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Sample records for duodenogastric reflux

  1. Morphine-augmented cholescintigraphy enhances duodenogastric reflux

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    Shih, Wei-Jen; Magoun, S.; Wierzbinski, B.; Ryo, U-Yun [Kentucky Univ., Lexington, KY (United States). Medical Center; Lee, Jong-Kang

    1995-11-01

    Morphine intervention in cholescintigraphy decreases imaging time to diagnose acute cholecystitis. Not infrequently we observe duodenogastric reflux during scintigraphy with and without morphine intervention. To evaluate occurrence of duodenogastric reflux related to morphine, we reviewed 55 patients who underwent cholescintigraphy with (32) and without (23) morphine intervention. Morphine was injected when there was bowel activity with non-visualization of the gallbladder at 60 min. Duodenogastric reflux was identified by the appearance of activity in the area just below or immediately adjacent to the tip of the left hepatic lobe laterally. Among 32 patients with morphine intervention, 19 had acute cholecystitis and 13 chronic cholecystitis. Eleven of 19 (58%) with acute cholecystitis had duodenogastric reflux and 6 of 13 (46%) had duodenogastric reflux in chronic cholecystitis. The total of duodenogastric reflux in the group with morphine injection was 53%. Two patients` duodenogastric reflux occurred before morphine injection and was more apparent after morphine was given. In the without morphine group, 3 had acute cholecystitis and 20 had chronic cholecystitis; 2 (one acute and one chronic cholecystitis) of these 23 (9%) had duodenogastric reflux. Our results indicate: occurrence of duodenogastric reflux in morphine augmented cholescintigraphy is not significantly different in cholecystitis from that in chronic cholecystitis; duodenogastric reflux in morphine augmentation occurs significantly more often than without morphine intervention (p<0.001). We conclude that cholescintigraphy with morphine enhances duodenogastric reflux. The degree of duodenogastric reflux in the acute cholecystitis patients has been more severe than in the chronic cholecystitis patients. (author).

  2. Comparative evaluation of scintigraphy and upper gastrointestinal tract endoscopy for detection of duodenogastric reflux

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    Mittal, B.R.; Ibrarullah, Mohammad; Agarwal, D.K.; Maini, Atul; Ali, Wasif; Sikora, S.S.; Das, B.K. (Sanjay Gandhi Postgraduate Inst. of Medical Sciences (India))

    1994-08-01

    Duodenogastric reflux, the reflux of duodenal bile into stomach, when suspected clinically requires an objective evaluation for proper management. In this study hepatobiliary scintigraphy in 91 patients of different clinical conditions was evaluated for presence of duodenogastric reflux. Upper gastrointestinal endoscopy was also performed in 44 of these patients. On scintigraphy duodenogastric reflux was present in 26 (29%) of 91 patients. Upper gastrointestinal endoscopy revealed presence of refluxed bile in the stomach in 12 (27%) of 44 patients. In the same groups of patients scintigraphy detected reflux in 18 (41%) of 44 patients. This shows that hepatobiliary scintigraphy is superior to upper gastrointestinal endoscopy in detection of duodenogastric reflux and also has the advantage of being non-invasive and physiological. (author).

  3. The role of duodenogastric reflux in formation of precarcinogenic gastric lesions: An experimental study

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    Zlatić Aleksandar

    2013-01-01

    Full Text Available Introduction. Duodenogastric reflux, commonly encountered as an aftermath of gastroenteroanastomosis, with or without gastric resection (Billroth I, Billroth II, vagotomy and pyloroplastic surgery, is known to cause inflammatory-dystrophic-metaplastic lesions of gastric mucosa. Our objective was to determine the effects of surgery-induced duodenogastric reflux on the development of precarcinogenic lesions or carcinoma in correlation with the reflux duration. Material and Methods. The experiment was performed on three groups of Wistar rats with 1 Billroth II-induced reflux surgery, 2 resection of the Roux-en-Y type reconstruction, and 3 control group with no resection. The aim of the experiment was to study the effects of duodenogastric reflux on the rat gastric mucosa in correlation with two different types of gastroenteroanastomosis 8, 16 and 24 weeks after the surgery. Results. In Billroth II group, hyperplastic changes were observed as early as in week 16. Statistically significant results were recorded in week 24, with 6.7% of metaplastic alterations, including dysplasia of all three degrees, dominantly severe dysplasia in 66.67%, early carcinoma in 20% and gastric carcinoma in 6.67%. In the Roux-en-Y group, gastric mucosa remained predominantly normal (60%, with somewhat increased frequency of gastritis and dysplasia in week 24. In the control group, the finding of normal gastric mucosa was constant. Conclusion. The experiment confirms that direct contact of duodenal juice with gastric mucosa associated with Billroth II resection causes precarcinogenic lesions. Development of adenocarcinoma caused solely by duodenogastric reflux, excluding a carcinogenic agent is possible 20 weeks after the experiment - earlier than suggested by previous researchers.

  4. Assessment of duodenogastric reflux by combined continuous intragastric pH and bilirubin monitoring

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    Fei Dai; Jun Gong; Ru Zhang; Jin-Yan Luo; You-Ling Zhu; Xue-Qin Wang

    2002-01-01

    AIM: To assess the diagnostic value of a combination of continuous intragastric pH and bilirubin monitoring in the detection of duodenogastric reflux (DGR), and the effects of diet on the bilirubin absorbance.METHODS: 30 healthy volunteers were divided into twogroups: standard diet group (Group 1) 18 cases, free diet group (Group 2) 12 cases. Each subjects were subjected to simultaneous 24 hour intragastric pH and spectrophotometric bilirubin concentration monitoring (Bilitec 2000).RESULTS: There was no difference of preprandial phasebilirubin absorbance between two groups. The absorbanceof postprandial phase was significantly increased in group 2than group 1. There was no difference between preprandialphase and postprandial phase absorbance in group 1.Postprandial phase absorbance was significantly higher ingroup 2. In a comparison of bile reflux with intragastric pHduring night time, there were 4 types of reflux:Simultaneous increase in absorbance and pH in only 19.6%, increase in bilirubin with unchanged pH 33. 3 %, pHincrease with unchanged absorbance 36. 3 %, and bothunchanged in 10. 8 %. Linear regression analysis showed nocorrelation between percertage total time of pH < 4 aridpercentage total time of absortance > 0. 14, r=0.068, P<0.05.CONCLUSION: Because of the dietary effect, highabsorbance fluids or foods should be avoided in detection.Intrsgastric pH and bilirubin monitoring separately predictthe presence of duodenal (and/or pancreatic) reflux and bilereflux. They can not substitute for each other. The detectionof DGR is improved if the two parameters are combinedsimultanoously.

  5. Duodenogastral reflux and its influence on manifestation of morphological changes of gastric mucosa

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    Stepanov Yu.M.

    2015-09-01

    Full Text Available Among the diseases of the gastroduodenal zone chronic gastritis (CG occupies one of the leading positions. One of the main forms of CG is reflux gastritis (RG based on long-term location of duodenal content in the gastric antrum, so-called duodenal reflux (DR. It is well known that stable inflammatory response of the gastric mucosa (GM appears under the influence of bile acid and gastric juice, leading to chronic antral gastritis followed by gradual development of atrophy, metaplasia and dysplasia appearance. Therefore the aim of our work was to investigate the influence of the DR on the course of chronic hepatitis and morphological changes in the gastric mucosa. We observed 70 patients with chronic RG, aged from 22 to 59 years, average age – 43,5±1,2 years. The control group consisted of 25 healthy individuals of both sexes aged from 19 to 39 years. As a result it was found out that pain and dyspeptic syndromes caused problems most of all. While studying the content of bile acids in gastric juice of all patients examined it was higher (1,42±0,05 g/L in comparison with the control group (0,65±0,04 g/L. Content of bile acids in groups of RG patients with atrophy and without it was analyzed. The role of DR as an independent factor of recomposing changes in GM in chronic RG was proved.

  6. Influence of duodenogastric reflux in the gastric mucosa histological changes of rats infected with Helicobacter pylori.

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    Araujo, José Carlos Ribeiro DE; Carvalho, Jorge José DE; Serra, Humberto Oliveira

    2016-01-01

    to evaluate the influence of Duodenal reflux in histological changes of the gastric mucosa of rats infected with Helicobacter pylori submitted to pyloroplasty. after two weeks of acclimation, we infected 30 male Wistar rats with Helicobacter pylori. We randomly divided them into three groups: one submitted to pyloroplasty, another to partial gastrectomy and the third, only infected, was not operated. After six months of surgery, euthanasia was carried out. Gastric fragments were studied by light microscopy to count the number of H. pylori, and to observe the histological changes (gastritis, metaplasia, dysplasia and neoplasia). We confirmed these changes by immunohistochemistry using the molecular markers PCNA and TGF-beta. the animals submitted to pyloroplasty had higher percentage of colonization by H. pylori (median=58.5; gastrectomy=16.5; control=14.5). There was a positive correlation between the amount of H. pylori and the occurrence of chronic gastritis present in the antral fragments. Neoplasia occurred in 40% of rats from the group submitted to pyloroplasty. The staining with PCNA and TGF-ß confirmed the histopathological changes visualized by optical microscopy. the antral region was the one with the highest concentration of H. pylori, regardless of the group. There was a positive correlation between the appearance of benign disorders (chronic gastritis, metaplasia, dysplasia) and cancer in mice infected with H. pylori submitted to pyloroplasty. avaliar a influência do refluxo duodenogástrico nas alterações histológicas da mucosa gástrica de ratos, infectados por Helicobacter pylori, submetidos à piloroplastia. após duas semanas de aclimatação, 30 ratos machos da raça Wistar, foram infectados com o microorganismo patogênico H. pylori. De forma aleatória, foram divididos em três grupos: um submetido à piloroplastia, outro à gastrectomia parcial e o terceiro, apenas infectados, não foi operado. Após seis meses de operados, procedeu-se a

  7. The influence of duodeno-gastric reflux on frequency of Helicobacter pylori infection at patients with ulcer gastric; Wplyw refluksu dwunastniczo-zoladkowego na czestosc wystepowania zakazenia Helicobacter pylori u chorych z wrzodem zoladka

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    Kopanski, Z.; Niziol, J.; Micherdzinski, J.; Wasilewska-Radwanska, M.; Cienciala, A.; Lasa, J. [Kliniczny Oddzial Chirurgii Ogolnej, Pracownia Medycyny Nuklearnej, Szpital Wojskowy, Cracow (Poland)]|[Wydzial Fizyki i Techniki Jadrowej AGH, Cracow (Poland)]|[Pracownia Chromatografii Gazowej, Instytut Fizyki Jadrowej, Cracow (Poland)

    1996-12-31

    To estimate the correlation between frequency of Helicobacter pylori (H. pylori) infection and intensity of duodeno-gastric reflux it was analysed 61 species with ulcer gastric. Bacterial infection was diagnosed by the breath test with {sup 14}C-labelled urea, whereas presence and intensity of the reflux was found with dynamic scintigraphy with {sup 99}Tm MBrIDA support. The H. pylori infection was present at 42 (68.9%) patients. The presence of throwing back the duodenal liquid was found at 32 (52.5%) diagnosed patients. At 19 (31.2%) of them the reflux has intensity of 1%, at 11 (18%)-2{sup o} and 2 (3.3%)-3{sup o}.The investigations which were carried out, showed that at patients with ulcer gastric disease, duodeno-gastric reflux is an agent which slows down H. pylori infection, however it is easily seen not earlier than at 2{sup o} of its intensity. (author) 33 refs, 1 tab

  8. The Dynamic Changes of Gastroesophageal pH in Children with Duodenogastric Reflux and Alkaline Gastroesophageal Reflux%小儿十二指肠胃返流与碱性胃食管返流的pH动态变化特点

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    王维林; 吉士俊; 王慧贞

    1997-01-01

    Objective:To study the physiopathologic significance of duodenogastric reflux and alkaline gastroesophageal reflux in children.Methods:Twenty-four hour double gastroesophageal pH monitoring was performed on 68 patients with pathologic reflux and 39 normal children.The gastroesophageal pH was monitored in feeding state,gastric emptying and upright or supine posture.Results:Duodenogastric reflux was observed on 19 cases(48.7%)of the control group.It was a transitory gastric pH alkalization after feeding and mainly in upright posture.Alkaline gastroesophageal reflux and duodenogastric reflux were observed on 22 cases(32.4%)of pathologic reflux group and it was a marked gastroesophageal pH alkalization of longer duration,mainly in gastric emptying state and supine posture.Conclusions:Transitory duodenogastric reflux after feeding might be a physiologic phenomenon.Alkaline gastroesophageal reflux occurred on the basis of duodenogastric reflux may be an important type of reflux in children with reflux diseases.To monitor the gastroesophageal pH in gastric emptying state and supine posture may be of great value to detect the pathologic reflux.%目的:动态监测小儿十二指肠胃返流与碱性胃食管返流的pH变化特点,研究返流发生的病理生理意义.方法:对68例病理性胃食管返流小儿及39例正常小儿进行胃食管双pH24小时动态监测,观察小儿在进餐及胃排空后以及不同体位下胃食管pH值的变化特点.结果:对照组中19例(48.7%)监测到十二指肠胃返流,以立位及进餐后发生为主,持续时间短暂.病理性胃食管返流者中22例(32.4%)监测到十二指肠胃返流及碱性胃食管返流,以空腹及卧位时发生为主,持续时间及pH值碱化强度显著高于对照组.结论:进餐后短暂的十二指肠胃返流可能为生理现象;在十二指肠胃返流基础上发生的碱性胃食管返流是小儿胃食管返流的主要类型之一;空腹及卧位时的胃食管双pH监测在

  9. Does troncular vagotomy modify the proliferative gastric lesions induced in rats by duodenogastric reflux? A vagotomia troncular modifica as lesões proliferativas gástricas induzidas em ratos pelo refluxo duodenogástrico?

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    Paulo Antônio Rodrigues

    2007-06-01

    Full Text Available PURPOSE: to investigate if combining VT to DGR through the pylorus can modulate the biological behavior of PL induced by DGR and to verify if TV alone can induce morphologic lesions in the gastric mucosa. METHODS: 62 male Wistar rats were assigned to four groups: 1 - Control (CT gastrotomy; 2 - Troncular Vagotomy (TV plus gastrotomy; 3 - Duodenogastric reflux through the pylorus (R and 4 - Troncular vagotomy plus DGR (RTV. The animals were killed at the 54 week of the experiment. DGR was obtained by anastomosing a proximal jejunal loop to the anterior gastric wall. TV was performed through isolation and division of the vagal trunks. Gastrotomy consisted of 1 cm incision at the anterior gastric wall. PL were analyzed gross and histologically in the antral mucosa, at the gastrojejunal stoma and at the squamous portion of the gastric mucosa. RESULTS: Groups R and RTV developed exophytic lesions in the antral mucosa (R=90.9%; RTV=100% and at the gastrojejunal stoma (R=54.54%; RTV=63.63%. Histologically they consisted of proliferative benign lesions, without cellular atypias, diagnosed as adenomatous hyperplasia. Both groups exposed to DGR presented squamous hyperplasia at the squamous portion of the gastric mucosa (R= 54.5%; RTV= 45.4%. TV, alone, did not induce gross or histological alterations in the gastric mucosa. TV did note change the morphologic pattern of the proliferative lesions induced by DGR. CONCLUSIONS: DGR induces the development of PL in the pyloric mucosa and at the gastrojejunal stoma. TV does not change the morphologic pattern of the proliferative lesions induced by DGR. TV alone is not able to induce morphologic lesions in the gastric mucosa.OBJETIVO: investigar se a adição da VT ao RDG através do piloro, interfere no comportamento biológico das LP induzidas pelo RDG e observar se a VT isoladamente leva ao desenvolvimento de lesões morfológicas na mucosa gástrica. MÉTODOS: Foram utilizados 62 ratos Wistar machos, distribu

  10. Helicobacter pylori may induce bile reflux: link between H pylori and bile induced injury to gastric epithelium.

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    Ladas, S D; Katsogridakis, J; Malamou, H; Giannopoulou, H; Kesse-Elia, M; Raptis, S A

    1996-01-01

    Helicobacter pylori and duodenogastric reflux are both recognised as playing aetiological roles in chronic gastritis. This study investigated whether H pylori colonisation of the antral mucosa and duodenogastric reflux are independent phenomena or have a causal relationship. Thirty eight patients (15 men, 23 women) aged (mean (SD)) 48 (17) years participated. Each patient underwent gastroscopy. Antral biopsy specimens were taken to investigate H pylori colonisation. In addition BrIDA-99mTc/111In-DTPA scintigraphy was used to quantify duodenogastric reflux. H pylori positive patients who were found to have duodenogastric reflux were treated with amoxycillin (1 g/d) and metronidazole (1.5 g/d) for seven days and four tablets of bismuth subcitrate daily for four weeks. Follow up antral biopsies and scintigraphy were repeated at six months. Duodenogastric reflux could not be found in 18 patients, including eight (44%) who were H pylori positive. Ten of the 11 patients who had duodenogastric reflux (reflux % 11.6 (9.2)), however, were H pylori positive (chi 2 = 6.26, p = 0.01). These 10 patients were given eradication treatment. At six months, in six patients who became H pylori negative, duodenogastric reflux was significantly reduced from a pretreatment value of 14.3% to 3.3% (two tail, paired t = 2.57, p = 0.016). These data suggest that H pylori may induced duodenogastric reflux which may be important in the pathogenesis of H pylori gastritis or carcinogenesis, or both. PMID:8566844

  11. Significance of gastrointestinal transit time and anorectal motility spectrum detection in patients with primary pathological duodenogastric reflux%十二指肠胃反流患者检测胃肠传输时间和肛门直肠动力学特征的意义

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    马晓莹; 吴振军; 邓现培; 宋卫青; 许琳

    2013-01-01

    Objective To study the pathological factors by analyzing the relationship among the bile reflux degrees, gastrointestinal transit time and anorectal motility spectrum in primary pathological DGR patients. Methods Gastrointestinal transit time and anorectal manometry were detected in 58 cases of primary pathological DGR patients and 21 healthy persons ( control group) . Results ①GITT in patients of primary pathological DGR was longer than that in the control group [ (40. 62 ± 10. 11) h vs (26. 57 ± 8. 54) h, P <0. 05 ]. Average barium bar left rate was higher than that in the control group [ (38. 51 ±0. 74) % vs ( 15. 28 ± 0. 67 ) % , P < 0. 05 ] . GITT in the patients of the high-reflux group was longer than the low-reflux group [ (48. 62 ±10.41)h vs (35. 35 ±10. 05)h ,P <0.05] , and average barium bar left rate was higher than that in the low-reflux group [ ( 50. 74 ± 0. 74 ) % vs ( 29. 56 ± 0. 68 ) % , P < 0. 05 ]. ② There were no difference of anorectal motility and rectal visceral perception to balloon distention between patients with primary pathological DGR and the control group;③The symptom scores of constipation in DGR patients had significantly difference compared with the control group, the scores of defecate frequence and time in the high-reflux patients were better than those in the low-reflux group, other symptom scores had no differences in high-reflux group. Conclusion The patients with primary pathological DGR have abnormal lower gastroenteral motility dysfunction, which may be same pathophysiological mechanism.%目的 通过分析原发性病理性十二指肠胃反流(DGR)患者胆汁反流程度与胃肠传输时间以及肛门直肠动力学特征之间的关系,探讨原发性病理性DGR致病因素.方法 对58例原发性病理性DGR患者和21例健康者(对照组)进行胃肠传输时间和肛门直肠测压检测,并计算DGR患者排便症状评分.结果 ① DGR组胃肠传输时间(gastrointestinal transit time

  12. Gastric Reflux on Routine Tc-99m DISIDA hepatobiliary Scintigraphy

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    Lee, Kang Wook; Lee, Heon Young [Chungnam National University College of Medicine, Daejeon (Korea, Republic of)

    1995-06-15

    Reflux of bile and digestive enzymes from the small bowel and duodenum into stomach has been observed in patients with various gastroduodenal diseases. Tc-99m iminodiacetic acid derivatives hepatobiliary scan has been used as a noninvasive method to detect duodenogastric reflux. Sometimes, gastric reflux can be observed incidentally on routine Tc-99m DISA hepatobiliary scintigraphy. To evaluate the clinical meaning of gastric reflux on routine Tc-99m DISIDA hepatobiliary scan, we analyzed 36 patients showed gastric reflux incidentally on the routine Tc-99m-DISIDA hepatobiliary scintigraphy from December 1991 to June 1995 in Chungnam National University Hospital. The results were as follows: 1) The gastric reflux was observed in 2.3% of 1,553 cases of routine Tc-99m DISIDA Hepatobiliary scintigraphy for 43 months. 2) Nineteen percent of patients with gastric reflux had the past medical history of operations on stomach or biliary system. And that history was more prevalent in patients with reflux than those without reflux, significantly (p<0.01). 3) On fiberoptic gastroduodenpscopic examination, 87% of the patients with gastric reflux had the gastroduodenal diseases such as gastritis, gastric ulcer, duodenal ulcer, gastric cancer, duodenal cancer and ampullary diverticulosis. We thought that the gastric reflux can be observed considerably in patients without any operation history on stomach or duodenum, although the operation history is more prevalent in patients with gastric reflux than those without reflux, significantly and most of patients with gastric reflux on routine Tc-99m DISIDA scan has various gastroduodenal diseases.

  13. Vesicoureteral Reflux

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    ... causing the reflux. References [1] Pohl HG, Joyce GM, Wise M, Cilento BG. Pediatric urologic disorders. In: ... for questions about any medications, contact the U.S. Food and Drug Administration toll-free at 1-888- ...

  14. Gastroesophageal reflux.

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    Yanet Hidalgo Marrero

    2005-12-01

    Full Text Available Although many infants has smaller degrees of gastroesophageal reflux, it is recognized that 1:3,000 at 1:10,000 of they have a pathological or symptomatic reflux. Near 90% of children vomits during the first 6 weeks of life, due primarily to the physiologic immaturity of antireflux mechanism. However, in 60% of cases, reflux disappears before 18 months, even without treatment. 30% maintains the symptoms, becoming in pathological, and of them, 10% develops serious problems, around 5% esophagitis with stenosis and between the 1 to 5% the death related with aspiration. We presented the Good Clinical Practices Guideline for Portal hypertension, approved by consensus in the 4th National Good Clinical Practices Workshop in Pediatric Surgery (Las Tunas, Cuba, March, 2005

  15. Vesicoureteral reflux and reflux nephropathy

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    Thomsen, H.S.

    Vesicoureteral reflux (VUR) is mainly a primary phenomenon due to incontinence of the ureterovesical junction, mostly affecting a pediatric population. During micturition cystourethrography (MCU) reflux into the kidney - intrarenal reflux (IRR) - is occasionally seen. In areas with IRR the kidney surface may subsequently be depressed and the papillae retracted (reflux nephropathy (RN)). VUR may lead to hypertension and/or end-stage renal failure. Most commonly, VUR is discovered during evaluation for urinary tract infection, but it may also be present in patients with hypertension, toxemia of pregnancy, chronic renal failure and proteinuria, and it may be found in siblings of patients with VUR. For the time being VUR is demonstrated at radiographic MCU, whereas RN is diagnosed by demonstration of focal scars and of abnormal parenchymal thickness at urography. In children with VUR and no abnormalities of calyces or parenchymal defects standardized measurement of the parenchymal thickness at three sites may identify kidneys which are likely to develop focal scars. Quantitation of focal scarring should be performed in connection with a measure of the overall kidney size. The occurrence of IRR is dependent of the papillary morphology, intrapelvic pressure and urine flow. There may be an important relationship between renal ischemia and IRR in producing a 'vicious circle of deleterious effects' which, combined with parenchymal extravasation, may lead to RN. Treatment of VUR includes medical and surgical management. Since renal scarring may occur in infancy, prevention should focus on infants and young children. Infants and young children with severe VUR may have normal urograms. Therefore a MCU should also be performed, preferably with the recommended standardized technique. (orig.).

  16. Reflux and Lung Disease

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    ... Healthy Eating Reflux and Lung Disease Reflux and Lung Disease Make an Appointment Ask a Question Find a Doctor Many people with chronic lung disease also suffer from gastroesophageal reflux (GERD). In this ...

  17. Gastroesophageal reflux.

    Science.gov (United States)

    Slater, Bethany J; Rothenberg, Steven S

    2017-04-01

    Gastroesophageal reflux disease (GERD) is a very common condition and affects approximately 7-20% of the pediatric population. Symptoms from pathological GERD include regurgitation, irritability when feeding, respiratory problems, and substernal pain. Treatment typically starts with dietary modifications and postural changes. Antireflux medications may then be added. Indications for operative management in the pediatric population include failure of medical therapy with poor weight gain or failure to thrive, continued respiratory symptoms, and complications such as esophagitis. Laparoscopic Nissen fundoplication has become the standard of care for surgical treatment of children with GERD. The key technical aspects of laparoscopic Nissen fundoplication include creation of an adequate intra-abdominal esophagus, minimal dissection of the hiatus with exposure of the right crus to identify the gastroesophageal junction, crural repair, and creation of floppy, 360° wrap that is oriented at the 11 o׳clock position. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. Reflux in Children

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    ... could be GERD. What causes reflux and GERD in children? There is a muscle (the lower esophageal ... contents don't flow back into the esophagus. In children who have reflux and GERD, this muscle ...

  19. Reflux in Infants

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    ... to 14 months. What causes reflux and GERD in infants? There is a muscle (the lower esophageal ... contents don't flow back into the esophagus. In babies who have reflux, the lower esophageal sphincter ...

  20. Laryngopharyngeal reflux in patients with reflux esophagitis

    Institute of Scientific and Technical Information of China (English)

    Yung-Chih Lai; Pa-Chun Wang; Jun-Chen Lin

    2008-01-01

    AIM: To assess the prevalence of laryngopharyngeal reflux (LPR) in patients with reflux esophagitis and dis-close factors contributing to the development of LPR.METHODS: A total of 167 patients who proved to have reflux esophagitis by endoscopy were enrolled.ings for the diagnosis of LPR. We used validated ques-tionnaires to identify the presence of laryngopharyn-geal symptoms, and stringent criteria of inclusion to increase the specificity of laryngoscopic findings. The data of patients were analyzed statistically to find out factors related to LPR.RESULTS: The prevalence rate of LPR in studied sub-jects with reflux esophagitis was 23.9%. Age, hoarse-ness and hiatus hernia were factors significantly as-sociated with LPR. In 23 patients with a hiatus hernia,the group with LPR was found to have a lower trend of esophagitis grading.CONCLUSION: Laryngopharyngeal reflux is present in patients with reflux esophagitis, and three predicting factors were identified. However, the development of LPR might be different from that of reflux esophagi-tis. The importance of hiatus hernia deserves further study.

  1. Reflux symptom questionnaire in the diagnosis of reflux oesophagitis

    Institute of Scientific and Technical Information of China (English)

    ZHANG Li; MENG Ling-mei; ZHANG Dong-hong; HUANG Shu-mei; QU Xue-fu; ZHOU Li-ya; LIN San-ren; DING Shi-gang; HUANG Yong-hui; GU Fang; LI Yuan; ZHANG Jing; YAN Xiu-e

    2007-01-01

    @@ Reflux symptom questionnaire (RSQ) is a useful tool in epidemiological study of gastroesophageal reflux disease (GERD),(1,2) but the correlation between RSQ and the refluX oesophagitis (RE) is still unclear.

  2. Familial vesicoureteral reflux

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    朴, 勺; 新井, 豊; 友吉, 唯夫; 吉田, 修

    1983-01-01

    Primary vesicoureteral reflux was seen in 2 siblings in a family of 5 (1 daughter and 2 sons). Voiding cystogram of elder sister, who complained of fever and backache, showed bilateral reflux at the age of 6. Left reflux disappeared soon but right reflux persisted. Right antireflux operation was performed at the age of 9, but right renal function deteriorated gradually. Right nephrectomy was done at the age of 12 because of persistent pyuria and renal stones. The second case was her younger b...

  3. [Reflux nephropathy in absence of obvious vesicoureteral reflux].

    Science.gov (United States)

    Vino, L; Pedrolli, A; Portuese, A; Dal Cerè, M; Pizzini, C; Sinaguglia, G; Fanos, V

    2000-01-01

    Although the majority of patients with vesicoureteric reflux presents DMSA scan alterations, parenchimal renal scars are found also in children without vesicoureteric reflux. Two clinical cases of reflux nephropathy without evidence of reflux are presented. Several explanations could be advocated to justify this picture, including haematogenous source of infection, inadequate timing and/or procedure of cystouretrography, intermittency of reflux, ascending bacteria, previous presence of reflux, and appearance of controlateral reflux during the natural history of a monolateral documented reflux. Tailored diagnostic and therapeutic strategy should discussed for each patient.

  4. Reflux and GERD in Infants

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    ... Z Celiac Disease Eosinophilic Esophagitis Inflammatory Bowel Disease Nutrition & Obesity Reflux & GERD Reflux & GERD in Infants Symptoms & Diagnosis ... Nutrition (NASPGHAN) Celiac Disease Eosinophilic Esophagitis Pediatric IBD Nutrition & Obesity Reflux & GERD Research & Grants Our Supporters Site Map © ...

  5. Reflux and GERD (in Children)

    Science.gov (United States)

    ... Z Celiac Disease Eosinophilic Esophagitis Inflammatory Bowel Disease Nutrition & Obesity Reflux & GERD Reflux & GERD in Infants GERD in ... Nutrition (NASPGHAN) Celiac Disease Eosinophilic Esophagitis Pediatric IBD Nutrition & Obesity Reflux & GERD Research & Grants Our Supporters Site Map © ...

  6. The Law of Reflux

    OpenAIRE

    Sproul, Michael

    2010-01-01

    The law of reflux is explained using an example of backed money. In the example, government-issued money is backed by the government’s assets (mainly taxes receivable) while bank-issued money is backed by the bank’s assets. The value of both kinds of money is determined by the amount of backing held per unit of money issued. The example shows that reflux maintains money’s value, not by assuring that excessive issues of money reflux to their issuers, but by providing people with access to the ...

  7. Refractory gastroesophageal reflux disease

    OpenAIRE

    Joaquim Prado P. Moraes-Filho

    2012-01-01

    CONTEXT: Gastroesophageal reflux disease (GERD) is a condition which develops when the reflux of stomach contents causes troublesome symptoms and/or complications. Its pathophysiology, diagnosis and treatment have frequently been analyzed but it is interesting to review some aspects of the GERD refractory patients to the proton pump inhibitors treatment. The treatment encompasses behavioral measures and pharmacological therapy. The majority of the patients respond well to proton pump inhibito...

  8. Gastroesophageal reflux - discharge

    Science.gov (United States)

    ... vegetables, such as citrus fruits, pineapple, tomatoes, or tomato-based dishes (pizza, chili, and spaghetti). Avoid items ... your stress and watch for stressful, tense times. Stress can bother your reflux ... medicines with plenty of water. When you start a new medicine, remember to ...

  9. Biomarkers of Reflux Disease.

    Science.gov (United States)

    Kia, Leila; Pandolfino, John E; Kahrilas, Peter J

    2016-06-01

    Gastroesophageal reflux disease (GERD) encompasses an array of disorders unified by the reflux of gastric contents. Because there are many potential disease manifestations, esophageal and extraesophageal, there is no single biomarker of the entire disease spectrum; a set of GERD biomarkers that each quantifies specific aspects of GERD-related pathology might be needed. We review recent reports of biomarkers of GERD, specifically in relation to endoscopically negative esophageal disease and excluding conventional pH-impedance monitoring. We consider histopathologic biomarkers, baseline impedance, and serologic assays to determine that most markers are based on manifestations of impaired esophageal mucosal integrity, which is based on increased ionic and molecular permeability, and/or destruction of tight junctions. Impaired mucosal integrity quantified by baseline mucosal impedance, proteolytic fragments of junctional proteins, or histopathologic features has emerged as a promising GERD biomarker.

  10. Current perspectives on reflux laryngitis.

    Science.gov (United States)

    Asaoka, Daisuke; Nagahara, Akihito; Matsumoto, Kenshi; Hojo, Mariko; Watanabe, Sumio

    2014-12-01

    Laryngopharyngeal reflux (LPR) is an extraesophageal manifestation of gastroesophageal reflux disease (GERD). With the increase of GERD patients, the importance of LPR is acknowledged widely. However, the pathophysiology of LPR is not understood completely and the diagnostic criteria for LPR remain controversial. Unfortunately, a gold standard diagnostic test for reflux laryngitis is not available. Recently, an experimental animal model for reflux laryngitis was developed to investigate the pathophysiology of reflux laryngitis. An empirical trial of lifestyle modification and proton pump inhibitor therapy is a reasonable approach for LPR symptoms. Alternatives after failure with aggressive medical treatment are limited and multichannel intraluminal impedance and pH monitoring is currently the best alternative to detect nonacid reflux. Additional prospective and evidence-based research is anticipated.

  11. Vesicoureteric reflux in children

    Directory of Open Access Journals (Sweden)

    Jameela A Kari

    2013-01-01

    Full Text Available Aim: This study aimed to identify the differences between primary and secondary vesicoureteric reflux (VUR and the effect of associated bladder abnormalities on kidney function. Patients and Methods: We retrospectively reviewed the medical records of children with VUR who were followed up at King Abdulaziz University Hospital from January 2005 to December 2010. The review included results of radiological investigations and kidney function tests. We used Chi-square test for statistical analysis and paired t-test to compare group means for initial and last creatinine levels. Results: Ninety-nine children were included in this study. Twenty (20.2% had primary VUR, 11 had high-grade VUR, while 9 had low-grade reflux. All children with low-grade VUR had normal dimercaptosuccinic acid (DMSA. Renal scars were present in 72% of the children with high-grade VUR. The mean creatinine levels (initial and last for both groups were normal. Seventy-nine (79.8% children had secondary VUR, which was due to posterior urethral valves (PUV (46.8%, neurogenic bladder caused by meningomyelocele (25.3%, non-neurogenic neurogenic bladder (NNB (21.5%, or neurogenic bladder associated with prune belly syndrome (6.3%. Children with NNB, meningomyelocele and PUV had high creatinine at presentation with no considerable worsening of their kidney functions during the last visit. Renal scars were present in 49.4% of the children with secondary VUR. Conclusion: Children with primary VUR and normal bladder had good-functioning kidneys, while those with secondary VUR associated with abnormal bladder caused by NNB, spina bifida or PUV had abnormal kidney functions. DMSA scans were useful in predicting higher grades of VUR in children with primary reflux.

  12. [Vesicoureteral reflux in adults].

    Science.gov (United States)

    Rollino, Cristiana; D'Urso, Leonardo; Beltrame, Giulietta; Ferro, Michela; Quattrocchio, Giacomo; Quarello, Francesco

    2011-01-01

    Vesicoureteral reflux (VUR) may be congenital or acquired. The most frequent form of congenital VUR is primary VUR. Its prevalence in adults is not exactly known, but it is higher in women, whose greater propensity for urinary tract infections increases the likelihood of an instrumental examination leading to the diagnosis of less severe cases. In men, even severe VUR may go undiagnosed for a long time. Primary VUR is due to a defect in the valve mechanism of the ureterovesical junction. In physiological conditions, the terminal ureter enters the bladder wall obliquely and bladder contraction leads to compression of this intravesical portion. Abnormal length of the intravesical portion of the ureter due to a genetic mutation (whose location is yet to be established) leads to VUR. In its less severe forms VUR may be asymptomatic, but in 50-70% of cases it manifests with recurrent cystitis or pyelonephritis. The manifestations leading to a diagnosis of VUR in adults, besides urinary tract infections, are proteinuria, renal failure and hypertension. The gold-standard diagnostic examination is a micturating cystourethrogram. Reflux nephropathy develops as a result of a pathogenetic mechanism unrelated to high cavity pressure or urinary tract infections but due to reduced formation of the normal renal parenchyma (hypoplasia or dysplasia). Abnormal renal parenchyma development is attributable to the same genes that control the development of the ureters and ureterovesical junction. VUR is considered only a marker of this abnormal development, playing no role in scar formation. There is no conclusive evidence regarding the indications for VUR correction. However, the risk that VUR leads to recurrent pyelonephritis and reflux nephropathy must be kept in mind. VUR certainly has to be corrected in women who contemplate pregnancy.

  13. Infant Reflux: Symptoms and Causes

    Science.gov (United States)

    ... the stomach contents to have enough acid to irritate the throat or esophagus and to cause signs ... as: GERD. The reflux has enough acid to irritate and damage the lining of the esophagus. Pyloric ...

  14. [Subglottic stenosis and gastroesophageal reflux].

    Science.gov (United States)

    Fligny, I; François, M; Aigrain, Y; Polonovski, J M; Contencin, P; Narcy, P

    1989-01-01

    The authors report the cases of ten children treated for sub-glottic laryngeal stenosis, in the Department of Pr. Narcy in Hospital Robert-Debre. Medical treatment of the laryngeal stenosis had failed in these cases. Treatment, most often surgical, of the gastro-oesophageal reflux present in these ten cases enabled these children to be cured. A review of the literature stresses the role and responsibility of gastro-oesophageal reflux in laryngeal pathology. Based on their experience, the authors suggest: systematic investigation for gastro-oesophageal reflux during management of laryngeal stenosis, especially when laryngeal inflammation is encountered; the adoption of an interventionist attitude vis-a-vis gastro-oesophageal reflux which would seem to have an important pathogenic role in certain laryngeal stenoses.

  15. Gastroesophageal reflux disease in children.

    Science.gov (United States)

    Barnhart, Douglas C

    2016-08-01

    Despite the frequency with which antireflux procedures are performed, decisions about gastroesophageal reflux disease treatment remain challenging. Several factors contribute to the difficulties in managing gastroesophageal reflux. First, the distinction between physiologic and pathologic gastroesophageal reflux (gastroesophageal reflux disease-GERD) is not always clear. Second, measures of the extent of gastroesophageal reflux often poorly correlate to symptoms or other complications attributed to reflux in infants and children. A third challenge is that the outcome of antireflux procedures, predominately fundoplications, are relatively poorly characterized. All of these factors contribute to difficulty in knowing when to recommend antireflux surgery. One of the manifestations of the uncertainties surrounding GERD is the high degree of variability in the utilization of pediatric antireflux procedures throughout the United States. Pediatric surgeons are frequently consulted for GERD and fundoplication, uncertainties notwithstanding. Although retrospective series and anecdotal observations support fundoplication in some patients, there are many important questions for which sufficient high-quality data to provide a clear answer is lacking. In spite of this, surgeons need to provide guidance to patients and families while awaiting the development of improved evidence to aid in these recommendations. The purpose of this article is to define what is known and what is uncertain, with an emphasis on the most recent evidence. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Correcting Reflux Laparoscopically

    Directory of Open Access Journals (Sweden)

    Eric C Poulin

    1998-01-01

    Full Text Available Most operations in the abdominal cavity and chest can be performed using minimally invasive techniques. As yet it has not been determined which laparoscopic procedures are preferable to the same operations done through conventional laparotomy. However, most surgeons who have completed the learning curves of these procedures believe that most minimally invasive techniques will be scientifically recognized soon. The evolution, validation and justification of advanced laparoscopic surgical methods seem inevitable. Most believe that the trend towards procedures that minimize or eliminate the trauma of surgery while adhering to accepted surgical principles is irreversible. The functional results of laparoscopic antireflux surgery in the seven years since its inception have been virtually identical to the success curves generated with open fundoplication in past years. Furthermore, overall patient outcomes with laparoscopic procedures have been superior to outcomes with the traditional approach. Success is determined by patient selection and operative technique. Patient evaluation should include esophagogastroduodenoscopy, barium swallow, 24 h pH study and esophageal motility study. Gastric emptying also should be evaluated. Patients who have abnormal propulsion in the esophagus should not receive a complete fundoplication (Nissen because it adds a factor of obstruction. Dor or Toupet procedures are adequate alternatives. Prokinetic agents, dilation or pyloroplasty are used for pyloric obstruction ranging from little to more severe. Correcting reflux laparoscopically is more difficult in patients with obesity, peptic strictures, paraesophageal hernias, short esophagus, or a history of previous upper abdominal or antireflux surgery.

  17. Relationship between reflux and laryngeal cancer

    NARCIS (Netherlands)

    Coca-Pelaz, A.; Rodrigo, J.P.; Takes, R.P.; Silver, C.E.; Paccagnella, D.; Rinaldo, A.; Hinni, M.L.; Ferlito, A.

    2013-01-01

    Gastroesophageal reflux disease (GERD), or its variation known as laryngopharyngeal reflux (LPR), has been recognized as a potential cause of several laryngeal disorders. Patients with laryngeal cancer have lifestyle risk factors, especially tobacco and alcohol consumption, that play an etiological

  18. [Therapeutic principles in gastroesophageal reflux].

    Science.gov (United States)

    Chassany, O; Elkharrat, D; Bergmann, J F; Segrestaa, J M

    1995-01-01

    Gastroesophageal reflux is a common disease. Its chronic course, even if mild, is sometimes complicated by erosive oesophagitis. Drug therapy acts against gastric acidity and motility disorders. Treatment of gastroesophageal reflux disease has three aims: improvement of symptoms and quality of life, healing erosive lesions and prevention of symptomatic and endoscopic relapses. Non-drug measures are always useful, even if their efficacy is not well established. Initial therapy of a symptomatic reflux or mild oesophagitis is most of the time effective (antacids, prokinetics, H2 receptor antagonists). Proton-pump inhibitors are also effective in healing and preventing severe oesophagitis. Questions about long-term treatment adverse events with powerful acid inhibitors, such as hypergastrinemia and the risk of gastric carcinoid tumours seem to be resolved. Studies are requested to define the optimal long-term maintenance treatment with cisapride, H2 receptor antagonists or proton-pump inhibitors at low doses in prevention of symptomatic and mild oesophagitis relapses.

  19. Vesicoureteral reflux: A historical perspective

    African Journals Online (AJOL)

    K.N. DeCotiis

    2016-12-28

    Dec 28, 2016 ... has evolved considerably throughout the years due to a dynamic ... 3. Grading of reflux is not important. 4. Bladder outlet obstruction ... ureteral reimplantation became the gold standard therapy for treat- ... In order to standardize terminology ... sified by Nguyen, et al. proposed imaging studies for patients.

  20. Treatment of uncomplicated reflux disease

    Institute of Scientific and Technical Information of China (English)

    Joachim Labenz; Peter Malfertheiner

    2005-01-01

    Uncomplicated reflux disease comprises the non-erosive reflux disease (NERD) and erosive reflux disease (ERD).The objectives of treatment are the adequate control of symptoms with restoration of quality of life, healing of lesions and prevention of relapse. Treatment of NERD consists in the administration of proton pump inhibitors (PPI) for 2-4 wk, although patients with NERD show an overall poorer response to PPI treatment than patients with ERD owing to the fact that patients with NERD do not form a pathophysiologically homogenous group. For long-term management on-demand treatment with a PPI is probably the best option. In patients with ERD, therapy with a standard dose PPI for 4-8 wk is always recommended.Long-term treatment of ERD is applied either intermittently or as continuous maintenance treatment with an attempt to reduce the daily dosage of the PPI (step-down principle).In selected patients requiring long-term PPI treatment,antireflux surgery is an alternative option. In patients with troublesome reflux symptoms and without alarming features empirical PPI therapy is another option for initial management. Therapy should be withdrawn after initial success. In the case of relapse, the long-term care depends on a careful risk assessment and the response to PPI therapy.

  1. Radiologic diagnosis of gastro-oesophageal reflux

    Energy Technology Data Exchange (ETDEWEB)

    Fransson, S.G.; Soekjer, H.; Johansson, K.E.; Tibbling, L.

    In 149 patients, a standardized radiologic method for the detection of gastro-oesophageal reflux was applied and compared with the results obtained at endoscopy and by a manometric reflux test. Radiologic reflux was recorded in 53 patients, of whom 25 had reflux without abdominal compression and 51 with compression. At least one of the other two types of examination disclosed pathologic conditions in all but 2 of 53 patients. Oesophagitis was significantly more severe among the patients with reflux observed at radiography. The presence of hiatal incompetence with reflux only to the hiatal hernia but not to the oesophagus was not a strong indicator of gastro-oesophageal reflux disease. Hiatal hernia was present in a significantly larger number of the patients with reflux at radiography than in those without reflux. Increased width of the hiatus gave stronger evidence for reflux disease than in patients with a normal hiatus. Thus, the width of the hiatus also had a bearing on the diagnosis of gastro-oesophageal reflux disease.

  2. The effect of decaffeination of coffee on gastro-oesophageal reflux in patients with reflux disease.

    Science.gov (United States)

    Pehl, C; Pfeiffer, A; Wendl, B; Kaess, H

    1997-06-01

    Patients with reflux disease often complain of heartburn after ingestion of coffee. Induction of gastro-oesophageal reflux has been demonstrated by pH-metry following the intake of coffee in healthy volunteers. The reflux was reduced when the coffee had undergone a decaffeination process. The aim of this study was to investigate the effect of decaffeination of coffee on reflux in patients with reflux disease. Seventeen reflux patients underwent two osesophageal 3-h pH measurements. The patients received, in a double-blind study design in a randomized order, 300 mL of either regular or decaffeinated coffee together with a standardized breakfast. The fraction time oesophageal pH decaffeinated coffee. The amount of gastro-oesophageal reflux induced by the intake of regular coffee in patients with reflux disease can be reduce by the decaffeination of coffee.

