimate the prevalence of HH in children undergoing esophagogastroduodenoscopy (EGD), irrespective of their symptoms. METHODS We prospectively enrolled 111 consecutive children (48 boys and 63 girls; mean age 94.9 ± 52.3 months) referred for EGD. In all of the patients a symptomatic score assessment based on the Rome III criteria was used to measure frequency, severity, and duration of gastrointestinal symptoms. HH presence was endoscopically defined; esophagitis presence was evaluated either endoscopically and histologically. Children were divided in 2 age-range groups: <48 months (group 1) and >48 months (group 2). RESULTS Twenty-three patients of 111 (20.7%) had evidence of a sliding HH at EGD. In children from group 2, we found a statistically significant association of HH with heartburn (P = 0.03, 95% confidence interval 1-9.3, r = 0.1) and regurgitation (P = 0.003, 95% confidence interval 1.7-20.4, r = 0.3). Regarding esophagitis presence, no association was found at any age either with defined esophagitis or with dilated intercellular spaces. CONCLUSIONS Prevalence of HH in our study population was 20.7%. According to our data, HH correlates with the presence of heartburn and regurgitation in children, but not in toddlers. No association was found with esophagitis at any age.
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El-Serag HB, Sweet S, Winchester CC, Dent J. Update on the epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut 2014; 63:871-80. [PMID: 23853213 PMCID: PMC4046948 DOI: 10.1136/gutjnl-2012-304269] [Citation(s) in RCA: 1106] [Impact Index Per Article: 110.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To update the findings of the 2005 systematic review of population-based studies assessing the epidemiology of gastro-oesophageal reflux disease (GERD). DESIGN PubMed and Embase were screened for new references using the original search strings. Studies were required to be population-based, to include ≥ 200 individuals, to have response rates ≥ 50% and recall periods <12 months. GERD was defined as heartburn and/or regurgitation on at least 1 day a week, or according to the Montreal definition, or diagnosed by a clinician. Temporal and geographic trends in disease prevalence were examined using a Poisson regression model. RESULTS 16 studies of GERD epidemiology published since the original review were found to be suitable for inclusion (15 reporting prevalence and one reporting incidence), and were added to the 13 prevalence and two incidence studies found previously. The range of GERD prevalence estimates was 18.1%-27.8% in North America, 8.8%-25.9% in Europe, 2.5%-7.8% in East Asia, 8.7%-33.1% in the Middle East, 11.6% in Australia and 23.0% in South America. Incidence per 1000 person-years was approximately 5 in the overall UK and US populations, and 0.84 in paediatric patients aged 1-17 years in the UK. Evidence suggests an increase in GERD prevalence since 1995 (p<0.0001), particularly in North America and East Asia. CONCLUSIONS GERD is prevalent worldwide, and disease burden may be increasing. Prevalence estimates show considerable geographic variation, but only East Asia shows estimates consistently lower than 10%.
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Affiliation(s)
- Hashem B El-Serag
- Section of Gastroenterology and Hepatology, Houston Veterans Affairs Medical Center (152), Houston, Texas, USA
| | - Stephen Sweet
- Research Evaluation Unit, Oxford PharmaGenesis, Oxford, UK
| | - Christopher C Winchester
- Research Evaluation Unit, Oxford PharmaGenesis, Oxford, UK,Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK
| | - John Dent
- Department of Gastroenterology, Hepatology and General Medicine, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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Kong CY, Kroep S, Curtius K, Hazelton WD, Jeon J, Meza R, Heberle CR, Miller MC, Choi SE, Lansdorp-Vogelaar I, van Ballegooijen M, Feuer EJ, Inadomi JM, Hur C, Luebeck EG. Exploring the recent trend in esophageal adenocarcinoma incidence and mortality using comparative simulation modeling. Cancer Epidemiol Biomarkers Prev 2014; 23:997-1006. [PMID: 24692500 PMCID: PMC4048738 DOI: 10.1158/1055-9965.epi-13-1233] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The incidence of esophageal adenocarcinoma (EAC) has increased five-fold in the United States since 1975. The aim of our study was to estimate future U.S. EAC incidence and mortality and to shed light on the potential drivers in the disease process that are conduits for the dramatic increase in EAC incidence. METHODS A consortium of three research groups calibrated independent mathematical models to clinical and epidemiologic data including EAC incidence from the Surveillance, Epidemiology, and End Results (SEER 9) registry from 1975 to 2010. We then used a comparative modeling approach to project EAC incidence and mortality to year 2030. RESULTS Importantly, all three models identified birth cohort trends affecting cancer progression as a major driver of the observed increases in EAC incidence and mortality. All models predict that incidence and mortality rates will continue to increase until 2030 but with a plateauing trend for recent male cohorts. The predicted ranges of incidence and mortality rates (cases per 100,000 person years) in 2030 are 8.4 to 10.1 and 5.4 to 7.4, respectively, for males, and 1.3 to 1.8 and 0.9 to 1.2 for females. Estimates of cumulative cause-specific EAC deaths between both sexes for years 2011 to 2030 range between 142,300 and 186,298, almost double the number of deaths in the past 20 years. CONCLUSIONS Through comparative modeling, the projected increases in EAC cases and deaths represent a critical public health concern that warrants attention from cancer control planners to prepare potential interventions. IMPACT Quantifying this burden of disease will aid health policy makers to plan appropriate cancer control measures. Cancer Epidemiol Biomarkers Prev; 23(6); 997-1006. ©2014 AACR.