  3. Esophageal motility abnormalities in gastroesophageal reflux disease

    Institute of Scientific and Technical Information of China (English)

    Irene; Martinucci; Nicola; de; Bortoli; Maria; Giacchino; Giorgia; Bodini; Elisa; Marabotto; Santino; Marchi; Vincenzo; Savarino; Edoardo; Savarino

    2014-01-01

    Esophageal motility abnormalities are among the main factors implicated in the pathogenesis of gastroesophageal reflux disease. The recent introduction in clinical and research practice of novel esophageal testing has markedly improved our understanding of the mechanisms contributing to the development of gastroesophageal reflux disease, allowing a better management of patients with this disorder. In this context, the present article intends to provide an overview of the current literature about esophageal motility dysfunctions in patients with gastroesophageal reflux disease. Esophageal manometry, by recording intraluminal pressure, represents the gold standard to diagnose esophagealmotility abnormalities. In particular, using novel techniques, such as high resolution manometry with or without concurrent intraluminal impedance monitoring, transient lower esophageal sphincter (LES) relaxations, hypotensive LES, ineffective esophageal peristalsis and bolus transit abnormalities have been better defined and strongly implicated in gastroesophageal reflux disease development. Overall, recent findings suggest that esophageal motility abnormalities are increasingly prevalent with increasing severity of reflux disease, from nonerosive reflux disease to erosive reflux disease and Barrett’s esophagus. Characterizing esophageal dysmotility among different subgroups of patients with reflux disease may represent a fundamental approach to properly diagnose these patients and, thus, to set up the best therapeutic management. Currently, surgery represents the only reliable way to restore the esophagogastric junction integrity and to reduce transient LES relaxations that are considered to be the predominant mechanism by which gastric contents can enter the esophagus. On that ground, more in depth future studies assessing the pathogenetic role of dysmotility in patients with reflux disease are warranted.

  4. Esophageal motility abnormalities in gastroesophageal reflux disease.

    Science.gov (United States)

    Martinucci, Irene; de Bortoli, Nicola; Giacchino, Maria; Bodini, Giorgia; Marabotto, Elisa; Marchi, Santino; Savarino, Vincenzo; Savarino, Edoardo

    2014-05-06

    Esophageal motility abnormalities are among the main factors implicated in the pathogenesis of gastroesophageal reflux disease. The recent introduction in clinical and research practice of novel esophageal testing has markedly improved our understanding of the mechanisms contributing to the development of gastroesophageal reflux disease, allowing a better management of patients with this disorder. In this context, the present article intends to provide an overview of the current literature about esophageal motility dysfunctions in patients with gastroesophageal reflux disease. Esophageal manometry, by recording intraluminal pressure, represents the gold standard to diagnose esophageal motility abnormalities. In particular, using novel techniques, such as high resolution manometry with or without concurrent intraluminal impedance monitoring, transient lower esophageal sphincter (LES) relaxations, hypotensive LES, ineffective esophageal peristalsis and bolus transit abnormalities have been better defined and strongly implicated in gastroesophageal reflux disease development. Overall, recent findings suggest that esophageal motility abnormalities are increasingly prevalent with increasing severity of reflux disease, from non-erosive reflux disease to erosive reflux disease and Barrett's esophagus. Characterizing esophageal dysmotility among different subgroups of patients with reflux disease may represent a fundamental approach to properly diagnose these patients and, thus, to set up the best therapeutic management. Currently, surgery represents the only reliable way to restore the esophagogastric junction integrity and to reduce transient LES relaxations that are considered to be the predominant mechanism by which gastric contents can enter the esophagus. On that ground, more in depth future studies assessing the pathogenetic role of dysmotility in patients with reflux disease are warranted.

  5. Interplay between vesicoureteric reflux and kidney infection in the development of reflux nephropathy in mice.

    Science.gov (United States)

    Bowen, Samantha E; Watt, Christine L; Murawski, Inga J; Gupta, Indra R; Abraham, Soman N

    2013-07-01

    Vesicoureteric reflux (VUR) is a common congenital defect of the urinary tract that is usually discovered after a child develops a urinary tract infection. It is associated with reflux nephropathy, a renal lesion characterized by the presence of chronic tubulointersitial inflammation and fibrosis. Most patients are diagnosed with reflux nephropathy after one or more febrile urinary tract infections, suggesting a potential role for infection in its development. We have recently shown that the C3H mouse has a 100% incidence of VUR. Here, we evaluate the roles of VUR and uropathogenic Escherichia coli infection in the development of reflux nephropathy in the C3H mouse. We find that VUR in combination with sustained kidney infection is crucial to the development of reflux nephropathy, whereas sterile reflux alone fails to induce reflux nephropathy. A single bout of kidney infection without reflux fails to induce reflux nephropathy. The host immune response to infection was examined in two refluxing C3H substrains, HeN and HeJ. HeJ mice, which have a defect in innate immunity and bacterial clearance, demonstrate more significant renal inflammation and reflux nephropathy compared with HeN mice. These studies demonstrate the crucial synergy between VUR, sustained kidney infection and the host immune response in the development of reflux nephropathy in a mouse model of VUR.

  6. Reflux perception and the esophageal mucosal barrier in gastroesophageal reflux disease

    NARCIS (Netherlands)

    P.W. Weijenborg

    2016-01-01

    Gastroesophageal reflux disease (GERD) is one of the most common disorders of the gastrointestinal tract. Heartburn, regurgitation and chest pain are the key symptoms. Patients with reflux symptoms often have more than average reflux of acidic contents in the esophagus. However, frequently there is

  7. Personal Experience in TCM Treatment of Reflux Esophagitis

    Institute of Scientific and Technical Information of China (English)

    洪流

    2003-01-01

    @@ Reflux esophagitis falls into the category of reflux gastroesophagopathy. It is characterized by inflammation, erosion, ulcer formation and fibrosis of the esophageal mucous membrane due to reflux of the content of the stomach and duodenum into the esophagus.

  8. Treatment of vesicoureteric reflux by endoscopic injection of Teflon.

    OpenAIRE

    1984-01-01

    Thirteen girls with grade III-V vesicoureteric reflux were treated by endoscopic injection of Teflon paste behind the intravesical ureter. Fourteen of the 18 treated ureters showed complete absence of reflux after one injection of Teflon. Three ureters required a second injection of Teflon for successful treatment of the reflux. One ureter with grade IV reflux was converted to grade II reflux. Properly carried out, this procedure corrects reflux. It takes less than 15 minutes, may be done as ...

  9. Cough in asthma triggered by reflux episodes.

    Science.gov (United States)

    Mehta, Devendra; He, Zhaoping; Padman, Raj

    2014-05-01

    With combined pH and impedance monitoring, non-acid, as well as acid reflux episodes, are more commonly detected immediately prior to cough in asthma in children. Gastroesophageal reflux should be evaluated as a trigger for cough in difficult childhood asthma.

  10. Reflux Revisited: Advancing the Role of Pepsin

    Directory of Open Access Journals (Sweden)

    Karna Dev Bardhan

    2012-01-01

    Full Text Available Gastroesophageal reflux disease is mediated principally by acid. Today, we recognise reflux reaches beyond the esophagus, where pepsin, not acid, causes damage. Extraesophageal reflux occurs both as liquid and probably aerosol, the latter with a further reach. Pepsin is stable up to pH 7 and regains activity after reacidification. The enzyme adheres to laryngeal cells, depletes its defences, and causes further damage internally after its endocytosis. Extraesophageal reflux can today be detected by recognising pharyngeal acidification using a miniaturised pH probe and by the identification of pepsin in saliva and in exhaled breath condensate by a rapid, sensitive, and specific immunoassay. Proton pump inhibitors do not help the majority with extraesophageal reflux but specifically formulated alginates, which sieve pepsin, give benefit. These new insights may lead to the development of novel drugs that dramatically reduce pepsinogen secretion, block the effects of adherent pepsin, and give corresponding clinical benefit.

  11. Endoscopic and laparoscopic treatment of gastroesophageal reflux.

    Science.gov (United States)

    Watson, David I; Immanuel, Arul

    2010-04-01

    Gastroesophageal reflux is extremely common in Western countries. For selected patients, there is an established role for the surgical treatment of reflux, and possibly an emerging role for endoscopic antireflux procedures. Randomized trials have compared medical versus surgical management, laparoscopic versus open surgery and partial versus total fundoplications. However, the evidence base for endoscopic procedures is limited to some small sham-controlled studies, and cohort studies with short-term follow-up. Laparoscopic fundoplication has been shown to be an effective antireflux operation. It facilitates quicker convalescence and is associated with fewer complications, but has a similar longer term outcome compared with open antireflux surgery. In most randomized trials, antireflux surgery achieves at least as good control of reflux as medical therapy, and these studies support a wider application of surgery for the treatment of moderate-to-severe reflux. Laparoscopic partial fundoplication is an effective surgical procedure with fewer side effects, and it may achieve high rates of patient satisfaction at late follow-up. Many of the early endoscopic antireflux procedures have failed to achieve effective reflux control, and they have been withdrawn from the market. Newer procedures have the potential to fashion a surgical fundoplication. However, at present there is insufficient evidence to establish the safety and efficacy of endoscopic procedures for the treatment of gastroesophageal reflux, and no endoscopic procedure has achieved equivalent reflux control to that achieved by surgical fundoplication.

  12. Reflux esophagitis and gastroesophageal reflux disease: a cross-sectional study of gastroesophageal reflux disease patients by age group

    Directory of Open Access Journals (Sweden)

    Flora Filho Rowilson

    1999-01-01

    Full Text Available The purpose of this study was to explore the relationship between the intensity of acid reflux and severity of esophageal tissue damage in a cross-sectional study of patients with gastroesophageal reflux disease (GERD. Seventy-eight patients with were selected in accordance with the strict 24-hour ambulatory esophageal pHmetry (24h-pHM criteria and distributed into three age groups: Group A: 14 - 24 years of age. Group B: 25 - 54; and Group C: 55 - 64. The 24h-pHM was carried out in accordance with DeMeester standardization, and the Savary-Miller classification for the diagnosis of reflux esophagitis was used. The groups were similar in 24h-pHM parameters (p > 0.05, having above normal values. For the study group as a whole, there was no correlation between age group and intensity of acid reflux, and there was no correlation between intensity of acid reflux and severity of esophageal tissue damage. However, when the same patients were sub-grouped in accordance with the depth of their epithelial injury and then distributed into age groups, there was a significant difference in esophagitis without epithelial discontinuity. Younger patients had less epithelial damage than older patients. Additionally, although there was a significant progression from the least severe to the moderate stages of epithelial damage among the age groups, there was no apparent difference among the age groups in the distribution between the moderate stages and most severe stages. The findings support the conclusion that the protective response of individuals to acid reflux varies widely. Continued aggression by acid reflux appears to lead to the exhaustion of individual mechanisms of epithelial protection in some patients, but not others, regardless of age or duration of the disease. Therefore, the diagnosis and follow-up of GERD should include both measurements of the quantity of refluxed acid and an assessment of the damage to the esophageal epithelium.

  13. Pediatric GERD (Gastro-Esophageal Reflux Disease)

    Science.gov (United States)

    ... in Toggle navigation b Join Now Donate Now Disclosure Form News About Us Our Campaigns Foundation Governance ... the stomach and out of the esophagus. The continuous entry of acid or refluxed materials into areas ...

  14. Laparoscopic Anti-Reflux (GERD) Surgery

    Science.gov (United States)

    ... Sponsorship Opportunities Log In Laparoscopic Anti-Reflux (GERD) Surgery Patient Information from SAGES Download PDF Find a SAGES Surgeon Surgery for “Heartburn” If you suffer from moderate to ...

  15. [Severe laryngitis associated to gastroesophageal reflux].

    Science.gov (United States)

    Botto, Hugo; Antonioli, Cintia; Nieto, Mary; Cocciaglia, Alejandro; Cuestas, Giselle; Roques Revol, Magdalena; López Marti, Jessica; Rodríguez, Hugo

    2014-02-01

    There is a strong association between gastroesophageal reflux and pharyngolaryngeal reflux as factors leading to respiratory disease, manifested as dysphonia, wheezing, coughing, recurrent laryngitis, bronchial obstruction, laryngospasm and apparent life-threatening events (ALTEs). These manifestations can be mild or severe and may sometimes put the patient's life at risk. We present two cases of patients with severe laryngitis who required endotracheal intubation, one of which underwent tracheostomy. The diagnostic methods and their limitations and the patients outcomes are described.

  16. Surgical management of vesicoureteral reflux in children.

    Science.gov (United States)

    Sung, Jennifer; Skoog, Steven

    2012-04-01

    Vesicoureteral reflux (VUR) is the most common uropathy affecting children. Compared to children without VUR, those with VUR have a higher rate of pyelonephritis and renal scarring following urinary tract infection (UTI). Options for treatment include observation with or without antibiotic prophylaxis and surgical repair. Surgical intervention may be necessary in patients with persistent reflux, renal scarring, and recurrent or breakthrough febrile UTI. Both open and endoscopic approaches to reflux correction are successful and reduce the occurrence of febrile UTI. Estimated success rates of open and endoscopic reflux correction are 98.1% (95% CI 95.1, 99.1) and 83.0% (95% CI 69.1, 91.4), respectively. Factors that affect the success of endoscopic injection include pre-operative reflux grade and presence of functional or anatomic bladder abnormalities including voiding dysfunction and duplicated collecting systems. Few studies have evaluated the long-term outcomes of endoscopic injection, and with variable results. In patients treated endoscopically, recurrent febrile UTI occurred in 0-21%, new renal damage in 9-12%, and recurrent reflux in 17-47.6% of treated ureters with at least 1 year follow-up. These studies highlight the need for standardized outcome reporting and longer follow-up after endoscopic treatment.

  17. Is obesity associated with gastropharyngeal reflux disease?

    Institute of Scientific and Technical Information of China (English)

    Cheol Woong Choi; Gwang Ha Kim; Chul Soo Song; Soo Geun Wang; Byung Joo Lee; Hoseok I; Dae Hwan Kang; Geun Am Song

    2008-01-01

    AIM: To examine the association between obesity and gastropharyngeal reflux disease (GPRD) as well as gastroesophageal reflux disease (GERD)METHODS: We conducted a cross-sectional study of consecutive patients undergoing ambulatory 24-h dual-probe pH monitoring from July 2003 to December 2006.The association between body mass index (BMI) and parameters about gastroesophageal or gastropharyngeal reflux was examined in univariate and multivariate analyses.RESULTS: A total of 769 patients (307 men and 462 women; mean age 50.7 years) were finally enrolled. Most variables showing gastroesophageal reflux was higher in the obese patients than the patients with normal BMI.There was no difference in all the variables showing gastropharyngeal reflux according to the BMI. After adjustment for age, sex, alcohol intake and smoking,obese patients demonstrated an about 2-fold increase in risk of GERD compared with patients with normal BMI (OR, 1.9; 95 CI, 1.3-2.9), but overweight patients did not demonstrate increased risk of GERD (OR, 1.2; 95 CI,0.8-1.7). Both obese patients and overweight patients did not demonstrated increased risk of GPRD compared with patients with normal BM[ (OR, 1.1; 95 CI, 0.8-1.7;and OR, 0.9; 95 CI, 0.6-1.3, respectively).CONCLUSION: Obesity is not associated with GPRD reflux while it is associated with GERD.

  18. Diagnosis and clinical implications of pancreatobiliary reflux

    Institute of Scientific and Technical Information of China (English)

    Terumi Kamisawa; Hajime Anjiki; Naoto Egawa; Masanao Kurata; Goro Honda; Kouji Tsuruta

    2008-01-01

    The sphincter of Oddi is located at the distal end of the pancreatic and bile ducts and regulates the outflow of bile and pancreatic juice.A common channel can be so long that the junction of the pancreatic and bile ducts is located outside of the duodenal wall,as occurs in pancreaticobiliary maljunction (PBM);in such cases,sphincter action does not functionally affect the junction.As the hydropressure within the pancreatic duct is usually greater than in the bile duct,pancreatic juice frequently refluxes into the biliary duct (pancreatobiliary reflux) in PBM,resulting in carcinogenetic conditions in the biliary tract.Pancreatobiliary reflux can be diagnosed from elevated amylase level in the bile,secretinstimulated dynamic magnetic resonance cholangiop ancreatography,and pancreatography via the minor duodenal papilla.Recently,it has become obvious that pancreatobiliary reflux can occur in individuals without PBM.Pancreatobiliary reflux might be related to biliary carcinogenesis even in some individuals without PBM.Since few systemic studies exist with respect to clinical relevance and implications of the pancreatobiliary reflux in individuals with normal pancreaticobiliary junction,further prospective clinical studies including appropriate management should be performed.

  19. Small saphenous vein: where does reflux go?

    Directory of Open Access Journals (Sweden)

    Guillermo Gustavo Rossi

    2013-06-01

    Full Text Available BACKGROUND: The anatomy of small saphenous vein (SSV is very variable because of its complex embryological origin. SSV incompetence often causes reflux that goes to the perforating veins, sometimes not respecting the anatomical course. OBJECTIVE: To analyze differences in reflux direction and reentry in the SSV. METHODS: In this prospective, observational study, 60 lower limbs with SSV incompetence of 43 patients were assessed using a color Doppler ultrasound protocol. RESULTS: Reentry variations were grouped into four types and subtypes. Percentage results were: Type A, perforating veins on the medial side = 25/60 cases (41.66%; subtypes: Cockett, Sherman, paratibial and vertex; Type B, lateral malleolus and perforating veins on the lateral side (fibular 17-26 cm = 15/60 cases (25%; subtypes: fibular and malleolus; Type C, two branches = 19/60 cases (31.66%; subtypes: gastrocnemius and Cockett, gastrocnemius and malleolus, and/or fibular, Cockett and malleolus, Cockett-vertex and fibular; Type D, reflux in the superficial system = 1/60 cases (1.66%. CONCLUSION: On most of the lower limbs assessed, reflux did not follow the classical anatomic course. Our findings demonstrated a high degree of variation in reflux/reentry, but no SSV anatomical variations. Reflux seems to, either look for the most accessible anatomical connection for reentry or be originated in the distal area and then reach the SSV.

  20. [Recommended diet for reflux spectrophotometry].

    Science.gov (United States)

    Felix, Valter Nilton; Viebig, Ricardo Guilherme

    2003-01-01

    The spectrophotometric probe, which uses bilirubin as a marker for the detection of duodenoesophagic reflux is subject to interference from strongly colored foods, which can cause erroneously high bilirubin absorbance readings. To overcome this problem it is necessary to ingest a diet that is free from such substances. To test the absorbance of 48 different food substances in an in vitro environment. Dry foods were blended with water or milk and non-dry solid foods were blended undiluted. It was utilized the proper calibration recipient to test them. The absorbance of weakly colored foods was usually lesser than the commonly accepted threshold of 0.14, and the absorbance of strongly colored foods was usually above this. Thirty-two from the 48 substances tested are suitable when the absorbance threshold is set at 0.14, but scrambled eggs, lacteous flour mush, green beans, beetroot, carrot, chayote, squash, "baroa" potato, boiled corn, orange, cashew, purple grape, avocado, mango, papaya and peach can alter the results and must be avoided. From the foods evaluated, enough are suitable at the 0.14 threshold to enable a suitable diet to be constructed for most patients during Bilitec studies.

  1. Bladder Dysfunction and Vesicoureteral Reflux

    Directory of Open Access Journals (Sweden)

    Ulla Sillén

    2008-01-01

    Full Text Available In this overview the influence of functional bladder disturbances and of its treatment on the resolution of vesicoureteral reflux (VUR in children is discussed. Historically both bladder dysfunction entities, the overactive bladder (OAB and the dysfunctional voiding (DV, have been described in conjunction with VUR. Treatment of the dysfunction was also considered to influence spontaneous resolution in a positive way. During the last decades, however, papers have been published which could not support these results. Regarding the OAB, a prospective study with treatment of the bladder overactivity with anticholinergics, did not influence spontaneous resolution rate in children with a dysfunction including also the voiding phase, DV and DES (dysfunctional elimination syndrome, most studies indicate a negative influence on the resolution rate of VUR in children, both before and after the age for bladder control, both with and without treatment. However, a couple of uncontrolled studies indicate that there is a high short-term resolution rate after treatment with flow biofeedback. It should be emphasized that the voiding phase dysfunctions (DV and DES are more severe than the genuine filling phase dysfunction (OAB, with an increased frequency of UTI and renal damage in the former groups. To be able to answer the question if treatment of bladder dysfunction influence the resolution rate of VUR in children, randomized controlled studies must be performed.

  2. Management of gastroesophageal reflux disease.

    Science.gov (United States)

    Tutuian, Radu; Castell, Donald O

    2003-11-01

    Gastroesophageal reflux disease (GERD) is a chronic condition requiring long-term treatment. Simple lifestyle modifications are the first methods employed by patients and, because of their low cost and simplicity, should be continued even when more potent therapies are initiated. Potent acid-suppressive therapy is currently the most important and successful medical therapy. Whereas healing of the esophageal mucosa is achieved with a single dose of any proton pump inhibitor (PPI) in more than 80% of cases, symptoms are more difficult to control. Patients with persistent symptoms on therapy should be tested (preferably with combined multichannel intraluminal impedance and pH) for association of symptoms with acid, nonacid, or no GER. Long-term follow-up studies indicate that PPIs are efficacious, tolerable, and safe medication. So far, promotility agents have shown limited efficacy, and their side-effect profile outweighs their benefits. Antireflux surgery in carefully selected patients (ie, young, typical GERD symptoms, abnormal pH study, and good response to PPI) is as effective as PPI therapy and should be offered to these patients as an alternative to medication. Still, patients should be informed about the risks of antireflux surgery (ie, risk of postoperative dysphagia; decreased ability to belch, possibly leading to bloating; increased flatulence). Endoscopic antireflux procedures are recommended only in selected patients and given the relative short experience with these techniques, patients treated with endoscopic procedures should be enrolled in a rigorous follow-up program.

  3. Relationship between acid pocket and acid reflux in gastroesophageal reflux disease

    Institute of Scientific and Technical Information of China (English)

    姚东英

    2014-01-01

    Objective To explore the relationship between acid pocket and acid reflux in gastroesophageal reflux disease(GERD).Methods From March 2011 to January 2012,29 patients with GERD were enrolled and nine healthy individuals were set as control.All objects of this study accepted esophageal manometry test,acid pocket test,test of the occurrence time of acid pocket and ambulatory

  4. Effect of coffee on gastro-oesophageal reflux in patients with reflux disease and healthy controls

    NARCIS (Netherlands)

    Boekema, PJ; Samsom, M; Smout, AJP

    1999-01-01

    Background Many patients with gastro-oesophageal reflux disease (GORD) report that coffee aggravates their symptoms and doctors tend to discourage its use in GORD. Objective To assess the effect of coffee ingestion on gastro-oesophageaI acid reflux. Design A randomized, controlled, crossover study.

  5. Gastro-oesophageal Reflux Disease: An Update

    Directory of Open Access Journals (Sweden)

    T Murphy

    2015-09-01

    Full Text Available Gastro-oesophageal reflux disease (GERD is a disorder in which reflux of stomach contents causes troublesome symptoms and/or complications and which affects health-related quality of life. It is one of the commonest disorders and appears to be increasing in incidence. The mechanisms leading to reflux are complex and multifactorial. The lower oesophageal sphincter (LES is an important part of the gastro-oesophageal barrier. Transient LES relaxations (TLESRs lead to reflux as these vagally mediated motor patterns cause relaxation of the LES and also result in oesophageal shortening and inhibition of the crural diaphragm. Heartburn and regurgitation are the characteristic symptoms of GERD. A clinical diagnosis of GERD can be made with typical symptoms. Oesophagitis is seen in a minority of patients with GERD. Lifestyle modification is widely advocated for patients with GERD. For short-term relief of symptoms of mild GERD, antacids/alginates are frequently used but they do not heal oesophagitis. Both histamine 2 receptor antagonists (H2RA and proton pump inhibitors (PPI have been shown to heal and prevent relapse of oesophagitis, although PPIs have been shown to be superior. The PPIs are the recommended first-line therapy for erosive oesophagitis and initial management of non-erosive reflux disease. Maintenance PPI therapy should be given to patients with oesophagitis, those who have recurrence of symptoms after discontinuation of medication and for those with complications of GERD.

  6. Gene expression in Barrett's esophagus and reflux esophagitis induced by gastroduodenoesophageal reflux in rats

    Institute of Scientific and Technical Information of China (English)

    Peng Cheng; Jun Gong; Tao Wang; Chen Jie; Gui-Sheng Liu; Ru Zhang

    2005-01-01

    AIM: To investigate the difference of gene expression profiles between Barrett's esophagus and reflux esophagitis induced by gastroduodenoesophageal reflux in rats.METHODS: Eight-week-old Sprague-Dawley rats were treated esophagoduodenostomy to produce gastroduodenoesophageal reflux, and another group received sham operation as control. Esophageal epithelial tissues were dissected and frozen in liquid nitrogen immediately for pathology 40 wk after surgery. The expression profiles of 4 096 genes in reflux esophagitis and Barrett's esophagus tissues were compared with normal esophageal epithelium by cDNA microarray.RESULTS: Four hundred and forty-eight genes in Barrett'sesophagus were more than three times different from those in normal esophageal epithelium, including 312 up regulated and 136 down-regulated genes. Two hundred and thirty-twogenes in RE were more than three times different from those in normal esophageal epithelium, 90up-regulated and 142 down-regulated genes. Compared to reflux esophagitis, there were 214 up-regulated and 142 down-regulated genes in Barrett's esophagus. CONCLUSION: Esophageal epithelium exposed excessively to harmful ingredients of duodenal and gastric reflux can develop esophagitis and Barrett's esophagus gradually.The gene expression level is different between reflux esophagitis and Barrett's esophagus and the differentially expressed genes might be related to the occurrence and development of Barrett's esophagus and the promotion or progression in adenocarcinoma.

  7. Gastroesophageal Reflux Disease and Sleep Quality in a Chinese Population

    Directory of Open Access Journals (Sweden)

    Mei-Jyh Chen

    2009-01-01

    Conclusion: The present study highlights the adverse effect of gastroesophageal reflux on sleep, even in the absence of reflux symptoms. This finding has therapeutic implications in patients with silent erosive disease, and future trials are warranted.

  8. Gastroesophageal reflux diagnosed by occlusal splint tintion.

    Science.gov (United States)

    Cebrián-Carretero, José Luis; López-Arcas-Calleja, José María

    2006-01-01

    The gastroesophageal reflux (GER) disease is a very frequent digestive disorder, mainly characterised by the reflux of the gastric acidic content to the esophage in abnormal quantities. There are different situations that favour this situation but almost in all of them rely an incompetence of the esophagic sphincter. The clinical consequences are many, including oral manifestations. Among all of them the most frequent is the esophagitis followed by symptoms at the pharynx or larynx and finally, the oral cavity. At this level fundamentally we will find enamel and oral mucosa erosions. We report the case of a patient who was indirectly diagnosed of her esophague disease by the observation of the alterations in the occlusal splint induced by the gastric reflux. We review the literature concerning the above topic and its possible association with the miofascial syndrome.

  9. Helicobacter pylori and gastroesophageal reflux disease

    Directory of Open Access Journals (Sweden)

    Nigro Casimiro

    2008-07-01

    Full Text Available Abstract Background The nature of the relationship between Helicobacter pylori and reflux oesophagitis is still not clear. To investigate the correlation between Helicobacter pylori infection and GERD taking into account endoscopic, pH-metric and histopathological data. Methods Between January 2001 and January 2003 a prospective study was performed in 146 patients with GERD in order to determine the prevalence of Helicobacter pylori infection at gastric mucosa; further the value of the De Meester score endoscopic, manometric and pH-metric parameters, i.e. reflux episodes, pathological reflux episodes and extent of oesophageal acid exposure, of the patients with and without Helicobacter pylori infection were studied and statistically compared. Finally, univariate analysis of the above mentioned data were performed in order to evaluate the statistical correlation with reflux esophagitis. Results There were no statistically significant differences between the two groups, HP infected and HP negative patients, regarding age, gender and type of symptoms. There was no statistical difference between the two groups regarding severity of symptoms and manometric parameters. The value of the De Meester score and the ph-metric parameters were similar in both groups. On univariate analysis, we observed that hiatal hernia (p = 0,01, LES size (p = 0,05, oesophageal wave length (p = 0,01 and pathological reflux number (p = 0,05 were significantly related to the presence of reflux oesophagitis. Conclusion Based on these findings, it seems that there is no significant evidence for an important role for H. pylori infection in the development of GERD and erosive esophagitis. Nevertheless, current data do not provide sufficient evidence to define the relationship between HP and GERD. Further assessments in prospective large studies are warranted.

  10. The Mystery and Misery of Acid Reflux in Children

    Science.gov (United States)

    Davenport, Mike; Davenport, Tracy

    2006-01-01

    When a child is sick, parents want answers. They want to know what is wrong, what they can do, and how to get their child healthy--pronto. Regrettably, there are some puzzling illnesses affecting children that are surrounded by mystery. One of them is gastroesophageal reflux (GER), otherwise known as acid reflux--or "reflux" for short. Reflux…

  11. Disagreement between symptom-reflux association analysis parameters in pediatric gastroesophageal reflux disease investigation

    Institute of Scientific and Technical Information of China (English)

    Samuel; C; Lüthold; Mascha; K; Rochat; Peter; Bhler

    2010-01-01

    AIM: To assess the agreement within 3 commonly used symptom-reflux association analysis (SAA) parameters investigating gastroesophageal reflux disease (GERD) in infants. METHODS: Twenty three infants with suspected GERD were included in this study. Symptom index (SI), Symptom sensitivity index (SSI) and symptom association probability (SAP) related to cough and irritability were calculated after 24 h combined pH/multiple intraluminal impedance (MII) monitoring. Through defined cutoff values, SI, SSI and SAP...

  12. [Alginates in therapy for gastroesophageal reflux disease].

    Science.gov (United States)

    Avdeev, V G

    2015-01-01

    This article presents evidence of the prevalence of gastroesophageal reflux disease (GERD) and highlights its main treatment options. Among its medications, particular emphasis is laid on alginates and their main mechanisms of action are described. There is information on the efficacy of alginates, including the alginate-antacid Gaviscon Double Action, in treating GERD. Recommendations for how to administer these drugs are given.

  13. Reflux Laryngitis: Correlation between the Symptoms Findings and Indirect Laryngoscopy.

    Science.gov (United States)

    Silva, Carlos Eduardo Dilen da; Niedermeier, Bruno Taccola; Portinho, Fernando

    2015-07-01

    Introduction The indirect laryngoscopy has an important role in the characterization of reflux laryngitis. Although many findings are nonspecific, some strongly suggest that the inflammation is the cause of reflux. Objective The aim of this study was to evaluate the correlation between reflux symptoms and the findings of indirect laryngoscopy. Methods We evaluated 27 patients with symptoms of pharyngolaryngeal reflux disease. Results Laryngoscopy demonstrated in all patients the presence of hypertrophy of the posterior commissure and laryngeal edema. The most frequent symptoms were the presence of dry cough and foreign body sensation. Conclusion There was a correlation between the findings at laryngoscopy and symptoms of reflux.

  14. Experimental and theoretical study of reflux condensation

    Energy Technology Data Exchange (ETDEWEB)

    Bakke, Knut

    1997-12-31

    This thesis studies the separation of gas mixtures in a reflux condenser. also called a dephlegmator. Reflux condensation is separation of a gas mixture, in reflux flow with condensing liquid, under continuous heat removal. A numerical model of a dephlegmator for binary mixtures was developed. The model may readily be extended to multi-component mixtures, as the solution method is based on a matrix solver. Separation of a binary mixture in a reflux condenser test rig is demonstrated. The test facility contains a single-tube test section that was designed and built as part of the project. Test mixtures of propane and n-butane were used, and a total of 15 experiments are reported. Limited degree of separation was achieved due to limited heat transfer area and narrow boiling point range of the test mixture. The numerical model reproduces the experimental data within reasonable accuracy. Deviation between calculated and measured properties is less than 6% of the measured temperature and less than 5% of the measured flow rate. The model is based on mechanistic models of physical processes and is not calibrated or tuned to fit the experimental data. The numerical model is applied to a number of separation processes. These case studies show that the required heat transfer area increases rapidly with increments in top product composition (light component). Flooding limits the amount of reflux liquid. The dephlegmator is suitable for separation of feed mixtures that are rich in light components. The gliding temperature in the dephlegmation process enables utilization of top product as refrigerant, with subsequent energy saving as a result. 61 refs., 50 figs., 34 tabs.

  15. Vesicoureteral reflux in adults studied by computerized radionuclide cystography

    Energy Technology Data Exchange (ETDEWEB)

    Kinn, A.C.; Jacobsson, H.; Schnell, P.O. (Depts. of Urology Diagnostic Radiology and Hospital Physics, Karolinska Sjukhuset, Stockholm (Sweden))

    1991-01-01

    Direct radionuclide cystography in a computerized method as described by Willi and Treves was used in adults with recurrent pyelites but without evidence of obstruction. Reflux was observed in 15 out of 38 patients. In patients with neurogenic bladder dysfunction or megaureters, reflux began early during the bladder filling and attained higher volumes than in those with uncomplicated pyelitis, who has minor reflux appearing mainly during voiding. Bladder capacity and detrusor compliance were lower in patients with reflux than in those without reflux. The low radiation exposure in radionuclide cystography permits observation of the urodynamic course of urinary reflux and correlation to the intravesical volume and pressure. The method is sensitive, and minorl refluxed volumes can be detected. Radionuclide cystrography can therefore be recommended for checking or surgical results and for follow-up of patients with neurogenic bladder dysfunction. (au).

  16. Does Impaired Gallbladder Function Contribute to the Development of Barrett's Esophagus and Esophageal Adenocarcinoma?

    LENUS (Irish Health Repository)

    Nassr, Ayman O

    2011-06-01

    Esophageal adenocarcinoma is aetiologically associated with gastro-esophageal reflux, but the mechanisms responsible for the metaplasia-dysplasia sequence are unknown. Bile components are implicated. Impaired gallbladder function may contribute to duodenogastric reflux (DGR) and harmful GERD.

  17. Prevalence of bile reflux in gastroesophageal reflux disease patients not responsive to proton pump inhibitors

    Institute of Scientific and Technical Information of China (English)

    Luigi Monaco; Antonio Brillantino; Francesco Torelli; Michele Schettino; Giuseppe Izzo; Angelo Cosenza; Natale Di Martino

    2009-01-01

    AIM: To determine the prevalence and characteristics of bile reflux in gastroesophageal reflux disease (GERD) patients with persistent symptoms who are nonresponsive to medical therapy.METHODS: Sixty-five patients (40 male, 25 female;mean age, 50 ± 7.8 years) who continued to report symptoms after 8 wk of high-dose proton pump inhibitor (PPI) therapy, as well as 18 patients with Barrett's esophagus, were studied. All patients filled out symptom questionnaires and underwent endoscopy,manometry and combined pH-metry and bilimetry.RESULTS: There were 4 groups of patients: 22 (26.5%)without esophagitis, 24 (28.9%) grade A-B esophagitis,19 (22.8%) grade C-D and 18 (21.6%) Barrett's esophagus. Heartburn was present in 71 patients (85.5%) and regurgitation in 55 (66.2%), with 44 (53%)reporting simultaneous heartburn and regurgitation. The prevalence of pathologic acid reflux in the groups without esophagitis and with grades A-B and C-D esophagitis was 45.4%, 66.6% and 73.6%, respectively. The prevalence of pathologic bilirubin exposure in these 3 groups was 53.3%, 75% and 78.9%, respectively. The overall prevalence of bile reflux in non-responsive patients was 68.7%. Pathologic acid and bile reflux was observed in 22.7% and 58.1% of non-esophagitic patients and esophagitic patients, respectively.CONCLUSION: The high percentage of patients poorly responsive to PPI therapy may result from poor control of duodenogastroesophageal reflux. Many patients without esophagitis have simultaneous acid and bile reflux, which increases with increasing esophagitis grade.

  18. Different risk factors between reflux symptoms and mucosal injury in gastroesophageal reflux disease

    Directory of Open Access Journals (Sweden)

    Chung-Hsien Li

    2015-06-01

    Full Text Available Gastroesophageal reflux disease (GERD is diagnosed based on typical symptoms in clinical practice. It can be divided into two groups using endoscopy: erosive and nonerosive reflux disease (NERD. This study aims to determine the risk factors of reflux symptoms and mucosal injury. This was a two-step case-control study derived from a cohort of 998 individuals having the data of reflux disease questionnaire (RDQ and endoscopic findings. Those with minor reflux symptoms were excluded. The first step compared symptomatic GERD patients with healthy controls. The 2nd step compared patients with erosive esophagitis with healthy controls. In this study, the prevalence of symptomatic GERD and erosive esophagitis were 163 (16.3% and 166 (16.6%, respectively. A total of 507 asymptomatic individuals without mucosal injury of the esophagus on endoscopy were selected as healthy controls. Compared with healthy controls, multivariate analyses showed that symptomatic GERD patients had a higher prevalence of hypertriglyceridemia [odds ratio (OR, 1.83; 95% confidence interval (CI 1.13–2.96] and obesity (OR, 1.85; 95% CI 1.08–3.02. By contrast, male sex (OR, 2.24; 95% CI 1.42–3.52, positive Campylo-like organism (CLO test (OR, 0.56; 95% CI 0.37–0.84, and hiatus hernia (OR, 14.36; 95% CI 3.05–67.6 were associated with erosive esophagitis. In conclusion, obesity and hypertriglyceridemia were associated with reflux symptoms. By contrast, male sex, negative infection of Helicobacter pylori, and hiatus hernia were associated with mucosal injury. Our results suggested that risk factors of reflux symptoms or mucosal injury might be different in GERD patients. The underlying mechanism awaits further studies to clarify.

  19. The Histological and Immunohistochemical Aspects of Bile Reflux in Patients with Gastroesophageal Reflux Disease

    Directory of Open Access Journals (Sweden)

    Andreas Nakos

    2011-01-01

    Full Text Available Introduction. The pathogenesis of GERD is strongly related with mixed acid and bile reflux. Benign and malignant esophageal and gastric lesions have been associated with synergetic activity between those parameters. Bile reflux causes reactive gastropathy evaluated with Bile Reflux Index (BRI. The aim was to investigate if the sequence: bile reflux-intestinal metaplasia-GERD-esophagitis, is associated with apoptotic/oncogenetic disturbances. Materials/Methods. Fifteen asymptomatic subjects and 53 GERD patients underwent gastroscopy with biopsies. The specimens examined histologically and immunohistochemically for p53, Ki-67, Bax, and Bcl-2. Results. Elevated BRI score detected in 47% (25/53 of patients with GERD and in 13% (2/15 of controls (=0.02. Severe esophageal lesions were significantly more common in BRI (+ patients (14/25 compared to BRI (− ones (=0.0049. Immunohistochemical analysis did not show associations between BRI score and biomarker expression. Conclusions. Bile reflux gastropathy is associated with GERD severity, but not with oncogene expression or apoptotic discrepancies of the upper GI mucosa.

  20. The histological and immunohistochemical aspects of bile reflux in patients with gastroesophageal reflux disease.

    Science.gov (United States)

    Nakos, Andreas; Kouklakis, Georgios; Pitiakoudis, Michail; Zezos, Petros; Efraimidou, Eleni; Giatromanolaki, Alexandra; Polychronidis, Alexandros; Liratzopoulos, Nikolaos; Sivridis, Efthimios; Simopoulos, Konstantinos

    2011-01-01

    Introduction. The pathogenesis of GERD is strongly related with mixed acid and bile reflux. Benign and malignant esophageal and gastric lesions have been associated with synergetic activity between those parameters. Bile reflux causes reactive gastropathy evaluated with Bile Reflux Index (BRI). The aim was to investigate if the sequence: bile reflux-intestinal metaplasia-GERD-esophagitis, is associated with apoptotic/oncogenetic disturbances. Materials/Methods. Fifteen asymptomatic subjects and 53 GERD patients underwent gastroscopy with biopsies. The specimens examined histologically and immunohistochemically for p53, Ki-67, Bax, and Bcl-2. Results. Elevated BRI score detected in 47% (25/53) of patients with GERD and in 13% (2/15) of controls (P = 0.02). Severe esophageal lesions were significantly more common in BRI (+) patients (14/25) compared to BRI (-) ones (P = 0.0049). Immunohistochemical analysis did not show associations between BRI score and biomarker expression. Conclusions. Bile reflux gastropathy is associated with GERD severity, but not with oncogene expression or apoptotic discrepancies of the upper GI mucosa.

  1. Diagnostic Approach to Reflux in 2007

    Directory of Open Access Journals (Sweden)

    Sumit Dave

    2008-01-01

    Full Text Available There is ongoing controversy regarding the association between vesicoureteric reflux (VUR, recurrent urinary tract infections (UTI, and renal damage. Despite this, routine work up for VUR is still recommended after febrile UTI in most children. The present article reviews the indications and imaging modalities available for VUR diagnosis. Alternative newer techniques like MR cystography and voiding urosonography are discussed. The increasing evidence of the role of DMSA scans in managing children with VUR is highlighted.

  2. Esophageal sphincter device for gastroesophageal reflux disease.

    Science.gov (United States)

    Ganz, Robert A; Peters, Jeffrey H; Horgan, Santiago; Bemelman, Willem A; Dunst, Christy M; Edmundowicz, Steven A; Lipham, John C; Luketich, James D; Melvin, W Scott; Oelschlager, Brant K; Schlack-Haerer, Steven C; Smith, C Daniel; Smith, Christopher C; Dunn, Dan; Taiganides, Paul A

    2013-02-21

    Patients with gastroesophageal reflux disease who have a partial response to proton-pump inhibitors often seek alternative therapy. We evaluated the safety and effectiveness of a new magnetic device to augment the lower esophageal sphincter. We prospectively assessed 100 patients with gastroesophageal reflux disease before and after sphincter augmentation. The study did not include a concurrent control group. The primary outcome measure was normalization of esophageal acid exposure or a 50% or greater reduction in exposure at 1 year. Secondary outcomes were 50% or greater improvement in quality of life related to gastroesophageal reflux disease and a 50% or greater reduction in the use of proton-pump inhibitors at 1 year. For each outcome, the prespecified definition of successful treatment was achievement of the outcome in at least 60% of the patients. The 3-year results of a 5-year study are reported. The primary outcome was achieved in 64% of patients (95% confidence interval [CI], 54 to 73). For the secondary outcomes, a reduction of 50% or more in the use of proton-pump inhibitors occurred in 93% of patients, and there was improvement of 50% or more in quality-of-life scores in 92%, as compared with scores for patients assessed at baseline while they were not taking proton-pump inhibitors. The most frequent adverse event was dysphagia (in 68% of patients postoperatively, in 11% at 1 year, and in 4% at 3 years). Serious adverse events occurred in six patients, and in six patients the device was removed. In this single-group evaluation of 100 patients before and after sphincter augmentation with a magnetic device, exposure to esophageal acid decreased, reflux symptoms improved, and use of proton-pump inhibitors decreased. Follow-up studies are needed to assess long-term safety. (Funded by Torax Medical; ClinicalTrials.gov number, NCT00776997.).

  3. Gastroesophageal reflux disease and asthma in children.

    Science.gov (United States)

    Khoshoo, Vikram; Haydel, Robert; Saturno, Emilio

    2006-06-01

    Gastroesophageal reflux disease (GERD) occurs in about two thirds of children with asthma. It may simply represent a concomitant unrelated finding or it may be responsible for provoking or worsening asthma. GERD could also be a byproduct of asthma itself. In any case, aggressive treatment of GERD seems to improve asthma outcomes. GERD should be suspected in asthma patients who do not have any known risk factors or those who are becoming difficult to treat.

  4. Laryngopharyngeal Reflux: Diagnosis, Treatment, and Latest Research

    Directory of Open Access Journals (Sweden)

    Campagnolo, Andrea Maria

    2014-01-01

    Full Text Available Introduction Laryngopharyngeal reflux (LPR is a highly prevalent disease and commonly encountered in the otolaryngologist's office. Objective To review the literature on the diagnosis and treatment of LPR. Data Synthesis LPR is associated with symptoms of laryngeal irritation such as throat clearing, coughing, and hoarseness. The main diagnostic methods currently used are laryngoscopy and pH monitoring. The most common laryngoscopic signs are redness and swelling of the throat. However, these findings are not specific of LPR and may be related to other causes or can even be found in healthy individuals. Furthermore, the role of pH monitoring in the diagnosis of LPR is controversial. A therapeutic trial with proton pump inhibitors (PPIs has been suggested to be cost-effective and useful for the diagnosis of LPR. However, the recommendations of PPI therapy for patients with a suspicion of LPR are based on the results of uncontrolled studies, and high placebo response rates suggest a much more complex and multifactorial pathophysiology of LPR than simple acid reflux. Molecular studies have tried to identify biomarkers of reflux such as interleukins, carbonic anhydrase, E-cadherin, and mucin. Conclusion Laryngoscopy and pH monitoring have failed as reliable tests for the diagnosis of LPR. Empirical therapy with PPIs is widely accepted as a diagnostic test and for the treatment of LPR. However, further research is needed to develop a definitive diagnostic test for LPR.

  5. Radionuclide voiding cystography in intrarenal reflux detection

    Energy Technology Data Exchange (ETDEWEB)

    Rizzoni, G.; Perale, R.; Bui, F.; Pitter, M.; Pavanello, L.; Boscolo, R.; Passerini Glazel, G.; Macri, C.

    1986-01-01

    In order to evaluate the possibility of detecting intra-renal reflux (IRR) with a more sensitive procedure, 48 children with recurrent urinary tract infections underwent intravenous urography (IVU) and voiding cystourethrogram (VCU) using a solution containing contrast medium and sup(99m)Tc-sulfur colloid particles which are known to persist in the renal parenchyma for a long time. Scintigraphic images were taken at 5 and 20 hours after VCU. 18 children had no vesico-ureteral reflux, 11 showed unilateral and 19 bilateral VUR, which was therefore present in 49 renal units. Among the 49 renal refluxing units (RRUs) IRR was detected radiologically in 8; of these isotopic activity in the renal area was present in all 6 RRUs who were examined at 20 hours. Of the remaining 41 RRUs with no radiologically detectable IRR 24 were evaluated at 20 hours and 5 (21%) showed renal radioactivity. Renal scars were significantly more frequent in kidneys with radioisotopic activity at 20 hours. The results of this study indicate that radionuclide cystography using sup(99m)Tc-sulfur colloid is a reliable procedure for demonstrating IRR, and to this end is more sensitive than X-ray VCU. Radionuclide cystography with sulfur colloid particles should therefore be considered a simple and useful complementary procedure, which is more sensitive than X-ray VCU in the diagnosis and follow-up of IRR.

  6. Diagnosis and treatment of gastroesophageal reflux disease

    Institute of Scientific and Technical Information of China (English)

    Raul; Badillo; Dawn; Francis

    2014-01-01

    Gastroesophageal reflux disease(GERD) is a common disease with a prevalence as high as 10%-20% in the western world. The disease can manifest in various symptoms which can be grouped into typical,atypi-cal and extra-esophageal symptoms. Those with the highest specificity for GERD are acid regurgitation and heartburn. In the absence of alarm symptoms,these symptoms can allow one to make a presumptive diagnosis and initiate empiric therapy. In certain situations,further diagnostic testing is needed to confirm the diagnosis as well as to assess for complications or alternate causes for the symptoms. GERD complications include erosive esophagitis,peptic stricture,Barrett’s esophagus,esophageal adenocarcinoma and pulmonary disease. Management of GERD may involve lifestyle modification,medical therapy and surgical therapy. Life-style modifications including weight loss and/or head of bed elevation have been shown to improve esophageal pH and/or GERD symptoms. Medical therapy involves acid suppression which can be achieved with antacids,histamine-receptor antagonists or proton-pump inhibitors. Whereas most patients can be effectively managed with medical therapy,others may go on to require anti-reflux surgery after undergoing a proper pre-operative evaluation. The purpose of this review is to discuss the current approach to the diagnosis and treatment of gas-troesophageal reflux disease.

  7. Gastroesophageal Reflux and Idiopathic Pulmonary Fibrosis: A Review

    Directory of Open Access Journals (Sweden)

    Ahmed Fahim

    2011-01-01

    Full Text Available The histological counterpart of idiopathic pulmonary fibrosis is usual interstitial pneumonia, in which areas of fibrosis of various ages are interspersed with normal lung. This pattern could be explained by repeated episodes of lung injury followed by abnormal wound healing responses. The cause of the initiating alveolar epithelial injury is unknown, but postulated mechanisms include immunological, microbial, or chemical injury, including aspirated gastric refluxate. Reflux is promoted by low basal pressure in the lower oesophageal sphincter and frequent relaxations, potentiated by hiatus hernia or oesophageal dysmotility. In susceptible individuals, repeated microaspiration of gastric refluxate may contribute to the pathogenesis of IPF. Microaspiration of nonacid or gaseous refluxate is poorly detected by current tests for gastroesophageal reflux which were developed for investigating oesophageal symptoms. Further studies using pharyngeal pH probes, high-resolution impedance manometry, and measurement of pepsin in the lung should clarify the impact of reflux and microaspiration in the pathogenesis of IPF.

  8. Vesical-ureteral reflux in children; Reflux vesico-ureteral chez l`enfant

    Energy Technology Data Exchange (ETDEWEB)

    Desvignes, V.; Palcoux, J.B. [Hotel-Dieu, 63 - Clermont-Ferrand (France); Cochat, P. [Hopital Edouard-Herriot, 69 - Lyon (France)

    1995-12-31

    The vesical-ureteral reflux is the most frequent uropathy in children. The diagnosis is made by uretero-cystography, often after pyelonephritis, sometimes after ante-natal diagnosis from echographic abnormalities. Spontaneous recovery is possible in 50 to 80% of cases. This is especially true in grade 1, 2 and 3, however complications may occur. They are more frequent in the case of reflux nephropathy with a resulting risk of hypertension and chronic renal failure. The therapeutic choice is between the conservative management with urinary antiseptics ad the surgical treatment with ureters re-implantation or endoscopic treatment. The therapeutic indications take into account vesical-ureteral reflux grades, the child`s age, the associated diseases and the child`s and parents` compliance. (authors). 22 refs., 2 figs.

  9. Comparison between the Reflux Finding Score and the Reflux Symptom Index in the Practice of Otorhinolaryngology.

    Science.gov (United States)

    Nunes, Heloisa Sobreira; Pinto, José Antonio; Zavanela, Adma Roberta; Cavallini, André Freitas; Freitas, Gabriel Santos; Garcia, Fabiola Esteves

    2016-07-01

    The Gastroesophageal Reflux Disease has a prevalence of ∼12% of the urban population in Brazil. Koufman proposed the term to designate Laryngeal Pharyngeal Reflux (LPR) symptoms, signs or tissue damage resulting from aggression of the gastrointestinal contents in the upper aerodigestive tract. Belafsky et al proposed a score that points to inflammatory laryngeal signs through videolaryngoscopic findings, the Reflux Finding Score (RFS). Moreover, in 2002, they published the Reflux Symptom Index (RSI). The objective of this study is to provide a comparison between the Reflux Finding Score and the Reflux Symptom Index in the practice of Otorhinolaryngology. Our study involved a total of 135 patients who visited the Ear, Nose, and Throat (ENT) clinic Núcleo de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço de São Paulo between April 2014 and May 2015 with suspected LPR. We excluded nine patients and the study group was 126 patients. All patients were ranked by their RSI and RFS scores. The study group consisted of 126 patients (88 women and 38 men). Their main complaints were cough (40.4%), globus (21.4%), dysphonia (19.8%), throat clearing (15.8%), postnasal drip (3.17%), snoring (1.5%), dysphagia (1.5%), cacosmia (0.7%), and regurgitation (1.5%). The RSI ranges from 13 to 42 with a mean of 20.7 (SD = 6.67). The RFS ranged from 3 to 19 with a mean of 9.53 (SD = 2.64). The RSI and RFS can easily be included in ENT routines as objective parameters, with low cost and high practicality. Based on the clinical index, the specialist can evaluate the need for further tests.

  10. Renal Agenesis with Full Length Ipsilateral Refluxing Ureter

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    DilipKumar Pal

    2016-04-01

    Full Text Available Unilateral renal agenesis with vesicoureteral reflux in the ipsilateral full length ureter is a rare phenomenon. Herein we report a case of 10-year old boy who presented with recurrent urinary tract infections. No renal tissue was identified on left side in various imaging studies. Micturating cystourethrogram (MCUG showed left sided refluxing and blind ending ureter. Left ureterectomy was done because of recurrent UTI in the refluxing system.

  11. How many cases of laryngopharyngeal reflux suspected by laryngoscopy are gastroesophageal reflux disease-related?

    Institute of Scientific and Technical Information of China (English)

    Nicola de Bortoli; Andrea Nacci; Edoardo Savarino; Irene Martinucci; Massimo Bellini; Bruno Fattori; Linda Ceccarelli

    2012-01-01

    AIM:To investigate the prevalence of gastroesophageal reflux disease (GERD) in patients with a laryngoscopic diagnosis of laryngopharyngeal reflux (LPR).METHODS:Between May 2011 and October 2011,41 consecutive patients with laryngopharyngeal symptoms (LPS) and laryngoscopic diagnosis of LPR were empirically treated with proton pump inhibitors (PPIs) for at least 8 wk,and the therapeutic outcome was assessed through validated questionnaires (GERD impact scale,GIS; visual analogue scale,VAS).LPR diagnosis was performed by ear,nose and throat specialists using the reflux finding score (RFS) and reflux symptom index (RSI).After a 16-d wash-out from PPIs,all patients underwent an upper endoscopy,stationary esophageal manometry,24-h multichannel intraluminal impedance and pH (MII-pH) esophageal monitoring.A positive correlation between LPR diagnosis and GERD was supposed based on the presence of esophagitis (ERD),pathological acid exposure time (AET) in the absence of esophageal erosions (NERD),and a positive correlation between symptoms and refluxes (hypersensitive esophagus,HE).RESULTS:The male/female ratio was 0.52 (14/27),the mean age ± SD was 51.5 ± 12.7 years,and the mean body mass index was 25.7 ± 3.4 kg/m2.All subjects reported one or more LPS.Twenty-five out of 41 patients also had typical GERD symptoms (heartburn and/or regurgitation).The most frequent laryngoscopic findings were posterior laryngeal hyperemia (38/41),linear indentation in the medial edge of the vocal fold (31/41),vocal fold nodules (6/41) and diffuse infraglottic oedema (25/41).The GIS analysis showed that 10/41 patients reported symptom relief with PPI therapy (P < 0.05); conversely,23/41 did not report any clinical improvement.At the same time,the VAS analysis showed a significant reduction in typical GERD symptoms after PPI therapy (P < 0.001).A significant reduction in LPS symptoms.On the other hand,such result was not recorded for LPS.Esophagitis was detected in 2/41 patients

  12. Gastroesophageal reflux. Reflujo gastroesofágico.

    Directory of Open Access Journals (Sweden)

    Lauro A. Melo Aguilera

    2005-12-01

    Full Text Available Although many infants has smaller degrees of gastroesophageal reflux, it is recognized that 1:3,000 at 1:10,000 of they have a pathological or symptomatic reflux. Near 90% of children vomits during the first 6 weeks of life, due primarily to the physiologic immaturity of antireflux mechanism. However, in 60% of cases, reflux disappears before 18 months, even without treatment. 30% maintains the symptoms, becoming in pathological, and of them, 10% develops serious problems, around 5% esophagitis with stenosis and between the 1 to 5% the death related with aspiration. We presented the Good Clinical Practices Guideline for Portal hypertension, approved by consensus in the 4th National Good Clinical Practices Workshop in Pediatric Surgery (Las Tunas, Cuba, March, 2005

    Aunque muchos lactantes tienen grados menores de reflujo gastroesofágico, se reconoce que entre 1:3,000 a 1:10,000 tiene un reflujo patológico o sintomático. Cerca del 90 % de los niños vomita durante las primeras 6 semanas de vida, debido primariamente a la inmadurez fisiológica del mecanismo antirreflujo. Sin embargo, en el 60 % de los casos el reflujo desaparece antes de los 18 meses, incluso sin tratamiento. Un 30 % mantiene la sintomatología convirtiéndose en patológico, y de ellos, el 10 % desarrolla problemas serios, alrededor de un 5 % esofagitis con estenosis y entre el 1 y el 5 % la muerte relacionada con aspiración. Se presenta la Guía de Buenas Prácticas Clínicas para reflujo gastroesofágico, aprobada por consenso en el 4º Taller Nacional de Buenas Prácticas Clínicas en Cirugía Pediátrica (Las Tunas, marzo de 2005.

  13. Dietary guideline adherence for gastroesophageal reflux disease

    Science.gov (United States)

    2014-01-01

    Background Gastroesophageal reflux disease (GERD) is the most common gastrointestinal disease, and the cost of health care and lost productivity due to GERD is extremely high. Recently described side effects of long-term acid suppression have increased the interest in nonpharmacologic methods for alleviating GERD symptoms. We aimed to examine whether GERD patients follow recommended dietary guidelines, and if adherence is associated with the severity and frequency of reflux symptoms. Methods We conducted a population-based cross-sectional study within the Kaiser Permanente Northern California population, comparing 317 GERD patients to 182 asymptomatic population controls. All analyses adjusted for smoking and education. Results GERD patients, even those with moderate to severe symptoms or frequent symptoms, were as likely to consume tomato products and large portion meals as GERD-free controls and were even more likely to consume soft drinks and tea [odds ratio (OR) = 2.01 95% confidence interval (CI) 1.12-3.61; OR = 2.63 95% CI 1.24-5.59, respectively] and eat fried foods and high fat diet. The only reflux-triggering foods GERD patients were less likely to consume were citrus and alcohol [OR = 0.59; 95% CI: 0.35-0.97 for citrus; OR = 0.41 95% CI 0.19-0.87 for 1 + drink/day of alcohol]. The associations were similar when we excluded users of proton pump inhibitors. Conclusions GERD patients consume many putative GERD causing foods as frequently or even more frequently than asymptomatic patients despite reporting symptoms. These findings suggest that, if dietary modification is effective in reducing GERD, substantial opportunities for nonpharmacologic interventions exist for many GERD patients. PMID:25125219

  14. Vesicoureteral reflux: From prophylaxis to surgery

    Science.gov (United States)

    Blais, Anne-Sophie; Bolduc, Stéphane; Moore, Katherine

    2017-01-01

    Vesicoureteral reflux (VUR) is one of the most common pathologies encountered in pediatric urology. Better understanding of the evolution of VUR and new endoscopic surgical techniques in the last decades have led to major changes in the management of this pathology. However, the treatment algorithm remains complex and is composed of a wide variety of options, from active surveillance to surgical treatment. Herein, we propose to review treatment options for VUR in order to help clinicians make the right treatment decision for the right patient.

  15. Posterior urethral valves: relationship between vesicoureteral reflux and renal function.

    Science.gov (United States)

    Cozzi, Denis A; Morgante, Debora; Frediani, Simone; Iaconelli, Romina; Ceccanti, Silvia; Mele, Ermelinda; Cozzi, Francesco

    2011-05-01

    To investigate the relationship between renal function and vesicoureteral reflux before and after valve ablation in patients with posterior urethral valves. In these patients, back pressure may not be the only cause of renal damage. We conducted a retrospective review of 37 patients with valves consecutively treated between 1970 and 2002. Data were available for 31 patients, 19 of whom presented reflux at presentation. Grade of reflux was ascertained by voiding cystourethrography. Overall renal function was measured by serum creatinine, and split renal function was estimated by dimercaptosuccinic acid scan available for all patients but two. Before relief of obstruction, there was no correlation between split renal function and grade of reflux into 25 kidneys of the 17 patients (r = -.13; 95% CI, -.50 to .27; P = .51). High-grade reflux (grade IV-V) affected 6 of the 11 renal units, with split renal function >40% vs 11 of the 14 units with split renal function 40% vs 4 of the 14 units with split renal function <40% (P = .0005). The good renal function of more than half of the renal units with high-grade reflux at presentation, and the persistence of reflux mainly in nonfunctioning or poorly functioning kidneys after valve ablation, support the concept that in some patients with valves, reflux and renal damage are associated anomalies. Copyright © 2011 Elsevier Inc. All rights reserved.

  16. New insights into aerophagia, belching and gastro-oesophageal reflux

    NARCIS (Netherlands)

    Hemmink, G.J.M.

    2009-01-01

    Gastro-oesophageal reflux is a physiological phenomenon and occurs in every healthy subject approximately 40 times every day. Twenty percent of the general western population experiences reflux symptoms such as heartburn, regurgitation, and retrosternal pain at least once a week. Gastro-oesophageal

  17. Gastroesophageal reflux in children with recurrent abdominal pain.

    Science.gov (United States)

    van der Meer, S B; Forget, P P; Kuijten, R H; Arends, J W

    1992-02-01

    In this study we investigated the presence of gastroesophageal reflux in children with recurrent abdominal pain and its possible relationship to food intolerance-associated duodenal inflammation. Twenty-four-hour intra-esophageal pH monitoring, an endoscopic duodenal biopsy and a small bowel 51Cr-EDTA permeability test were performed in 25 children with recurrent abdominal pain. In 14 cases (56%) the pH monitoring was abnormal, pointing to the presence of pathological gastroesophageal reflux. Treatment of gastroesophageal reflux in the latter patients resulted in resolution or improvement of abdominal pain in 10 cases (71%). Gastroesophageal reflux did not appear to be associated with either intestinal permeability to 51Cr-EDTA or duodenal biopsy findings. We conclude that pathological gastroesophageal reflex is a frequent finding in children with recurrent abdominal pain, that it is unrelated to duodenal inflammation and that there might be a causal relationship between pathological gastroesophageal reflux and recurrent abdominal pain in children.

  18. Current Pharmacological Management of Gastroesophageal Reflux Disease

    Directory of Open Access Journals (Sweden)

    Yao-Kuang Wang

    2013-01-01

    Full Text Available Gastroesophageal reflux disease (GERD, a common disorder with troublesome symptoms caused by reflux of gastric contents into the esophagus, has adverse impact on quality of life. A variety of medications have been used in GERD treatment, and acid suppression therapy is the mainstay of treatment for GERD. Although proton pump inhibitor is the most potent acid suppressant and provides good efficacy in esophagitis healing and symptom relief, about one-third of patients with GERD still have persistent symptoms with poor response to standard dose PPI. Antacids, alginate, histamine type-2 receptor antagonists, and prokinetic agents are usually used as add-on therapy to PPI in clinical practice. Development of novel therapeutic agents has focused on the underlying mechanisms of GERD, such as transient lower esophageal sphincter relaxation, motility disorder, mucosal protection, and esophageal hypersensitivity. Newer formulations of PPI with faster and longer duration of action and potassium-competitive acid blocker, a newer acid suppressant, have also been investigated in clinical trials. In this review, we summarize the current and developing therapeutic agents for GERD treatment.

  19. Analytical Investigation of a Reflux Boiler

    Science.gov (United States)

    Simon, William E.; Young, Fred M.; Chambers, Terrence L.

    1996-01-01

    A thermal model of a single Ultralight Fabric Reflux Tube (UFRT) was constructed and tested against data for an array of such tubes tested in the NASA-JSC facility. Modifications to the single fin model were necessary to accommodate the change in radiation shape factors due to adjacent tubes. There was good agreement between the test data and data generated for the same cases by the thermal model. The thermal model was also used to generate single and linear array data for the lunar environment (the primary difference between the test and lunar data was due to lunar gravity). The model was also used to optimize the linear spacing of the reflux tubes in an array. The optimal spacing of the tubes was recommended to be about 5 tube diameters based on maximizing the heat transfer per unit mass. The model also showed that the thermal conductivity of the Nextel fabric was the major limitation to the heat transfer. This led to a suggestion that the feasibility of jacketing the Nextel fiber bundles with copper strands be investigated. This jacketing arrangement was estimated to be able to double the thermal conductivity of the fabric at a volume concentration of about 12-14%. Doubling the thermal conductivity of the fabric would double the amount of heat transferred at the same steam saturation temperature.

  20. Gallbladder carcinoma associated with pancreatobiliary reflux

    Institute of Scientific and Technical Information of China (English)

    Jin Kan Sai; Masafumi Suyama; Yoshihiro Kubokawa; Bunsei Nobukawa

    2006-01-01

    AIM: To detect the patients with and without pancreaticobiliary maljunction who had pancreatobiliary reflux with extremely high biliary amylase levels.METHODS: Ninety-six patients, who had diffuse thickness (>3 mm) of the gallbladder wall and were suspected of having a pancreaticobiliary maljunction on ultrasonography, were prospectively subjected to endoscopic retrograde cholangiopancreatography, and bile in the common bile duct was sampled. Among them,patients, who had extremely high biliary amylase levels (>10000 IU/L), underwent cholecystectomy, and the clinicopathological findings of those patients with and without pancreaticobiliary maljunction were examined.RESULTS: Seventeen patients had biliary amylase levels in the common bile duct above 10000 IU/L, including 11 with pancreaticobiliary maljunction and 6 without pancreaticobiliary maljunction. The occurrence of gallbladder carcinoma was 45.5% (5/11) in patients with pancreaticobiliary maljunction, and 50% (3/6) in those without pancreaticobiliary maljunction.CONCLUSION: Pancreatobiliary reflux with extremely high biliary amylase levels and associated gallbladder carcinoma could be identified in patients with and without pancreaticobiliary maljunction, and those patients might be detected by ultrasonography and bile sampling.

  1. Composite score of reflux symptoms in diagnosis of gastroesophageal reflux disease

    Institute of Scientific and Technical Information of China (English)

    Jin-Hai Wang; Jin-Yan Luo; Lei Dong; Jun Gong; Ai-Li Zuo

    2004-01-01

    AIM: To evaluate the significance of the composite score of reflux symptoms in the diagnosis of gastroesophageal reflux disease (GERD), and to determine the relationship of the composite score with reflux esophagitis (RE) and pathological gastroesophageal reflux (PGER).METHODS: Upper digestive endoscopy and /or 24-h esophageal pH monitoring were performed in 244 subjects.Of these, 54 were consecutive patients attending our clinic with symptoms suggestive of GERD, and 190 were randomly selected from 2532 respondents who participated in our previous general population-based study on GERD. A standardized questionnaire was used to classify both the frequency and severity of typical symptoms of GERD(heartburn, acid and food regurgitation) using a 4-score scale, and the composite score of main reflux symptoms(score index: SI, range from 0 to 18) were calculated for every subject. RE was diagnosed according to the SavaryMiller criteria. Subjects with abnormal pH-metry (DeMeester score more than 14.7) were considered to have PGER.GERD patients were defined as the subjects with RE and/or PGER.RESULTS: The sensitivity of SI in the diagnosis of GERD was inversely associated with SI, but the specificity tended to increase with increased SI. With the cut-off of 8, the SI achieved the highest accuracy of 70.0%, with a sensitivity of 78.6% and a specificity of 69.2% in diagnosing GERD,followed by the cut-off of 3, which had an accuracy of 62.1%,a sensitivity of 96.4% and a specificity of 34.6%. The prevalence of RE, PGER and GERD was strongly associated with increased SI (P<0.01), but there was no significant association between the severity of RE and SI (P>0.05).Among patients with RE, 69.2% had PGER, and 30.8%were confirmed to have negative findings of pH monitoring.Among patients with PGER, 52.9% were identified to have RE and 47.1% had negative endscopic findings in esophagus.CONCLUSION: According to the composite score of main reflux symptoms, the diagnosis of GERD can

  2. LINX(™) Reflux Management System: magnetic sphincter augmentation in the treatment of gastroesophageal reflux disease.

    Science.gov (United States)

    Bonavina, Luigi; DeMeester, Tom R; Ganz, Robert A

    2012-12-01

    Gastroesophageal reflux disease (GERD), commonly manifested by heartburn or regurgitation, is a chronic, progressive condition in which failed sphincter function allows the contents of the stomach to reflux into the esophagus, the airways and the mouth. Chronic GERD affects 10% of Western society. The majority of patients receive adequate relief from proton pump inhibitors, but up to 40% have incomplete relief of symptoms that cannot be addressed by increasing the dose of medications. The laparoscopic Nissen fundoplication is the surgical gold standard; however, the level of technical difficulty and its side effects have limited its use to less than 1% of the GERD population. These factors have contributed to the propensity of patients to persist with medical therapy, even when inadequate to control symptoms and complications of the disease. Consequently, a significant gap in the treatment continuum for GERD remains evident in current clinical practice. The LINX(™) Reflux Management System (Torax Medical) is designed to provide a permanent solution to GERD by augmenting the physiologic function of the sphincter barrier with a simple and reproducible laparoscopic procedure that does not alter gastric anatomy and can be easily reversed if necessary.

  3. Diagnosis of intrarenal reflux and its role in pathogenesis of reflux nephropathy in children

    Energy Technology Data Exchange (ETDEWEB)

    Fujimatsu, Akiko [Kurume Univ., Fukuoka (Japan). School of Medicine

    2000-06-01

    We compared newly developed radionuclide cystography with conventional contrast voiding cystography (VCG) with regard to their diagnostic usefulness of intrarenal reflux (IRR) in children. Based on the imaging findings, we assessed the role of IRR in the pathogenesis of reflux nephropathy (RN). Among the ureters which revealed IRR diagnosed by radionuclide cystography, 38.9% (7 out of 18 ureters) of the cases examined by VCG had IRR. In the case of VCG, the sensitivity and specificity of IRR detection were 33.3% and 100%, respectively. There was a statistical correlation between the presence/absence of IRR and vesicoureteral reflux (VUR). RN was significantly correlated with advanced grade of VUR associated with IRR. Among 9 kidneys of the subjects who had suffered from urinary tract infection (UTI) only once, IRR was detected in 33.3% (3/9) and RN in 66.7% (2/3). From these findings, conventional contrast VCG is considered not effective for the diagnosis of IRR. Moreover, it is suggested that VUR complicated with IRR is deeply associated with the development of RN. In addition, it is suggested that UTI might be related to the onset of IRR. (author)

  4. [Gastroesophageal reflux disease and respiratory disease].

    Science.gov (United States)

    Mattioli, G; Caffarena, P E; Battistini, E; Fregonese, B; Barabino, A; Jasonni, V

    1995-01-01

    The patients treated for oesophageal atresia present a correlation between the clinical sintomatology after recanalization characterized by disfagia, dispnea, recurrent cough, chronic pneumopaties and oesophageal anomalies. Where morphological alterations accounting for the presence of gastro-oesophageal reflux (GOR) were not evident, possible functional alterations of the motility were considered. The incidence of GOR was considerably high and, expression of a congenital alteration of the lower oesophageal sphincter and of oesophageal peristalsis, becomes even more severe due to further stretching of the gastro-esophageal junction. The authors underline that the early demonstration of histological changes, even before recanalization, and the motility disorders of the oesophagus have to be well studied, while the LES is normalized, in order to prevent and treat the possible appearance of the well-known complications of GOR.

  5. [Roxatidine acetate in therapy of reflux esophagitis].

    Science.gov (United States)

    Friedrich, P; Botzler, R; Mayershofer, R; Kriech, W

    1996-06-10

    A total of 3409 patients with gastro-oesophageal reflux disease were treated with roxatidine acetate. 60.7% of the patients received a daily dose of 2 x 75 mg roxatidine acetate, and the median duration of treatment was 5 weeks. Symptoms improved in about 90% of patients. For 1687 patients, endoscopic findings were available at the beginning and end of the treatment period. The overall endoscopic healing rate was 65.3%, and, depending on the initial finding (if), decreased from 92.9% (if: Savary-Miller stage I) to 67.5% (if: stage II), 40.7% (if: stage III), and to 22.5% (if: stage IV). Twenty-one patients experienced adverse events during the course of treatment, which, however, were either only minor or not related to the use of roxatidine acetate.

  6. Gastroesophageal Reflux in Children with Refractory Asthma

    Directory of Open Access Journals (Sweden)

    Alaa S. Deeb

    2010-07-01

    Full Text Available Objectives: To investigate the association between clinical and macroscopic findings of GER and severity of refractory asthma (statistical study.Methods: A prospective study in a university-based practice of 75 children who were diagnosed with refractory asthma because they exhibited no satisfactory response for at least three months of treatment. Medical history, physical examination, spirometrical measurements and prick skin test were conducted on all patients. Endoscopic and macroscopic evaluations for esophagitis were performed on all patients regardless of the presence of GER symptoms.Results: Endoscopy was done for 75 children with refractory asthma. GER was symptomatic in 65% of all patients with no statistical significance (p>0.05 and the most frequent symptom was abdominal pain (67%. The frequency of these symptoms was 50% in mild asthma, 58% in moderate asthma and 72% in severe asthma with no statistical significance (p>0.05. The frequency of macroscopic esophagitis was 71%, distributed in three asthmatic groups as in order of 75% in mild asthma, 58.3% in moderate asthma and 76.6% in severe asthma (p>0.05. Regarding the relationship between GER and nocturnal attacks or spasmodic cough, the frequency of the latest was 66.7%. The differences have no statistical significance regarding GER symptoms (p>0.05, but they are statistically significant regarding the reflux esophagitis (p<0.05. Also endoscopic reflux was as frequent as76.3% in non allergic patients, and this result is statistically significant (p<0.05.Conclusion: In spite of the fact that there was no relationship between the severity of asthma and the symptoms of GER, or its endoscopic findings, the frequency of GER in asthmatic children was higher than its frequency in other children.

  7. Long-term follow-up of reflux nephropathy in adults with vesicoureteral reflux - radiological and pathoanatomical analysis

    Energy Technology Data Exchange (ETDEWEB)

    Koehler, J.; Thysell, H.; Tencer, J. [Univ. Hospital, Lund (Sweden). Dept. of Nephrology; Forsberg, L.; Hellstroem, M. [Sahlgrenska Univ. Hospital, Goeteborg (Sweden). Dept. of Diagnostic Radiology

    2001-03-01

    Purpose: To study the long-term development of urographic renal morphology in adults with vesicoureteral reflux, to investigate the relationship between renal damage and reflux grade, and to analyse the association between the long-term urographic outcome and the occurrence of acute pyelonephritis and reflux during follow-up. The purpose was also to try to distinguish between acquired and developmental renal damage, based on analyses of renal histological specimens and urographic features, and to analyse associated congenital urogenital abnormalities and family history of reflux, reflux nephropathy, urological malformation or death from end-stage renal disease. Material and Methods: Renal damage was identified in 100 (83 women) of 115 adults, selected because of documented reflux. Eighty-seven patients had two urographies done (median interval 14.3 years). The extent and progression of renal damage were assessed and features of developmental renal damage were determined. Histological renal specimens were available in 23 patients with renal damage. Results and Conclusions: The extent of renal damage correlated positively with the severity of reflux. No renal damage developed during the follow-up in 45 previously undamaged kidneys and progression of renal damage was rare (4 of 120 previously damaged kidneys), despite persisting reflux in half of the cases and episodes of acute pyelonephritis during follow-up. Thus, repeated renal imaging is rarely justified in adults with reflux nephropathy. Histological examination showed 'chronic pyelonephritis' in all 23 cases and co-existing renal dysplasia in 1 case. The detailed urographic analysis did not reveal support for developmental renal damage. High frequencies of associated congenital urogenital abnormalities and of a positive family history were found. Thus, congenital and/or hereditary factors cannot be discarded as background factors for the development of renal damage.

  8. Synthesis of todorokite by refluxing process and its primary characteristics

    Institute of Scientific and Technical Information of China (English)

    FENG Xionghan; LIU Fan; TAN Wenfeng; LIU Xiangwen; HU Hongqing

    2004-01-01

    Single phase and well-crystallined todorokite were synthesized by heating and refluxing process from birnessite as a precursor. The average chemical composition of the synthesized todorokites by refluxing for 8 h and for 24 h was Mg0.19MnO2.11(H2O)1.15 and Mg0. 17-MnO2.10(H2O)0.88, respectively. The crystallinity of the todorokite increased and no other phase was produced with increasing refluxing period. The synthesized todorokites have the same morphologies and the similar structural characteristics with the natural todorokites and hydrothermally synthesized samples. The chemical compositions of the synthetic tordorokites by refluxing process are close to those of todorokites synthesized by hydrothermal process, except a higher average oxidation state of Mn for the former.

  9. Retrocaval ureter with vesicoureteric reflux, a very rare entity

    African Journals Online (AJOL)

    M.C. Arya

    2016-12-26

    Dec 26, 2016 ... The prob- lem is similar to pelviureteric junction obstruction and ipsilateral reflux. .... VUR is retrograde flow of urine from bladder into the ureter or pelvicalyceal ... MR urogram confirmed type 1 right retrocaval ureter on T-2.

  10. How to Approach Laryngopharyngeal Reflux: An Otolaryngology Perspective.

    Science.gov (United States)

    Dhillon, Vaninder K; Akst, Lee M

    2016-08-01

    In the otolaryngology practice, there is a rising concern with the current diagnosis and management of laryngopharyngeal reflux (LPR). The implication of LPR in many common head and neck symptoms, along with the rising cost of empiric therapy and no overall improvement in patient symptoms, has established a need to review what are indeed laryngopharyngeal complaints secondary to reflux and what are not. This article reviews the otolaryngologist's approach to LPR, the various ways diagnosis is made, and the guidelines that inform the current trends in otolaryngology management of LPR. The goal of this article is to recognize that reflux can be the cause of a variety of laryngopharyngeal complaints seen within an otolaryngology practice, but when empiric therapy does not improve symptoms, consideration should be given to other non-reflux causes.

  11. Hot-electron refluxing enhanced relativistic transparency of overdense plasmas

    CERN Document Server

    Yu, Yong; Chen, Zi-Yu; Wang, Jia-Xiang; Zhu, Wen-Jun

    2013-01-01

    A new phenomenon of enhancing the relativistic transparency of overdense plasmas by the influence of hot-electron refluxing has been found via particle-in-cell simulations. When a p-polarized laser pulse, with intensity below the self-induced-transparency (SIT) threshold, obliquely irradiates a thin overdense plasma, the initially opaque plasma would become transparent after a time interval which linearly relies on the thickness of the plasma. This phenomenon can be interpreted by the influence of hot-electron refluxing. As the laser intensity is higher than the SIT threshold, the penetration velocity of the laser in the plasma is enhanced when the refluxing is presented. Simulation data with ion motion considered is also consistent with the assumption that hot-electron refluxing enhances transparency. These results have potential applications in laser shaping.

  12. Gastroesophageal Reflux Disease in Children with Interstitial Lung Disease.

    Science.gov (United States)

    Dziekiewicz, M A; Karolewska-Bochenek, K; Dembiński, Ł; Gawronska, A; Krenke, K; Lange, J; Banasiuk, M; Kuchar, E; Kulus, M; Albrecht, P; Banaszkiewicz, A

    2016-01-01

    Gastroesophageal reflux disease is common in adult patients with interstitial lung disease. However, no data currently exist regarding the prevalence and characteristics of the disease in pediatric patients with interstitial lung disease. The aim of the present study was to prospectively assess the incidence of gastroesophageal reflux disease and characterize its features in children with interstitial lung disease. Gastroesophageal reflux disease was established based on 24 h pH-impedance monitoring (MII-pH). Gastroesophageal reflux episodes (GERs) were classified according to widely recognized criteria as acid, weakly acid, weakly alkaline, or proximal. Eighteen consecutive patients (15 boys, aged 0.2-11.6 years) were enrolled in the study. Gastroesophageal reflux disease was diagnosed in a half (9/18) of children. A thousand GERs were detected by MII-pH (median 53.5; IQR 39.0-75.5). Of these, 585 (58.5 %) episodes were acidic, 407 (40.7 %) were weakly acidic, and eight (0.8 %) were weakly alkaline. There were 637 (63.7 %) proximal GERs. The patients in whom gastroesophageal reflux disease was diagnosed had a significantly higher number of proximal and total GERs. We conclude that the prevalence of gastroesophageal reflux disease in children with interstitial lung disease is high; thus, the disease should be considered regardless of presenting clinical symptoms. A high frequency of non-acid and proximal GERs makes the MII-pH method a preferable choice for the detection of reflux episodes in this patient population.

  13. Quantitative assay for the detection of vesicoureteral reflux in childhood

    Energy Technology Data Exchange (ETDEWEB)

    Linden, A.; Schnippering, H.G.; Ritzl, F.

    1984-04-01

    Using a method in which the camera computer system is adjusted for the individual patient, a quantitative isotopic micturition cystourethrogram (Nuclear Cystogram) can be obtained with less radiation exposure for the patient and more sensitively compared to the equivalent X-ray micturition cysto-urethrogram. Less than 0,1 ml reflux urine can be measured and it can be determined whether reflux occurs during bladder filling or emptying.

  14. Vesicoureteric reflux: Evaluation by bladder volume graded direct radionuclide cystogram

    OpenAIRE

    Agrawal Vikesh; Rangarajan Venkatesh; Kamath Tejaswini; Borwankar S

    2009-01-01

    Aim : Evaluation of vesicoureteric reflux (VUR) in children by bladder volume graded direct radionuclide cystogram (BVG DRC). This technique allows detection of VUR at different bladder volume grades. Materials and Methods : In this prospective study, 33 patients (66 renal units) with suspected vesicoureteric reflux were subjected to a voiding cystourethrogram (VCUG) and BVG DRC. The patients were assessed further with radioisotope renal scans for renal cortical scars. Results : Twenty-two...

  15. Dental erosion caused by gastroesophageal reflux disease: a case report

    OpenAIRE

    Cengiz,Seda; Cengiz, M ?nan?; Sara?, Y ?inasi

    2009-01-01

    Introduction Chronic regurgitation of gastric acids in patients with gastroesophageal reflux disease may cause dental erosion, which can lead in combination with attrition or bruxism to extensive loss of coronal tooth tissue. Case presentation This clinical report describes treatment of severe tooth wear of a gastroesophageal reflux disease patient who is 54-year-old Turkish male patient. After his medical treatment, severe tooth wear, bruxism and decreased vertical dimensions were determined...

  16. A PROPOSITION FOR THE DIAGNOSIS AND TREATMENT OF GASTROESOPHAGEAL REFLUX DISEASE IN CHILDREN - A REPORT FROM A WORKING GROUP ON GASTROESOPHAGEAL REFLUX DISEASE

    NARCIS (Netherlands)

    VANDENPLAS, Y; ASHKENAZI, A; BELLI, D; BOIGE, N; BOUQUET, J; CADRANEL, S; CEZARD, JP; CUCCHIARA, S; DUPONT, C; GEBOES, K; GOTTRAND, F; HEYMANS, HSA; JASINSKI, C; KNEEPKENS, CMF; KOLETZKO, S; MILLA, P; MOUGENOT, JF; NUSSLE, D; NAVARRO, J; NEWELL, SJ; OLAFSDOTTIR, E; PEETERS, S; RAVELLI, A; POLANCO, [No Value; SANDHU, BK; TOLBOOM, J

    1993-01-01

    In this paper, a Working Group on Gastro-Oesophageal Reflux discusses recommendations for the first line diagnostic and therapeutic approach of gastro-oesophageal reflux disease in infants and children. All members of the Working Group agreed that infants with uncomplicated gastro-oesophageal reflux

  17. Pulmonary manifestations of gastroesophageal reflux disease

    Directory of Open Access Journals (Sweden)

    Gaude Gajanan

    2009-01-01

    Full Text Available Gastroesophageal reflux disease (GERD may cause, trigger or exacerbate many pulmonary diseases. The physiological link between GERD and pulmonary disease has been extensively studied in chronic cough and asthma. A primary care physician often encounters patients with extra esophageal manifestations of GERD in the absence of heartburn. Patients may present with symptoms involving the pulmonary system; noncardiac chest pain; and ear, nose and throat disorders. Local irritation in the esophagus can cause symptoms that vary from indigestion, like chest discomfort and abdominal pain, to coughing and wheezing. If the gastric acid reaches the back of the throat, it may cause a bitter taste in the mouth and/or aspiration of the gastric acid into the lungs. The acid can cause throat irritation, postnasal drip and hoarseness, as well as recurrent cough, chest congestion and lung inflammation leading to asthma and/or bronchitis/ pneumonia. This clinical review examines the potential pathophysiological mechanisms of pulmonary manifestations of GERD. It also reviews relevant clinical information concerning GERD-related chronic cough and asthma. Finally, a potential management strategy for GERD in pulmonary patients is discussed.

  18. Health economics of gastroesophageal reflux disease.

    Science.gov (United States)

    Sadowski, D; Champion, M; Goeree, R; Leddin, D; Otten, N; Morris, G; Beck, I; Faloon, T; Fedorak, R N

    1997-09-01

    The present study provides an overview of the current state of health economics studies of gastroesophageal reflux disease (GERD). It indicates the strengths and weaknesses of individual studies, and the state of health economics analysis in general as they apply to GERD. Specifically, this study adopts a pharmacoeconomic perspective, which is a subsection of health economics analytical methods, to provide a comparative analysis of alternative courses of action based on cost and consequence. The pharmacoeconomic outlook is most effective when it considers a comprehensive societal perspective, with special consideration given to other relevant viewpoints, such as the payer, the primary provider and, most important, the patient. Pharmacoeconomics provides several specific analytical techniques for GERD-related health economics analysis. The Canadian Association of Gastroenterology consensus conference on GERD in 1996 thought that a cost effective analysis was the most appropriate technique to assess the pharmacoeconomics of GERD. Six previous studies on GERD health economics have been performed comparing omeprazole with H2 receptor antagonists. These studies vary in cost data collected and in analytical techniques. In general, the existing outcome measurements of these previous health economics studies are not ideal. Namely, they combine various GERD grades, use randomized controls, are endoscopically based, assess pharmaceutical therapy only and are short term. More appropriate health economic trials in GERD, which focus on GERD management strategies and therapeutic treatment of GERD, need to be designed and conducted. These economic assessments, however, should not replace detailed thinking, careful observation, good judgement and common sense.

  19. Gastroesophageal reflux disease correlation with posterior laryngitis

    Directory of Open Access Journals (Sweden)

    Dimitrijević Milovan

    2009-01-01

    Full Text Available Background/Aim. Over the last years numerous studies have been performed dealing with mutual relations among gastroesophageal reflux disease (GERD and numerous diseases of the upper airways. The aim of the present study was to establish possible causal relationship between GERD and posterior laryngitis (PL. Methods. The study included 103 patients with gastrointestinal complaints. Diagnostic procedure included a medical history, gastroscopy and laryngeal directoscopy. The obtained data processed using classic methods of the descriptive statistics, as well as Pearson's chi-square test, Student's t test, rank sum test and Fisher's parametric analysis of variance. Results. Out of the total number of 103 examined patients, 33 (32% were diagnosed with PL, while GERD was diagnosed in five of the examined patients all belonging to the PL group (15% of the patients with PL. In the remaining patients, PL was caused by other factors. All the patients with GERD had PL and globus sensation while 80% of GERD patients had prominent symptom of pain. Conclusion. The results of the study are indicative of the causal relationship between GERD and PL.

  20. Biomarkers for Gastroesophageal Reflux in Respiratory Diseases

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    Össur Ingi Emilsson

    2013-01-01

    Full Text Available Gastroesophageal reflux (GER is commonly associated with respiratory symptoms, either through a vagal bronchoconstrictive reflex or through microaspiration of gastric contents. No diagnostic test is available, however, to diagnose when respiratory illnesses are caused by GER and when not, but research in this field has been moving forward. Various biomarkers in different types of biosamples have been studied in this context. The aim of this review is to summarize the present knowledge in this field. GER patients with respiratory diseases seem to have a different biochemical profile from similar patients without GER. Inflammatory biomarkers differ in asthmatics based on GER status, tachykinins are elevated in patients with GER-related cough, and bile acids are elevated in lung transplant patients with GER. However, studies on these biomarkers are often limited by their small size, methods of analysis, and case selections. The two pathogenesis mechanisms are associated with different respiratory illnesses and biochemical profiles. A reliable test to identify GER-induced respiratory disorders needs to be developed. Bronchoalveolar lavage is too invasive to be of use in most patients. Exhaled breath condensate samples need further evaluation and standardization. The newly developed particles in exhaled air measurements remain to be studied further.

  1. Gastroesophageal Reflux Disease: Medical or Surgical Treatment?

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    Theodore Liakakos

    2009-01-01

    Full Text Available Background. Gastroesophageal reflux disease is a common condition with increasing prevalence worldwide. The disease encompasses a broad spectrum of clinical symptoms and disorders from simple heartburn without esophagitis to erosive esophagitis with severe complications, such as esophageal strictures and intestinal metaplasia. Diagnosis is based mainly on ambulatory esophageal pH testing and endoscopy. There has been a long-standing debate about the best treatment approach for this troublesome disease. Methods and Results. Medical treatment with PPIs has an excellent efficacy in reversing the symptoms of GERD, but they should be taken for life, and long-term side effects do exist. However, patients who desire a permanent cure and have severe complications or cannot tolerate long-term treatment with PPIs are candidates for surgical treatment. Laparoscopic antireflux surgery achieves a significant symptom control, increased patient satisfaction, and complete withdrawal of antireflux medications, in the majority of patients. Conclusion. Surgical treatment should be reserved mainly for young patients seeking permanent results. However, the choice of the treatment schedule should be individualized for every patient. It is up to the patient, the physician and the surgeon to decide the best treatment option for individual cases.

  2. LINX(®) Reflux Management System in chronic gastroesophageal reflux: a novel effective technology for restoring the natural barrier to reflux.

    Science.gov (United States)

    Bonavina, Luigi; Saino, Greta; Lipham, John C; Demeester, Tom R

    2013-07-01

    Gastroesophageal reflux disease (GERD) results from incompetency of the lower esophageal sphincter that allows the contents of the stomach to reflux into the esophagus, the airways, and the mouth. The disease affects about 10% of the western population and has a profound negative impact on quality of life. The majority of patients are successfully treated with proton-pump inhibitors, but up to 40% have incomplete relief of symptoms even after dose adjustment. The laparoscopic Nissen fundoplication represents the surgical gold standard, but is largely underused because of the level of technical difficulty and the prevalence of side effects. These factors have contributed to the propensity of patients to continue with medical therapy despite inadequate symptom control and complications of the disease. As a consequence, a significant 'therapy gap' in the treatment of GERD remains evident in current clinical practice. The LINX(®) Reflux Management System (Torax Medical, St. Paul, MN, USA) is designed to provide a permanent solution to GERD by augmenting the sphincter barrier with a standardized, reproducible laparoscopic procedure that does not alter gastric anatomy and is easily reversible. Two single-group trials confirmed that a magnetic device designed to augment the lower esophageal sphincter can be safely and effectively implanted using a standard laparoscopic approach. The device decreased esophageal acid exposure, improved reflux symptoms and quality of life, and allowed cessation of proton-pump inhibitors in the majority of patients.

  3. Clinical pathology of primary bile reflux gastritis

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    Ping YAO

    2011-05-01

    Full Text Available Objective To analyze the clinical and pathological features of primary bile reflux gastritis(BRG.Methods Endoscopy,Helicobacter pylori(H.pylori detection,and histopathologic examination were performed in 218 patients with primary BRG(observed group and 236 patients with simple chronic gastritis(SCG,control group as identified by gastroscope in order to analyze the endoscopic abnormalities,the frequency of H.pylori infection,pathological features and scores of inflammation.Results The frequency of H.pylori infection was 39.0%(85/218 in the observed group,which was significantly lower than that in the control group [52.1%(123/236].The topographic abnormalities of the antral mucosa as detected by gastroscopy,i.e.,congestion,hemorrhagic spots,erosion were not significantly different between BRG and SCG patients(P > 0.05.The scores of chronic and active inflammation were higher in patients when H.pylori infection was present than in patients without H.pylori infection in both groups(P < 0.05.The scores of inflammation,the detection rates of the antral intestinal metaplasia,antral atrophy and atypical hyperplasia were all higher in observed group than in control group(P < 0.05.The incidence of lengthening of gastric pits,telangiectasis or interstitial edema in BRG patients was also significantly higher than those in SCG patients(P < 0.05.Conclusions Primary BRG shows features of chemical gastritis with a higher tendency toward mucosal atrophy,intestinal metaplasia and atypical hyperplasia.Gastropic examination and biopsy should be emphasized.