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Affiliation(s)
- Chung Yin Kong
- Authors' Affiliations: Institute for Technology Assessment; Gastrointestinal Unit, Massachusetts General Hospital; Harvard Medical School, Boston, Massachusetts; Department of Applied Mathematics; Division of Gastroenterology, School of Medicine, University of Washington; Program in Biostatistics and Biomathematics; Program in Computational Biology, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Epidemiology, University of Michigan, Ann Arbor, Michigan; Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland; and Department of Public Health, Erasmus MC, Rotterdam, the NetherlandsAuthors' Affiliations: Institute for Technology Assessment; Gastrointestinal Unit, Massachusetts General Hospital; Harvard Medical School, Boston, Massachusetts; Department of Applied Mathematics; Division of Gastroenterology, School of Medicine, University of Washington; Program in Biostatistics and Biomathematics; Program in Computational Biology, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Epidemiology, University of Michigan, Ann Arbor, Michigan; Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland; and Department of Public Health, Erasmus MC, Rotterdam, the Netherlands
| | - Sonja Kroep
- Authors' Affiliations: Institute for Technology Assessment; Gastrointestinal Unit, Massachusetts General Hospital; Harvard Medical School, Boston, Massachusetts; Department of Applied Mathematics; Division of Gastroenterology, School of Medicine, University of Washington; Program in Biostatistics and Biomathematics; Program in Computational Biology, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Epidemiology, University of Michigan, Ann Arbor, Michigan; Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland; and Department of Public Health, Erasmus MC, Rotterdam, the Netherlands
| | - Kit Curtius
- Authors' Affiliations: Institute for Technology Assessment; Gastrointestinal Unit, Massachusetts General Hospital; Harvard Medical School, Boston, Massachusetts; Department of Applied Mathematics; Division of Gastroenterology, School of Medicine, University of Washington; Program in Biostatistics and Biomathematics; Program in Computational Biology, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Epidemiology, University of Michigan, Ann Arbor, Michigan; Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland; and Department of Public Health, Erasmus MC, Rotterdam, the Netherlands
| | - William D Hazelton
- Authors' Affiliations: Institute for Technology Assessment; Gastrointestinal Unit, Massachusetts General Hospital; Harvard Medical School, Boston, Massachusetts; Department of Applied Mathematics; Division of Gastroenterology, School of Medicine, University of Washington; Program in Biostatistics and Biomathematics; Program in Computational Biology, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Epidemiology, University of Michigan, Ann Arbor, Michigan; Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland; and Department of Public Health, Erasmus MC, Rotterdam, the Netherlands
| | - Jihyoun Jeon
- Authors' Affiliations: Institute for Technology Assessment; Gastrointestinal Unit, Massachusetts General Hospital; Harvard Medical School, Boston, Massachusetts; Department of Applied Mathematics; Division of Gastroenterology, School of Medicine, University of Washington; Program in Biostatistics and Biomathematics; Program in Computational Biology, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Epidemiology, University of Michigan, Ann Arbor, Michigan; Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland; and Department of Public Health, Erasmus MC, Rotterdam, the Netherlands
| | - Rafael Meza
- Authors' Affiliations: Institute for Technology Assessment; Gastrointestinal Unit, Massachusetts General Hospital; Harvard Medical School, Boston, Massachusetts; Department of Applied Mathematics; Division of Gastroenterology, School of Medicine, University of Washington; Program in Biostatistics and Biomathematics; Program in Computational Biology, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Epidemiology, University of Michigan, Ann Arbor, Michigan; Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland; and Department of Public Health, Erasmus MC, Rotterdam, the Netherlands
| | - Curtis R Heberle
- Authors' Affiliations: Institute for Technology Assessment; Gastrointestinal Unit, Massachusetts General Hospital; Harvard Medical School, Boston, Massachusetts; Department of Applied Mathematics; Division of Gastroenterology, School of Medicine, University of Washington; Program in Biostatistics and Biomathematics; Program in Computational Biology, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Epidemiology, University of Michigan, Ann Arbor, Michigan; Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland; and Department of Public Health, Erasmus MC, Rotterdam, the NetherlandsAuthors' Affiliations: Institute for Technology Assessment; Gastrointestinal Unit, Massachusetts General Hospital; Harvard Medical School, Boston, Massachusetts; Department of Applied Mathematics; Division of Gastroenterology, School of Medicine, University of Washington; Program in Biostatistics and Biomathematics; Program in Computational Biology, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Epidemiology, University of Michigan, Ann Arbor, Michigan; Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland; and Department of Public Health, Erasmus MC, Rotterdam, the Netherlands