  4. The evaluation of gastroesophageal reflux before and after medical therapies

    Energy Technology Data Exchange (ETDEWEB)

    Malmud, L.S.; Fisher, R.S.

    1981-07-01

    Gastroesophageal scintigraphy is a quantitative technique that can be employed to detect and quantitate gastroesophageal reflux before and after the application of therapeutic modalities, including change in body position, bethanechol, atropine, antacids, and antacid-alginate compounds. Five groups of 10-15 patients each were studied before and after using each therapeutic modality and before and after atropine. The results were compared to the patient's symptomatology and to the acid reflux test. Gastroesophageal scintigraphy was performed following oral administration of 300 microCi 99mTc-sulfur colloid in 300 ml acidified orange juice. Thirty-second gamma camera images were obtained as the gastroesophageal gradient was increased from approximately 10 to 35 mm Hg at 5 mm Hg increments using an inflatable abdominal binder. Data were processed using a digital computer. Reflux was reduced by change in position from recumbent to upright, and by the use of subcutaneous bethanechol, oral antacid, or oral antacidalginate compound. Atropine increased reflux. Gastroesophageal scintigraphy is more sensitive than fluoroscopy, correlates well with clinical symptomatology, and is a reliable and convenient technique for the quantitative estimation of reflux before and after therapy.

  5. Gastroesophageal reflux disease: A review of surgicaldecision making

    Institute of Scientific and Technical Information of China (English)

    2016-01-01

    Gastroesophageal reflux disease (GERD) is a verycommon disorder with increasing prevalence. It isestimated that up to 20%-25% of Americans experiencesymptoms of GERD weekly. Excessive reflux ofacidic often with alkaline bile salt gastric and duodenalcontents results in a multitude of symptoms for thepatient including heartburn, regurgitation, cough, anddysphagia. There are also associated complications ofGERD including erosive esophagitis, Barrett's esophagus,stricture and adenocarcinoma of the esophagus. Whilefirst line treatments for GERD involve mainly lifestyleand non-surgical therapies, surgical interventions haveproven to be effective in appropriate circumstances.Anti-reflux operations are aimed at creating an effectivebarrier to reflux at the gastroesophageal junction andthus attempt to improve physiologic and mechanicalissues that may be involved in the pathogenesis ofGERD. The decision for surgical intervention in thetreatment of GERD, moreover, requires an objectiveconfirmation of the diagnosis. Confirmation is achievedusing various preoperative evaluations includingambulatory pH monitoring, esophageal manometry,upper endoscopy (esophagogastroduodenoscopy) andbarium swallow. Upon confirmation of the diagnosisand with appropriate patient criteria met, an antirefluxoperation is a good alternative to prolongedmedical therapy. Currently, minimally invasive gastroesophagealfundoplication is the gold standard forsurgical intervention of GERD. Our review outlines themany factors that are involved in surgical decisionmaking.We will review the prominent features thatreflect appropriate anti-reflux surgery and presentsuggestions that are pertinent to surgical practices,based on evidence-based studies.

  6. A Study on the Relationship between Reflux Esophagitis and Periodontitis.

    Science.gov (United States)

    Adachi, Kyoichi; Mishiro, Tomoko; Tanaka, Shino; Yoshikawa, Hiroo; Kinoshita, Yoshikazu

    2016-01-01

    Objective Metabolic syndrome and dental erosion have been demonstrated to correlate with gastroesophageal acid reflux disease (GERD), while periodontitis has been reported to have a positive relationship with metabolic syndrome. However, no correlation between periodontitis and GERD has yet been reported. We therefore investigated the relationship between periodontitis and GERD. Methods The subjects consisted of 280 individuals who visited the Health Center for a detailed medical checkup examination. Each underwent upper endoscopy and periodontitis examinations, with the latter performed by measuring the concentrations of lactate dehydrogenase and hemoglobin in saliva. The subjects were divided into those with positive and negative periodontitis findings, and the prevalence rates of endoscopically proven reflux esophagitis, dyslipidemia, hypertension, and hyperglycemia were compared. Results The number of subjects positive for periodontitis was 93, while 187 had negative findings. The prevalence of reflux esophagitis was not different between the positive and negative groups (8.6% vs. 8.0%). In addition, a multiple logistic regression analysis did not identify a positive relationship between the presence of periodontitis and reflux esophagitis. On the other hand, dyslipidemia and hypertension were more frequently observed in the subjects that were positive for periodontitis. Conclusion We did not find an association between periodontitis and reflux esophagitis in the present study. On the other hand, the presence of periodontitis was found to correlate with hypertension and dyslipidemia.

  7. Is ineffective esophageal motility associated with gastropharyngeal reflux disease?

    Institute of Scientific and Technical Information of China (English)

    Kyung Yup Kim; Gwang Ha Kim; Dong Uk Kim; Soo Geun Wang; Byung Joo Lee; Jin Choon Lee; Do Youn Park; Geun Am Song

    2008-01-01

    AIM: To evaluate the association between IEM and gastropharyngeal reflux disease (GPRD) in patients who underwent ambulatory 24-h dual-probe pH monitoring for the evaluation of supraesophageal symptoms.METHODS: A total of 632 patients who underwent endoscopy, esophageal manometry and ambulatory 24-h dual-pH monitoring due to supraesophageal symptoms (e.g. globus, hoarseness, or cough) were enrolled. Of them, we selected the patients who had normal esophageal motility and IEM. The endoscopy and ambulatory pH monitoring findings were compared between the two groups.RESULTS: A total of 264 patients with normal esophageal motility and 195 patients with the diagnosis of IEM were included in this study. There was no difference in the frequency of reflux esophagitis and hiatal hernia between the two groups. All the variables showing gastroesophageal reflux and gastropharyngeal reflux were not different between the two groups. The frequency of GERD and GPRD, as defined by ambulatory pH monitoring, was not different between the two groups.CONCLUSION: There was no association between IEM and GPRD as well as between IEM and GERD. IEM alone cannot be considered as a definitive marker for reflux disease.

  8. Comparison of Endoscopic Findings with Gastroesophageal Reflux Disease Questionnaires (GerdQ and Reflux Disease Questionnaire (RDQ for Gastroesophageal Reflux Disease in Medan

    Directory of Open Access Journals (Sweden)

    Gontar Alamsyah Siregar

    2015-12-01

    Full Text Available ABSTRACT Background: There are many questionnaires that have been developed to diagnose gastroesophageal reflux disease (GERD, i.e. reflux disease questionnaire (RDQ, and the recently developed, gastroesophageal reflux disease questionnaires (GerdQ. In this study, we tried to compare GerdQ and RDQ in terms of sensitivity and specificity to diagnose GERD and its relationship with endoscopic findings. Method: This study was a cross sectional analytical study. Subsequently, all the subjects were evaluated using the GerdQ and RDQ, then underwent esophagogastroduodenoscopy examination. The severity of endoscopically observed reflux esophagitis was graded with the Los Angeles classification. All endoscopy was performed by well-trained doctor. Results: A total of 85 patients were examined, 34 (40% patients had reflux esophagitis at endoscopy examination, including 15 (44.1% cases of grade A, 11 (32.3% cases of grade B, 4 (11.8% cases of grade C, and 4 (11.8% cases of grade D. Analysis study using sensitivity, specificity, and receiver operating characteristic (ROC test showed that GerdQ had sensitivity (49%, specificity (91%, and an area under the ROC of 0.701 (p value = 0.002. RDQ had sensitivity (24%, specificity (91%, and an area under the ROC of 0.574 (p value = 0.253. Taking 11 as the cut off point for GerdQ, a maximal sensitivity of 73.5%, specificity of 82.4%, and an area under the ROC of 0.779 was achieved. Conclusion: GerdQ and RDQ can be used to help diagnose GERD, but GerdQ is more superior than RDQ in diagnosing GERD. A multi-center study with larger samples is needed to determine the best GerdQ’s cut off point in Indonesia.

  9. Risk factors for gastroesophageal reflux disease, reflux esophagitis and non-erosive reflux disease among Chinese patients undergoing upper gastrointestinal endoscopic examination

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    AIM: To analyze the spectrum and risk factors of gastroesophageal reflux disease (GERD) based on presenting symptoms and endoscopic findings. METHODS: A cross-sectional survey in a cluster random sample was conducted from November 2004 to June 2005 using a validated Chinese version Reflux Disease Questionnaire (RDQ) and other items recording the demographic characteristics and potential risk factors for GERD. Subjects were defined as having GERD symptoms according to the RDQ score (>12). All subjects were endoscopied and the definition and severity of erosive esephagitis were evaluated by Los Angeles classification.The statistical analysis was performed with SPSS13.0 programs. RESULTS: Of 2231 recruited participants, 701 (31.40%) patients were diagnosed as having GFRD while 464 (20.80%) patients had objective findings of reflux esophagitis (RE). Of those 464 patients, only 291 (13.00%) were reported as subjects with GERD symptoms. A total of 528 (23.70%) patients were found to have GERD symptoms, including 19.50% patients with grade A or B reflux esophagitis, 0.90% with grade C and 0.40% with grade D. On multivariate analysis, old age,male, moderate working burden, divorced/widowed and strong tea drinking remained as significant independent risk factors for erosive esophagitis. Meanwhile, routine usage of greasy food and constipation were considered as significant independent risk factors for non-erosive reflux disease (NERD).CONCLUSION: GERD is one of the common GI diseases with a high occurrence rate in China and its main associated factors include sex, anthropometrical variables and sociopsychological characteristics.

  10. Features of Motor and Secretory Disorders in Gastroesophageal Reflux Disease in Young Patients with Concomitant Obesity

    Directory of Open Access Journals (Sweden)

    O.A. Oparin

    2015-09-01

    Materials and Results of the Study. The study included 50 patients with gastroesophageal reflux disease, they we divided into 2 groups, depending on the presence of concomitant obesity. The first group included patients with gastroesophageal reflux disease and concomitant obesity, the second one — patients with gastroesophageal reflux disease without comorbidity. Control group consisted of 20 apparently healthy individuals. The study found that patients with gastroesophageal reflux disease and concomitant obesity had severe motor disturbances which were evaluated using ultrasound study (there were evaluated the diameter of esophageal hiatus, the thickness of esophageal wall, esophageal lumen width in the lower third, as well as the presence or absence of reflux, and were in close correlation with specific clinical manifestations of gastroesophageal reflux disease, measured by GERDQ questionnaires (international questionnaires for the diagnosis of gastroesophageal reflux disease compared with the group of patients with gastroesophageal reflux disease without comorbidity.

  11. Oesophagitis, signs of reflux, and gastric acid secretion in patients with symptoms of gastro-oesophageal reflux disease

    Energy Technology Data Exchange (ETDEWEB)

    Johansson, K.E.; Ask, P.; Boeryd, B.; Fransson, S.G.; Tibbling, L.

    1986-01-01

    In a study comprising 100 patients referred to a surgical clinic with symptons suggestive of gastro-oesophageal reflux disease, the value of different diagnostic procedures was investigated. Positive acid perfusion and 24-h pH tests were the commonest findings. Forty-nine per cent showed normal oesophageal mucosa or diffuse oesophagitis at endoscopy. The severity of heartburn and regurgitation did not differ between patients with normal oesophageal mucosa and oesophagitis of various severities. The severity of macroscopic oesophagitis was significantly corelated to the total reflux time, the presence of reflux or a hiatal hernia at radiology, an open cardia or reflux at endoscopy, pressure transmission or reflux, and low lower oesophageal sphincter pressure at manometry. Gastric hypersecretion was found in 66% of the patients. Gastric acid secretion was not correlated to the severity of oesophagitis or to the findings at 24-h pH test. In patients with severe oesophagitis the sensivity for radiologic, manometric and endoscopic signs of incompetence of the gastro-oesophageal junction was 94%.

  12. [Gastro-esophageal reflux and chronic respiratory diseases].

    Science.gov (United States)

    Dirou, S; Germaud, P; Bruley des Varannes, S; Magnan, A; Blanc, F-X

    2015-12-01

    Gastroesophageal reflux disease (GERD) frequently occurs in association with chronic respiratory diseases although the casual link is not always clear. Several pathophysiological and experimental factors are considered to support a role for GERD in respiratory disease. Conversely, respiratory diseases and bronchodilator treatment can themselves exacerbate GERD. When cough or severe asthma is being investigated, GERD does not need to be systematically looked for and a therapeutic test with proton pump inhibitors is not always recommended. pH impedance monitoring is now the reference diagnostic tool to detect non acid reflux, a form of reflux for which proton pump inhibitor treatment is ineffective. Recent data have shown a potential role of GERD in idiopathic pulmonary fibrosis and bronchiolitis obliterans following lung transplantation, leading to discussions about the place of surgery in this context. However, studies using pH impedance monitoring are still needed to better understand and manage the association between GERD and chronic respiratory diseases.

  13. Applying the ALARA concept to the evaluation of vesicoureteric reflux

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Richard S.; Diamond, David A. [Children' s Hospital Boston, Department of Urology, Boston, MA (United States); Chow, Jeanne S. [Children' s Hospital Boston, Department of Radiology, Boston, MA (United States)

    2006-09-15

    The voiding cystourethrogram (VCUG) is a widely used study to define lower urinary tract anatomy and to diagnose vesicoureteric reflux (VUR) in children. We examine the technical advances in the VCUG and other examinations for reflux that have reduced radiation exposure of children, and we give recommendations for the use of imaging studies in four groups of children: (1) children with urinary tract infection, (2) siblings of patients with VUR, (3) infants with antenatal hydronephrosis (ANH), and (4) children with a solitary functioning kidney. By performing examinations with little to no radiation, carefully selecting only the children who need imaging studies and judiciously timing follow-up examinations, we can reduce the radiation exposure of children being studied for reflux. (orig.)

  14. Diagnosis and Treatment of Refractory Gastroesophageal Reflux Disease (GERD

    Directory of Open Access Journals (Sweden)

    Selfie

    2015-12-01

    Full Text Available Gastroesophageal reflux disease (GERD was a damage in mucosal layer caused by gastric acid reflux. GERD was found about 10-20% in Western Countries and less in Asia, about 2,6-6,7%. Among different type of GERD, refractory GERD was a problem found in daily clinical practice. This terminology was used in patients with regurgitation and heartburn symptoms which is not responsive to 8 weeks proton pump inhibitor (PPI therapy. There were several mechanisms underlying the etiology and pathophysiology of refractory GERD. In general, refractory GERD diagnosis was based on clinical findings, objective endoscopic examination, ambulatory reflux monitoring, and response to antiacid-secretion therapy. Reevaluation of patients compliance should be the first step in refractory GERD management. A further treatment strategies could be started, consist of medical and surgical therapies. A basic clinical knowledge of refractory GERD would help clinician in deciding the best approach for diagnosis and therapy.

  15. Omeprazole for Refractory Gastroesophageal Reflux Disease during Pregnancy and Lactation

    Directory of Open Access Journals (Sweden)

    John K Marshall

    1998-01-01

    Full Text Available Symptomatic gastroesophageal reflux is a common complication of pregnancy and lactation. However, the safety of many effective medical therapies, including oral proton pump inhibitors, has not been well defined. The administration of oral omeprazole to a 41-year-old female during the third trimester of pregnancy, after ranitidine and cisapride failed to control her refractory gastroesophageal reflux, is reported. No adverse fetal effects were apparent, and the patient elected to continue omeprazole therapy (20 mg/day while breastfeeding. Peak omeprazole concentrations in breast milk (58 nM, 3 h after ingestion were less than 7% of the peak serum concentration (950 nM at 4 h, indicating minimal secretion. Although omeprazole is a potentially useful therapy for refractory gastroesophageal reflux during pregnancy and lactation, further data are needed to define better its safety and efficacy.

  16. Bethanechol versus antiacids in the treatment of gastroesophageal reflux.

    Science.gov (United States)

    Levi, P; Marmo, F; Saluzzo, C; Dell'Olio, D; Ansaldi, N; Giuliani, L; Guardamagna, O; Mostert, M; Ponzone, A

    1985-12-01

    To compare the efficacy of bethanechol in the treatment of gastroesophageal reflux with that of antiacids, a prospective, cross-over study was undertaken, in which 20 affected infants and children were randomized into two groups on 6-week alternate bethanechol and antiacids oral medication. Patients were evaluated clinically and by esophageal pH-metry before and after each treatment. Clinical score amelioration was achieved earlier than reflux number reduction and with similar incidence in both groups of patients, irrespectively to the initial medication; moreover, the differences in the degree of improvement between the two groups after either treatment were not found to be significant. These results fail to show that bethanechol is more effective than antiacids in controlling gastroesophageal reflux; moreover, bethanechol is more difficult to administer and offers a higher rate of undesired side effects.

  17. Evaluation of reflux nephropathy, pyelonephritis and renal dysplasia

    Energy Technology Data Exchange (ETDEWEB)

    Grattan-Smith, J.D. [Emory University School of Medicine, Children' s Healthcare of Atlanta, Department of Radiology, Atlanta, GA (United States); Children' s Healthcare of Atlanta, Department of Radiology, Atlanta, GA (United States); Little, Stephen B. [Children' s Healthcare of Atlanta, Department of Radiology, Atlanta, GA (United States); Jones, Richard A. [Emory University School of Medicine, Children' s Healthcare of Atlanta, Department of Radiology, Atlanta, GA (United States)

    2008-01-15

    MR urography has the potential to significantly improve our understanding of the relationship between reflux nephropathy, pyelonephritis, vesicoureteric reflux and renal dysplasia. MR urography utilizes multiple parameters to assess both renal anatomy and function and provides a more complete characterization of acquired and congenital disease. Pyelonephritis and renal scarring can be distinguished by assessing the parenchymal contours and signal intensity. Characteristic imaging features of renal dysplasia include small size, subcortical cysts, disorganized architecture, decreased and patchy contrast enhancement as well as a dysmorphic pelvicalyceal system. Because of its ability to subdivide and categorize this heterogeneous group of disorders, it seems inevitable that MR urography will replace DMSA renal scintigraphy as the gold standard for assessment of pyelonephritis and renal scarring. MR urography will contribute to our understanding of renal dysplasia and its relationship to reflux nephropathy. (orig.)

  18. Chronic laryngitis as a result of gastro esophageal reflux disease

    Directory of Open Access Journals (Sweden)

    Trajković Rada

    2014-01-01

    Full Text Available Reflux of gastric contents to the level of the pharynx and larynx is called laryngopharyngeal reflux, which can exist as such or laryngeal and pharyngeal reflux as separate entities, and in such form may lead to other diseases such as rhinitis, sinusitis, otitis media, and precancerous cancerous condition. To determine the relationship and impact of gastroesophageal reflux disease on the occurrence, frequency and duration of inflammatory processes and mucosal damage to the larynx. All patients were obtained anamnesticly, lab test done in all patients, indirect hipofaringo and laryngoscopy was performed in all patients. Based on the feedback reports gastroenterologists, we obtained data of gastroscopy. Results: 120 subjects were processed with dyspeptic symptoms. Based on history, all patients had some symptoms of upper respiratory tract disease.62 (51.66% male respondents and 58 (48.33% females. The average age of 54 years. In 82 (68.33% patients was increased salivation (one of the leading symptoms, of that number in 61 (74.39% participants laryngitis was present. In 68 (56.66% cases where the predominant symptom was cough, laryngitis was present in 26 (38.23%. In 70 (58.33% of patients with globus sensation, laryngitis was present in 38 (54.28% patients. Smoking has been represented with 65.83% (70 respondents, the percentage of patients with chronic laryngitis in this group was 69.62% (55 respondents. Been held after gastroscopy and otorinolaryngological examination in 62 (51.66% patients were diagnosed gastroesophageal reflux disease (GERD, of which, in 43 (69.35% patients laryngitis was present. After a three-month follow-up of patients with therapy (H2 blockers, proton pump inhibitors and antacids 28 (65.11% subjects (total treated, showed an improvement. The results of this study indicate a significant correlation between gastroesophageal reflux disease and chronic laryngitis, as well as the favorable impact and effect of antacid therapy

  19. Gastroesophageal Reflux Disease in Children with Cystic Fibrosis.

    Science.gov (United States)

    Dziekiewicz, Marcin A; Banaszkiewicz, Aleksandra; Urzykowska, Agnieszka; Lisowska, Aleksandra; Rachel, Marta; Sands, Dorota; Walkowiak, Jaroslaw; Radzikowski, Andrzej; Albrecht, Piotr

    2015-01-01

    Previously published studies have indicated that gastroesophageal reflux (GER) disease is common in pediatric patients with cystic fibrosis. The aim of the present study was to get insight into the incidence of GER and to characterize the nature of reflux episodes in children with cystic fibrosis. This was a multicenter, prospective study of children with cystic fibrosis older than 18 months. Forty four consecutive patients (22 boys, mean age 10.4 ± 3.6, range 3.0-17.8 years) were enrolled into the study. All patients underwent 24 h pH-impedance monitoring. GER were classified according to the widely recognized criteria as an acid, weakly acid, weakly alkaline, or proximal. The pH-impedance trace was considered abnormal when acid exposure was >6 %. GER was diagnosed in 24/44 (54.5 %) children. A total of 1585 (median 35, range 7-128) reflux episodes were detected; 1199 (75.6 %) were acidic, 382 (24.1 %) weakly acidic, and 4 (0.3 %) weakly alkaline. Six hundred and ninety-one (43.6 %) reflux episodes reached the proximal esophagus. In 14/44 patients typical GER symptoms were present. We conclude that the incidence of GER in children with cystic fibrosis is very high. In the majority of patients typical GER symptoms are absent. Therefore, diagnostic procedures should be considered, regardless of lacking symptoms. Although acid reflux episodes predominate in children with cystic fibrosis, classical pH-metry may not constitute a sufficient diagnostic method in this population because of a relatively high number of proximal reflux episodes. Such episodes also indicate an increased risk for aspiration. The pH-impedance diagnostic measurement is advocated when suspecting GER in children with cystic fibrosis.

  20. The Association between Childhood Overweight and Reflux Esophagitis

    Directory of Open Access Journals (Sweden)

    Nirav R. Patel

    2010-01-01

    Full Text Available Background. In adults, it has been shown that obesity is associated with gastroesophageal reflux disease (GERD and GERD-related complications. There are sparse pediatric data demonstrating associations between childhood overweight and GERD. Objective. To investigate the association between childhood overweight and RE. Methods. We performed a retrospective chart review of 230 children (M : F=114 : 116 who underwent esophagogastroduodenoscopy (EGD with biopsies between January 2000 and April 2006. Patient demographics, weight, height, clinical indications for the procedure, the prevalence of BMI classification groups, the prevalence of RE and usage of anti-reflux medications were reviewed. For these analyses, the overweight group was defined to include subjects with BMI≥ 85th percentile. The normal weight group was defined to include subjects with BMI 5th to 85th percentile. Results. Among the 230 subjects, 67 (29.1% had BMI percentiles above the 85th percentile for age and gender. The prevalence of RE in the overweight group did not differ significantly from that in the normal weight group (23.9% versus 24.5%, resp.. Overweight subjects taking anti-reflux medications clearly demonstrated a higher prevalence of biopsy-proven RE compared to overweight subjects not taking anti-reflux medications (34.1% versus 7.7%, =.009. Conclusions. There was no significant difference in the prevalence of biopsy-proven RE in the overweight group compared to the normal weight group. However, the prevalence of RE was significantly higher in overweight subjects on anti-reflux medications compared to overweight subjects not taking anti-reflux medications. This finding emphasizes the importance of early recognition and treatment of GERD for the overweight pediatric patients with symptoms in conjunction with weight loss program for this population to reduce long-term morbidities associated with GERD.

  1. Unmet Needs in the Treatment of Gastroesophageal Reflux Disease.

    Science.gov (United States)

    Dickman, Ram; Maradey-Romero, Carla; Gingold-Belfer, Rachel; Fass, Ronnie

    2015-07-30

    Gastroesophageal reflux disease (GERD) is a highly prevalent gastrointestinal disorder. Proton pump inhibitors have profoundly revolutionized the treatment of GERD. However, several areas of unmet need persist despite marked improvements in the ther-apeutic management of GERD. These include the advanced grades of erosive esophagitis, nonerosive reflux disease, main-tenance treatment of erosive esophagitis, refractory GERD, postprandial heartburn, atypical and extraesophageal manifestations of GERD, Barrett's esophagus, chronic protein pump inhibitor treatment, and post-bariatric surgery GERD. Consequently, any fu-ture development of novel therapeutic modalities for GERD (medical, endoscopic, or surgical), would likely focus on the afore-mentioned areas of unmet need.

  2. Reflux and acid peptic diseases in the elderly.

    Science.gov (United States)

    Soumekh, Amir; Schnoll-Sussman, Felice H; Katz, Philip O

    2014-02-01

    Gastroesophageal reflux disease (GERD) is a common disorder among elderly patients seeking medical care. Diagnosis and management of GERD in the older patient is a unique challenge for both the primary care provider and the gastroenterologist. Such patients may have atypical symptoms, more severe disease, and a higher rate of complications such as erosive esophagitis, Barrett esophagus, and esophageal cancer. Moreover, the elderly may be more sensitive to the morbidity and mortality of the available treatments for GERD. A careful and vigilant approach to the diagnosis, monitoring, and treatment of reflux disease in the elderly is warranted.

  3. [Dyspepsia, Ulcer Disease – Helicobacter pylori, Gastroesophageal Reflux Disease].

    Science.gov (United States)

    Wirth, Hans-Peter

    2016-06-01

    Prevalence of H. pylori (HP) is declining, whereas reflux disease and the proportion of non-steroidal antiinflammatory drugs (NSAR) to HP-induced ulcers increase. Eradication heals HP-ulcer disease, interrupts cancerous progression and can improve dyspeptic symptoms. NSAR-ulcers heal under proton pump inhibitor (PPI) therapy but tend to recur after reexposition. Anticoagulants and antiplatlet agents increase the risk additionally. PPI reduces NSAR-ulcer recurrence. Reflux patients with severe inflammation and complications often need long-term therapy. Barrett’s esophagus patients are at risk of esophageal adenocarcinoma.

  4. Use of acid-suppressive therapy before anti-reflux surgery in 2922 patients

    DEFF Research Database (Denmark)

    Lødrup, A; Pottegård, A; Hallas, J

    2015-01-01

    BACKGROUND: Guidelines recommend that patients with gastro-oesophageal reflux disease are adequately treated with acid-suppressive therapy before undergoing anti-reflux surgery. Little is known of the use of acid-suppressive drugs before anti-reflux surgery. AIM: To determine the use of proton pump...

  5. Characteristics of gastroesophageal reflux in symptomatic patients with and without excessive esophageal acid exposure

    NARCIS (Netherlands)

    Bredenoord, Albert J.; Weusten, Bas L. A. M.; Timmer, Robin; Smout, Andre J. P. M.

    2006-01-01

    OBJECTIVE: In some patients with a physiological esophageal acid exposure, an association between reflux episodes and symptoms can be demonstrated. Besides acidity, other factors such as proximal extent may determine whether a reflux episode is perceived or not. We aimed to investigate the reflux pr

  6. Gastric reflux: association with aspiration and oral secretion pH as marker of reflux: a descriptive correlational study.

    Science.gov (United States)

    Schallom, Marilyn; Orr, James A; Metheny, Norma; Kirby, John; Pierce, Janet

    2015-01-01

    Gastric reflux leading to pulmonary aspiration is a frequent event in mechanically ventilated, gastric-fed patients, which can lead to ventilator-associated complications and pneumonia. The objectives of this study were to determine the association between gastric reflux and aspiration using the presence of pepsin in oral or tracheal secretions as a marker of reflux or aspiration and to determine the association between the pH (range, 0-14) and the presence of pepsin in oral secretions. A descriptive correlational study was conducted in mechanically ventilated surgical or medical patients receiving gastric tube feedings. Oral secretions were suctioned hourly and tracheal secretions every 2 to 3 hours for 12-hour periods over 1 to 2 days in 15 patients. There were 142 paired samples of oral tracheal secretions. A majority of samples (60%) had the same results, with 32% both pepsin-positive and 27% both pepsin-negative. The range of pH measurements was 4 to 8, with a mean of 6.3 ± 0.05. Ninety oral specimens had a pH of 4 to 6. Forty-seven of the oral specimens with pH measures between 4 and 6 (52%) were pepsin-positive. The correlation of pH percent pepsin-positive oral secretions was not significant. Aspiration events were more frequent than reflux events. Measurement of actual pepsin concentration to detect new reflux and aspiration events is recommended in future studies. Bedside pH measures of oral secretions are not a valid marker of gastric reflux.

  7. Does the Compliance of the Bladder Affect the Grade of Vesicoureteral Reflux?

    Directory of Open Access Journals (Sweden)

    Ferhat Kilinc

    2013-10-01

    Full Text Available Aim: We retrospectively reviewed videourodynamic outcomes in children with primary vesicoureteral reflux. The aim of this study to evaluate the relationship between vesicoureteral reflux grade and bladder compliance. Material and Method: Videourodynamic traces of 53 children with primary vesicoureteral reflux investigated between January 2004 and January 2012 were reviewed. The detrusor pressures of the point when the reflux started were recorded. The detrusor pressures 10 cmH2O or less at that point was accepted as normal compliance (Group 1, the detrusor pressures more than10 cm H2O was accepted as hipocompliance (Group 2. The reflux grades were divided into two grades, low-grade reflux (grades 1 and 2, high-grade reflux (grades 3, 4 and 5. Data were analyzed using the chi-square test. Results: Patients’ ages ranged between 5 and 11 years (mean 7.09±1.81 years. Of the 53 patients, 29 (54.7% had normal compliance (Group 1, 24 (45.3% had hipocompliance (Group 2. Twenty-four (82.8% patients in-group 1 had a low-grade reflux, 5 (17.2% patients had a high-grade reflux. In group 2, 8 (33.3% patients had a low-grade reflux, 16 (66.7% patients had a high-grade reflux. The detected high-grade reflux in-group 2 was significantly higher than in-group 1 (p<0.001. Discussion: The physicians should be considering the bladder compliance at the point when the reflux started in primary vesicoureteral reflux cases. The bladder hipocompliance may play a secondary role in reflux grade.

  8. Urodynamics in boys after prenatally diagnosed vesicoureteric reflux

    DEFF Research Database (Denmark)

    Thorup, Jørgen Mogens

    1996-01-01

    Over the years, several theories have been presented regarding the pathogenesis of vesicoureteral reflux (VUR) in children without neurological disease or posterior urethral valves. Primary VUR is one of many fetal uropathies detectable by prenatal sonography. Thirteen boys with a prenatal...

  9. Associations between peripheral vertigo and gastroesophageal reflux disease.

    Science.gov (United States)

    Viliušytė, Edita; Macaitytė, Raminta; Vaitkus, Antanas; Rastenytė, Daiva

    2015-09-01

    We hypothesize that peripheral vertigo is associated with gastroesophageal reflux disease (GERD). Two mechanisms could be considered – gastric acids may directly irritate the respiratory mucosa and cause inflammation, or Helicobacter pylori (H. pylori) could be present and cause local infection. Reflux material (Hydrochloric acid (HCl) and pepsin) could get into the middle ear via Eustachian tube and affect osseous structures directly. Disturbance of ossicles could cause tinnitus, which is more common for peripheral vertigo. H. pylori could also get in the esophagus and in the upper respiratory tract via gastroesophageal reflux, and could cause tympanosclerosis and fixation of ossicles. In our study group, 120 of 153 (78.4%) patients had gastroesophageal reflux disease (GERD). Diagnostic tests of H. pylori (rapid urease test or blood antibody test) were performed for 96 of 120 (80%) patients with GERD and were found positive for 32 of 96 (33.3%) patients. Peripheral vertigo was present in 93 of 120 (77.6%) patients with GERD compared to 33 of 126 (26%) patients without GERD (χ(2)=9.016, p=0.003). H. pylori and peripheral vertigo coexisted in 26 of 126 patients (20.6%) (OR 1.36; 95% CI 0.49-3.74, p=0.55). Our study demonstrated statistically significant association between peripheral vertigo and GERD but not between peripheral vertigo and H. pylori. Further more extensive investigations are needed in order to explore our hypothesis. Copyright © 2015 Elsevier Ltd. All rights reserved.

  10. Vesicoureteric reflux: Evaluation by bladder volume graded direct radionuclide cystogram

    Directory of Open Access Journals (Sweden)

    Agrawal Vikesh

    2009-01-01

    Full Text Available Aim : Evaluation of vesicoureteric reflux (VUR in children by bladder volume graded direct radionuclide cystogram (BVG DRC. This technique allows detection of VUR at different bladder volume grades. Materials and Methods : In this prospective study, 33 patients (66 renal units with suspected vesicoureteric reflux were subjected to a voiding cystourethrogram (VCUG and BVG DRC. The patients were assessed further with radioisotope renal scans for renal cortical scars. Results : Twenty-two patients and 36 renal units were found to have VUR in either of the reflux studies. A VCUG was able to detect 20 units (55.50% and a BVG DRC was able to detect 35 units (97.2%. A VCUG had a test accuracy of 77.8% and a BVG DRC had a test accuracy of 98.6%. There was a positive correlation between bladder volume grades and scarring on a DMSA scan. Conclusions : Like a conventional DRC, BVG DRC is a sensitive and an accurate test. It gives additional information on the reflux phenomenon with respect to bladder filling. The bladder volume graded technique is better than conventional DRC for grading of VUR.

  11. Percutaneous endoscopic gastrostomy and gastrooesophageal reflux in neurologically impaired children

    Institute of Scientific and Technical Information of China (English)

    Mike Thomson; Prithviraj Rao; David Rawat; Tobias G Wenzl

    2011-01-01

    AIM: To investigate the effects of percutaneous endoscopic gastrostomy (PEG) feeding on gastro-oesophageal reflux (GOR) in a group of these children using combined intraluminal pH and multiple intraluminal impedance (pH/MII).METHODS: Ten neurologically impaired children underwent 12 h combined pH/MII procedures at least 1 d before and at least 12 d after PEG placement.METHODS: Prior to PEG placement (pre-PEG) a total of 183 GOR episodes were detected, 156 (85.2%) were non-acidic. After PEG placement (post-PEG) a total of 355 episodes were detected, 182 (51.3%) were nonacidic.The total number of distal acid reflux events statistically significantly increased post-PEG placement (pre-PEG total 27, post-PEG total 173, P = 0.028) and the mean distal pH decreased by 1.1 units. The distal reflux index therefore also significantly increased post-PEG [pre-PEG 0.25 (0-2), post-PEG 2.95 (0-40)]. Average proximal pH was lower post-PEG but the within subject difference was not statistically significant (P = 0.058).Median number of non-acid GOR, average reflux height,total acid clearance time and total bolus clearance time were all lower pre-PEG, but not statistically significant.CONCLUSION: PEG placement increases GOR episodes in neurologically impaired children.

  12. [Severe interstitial lung disease from pathologic gastroesophageal reflux in children].

    Science.gov (United States)

    Ahrens, P; Weimer, B; Hofmann, D

    1999-07-01

    Interstitial lung diseases comprise a heterogeneous group of pulmonary conditions that cause restrictive lung disease of poor prognosis, especially if growth failure, pulmonary hypertension and fibrosis appears. We report on the case of a girl of 11 years of age who suffered from severe nonallergic asthma in early childhood and who developed severe interstitial pulmonary disease caused by gastro-oesophageal reflux at the age of 8 years. This diagnosis was established by lung biopsy, bronchoalveolar lavage and a high amount of lipid-laden alveolar macrophages, 2-level pH measurement and oesophageal biopsy. Because therapy with oral and inhaled steroids failed and Omeprazol showed benificial effects, hemifundoplication according to THAL was performed. At present the lung function is clearly normal and there is no need of any medicaments. Following the history, we can assume the pathological gastro-oesophageal reflux to be the cause of the disease. It is important to state that there were no typical symptoms at any time pointing to gastro-oesophageal reflux disease. The development of pulmonary disease by pathological reflux is very often caused by "silent aspiration". Very typically there are no symptoms such as vomiting, heartburn and pain but only signs of chronic lung disease.

  13. The human laryngeal microbiome: effects of cigarette smoke and reflux

    Science.gov (United States)

    Jetté, Marie E.; Dill-McFarland, Kimberly A.; Hanshew, Alissa S.; Suen, Garret; Thibeault, Susan L.

    2016-01-01

    Prolonged diffuse laryngeal inflammation from smoking and/or reflux is commonly diagnosed as chronic laryngitis and treated empirically with expensive drugs that have not proven effective. Shifts in microbiota have been associated with many inflammatory diseases, though little is known about how resident microbes may contribute to chronic laryngitis. We sought to characterize the core microbiota of disease-free human laryngeal tissue and to investigate shifts in microbial community membership associated with exposure to cigarette smoke and reflux. Using 454 pyrosequencing of the 16S rRNA gene, we compared bacterial communities of laryngeal tissue biopsies collected from 97 non-treatment-seeking volunteers based on reflux and smoking status. The core community was characterized by a highly abundant OTU within the family Comamonadaceae found in all laryngeal tissues. Smokers demonstrated less microbial diversity than nonsmokers, with differences in relative abundances of OTUs classified as Streptococcus, unclassified Comamonadaceae, Cloacibacterium, and Helicobacter. Reflux status did not affect microbial diversity nor community structure nor composition. Comparison of healthy laryngeal microbial communities to benign vocal fold disease samples revealed greater abundance of Streptococcus in benign vocal fold disease suggesting that mucosal dominance by Streptococcus may be a factor in disease etiology. PMID:27775059

  14. The influence of laparoscopic adjustable gastric banding on gastroesophageal reflux

    NARCIS (Netherlands)

    de Jong, [No Value; van Ramshorst, B; Timmer, R; Gooszen, HG; Smout, AJPM

    2004-01-01

    Background: Laparoscopic adjustable gastric banding (LAGB) influences gastroesophageal reflux. Methods: 26 patients undergoing gastric banding were assessed by a questionnaire for symptom analysis, 24-hour pH monitoring, endoscopy and barium swallows, preoperatively, at 6 weeks and at 6 months after

  15. Heartburn, gastro-oesophageal reflux disease and non-erosive ...

    African Journals Online (AJOL)

    2010-01-31

    Jan 31, 2010 ... stomach acid causes troublesome reflux-associated symptoms and/or .... Magnesium salts, however, can lead to diarrhoea, and aluminium salts can cause ... relieve symptoms for longer periods.12 Although some proton ... 15 mg and pantoprazole 20 mg.13 Higher dosage PPIs and other. PPIs are ...

  16. Robotic-Assisted Laparoscopic Management of Vesicoureteral Reflux

    OpenAIRE

    Thomas Lendvay

    2008-01-01

    Robotic-assisted laparoscopy (RAL) has become a promising means for performing correction of vesicoureteral reflux disease in children through both intravesical and extravesical techniques. We describe the importance of patient selection, intraoperative patient positioning, employing certain helpful techniques for exposure, and recognizing the limitations and potential complications of robotic reimplant surgery. As more clinicians embrace robotic surgery and more urology residents are traine...

  17. Inducing and Aggravating Factors of Gastroesophageal Reflux Symptoms

    Directory of Open Access Journals (Sweden)

    Radhiyatam Mardhiyah

    2016-12-01

    Full Text Available Gastroesophageal reflux disease (subsequently abbreviated as GERD is a disease commonly found in the community. Several factors have been recognized as inducing and aggravating factors of GERD symptoms such as older age, female gender, obesity, smoking habit, alcohol consumption, certain diet and poor eating habit like eating fatty, spicy, and acid food.

  18. Erroneous Diagnosis of Gastroesophageal Reflux Disease in Achalasia

    NARCIS (Netherlands)

    B.F. Kessing; A.J. Bredenoord; A.J.P.M. Smout

    2011-01-01

    BACKGROUND & AIMS: Most experienced gastroenterologists have seen one or several cases of achalasia patients who have been erroneously diagnosed with gastroesophageal reflux disease (GERD) or even underwent antireflux surgery. We aim to describe the current knowledge about the diagnostic features of

  19. Gastroesophageal reflux disease: exaggerations, evidence and clinical practice

    Directory of Open Access Journals (Sweden)

    Cristina Targa Ferreira

    2014-04-01

    Full Text Available OBJECTIVE: there are many questions and little evidence regarding the diagnosis and treatment of gastroesophageal reflux disease (GERD in children. The association between GERD and cow's milk protein allergy (CMPA, overuse of abdominal ultrasonography for the diagnosis of GERD, and excessive pharmacological treatment, especially proton-pump inhibitors (PPIs are some aspects that need clarification. This review aimed to establish the current scientific evidence for the diagnosis and treatment of GERD in children. DATA SOURCE: a search was conducted in the MEDLINE, PubMed, LILACS, SciELO, and Cochrane Library electronic databases, using the following keywords: gastroesophageal reflux; gastroesophageal reflux disease; proton-pump inhibitors; and prokinetics; in different age groups of the pediatric age range; up to May of 2013. DATA SYNTHESIS: abdominal ultrasonography should not be recommended to investigate gastroesophageal reflux (GER. Simultaneous treatment of GERD and CMPA often results in unnecessary use of medication or elimination diet. There is insufficient evidence for the prescription of prokinetics to all patients with GER/GERD. There is little evidence to support acid suppression in the first year of life, to treat nonspecific symptoms suggestive of GERD. Conservative treatment has many benefits and with low cost and no side-effects. CONCLUSIONS: there have been few randomized controlled trials that assessed the management of GERD in children and no examination can be considered the gold standard for GERD diagnosis. For these reasons, there are exaggerations in the diagnosis and treatment of this disease, which need to be corrected.

  20. Nasogastric intubation causes gastroesophageal reflux in patients undergoing elective laparotomy.

    LENUS (Irish Health Repository)

    Manning, B J

    2012-02-03

    BACKGROUND: The routine use of nasogastric tubes in patients undergoing elective abdominal operation is associated with an increased incidence of postoperative fever, atelectasis, and pneumonia. Previous studies have shown that nasogastric tubes have no significant effect on the incidence of gastroesophageal reflux or on lower esophageal sphincter pressure in healthy volunteers. We hypothesized that nasogastric intubation in patients undergoing laparotomy reduces lower esophageal sphincter pressure and promotes gastroesophageal reflux in the perioperative period. METHODS: A prospective randomized case-control study was undertaken in which 15 consenting patients, admitted electively for bowel surgery, were randomized into 2 groups. Group 1 underwent nasogastric intubation after induction of anesthesia, and Group 2 did not. All patients had manometry and pH probes placed with the aid of endoscopic vision at the lower esophageal sphincter and distal esophagus, respectively. Nasogastric tubes, where present, were left on free drainage, and sphincter pressures and pH were recorded continuously during a 24-hour period. Data were analyzed with 1-way analysis of variance. RESULTS: The mean number of reflux episodes (defined as pH < 4) in the nasogastric tube group was 137 compared with a median of 8 episodes in the group managed without nasogastric tubes (P =.006). The median duration of the longest episode of reflux was 132 minutes in Group 1 and 1 minute in Group 2 (P =.001). A mean of 13.3 episodes of reflux lasted longer than 5 minutes in Group 1, with pH less than 4 for 37.4% of the 24 hours. This was in contrast to Group 2 where a mean of 0.13 episodes lasted longer than 5 minutes (P =.001) and pH less than 4 for 0.2% of total time (P =.001). The mean lower esophageal sphincter pressures were lower in Group 1. CONCLUSIONS. These findings demonstrate that patients undergoing elective laparotomy with routine nasogastric tube placement have significant gastroesophageal

  1. 萘丁美酮对十二指肠胃返流所致胃黏膜损伤保护作用的实验研究%The experimental study of the protective function of nabumetone on the injury of gastric mucosa caused by duodenogastric reflux

    Institute of Scientific and Technical Information of China (English)

    史冉庚; 龚均; 董蕾; 常英

    2005-01-01

    目的探讨非甾体类消炎药萘丁美酮对十二指肠返流导致返流性胃炎的治疗作用.方法用SD大鼠建立十二指肠胃返流模型,40只模型大鼠等分为萘丁美酮组和西沙比利组、铝碳酸镁组、空白手术组;另取10只SD大鼠作为假手术组.干预时间12周.对模型大鼠的胃标本进行病理学检查,采用免疫组化方法对胃黏膜的COX-2和TNF-α进行染色.结果萘丁美酮组的病理改变明显轻于空白手术组(P0.05).TNF-α的免疫组化染色显示,萘丁美酮组与其他各组间均无显著性差异(P>0.05).COX-2的免疫组化染色显示,萘丁美酮组与空白手术组相比COX-2表达明显降低( P0.05).结论在十二指肠返流导致的返流性胃炎中,萘丁美酮有明显的治疗效果.萘丁美酮可明显降低胃黏膜组织中COX-2水平.

  2. Obesity and gastroesophageal reflux disease and gastroesophageal reflux symptoms in children

    Directory of Open Access Journals (Sweden)

    Hoda M Malaty, J Kennard Fraley

    2009-03-01

    Full Text Available Hoda M Malaty1, J Kennard Fraley1,2, Suhaib Abudayyeh1, Kenneth W Fairly1, Ussama S Javed1, et al1Department of Medicine, 2Children’s Nutrition Research Center (CNRC, 4Department of Pediatrics, 5Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA; 3Department of Gastroenterology, Oregon Health and Science University, Portland, OR, USABackground: The association between body mass index (BMI and gastroesophageal reflux disease (GERD has been extensively studied among adults but few studies have examined such association in children. Aims: 1 to determine the relationship between BMI in children and GERD, and 2 to use the National Center for Health Statistics (NCHS values for BMI as a valid source for comparison. Methods: We identified two cohorts of children aged between two and 17 years who were seen at Texas Children’s Hospital (TCH. The first cohort consisted of children diagnosed with GERD based on upper gastrointestinal endoscopic and histologic evaluation, which was recorded in the Pediatric Endoscopic Database System-Clinical Outcomes Research Initiative (PEDS-CORI at TCH. A diagnosis of GERD was based on the presence of erosive esophagitis or esophageal ulcers. Endoscopic reports that were incomplete or did not include demographic features, indications for endoscopy, or endoscopic findings were excluded. The second cohort consisted of all children with symptoms due to gastroesophageal reflux (GER who received outpatient gastrointestinal (GI consultation at TCH for any 9th revision of the International Statistical Classification of Diseases (ICD-9 code suggestive of GER. There was no overlap between the two cohorts as each child was indexed only once. Children with any comorbid illnesses were excluded.Measurements: The records for each child namely, age, gender, height, and weight were obtained on the same date as that of the diagnosis. Using the growth curves published by the NCHS, the gender/age specific weight

  3. Technical Limitations in Detection of Gastroesophageal Reflux (GER) in Neonates

    Science.gov (United States)

    Di Fiore, Juliann M.; Arko, Marina; Churbock, Kim; Hibbs, Anna Maria; Martin, Richard J.

    2009-01-01

    Objective Characterize the incidence and possible etiologies of acid reflux events detected by pH and not identified by intraluminal impedance (MII) monitoring. Methods Acid reflux events detected by pH but not identified by MII (pH-only) were documented in 80 preterm and 39 term infants. Reason for failure of MII to detect these events were classified as failure to meet MII scoring criteria, presence of an air bolus, technical artifact, and no change in impedance. Events with no change in impedance were stratified to; 1) low impedance throughout the study (possible esophageal inflammation), 2) transient decrease in pre-event impedance (presence of refluxate), 3) occurrence <30 seconds of a preceding event and 4) no explanation. Results 2572 events were detected by pH with 59% of events not identified by MII. A higher incidence of pH-only events occurred in preterm versus term infants (54±27% vs 42±23%, p=.025, respectively). Thirteen percent of pH-only events were missed due to MII scoring criteria, 12% due to technical artifact, 11% due to an air bolus and 64% had no change in impedance. Of the 978 events with no change in impedance 154 were associated with low impedance throughout the study, 430 with a transient decrease in pre-event impedance, and 175 were preceded by a reflux episode within 30sec. Conclusion There was a high incidence of acid reflux events detected by pH but not identified by MII. This occurred more often in the least mature infants and we speculate that delayed esophageal fluid clearance is the major underlying mechanism. PMID:19581816

  4. Milk /sup 99/Tcsup(m)-EHIDA test for enterogastric bile reflux

    Energy Technology Data Exchange (ETDEWEB)

    Mackie, C.R.; Wisbey, M.L.; Cuschieri, A. (Ninewells Hospital and Medical School, Dundee (UK))

    1982-02-01

    The study and clinical assessment of enterogastric bile reflux has been restricted for want of a simple non-invasive test for its detection and quantification. This paper describes such a test in which biliary excretion scintigraphy has been combined with a milk meal provocation. Two of 10 healthy volunteers studied showed probable reflux of approximately 5 per cent of total initial abdominal field activity. Among 73 patients studied, 37 patients showed definite reflux of up to 47 per cent. Reflux occurred in 19 of 22 post-gastric surgery patients and in 7 of 22 patients with peptic ulcer disease, gastritis or gastro-oesophageal reflux. None of 7 patients with 'non-specific' abdominal pain showed any reflux, but 11 of 22 patients with gallstone disease or previous cholecystectomy showed reflux of up to 35 per cent, including 9 of 11 patients with loss of gallbladder reservoir function.

  5. Esophagogastric Junction Contractility Integral Reflect the Anti-reflux Barrier Dysfunction in Patients with Gastroesophageal Reflux Disease

    Science.gov (United States)

    Xie, Chenxi; Wang, Jinhui; Li, Yuwen; Tan, Niandi; Cui, Yi; Chen, Minhu; Xiao, Yinglian

    2017-01-01

    Background/Aims Anti-reflux barrier dysfunction is one of the primary mechanisms in gastroesophageal reflux disease (GERD) pathogenesis. The esophagogastric junction contractile integral (EGJ-CI) is a new metric adopted to evaluate the EGJ contractility, which implies the anti-reflux barrier function. The aim of the current study was to validate this new metric in patients with GERD and its correlation with the esophageal acid exposure, as well as the efficacy of proton pump inhibitor treatment. Methods Ninety-eight patients with GERD and 21 healthy controls were included in the study. Upper endoscopy, high-resolution manometry (HRM) and 24-hour multichannel intraluminal impedance-pH monitoring were performed in all patients. Three respiration cycles were chosen at the initial HRM resting frame and the value computed with distal contractile integral tool was then divided by the duration of the cycles to yield EGJ-CI. All the patients were treated with esomeprazole 20 mg twice-daily for 8 weeks. Results EGJ-CI was lower in the patients with GERD than that of the controls (P < 0.05). For patients with GERD, EGJ-CI was lower in those with hiatal hernia (P < 0.05). The new metric correlated with esophageal acid exposure in the supine position (P < 0.05), and it also negatively correlated to the total reflux episodes (P < 0.05). There was no significant difference on EGJ-CI between patients with and without response to the esomeprazole treatment (P = 0.627). Conclusions EGJ-CI reflected the dysfunction of the anti-reflux barrier in patients with GERD, but it had little impact on the esomeprazole response. PMID:27426485

  6. Associations between flow in paratibial perforating veins and great saphenous vein patterns of reflux

    Directory of Open Access Journals (Sweden)

    Carlos Alberto Engelhorn

    2015-06-01

    Full Text Available Perforating veins contribute to chronic venous valvular insufficiency (CVVI, subset of CVI of lower extremities (LE. We investigated the role of medial, proximal calf paratibial perforating veins (PTPV. Women with PTPV reflux, diameter ≥3 mm, or tortuosity were selected among 2199 LE mappings. Duplex ultrasonography (US was performed standing. Reflux >0.5 s was abnormal. PTPV conditions were related to great saphenous vein (GSV patterns of reflux. US of 442 LE of 379 women were analyzed, all being Clinical-Etiology-Anatomy-Pathophysiology (CEAP classification C1, C2, and/or having intermittent, conditional swelling. Etiology was primary. Pathophysiology was reflux, not thrombosis or obstruction. Most PTPV drained (n=281, 64% of 442 or 13% of 2199, or were source (n=73, 17%/442, 3%/2199 of GSV reflux; 49 (11%/442, 2%/2199 had reflux not associated with GSV; 39 (9%/442, 2%/2199 did not have reflux. PTPV, when significative for CVVI, primarily drained-GSV reflux. PTPV was linked to reflux in 1 of 5 and was a major source of reflux in 1 of 20 legs. Detailed US of PTPV insured over 80% accuracy in CVVI mapping.

  7. A proposition for the diagnosis and treatment of gastro-oesophageal reflux disease in children: A report from a working group on gastro-oesophageal reflux disease

    NARCIS (Netherlands)

    Y. Vandenplas (Yvan); A. Ashkenazi (A.); D. Belli (D.); N. Boige (N.); J. Bouquet (Jan); S. Cadranel (S.); J.P. Cezard (J.); S. Cucchiara (S.); C. Dupont (C.); K. Geboes (K.); F. Gottrand; H.S.A. Heymans (Hugo); C. Jasinski (C.); C.M.F. Kneepkens (Frank); S. Koletzko (Sybille); P. Milla (Peter); J.F. Mougenot (J.); D. Nusslé (D.); J. Navarro (J.); S.J. Newell (S.); E. Olafsdottir (E.); S. Peeters (S.); A. Ravelli (A.); I. Polanco (I.); B. Sandhu; J.J. Tolboom (Jules)

    1993-01-01

    textabstractIn this paper, a Working Group on Gastro-Oesophageal Reflux discusses recommendations for the first line diagnostic and therapeutic approach of gastro-oesophageal reflux disease in infants and children. All members of the Working Group agreed that infants with uncomplicated gastro-oesoph

  8. REFLUX ESOPHAGITIS IN INFANTS AND CHILDREN - A REPORT FROM THE WORKING GROUP ON GASTROESOPHAGEAL REFLUX DISEASE OF THE EUROPEAN-SOCIETY-OF-PEDIATRIC-GASTROENTEROLOGY-AND-NUTRITION

    NARCIS (Netherlands)

    VANDENPLAS, Y; ASHKENAZI, A; BELLI, D; BLECKER, U; BOIGE, N; BOUQUET, J; CADRANEL, S; CEZARD, JP; CUCCHIARA, S; DEVREKER, T; DUPONT, C; GEBOES, K; GOTTRAND, F; HEYMANS, HSA; JASINSKI, C; KNEEPKENS, CMF; KOLETZKO, S; MILLA, P; MOUGENOT, JF; NAVARRO, J; NEWELL, SJ; NUSSLE, D; OLAFSDOTTIR, E; POLANCO, [No Value; RAVELLI, A; SANDHU, BK; TOLBOOM, J

    1994-01-01

    In this article, the Working Group on Gastro-Oesophageal Reflux of the European Society of Paediatric Gastroenterology and Nutrition presents and discusses a definition of reflux esophagitis and recommends a diagnostic approach and therapeutic management for this condition. Histologic criteria for r

  9. Knowledge of pediatrician on gastroesophageal reflux/gastroesophageal reflux disease in children: a preliminary study

    Directory of Open Access Journals (Sweden)

    Edward Surjono

    2016-10-01

    Full Text Available Background Gastroesophageal reflux (OER is involuntary movement of gastric content into esophagus due to transient lower esophageal sphincter relaxation. This condition usually ignored by physician. Many GER cases have severe complication before properly managed. Ten years after incorporating GER into Indonesia pediatric training curriculum, the knowledge of GER among pediatrician need to be measured. Objectives To measure pediatrician's knowledge of GER/GERD in children. Methods This was a cross sectional study using questionnaire and interview. Result There were 387 respondents who filled the questionnaire and being interviewed. The majority of respondents were between 25-45 years old (33.6%. Respondents who graduated before the year 2000 were 48.3%, and after 2000 were 51.7%. Majority of respondents were general pediatrician (90.2% and 41.3% working in teaching hospitals Among pediatricians graduated after year 2000,6 6%,5 0.5% and 57.5% could gave more than 80% correct answer to questions about general knowledge, diagnosis and management of GERD as compared to 49.2%, 42.2% and 47% subjects graduated before year 2000. More pediatricians graduated before year 2000 answered the questions on general knowledge, diagnosis and management < 60% correctly compared to those graduated after year 2000 (42.2%, 25.2% and 28.3% vs. 14%,11.5% and 12%, respectively. Fifty five of 160 (34.4% respondents who working in teaching hospital gave more than 80% correct answer to questions about GERD. Compared to those working in non-teaching hospitals, only 17.6% were able to correctly answer more than 80% of questions. Conclusions Better knowledge about GER/GERD are found among pediatricians graduated after the topics has been introduced to the curriculum and among those practicing in teaching hospitals.

  10. Editorial: Reflux, dyspepsia, and Rome III (or Rome IV?).

    Science.gov (United States)

    Stanghellini, Vincenzo; Frisoni, Chiara

    2010-12-01

    The paper by Xiao et al. in this issue of American Journal of Gastroenterology reports that patients with functional dyspepsia (FD) complaining of epigastric burning have a higher probability to present abnormal gastroesophageal acid reflux, as well as response to proton pump inhibitor therapy than those complaining of epigastric pain, bothersome postprandial fullness, or early satiety. No differences in the above parameters were detected when comparing patients with epigastric pain syndrome and postprandial distress syndrome, as proposed by the Rome III classification of FD. If confirmed, these results contribute to clarify the relationship between FD and gastroesophageal reflux disease and, at the same time, highlight the importance of analyzing individual symptoms rather than clusters of symptoms, when managing patients complaining of upper gastrointestinal symptoms.

  11. [Differencial diagnosis of gastroesophageal reflux disease -- eosinophilic esophagitis: case report].

    Science.gov (United States)

    Franzius, M; Stolte, M; Porschen, R

    2005-04-01

    We report on a 22-year-old man with dysphagia and repeated bolus impaction in the esophagus for 10 years. Bolus impactions were frequently mobilised using an endoscope. At endoscopy, esophagitis IV degrees was described. After treatment with omeprazol there was no improvement. The patient was submitted to our hospital for fundoplication. pH-metry demonstrated an increased reflux. At endoscopy of the esophagus, we found red stripes which did not show the typical appearance of erosions. Manometry and X-ray films of the esophagus did not reveal any pathological findings. In combination with anamnesis, symptoms, and endoscopy, the diagnosis of eosinophilic esophagitis was documented by histology. After administration of oral corticosteroids a rapid improvement of the clinical symptoms was observed. The diagnosis of eosinophilic esophagitis should be kept in mind in patients with chronic symptoms of gastroesophageal reflux persisting despite medical therapy, pathological pH-metry and repeated bolus impactions.

  12. Update on childhood urinary tract infection and vesicoureteral reflux.

    Science.gov (United States)

    Bell, Lorraine E; Mattoo, Tej K

    2009-07-01

    Urinary tract infection (UTI) is a leading cause of serious bacterial infection in young children. Vesicoureteral reflux (VUR), a common pediatric urologic disorder, is believed to predispose to UTI, and both are associated with renal scarring. The complex interaction of bacterial virulence factors and host defense mechanisms influence renal damage. However, some renal parenchymal abnormalities associated with VUR are noninfectious in origin. Long-term, renal parenchymal injury may be associated with hypertension, pregnancy complications, proteinuria, and renal insufficiency. Optimal management of VUR and UTI is controversial because of the paucity of appropriate randomized controlled trials; there is a need for well-designed studies. The recently launched Randomized Intervention for children with VesicoUreteral Reflux (RIVUR) study hopefully will provide insight into the role of antimicrobial prophylaxis of UTI in children with VUR.

  13. Can yoga be used to treat gastroesophageal reflux disease?

    Directory of Open Access Journals (Sweden)

    Dharmesh Kaswala

    2013-01-01

    Full Text Available Yoga methods including Pranayama are the best ways to prevent many diseases and their progression. Even though, Yoga is widely practiced, its effects on certain medical conditions have not been studied or reported. Gastroesophageal reflux disease (GERD is one of them. GERD is extremely common condition requiring frequent consumption of over-the-counter or prescribed proton pump inhibitors (PPI. In severe symptoms of GERD and in the presence of multiple etiologies, PPIs are insufficient to relieve the symptoms of gastric reflux. Regular and proper use of the Yoga along with PPI can control the severe symptoms of GERD and can avoid or delay the necessity of invasive procedures. This evidence-based case report focuses on the effects of Yoga on GERD. Our case report showed that regular practice of Kapalbhati and Agnisar kriya along with PPI, patients with hiatal hernia had improvement in severe symptoms of GERD, which were initially refractory to PPI alone.

  14. Can yoga be used to treat gastroesophageal reflux disease?

    Science.gov (United States)

    Kaswala, Dharmesh; Shah, Shamik; Mishra, Avantika; Patel, Hardik; Patel, Nishith; Sangwan, Pravesh; Chodos, Ari; Brelvi, Zamir

    2013-01-01

    Yoga methods including Pranayama are the best ways to prevent many diseases and their progression. Even though, Yoga is widely practiced, its effects on certain medical conditions have not been studied or reported. Gastroesophageal reflux disease (GERD) is one of them. GERD is extremely common condition requiring frequent consumption of over-the-counter or prescribed proton pump inhibitors (PPI). In severe symptoms of GERD and in the presence of multiple etiologies, PPIs are insufficient to relieve the symptoms of gastric reflux. Regular and proper use of the Yoga along with PPI can control the severe symptoms of GERD and can avoid or delay the necessity of invasive procedures. This evidence-based case report focuses on the effects of Yoga on GERD. Our case report showed that regular practice of Kapalbhati and Agnisar kriya along with PPI, patients with hiatal hernia had improvement in severe symptoms of GERD, which were initially refractory to PPI alone. PMID:23930033

  15. Extra-Esophageal Pepsin from Stomach Refluxate Promoted Tonsil Hypertrophy

    Science.gov (United States)

    Kim, Jin Hyun; Jeong, Han-Sin; Kim, Kyung Mi; Lee, Ye Jin; Jung, Myeong Hee; Park, Jung Je; Kim, Jin Pyeong; Woo, Seung Hoon

    2016-01-01

    Background Gastroesophageal reflux is associated with numerous pathologic conditions of the upper aerodigestive tract. Gastric pepsin within reflux contributes to immunologic reactions in the tonsil. In this study, we aimed to find the relationships between pepsin and tonsillar hypertrophy. Methods and finding We explored the notion whether tonsillar hypertrophy was due to pepsin-mediated gastric reflux in tonsil hypertrophy. Fifty-four children with tonsil hypertrophy and 30 adults with tonsillitis were recruited before surgical treatment. Blood and tonsil tissues from each patient were harvested for analysis of changes in lymphocyte and macrophage numbers coupled with histological and biochemical analysis. Pepsin was expressed at different levels in tonsil tissues from each tonsillar hypertrophy. Pepsin-positive cells were found in the crypt epithelium, surrounding the lymphoid follicle with developing fibrosis, and also surrounding the lymphoid follicle that faced the crypt. And also, pepsin staining was well correlated with damaged tonsillar squamous epithelium and TGF-β1 and iNOS expression in the tonsil section. In addition, pepsin and TGF-β1-positive cells were co-localized with CD68-positive cells in the crypt and surrounding germinal centers. In comparison of macrophage responsiveness to pepsin, peripheral blood mononuclear cells (PBMNCs) were noticeably larger in the presence of activated pepsin in the child group. Furthermore, CD11c and CD163-positive cells were significantly increased by activated pepsin. However, this was not seen for the culture of PBMNCs from the adult group. Conclusions The lymphocytes and monocytes are in a highly proliferative state in the tonsillar hypertrophy and associated with increased expression of pro-inflammatory factors as a result of exposure to stomach reflux pepsin. PMID:27058240

  16. Bacterial biota in reflux esophagitis and Barrett's esophagus

    Institute of Scientific and Technical Information of China (English)

    Zhiheng Pei; Liying Yang; Richard M Peek; Jr Steven M Levine; David T Pride; Martin J Blaser

    2005-01-01

    AIM: To identify the bacterial flora in conditions such as Barrett's esophagus and reflux esophagitis to determine if they are similar to normal esophageal flora.METHODS: Using broad-range 16S rDNA PCR,esophageal biopsies were examined from 24 patients [9with normal esophageal mucosa, 12 with gastroesophageal reflux disease (GERD), and 3 with Barrett's esophagus].Two separate broad-range PCR reactions were performed for each patient, and the resulting products were cloned.In one patient with Barrett's esophagus, g9 PCR clones were analyzed.RESULTS: Two separate clones were recovered from each patient (total = 48), representing 24 different species, with 14 species homologous to known bacteria,5 homologous to unidentified bacteria, and 5 were not homologous (<97% identity) to any known bacterial 16S rDNA sequences. Seventeen species were found in the reflux esophagitis patients, 5 in the Barrett's esophagus patients, and 10 in normal esophagus patients.Further analysis concentrating on a single biopsy from an individual with Barrett's esophagus revealed the presence of 21. distinct bacterial species. Members of four phyla were represented, including Bacteroidetes,Firmicutes, Proteobacteria, and Actinobacteria.Microscopic examination of each biopsy demonstrated bacteria in intimate association with the distal esophageal epithelium, suggesting that the presence of these bacteria is not transitory.CONCLUSION: These findings provide evidence for a complex, residential bacterial population in esophageal reflux-related disorders. While much of this biota is present in the normal esophagus, more detailed comparisons may help identify potential disease associations.

  17. Extra-Esophageal Pepsin from Stomach Refluxate Promoted Tonsil Hypertrophy.

    Science.gov (United States)

    Kim, Jin Hyun; Jeong, Han-Sin; Kim, Kyung Mi; Lee, Ye Jin; Jung, Myeong Hee; Park, Jung Je; Kim, Jin Pyeong; Woo, Seung Hoon

    2016-01-01

    Gastroesophageal reflux is associated with numerous pathologic conditions of the upper aerodigestive tract. Gastric pepsin within reflux contributes to immunologic reactions in the tonsil. In this study, we aimed to find the relationships between pepsin and tonsillar hypertrophy. We explored the notion whether tonsillar hypertrophy was due to pepsin-mediated gastric reflux in tonsil hypertrophy. Fifty-four children with tonsil hypertrophy and 30 adults with tonsillitis were recruited before surgical treatment. Blood and tonsil tissues from each patient were harvested for analysis of changes in lymphocyte and macrophage numbers coupled with histological and biochemical analysis. Pepsin was expressed at different levels in tonsil tissues from each tonsillar hypertrophy. Pepsin-positive cells were found in the crypt epithelium, surrounding the lymphoid follicle with developing fibrosis, and also surrounding the lymphoid follicle that faced the crypt. And also, pepsin staining was well correlated with damaged tonsillar squamous epithelium and TGF-β1 and iNOS expression in the tonsil section. In addition, pepsin and TGF-β1-positive cells were co-localized with CD68-positive cells in the crypt and surrounding germinal centers. In comparison of macrophage responsiveness to pepsin, peripheral blood mononuclear cells (PBMNCs) were noticeably larger in the presence of activated pepsin in the child group. Furthermore, CD11c and CD163-positive cells were significantly increased by activated pepsin. However, this was not seen for the culture of PBMNCs from the adult group. The lymphocytes and monocytes are in a highly proliferative state in the tonsillar hypertrophy and associated with increased expression of pro-inflammatory factors as a result of exposure to stomach reflux pepsin.

  18. Relationship between gastroesophageal reflux symptoms and dietary factors in Korea.

    Science.gov (United States)

    Song, Ji Hyun; Chung, Su Jin; Lee, Jun Haeng; Kim, Young-Ho; Chang, Dong Kyung; Son, Hee Jung; Kim, Jae J; Rhee, Jong Chul; Rhee, Poong-Lyul

    2011-01-01

    The incidence of gastroesophageal reflux disease (GERD) is increasing in Korea. The aim of this study was to evaluate the relationship between GERD symptoms and dietary factors in Korea. From January 2007 to April 2008, 162 subjects were enrolled (81 in GERD group and 81 in control group). They were asked to complete the questionnaires about GERD symptoms and dietary habits. The symptom severity score was recorded by visual analogue scale. Subjects with overweight or obesity had an increased risk for GERD (OR, 2.52; 95% CI, 1.18-5.39). Irregular dietary intake was one of the risk factors for GERD (OR, 2.33; 95% CI, 1.11-4.89). Acid regurgitation was the most suffering (2.85 ± 2.95 by visual analogue scale) and frequent reflux-related symptom (57.5%) in GERD. Noodles (OR, 1.22; 95% CI, 1.12-1.34), spicy foods (OR, 1.09; 95% CI, 1.02-1.16), fatty meals (OR, 1.20; 95% CI, 1.09-1.33), sweets (OR, 1.42; 95% CI, 1.00-2.02), alcohol (OR, 1.16; 95% CI, 1.03-1.31), breads (OR, 1.17; 95% CI, 1.01-1.34), carbonated drinks (OR, 1.69; 95% CI, 1.04-2.74) and caffeinated drinks (OR,1.41; 95% CI, 1.15-1.73) were associated with symptom aggravation in GERD. Among the investigated noodles, ramen (instant noodle) caused reflux-related symptoms most frequently (52.4%). We found that noodles, spicy foods, fatty meals, sweets, alcohol, breads, carbonated drinks and caffeinated drinks were associated with reflux-related symptoms.

  19. Relationship Between Gastroesophageal Reflux Symptoms and Dietary Factors in Korea

    OpenAIRE

    Song, Ji Hyun; Chung, Su Jin; Lee, Jun Haeng; Kim, Young-Ho; Chang, Dong Kyung; Son, Hee Jung; Kim, Jae J.; Rhee, Jong Chul; Rhee, Poong-Lyul

    2011-01-01

    Background/Aims The incidence of gastroesophageal reflux disease (GERD) is increasing in Korea. The aim of this study was to evaluate the relationship between GERD symptoms and dietary factors in Korea. Methods From January 2007 to April 2008, 162 subjects were enrolled (81 in GERD group and 81 in control group). They were asked to complete the questionnaires about GERD symptoms and dietary habits. The symptom severity score was recorded by visual analogue scale. Results Subjects with overwei...

  20. Two Cases of Hiccups due to Gastroesophageal Reflux Disease

    OpenAIRE

    KOÇKAR, Cem; İşler, Mehmet; CÜRE, Erkan; Şenol, Altuğ; Bastürk, Abdulkadir

    2015-01-01

    Hiccup is a spasmodic, involuntary contraction of the inspiratory muscles, associated with delayed, abrupt glottic closure, causing a peculiar sound. There are numerous causes of hiccup, including diseases of the gastrointestinal tract. Hiccup is reported to represent an atypical manifestation of the gastroesophageal reflux disease (GERD).We report two cases with hiccup due to GERD. Endoscopic examinations showed esophagitis, Los Angeles class grade A and B, in two cases whose hiccups were im...

  1. Evaluating the autonomic nervous system in patients with laryngopharyngeal reflux.

    Science.gov (United States)

    Huang, Wan-Ju; Shu, Chih-Hung; Chou, Kun-Ta; Wang, Yi-Fen; Hsu, Yen-Bin; Ho, Ching-Yin; Lan, Ming-Ying

    2013-06-01

    The pathogenesis of laryngopharyngeal reflux (LPR) remains unclear. It is linked to but distinct from gastroesophageal reflux disease (GERD), which has been shown to be related to disturbed autonomic regulation. The aim of this study is to investigate whether autonomic dysfunction also plays a role in the pathogenesis of LPR. Case-control study. Tertiary care center. Seventeen patients with LPR and 19 healthy controls, aged between 19 and 50 years, were enrolled in the study. The patients were diagnosed with LPR if they had a reflux symptom index (RSI) ≥ 13 and a reflux finding score (RFS) ≥ 7. Spectral analysis of heart rate variability (HRV) analysis was used to assess autonomic function. Anxiety and depression levels measured by the Beck Anxiety Inventory (BAI) and Beck Depression Inventory II (BDI-II) were also conducted. In HRV analysis, high frequency (HF) represents the parasympathetic activity of the autonomic nervous system, whereas low frequency (LF) represents the total autonomic activity. There were no significant differences in the LF power and HF power between the 2 groups. However, significantly lower HF% (P = .003) and a higher LF/HF ratio (P = .012) were found in patients with LPR, who demonstrated poor autonomic modulation and higher sympathetic activity. Anxiety was also frequently observed in the patient group. The study suggests that autonomic dysfunction seems to be involved in the pathogenesis of LPR. The potential beneficial effect of autonomic nervous system modulation as a therapeutic modality for LPR merits further investigation.

  2. Fabrication of hydroxyapatite from fish bones waste using reflux method

    Science.gov (United States)

    Cahyanto, A.; Kosasih, E.; Aripin, D.; Hasratiningsih, Z.

    2017-02-01

    The aim of this present study was to investigate the fabrication of hydroxyapatites, which were synthesized from fish bone wastes using reflux method. The fish bone wastes collected from the restaurant were brushed and boiled at 100°C for 10 minutes to remove debris and fat. After drying, the fish bones were crushed, and ball milled into a fine powder. The fish bone wastes were then processed by refluxing using KOH and H3PO4 solutions. The samples were calcined at 900°C and characterized by X-Ray Diffraction (XRD) and Fourier Transform Infrared Spectrometry (FT-IR). The XRD pattern of samples after treatment revealed that the peak of hydroxyapatite was observed and the bands of OH- and PO4 3- were observed by FT-IR. The scanning electron microscope evaluation of sample showed the entangled crystal and porous structure of hydroxyapatite. In conclusion, the hydroxyapatite was successfully synthesized from fish bone wastes using reflux method.

  3. Animal study for airway inflammation triggered by gastroesophageal reflux

    Institute of Scientific and Technical Information of China (English)

    LAI Yun-gang; WANG Zhong-gao; JI Feng; WU Ji-min; CHEN Xiu; LI Zhen; DONG Shu-kui

    2009-01-01

    Background Gastroesophageal reflux disease with extra-esophageal symptoms, especially those with respiratory istress was attracting more and more attention. The related mechanisms were still in controversy. The purpose of the work was to explore airway inflammation triggered by gastroesophageal reflux.Methods Sixteen Sprague-Dawley rats were used as study group and 9 as control. In the study group, a plastic extender with a trumpet-shaped distal end was inserted into the lower esophagus to dilate the cardia, the pylorus was ligated. One ml of 0.1 mol/L hydrochloric acid was injected into the stomach, While a simple laparotomy was performed for control animals. All animals from two groups were sacrificed 24 hours after operation. Then tracheotomy was carried and the bronchoalveolar lavage fluid was collected in all animals. Cells in the fluid were counted and levels of intedeukin (IL)-5, -6, -8 in it were measured.Results Compared with control group, the study group presented a neutrophil pattem of airway inflammation and an elevated concentration of IL-5, -6, -8 with no significant difference regarding eosinophil count.Conclusion The gastroesophageal reflux-triggered airway inflammation is characterized by a neutrophilic airway inflammation which differed from that caused by asthma, and enhanced levels of IL-5, -6 and -8, which are similar to that caused by asthma.

  4. Evaluating kidney damage from vesico-ureteral reflux in children

    Directory of Open Access Journals (Sweden)

    Zaffanello M

    2009-01-01

    Full Text Available To review the most relevant clinical studies that evaluate kidney damage in children with primary vesico-ureteral reflux (VUR, we reviewed and compared randomized controlled trials and clinical trials from scientific literature. In these studies, vesico-ureteral reflux was diagnosed by voiding cystourethrogram and kidney damage was assessed by either DMSA scan or urography. Relative risk with 95% confidence intervals was calculated using Review Manager Software (The Cochrane Collaboration, 2000. The overall relative risk of kidney damage shown by DMSA scan and urography was statistically higher in children with vesico-ureteral reflux of various degrees than in controls (3.7 times and 2.8 times, respectively. However, in high-grade VUR, the relative risk of congenital kidney damage was 5.6 times that of controls. We conclude that severe VUR is frequently associated with early kidney damage, perhaps with prenatal onset. Progression of kidney damage may depend on the severity of VUR and untreated urinary tract infections. Prevention of congenital kidney damage from severe VUR is possible when there is early intervention, even during fetal growth.

  5. Barrett's esophagus and its correlation with gastroesophageal reflux in Chinese

    Institute of Scientific and Technical Information of China (English)

    Jun Zhang; Xiao-Li Chen; Kang-Min Wang; Xiao-Dan Guo; Ai-Li Zuo; Jun Gong

    2004-01-01

    AIM: To study the prevalence of Barrett's esophagus in Chinese and its correlation with gastroesophageal reflux.METHODS: This study was carried out in a large prospective series of 391 patients who had undergone upper endoscopy.The patients were divided into 3 groups according to the position of squamocolumnar junction (SCJ). Reflux esophagitis (RE) and its degree were recorded. Intestinal metaplasia (IlMl) in biopsy specimen was typed according to histochemistry and HE and alcian blue (pH2.5) staining separately. Results correlating with clinical, endoscopic, and pathological data were analysed.RESULTS: The prevalence of IM endoscopically appearing Long-segment Barrett's Esophagus (LSBE) was 26.53%,Short-segment Barrett's Esophagus (SSBE) was 33.85% and gastroesophageal junction (GFJ) was 34.00% . IM increased with age of above 40 years old and no difference was found between male and female. Twelve were diagnosed as dysplasia (7 low -grade, 5 high-grade), 16 were diagnosed as cardiac adenocarcinoma and 1 as esophageal adenocarcinoma. The more far away the SCJ moved upward above GFJ, the higher the prevalence and the more severe the RE were.CONCLUSION: There was no difference of the prevalence of IM in different places of SCJ, and IM increased with age of above 40 years old. It is important to pay attention to dysplasia in the distal esophagus and gastro-esophageal junction, and adenocarcinoma is more common in cardia than in esophagus. BE is a consequence of gastroesophageal reflux disease.

  6. Integrative Treatment of Reflux and Functional Dyspepsia in Children

    Directory of Open Access Journals (Sweden)

    Ann Ming Yeh

    2014-08-01

    Full Text Available Gastroesophageal reflux disease (GERD and functional dyspepsia (FD are common problems in the pediatric population, with up to 7% of school-age children and up to 8% of adolescents suffering from epigastric pain, heartburn, and regurgitation. Reflux is defined as the passage of stomach contents into the esophagus, while GERD refers to reflux symptoms that are associated with symptoms or complications—such as pain, asthma, aspiration pneumonia, or chronic cough. FD, as defined by the Rome III classification, is a persistent upper abdominal pain or discomfort, not related to bowel movements, and without any organic cause, that is present for at least two months prior to diagnosis. Endoscopic examination is typically negative in FD, whereas patients with GERD may have evidence of esophagitis or gastritis either grossly or microscopically. Up to 70% of children with dyspepsia exhibit delayed gastric emptying. Treatment of GERD and FD requires an integrative approach that may include pharmacologic therapy, treating concurrent constipation, botanicals, mind body techniques, improving sleep hygiene, increasing physical activity, and traditional Chinese medicine and acupuncture.

  7. PSYCHOSOMATIC ASPECTS IN THE TREATMENT OF GASTROESOPHAGEAL REFLUX DISEASE

    Directory of Open Access Journals (Sweden)

    V. I. Trofimov

    2015-01-01

    Full Text Available Gastroesophageal reflux disease is the most common disease of the esophagus, through the development of which is impaired motor function of the upper gastrointestinal system, allowing the disease to be quite be classified as psychosomatic, especially in the early stages of development, when no apparent organic complications that affect the structure of tissues. A significant percentage of mental disorders is observed in patients even before the development of somatic complaints. Patients in number of 105 people are examined. The first group — experienced (71 patient received complex treatment, which includes the basic pathogenetic, symptomatic, and psychotropic treatment in the form of anxiolytics and antidepressants. The choice of drug was based on the results of psychological testing. The second group — the comparison group (34 patients received only conventional treatment, without psychiatric support. Analysis was conducted of the astheno-vegetative syndrome, psychological characteristics of patients in relation to their disease, indicators of anxiety level and severity of depression. Patients with not erosive reflux disease have a frequency of detection of a depression and uneasiness was more than twice higher, than at patients with erosive reflux disease. After carrying out psychotropic treatment these indicators were practically made even. Prescription of psychotropic therapy in the form of antidepressants and anxiolytics has allowed to minimize the timing regression of clinical and psychosomatic manifestations of disease.

  8. Prevalence of overweightedness in patients with gastro-esophageal reflux

    Institute of Scientific and Technical Information of China (English)

    Luca Piretta; Federico Alghisi; Fiorella Anzini; Enrico Corazziari

    2007-01-01

    AIM: To evaluate whether the prevalence of overweight and obese conditions is increased in gastro-esophageal reflux disease (GERD) patients (with 24-h pathological pH recordings) in comparison to general population.METHODS: A total of 196 consecutive patients (103females, age range 18-83 years) with symptoms of gastro-esophageal reflux (GER) and 24-h pathological esophageal pH-metry. Body mass index (BMI) of the patients was calculated and its distribution (%) was compared with that of the Italian general population as assessed by National Bureau of Census (ISTAT). To evaluate the association of GERD with weight categories,the binomial test was employed. P < 0.05 was considered statistically significant.RESULTS: In males, overweightedness (BMI 25-25.9)was present in 43% of GERD patients vs 41.8% of Italian population (IP) (ns), obesity (BMI ≥ 30) in 10.9% vs9.1% (ns). In females overweight was present in 34.9%of GERD patients vs 25.7% of IP (P < 0.01), obesity in 13.6% of GERD patients vs 9.1% of IP (P < 0.01). No statistically significant differences were noted in different age classes.CONCLUSION: In comparison to the Italian general population, the prevalence of overweightedness and obesity is increased in female but not in male patients with ascertained gastro-esophageal reflux disease.

  9. Bronchial hyperreactivity in non-atopic children with asthma and reflux: effect of anti-reflux treatment.

    Science.gov (United States)

    Khoshoo, Vikram; Mohnot, Sopan; Haydel, Robert; Saturno, Emilio; Edell, Dean; Kobernick, Aaron

    2009-11-01

    The prevalence of bronchial hyperreactivity (BHR) or the effect of anti-reflux treatment on BHR in children with asthma and gastroesophageal reflux disease (GERD) is not known. Thirty non-atopic children with persistent asthma were studied. Extended esophageal pH monitoring was used to diagnose GERD and methacholine challenge test (MCT) was used as a marker of BHR and performed before and 2 years after anti-GERD treatment. Of the 21 patients positive for GERD (group A), 15 had positive MCT suggesting BHR. Of the 9 patients negative for GERD (group B), 5 had positive MCT. On repeat testing 2 years later, 11/15 group A patients and 3/5 group B patients tested negative for BHR. Group A patients were receiving fewer asthma medications and experienced fewer exacerbations than Group B patients. BHR is prevalent in children with asthma and GERD and improves with anti-GERD treatment.

  10. Diagnostic value of the reflux sign in cholescintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Itoh, Hisao (Ehime Univ., Shigenobu (Japan). School of Medicine)

    1990-09-01

    This study reviewed 27 patients with the reflux sign in cholescintigraphy to assess its diagnostic value in detecting incomplete obstruction of the common bile duct (CBD). After at least 5 hours of fasting 5 mCi of Tc-99m PMT or Tc-99m (p-butyl) IDA was injected intravenously and serial images were recorded before and after administration of 10 {mu}g of ceruletide diethylamine (caerulein). The reflux sign was determined to be positive when increased radioactivities in the right or left hepatic duct (minor reflux: MIR) or more peripheral intrahepatic ducts (major reflux; MAR) were recognized after gallbladder stimulation. The reflux sign was found in 30 of 266 consecutive studies. Direct and/or indirect X-ray cholangiograms were available in 27 (MIR; 13, MAR; 14), including juxtapapillary duodenal diverticulum (8), biliary dyskinesia (6), CBD stone (5), chronic pancreatitis (4), gallbladder stone (4), duodenal ulcer (2), chronic cholecystitis (2), CBD adenoma, duodenal papillitis, pancreatic pseudocyst, acute cholangitis, chronic hepatitis, and postgastrectomy (1 each). The caliber of the CBD on X-ray cholangiogram ranged from 4 to 16 mm. CBD dilatation of more than or equal to 10 mm was found in 23% of the MIR and in 79% of the MAR. Apparent stenosis of the CBD was found in 8% of the MIR and in 36% of the MAR. There was no significant difference in the ejection fraction of the gallbladder between MIR and MAR. MAR sign seemed to correspond to an increase in the caliber of the common hepatic duct more than 2 mm after caerulein injection on DIC. Persistent stasis of RI in the biliary system was found in 36% of the MAR. Duodenum appearance time of RI was prolonged by more than 60 min in 54% of the MIR and in 79% of the MAR. When the MAR sign was interpreted as positive for incomplete obstruction of the CBD including apparent stenosis of the CBD and/or CBD stone, the sensitivity, specificity, and accuracy were 89%, 67%, and 74%, respectively. (J.P.N.).

  11. Acid suppression increases rates of Barrett's esophagus and esophageal injury in the presence of duodenal reflux.

    LENUS (Irish Health Repository)

    2012-01-31

    BACKGROUND: The contribution of gastric acid to the toxicity of alkaline duodenal refluxate on the esophageal mucosa is unclear. This study compared the effect of duodenal refluxate when acid was present, decreased by proton pump inhibitors (PPI), or absent. METHODS: We randomized 136 Sprague-Dawley rats into 4 groups: group 1 (n = 33) were controls; group 2 (n = 34) underwent esophagoduodenostomy promoting "combined reflux"; group 3 (n = 34) underwent esophagoduodenostomy and PPI treatment to decrease acid reflux; and group 4, the \\'gastrectomy\\' group (n = 35) underwent esophagoduodenostomy and total gastrectomy to eliminate acid in the refluxate. Esophaguses were examined for inflammatory, Barrett\\'s, and other histologic changes, and expression of proliferative markers Ki-67, proliferating cell nuclear antigen (PCNA), and epidermal growth factor receptor (EGFR). RESULTS: In all reflux groups, the incidence of Barrett\\'s mucosa was greater when acid was suppressed (group C, 62%; group D, 71%) than when not suppressed (group B, 27%; P = 0.004 and P < .001). Erosions were more frequent in the PPI and gastrectomy groups than in the combined reflux group. Edema (wet weight) and ulceration was more frequent in the gastrectomy than in the combined reflux group. Acute inflammatory changes were infrequent in the PPI group (8%) compared with the combined reflux (94%) or gastrectomy (100%) groups, but chronic inflammation persisted in 100% of the PPI group. EGFR levels were greater in the PPI compared with the combined reflux group (P = .04). Ki-67, PCNA, and combined marker scores were greater in the gastrectomy compared with the combined reflux group (P = .006, P = .14, and P < .001). CONCLUSION: Gastric acid suppression in the presence of duodenal refluxate caused increased rates of inflammatory changes, intestinal metaplasia, and molecular proliferative activity. PPIs suppressed acute inflammatory changes only, whereas chronic inflammatory changes persisted.

  12. Two years of experience with robot-assisted anti-reflux surgery

    DEFF Research Database (Denmark)

    Sanberg Jensen, Jonas; Kold Antonsen, Henning; Durup, Jesper

    2017-01-01

    Background and aims Robot-assisted anti-reflux surgery (RAAS) is an alternative to conventional laparoscopic anti-reflux surgery (CLAS). The purpose of this study was to evaluate initial Danish experiences with robot-assisted anti-reflux surgery compared to conventional laparoscopic anti...... no particular advantages to performing antireflux surgery as robot-assisted procedures neither intra-operatively nor at follow-up.......-reflux surgery incorporating follow-up and evaluation of possible learning curve. Material and methods Patients undergoing primary RAAS or CLAS at The Department of Surgery A, Odense University Hospital and The Department of General Surgery, Kolding Hospital from April 2013 to April 2015 was included...

  13. Intravoxel incoherent motion magnetic resonance imaging to predict vesicoureteral reflux in children with urinary tract infection

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jeong Woo; Lee, Chang Hee; Park, Yang Shin; Kim, Kyeong Ah; Park, Cheol Min [Korea University College of Medicine, Departments of Radiology, Korea University Guro Hospital, 80 Guro-dong, Guro-gu, Seoul (Korea, Republic of); Yoo, Kee Hwan [Korea University College of Medicine, Departments of Pediatrics, Korea University Guro Hospital, Seoul (Korea, Republic of); Je, Bo-Kyung [Korea University College of Medicine, Department of Radiology, Korea University Ansan Hospital, Seoul (Korea, Republic of); Kiefer, Berthold [Oncology Application Development, Siemens Healthcare, Erlangen (Germany)

    2016-06-15

    To compare the diffusion parameters of intravoxel incoherent motion (IVIM) diffusion-weighted imaging (DWI) between the ''reflux'' and the ''non-reflux'' kidneys, and to evaluate the feasibility of using IVIM DWI to predict vesicoureteral reflux (VUR) in children with a urinary tract infection (UTI). Eighty-three kidneys from 57 pediatric patients with a UTI were classified into ''reflux'' and ''non-reflux'' groups according to voiding cystourethrography (VCUG) results. The apparent diffusion coefficient (ADC), true diffusion coefficient (D), pseudo-diffusion coefficient (D*), and perfusion fraction (PF) were measured and compared in the renal pelvis of both groups. Four indices (D*/ADC, PF/ADC, D*/D, and PF/D) were calculated and receiver operating characteristic (ROC) curve analyses were performed. VURs were detected on VCUG in 21 kidneys. PF and D* were significantly higher in the ''reflux'' group than in the ''non-reflux'' group. The indices were all significantly higher. The PF/D index showed the best diagnostic performance in predicting VUR in children with UTI (A{sub z} = 0.864). PF and D* were significantly higher in the ''reflux'' kidney than in the ''non-reflux'' kidney. Our new index (PF/D) could prove useful for predicting VUR. (orig.)

  14. The effect of N-acetyl cysteine on laryngopharyngeal reflux.

    Directory of Open Access Journals (Sweden)

    Payman Dabirmoghaddam

    2013-11-01

    Full Text Available Laryngopharyngeal reflux (LPR is a variant of gastroesophageal reflux disease (GERD in which the stomach contents go up into the pharynx and then down into the larynx. LPR causes a wide spectrum of manifestations mainly related to the upper and the lower respiratory system such as laryngitis, asthma, chronic obstructive pulmonary disease, cough, hoarseness, postnasal drip disease, sinusitis, otitis media, recurrent pneumonia, laryngeal cancer and etc. The object of this study was to examine the effect of N-acetyl Cysteine (NAC with and without Omeprazole on laryngitis and LPR. Ninety patients with laryngitis or its symptoms were referred and randomly assigned into three groups. The first group was treated by Omeprazole and NAC. The second group was treated by Omeprazole and placebo and the last group was treated by NAC and placebo. Duration of treatment was 3 months and all patients were evaluated at the beginning of study, one month and three month after treatment of sign and symptoms, based on reflux symptom index (RSI and reflex finding score (RFS. Based on the results of this study, despite therapeutic efficacy of all treatment protocols, the RSI before and after 3 months treatment had significant difference in (NAS+ Omeprazole and (Omeprazole+ placebo group (P<0.001 in the first group, P<0.001 in the second group and P=0.35 in the third group. Whereas RFS before and after 3 month treatment had significant difference in all groups. (P<0.001 in each group in comparison with itself but this results had not significant difference after 1 month treatment. Our results showed that the combination therapy with Omeprazole and NAC treatment had the most effect on both subjective and objective questionnaire at least after 3 months treatment. Based on the results of the present study, it seems that the use objective tools are more accurate than subjective tools in evaluation of therapeutic effects in patients with GERD-related laryngitis.