| | - Melecia C Miller
- Authors' Affiliations: Institute for Technology Assessment; Gastrointestinal Unit, Massachusetts General Hospital; Harvard Medical School, Boston, Massachusetts; Department of Applied Mathematics; Division of Gastroenterology, School of Medicine, University of Washington; Program in Biostatistics and Biomathematics; Program in Computational Biology, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Epidemiology, University of Michigan, Ann Arbor, Michigan; Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland; and Department of Public Health, Erasmus MC, Rotterdam, the NetherlandsAuthors' Affiliations: Institute for Technology Assessment; Gastrointestinal Unit, Massachusetts General Hospital; Harvard Medical School, Boston, Massachusetts; Department of Applied Mathematics; Division of Gastroenterology, School of Medicine, University of Washington; Program in Biostatistics and Biomathematics; Program in Computational Biology, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Epidemiology, University of Michigan, Ann Arbor, Michigan; Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland; and Department of Public Health, Erasmus MC, Rotterdam, the Netherlands
| | - Sung Eun Choi
- Authors' Affiliations: Institute for Technology Assessment; Gastrointestinal Unit, Massachusetts General Hospital; Harvard Medical School, Boston, Massachusetts; Department of Applied Mathematics; Division of Gastroenterology, School of Medicine, University of Washington; Program in Biostatistics and Biomathematics; Program in Computational Biology, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Epidemiology, University of Michigan, Ann Arbor, Michigan; Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland; and Department of Public Health, Erasmus MC, Rotterdam, the NetherlandsAuthors' Affiliations: Institute for Technology Assessment; Gastrointestinal Unit, Massachusetts General Hospital; Harvard Medical School, Boston, Massachusetts; Department of Applied Mathematics; Division of Gastroenterology, School of Medicine, University of Washington; Program in Biostatistics and Biomathematics; Program in Computational Biology, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Epidemiology, University of Michigan, Ann Arbor, Michigan; Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland; and Department of Public Health, Erasmus MC, Rotterdam, the Netherlands
| | - Iris Lansdorp-Vogelaar
- Authors' Affiliations: Institute for Technology Assessment; Gastrointestinal Unit, Massachusetts General Hospital; Harvard Medical School, Boston, Massachusetts; Department of Applied Mathematics; Division of Gastroenterology, School of Medicine, University of Washington; Program in Biostatistics and Biomathematics; Program in Computational Biology, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Epidemiology, University of Michigan, Ann Arbor, Michigan; Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland; and Department of Public Health, Erasmus MC, Rotterdam, the Netherlands
| | - Marjolein van Ballegooijen
- Authors' Affiliations: Institute for Technology Assessment; Gastrointestinal Unit, Massachusetts General Hospital; Harvard Medical School, Boston, Massachusetts; Department of Applied Mathematics; Division of Gastroenterology, School of Medicine, University of Washington; Program in Biostatistics and Biomathematics; Program in Computational Biology, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Epidemiology, University of Michigan, Ann Arbor, Michigan; Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland; and Department of Public Health, Erasmus MC, Rotterdam, the Netherlands
| | - Eric J Feuer
- Authors' Affiliations: Institute for Technology Assessment; Gastrointestinal Unit, Massachusetts General Hospital; Harvard Medical School, Boston, Massachusetts; Department of Applied Mathematics; Division of Gastroenterology, School of Medicine, University of Washington; Program in Biostatistics and Biomathematics; Program in Computational Biology, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Epidemiology, University of Michigan, Ann Arbor, Michigan; Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland; and Department of Public Health, Erasmus MC, Rotterdam, the Netherlands
| | - John M Inadomi