  15. Vesicoureteral reflux and antibiotic prophylaxis: why cohorts and methodologies matter

    Science.gov (United States)

    Greenfield, Saul P.; Cheng, Earl; DeFoor, William; Kropp, Bradley; Rushton, H. Gil; Skoog, Steve; Carpenter, Myra

    2016-01-01

    Purpose Published cohorts of children with vesicoureteral reflux placed on antibiotic prophylaxis differ in baseline characteristics and methodology. These data have been combined in meta-analyses to derive treatment recommendations. We analyzed these cohorts in an attempt to understand the disparate outcomes reported. Materials and Methods Eighteen studies were identified from 1987 to 2013. These either retrospectively or prospectively evaluated children with VUR who were on long-term antibiotic prophylaxis. The presenting demographic data, criteria and methods of evaluation were tabulated. Outcomes were compared—specifically recurrent urinary infection and renal scarring. Results Significant differences in baseline characteristics and methodology were identified: gender, circumcision status, grade of reflux, evaluation of bowel and bladder dysfunction (BBD), methodology of urine collection, definition of urinary infection (UTI), measurement of compliance, means of identifying renal scarring. Cohorts with larger numbers of uncircumcised boys had more breakthrough UTI’s. Both infection and renal scarring rates were higher in series with higher grades of reflux. Bagged urine specimens were allowed in 6 series, rendering the data suspect. Children with BBD were excluded from 3 cohorts; only in 1 was BBD correlated with outcome. Compliance was monitored in only 6 studies. Conclusions Sub-populations as well as methodologies vary significantly in published series of children with VUR on anti-biotic prophylaxis. It is inappropriate to combine outcome data from these series in a meta-analysis, since this serves to blur distinctions between these sub-populations. Broad recommendations or guidelines based upon meta-analyses should be viewed with caution. PMID:22910235

  16. Prevalence of pancreaticobiliary reflux in symptomatic cholelithiasis and its significance

    Directory of Open Access Journals (Sweden)

    TP Bohara

    2014-01-01

    Full Text Available Aims: Pancreaticobiliary reflux (PBR is reflux of pancreatic enzymes into the biliary tree which occurs as a result of an anamoly of pancreaticobiliary junction (PBJ or functionally impaired sphincter. PBR is associated with changes in biliary epithelium and is known to cause benign and malignant biliary pathology. Various authors have reported prevalence of PBR in patients with normal PBJ ranging from 20 % to 83.5 %. With aim to detect the prevalence of PBR in patients with symptomatic cholelithiasis in Nepalese population we conducted this study. Materials and methods: Thirty patients undergoing elective laparoscopic cholecystectomy (LC for symptomatic cholelithiasis were included in the study. History, physical findings and relevant investigations including liver function test, serum amylase and abdominal ultrasound were recorded. Bile sample for amylase was taken from gall bladder during LC percuatneously before manipulation of calot’s triangle and common bile duct. Bile amylase level above serum amylase level was considered positive for PBR. Results: Mean age of the patient was 37.27 (± 14.41 years. Out of 30, 6 (20 % patients were male and 24 (80 % were female. Mean BMI was 21.58 (± 3.2. PBR reflux was present in 66.7 % of patients out of which 2 were male and 18 were female that was not statistically significant (p = 1.41 when compared with patients without PBR. Conclusion: PBR occurs in patient with cholelithiasis and has role in pathogenesis of gallstones disease and gall bladder carcinoma. Long term surveillance would be required to ascertain the significance of detection of PBR after LC. Journal of College of Medical Sciences-Nepal, 2013, Vol-9, No-1, 1-6 DOI: http://dx.doi.org/10.3126/jcmsn.v9i1.9666

  17. Gastroesophageal reflux disease update for the primary care physician.

    Science.gov (United States)

    Mitz, H S

    1999-08-01

    Gastroesophageal reflux disease (GERD) is one of the most common ailments that can decrease quality of life to below that of patients with congestive heart failure. Patients can present with typical, atypical, or serious symptoms, either alone or in combination. History, esophagogastroduodenoscopy, and 24-hour pH monitoring can help with the diagnosis; but all are not needed for each patient. This clinical review will help primary care physicians to make a rapid diagnosis, guide subsequent treatment, and indicate when to order additional testing or referral, or both.

  18. Reflux esophagitis revisited: Prospective analysis of radiologic accuracy

    Energy Technology Data Exchange (ETDEWEB)

    Ott, D.J.; Gelfand, D.W.; Wu, W.C.

    1981-01-15

    A prospective radiologic-endoscopic study of the esophagogastric region in 266 patients, including 206 normals and 60 with esophagitis, is reported. The endoscopic classification grading severity of esophagitis was grade 1-normal; grades 2. 3. and 4-mild, moderate, and severe esophagitis, respectively. Radiology detected 22% of patient with mild esophagitis, 83% with moderate esophagitis, and 95% with severe esophagitis. Although hiatal hernia was present in 40% of normals and 89% with esophagitis, absence of radiographic hiatal hernia excluded esophagitis with 95% accuracy. The implications of this study regarding the role of radiology in evaluating patient with suspected reflux esophagitis are discussed.

  19. Gastroesophageal reflux disease at the turn of millennium

    Institute of Scientific and Technical Information of China (English)

    Lee-Guan Lim; Khek-Yu Ho

    2003-01-01

    Gastroesophageal reflux disease (GERD) has been an area of active research in the Asia-Pacific region in the recent years. This article outlines some of the interesting research findings. It comprises three parts. The first part dealt with recent data on the changing epidemiology of GERD in Asia.The second part summarized published studies on the relationship between GERD and Helicobacter pylori, relevant to the Asia-Pacific region. The last part discussed some of the recent advances in the treatment of GERD.

  20. Robotic-Assisted Laparoscopic Management of Vesicoureteral Reflux

    Directory of Open Access Journals (Sweden)

    Thomas Lendvay

    2008-01-01

    Full Text Available Robotic-assisted laparoscopy (RAL has become a promising means for performing correction of vesicoureteral reflux disease in children through both intravesical and extravesical techniques. We describe the importance of patient selection, intraoperative patient positioning, employing certain helpful techniques for exposure, and recognizing the limitations and potential complications of robotic reimplant surgery. As more clinicians embrace robotic surgery and more urology residents are trained in robotics, we anticipate an expansion of the applications of robotics in children. We believe that it is necessary to develop robotic surgery curricula for novice roboticists and residents so that patients may experience improved surgical outcomes.

  1. Reflux oesophagitis in the rat : the damaging action of pancreatic juice : the development of mural fibrosis

    NARCIS (Netherlands)

    H.J. Mud

    1981-01-01

    textabstractThe results obtained in a recent study of surgically induced reflux oesophagitis in rats (Kranendonk, 1980) prompted the study presented in this thesis. In the randomized study by Kranendonk (1980) the reflux of pancreatic juice invariably resulted in oesophagitis; admixture of bile and/

  2. Gastro-esophageal reflux disease and exacerbations in chronic obstructive pulmonary disease

    DEFF Research Database (Denmark)

    Ingebrigtsen, Truls S; Marott, Jacob L; Vestbo, Jørgen

    2015-01-01

    applied a multivariable Cox regression analysis with adjustment for well-established risk factors associated with COPD exacerbations or gastro-esophageal reflux disease, including COPD severity, and symptoms. RESULTS: Individuals with COPD and gastro-esophageal reflux disease had more chronic bronchitis...

  3. Current Advances in the Diagnosis and Treatment of Nonerosive Reflux Disease

    Directory of Open Access Journals (Sweden)

    Chien-Lin Chen

    2013-01-01

    Full Text Available Nonerosive reflux disease (NERD is a distinct pattern of gastroesophageal reflux disease (GERD. It is defined as a subcategory of GERD characterized by troublesome reflux-related symptoms in the absence of esophageal mucosal erosions/breaks at conventional endoscopy. In clinical practice, patients with reflux symptoms and negative endoscopic findings are markedly heterogeneous. The potential explanations for the symptom generation in NERD include microscopic inflammation, visceral hypersensitivity (stress and sleep, and sustained esophageal contractions. The use of 24-hour esophageal impedance and pH monitoring gives further insight into reflux characteristics and symptom association relevant to NERD. The treatment choice of NERD still relies on acid-suppression therapy. Initially, patients can be treated by a proton pump inhibitor (PPI; standard dose, once daily for 2–4 weeks. If initial treatment fails to elicit adequate symptom control, increasing the PPI dose (standard dose PPI twice daily is recommended. In patients with poor response to appropriate PPI treatment, 24-hour esophageal impedance and pH monitoring is indicated to differentiate acid-reflux-related NERD, weakly acid-reflux-related NERD (hypersensitive esophagus, nonacid-reflux-related NERD, and functional heartburn. The response is less effective in NERD as compared with erosive esophagitis.

  4. Venous reflux on contrast-enhanced head and neck magnetic resonance angiography: Analysis of causative factors

    Energy Technology Data Exchange (ETDEWEB)

    Shin, Dong Jae; Lee, Eun Ja [Dept. of Radiology, Dongguk University Ilsan Hospital, Goyang (Korea, Republic of); Bae, Jong Myon [Dept. of Preventive Medicine, Jeju National University School of Medicine, Jeju (Korea, Republic of)

    2016-12-15

    The purpose of this study was to analyze the causative factors of venous reflux on contrast-enhanced head and neck magnetic resonance angiography. We retrospectively reviewed 150 patients with right-arm injections and 150 patients with left-arm injections. We included the age, gender, body mass index, history of hypertension, and history of diabetes mellitus in the evaluation of all patients. We measured the shortest width of the left or right brachiocephalic vein (BCV), the diameter of the aortic arch, and the distance between the sternum and vertebral body. The relationship between these factors and the venous reflux was analyzed. In patients with venous reflux, we performed qualitative image scoring for suboptimal images. In patients with venous reflux, the image quality of the left-arm injection group was significantly inferior to the image quality of the right-arm injection group. The mean age and the male-to-female ratio of patients with venous reflux were significantly higher than those of patients without venous reflux. In patients receiving the left-arm injection, the mean shortest width of the left BCV was significantly narrower in patients with venous reflux than in patients without venous reflux. A left-arm injection should be avoided, especially in elderly patients, to acquire an optimal image.

  5. Metabolic changes in the lower esophageal sphincter influencing the result of anti-reflux surgical interventions in chronic gastroesophageal reflux disease

    Institute of Scientific and Technical Information of China (English)

    Aron Altorjay; Arpad Juhasz; Viola Kellner; Gellert Sohar; Matyas Fekete; Istvan Sohar

    2005-01-01

    AIM: With the availability of a minimally invasive approach, anti-reflux surgery has recently experienced a renaissance as a cost-effective alternative to life-long medical treatment in patients with gastroesophageal reflux disease (GERD). We are not aware of the fact whether reflux episodes causing complaints for a long time i.e., at least for one year are associated with metabolic changes in the lower esophageal sphincter, and if so,whether these may influence functional results achieved after anti-reflux surgery.METHODS: Between 1 January 2001 and 31 December 2002 we performed anti-reflux surgery on 79 patients.Muscle samples were taken from the lower esophageal sphincter (LES) in 33 patients during anti-reflux surgery.Inclusion criteria were: LES resting pressure below 10 mmHg and a marked, pH proven acid exposure to the esophagus of at least one year's duration, causing subjective complaints and requiring continuous proton pump inhibitor treatment. Control samples were obtained from muscle tissue in the gastroesophageal junction that had been removed from 17 patients undergoing gastric or esophageal resection. Metabolic and lysosomal enzyme activities and special protein concentrations 16 parameters in total were evaluated in tissue taken from control specimens and tissue taken from patients with GERD. The biochemical parameters of these intra-operative biopsies were used to correlate the results of anti-reflux operations (Visick I and II-III).RESULTS: In the reflux-type muscle, we found a significant increase of the energy-enzyme activities e.g., creatine kinase, lactate dehydrogenase, β-hydroxybutyrate dehydrogenase, and aspartate aminotransaminase-. The concentration of the structural protein S-100 and the myofibrillar protein troponin I were also significantly increased. Among lysosomal enzymes, we found that the activities of cathepsin B, tripeptidyl-peptidase I, dipeptidylpeptidase II, β-hexosaminidase B, β-mannosidase and β-galactosidase were

  6. Is There Hope for Renal Growth on Imaging Studies Following Ureteral Reimplant for Boys With Fetal Hydronephrosis and Urinary Reflux?

    Directory of Open Access Journals (Sweden)

    Ming-Hsien Wang

    2015-07-01

    Full Text Available Reflux nephropathy is thought to be the etiology for renal maldevelopment. We present two boys with fetal hydronephrosis and sterile vesicoureteral reflux (VUR. There was lack of renal growth of the refluxing renal units on surveillance renal ultrasound. Parents elected to undergo open ureteral reimplants. Post-surgical ultrasounds demonstrated improved renal growth.

  7. Pharmacological Therapy of Gastroesophageal Reflux in Preterm Infants

    Directory of Open Access Journals (Sweden)

    Luigi Corvaglia

    2013-01-01

    Full Text Available Although gastroesophageal reflux (GER is a very common phenomenon among preterm infants, its therapeutic management is still an issue of debate among neonatologists. A step-wise approach should be advisable, firstly promoting nonpharmacological interventions and limiting drugs to selected infants unresponsive to the conservative measures or who are suffering from severe GER with clinical complications. Despite of this, a concerning pharmacological overtreatment has been increasingly reported. Most of the antireflux drugs, however, have not been specifically assessed in preterm infants; moreover, serious adverse effects have been noticed in association to their administration. This review mainly aims to draw the state of the art regarding the pharmacological management of GER in preterm infants, analyzing the best piecies of evidence currently available on the most prescribed anti-reflux drugs. Although further trials are required, sodium alginate-based formulations might be considered promising; however, data regarding their safety are still limited. Few piecies of evidence on the efficacy of histamine-2 receptor blockers and proton pump inhibitors in preterm infants with GER are currently available. Nevertheless, a significantly increased risk of necrotizing enterocolitis and infections has been largely reported in association with their use, thereby leading to an unfavorable risk-benefit ratio. The efficacy of metoclopramide in GER’s improvement still needs to be clarified. Other prokinetic agents, such as domperidone and erythromycin, have been reported to be ineffective, whereas cisapride has been withdrawn due to its remarkable cardiac adverse effects.

  8. Effect of pancreatic biliary reflux as a cofactor in cholecystitis.

    Science.gov (United States)

    Amr, Abdel Raouf; Hamdy, Hussam Mohamed; Nasr, Magid Mahmoud; Hedaya, Mohammed Saied; Hassan, Ahmed Mohamed Abdelaziz

    2012-04-01

    This study assessed the effect of pancreatico-biliary reflux (PBR) as co-factor in the process of chronic cholecystitis by measurement of the levels of active pancreatic enzyme amylase in gallbladder bile and serum of patients undergoing cholecystectomy. Pancreatic Amylase levels in bile from the gallbladder and serum were measured during surgery in 68 patients with chronic calcular cholecystitis subjected to elective open or laparoscopic cholecystectomy in the National Hepatology and Tropical Medicine Research Institution and Theodore Bilharz Research Institute. Bile amylase was detected in 64 patients (94.1%) indicating pancreatico-biliary reflux. Biliary amylase level ranged from 20-50 IU/L in 42 patients (61.76%), below 20 IU/l in 14 patients (20.59%), over 50 IU/L in 8 patients (11.76%) and undetectable in two patients. According to gallbladder bile amylase, the incidence of Occult PBR in patients operated upon for chronic calcular cholecystitis was 94.1%. The reason should be clarified by further research and wider scale study. Routinely investigating biliary amylase in every patient having cholecystitis can be a method for early detection of precancerous lesions.

  9. Strategy for treatment of nonerosive reflux disease in Asia

    Institute of Scientific and Technical Information of China (English)

    Toru Hiyama; Masaharu Yoshihara; Shinji Tanaka; Ken Haruma; Kazuaki Chayama

    2008-01-01

    The paper is to review the clinical and pathophysiologic differences between of nonerosive reflux disease (NERD) and reflux esophagitis (RE),and to propose a treatment strategy for NERD,especially for patients in Asia.A Nedline search was performed regarding the clinical and pathophysiologic differences between NERD and RE,and treatment of NERD and RE.The characteristics of NERD patients in Asia are as follows:(1) high proportion of female patients,(2)low frequency of hiatal hernia,(3) high frequency of H pylori infection,(4) severe glandular atrophy of the gastric mucosa,and (5) frequent resistance to proton pump inhibitor (PPI) therapy.In Asian NERD patients,exposure of the esophagus to acid is not increased,and esophageal motility is normal.These characteristics are similar to those of patients in Western countries.Our recommended first-choice treatment is administration of PPI in combination with a prokinetic agent.However,at present,because there is limited evidence regarding effective treatments for NERD,it is best to try several different treatment strategies to find the best treatment for each patient.

  10. Factors that influence therapeutic outcomes in symptomatic gastroesophageal reflux disease.

    LENUS (Irish Health Repository)

    Quigley, Eamonn M M

    2012-02-03

    The term "symptomatic gastroesophageal reflux disease" (GERD) refers to those patients who present with the typical GERD symptoms of heartburn and regurgitation, yet do not have endoscopic evidence of esophagitis. The primary goals of managing symptomatic GERD are to control symptoms and improve quality of life. A clinical assessment of the GERD patient can identify important clinical features, such as atypical and extraesophageal symptoms for which acid-suppressive agents tend to be less effective. Performing an endoscopy can further identify the patient as having nonerosive reflux disease, erosive esophagitis, or Barrett\\'s esophagus-diagnoses which can help determine treatment but may not prove predictive of therapeutic response. Determining acid exposure through pH testing can predict therapeutic response, with those revealing an abnormal acid exposure time being more responsive to acid-suppressive therapy. However, the performance of an endoscopy and pH testing on each patient is clearly not practical. Whereas the natural history of symptomatic GERD is still largely undefined, acid-suppressive therapy appears to be the best approach available for both the short-term and long-term management of this disease.

  11. Reflux-free cannula for convection-enhanced high-speed delivery of therapeutic agents

    Science.gov (United States)

    Krauze, Michal T.; Saito, Ryuta; Noble, Charles; Tamas, Matyas; Bringas, John; Park, John W.; Berger, Mitchel S.; Bankiewicz, Krystof

    2013-01-01

    Object Clinical application of the convection-enhanced delivery (CED) technique is currently limited by low infusion speed and reflux of the delivered agent. The authors developed and evaluated a new step-design cannula to overcome present limitations and to introduce a rapid, reflux-free CED method for future clinical trials. Methods The CED of 0.4% trypan blue dye was performed in agarose gel to test cannula needles for distribution and reflux. Infusion rates ranging from 0.5 to 50 μl/minute were used. Agarose gel findings were translated into a study in rats and then in cynomolgus monkeys (Macaca fascicularis) by using trypan blue and liposomes to confirm the efficacy of the reflux-free step-design cannula in vivo. Results of agarose gel studies showed reflux-free infusion with high flow rates using the step-design cannula. Data from the study in rats confirmed the agarose gel findings and also revealed increasing tissue damage at a flow rate above 5-μl/minute. Robust reflux-free delivery and distribution of liposomes was achieved using the step-design cannula in brains in both rats and nonhuman primates. Conclusions The authors developed a new step-design cannula for CED that effectively prevents reflux in vivo and maximizes the distribution of agents delivered in the brain. Data in the present study show reflux-free infusion with a constant volume of distribution in the rat brain over a broad range of flow rates. Reflux-free delivery of liposomes into nonhuman primate brain was also established using the cannula. This step-design cannula may allow reflux-free distribution and shorten the duration of infusion in future clinical applications of CED in humans. PMID:16304999

  12. The association between reflux esophagitis and airway hyper-reactivity in patients with gastro-esophageal reflux

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    Ashraf Karbasi

    2013-01-01

    Full Text Available Background: The association of gastro-esophageal reflux (GER with a wide variety of pulmonary disorders was recognized. We aimed to evaluate the effect of GER-induced esophagitis on airway hyper-reactivity (AHR in patients and the response to treatment. Materials and Methods: In this cohort study, 30 patients attending the gastrointestinal clinic of a university hospital with acid reflux symptoms were included. All patients were evaluated endoscopically and divided into case group with esophagitis and control group without any evidence of esophagitis. Spirometry and methacholine test were done in all patients before and after treatment of GER with pantoprazole 40 mg daily for six months. Results: There was a significant difference in the rate of positive methacholine test between the cases (40% and the controls (6.7% prior to anti-acid therapy (P < 0.0001. After six months of treatment, the frequency of positive methacholine test diminished from 40 to 13.3% in the case group (P < 0.05 but did not change in the controls (P = 0.15. Conclusion: The presence of esophagitis due to GER would increase the AHR and treatment with pantoperazole would decrease AHR in patients with proved esophagitis and no previous history of asthma after six months.

  13. Endoscopic treatment for vesicoureteral reflux: how important is technique?

    Science.gov (United States)

    Watters, Sean T; Sung, Jennifer; Skoog, Steven J

    2013-12-01

    Endoscopic dextranomer/hyaluronic acid (Dx/HA) injection by subureteric transurethral injection (STING) or hydrodistention implantation technique (HIT) for treatment of vesicoureteral reflux (VUR) has variable results with HIT reporting better outcomes. We determined outcomes with each technique comparing reflux resolution rates and evaluating predictors of treatment success and failure. Univariate and multivariate analysis compared 163 patients (246 ureters) who underwent a single endoscopic Dx/HA injection from December 2001 to April 2010. Data on pre, peri, and post-operative variables were prospectively collected. Resolution was defined as no reflux on voiding cystourethrogram (VCUG) at 3 month follow up. Calculated ellipsoid volume (CEV) of Dx/HA mounds was defined as (4/3π(height/2) × (length/2) × (width/2)) based on post-operative ultrasound dimensions. Ureter resolution was 79.75% and 80.84% for STING and HIT, respectively (p = 0.86). Patient resolution was 70.0% and 74.3% for STING and HIT, respectively (p = 0.57). Multivariate ureter analysis revealed lower pre-operative grade (p = 0.004) and injected Dx/HA volume 0.80-1.00 mL (p = 0.039) as predictors of success. CEV <0.20 mL (p = 0.002) and CEV/injected-volume <25% (p = 0.006) were predictors of failure. Volcano morphology (p = 0.004) and lower pre-op grade (p = 0.015) were predictors of success for STING and HIT, respectively. We found no differences in ureter or patient resolution between endoscopic Dx/HA injection techniques STING or HIT. Lower pre-operative grade and moderated Dx/HA volume were predictors of success regardless of technique. Copyright © 2013 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

  14. Testing of Stirling engine solar reflux heat-pipe receivers

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    Rawlinson, S.; Cordeiro, P.; Dudley, V.; Moss, T.

    1993-07-01

    Alkali metal heat-pipe receivers have been identified as a desirable interface to couple a Stirling-cycle engine with a parabolic dish solar concentrator. The reflux receiver provides power nearly isothermally to the engine heater heads while de-coupling the heater head design from the solar absorber surface design. The independent design of the receiver and engine heater head leads to high system efficiency. Heat pipe reflux receivers have been demonstrated at approximately 30 kW{sub t} power throughput by others. This size is suitable fm engine output powers up to 10 kW{sub e}. Several 25-kW{sub e}, Stirling-cycle engines exist, as well as designs for 75-kW{sub t} parabolic dish solar concentrators. The extension of heat pipe technology from 30 kW{sub t} to 75 kW{sub t} is not trivial. Heat pipe designs are pushed to their limits, and it is critical to understand the flux profiles expected from the dish, and the local performance of the wick structure. Sandia has developed instrumentation to monitor and control the operation of heat pipe reflux receivers to test their throughput limits, and analytical models to evaluate receiver designs. In the past 1.5 years, several heat pipe receivers have been tested on Sandia`s test bed concentrators (TBC`s) and 60-kW{sub t} solar furnace. A screen-wick heat pipe developed by Dynatherm was tested to 27.5 kW{sub t} throughput. A Cummins Power Generation (CPG)/Thermacore 30-kW{sub t} heat pipe was pushed to a throughput of 41 kW{sub t} to verify design models. A Sandia-design screen-wick and artery 75-kW{sub t} heat pipe and a CPG/Thermacore 75-kW{sub t} sintered-wick heat pipe were also limit tested on the TBC. This report reviews the design of these receivers, and compares test results with model predictions.

  15. Saliva transit in patients with gastroesophageal reflux disease.

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    Cassiani, R A; Mota, G A; Aprile, L R O; Dantas, R O

    2015-10-01

    Saliva is an important factor in the neutralization of the acidity of the refluxed material that comes from the stomach to the esophagus. The impairment of saliva transit from oral cavity to distal esophagus may be one of the causes of esophagitis and symptoms in gastroesophageal reflux disease (GERD). With the scintigraphic method, the transit of 2 mL of artificial saliva was measured in 30 patients with GERD and 26 controls. The patients with GERD had symptoms of heartburn and acid regurgitation, a 24-hour pH monitoring with more than 4.2% of the time with pH below four, 26 with erosive esophagitis, and four with non-erosive reflux disease. Fourteen had mild dysphagia for solid foods. Twenty-one patients had normal esophageal manometry, and nine had ineffective esophageal motility. They were 15 men and 15 women, aged 21-61 years, mean 39 years. The control group had 14 men and 12 women, aged 19-61 years, mean 35 years. The subjects swallowed in the sitting and supine position 2 mL of artificial saliva labeled with 18 MBq of (99m) Technetium phytate. The time of saliva transit was measured from oral cavity to esophageal-gastric transition, from proximal esophagus to esophageal-gastric transition, and the transit through proximal, middle, and distal esophageal body. There was no difference between patients and controls in the time for saliva to go from oral cavity to esophageal-gastric transition, and from proximal esophagus to esophageal-gastric transition, in the sitting and supine positions. In distal esophagus in the sitting position, the saliva transit duration was shorter in patients with GERD (3.0 ± 0.8 seconds) than in controls (7.6 ± 1.7 seconds, P = 0.03). In conclusion, the saliva transit from oral cavity to the esophageal-gastric transition in patients with GERD has the same duration than in controls. Saliva transit through the distal esophageal body is faster in patients with GERD than controls. © 2014 International Society for Diseases of the

  16. The effect of famotidine on gastroesophageal and duodeno-gastro-esophageal refluxes in critically ill Patients

    Institute of Scientific and Technical Information of China (English)

    Ying Xin; Ning Dai; Lan Zhao; Jian-Guo Wang; Jian-Ming Si

    2003-01-01

    AIM: To investigate t he effect of famotidine ongastroesophageal reflux (GER) and duodeno-gastro-esophageal reflux(DGER) and to explore it's possiblemechanisms. To identify the relevant factors of the reflux.METHODS: Ninteen critically iii patients were consecutivelyenrolled in the study. Dynamic 24 hours monitoring of GERand DGER before and after administration of famotidine wasperformed. The parameters of gastric residual volume,multiple organ disorder syndrome (NODS) score, acutephysiology and chronic health evaluation Ⅱ (APACHE Ⅱ) scoreand PEEP were recorded. Paired ttest; Wilcoxon signedranks test and Univariate analysis with Spearman's rankcorrelation were applied to analyse the data.RESULTS: Statistical significance of longest acid reflux,reflux time of pH<4 and fraction time of acid reflux wasobserved in ten critically ill patients before and afteradministration. Pvalue is 0.037, 0.005, 0.005 respectively.Significance change of all bile reflux parameters wasobserved before and after administration. Pvalue is 0.007,0.024, 0.005, 0.007, 0.005. GER has positive correlationwith APACHE Ⅱ score and gastric residual volume withcorrelation coefficient of 0.720, 0.932 respectively.CONCLUSION: GER and DGER are much improved afterthe administration of famotidine. GER is correlated withAPACHE Ⅱ score and gastric residual volume.

  17. Salivary transforming growth factor alpha in patients with Sjögren's syndrome and reflux laryngitis

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    Marco Antonio dos Anjos Corvo

    2014-12-01

    Full Text Available Introduction: Saliva plays a key role in the homeostasis of the digestive tract, through its inorganic components and its protein growth factors. Sjögren's syndrome patients have a higher prevalence of gastroesophageal reflux disease and laryngopharyngeal reflux. Decreased salivary transforming growth factor alpha levels were observed in dyspeptic patients, but there have been no studies in patients with Sjögren's syndrome and laryngopharyngeal reflux. Objective: To compare the salivary transforming growth factor alpha levels of patients with Sjögren's syndrome and laryngopharyngeal reflux to those of healthy controls. Methods: This is a prospective controlled study. Twelve patients with Sjögren's syndrome and laryngopharyngeal reflux and 11 controls were prospectively evaluated. Spontaneous and stimulated saliva samples were obtained to establish salivary transforming growth factor alpha concentrations. Results: The salivary transforming growth factor alpha levels of patients were significantly higher than those of healthy controls. Five patients with laryngopharyngeal reflux also had erosive esophagitis; their salivary transforming growth factor alpha levels were comparable to controls. Conclusion: Salivary transforming growth factor alpha level was significantly higher in patients with Sjögren's syndrome and laryngopharyngeal reflux when compared to the control group.

  18. Incidence of gastro-oesophageal reflux in geriatric clinical patients - a radiological study

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    Brackins-Romero, J.; Bruening, B.; Beyer, H.K.

    1984-05-01

    Gastro-oesophageal reflux is obviously caused by an insufficiency of the dilatable lower end of the oesophagus. The physiological pressure acting on it corresponds to 15-30 mm Hg so that the gastric juice is prevented from entering the oesophagus. Reflux is associated with a reduction of that pressure. Many causes may be responsible, although hiatal hernia, where confirmed, will only play a secondary part. In half of the 74 examined elderly patients, gastro-oesophageal reflux was confirmed by radiology. About half of these suffered also from hiatal hernia which was a sliding hernia in 75 per cent of the cases. In about 25 per cent of the patients suffering from gastro-oesophageal reflux, signs of oesophagitis were discovered by radiology. There was no correlation between overweight and the incidence of reflux, but hiatus hernia and a positive Broca test were distinctly related to one another. In patients with gastro-oesophageal reflux, vomiting as a key symptom was more frequently confirmed than in patients without reflux.

  19. The Effect of Cholecystectomy on the Histology of Antrum and Helicobacter Pylori Colonization

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    Hüseyin Özer

    2013-07-01

    Full Text Available Aim: Notwithstanding cholecystectomy’s being the standard cure for symptomatic gallbladder stones, it might as well trigger changes that result in the increase of duodenogastric reflux and the emergence of relevant clinic and laboratorial data. The aim of this thesis is to explore the effect of cholecystectomy on the duodenogastric reflux, histopathologic changes in the antral mucosa and Helicobacter pylori colonization. Material and Method: This prospective research is based upon data collected from 45 patients (28 of them being female and 17 of them being male patients with an average age of 50.9, who would undergo cholecystectomic surgery. Upper gastrointestinal endoscopy has been performed on patients before the operation and at least two months after the operation in order to examine the existence of bile in the stomach. The tissues removed from the antrum during these endoscopic biopsies have been examined to spot the histopathologic changes and the existence of Helicobacter pylori in the mucosa (chronic gastritis, activation findings, and intestinal metaplasia. Results: Duodenogastric reflux, chronic gastritis, and intestinal metaplasia have been observed to increase significantly after cholecystectomy (p<0.001 for duodenogastric reflux and chronic gastritis, p<0.05 for intestinal metaplasia. On the other hand, no significant data have been attained in terms of activation findings and the existence of H.pylori before and after the operation. Discussion: Although cholecystectomy cause duodenogastric reflux and histopathologic changes in the antrum, it does not affect  H.pylori colonization.

  20. Acid reflux directly causes sleep disturbances in rat with chronic esophagitis.

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    Kenichi Nakahara

    Full Text Available BACKGROUND & AIMS: Gastroesophageal reflux disease (GERD is strongly associated with sleep disturbances. Proton pump inhibitor (PPI therapy improves subjective but not objective sleep parameters in patients with GERD. This study aimed to investigate the association between GERD and sleep, and the effect of PPI on sleep by using a rat model of chronic acid reflux esophagitis. METHODS: Acid reflux esophagitis was induced by ligating the transitional region between the forestomach and the glandular portion and then wrapping the duodenum near the pylorus. Rats underwent surgery for implantation of electrodes for electroencephalogram and electromyogram recordings, and they were transferred to a soundproof recording chamber. Polygraphic recordings were scored by using 10-s epochs for wake, rapid eye movement sleep, and non-rapid eye movement (NREM sleep. To examine the role of acid reflux, rats were subcutaneously administered a PPI, omeprazole, at a dose of 20 mg/kg once daily. RESULTS: Rats with reflux esophagitis presented with several erosions, ulcers, and mucosal thickening with basal hyperplasia and marked inflammatory infiltration. The reflux esophagitis group showed a 34.0% increase in wake (232.2±11.4 min and 173.3±7.4 min in the reflux esophagitis and control groups, respectively; p<0.01 accompanied by a reduction in NREM sleep during light period, an increase in sleep fragmentation, and more frequent stage transitions. The use of omeprazole significantly improved sleep disturbances caused by reflux esophagitis, and this effect was not observed when the PPI was withdrawn. CONCLUSIONS: Acid reflux directly causes sleep disturbances in rats with chronic esophagitis.

  1. Spontaneous resolution rates of vesicoureteral reflux in Brazilian children: a 30-year experience

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    Miguel Zerati Filho

    2007-04-01

    Full Text Available OBJECTIVE: We evaluated clinical characteristics of primary vesicoureteral reflux (VUR in infants in a 30-year period in Brazil with special reference to the relation of renal parenchymal damage to urinary tract infection and gender. MATERIALS AND METHODS: From 1975 through 2005, 417 girls (81.6% and 94 boys (18.4% with all grades of reflux were retrospectively reviewed. Patients were categorized by the worst grade of reflux, maintained on antibiotic prophylaxis and underwent yearly voiding cystourethrography until the reflux was resolved. VUR was considered resolved when a follow-up cystogram demonstrated no reflux. Surgical correction was recommended for those who fail medical therapy, severe renal scarring or persistent VUR. RESULTS: Grades I to V VUR resolved in 87.5%, 77.6%, 52.8%, 12.2% and 4.3%, respectively. Renal scars were present at presentation in 98 patients (19.2%. Neither gender nor bilaterality versus unilaterality was a helpful predictor of resolution. The significant difference was found among the curves using the log rank (p < 0.001 or Wilcoxon (p < 0.001 test. CONCLUSION: Despite the current use of screening prenatal ultrasound, many infants are still diagnosed as having vesicoureteral reflux only after the occurrence of urinary tract infection in our country. Scarring may be associated to any reflux grade and it may be initially diagnosed at any age but half of the scars are noted with higher grades of reflux (IV and V. The incidence of reflux related morbidity in children has significantly diminished over the last three decades.

  2. Findings in cystourethrography that suggest lower urinary tract dysfunction in children with vesicoureteral reflux

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    Ubirajara Barroso Jr

    2004-12-01

    Full Text Available PURPOSE: Children with lower urinary tract dysfunction and vesicoureteral reflux, at cystography assessment, frequently present alterations in the lower urinary tract anatomy such as dilated posterior urethra, irregularity of the bladder wall and diverticula. However, the significance of these findings is unknown. The objective of this study is to evaluate the incidence of these findings, their time of disappearance and their correlation with the severity of the reflux. MATERIALS AND METHODS: 193 children with vesicoureteral reflux, considered simple, in the age group above 5 years at the moment of diagnosis, were analyzed. The recommendation for follow-up of these patients was one voiding cystoureterography (VCUG each year. Only patients with a minimum of 2 VCUGs performed in a period of at least 6 months were considered. The VCUGs were classified as positive and negative in relation to findings that were characteristic of lower urinary tract dysfunction (LUTD. RESULTS: From the 193 children analyzed, 50 (26% presented positive VCUG and 143 negative VCUG. From the patients without symptoms of lower urinary tract dysfunction (n = 135, 12 (9% presented positive VCUG and 123 (91% a negative VCUG. From the patients with negative VCUG, 68 (48% presented unilateral reflux and 75 (52% presented bilateral reflux. From those with positive VCUG, 26 (52% had unilateral reflux and 24 bilateral reflux (48%. This difference was not statistically significant. A higher incidence of grade II reflux was more evident in patients with negative VCUG and degree III in patients with positive VCUG (p < 0.05. CONCLUSIONS: Our study demonstrated that 64% of the patients with LUTD and reflux presented findings in the VCUG that suggest dysfunction.

  3. Endoscopic treatment of vesicoureteral reflux in pediatric patients

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    Jong Wook Kim

    2013-04-01

    Full Text Available Endoscopic treatment is a minimally invasive treatment for managing patients with vesicoureteral reflux (VUR. Although several bulking agents have been used for endoscopic treatment, dextranomer/hyaluronic acid is the only bulking agent currently approved by the U.S. Food and Drug Administration for treating VUR. Endoscopic treatment of VUR has gained great popularity owing to several obvious benefits, including short operative time, short hospital stay, minimal invasiveness, high efficacy, low complication rate, and reduced cost. Initially, the success rates of endoscopic treatment have been lower than that of open antireflux surgery. However, because injection techniques have been developed, a recent study showed higher success rates of endoscopic treatment than open surgery in the treatment of patients with intermediate- and high-grade VUR. Despite the controversy surrounding its effectiveness, endoscopic treatment is considered a valuable treatment option and viable alternative to long-term antibiotic prophylaxis.

  4. Update on Gastroesophageal Reflux and Respiratory Disease in Children

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    Susan R Orenstein

    2000-01-01

    Full Text Available Pediatric respiratory diseases have been linked to gastroesophageal reflux disease (GERD, but evidence regarding the association and its potential mechanisms continues to accumulate, and important aspects remain to be determined. Evidence for the association in two common pediatric respiratory disorders - infantile apnea and asthma in older children - and difficult clinical issues associated with the diagnosis and treatment of these two disorders are reviewed. The provocative embryological and physiological connections between the upper gastrointestinal tract and the respiratory tract, and recent understanding of the compensatory anatomy and physiology that protect the normal individual from respiratory manifestations of GERD are also explored. Dysfunctions of these protections likely underlie the pathophysiology of these disorders.

  5. [Holter monitoring data in children with gastroesophageal reflux disease].

    Science.gov (United States)

    Apenchenko, Iu S; Shcherbakov, P L; Gnusaev, S F; Ivanova, I I; Rozov, D N

    2014-01-01

    The aim of research is to estimate the functional state of the cardiovascular system in children with gastroesophageal reflux disease (GERD) with the help of Holter monitoring. 117 children of school age were examined: 69 children with GERD and 48 children with chronic gastroduodenitis. All children passed esophagogastroduodenoscopy, 24-hour pH-monitoring, electrocardiography and Holter monitoring. According to Holter monitoring data it was revealed that children with GERD had increased low-frequency components of frequency domain analyses, increased number of nocturnal PVCs and increased time of enhanced dispertion periods. Holter monitoring in patients with GERD can be used to detect preclinical ectopic rhythm, to evaluate autonomic dysfunction by frequency domain analyses, to predict nocturnal symptoms.

  6. Surgery for gastroesophageal reflux disease with Gaucher disease type 2.

    Science.gov (United States)

    Kubo, Hiroyuki; Shimono, Ryuichi; Tanaka, Aya; Fujii, Takayuki; Yasuda, Saneyuki; Koyano, Kosuke; Jinnai, Wataru; Kondo, Sonoko; Kondo, Takeo; Kusaka, Takashi

    2016-07-01

    Gaucher disease, the most common lysosomal storage disease, is sometimes complicated with gastroesophageal reflux disease (GERD). The present patient was a 136-day-old Japanese boy with Gaucher disease type 2. Enzyme replacement therapy and chemical chaperone therapy were successful for the skin disorders, joint contractures, hepatosplenomegaly and thrombocytopenia, but he also had GERD. Accordingly, a Nissen fundoplication with gastrostomy was performed. There was no vulnerability of organs, easy bleeding or difficulty of maintaining the visual field because of hepatosplenomegaly during operation. In the perioperative period, there was no prolonged wound healing or infection. GERD was improved. In the near future, the number of long-term survivors of Gaucher disease will increase due to improvements in medical therapy. Therefore, it is expected that the number of patients requiring fundoplication will also increase. In patients with successful medical therapy, surgical fundoplication can be safely and effectively performed.

  7. Validation of the Reflux Disease Questionnaire into Greek

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    Eirini Oikonomidou

    2012-09-01

    Full Text Available Primary care physicians face challenges in diagnosing and managing gastroesophageal reflux disease (GERD. The Reflux Disease Questionnaire (RDQ meets the standards of validity, reliability, and practicability. This paper reports on the validation of the Greek translation of the RDQ. RDQ is a condition specific instrument. For the validation of the questionnaire, the internal consistency of its items was established using the alpha coefficient of Chronbach. The reproducibility (test-retest reliability was measured by kappa correlation coefficient and the criterion of validity was calculated against the diagnosis of another questionnaire already translated and validated into Greek (IDGP using kappa correlation coefficient. A factor analysis was also performed. Greek RDQ showed a high overall internal consistency (alpha value: 0.91 for individual comparison. All 8 items regarding heartburn and regurgitation, GERD, had good reproducibility (Cohen’s κ 0.60-0.79, while the remaining 4 items about dyspepsia had a moderate reproducibility (Cohen’s κ=’ 0.40-0.59 The kappa coefficient for criterion validity for GERD was rather poor (0.20, 95% CI: 0.04, 0.36 and the overall agreement between the results of the RDQ questionnaire and those based on the IDGP questionnaire was 70.5%. Factor analysis indicated 3 factors with Eigenvalue over 1.0, and responsible for 76.91% of variance. Regurgitation items correlated more strongly with the third component but pain behind sternum and upper stomach pain correlated with the second component. The Greek version of RDQ seems to be a reliable and valid instrument following the pattern of the original questionnaire, and could be used in primary care research in Greece.

  8. Multicystic dysplastic kidney and contralateral vesicoureteral reflux. Renal growth.

    Science.gov (United States)

    Fanos, V; Sinaguglia, G; Vino, L; Pizzini, C; Portuese, A

    2001-04-01

    To evaluate if vesicoureteral reflux (VUR) contralateral to the multicystic dysplastic kidney can interfere with the compensatory renal hypertrophy. Twenty-seven patients (17 males, 10 females) with multicystic dysplastic kidney (MDK) (14 on the right, 13 on the left) have been treated at the Nephrology Unit of the Pediatric Department of the University of Verona from birth up to the second year of life. All these patients were diagnosed as having MDK by prenatal ultrasonography. Seven children (4 males and 3 females) had VUR (5 monolateral, 2 bilateral), diagnosed at the end of the first month of life. After diagnosis children underwent antibiotic prophylaxis with beta-lactam compounds at low doses. Four patients underwent a surgical correction of VUR associated with nephrectomy within the second year of life. The remaining 3 patients were treated with antibiotic prophylaxis; a progressive resolution or downgrading of reflux grade took place respectively in 1 and in 2 of them. Only 6 children with MDK underwent nephrectomy. Renal growth was studied by serial echographic measurements of the longitudinal renal lenght (performed at birth, at 6 months, and at 2 years of life). Renal length was 5.68+/-1.24 cm, 6.72+/-0.88 cm, 8.56+/-1.27 cm in children without VUR, respectively at birth, 6 months and 2 years of life. Renal length was 4.65+/-0.63 cm, 6.70+/-0.64 cm, 7.07+/-1.14 cm in children with VUR, respectively at birth, 6 months and 2 years of life. A statistically significant difference was observed between the two groups at birth (p<0.05) and at 2 years of life (p<0.01). The conclusion is that VUR contralateral to the MDK is associated with small kidneys and reduced renal growth both at birth and at 2 years of life.

  9. Systematic review: questionnaires for assessment of gastroesophageal reflux disease.

    Science.gov (United States)

    Bolier, E A; Kessing, B F; Smout, A J; Bredenoord, A J

    2015-01-01

    Numerous questionnaires with a wide variety of characteristics have been developed for the assessment of gastroesophageal reflux disease (GERD). Four well-defined dimensions are noticeable in these GERD questionnaires, which are symptoms, response to treatment, diagnosis, and burden on the quality of life of GERD patients. The aim of this review is to develop a complete overview of all available questionnaires, categorized per dimension of the assessment of GERD. A systematic search of the literature up to January 2013 using the Pubmed database and the Embase database, and search of references and conference abstract books were conducted. A total number of 65 questionnaires were extracted and evaluated. Thirty-nine questionnaires were found applicable for the assessment of GERD symptoms, three of which are generic gastrointestinal questionnaires. For the assessment of response to treatment, 14 questionnaires were considered applicable. Seven questionnaires with diagnostic purposes were found. In the assessment of quality of life in GERD patients, 18 questionnaires were found and evaluated. Twenty questionnaires were found to be used for more than one assessment dimension, and eight questionnaires were found for GERD assessment in infants and/or children. A wide variety of GERD questionnaires is available, of which the majority is used for assessment of GERD symptoms. Questionnaires differ in aspects such as design, validation and translations. Also, numerous multidimensional questionnaires are available, of which the Reflux Disease Questionnaire is widely applicable. We provided an overview of GERD questionnaires to aid investigators and clinicians in their search for the most appropriate questionnaire for their specific purposes. © 2013 International Society for Diseases of the Esophagus.

  10. Nickel sensitivity in patients with gastroesophageal reflux disease.

    Science.gov (United States)

    Aslan, Nurşad; Sezikli, Mesut; Erdal, Emel

    2017-12-01

    Various foods play important role in the pathogenesis of gastroesophageal reflux disease (GERD). These foods are shown to increase gastroesophageal reflux symptoms via various mechanisms and majority of these foods also contain nickel. The purpose of this study is to evaluate the relationship between Nickel sensitivity and GERD. Fifty-four patients diagnosed with GERD and 50 healthy volunteers who were admitted to our gastroenterology outpatient clinic were took part in the study. European standard patch test series, nickel-containing test units and corticosteroids were applied to the patient body; upper back. Evaluation was performed according to the scheme of the International Contact Dermatitis Research Group (ICDRG). The positive and negative reactions were recorded at the hours of 48, 72 and 96. Following the test implementations, 7 days later, the tests were reevaluated for late reactions. Statistics package for Social Sciences (SPSS) 17 package program was used for statistical evaluation and results of tests were compared between groups with the Chi-squared test. p < 0.05 was considered statistically significant. Individuals in both groups were statistically similar in terms of age and gender. Nickel sensitivity was found to be positive in 48.2 and %22 of the GERD patients and control group, respectively. Difference between groups was statistically significant (p = 0.008). Nickel sensitivity was significantly higher in GERD patients compared to the control group. In addition to imbalance between defensive and aggressive forces of the esophagus, there seems to be an association between nickel sensitivity and GERD.