- Authors' Affiliations: Institute for Technology Assessment; Gastrointestinal Unit, Massachusetts General Hospital; Harvard Medical School, Boston, Massachusetts; Department of Applied Mathematics; Division of Gastroenterology, School of Medicine, University of Washington; Program in Biostatistics and Biomathematics; Program in Computational Biology, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Epidemiology, University of Michigan, Ann Arbor, Michigan; Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland; and Department of Public Health, Erasmus MC, Rotterdam, the Netherlands
| | - Chin Hur
- Authors' Affiliations: Institute for Technology Assessment; Gastrointestinal Unit, Massachusetts General Hospital; Harvard Medical School, Boston, Massachusetts; Department of Applied Mathematics; Division of Gastroenterology, School of Medicine, University of Washington; Program in Biostatistics and Biomathematics; Program in Computational Biology, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Epidemiology, University of Michigan, Ann Arbor, Michigan; Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland; and Department of Public Health, Erasmus MC, Rotterdam, the NetherlandsAuthors' Affiliations: Institute for Technology Assessment; Gastrointestinal Unit, Massachusetts General Hospital; Harvard Medical School, Boston, Massachusetts; Department of Applied Mathematics; Division of Gastroenterology, School of Medicine, University of Washington; Program in Biostatistics and Biomathematics; Program in Computational Biology, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Epidemiology, University of Michigan, Ann Arbor, Michigan; Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland; and Department of Public Health, Erasmus MC, Rotterdam, the NetherlandsAuthors' Affiliations: Institute for Technology Assessment; Gastrointestinal Unit, Massachusetts General Hospital; Harvard Medical School, Boston, Massachusetts; Department of Applied Mathematics; Division of Gastroenterology, School of Medicine, University of Washington; Program in Biostatistics and Biomathematics; Program in Computational Biology, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Epidemiology, University of Michigan, Ann Arbor, Michigan; Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland; and Depart
| | - E Georg Luebeck
- Authors' Affiliations: Institute for Technology Assessment; Gastrointestinal Unit, Massachusetts General Hospital; Harvard Medical School, Boston, Massachusetts; Department of Applied Mathematics; Division of Gastroenterology, School of Medicine, University of Washington; Program in Biostatistics and Biomathematics; Program in Computational Biology, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Epidemiology, University of Michigan, Ann Arbor, Michigan; Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland; and Department of Public Health, Erasmus MC, Rotterdam, the Netherlands
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Woodley FW, Machado RS, Hayes D, Di Lorenzo C, Kaul A, Skaggs B, McCoy K, Patel A, Mousa H. Children with cystic fibrosis have prolonged chemical clearance of acid reflux compared to symptomatic children without cystic fibrosis. Dig Dis Sci 2014; 59:623-30. [PMID: 24287640 DOI: 10.1007/s10620-013-2950-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 11/11/2013] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Few studies compare gastroesophageal reflux (GER) parameters of cystic fibrosis (CF) children and symptomatic non-CF children. We aimed to compare the impedance-pH (IMP-pH) parameters for these two groups and to test the hypothesis that prolonged acid exposure in CF patients is due to delayed chemical clearance (CC). METHODS IMP-pH tracings from 16 CF children (median 8.2 years) and 16 symptomatic non-CF children (median 8.3 years) were analyzed. Software was used to generate IMP-pH reports and parameter data were extracted. IMP-pH was used to calculate the mean CC for each patient. RESULTS pH studies showed no difference in acid GER (AGER) frequency (p = 0.587); however, mean AGER duration, duration of longest AGER, AGER index, and DeMeester scores were all significantly higher for CF patients. IMP showed no difference in GER frequency [neither acidic (p = 0.918) nor non-acidic (p = 0.277)], but total bolus clearance was more efficient in CF patients (p = 0.049). A larger percentage of total GER reached the proximal esophagus in non-CF children (p = 0.039). Analyses of two-phase AGER episodes showed that these events were more acidic (p = 0.003) and the CC phase was significantly prolonged in the CF cohort (p = 0.001). CONCLUSIONS Compared to symptomatic non-CF children, CF children do not have more frequent reflux. Actually, they have better bolus clearance efficiency following reflux and may even have better control over the number of GER episodes that reach the proximal esophagus. CC of AGER, however, is significantly prolonged in the CF cohort, likely due to hyperacidity of refluxed gastric contents.
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Affiliation(s)
- Frederick W Woodley
- Division of Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, Columbus, OH, USA,
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Sakaguchi K, Yagi T, Maeda A, Nagayama K, Uehara S, Saito-Sakoguchi Y, Kanematsu K, Miyawaki S. Association of problem behavior with sleep problems and gastroesophageal reflux symptoms. Pediatr Int 2014; 56:24-30. [PMID: 23937680 DOI: 10.1111/ped.12201] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 07/29/2013] [Accepted: 08/02/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND There are few large-scale epidemiologic studies examining the associations between sleep problems, gastroesophageal reflux disease (GERD) symptoms, lifestyle and food habits and problem behaviors (PB) in adolescents. The aim of this study was to evaluate the associations among these factors in Japanese adolescents. METHODS A cross-sectional survey of 1840 junior high school students was carried out using questionnaires. The subjects were classified into PB or normal behavior (NB) groups using the Pediatric Symptom Checklist (PSC). The scores of the sleep-related factors, sleep bruxism, lifestyle and food habits, and GERD symptoms were compared. Logistic regression analysis was used to determine the factors related to PB. RESULTS Mean subject age was 13.3 ± 1.8 years. The PB group had significantly longer sleep latency and higher GERD symptom score (P < 0.001). Furthermore, the PB group was significantly more likely to experience absence of the mother at dinner time, skip breakfast, and have <30 min of conversation among family at dinner time. The PB group had significantly higher frequencies of sleep bruxism, difficulty falling asleep within 30 min, nightmares, feeling of low sleep quality, daytime somnolence, and daytime lack of motivation. Feelings of low sleep quality had the strongest association with PB, with an adjusted odds ratio of 12.88 (95% confidence interval: 8.99-18.46). CONCLUSIONS PB in adolescents are associated with sleep problems, including sleep bruxism, as well as lifestyle and food habits and GERD symptoms.
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Affiliation(s)
- Katsuyoshi Sakaguchi
- Department of Orthodontics, Field of Developmental Medicine, Health Research Course, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
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Almadi MA, Almousa MA, Althwainy AF, Altamimi AM, Alamoudi HO, Alshamrani HS, Alharbi OR, Azzam NA, Sadaf N, Aljebreen AM. Prevalence of symptoms of gastroesopahgeal reflux in a cohort of Saudi Arabians: a study of 1265 subjects. Saudi J Gastroenterol 2014; 20:248-54. [PMID: 25038211 PMCID: PMC4131308 DOI: 10.4103/1319-3767.136982] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND/AIMS In this study, we aimed to determine the prevalence of gastroesophageal reflux disease (GERD) in the general population of the capital city of Riyadh and to assess its association with other factors including age, smoking, body mass index (BMI), asthma, as well as the presence of other co-morbid diseases. MATERIALS AND METHODS We used the Gastroesophageal Reflux Disease Questionnaire (GerdQ) for diagnosing GERD, based on a GerdQ score of 8 or more. Riyadh was divided into four quadrants, and from each area, a single shopping mall was chosen randomly to conduct our surveys. Data collected included age, sex, history of smoking, history of asthma or any other medical condition, dietary habits, monthly household income, history and frequency of heartburn, epigastric pain, regurgitation of food, nausea, sleep disturbance from heartburn, the use of common over-the-counter antacids for the control of their symptoms, and their height and weight. RESULTS Over a 4-week period from the 19 December 2012 to 17 January 2013, a total of 1265 individuals were included in the survey. The mean age was 29.97 ± 11.58 years. Females formed 67.81% of the respondents and 62.73% had one or more episodes of heartburn per week. Based on a cutoff GERDQ score of 8, the prevalence of GERD in the surveyed population was 45.4%. GERD was more prevalent in older individuals (mean age 31.9 vs. 30.0 years, P < 0.001) and in those with a higher BMI (27.29 vs. 26.31 kg/m 2 , P = 0.02). There was no difference between males (45.43%) and females (45.13%) (P = 0.92); there was a trend of a higher prevalence in smokers (51.63% vs. 44.41%), but it did not reach statistical significance (P = 0.09). CONCLUSION Symptoms suggestive of GERD as determined by the translated GerdQ are prevalent among this study population.