  11. Asthma and gastroesophageal reflux disease: Effect of longterm pantoprazole therapy

    Institute of Scientific and Technical Information of China (English)

    Calabrese Carlo; Fabbri Anna; Areni Alessandra; Scialpi Carlo; Zahlane Desiree; Di Febo Giulio

    2005-01-01

    AIM: To define the prevalence of gastroesophageal reflux disease (GERD) in mild persistent asthma and to value the effect of pantoprazole therapy on asthmatic symptoms.METHODS: Seven of thirty-four asthmatic patients without GERD served as the non-GERD control group.Twenty-seven of thirty-four asthmatic patients had GERD (7/27 also had erosive esophagitis, sixteen of them presented GERD symptoms. An upper gastrointestinal endoscopy was performed in all the subjects to obtain five biopsy specimens from the lower 5 cm of the esophagus. Patients were considered to have GERD when they had a dilation of intercellular space (DIS)>0.74 μm at transmission electron microscopy.Patients with GERD were treated with pantoprazole,80 mg/day. Forced expiratory volume in one second (FEV1) was performed at entry and after 6 mo of treatment. Asthmatic symptoms were recorded. The required frequency of inhaling rapid acting 32-agonists was self-recorded in the patients' diaries.RESULTS: Seven symptomatic patients presented erosive esophagitis. Among the 18 asymptomatic patients, 11 presented DIS, while all symptomatic patients showed ultrastructural esophageal damage.Seven asymptomatic patients did not present DIS. At entry the mean of FEV1 was 1.91 L in symptomatic GERD patients and 1.88 L in asymptomatic GERD patients.After the treatment, 25 patients had a complete recovery of DIS and reflux symptoms. Twenty-three patients presented a regression of asthmatic symptoms with normalization of FEV1. Four patients reported a significant improvement of symptoms and their FEV1 was over 80%.CONCLUSION: GERD is a highly prevalent condition in asthma patients. Treatment with pantoprazole (80 mg/day)determines their improvement and complete regression.

  12. [Esophageal diseases: gastroesophageal reflux disease, Barrett's esophagus, achalasia and eosinophilic esophagitis].

    Science.gov (United States)

    Calvet, Xavier; Villoria, Albert

    2013-10-01

    Important new advances were presented in esophageal disease in Digestive Disease Week 2013. A highlight was confirmation of the high efficacy of weight loss to treat symptoms of reflux and an interesting pilot study suggesting that a simple ligature with supra- and infracardial bands could be an effective technique in esophageal reflux. If the excellent results and safety and efficacy of this technique are confirmed in the long term, it could revolutionize the management of gastroesophageal reflux disease. Also of note this year was the presentation of multiple studies validating a new technique, peroral endoscopic myotomy (POEM) for the endoscopic treatment of achalasia. This technique seems to have excellent efficacy and safety.

  13. Stillage reflux in food waste ethanol fermentation and its by-product accumulation.

    Science.gov (United States)

    Ma, Hongzhi; Yang, Jian; Jia, Yan; Wang, Qunhui; Tashiro, Yukihiro; Sonomoto, Kenji

    2016-06-01

    Raw materials and pollution control are key issues for the ethanol fermentation industry. To address these concerns, food waste was selected as fermentation substrate, and stillage reflux was carried out in this study. Reflux was used seven times during fermentation. Corresponding ethanol and reducing sugar were detected. Accumulation of by-products, such as organic acid, sodium chloride, and glycerol, was investigated. Lactic acid was observed to accumulate up to 120g/L, and sodium chloride reached 0.14mol/L. Other by-products did not accumulate. The first five cycles of reflux increased ethanol concentration, which prolonged fermentation time. Further increases in reflux time negatively influenced ethanol fermentation. Single-factor analysis with lactic acid and sodium chloride demonstrated that both factors affected ethanol fermentation, but lactic acid induced more effects.

  14. Effects of reflux laryngitis on non-nutritive swallowing in newborn lambs.

    Science.gov (United States)

    Brisebois, Simon; Samson, Nathalie; Fortier, Pierre-Hugues; Doueik, Alexandre A; Carreau, Anne-Marie; Praud, Jean-Paul

    2014-08-15

    Reflux laryngitis in infants may be involved not only in laryngeal disorders, but also in disorders of cardiorespiratory control through its impact on laryngeal function. Our objective was to study the effect of reflux laryngitis on non-nutritive swallowing (NNS) and NNS-breathing coordination. Two groups of six newborn lambs, randomized into laryngitis and control groups, were surgically instrumented for recording states of alertness, swallowing and cardiorespiratory variables without sedation. A mild to moderate reflux laryngitis was induced in lambs from the experimental group. A significant decrease in the number of NNS bursts and apneas was observed in the laryngitis group in active sleep (p=0.03). In addition, lower heart and respiratory rates, as well as prolonged apnea duration (plaryngitis group. We conclude that a mild to moderate reflux laryngitis alters NNS burst frequency and autonomous control of cardiac activity and respiration in lambs.

  15. Operative Treatments for Reflux After Bariatric Surgery: Current and Emerging Management Options.

    Science.gov (United States)

    Treitl, Daniela; Nieber, Derek; Ben-David, Kfir

    2017-03-01

    Gastroesophageal reflux disease (GERD) is a common disorder that has a well-established connection with obesity. To ameliorate the morbidity associated with obesity, bariatric procedures have become an established pathway to accomplish sustained weight loss. In some procedures, such as with the Roux-en-Y gastric bypass surgery, weight loss is also accompanied by the resolution of GERD symptoms. However, other popular bariatric surgeries, such as the sleeve gastrectomy, have a controversial impact on their effect on reflux. Consequently, increased attention has been given to the development of strategies for the management of de novo or recurrent reflux after bariatric surgery. This article aims to discuss medical and surgical strategies for reflux after bariatric surgery, and their outcomes.

  16. Esophageal mucosal integrity improves after laparoscopic antireflux surgery in children with gastroesophageal reflux disease

    NARCIS (Netherlands)

    Mauritz, F.A.; Rinsma, N.F.; Heurn, E.L. van; Sloots, C.E.; Siersema, P.D.; Houwen, R.H.; Zee, D.C. van der; Masclee, A.A.M.; Conchillo, J.M.; Herwaarden-Lindeboom, M.Y. van

    2017-01-01

    BACKGROUND: Esophageal intraluminal baseline impedance reflects the conductivity of the esophageal mucosa and may be an instrument for in vivo evaluation of mucosal integrity in children with gastroesophageal reflux disease (GERD). Laparoscopic antireflux surgery (LARS) is a well-established

  17. Clinical characteristics of patients with gastroesophageal reflux disease in several centers of Northwest China

    Institute of Scientific and Technical Information of China (English)

    高麦仓

    2013-01-01

    Objective To investigate the clinical characteristics of gastroesophageal reflux disease (GERD) in several endoscopy centers of Northwest China.Methods From September 2008 to September 2009,a questionnaire survey was carried out in the endoscopy centers of four hospitals

  18. Vesicoureteral Reflux in the Child with Lazy Bladder Syndrome: The Infrequent Voider

    Directory of Open Access Journals (Sweden)

    Marco Grasso

    2008-01-01

    Therefore we must stress that it is prominently important considering about infrequent micturition in a paediatric case history or a large capacity bladder, possible presence of bladder dysfunction and vesicoureteral reflux too.

  19. [Nocturnal long-term monitoring of lung sounds in patients with gastro-oesophageal reflux disease].

    Science.gov (United States)

    Lenniger, P; Gross, V; Kunsch, S; Nell, C; Nolte, J E S; Sohrabi, A K; Koehler, U

    2010-04-01

    Gastro-oesophageal reflux disease (GERD) is one of the most common clinical conditions in the developed countries. Particular interest in pulmonary manifestations of this disease has arisen over the last few years. Although the high coincidence between reflux and chronic cough is unquestioned, the proof of a causal correlation is still lacking. In this paper we present the Marburger Lung-Sound-Monitoring as a new method for the detection of nocturnal respiratory symptoms such as cough, wheezing and throat clearing and their temporal correlation with reflux. This method will in future allow us to precisely record and to evaluate the extent and duration of reflux events and their correlation with respiratory symptoms. Georg Thieme Verlag KG Stuttgart . New York.

  20. Longterm outcome of Macroplatique injection for treatment of vesicoureteral reflux in children

    Directory of Open Access Journals (Sweden)

    Elrahmany A. Mohamed

    2014-01-01

    Full Text Available Background: This study examined our experience with one year follow-up of 20 cases of vesicoureteric reflux in children after treatment with Macroplastique ® injection. Patient and Methods: A total of 20 children (31 ureters with primary grades II to V vesicoureteral reflux were treated with subureteral Macroplastique ® injection from 2010 to 2011 and followed for an average of 12 months (range 3 to 24. Vesicoureteral reflux was grade II in 3, III in 7, IV in 9 and V in 12 ureters. Each child underwent pre-operative voiding cystourethrography, abdominopelvic ultrasound, urine analysis/culture, S. creatinine and CBC. Dimercapto-succinic acid scan (DMSA scan and magnetic resonance urography (MRU were done in some patients. Voiding cystourethrography at 3 months was done to rule out persistent reflux. Results: Overall, reflux was corrected in 11 (35.5% ureters and 9 (45% children after a single injection. With repeat injection, reflux was corrected in 16 (51.6% ureters and 11 (55% children, reflux improved/downgrade in 4 (12.9% ureters and 2 (10% children. Correction by grade was 100%, 100%, 9.7%, 9.7% for grades II to V, respectively. There were no surgical complications. None of the cured patients had recurrent reflux during follow-up. There were 9 (45% children who required open ureteral re-implantation for failed injection. Conclusion: Sub-ureteral Macroplastique ® injection therapy could be a primary treatment for low grade VUR (grade III or less in children because it is simple, safe, effective, less invasive, decreased.

  1. Endoscopic treatment of vesicoureteral reflux with a self-detachable balloon system.

    Science.gov (United States)

    Atala, A; Peters, C A; Retik, A B; Mandell, J

    1992-08-01

    There is controversy about the use of polytetrafluoroethylene (Teflon) paste in children for the endoscopic treatment of vesicoureteral reflux due to evidence of particle migration. However, there are definite advantages in treating patients endoscopically. It is evident that the ideal substance should be able to be delivered endoscopically, conserve its volume, and be nonmigratory and nonantigenic. Towards this goal we developed a catheter with an inflatable, detachable and self-sealing silicone balloon that would fit through a 19 gauge cystoscopic needle. Hydroxy-ethyl-methyl acrylate, a hydrophilic polymer that solidifies within 60 minutes after the addition of ferrous sulfate, was chosen as the filling material for the balloon. Conceptually, the sealed balloon would prevent the migration of hydroxy-ethyl-methyl acrylate and the solidified polymer would prevent volume loss. To test this system reflux was created in 6 Hanford mini-pigs by unroofing the ureters bilaterally. In 2 pigs a previously described method of open surgery was used and in the other 4 reflux was created endoscopically using the resectoscope and laparoscopic scissors. The presence of bilateral reflux was confirmed 4 weeks later with a cystogram and the balloon was implanted unilaterally through a cystoscope. The opposite ureter served as an internal control in all animals. A repeat cystogram was performed 2 to 4 weeks after implantation, demonstrating resolution of reflux in the treated side and persistence of reflux in the opposite untreated ureter. Serial cystograms, ultrasound and excretory urography showed no reflux on the implanted side nor any evidence of obstruction. Tissue sections from various organs showed no evidence of particle migration, granuloma formation or inflammatory reaction. Short-term results show that the balloon implants are able to correct reflux without evidence of obstruction.

  2. A Fiber Optic System For The Detection Of Entero-Gastric Reflux

    Science.gov (United States)

    Falciai, R.; Baldini, F.; Conforti, G.; Cosi, F.; Scheggi, A. M...; Bechi, P.

    1989-01-01

    The study and the development of an optical fiber sensor for entero-gastric and non-acid gastro-esophageal reflux is described. The working principle, based on the spectrophotometric properties of the bile, which constitutes the main part of the reflux, differs from the traditional measurement method, based on pH monitoring. The measuring apparatus is described as well as experimental "in vitro" and preliminary "in vivo" tests are reported.

  3. Prevalence of urinary tract infection and vesicoureteral reflux in children with lower urinary tract dysfunction.

    Science.gov (United States)

    Van Batavia, Jason P; Ahn, Jennifer J; Fast, Angela M; Combs, Andrew J; Glassberg, Kenneth I

    2013-10-01

    Lower urinary tract dysfunction is a common pediatric urological problem that is often associated with urinary tract infection. We determined the prevalence of a urinary tract infection history in children with lower urinary tract dysfunction and its association, if any, with gender, bowel dysfunction, vesicoureteral reflux and specific lower urinary tract conditions. We retrospectively reviewed the charts of children diagnosed with and treated for lower urinary tract dysfunction, noting a history of urinary tract infection with or without fever, gender, bowel dysfunction and vesicoureteral reflux in association with specific lower urinary tract conditions. Of the 257 boys and 366 girls with a mean age of 9.1 years 207 (33%) had a urinary tract infection history, including 88 with at least 1 febrile infection. A total of 64 patients underwent voiding cystourethrogram/videourodynamics, which revealed reflux in 44 (69%). In 119 of the 207 patients all infections were afebrile and 18 underwent voiding cystourethrogram/videourodynamics, which revealed reflux in 5 (28%). A urinary tract infection history was noted in 53% of girls but only 5% of boys (p infection history than patients with idiopathic detrusor overactivity disorder or primary bladder neck dysfunction (each p urinary tract dysfunction have a much higher urinary tract infection incidence than males. This association was most often noted for lower urinary tract conditions in which urinary stasis occurs, including detrusor underutilization disorder and dysfunctional voiding. Reflux was found in most girls with a history of febrile infections. Since reflux was identified in more than a quarter of girls with only afebrile infections who were evaluated for reflux, it may be reasonable to perform voiding cystourethrogram or videourodynamics in some of them to identify reflux. Copyright © 2013 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  4. Detection of Gastroesophageal Reflux Esophagitis Using 2-fluoro-2-deoxy-d-glucose Positron Emission Tomography

    OpenAIRE

    Min-Kuei Tsai; Hueisch-Jy Ding; Hsueh-Chou Lai; Kuo-Yang Yen; Chia-Ing Li; Yu-Yi Lin; Kai-Yuan Cheng; Keh-Bin Wang; Chia-Hung Kao

    2012-01-01

    Background. Gastroesophageal reflux disease (GERD) is a common disease and a major upper gastrointestinal problem. The purpose of the present study is to evaluate the use of noninvasive 2-fluoro-2-deoxy-d-glucose positron emission tomography (FDG-PET) to detect gastroesophageal reflux esophagitis. Materials and Methods. This is a retrospective study reviewing 408 healthy check-up subjects (169 females and 239 men), who underwent both FDG-PET and upper gastrointestinal endoscopy during Septemb...

  5. Complications following endoscopic treatment of vesicoureteric reflux with Deflux(®) - two case studies.

    Science.gov (United States)

    Zyczkowski, Marcin; Prokopowicz, Grzegorz; Zajęcki, Wojciech; Paradysz, Andrzej

    2012-01-01

    The endoscopic injection of vesicoureteric orifices with synthetic or natural materials is a widely recognized method of treating vesicoureteral reflux (VUR). The aim of this study is to present two cases of clinically significant complications following the use of dextranomer/hyaluronic acid copolymer, which led to the progression of the reflux degree, permanent infection of the urinary tract, and the necessity to perform surgical treatment.

  6. Numerical modelling of geothermal and reflux circulation in Enewetak Atoll: Implications for dolomitization

    Science.gov (United States)

    Jones, G.; Whitaker, F.; Smart, P.; Sanford, W.

    2000-01-01

    Two types of regional-scale seawater circulation have been proposed to explain the formation of Enewetak Atoll dolomites: geothermal and reflux circulation. We have used a finite element groundwater flow model to examine the pattern, magnitude and dynamic interaction of these two different circulation mechanisms in Enewetak Atoll. Geothermal circulation is concentrated around the atoll-margin whereas refluxing mesosaline brines flow from the atoll interior towards the margin to restrict and eventually shut off geothermal circulation. Refluxing brines of 36-80??? can account for the salinity signature recorded in dolomite fluid inclusions. Distributions of fluid flux and Mg mass-balance calculations suggest that both geothermal and reflux circulation mechanisms could account for the observed distribution of dolomite in Enewetak Atoll. Furthermore, the atoll interior may be extensively dolomitized as observed in other atolls. (C) 2000 Elsevier Science B.V. All rights reserved.Two types of regional-scale seawater circulation have been proposed to explain the formation of Enewetak Atoll dolomites: geothermal and reflux circulation. We have used a finite element groundwater flow model to examine the pattern, magnitude and dynamic interaction of these two different circulation mechanisms in Enewetak Atoll. Geothermal circulation is concentrated around the atoll-margin whereas refluxing mesosaline brines flow from the atoll interior towards the margin to restrict and eventually shut off geothermal circulation. Refluxing brines of 36-80 per mil can account for the salinity signature recorded in dolomite fluid inclusions. Distributions of fluid flux and Mg mass-balance calculations suggest that both geothermal and reflux circulation mechanisms could account for the observed distribution of dolomite in Enewetak Atoll. Furthermore, the atoll interior may be extensively dolomitized as observed in other atolls.

  7. A belated revelation: from gastroesophageal reflux derived asthma to laryngotracheal irritation even spasm

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    The author has been inspired by the Global Evidence-Based Consensus for gastroesophageal reflux (GER),which put forward four extra-esophageal syndromes:reflux cough syndrome,reflux laryngitis syndrome,reflux dental erosion syndrome and the reflux asthma syndrome.The author himself happened to receive five emergency rescue treatments following apparent "bronchial asthma",which was to be diagnosed as GER at his own insistence.PPI resulted in some relief.After being rescued again from suffocation,he had a fundaplication,which was performed at the Englewood Hospital & Medical Center,Englewood,USA in March 2006.The procedure immediately cleared up his "asthma".A month later he brought forth a Center for GER in an army hospital in Beijing,China.Up to now,601 patients with mainly respiratory distress(84%)were treated by Stretta Radiofrequency,58 by surgery and more by PPI.The GER Center is now complete with a ward.GER patients with respiratory distresses turned out to fare better than those with acid regurgitation.A nozzle"shaped pharynx was found in patients with the reflux.Animal study revealed that the refluxate entered into trachea and even lungs.Gradually a hypothesis of a gastrooesophago-laryngo-tracheal reflux took shape.Our modest effort to treat GER-derived respiratory distresses has got off to an encouraging start amid relative shortage of experience and facilities.We would like to share two thoughts with scholars and experts at home and abroad:1.The GER-derived asthma is not asthma,but GER pure and simple;2.The pathogenesis of "asthma" is not asthma,but laryngotracheal irritation/spasm and its sequence.

  8. Unilateral ventricular reflux and asymmetric ventricular distribution of intrathecally introduced contrast medium or tracer

    Energy Technology Data Exchange (ETDEWEB)

    Deisenhammer, E.; Hammer, B.

    Fourteen cases of totally or predominantly unilateral ventricular reflux and stasis of intrathecally injected radioisotope or contrast medium were demonstrated by scintigraphy or computed tomographic cisternography. All showed asymmetric enlargement of the lateral ventricles and nine had ipsilateral brain lesions. Four case reports are presented. The pathophysiologic mechanism of communicating hydrocephalus and possible causes of unilateral ventricular reflux are discussed, as well as indications for ventricular shunt installation.

  9. Time esophageal pH < 4 overestimates the prevalence of pathologic esophageal reflux in subjects with gastroesophageal reflux disease treated with proton pump inhibitors

    Directory of Open Access Journals (Sweden)

    Sloan Sheldon

    2008-05-01

    Full Text Available Abstract Background A Stanford University study reported that in asymptomatic GERD patients who were being treated with a proton pump inhibitor (PPI, 50% had pathologic esophageal acid exposure. Aim We considered the possibility that the high prevalence of pathologic esophageal reflux might simply have resulted from calculating acidity as time pH Methods We calculated integrated acidity and time pH Results The prevalence of pathologic 24-hour esophageal reflux in both studies was significantly higher when measured as time pH Conclusion In GERD subjects treated with a PPI, measuring time esophageal pH

  10. [Influence of chest physiotherapy on gastro-œsophageal reflux in children].

    Science.gov (United States)

    Reychler, G; Jacques, L; Arnold, D; Scheers, I; Smets, F; Sokal, E; Stephenne, X

    2015-05-01

    Chest physiotherapy is regularly prescribed for children, particularly in cystic fibrosis. Gastro-oesophageal reflux is common in this disease and is associated with certain chest physiotherapy manoeuvres. To evaluate the influence of two chest physiotherapy techniques on gastro-oesophageal reflux in children. Twenty-nine children were investigated by routine pHmetry. During the examination, they performed two chest physiotherapy manoeuvres in a seated position for 10 minutes each with a 5 minutes rest between them. The two manoeuvres used were a slow expiration technique (ELPr) and positive expiratory pressure (PEP). It was a prospective study and the order of manoeuvres was randomised. The pH traces were analysed blindly when all the studies had been completed. In the sample, 21% of children had gastro-oesophageal reflux during the physiotherapy session. No relationship was found between reflux during physiotherapy and pathological reflux (P=0.411) nor the physiotherapy technique used (P=0.219). The use of these two chest physiotherapy techniques in children in a seated position can produce gastro-oesophageal reflux. Copyright © 2015 SPLF. Published by Elsevier Masson SAS. All rights reserved.

  11. Relationship between endoscopic esophagitis and patterns of gastroesophageal reflux in ambulatory pHmetry.

    Science.gov (United States)

    Sánchez-Gey Venegas, S; Yerro Páez, V M; Pellicer Bautista, F J; Fuerte Seda, M; Herrerías Gutiérrez, J M

    1999-02-01

    to evaluate the possible relationship between the various grades of endoscopic esophagitis and the different patterns of reflux determined by 24-hour ambulatory pH-metry. we selected 80 patients with symptoms of gastroesophageal reflux disease in whom upper digestive tract endoscopy revealed some degree of mucosal lesion. These patients subsequently underwent 24-hour ambulatory pH-metry. The lesions of the mucosa were classified into 4 grades according to the criteria of Savary and Miller. The patterns of reflux were determined by 24-hour pH-metry and classified according to the severity of reflux (slight, moderate or severe, using DeMeester's table) and the type of reflux (in bipedestation, supine or mixed) according to the percentage of time at pH bipedestation, in decubitus or in both positions. patients with grades I and II esophagitis showed variable patterns of reflux, although the most frequent seemed to be slight in bipedestation, which we observed in 34% of the patients. Most (76. 2%) of the patients with grades III or IV (p patients at higher risk for developing severe esophagitis or other complications.

  12. Reflux Incidence among Exclusively Breast Milk Fed Infants: Differences of Feeding at Breast versus Pumped Milk.

    Science.gov (United States)

    Yourkavitch, Jennifer; Zadrozny, Sabrina; Flax, Valerie L

    2016-10-14

    The practice of feeding infants expressed breast milk is increasing in the United States, but the impacts on infant and maternal health are still understudied. This study examines the monthly incidence of regurgitation (gastro-esophageal reflux) in exclusively breast milk fed infants from ages two to six months. Among infants whose mothers participated in the Infant Feeding Practices II Study (IFPS II; 2005-2007), data on reflux and feeding mode were collected by monthly questionnaires. A longitudinal, repeated measures analysis was used, with feeding mode lagged by one month in order to compare reflux incidence among infants fed directly at the breast to infants receiving pumped breast milk. Mothers in both feeding groups had similar characteristics, although a greater proportion feeding at least some pumped milk were primiparous. The number of exclusively breastfed infants decreased steadily between months 2 and 6, although the proportion fed at the breast remained similar over time. An association between feeding mode and reflux incidence was not found; however, the analyses were limited by a small number of reported reflux cases. More studies are needed to further explain the relationship between different feeding modes and infant reflux.

  13. Patient symptoms correlate poorly with objective measures among patients with gastroesophageal reflux disease.

    Science.gov (United States)

    Levy, Salomon; Plymale, Margaret; Davenport, Daniel L; Moreno Ponte, Oscar I; Roth, J Scott

    2014-09-01

    Presentation of gastroesophageal reflux disease (GERD) varies among patients. To attempt to understand the patient's perception of the severity of their reflux symptoms, we developed a questionnaire on which patients rated symptom severity at each office visit. After receiving Institutional Review Board approval, we retrospectively reviewed patient charts of all patients seen by one surgeon for GERD symptoms and/or presence of hiatal hernia (HH) from September 2012 to April 2013. Data from patient questionnaires combined with objective findings from subsequent or prior workup and eventual operative information were recorded. A total of 144 questionnaires were reviewed from 108 patients. Frequencies were calculated for categorical variables. Patients were divided into four categories based on size of the HH on the endoscopic report; 10 patients had no HH, 15 had small HH, 20 had medium HH, and 31 patients had large HH. Size of HH was not available for three patients. Pre- and postoperative questionnaire responses were obtained for 15 patients. A combined reflux score was calculated using the median for each symptom. Patient perception of severity of symptoms does not necessarily predict presence of pathological reflux or HH nor is there a perfect combination of symptoms to predict the presence of pathological reflux or HH based on our sample. The workup of this pathology must be comprehensive, and the confirmation of reflux is imperative when the diagnosis is unclear.

  14. Is scintigraphy of value in the diagnosis of gastrooesophageal reflux disease

    Energy Technology Data Exchange (ETDEWEB)

    Kjellen, G.; Brudin, L.; Haakansson, H.O. (Centrallasarettet, Kalmar (Sweden))

    1991-01-01

    110 patients with suspected oesophageal symptoms were investigated by means of oesophageal endoscopy (OE), 24-h pH- metry, and oesophageal scintigraphy (ES). When 24-h pH-metry formed the basis for diagnosis of gastrooesophageal reflux disease (GERD), the sensitivity for ES at abdominal compression was 64%, but no statistically significant differences were found among erect refluxers, supine refluxers, and comibined refluxers. Only 4% of the GERD patients had pathologic oesophageal clearing at ES. The more severe the macroscopic oesophagitis found by OE, the more pronounced were the abnormal findings at 24-h pH-metry and at ES with abdominal compression. Increased postprandial reflux was associated with gastro-oesophageal reflux and hiatal hernia at ES with abdominal compression and the most severe form of oesophagitis, respectively. It is concluded that ES has too low sensitivity to be recommended as a screening test for GERD. Nevertheless, the specificity of 76% can to some extent help us to rule out GERD in patients. 19 refs., 7 tabs.

  15. The relationship between helicobacter pylori infection and gastro-esophageal reflux disease

    Directory of Open Access Journals (Sweden)

    Batool M Mahdi

    2011-01-01

    Full Text Available Background : Gastro-esophageal reflux disease is a common condition, affecting 25%-40% of the population. Increasing attention has been paid to the relationship between Helicobacter pylori infection and reflux esophagitis. Aim: The aim of this study was to investigate the association between CagA+ H. pylori and endoscopically proven gastro-esophageal reflux disease. Patients and Methods: The study group included 60 hospital patients with gastro-esophageal reflux disease between 2007 and 2009 as compared with 30 healthy patients from a control group that was age and sex matched. Helicobacter pylori CagA+ was identified by an immunological test (Immunochromatography test (ACON, USA. Results : Helicobacter pylori CagA+ was present in 42/60 (70% of the patients with gastro-esophageal reflux disease and in 11/30 (36.6% patients in the control group (p=0.002. The Odds ratio = 0.8004 with 95% Confidence Interval = from 0.3188 to 2.0094. The relative risk=1.35 that indicates an association between Helicobacter pylori and disease. Conclusions: The presence of Helicobacter pylori is significantly increased in patients with gastro-esophageal reflux disease as compared with the control group.

  16. Gastro-oesophageal reflux disease and non-asthma lung disease

    Directory of Open Access Journals (Sweden)

    R. S. Morehead

    2009-12-01

    Full Text Available Gastro-oesophageal reflux disease (GERD is a common disorder in Western countries, and its relationship to airways disorders (e.g. asthma has been well established. Lung diseases other than asthma have also been associated with GERD, but the nature and scope of this relationship has not been fully defined. Diseases that have been associated with GERD include bronchiolitis syndromes, idiopathic pulmonary fibrosis, scleroderma and nontubercular mycobacterial infection. Diagnostic evaluation centres upon proving both reflux and pulmonary aspiration, which may be accomplished in some cases by lung biopsy. However, in many cases a compatible clinical and radiographic picture coupled with proof of proximal reflux by combined oesophageal probe testing may suffice for a provisional diagnosis and allow institution of anti-reflux measures. Proton-pump inhibitors are the medications of choice for GERD; other interventions shown to reduce reflux are weight loss, elevation of the head of the bed and avoidance of recumbency after meals. However, acid suppression therapy does not address non-acid reflux that may be important in disease pathogenesis in select patients, and lifestyle modifications often fail. Laparoscopic fundoplication is the procedure of choice for medically refractory GERD with excellent short-term results with respect to respiratory symptoms associated with GERD; however, long-term studies document a significant percentage of patients requiring ongoing acid suppression therapy.

  17. Prevalence of gastroesophageal reflux in end-stage lung disease candidates for lung transplant.

    Science.gov (United States)

    D'Ovidio, Frank; Singer, Lianne G; Hadjiliadis, Denis; Pierre, Andrew; Waddell, Thomas K; de Perrot, Marc; Hutcheon, Micheal; Miller, Linda; Darling, Gail; Keshavjee, Shaf

    2005-10-01

    Aspiration secondary to gastroesophageal reflux has been postulated to be a contributing factor in bronchiolitis obliterans after lung transplantation. It is not clear whether gastroesophageal reflux is a preexisting condition or secondary to intraoperative vagal injury or drug-induced prolonged gastric emptying. The prevalence of gastroesophageal reflux was examined in 78 consecutive end-stage lung disease patients assessed for lung transplantation: emphysema, 21; cystic fibrosis, 5; idiopathic pulmonary fibrosis, 26; scleroderma, 10; and miscellaneous diseases, 16. All underwent esophageal manometry. Two-channel esophageal 24-hour pH testing was completed in 76 patients. Gastric emptying studies were conducted in 36 patients. Typical gastroesophageal reflux symptoms were documented in 63% of patients. The lower esophageal sphincter was hypotensive in 72% of patients, and 33% had esophageal body dysmotility. Prolonged gastric emptying was documented in 44%, and 38% had abnormal pH testing. The overall DeMeester score was above normal in 32% of patients, and 20% had abnormal proximal pH probe readings. Gastroesophageal reflux is highly prevalent in end-stage lung disease patients who are candidates for lung transplantation. Further investigation is needed to study the prevalence of gastroesophageal reflux after lung transplantation and its contribution to chronic allograft dysfunction.

  18. Evaluation of bile reflux in HIDA images based on fluid mechanics.

    Science.gov (United States)

    Lo, Rong-Chin; Huang, Wen-Lin; Fan, Yu-Ming

    2015-05-01

    We propose a new method to help physicians assess, using a hepatobiliary iminodiacetic acid scan image, whether or not there is bile reflux into the stomach. The degree of bile reflux is an important index for clinical diagnosis of stomach diseases. The proposed method applies image-processing technology combined with a hydrodynamic model to determine the extent of bile reflux or whether the duodenum is also folded above the stomach. This condition in 2D dynamic images suggests that bile refluxes into the stomach, when endoscopy shows no bile reflux. In this study, we used optical flow to analyze images from Tc99m-diisopropyl iminodiacetic acid cholescintigraphy (Tc99m-DISIDA) to ascertain the direction and velocity of bile passing through the pylorus. In clinical diagnoses, single photon emission computed tomography (SPECT) is the main clinical tool for evaluating functional images of hepatobiliary metabolism. Computed tomography (CT) shows anatomical images of the external contours of the stomach, liver, and biliary extent. By exploiting the functional fusion of the two kinds of medical image, physicians can obtain a more accurate diagnosis. We accordingly reconstructed 3D images from SPECT and CT to help physicians choose which cross sections to fuse with software and to help them more accurately diagnose the extent and quantity of bile reflux.

  19. Pyelonephritis, renal scarring, and reflux nephropathy: a pediatric urologist's perspective

    Energy Technology Data Exchange (ETDEWEB)

    Smith, Edwin A. [Emory University School of Medicine, Department of Urology, Atlanta, GA (United States)

    2008-01-15

    Imaging of children with a clinical diagnosis of pyelonephritis is performed to characterize the extent of the infection, to identify associated renal injury and to uncover risk factors for future infections and renal damage. Although there is general agreement regarding the need for parenchymal imaging and the need to exclude processes that are either functionally or anatomically obstructive, there is controversy regarding the need for routine cystography, especially when parenchymal involvement has not been documented. A protocol that limits the use of cystography for evaluation of urinary tract infections must assume that the diagnosis of reflux is at least of variable clinical significance. It is now clear that vesicoureteral reflux and reflux nephropathy represent a diverse population that includes both congenital and acquired processes. MR imaging will improve our understanding of vesicoureteral reflux, pyelonephritis and renal scarring and might help us to identify and manage those patients most at risk for recurrent infections and renal injury. To recognize the potential contributions of this newer imaging technique it is helpful to look at our understanding of the pathophysiology of pyelonephritis, reflux and reflux nephropathy. (orig.)

  20. Modeling the detectability of vesicoureteral reflux using microwave radiometry

    Energy Technology Data Exchange (ETDEWEB)

    Arunachalam, Kavitha [Department of Engineering Design, Indian Institute of Technology Madras, Chennai (India); Maccarini, Paolo F; Stauffer, Paul R [Department of Radiation Oncology, Duke University Medical Center, Durham, NC (United States); De Luca, Valeria [Department of Information Tech and Electrical Eng., ETH Zurich (Switzerland); Bardati, Fernando [Department of Computer Science, Systems and Production, University of Rome, Tor Vergata, Roma (Italy); Snow, Brent W, E-mail: akavitha@iitm.ac.i [University of Utah and Primary Children' s Medical Center, Salt Lake City, UT (United States)

    2010-09-21

    We present the modeling efforts on antenna design, frequency selection and receiver sensitivity estimation to detect vesicoureteral reflux (VUR) using microwave (MW) radiometry as warm urine from the bladder maintained at fever range temperature using a MW hyperthermia device reflows into the kidneys. The radiometer center frequency (f{sub c}), frequency band ({Delta}f) and aperture radius (r{sub a}) of the physical antenna for kidney temperature monitoring are determined using a simplified universal antenna model with a circular aperture. Anatomical information extracted from the computed tomography (CT) images of children aged 4-6 years is used to construct a layered 3D tissue model. Radiometric antenna efficiency is evaluated in terms of the ratio of the power collected from the target at depth to the total power received by the antenna ({eta}). The power ratio of the theoretical antenna is used to design a microstrip log spiral antenna with directional radiation pattern over f{sub c} {+-} {Delta}f/2. Power received by the log spiral from the deep target is enhanced using a thin low-loss dielectric matching layer. A cylindrical metal cup is proposed to shield the antenna from electromagnetic interference (EMI). Transient thermal simulations are carried out to determine the minimum detectable change in the antenna brightness temperature ({delta}T{sub B}) for 15-25 mL urine refluxes at 40-42 {sup 0}C located 35 mm from the skin surface. Theoretical antenna simulations indicate maximum {eta} over 1.1-1.6 GHz for r{sub a} = 30-40 mm. Simulations of the 35 mm radius tapered log spiral yielded a higher power ratio over f{sub c} {+-} {Delta}f/2 for the 35-40 mm deep targets in the presence of an optimal matching layer. Radiometric temperature calculations indicate {delta}T{sub B} {>=} 0.1 K for the 15 mL urine at 40 {sup 0}C and 35 mm depth. Higher {eta} and {delta}T{sub B} were observed for the antenna and matching layer inside the metal cup. Reflection measurements

  1. Modeling the detectability of vesicoureteral reflux using microwave radiometry

    Science.gov (United States)

    Arunachalam, Kavitha; Maccarini, Paolo F.; De Luca, Valeria; Bardati, Fernando; Snow, Brent W.; Stauffer, Paul R.

    2010-09-01

    We present the modeling efforts on antenna design, frequency selection and receiver sensitivity estimation to detect vesicoureteral reflux (VUR) using microwave (MW) radiometry as warm urine from the bladder maintained at fever range temperature using a MW hyperthermia device reflows into the kidneys. The radiometer center frequency (fc), frequency band (Δf) and aperture radius (ra) of the physical antenna for kidney temperature monitoring are determined using a simplified universal antenna model with a circular aperture. Anatomical information extracted from the computed tomography (CT) images of children aged 4-6 years is used to construct a layered 3D tissue model. Radiometric antenna efficiency is evaluated in terms of the ratio of the power collected from the target at depth to the total power received by the antenna (η). The power ratio of the theoretical antenna is used to design a microstrip log spiral antenna with directional radiation pattern over fc ± Δf/2. Power received by the log spiral from the deep target is enhanced using a thin low-loss dielectric matching layer. A cylindrical metal cup is proposed to shield the antenna from electromagnetic interference (EMI). Transient thermal simulations are carried out to determine the minimum detectable change in the antenna brightness temperature (δTB) for 15-25 mL urine refluxes at 40-42 °C located 35 mm from the skin surface. Theoretical antenna simulations indicate maximum η over 1.1-1.6 GHz for ra = 30-40 mm. Simulations of the 35 mm radius tapered log spiral yielded a higher power ratio over fc ± Δf/2 for the 35-40 mm deep targets in the presence of an optimal matching layer. Radiometric temperature calculations indicate δTB >= 0.1 K for the 15 mL urine at 40 °C and 35 mm depth. Higher η and δTB were observed for the antenna and matching layer inside the metal cup. Reflection measurements of the log spiral in a saline phantom are in agreement with the simulation data. The numerical study

  2. Role of PH Monitoring in Laryngopharyngeal Reflux Patients with Voice Disorders

    Science.gov (United States)

    Maldhure, Swati; Chandrasekharan, Ramanathan; Dutta, Amit- Kumar; Chacko, Ashok; Kurien, Mary

    2016-01-01

    Introduction: Laryngopharyngeal reflux (LPR) is considered an important cause of voice disorder. We aimed to determine the frequency of LPR in patients with voice disorder and the association between Koufman Reflux Symptom Index (RSI), Reflux Finding Score (RFS), gastroesophageal reflux disease (GERD), and proximal acid reflux in these patients. Materials and Methods: We performed a prospective study in patients aged more than 18 years presenting at the ear, nose, and throat (ENT) clinic with a change in voice lasting more than 3 weeks. All patients underwent nasopharyngolaryngoscopy and a dual-probe esophageal pH study. LPR was diagnosed by a Koufman RSI of >13 and/or RFS of >7. GERD was diagnosed according to a DeMeester Johnson score of >14.7. Proximal acid reflux was diagnosed if acid exposure time was >0.02% in a proximal pH probe. Results: The study included 30 patients with a voice disorder. The mean age of participants was 38.5 years and 40% of patients were female. Using either of the two criteria, LPR was present in 46.7% of patients, half of whom had GERD. Among the remaining 53.3% patients with a voice disorder and no evidence of LPR, GERD was present in 25%. There was no significant association between the presence of LPR based on RSI (P=1) and GERD or RFS and GERD (P=0.06). Proximal acid reflux was present in only 10% patients with a voice disorder, and there was no significant association of this test with RFS (P=1) or RSI (P=1). Conclusions: Approximately half of the patients with a voice disorder have LPR, and only a subset of these patients have evidence of GERD. Fiberoptic laryngoscopic findings (RFS) complementing RSI appears to be important in diagnosing possible reflux etiology in voice disorders and can be an indicator for instituting anti-reflux therapy. However, there is no significant association between RSI, RFS, and GERD suggesting that these tests evaluate different features of the disease. Proximal acid reflux is uncommon in patients

  3. Prophylactic antibiotics in vesicoureteric reflux: Evidence-based analysis

    Directory of Open Access Journals (Sweden)

    M S Ansari

    2009-01-01

    Full Text Available Objectives: The aim of this review was to systematically examine the available evidence for the effectiveness of prophylactic antibiotics in cases of vesicoureteric reflux (VUR. Materials and Methods: We searched the relevant data on medical management of VUR and the date of last search was June 2008. The search included both randomized controlled trials as well as the nonrandomized trials and the data sources were; MEDLINE, online peer reviewed journals, Cochrane database and abstracts from conference proceedings. Results: Barring few most of the studies published on medical management were nonrandomized. Besides being small in number many of these studies were of poor-quality and poorly designed eventually failing in giving a reliable answer in this regard. Few of the studies suggest that the children with low grade VUR might do well even without antibiotic prophylaxis. Conclusions : In the absence of properly designed, randomized controlled trials and long-term follow-up the question of antibiotic prophylaxis in cases of VUR remains unanswered in large part of it. Whether to give prophylactic antibiotics or not would ultimately need a shared decision-making involving both the treating physician and the parents assessing both the risks and the benefits.

  4. Complications of bariatric surgery: dumping syndrome, reflux and vitamin deficiencies.

    Science.gov (United States)

    Tack, Jan; Deloose, Eveline

    2014-08-01

    Bariatric surgical procedure are increasingly and successfully applied in the treatment of morbid obesity. Nevertheless, these procedures are not devoid of potential long-term complications. Dumping syndrome may occur after procedures involving at least partial gastric resection or bypass, including Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy. Diagnosis is based on clinical alertness and glucose tolerance testing. Treatment may involve dietary measures, acarbose and somatostatin analogues, or surgical reintervention for refractory cases. Gastro-esophageal reflux disease (GERD) can be aggravated by vertical banded gastroplasty and sleeve gastrectomy procedures, but pre-existing GERD may improve after RYGB and with adjustable gastric banding. Nutrient deficiencies constitute the most important long-term complications of bariatric interventions, as they may lead to haematological, metabolic and especially neurological disorders which are not always reversible. Malabsorptive procedures, poor postoperative nutrient intake, recurrent vomiting and poor compliance with vitamin supplement intake and regular follow-up are important risk factors. Preoperative nutritional assessment and rigourous postoperative follow-up plan with administration of multi-vitamin supplements and assessment of serum levels is recommended in all patients.

  5. Laparoscopy in the management of pediatric vesicoureteral reflux

    Directory of Open Access Journals (Sweden)

    Atul A Thakre

    2007-01-01

    Full Text Available The prevalence of vesicoureteral reflux (VUR has been estimated as. 4 to 1.8% among the pediatric population. In children with urinary tract infection the prevalence is typically from 30-50% with higher incidence occurring in infancy. When correction of VUR is determined to be necessary, traditionally open ureteral reimplantation by a variety of techniques has been the mainstay of treatment. This approach is justified because surgical correction affords a very high success rate of 99% in experienced hands and a low complication rate. In that context the purpose of this review article is to highlight the use of laparoscopy and robot-assisted techniques to perform ureteric reimplantation for the management of pediatric VUR. A detailed review of recent literature on the subject is performed to find out various aspects of minimally invasive surgery in the treatment of VUR, highlighting evolution of management approaches, operative steps, complications, results and the current status in clinical practice. We also share our experience on the subject.

  6. Psychological modulation in patients surgically intervened for gastroesophageal reflux disease.

    Science.gov (United States)

    Lara, F J Pérez; Carranque, G; Oehling, H; Hernández, J M; Oliva, H

    2014-08-01

    Gastroesophageal reflux disease (GERD) has been related with certain psychological dimensions. The influence of mood, emotional intelligence, and perceived quality of life on clinical symptoms and outcome of antireflux surgery was evaluated in GERD patients with and without hiatal hernia. The study included 61 patients who were diagnosed with GERD between 2003 and 2008: 16 of them without hiatal hernia (group A) and 45 of them with hiatal hernia (group B). All of these patients had undergone laparoscopic antireflux surgery. Patients were clinically examined and evaluated with the following instruments: Short Form (SF)-36 Health Survey, Gastrointestinal Quality of Life Index, Hospital Anxiety and Depression (HAD) Scale, and Trait Meta-Mood Scale (TMMS)-24. Proportions were compared by using the chi-squared test; averages were compared by using the Student's t-test (with Bonferroni's correction). In general, our patients intervened for GERD showed results lower than normal or close to the lower limit of normal in the administered tests. Patients in the group without hernia were younger (P frustration, fear, and worry. On the basis of such unfavorable phychoemotional results observed with GERD patients (especially those without hernia) in the different tests, we propose that improving our knowledge of the psychological profile of GERD patients - particularly those without hiatal hernia - could help in designing individualized medical and psychological therapies and increase success rates.

  7. A Correlation between Renal Anomalies and Vesicoureteral Reflux

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Seung Soo; Kim, Young Tong; Kim, Il Young; Shin, Hyeong Cheol [Dept. of Radiology, Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan (Korea, Republic of)

    2011-12-15

    To investigate the frequency of vesicoureteral reflux (VUR) in children with renal anomalies a evaluate the correlation between renal anomalies and VUR. Eighty-one children (1 day-8 years) with renal anomalies underwent voiding cystourethrogram between 2006 and 2009 were reviewed. This study included ureteropelvic junction stenosis (n = 32), ureteropelvic duplication (n = 20), multicystic dysplastic kidney (n = 12), fusion anomaly (n = 11), renal agenesis (n = 3), unilateral renal hypoplasia (n = 2), and ectopic kidney (n = 1). The frequency, grade, and location of VUR were evaluated. The grade of VUR according to age and anomaly type was statistically analyzed, and the patients with VUR were followed. The VUR was present in 14 (17.3%); ipsilateral VUR was present in 8 (57.1%), bilateral VUR in 4 (28.6%), and contralateral VUR in 2 (14.2%). VUR was detected in 9 patients under the age of one. There was no statistical correlation between VUR grade and either age or anomaly type of the nine patients showed continuous VUR on up. The frequency of VUR in children with renal anomalies was 17.3%. VUR was most frequently detected in children under the age of one, and VUR grade was not related to age and anomaly type.