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Affiliation(s)
- Majid A. Almadi
- Division of Gastroenterology, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia,Division of Gastroenterology, The McGill University Health Center, Montreal General Hospital, McGill University, Montreal, Canada,Address for correspondence: Dr. Majid A. Almadi, Division of Gastroenterology, King Khalid University Hospital, King Saud University, Riyadh, P.O. Box 2925 (59), Riyadh 11461, Saudi Arabia. E-mail:
| | - Maitha A. Almousa
- College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Amani F. Althwainy
- College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Afnan M. Altamimi
- College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Hala O. Alamoudi
- College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Hiba S. Alshamrani
- College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Othman R. Alharbi
- Division of Gastroenterology, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Nahla A. Azzam
- Division of Gastroenterology, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Nazia Sadaf
- Division of Gastroenterology, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Abdulrahman M. Aljebreen
- Division of Gastroenterology, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
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Prell C, Koletzko S. Gastroösophageale Refluxkrankheit im Kindes- und Jugendalter. Monatsschr Kinderheilkd 2013. [DOI: 10.1007/s00112-013-3049-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Combined multichannel intraluminal impedance and pH monitoring assists the diagnosis of sliding hiatal hernia in children with gastroesophageal reflux disease. J Gastroenterol 2013; 48:1242-8. [PMID: 23397115 DOI: 10.1007/s00535-013-0750-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Accepted: 01/04/2013] [Indexed: 02/04/2023]
Abstract
BACKGROUND The role of combined multichannel intraluminal impedance and pH monitoring (MII-pH) in diagnosing sliding hiatal hernia in gastroesophageal reflux disease (GERD) children remains unclear. We aimed to explore the clinical efficacy of MII-pH as a supplement diagnostic method for sliding hiatal hernia. METHODS A total of 104 symptomatic GERD children [mean ± standard deviation (SD) age = 4.5 ± 5.5 years] were recruited. All of them were diagnosed as GERD with and without sliding hiatal hernia by barium and/or esophagogastroduodenoscopy study. All subjects received 24 h MII-pH monitoring to test the efficacy of this new modality. RESULTS Sixteen children were diagnosed to have sliding hiatal hernia, and nine (56.3%) of them received fundoplication. None of non-hiatal hernia children were indicated for fundoplication [risk difference (RD) 0.56; P < 0.001]. Impedance probes detected more reflux episodes than pH-probe in the whole study population (mean ± SD = 62.1 ± 47.8 vs. 47.8 ± 48.1 episodes; P = 0.02, paired t test). Due to the presence of pH-only reflux, the reflux episodes detected by impedance probes is less than that by pH probe in sliding hiatal hernia children (mean ± SD = 49.2 ± 78.9 vs. 103.7 ± 60.4 episodes; P = 0.01, paired t test). Ratio of reflux episodes detected by pH-probe to that by impedance probes >1 was more frequently noted in sliding hiatal hernia children than non-sliding hiatal hernia children (Odds ratio 58.33, P < 0.001). The sensitivity and specificity of this diagnostic tool to predict sliding hiatal hernia in GERD children are 93.8 and 79.6%, respectively. CONCLUSIONS Ratio of reflux episodes detected by pH-probe to that by impedance probes >1 demonstrated by MII-pH study is a good screening test of sliding hiatal hernia in GERD children.
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Solomons N, Nortje N. Treating an intervention level 1 patient: futile or brave? SOUTH AFRICAN JOURNAL OF CLINICAL NUTRITION 2013. [DOI: 10.1080/16070658.2013.11734469] [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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Park KY, Chang SH. Gastro-esophageal reflux disease in healthy older children and adolescents. Pediatr Gastroenterol Hepatol Nutr 2012; 15:220-8. [PMID: 24010091 PMCID: PMC3746054 DOI: 10.5223/pghn.2012.15.4.220] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2012] [Revised: 12/16/2012] [Accepted: 12/18/2012] [Indexed: 12/30/2022] Open
Abstract
Gastro-esophageal reflux disease (GERD) in otherwise healthy older children and adolescents is commonly encountered in pediatric clinics and poses a complex treatment problem involving changes of diets and lifestyle. After an initial history taking and a physical examination, typical symptoms of GERD in older children and adolescenct are initially treated with the trials of acid suppressants. With an increase of severe cases, more and more GERD children have been evaluated with endoscopy, which helps to delineate an erosive esophagitis from a non-erosive reflux disease as they are presumed to have different pathogenesis. For the pediatric patients without a significant underlying disease, a reflux esophagitis can be treated adequately with acid suppressants. Recently, the rapid increase of children who are taking anti-reflux medication has brought up a serious alarm among pediatricians. Some at risk pediatric patients with recurrent and/or chronic GERD have been linked to adulthood GERD. In this paper, pediatric GERD with and without erosive esophagitis was reviewed along with treatment options and issues specifically for the otherwise healthy older children and adolescents in the primary clinics or the secondary hospitals.
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Affiliation(s)
- Kie Young Park
- Department of Pediatrics, Gangneung Asan Hospital, College of Medicine, Ulsan University, Gangneung, Korea
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Martigne L, Delaage PH, Thomas-Delecourt F, Bonnelye G, Barthélémy P, Gottrand F. Prevalence and management of gastroesophageal reflux disease in children and adolescents: a nationwide cross-sectional observational study. Eur J Pediatr 2012; 171:1767-73. [PMID: 22903328 DOI: 10.1007/s00431-012-1807-4] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Revised: 07/18/2012] [Accepted: 07/20/2012] [Indexed: 01/10/2023]
Abstract
UNLABELLED This cross-sectional observational study aimed to determine the nationwide prevalence of gastroesophageal reflux disease (GORD) in French children and adolescents. Four hundred four general practitioners and 180 paediatricians compiled a register of all children and adolescents (n = 10,394, aged 0 to 17 years, mean 3.8 ± 5.6 years) who presented over two 3-day periods. For all children who, in the physician's opinion, showed symptoms of gastroesophageal reflux (GOR), a 24-item questionnaire covering the history and management of GOR was completed. Children with symptoms that impaired their daily lives were defined as having GORD, the remainder as having physiological GOR. Of the patients, 15.1 % showed GOR symptoms. Extrapolation to the overall French population yielded a prevalence of 10.3 % for GOR and 6.2 % for GORD. There was a significantly (p < 0.05) greater use of volume reduction or milk thickeners and dorsal positioning among infants with GORD versus physiological GOR. Significantly (p < 0.05) more of the infants and children with GORD received pharmacological therapy. The use of proton pump inhibitors increased with age but was significantly (p < 0.05) higher among those with GORD. CONCLUSIONS Ten percent of French children and adolescents show GOR symptoms and 6 % have GORD. Clinical presentation and treatment vary in different age groups, but those with GORD are more likely to require pharmacological treatment.
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Affiliation(s)
- Léonie Martigne
- Unité Inserm U995, Service de Gastroentérologie, Hépatologie et Nutrition Pédiatrique, Pôle Enfant, Hôpital Jeanne de Flandre, CHRU de Lille, Avenue Eugène Avinée, 59037 Lille Cedex, France
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Goldani HA, Nunes DL, Ferreira CT. Managing gastroesophageal reflux disease in children: The role of endoscopy. World J Gastrointest Endosc 2012; 4:339-46. [PMID: 22912907 PMCID: PMC3423514 DOI: 10.4253/wjge.v4.i8.339] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Revised: 06/28/2012] [Accepted: 08/08/2012] [Indexed: 02/05/2023] Open
Abstract
Gastroesophageal reflux disease (GERD) is a growing problem in the pediatric population and recent advances in diagnostics and therapeutics have improved their management, particularly the use of esophago-gastroduodenoscopy (EGD). Most of the current knowledge is derived from studies in adults; however there are distinct features between infant onset and adult onset GERD. Children are not just little adults and attention must be given to the stages of growth and development and how these stages impact the disease management. Although there is a lack of a gold standard test to diagnose GERD in children, EGD with biopsy is essential to assess the type and severity of tissue damage. To date, the role of endoscopy in adults and children has been to assess the extent of esophagitis and detect metaplastic changes complicating GERD; however the current knowledge points another role for the EGD with biopsy that is to rule out other potential causes of esophagitis in patients with GERD symptoms such as eosinophilic esophagitis. This review highlights special considerations about the role of EGD in the management of children with GERD.
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Affiliation(s)
- Helena As Goldani
- Helena AS Goldani, Daltro LA Nunes, Cristina T Ferreira, Department of Pediatrics and Gastroenterology Unit, Hospital de Clinicas de Porto Alegre, Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, 90035-903 Porto Alegre-RS, Brazil
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Macharia EW. Comparison of upper gastrointestinal contrast studies and pH/impedance tests for the diagnosis of childhood gastro-oesophageal reflux. Pediatr Radiol 2012; 42:946-51. [PMID: 22864731 DOI: 10.1007/s00247-012-2405-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2011] [Revised: 01/09/2012] [Accepted: 02/12/2012] [Indexed: 02/06/2023]
Abstract
BACKGROUND The upper gastrointestinal (UGI) contrast study is used in the assessment of children with gastro-oesophageal reflux (GOR) and for detection of structural anomalies. The pH study is more sensitive than the UGI study for the diagnosis of GOR. The pH study has been replaced by the pH/impedance test, which detects both acid and nonacid reflux. OBJECTIVE To compare the UGI contrast study with the pH/impedance test for the diagnosis of GOR in children. MATERIALS AND METHODS We retrospectively reviewed consecutive records of children investigated for GOR from October 2008 to February 2010, and compared the findings of UGI studies with those of pH/impedance tests. RESULTS The UGI studies revealed GOR in 116 of 579 children (20%). Of the children undergoing a UGI study, 66 also underwent a pH/impedance test. Using the pH/impedance tests as the reference for GOR, UGI had a sensitivity of 42.8% and a negative predictive value of 24%. There was no significant correlation (P > 0.05) between the reflux index and the number of reflux episodes in the pH/impedance tests and height of reflux in the UGI study. There were low incidences of malrotation (0.9%), hiatus hernia (1%) and delayed gastric emptying (0.4%). CONCLUSION The UGI study had low sensitivity for the diagnosis of GOR and low yield for the diagnosis of structural anomalies.
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Affiliation(s)
- Eva W Macharia
- Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK.
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Ruigómez A, Johansson S, Wernersson B, Fernández Cantero O, García Rodríguez LA. Gastroesophageal reflux disease in primary care: using changes in proton pump inhibitor therapy as an indicator of partial response. Scand J Gastroenterol 2012; 47:751-61. [PMID: 22519917 DOI: 10.3109/00365521.2012.679682] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Up to one-third of patients with gastroesophageal reflux disease (GERD) in primary care have residual symptoms despite proton pump inhibitor (PPI) therapy. We aimed to characterize partial response to PPIs among adult patients in UK primary care. MATERIAL AND METHODS Newly diagnosed GERD patients aged 20-79 years who were prescribed PPI for treatment of GERD were identified in The Health Improvement Network. Those with a treatment change suggesting partial response to PPIs (new treatment added to PPI, increased PPI dose, or switching PPI) during the subsequent 6 months were identified as potential cases and confirmed after manual review of each patient's complete computer medical record including free-text comments. Patients without these treatment changes were study controls. A nested case-control analysis was conducted using logistic regression. RESULTS The proportion of newly diagnosed GERD patients with partial response to PPI therapy was 18.6% (1201/6453). Partial response was associated with female gender (odds ratio [OR]: 1.20; 95% confidence interval [CI]: 1.05-1.37), anxiety or depression (OR: 1.15; 95% CI: 1.00-1.31), and prescription of ≥ 6 drugs in the month before GERD diagnosis (OR: 1.42; 95% CI: 1.14-1.78). Among new PPI users (n = 2907), partial response was associated with esophageal ulcer or Barrett's esophagus at initial diagnosis (OR: 3.14; 95% CI: 1.60-6.17). CONCLUSIONS Approximately one in five newly diagnosed patients with GERD appear to have a partial response to PPI therapy. Female gender, polymedication, and a severe initial diagnosis may be associated with partial response.
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Affiliation(s)
- Ana Ruigómez
- Spanish Centre for Pharmacoepidemiologic Research-CEIFE, Madrid, Spain.
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