  8. EMPIRIC THERAPY IN OTOLARYNGOLOGIC MANIFESTATIONS OF GASTROESOPHAGEAL REFLUX DISEASE

    Directory of Open Access Journals (Sweden)

    M. Mohammadi

    2005-04-01

    Full Text Available The review of literature shows that a strong relationship exists between the symptoms of otolaryngologic diseases and gastroesophageal reflux disease (GERD. It is commonly observed that an extended physical examination is needed to determine the occurrence of GERD. This non-randomized,prospective quasi-experimental study was performed to clinically verify the relationship between otolaryngologic symptoms and GERD and to show that a search for GERD is necessary under conditions that patients do not respond to initial routine treatment for otolaryngologic symptoms. Extended physical examination of patients who had been referred to an Ear, Nose and throat (ENThospital revealed that GERD-related laryngeal signs were present in 55 patients. Otolaryngologic symptoms detected in decreasing order of occurrence were posterior nasal drip, chronic pharyngitis, chronic cough, hoarseness, ear pain, chronic throat clearing and pruritus in the ear. Furthermore, 66% of the patients had gastrointestinal symptoms that included heartburn, dysphagia, odynophagia, aspiration, globus hystericus, dyspepsia and foreign body sensation. Signs observed during the physical examination were posterior pharyngitis, granular pharyngitis, inflamed arytenoids, contact granuloma, and pachyderma laryngitis. We administered proton pump inhibitor to all patients and recommended to change their life style. The follow up program was a 6-month period. Only 53 patients showed up for the follow up. The overall response rate to the therapeutic regimen was 83%. In treating otolaryngologic patients, especially those who are resistant to routine treatments, a careful extended physical examination including an indirect laryngoscopy for diagnosis of GERD is recommended.

  9. Histologic definition of gastro-esophageal reflux disease.

    Science.gov (United States)

    Chandrasoma, Parakrama T

    2013-07-01

    To review recent data supporting the development of new histology-based definitions of gastro-esophageal reflux disease (GERD). Three precisely definable columnar epithelial types--cardiac, oxyntocardiac and intestinal--may be interposed between esophageal squamous epithelium and gastric oxyntic (acid secreting) mucosa. This enables definition of a new histologic concept: the squamo-oxyntic gap. The squamo-oxyntic gap is zero or very small in autopsies performed on patients without evidence of GERD. The gap progressively increases in length with the severity of GERD, indicating that the squamo-oxyntic gap is a marker for chronic GERD. The distal part of the gap lines gastric-type rugal folds and, therefore, is distal to the present endoscopic definition of the gastro-esophageal junction. I contend that this distal gap segment (which has esophageal submucosal glands) is actually the dilated distal esophagus; this is the pathologic correlate of destruction of the abdominal segment of the lower esophageal sphincter. The dilated distal esophagus is mistaken for 'gastric cardia' by present endoscopic definitions. I believe that these data support the adoption of novel histologic definitions of GERD as follows: the presence of any squamo-oxyntic gap defines GERD; the length of the gap is a measure of severity of chronic GERD; and the presence of intestinal metaplasia in the gap defines Barrett esophagus and cancer risk.

  10. Gastroesophagial reflux disease and asthma in pregnant women with dyspnea.

    Directory of Open Access Journals (Sweden)

    Katayoon Bidad

    2014-04-01

    Full Text Available Asthma and gastroesophageal reflux disease (GERD are two common problems in pregnancy and they affect pregnancy in several ways. In this study, we aimed to evaluate GERD and asthma in pregnant women who referred for prenatal care visits. One-hundred and seventy three pregnant women with a complaint of dyspnea were included in the study. A questionnaire was filled and lung function tests were performed. All patients were visited by a respiratory specialist and questionnaires were evaluated by a gastroenterologist. Out of the total number of women studied, 37% were diagnosed to have asthma and 36.4% were non-asthmatics. Twenty six percent of the pregnant women who had symptoms and signs of asthma with normal spirometry were classified as probable to have asthma. GERD was diagnosed in 80.9% of the pregnant women, but it was not significantly higher in asthmatic or probable asthmatic women compared to non-asthmatic ones. However, severity of GERD was significantly higher in asthmatic pregnant women compared to the others. In conclusion, the prevalence of GERD was quite high in pregnant women, irrespective of the fact that they were asthmatic or non-asthmatic. Further studies evaluating women throughout pregnancy will inform us more about this relationship.

  11. Reflux symptoms and side effects among patients with gastroesophageal reflux disease at baseline, during treatment with PPIs, and after Nissen fundoplication.

    Science.gov (United States)

    Rantanen, Tuomo; Kiljander, Toni; Salminen, Paulina; Ranta, Arto; Oksala, Niku; Kellokumpu, Ilmo

    2013-06-01

    There are no prospective studies available on the behavior of extraesophageal and esophageal symptoms and treatment-related side effects in patients without effective antireflux medication, receiving the most effective antireflux medication, and after laparoscopic fundoplication. Extraesophageal and esophageal reflux symptoms and treatment-related side effects were assessed in 60 patients while they were on no effective antireflux medication (three-week washout period), after three month of treatment with double-dose esomeprazole, and 3 months after laparoscopic Nissen fundoplication. Esophageal and extraesophageal reflux symptoms, rectal flatulence, and bloating were analyzed with the visual analog scale. In addition, dysphagia, rectal flatulence, and bloating were recorded as none, mild, moderate, or severe. Both extraesophageal and esophageal reflux symptoms decreased after treatment with esomeprazole and were further reduced after fundoplication. Dysphagia and flatulence did not increase from baseline after surgery. Bloating decreased both after treatment with esomeprazole and after fundoplication. In contrast, dysphagia and increased flatus were found more often after surgery than during treatment with esomeprazole. Dysphagia and rectal flatulence were less common during treatment with esomeprazole than at baseline or after surgery. Both extraesophageal and esophageal reflux symptoms decreased after treatment with esomeprazole and were reduced further after fundoplication. Any treatment-related side effect was not increased after surgery when compared to baseline. However, compared to esomeprazole there was more dysphagia and flatulence after fundoplication.

  12. Ultrasonographic study of postcibal gastro-esophageal reflux and gastric emptying in infants with recurrent respiratory disease

    Institute of Scientific and Technical Information of China (English)

    Agostino Di Ciaula; Piero Portincasa; Leonardo Di Terlizzi; Domenico Paternostro; Giuseppe Palasciano

    2005-01-01

    AIM: To check the utility of postcibal ultrasonography for the evaluation of reflux in relation to gastric emptying in infants with recurrent respiratory symptoms and to link imaging with clinical data.METHODS: Esophageal reflux (hyperechoic retrograde filling) and gastric emptying (antral areas) were quantified before and after ingestion of a standard formula in 35 untreated infants (13 with chronic cough,22 with recurrent bronchitis) and in 31 controls.RESULTS: The prevalence of abnormal (≥8 episodes)postcibal refluxes was 74% in patients and 3% in controls. Number, duration of the longest episode and extent of refluxes were significantly higher in patients compared to controls. Number of refluxes was higher in patients with symptomatic refluxes than in those without.Infants with recurrent bronchitis had more refluxes than those with chronic cough and controls. Extent and timing of gastric emptying were similar in patients and controls.CONCLUSION: Esophageal ultrasonography is a useful and physiological test in infants with recurrent respiratory diseases, which have a high prevalence of abnormal postcibal esophageal reflux and a gastric emptying similar to that of normal controls. Esophageal reflux is more severe in subjects with recurrent bronchitis than in those with chronic cough.

  13. Effect of Helicobacter pylori Eradication on Reflux Esophagitis Therapy: A Multi-center Randomized Control Study

    Institute of Scientific and Technical Information of China (English)

    Yan Xue; Li-Ya Zhou; San-Ren Lin; Xiao-Hua Hou; Zhao-Shen Li; Min-Hu Chen; Xiu-E Yan

    2015-01-01

    Background:Helicobacterpylori (H.pylori) frequently colonizes the stomach.Gastroesophageal reflux disease (GERD) is a common and costly disease.But the relationship ofH.pylori and GERD is still unclear.This study aimed to explore the effect ofH.pylori and its eradication on reflux esophagitis therapy.Methods:Patients diagnosed with reflux esophagitis by endoscopy were enrolled;based on rapid urease test and Warth-Starry stain,they were divided into H.pylori positive and negative groups.H.pylori positive patients were randomly given H.pylori eradication treatment for 1 0 days,then esomeprazole 20 mg bid for 46 days.The other patients received esomeprazole 20 mg bid therapy for 8 weeks.After treatment,three patient groups were obtained:H.pylori positive eradicated,H.pylori positive uneradicated,and H.pylori negative.Before and after therapy,reflux symptoms were scored and compared.Healing rates were compared among groups.The x2 test and t-test were used,respectively,for enumeration and measurement data.Results:There were 176 H.pylori positive (with 92 eradication cases) and 180 negative cases.Healing rates in the H.pylori positive eradicated and H.pylori positive uneradicated groups reached 80.4% and 79.8% (P =0.911),with reflux symptom scores of 0.22 and 0.14 (P =0.588).Healing rates of esophagitis in the H.pylori positive uneradicated and H.pylori negative groups were,respectively,79.8% and 82.2% (P =0.848);reflux symptom scores were 0.14 and 0.21 (P =0.546).Conclusions:Based on esomeprazole therapy,H.pylori infection and eradication have no significant effect on reflux esophagitis therapy.

  14. Recurrent urinary tract infections in young children: role of DMSA scintigraphy in detecting vesicoureteric reflux

    Energy Technology Data Exchange (ETDEWEB)

    Awais, Muhammad; Rehman, Abdul; Nadeem, Naila [Aga Khan University Hospital, Department of Radiology, Karachi (Pakistan); Zaman, Maseeh Uz [Aga Khan University Hospital, Nuclear Medicine, Department of Radiology, Karachi (Pakistan)

    2014-07-04

    Performing micturiting cystourethrography (MCUG) in young children with recurrent urinary tract infections is controversial with discrepancy among the major guidelines. Previous studies have shown that a normal dimercaptosuccinic acid (DMSA) scintigraphy may avoid the need of performing MCUG for detecting vesicoureteric reflux in children with first febrile urinary tract infection. However, the role of DMSA for ruling out vesicoureteric reflux in children with recurrent urinary tract infections has not been studied. Approval from institutional ethical review committee was sought and the requirement of informed consent was waived. A total of 50 children under the age of 10 years with recurrent urinary tract infections underwent MCUG scan within 3 months of DMSA scan from January 2011 to September 2012 at our institution. Diagnosis of recurrent urinary tract infections and grading of vesicoureteric reflux was according to previously established standards. Abnormalities on DMSA scan - scarring, hydronephrosis and reduced differential renal function - were compared with presence of vesicoureteric reflux on MCUG. High-grade vesicoureteric reflux was noted on MCUG in 22 (44%) cases. The findings on DMSA included hydronephrosis and scarring in 25 (50%) and 25 (50%) cases, respectively. Abnormalities on DMSA scan for detecting the presence of high-grade vesicoureteric reflux on MCUG examination had sensitivity, specificity, positive and negative predictive values of 95.45%, 35.71%, 53.85% and 90.91%, respectively. The positive and negative likelihood ratios were 1.48 and 0.13 respectively. DMSA scan had high overall sensitivity and negative predictive value with a low negative likelihood ratio for ruling out high-grade vesicoureteric reflux on MCUG, which may obviate the need of invasive MCUG along with its associated drawbacks. (orig.)

  15. Endoscopic treatment of vesicoureteral reflux with polyacrylate polyalcohol copolymer and dextranomer/hyaluronic acid in adults

    Directory of Open Access Journals (Sweden)

    Akif Turk

    2014-06-01

    Full Text Available Purpose Aim of this study is to examine the effectiveness of dextranomer/hyaluronic acid copolymer and polyacrylate polyalcohol copolymer in endoscopic treatment of vesicoureteral reflux disease in adult patients with and without chronic renal failure. Materials and Methods Thirty two patients (12 female, 20 male with a total of 50 renal units were treated for vesicoureteral reflux. There were 26 (81% chronic renal failure patients. The success of treatment was evaluated by voiding cystouretrography at 3rd and 12th months after subureteric injection. The persistence of reflux was considered as failure. Patients were divided into two groups according to injected material. Age, sex, grade of reflux and treatment results were recorded and evaluated. Results Reflux was scored as grade 1 in seven (14%, grade 2 in 16 (32%, grade 3 in 21 (42% and grade 4 in six (12% renal units. There was not patient with grade 5 reflux. Fourteen renal units (28% were treated with dextranomer/hyaluronic acid copolymer (group 1 and 36 renal units (72% were treated with polyacrylate polyalcohol copolymer (group 2. The overall treatment success was achieved at 40 renal units (80%. The treatment was successful at 11 renal units (79% in group 1 and 29 renal units (81% in group 2 (p = 0.71. There was not statistically significant difference between two groups with patients with chronic renal failure in terms of treatment success (p = 1.00. Conclusions The effectiveness of two bulking agents was similar in treatment of vesicoureteral reflux disease in adult patients and patients with chronic renal failure.

  16. Pancreaticobiliary reflux in patients with a normal pancreaticobiliary junction:Pathologic implications

    Institute of Scientific and Technical Information of China (English)

    Marcelo A Beltrán

    2011-01-01

    Knowledge on pancreaticobiliary reflux in normal pancreaticobiliary junction and its pathologic implications has experienced tremendous progress during the last few years.This editorial reviews the current knowledge on this condition and its pathological implications on gallbladder diseases.The following aspects were defined appropriate for discussion:(1) Evidence of carcinogenesis associated with pancreaticobiliary reflux; (2) Evidence of pancreaticobiliary reflux in normal pancreaticobiliary junction; and (3) Evidence of sphincter of Oddi (SO) dysfunction as a cause of pancreaticobiliary reflux in normal pancreaticobiliary junction.The articles reviewed were selected and classified according to five levels of evidence:LevelⅠ,meta-analysis double-blind randomized clinical trials,Level Ⅱ,cohort non-blinded studies and non-randomized clinical trials,Level Ⅲ, good quality case-control studies and non-randomized cohort studies,Level Ⅳ,case series and poor quality case-control studies,and Level Ⅴ,case report articles and experts' opinion.Evidence levels Ⅱ,Ⅲ,Ⅳ and Ⅴ were found to support biliary carcinogenesis associated with pancreaticobiliary reflux in normal and abnormal pancreaticobiliary junction.The same levels of evidence were found to support the common occurrence of pancreaticobiliary reflux in normal pancreaticobiliary junction, and SO dysfunction as the most plausible cause of this condition.Although an important body of research has been published regarding pancreaticobiliary reflux in normal pancreaticobiliary junction and its clinical significance, the current evidence does not fully support what has been suggested.Studies with evidence level I have not been undertaken.This is a fascinating subject of study,and if finally supported by evidence level I, the importance of this condition will constitute a major breakthrough in biliary pathology.

  17. Effect of impeller reflux balance holes on pressure and axial force of centrifugal pump

    Institute of Scientific and Technical Information of China (English)

    CAO Wei-dong; DAI Xun; HU Qi-xiang

    2015-01-01

    The size of impeller reflux holes for centrifugal pump has influence on the pressure distribution of front and rear shrouds and rear pump chamber, as well as energy characteristics of whole pump and axial force. Low specific-speed centrifugal pump with Q=12.5 m3/h,H=60 m,n=2950 r/min was selected to be designed with eight axial reflux balance holes with 4.5 mm in diameter. The simulated Q-H curve and net positive suction head (NPSH) were in good agreement with experimental results, which illustrated that centrifugal pump with axial reflux balance holes was superior in the cavitation characteristic; however, it showed to little superiority in head and efficiency. The pressure in rear pump chamber at 0.6 times rate flow is 29.36% of pressure difference between outlet and inlet, which reduces to 29.10% at rate flow and 28.33% at 1.4 times rate flow. As the whole, the pressure distribution on front and rear shrouds from simulation results is not a standard parabola, and axial force decreases as flow rate increases. Radical reflux balance holes chosen to be 5.2 mm and 5.9 mm in diameter were further designed with other hydraulic parts unchanged. With structural grids adopted for total flow field, contrast numerical simulation on internal flow characteristics was conducted based on momentum equations and standard turbulence model (κ-ε). It is found that axial force of pump with radical reflux balance holes of 5.2 mm and 5.9 mm in diameter is significantly less than that with radical reflux balance holes of 4.5 mm in diameter. Better axial force balance is obtained as the ratio of area of reflux balance holes and area of sealing ring exceeds 6.

  18. Gastroesophageal Reflux is Not Associated with Dental Erosion in Children

    Science.gov (United States)

    Wild, Yvette K.; Heyman, Melvin B.; Vittinghoff, Eric; Dalal, Deepal H.; Wojcicki, Janet M.; Clark, Ann L.; Rechmann, Beate; Rechmann, Peter

    2011-01-01

    Background & Aims Dental erosion is a complication of gastroesophageal reflux (GER) in adults; in children, it is not clear if GER has a role in dental pathologic conditions. Dietary intake, oral hygiene, high bacterial load, and decreased salivary flow might contribute independently to GER development or dental erosion, but their potential involvement in dental erosion from GER is not understood. We investigated the prevalence of dental erosion among children with and without GER symptoms, and whether salivary flow rate or bacterial load contribute to location-specific dental erosion. Methods We performed a cross-sectional study of 59 children (ages 9–17 y) with symptoms of GER and 20 asymptomatic children (controls); all completed a questionnaire on dietary exposure. Permanent teeth were examined for erosion into dentin, erosion locations, and affected surfaces. The dentist was not aware of GER status, nor was the gastroenterologist aware of dental status. Stimulated salivary flow was measured and salivary bacterial load was calculated for total bacteria, Streptococcus mutans and Lactobacilli. Results Controlling for age, dietary intake, and oral hygiene, there was no association between GER symptoms and dental erosion, by tooth location or affected surface. Salivary flow did not correlate with GER symptoms or erosion. Erosion location and surface were independent of total bacteria and levels of Streptococcus mutans and Lactobacilli. Conclusions Location-specific dental erosion is not associated with GER, salivary flow, or bacterial load. Prospective studies are required to determine the pathogenesis of GER-associated dental erosion and the relationship between dental caries to GER and dental erosion. PMID:21820389

  19. Clinical and endoscopic features of Chinese reflux esophagitis patients

    Institute of Scientific and Technical Information of China (English)

    Wei Li; Shu-Tian Zhang; Zhong-Lin Yu

    2008-01-01

    AIM: To analyze the clinical and endoscopic features of Chinese patients with reflux esophagitis (RE).METHODS: A total of 1405 RE patients were analyzed retrospectively. Data on gender, age, presence/absence of H pylori infection and associated esophageal hiatal hernia were collected. Esophagitis was divided into different grades according to Los Angeles Classification.RESULTS: Of 18823 patients, 1405 were diagnosed as RE. The ratio of male to female patients was 1.75:1 (P < 0.01). The mean age of male and female patients was significantly different (P = 0.01). The peak age at onset of the disease was 40-60 years. According to Los Angeles Classification, there were significant differences in the age of patients with grades A and B compared to patients with grades C and D (P < 0.01). Two hundred and seventy-seven patients were infected with H pylori, the infection rate was low (P < 0.01). Complication of esophageal hiatal hernia was found to be significantly associated with the severity of esophagitis and age in 195 patients (P < 0.01). Esophageal mucosa damages were mainly located at the right esophageal wall.CONCLUSION: The peak age of onset of RE is 40-60 years and higher in males than in females. The mean age of onset of RE is lower in males than in females. The infection rate of H pylori is significantly decreased in patients with esophagitis. Old age and esophageal hiatal hernia are associated with more severe esophagitis. Right esophageal mucosal damage can occur more often in RE patients.

  20. Gastroesophageal reflux disease in COPD: links and risks

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    Lee AL

    2015-09-01

    Full Text Available Annemarie L Lee,1–3 Roger S Goldstein1,2,4 1West Park Healthcare Centre, 2Department of Physical Therapy, University of Toronto, Toronto, ON, Canada; 3Institute for Breathing and Sleep, Austin Hospital, Melbourne, VIC, Australia; 4Department of Medicine, University of Toronto, Toronto, ON, Canada Abstract: COPD is a long-term condition associated with considerable disability with a clinical course characterized by episodes of worsening respiratory signs and symptoms associated with exacerbations. Gastroesophageal reflux disease (GERD is one of the most common gastrointestinal conditions in the general population and has emerged as a comorbidity of COPD. GERD may be diagnosed by both symptomatic approaches (including both typical and atypical symptoms and objective measurements. Based on a mix of diagnostic approaches, the prevalence of GERD in COPD ranges from 17% to 78%. Although GERD is usually confined to the lower esophagus in some individuals, it may be associated with pulmonary microaspiration of gastric contents. Possible mechanisms that may contribute to GERD in COPD originate from gastroesophageal dysfunction, including altered pressure in the lower esophageal sphincter (which normally protect against GERD and changes in esophageal motility. Proposed respiratory contributions to the development of GERD include respiratory medications that may alter esophageal sphincter tone and changes in respiratory mechanics, with increased lung hyperinflation compromising the antireflux barrier. Although the specific cause and effect relationship between GERD and COPD has not been fully elucidated, GERD may influence lung disease severity and has been identified as a significant predictor of acute exacerbations of COPD. Further clinical effects could include a poorer health-related quality of life and an increased cost in health care, although these factors require further clarification. There are both medical and surgical options available for the

  1. Correlation of ventilator-associated pneumonia with gastroesophageal reflux

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    Chun-Yan Zhou

    2016-01-01

    Objective:To explore the correlation of gastroesophageal reflux with ventilator-associated pneumonia (VAP).Methods: A total of 84 patients who were performed with mechanical assisted ventilation in our hospital were included in the study. The pharyngeal and tracheal secretions 2 d (T1), 4 d (T2), and 6 d (T3) after mechanical ventilation were collected, respectively. ELISA was used to detect the pepsin concentration. The clinical pulmonary infection score (CPIS) was performed to the patients in order to analyze the correlation of pepsin concentration with CPIS.Results:The positive rate of pharyngeal pepsin at T1 was 16.7%, at T2 was 54.8%, and at T3 was 78.6%. The positive rate of pepsin was increased with the extending of mechanical ventilation time. The comparison of pepsin concentration in the pharyngeal secretions at T1 between the VAP patients and non-VAP patients was not statistically significant, but the pepsin concentration in the tracheal secretions was significantly higher than that in the non-VAP patients. The pepsin concentration in the pharyngeal and tracheal secretions at T2 and T3 in the VAP patients was significantly higher than that in the non-VAP patients. The pepsin concentration in the tracheal secretions in the VAP patients was associated with CPIS.Conclusions:The positive rate of pepsin concentration in the pharyngeal and tracheal secretions in the VAP patients is increased with the extending of mechanical ventilation time. The positive rate of pepsin concentration in the tracheal secretions at each timing point in the VAP patients is significantly higher than that in the non-VAP patients. The pepsin concentration in the pharyngeal and tracheal secretions in the VAP patients is positively correlated with CPIS.

  2. Risk factors of gastroesophageal reflux disease in Shiraz, southern Iran

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    AIM: To determine the prevalence and symptoms of gastroesophageal reflux disease (GERD) in a healthy general population in relation to demographic, lifestyle and health-seeking behaviors in Shiraz, southern Iran. METHODS: A total of 1978 subjects aged > 35 years who referred to Gastroenterohepatology Research Center and who completed a questionnaire consisting of 27 questions for GERD in relation to demographic, lifestyle and health-seeking behaviors were included in this study for a period of five months. The validity and reliability of the questionnaire were determined.RESULTS: The prevalence of GERD was 15.4%, which was higher in females (17.3%), in rural areas (19.8%),and in illiterate subjects (21.5%) and those with a mean age of 50.25 years. The prevalence was significantly lower in subjects having fried food (14.8%), and fruit and vegetables (14.6%). More symptoms were noticed in subjects consuming pickles (22.1%), taking aspirin (21%)and in subjects with psychological distresses (27.2%)and headaches (22%). The correlation was statistically significant between GERD and halitosis (18.3%),dyspepsia (30.6%), anxiety (19.5%), nightmares (23.9%)and restlessness (18.5%). Their health seeking behavior showed that there was a significant restriction of diet (20%), consumption of herbal medicine (19%), using over-the-counter drugs (29.9%) and consulting with physicians (24.8%). Presence of GERD symptoms was also significantly related to a previous family history of the disease (22.3%).CONCLUSION: GERD is more common in females, rural and illiterate subjects and correlated with consumption of pickles, occurrence of headache, psychological distress,dyspepsia, halitosis, anxiety, nightmare and restlessness,and a family history of GERD and aspirin intake, but the correlation was negative with consumption of fat and fiber intake.

  3. Radiofrequency treatment on respiratory symptoms due to gastroesophageal reflux disease

    Institute of Scientific and Technical Information of China (English)

    GAO Xiang; TIAN Shu-rui; WANG Zhong-gao; WU Ji-min; JI Feng; ZHANG Cheng-chao; NING Ya-chan; LI Zhi-tong; HU Zhi-wei; CHEN Xiu

    2011-01-01

    Background Diagnosis and treatment for respiratory symptoms (RSs) of gastroesophageal reflux disease (GERD) is more difficult than that for common esophageal symptoms. The goal of this study was to evaluate the efficacy and safety of radiofrequency (RF) treatment on RSs of GERD in a preliminary 12-month follow-up observation.Methods From April 2006 to October 2008,505 GERD patients with mainly respiratory presentations such as wheezing,chronic cough or hoarseness,were treated by endoscopic RF. A questionnaire was completed before and after treatment,using a six-point scale ranging from 0 to 5 to assess symptom severity and frequency. The symptom score was the sum of frequency and severity.Results Symptom scores were significantly improved at the end of the follow-up period. The mean heartburn score decreased from 5.31 to 1.79. The mean regurgitation score decreased from 5.02 to 1.64;mean cough score decreased from 6.77 to 2.85;mean wheezing score decreased from 7.83 to 3.07;and mean hoarseness score decreased from 5.13 to 1.81 (P <0.01). No major complications or deaths occurred. Minor complications included temporary post-procedural retrosternal unease or pain (n=106;21.0%),mild fever (n=86;17.0%),transient nausea/vomiting (n=97;19.2%),and transient dysphagia (n=42;9.3%). Thirty-five (6.9%) patients had recurrence of symptoms. Endoscopic RF treatment was repeated in six patients,and laparoscopic fundoplication was performed in seven.Conclusion Endoscopic RF is an effective and safe means to treat RSs in patients with GERD.

  4. Gastroesophageal Reflux Symptoms not Responding to Proton Pump Inhibitor: GERD, NERD, NARD, Esophageal Hypersensitivity or Dyspepsia?

    Directory of Open Access Journals (Sweden)

    Mohammad Bashashati

    2014-01-01

    Full Text Available Gastroesophageal reflux (GER is a common gastrointestinal process that can generate symptoms of heartburn and chest pain. Proton pump inhibitors (PPIs are the gold standard for the treatment of GER; however, a substantial group of GER patients fail to respond to PPIs. In the past, it was believed that acid reflux into the esophagus causes all, or at least the majority, of symptoms attributed to GER, with both erosive esophagitis and nonerosive outcomes. However, with modern testing techniques it has been shown that, in addition to acid reflux, the reflux of nonacid gastric and duodenal contents into the esophagus may also induce GER symptoms. It remains unknown how weakly acidic or alkaline refluxate with a pH similar to a normal diet induces GER symptoms. Esophageal hypersensitivity or functional dyspepsia with superimposed heartburn may be other mechanisms of symptom generation, often completely unrelated to GER. Detailed studies investigating the pathophysiology of esophageal hypersensitivity are not conclusive, and definitions of the various disease states may overlap and are often confusing. The authors aim to clarify the pathophysiology, definition, diagnostic techniques and medical treatment of patients with heartburn symptoms who fail PPI therapy.

  5. Review article: gastro-oesophageal reflux disease--the health economic implications.

    Science.gov (United States)

    Mason, J; Hungin, A P S

    2005-08-01

    For the vast majority of patients with gastro-oesophageal reflux disease appropriate care involves the management of symptoms with lifestyle advice and drugs. However, there is dissension about the appropriate use of endoscopy, whether drugs should be stepped up or down according to potency, how long drugs should be used for, the role of lifestyle advice, and, related to this, the role of patients' lifestyle choices. This exploration of the economics of gastro-oesophageal reflux disease reviews its cost burden to the UK, assesses published economic models for their strengths and weaknesses and examines current recommendations for gastro-oesophageal reflux disease management from a socioeconomic perspective. Drugs prescribed predominantly for dyspepsia cost the UK National Health Service a projected pound sterling 625 million in 2004, 7% of the primary care prescribing budget. When general practitioners consultations, endoscopies, over-the-counter sales and sickness absences are included the UK cost rises to pound sterling 1.5 billion: approximately half of this cost can be ascribed to gastro-oesophageal reflux disease. Emphasis upon regular review and stepping down treatment (while maintaining adequate symptom relief) is both clinically appropriate and resource efficient. Other cost-effectiveness issues largely lack objective answers because investment in treatment for gastro-oesophageal reflux disease depends upon how much more, at the margin, society wishes to invest for further but diminishing symptom relief.

  6. Effect of percutaneous endoscopic gastrostomy on gastro-esophageal reflux in mechanically-ventilated patients

    Institute of Scientific and Technical Information of China (English)

    Emmanuel E Douzinas; Andreas Tsapalos; Antonios Dimitrakopoulos; Evanthia Diamanti-Kandarakis; Alexandros D Rapidis; Charis Roussos

    2006-01-01

    AIM: To investigate the effect of percutaneous endoscopic gastrostomy (PEG) on gastroesophageal reflux (GER) in mechanically-ventilated patients.METHODS: In a prospective, randomized, controlled study 36 patients with recurrent or persistent ventilatorassociated pneumonia (VAP) and GER > 6% were divided into PEG group (n=16) or non-PEG group (n = 20).Another 11 ventilated patients without reflux (GER<3%) served as control group. Esophageal pH-metry was performed by the "pull through" method at baseline, 2and 7 d after PEG. Patients were strictly followed up for semi-recumbent position and control of gastric nutrient residue.RESULTS: A significant decrease of median (range) reflux was observed in PEG group from 7.8 (6.2-15.6) at baseline to 2.7 (0-10.4) on d 7 post-gastrostomy (P<0.01), while the reflux increased from 9 (6.2-22) to 10.8(6.3-36.6) (P<0.01) in non-PEG group. A significant correlation between GER (%) and the stay of nasogastric tube was detected (r=0.56, P<0.01).CONCLUSION: Gastrostomy when combined with semirecumbent position and absence of nutrient gastric residue reduces the gastroesophageal reflux in ventilated patients.

  7. Dental and oropharyngeal lesions in rats with chronic acid reflux esophagitis.

    Science.gov (United States)

    Shimazu, Rintaro; Yamamoto, Mihoko; Minesaki, Akimichi; Kuratomi, Yuichiro

    2017-09-04

    In this study, we evaluated pathological changes in the tooth and pharynx of GERD rats to elucidate the association between gastric acid reflux and oral and pharyngeal diseases. An experimental rat model of chronic acid reflux esophagitis was surgically created. The oral cavities were observed histologically every 2 weeks until 20 weeks after surgery. At 10 weeks after surgery, molar crown heights in GERD rats were shorter than that in control rats, and inflammatory cell infiltration by gastric acid reflux was found in the periodontal mucosa of GERD rats. Furthermore, dental erosion progressed in GERD rats at 20 weeks after surgery, and enamel erosion and dentin exposure were observed. During the same period, inflammatory cell infiltration was observed in the mucosa of the posterior part of the tongue. These findings suggest that gastric acid reflux may be one of the exacerbating factors of dental erosion, periodontitis and glossitis. We investigated oral changes in an experimental rat model of GERD and observed development of dental erosion, periodontitis and glossitis. Our findings suggested chronic gastric acid reflux may be involved in the pathogenesis of oral disease. Copyright © 2017 Elsevier B.V. All rights reserved.

  8. Reflux extraction and analysis of polyethylene wax in soil 

    Institute of Scientific and Technical Information of China (English)

    XIONG Xiao-li; CHEN Cheng; LUO Xue-gang

    2014-01-01

    An efficient reflux extraction of polyethylene wax (PEW) in soil is presented, followed by molecular structure characterization methods to explore its degradation mechanism. To more realistically simulate the actual degradation of PE film powders in soil, low density PE (M=5 000) powders, being used as simulated PEW residue sample, were uniformly mixed with soil and then recovered by reflux extraction with decahydronaphthalen (decalin) at 90°C for 60 min. The average recovery of PEW from fortified soils was 96.5%with the developed reflux extraction procedure. The recovered PEW residue samples were characterized by infrared spectroscopy (IR), element analysis (EA), X-ray fluorescence (XFR), and high-temperature gel permeation chromatography (GPC). The results from spectra analysis show that there were no significant changes in molecular structures and molecular mass distribution of PEW samples after the reflux extraction, which demonstrate the reliability of this method. These results also indicate that the reflux extraction procedure and analytical methods of characterization could serve as a novel measurement technique to evaluate the degradation of low-density PE powders in soil over time.

  9. Levels of serologic markers of celiac disease in patients with reflux esophagitis

    Institute of Scientific and Technical Information of China (English)

    Sait Bagci; C Nuri Ercin; Zeki Yesilova; Ayhan Ozcan; Bulent Degertekin; Kemal Dagalp

    2006-01-01

    AIM: To investigate the prevalence of celiac disease serologic markers (antigliadin IgA, IgG, and antiendomysial IgA) in patients with reflux esophagitis and to detect the relationship between reflux esophagitis and celiac disease (CD).METHODS: This study was performed prospectively between January 2003 and January 2004. Sixty-eight adult reflux esophagitis patients and 40 people as control group for symptoms related with gastrointestinal system were enrolled in this study. The diagnostic work-up included an accurate medical history with gastrointestinal symptoms, routine laboratory measurements, the detection of antibodies against gliadin (IgA and IgG)and endomysium (IgA), and an upper endoscopy with postbulbar biopsy.RESULTS: IgA-AGA and IgG-AGA were positive at 8.8%and 10.3% in patients with reflux esophagitis. In control group, it was found that 10% people had positive IgAAGA, and 7.5% people had positive IgG-AGA. There was no significant relationship between patients and control group regarding positive IgA-AGA and IgGAGA. The patients and persons in control group had no positive IgA-EMA. On postbulbar biopsies, no finding was detected concerning celiac disease. There were no symptoms and signs for gluten enteropathy in patients and control group.CONCLUSION: This review supports that an association does not exist between celiac disease and reflux esophagitis. We think these diseases exist independently from each other.

  10. Design of Batch Distillation Columns Using Short-Cut Method at Constant Reflux

    Directory of Open Access Journals (Sweden)

    Asteria Narvaez-Garcia

    2013-01-01

    Full Text Available A short-cut method for batch distillation columns working at constant reflux was applied to solve a problem of four components that needed to be separated and purified to a mole fraction of 0.97 or better. Distillation columns with 10, 20, 30, 40, and 50 theoretical stages were used; reflux ratio was varied between 2 and 20. Three quality indexes were used and compared: Luyben’s capacity factor, total annual cost, and annual profit. The best combinations of theoretical stages and reflux ratio were obtained for each method. It was found that the best combinations always required reflux ratios close to the minimum. Overall, annual profit was the best quality index, while the best combination was a distillation column with 30 stages, and reflux ratio’s of 2.0 for separation of benzene (i, 5.0 for the separation of toluene (ii, and 20 for the separation of ethylbenzene (iii and purification of o-xylene (iv.

  11. Optimal timing of saliva collection to detect pepsin in patients with laryngopharyngeal reflux.

    Science.gov (United States)

    Na, Se Young; Kwon, Oh Eun; Lee, Young Chan; Eun, Young-Gyu

    2016-12-01

    To determine salivary pepsin levels as a function of collection time. A prospective, case-control study. We selected 57 patients with clinical symptoms and signs of laryngopharyngeal reflux who underwent 24-hour multichannel intraluminal impedance-pH (24h MII-pH) monitoring tests, and 12 control subjects without clinical symptoms and signs of laryngopharyngeal reflux. All subjects were instructed to collect saliva samples upon waking, 1 hour after each meal (3 times per day), and upon any occurrence of laryngopharyngeal reflux (LPR) symptoms. The pepsin levels in saliva were measured by using enzyme-linked immunosorbent assay. The Reflux Symptom Index survey was also administered. A total of 50 patients in whom LPR was diagnosed based on results of 24h MII-pH monitoring test were enrolled in the study. The average pepsin level upon waking was 17.2 ng/mL, which was significantly higher than that measured in samples collected at any other time (P saliva collected upon waking were significantly higher in the group of patients presenting with LPR symptoms and who demonstrated at least one episode of proximal esophageal reflux during 24h MII-pH monitoring. Furthermore, the average pepsin level upon waking was higher than that measured at any other time. Measuring pepsin levels in the saliva upon waking may be a useful method in the diagnosis of LPR. 3b Laryngoscope, 126:2770-2773, 2016. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

  12. Reflux venous flow in dural sinus and internal jugular vein on 3D time-of-flight MR angiography

    Energy Technology Data Exchange (ETDEWEB)

    Jang, Jinhee; Kim, Bum-soo; Kim, Bom-yi; Choi, Hyun Seok; Jung, So-Lyung; Ahn, Kook-Jin; Byun, Jae Young [The Catholic University of Korea, Department of Radiology, Seoul St. Mary' s Hospital, School of Medicine, Seoul (Korea, Republic of)

    2013-10-15

    Reflux venous signal on the brain and neck time-of-flight magnetic resonance angiography (TOF MRA) is thought to be related to a compressed left brachiocephalic vein. This study is aimed to assess the prevalence of venous reflux flow in internal jugular vein (IJV), sigmoid sinus/transverse sinus (SS/TS), and inferior petrosal sinus (IPS) on the brain and neck TOF MRA and its pattern. From the radiology database, 3,475 patients (1,526 men, 1,949 women, age range 19-94, median age 62 years) with brain and neck standard 3D TOF MRA at 3 T and 1.5 T were identified. Rotational maximal intensity projection images of 3D TOF MRA were assessed for the presence of reflux flow in IJV, IPS, and SS/TS. Fifty-five patients (1.6 %) had reflux flow, all in the left side. It was more prevalent in females (n = 43/1,949, 2.2 %) than in males (n = 12/1,526, 0.8 %) (p = 0.001). The mean age of patients with reflux flow (66 years old) was older than those (60 years old) without reflux flow (p = 0.001). Three patients had arteriovenous shunt in the left arm for hemodialysis. Of the remaining 52 patients, reflux was seen on IJV in 35 patients (67.3 %). There were more patients with reflux flow seen on SS/TS (n = 34) than on IPS (n = 25). Venous reflux flow on TOF MRA is infrequently observed, and reflux pattern is variable. Because it is exclusively located in the left side, the reflux signal on TOF MRA could be an alarm for an undesirable candidate for a contrast injection on the left side for contrast-enhanced imaging study. (orig.)

  13. Gastroesophageal reflux - correlation between diagnostic methods; Refluxo gastroesofagico - correlacao entre metodos diagnosticos

    Energy Technology Data Exchange (ETDEWEB)

    Cruz, Maria das Gracas de Almeida; Penas, Maria Exposito; Fonseca, Lea Mirian Barbosa [Universidade Federal, Rio de Janeiro, RJ (Brazil). Faculdade de Medicina. Dept. de Radiologia-Medicina Nuclear; Lemme, Eponina Maria O. [Universidade Federal, Rio de Janeiro, RJ (Brazil). Faculdade de Medicina. Dept. de Clinia Medica-Gastroenterologia; Martinho, Maria Jose Ribeiro [Hospital Universitario Clementino Fraga Filho, Rio de Janeiro, RJ (Brazil). Servico de Medicina Nuclear

    1999-02-01

    A group of 97 individuals with typical symptoms of gastroesophageal reflux disease (GERD) was submitted to gastroesophageal reflux scintigraphy (GES) and compared to the results obtained from endoscopy, histopathology and 24 hours pHmetry. Twenty-four healthy individuals were used as a control group and they have done only the GERS. The results obtained showed that: (a) the difference in the reflux index (RI) for the control group and the sick individuals was statistically significant (p < 0.0001); (b) the correlation between GERS and the other methods showed the following results: sensitivity, 84%; specificity, 95%; positive predictive value, 98%; negative predictive value, 67%; accuracy, 87%. We have concluded that the scintigraphic method should be used to confirm the diagnosis of GERD and also recommended as initial investiative procedure. (author)

  14. Effects of omeprazole and cisapride treatment in Japanese asthmatics with reflux esophagitis

    Directory of Open Access Journals (Sweden)

    Katsuya Fujimori

    1997-01-01

    Full Text Available In the United States and Europe, gastroesophageal reflux (GER is receiving attention as a potential cause of bronchial asthma. Few Japanese case reports have described this relationship. Therefore, we investigated the effect of omeprazole and cisapride on pulmonary function tests, blood gases and home peak expiratory flow rates (PEFR in six Japanese outpatients with asthma and proven GER. After 8 weeks of treatment, reflux esophagitis had improved in all patients. However, the parameters of pulmonary function showed no change other than a significant post- treatment increase in home PEFR (4.4-27.7% in three patients. These results suggest that anti-reflux (omeprazole and cisapride treatment will produce small improvements in the PEFR in some Japanese asthmatics with GER.

  15. Floral aroma improvement of Muscat spirits by packed column distillation with variable internal reflux.

    Science.gov (United States)

    Matias-Guiu, Pau; Rodríguez-Bencomo, Juan José; Orriols, Ignacio; Pérez-Correa, José Ricardo; López, Francisco

    2016-12-15

    The organoleptic quality of wine distillates depends on raw materials and the distillation process. Previous work has shown that rectification columns in batch distillation with fixed reflux rate are useful to obtain distillates or distillate fractions with enhanced organoleptic characteristics. This study explores variable reflux rate operating strategies to increase the levels of terpenic compounds in specific distillate fractions to emphasize its floral aroma. Based on chemical and sensory analyses, two distillate heart sub-fractions obtained with the best operating strategy found, were compared with a distillate obtained in a traditional alembic. Results have shown that a drastic reduction of the reflux rate at an early stage of the heart cut produced a distillate heart sub-fraction with a higher concentration of terpenic compounds and lower levels of negative aroma compounds. Therefore, this sub-fraction presented a much more noticeable floral aroma than the distillate obtained with a traditional alembic. Copyright © 2016 Elsevier Ltd. All rights reserved.

  16. Cardiac tamponade: contrast reflux as an indicator of cardiac chamber equalization

    Directory of Open Access Journals (Sweden)

    Nauta Foeke Jacob

    2012-05-01

    Full Text Available Abstract Background Traumatic hemopericardium remains a rare entity; it does however commonly cause cardiac tamponade which remains a major cause of death in traumatic blunt cardiac injury. Objectives We present a case of blunt chest trauma complicated by cardiac tamponade causing cardiac chamber equalization revealed by reflux of contrast. Case report A 29-year-old unidentified male suffered blunt chest trauma in a motor vehicle collision. Computed tomography (CT demonstrated a periaortic hematoma and hemopericardium. Significant contrast reflux was seen in the inferior vena cava and hepatic veins suggesting a change in cardiac chamber pressures. After intensive treatment including cardiac massage this patient expired of cardiac arrest. Conclusion Reflux of contrast on CT imaging can be an indicator of traumatic cardiac tamponade.

  17. Esophageal epithelial surface in patients with gastroesophageal reflux disease: An electron microscopic study

    Institute of Scientific and Technical Information of China (English)

    Takane Azumi; Nobuo Ashizawa; Yoshikazu Kinoshita; Kyoichi Adachi; Kenji Furuta; Shuji Nakata; Shunji Ohara; Kenji Koshino; Masaharu Miki; Terumi Morita; Takashi Tanimura,

    2008-01-01

    AIM: To investigate the intercellular spaces between the most superficially located esophageal epithelial cells in patients with gastroesophageal reflux disease (GERD).METHODS: Eighteen patients with erosive esophagitis,10 patients with non-erosive reflux disease (NERD),and 18 normal asymptomatic volunteers were enrolled.Biopsy specimens were obtained from the lower esophageal mucosa without ulcer or erosion.Scanning electron microscopy was employed to investigate the tightness of the superficial cellular attachment.RESULTS: The intercellular space between the most superficially located epithelial cells in patients with erosive esophagitis or NERD was not different from that in asymptomatic healthy individuals.CONCLUSION: Widened luminal intercellular spaces of esophageal superficial epithelium are not responsible for the induction of reflux symptoms in patients with GERD.

  18. The Significance of Anti Reflux Effect of Esophago -gastric Anastomosis with Mucosal Valve

    Institute of Scientific and Technical Information of China (English)

    邱社祥; 杨殿才; 蔡辉华

    2001-01-01

    Objective To evaluate the preventive effect of reflux following esophago-gastric anastomosis with mucosal valve. Methods Retrospective analysis of 554 cases of esophageal or cardiac cancer treated in recent 10 years. Of them 207 cases of anastomosis 186 cases of tubular stepler and 161 cases of 1 layer anastomosis were fashioned with this method. The clinical results of these groups were compared. Results There were 51 reflux esophagitis cases found in 548 patients(9.3%). In group A 2 patients had this complication(0.48%). None had anastomotic leakage ,but only 1 patient had anastomotic stricture. The difference of the complications among the 3 groups were significant (P<0.01). Conclusions The results of the first group were better than those of the other two groups. It had less complications, and marked anti reflux effect. The life quality was also better. The technique is simple and easy to perform.

  19. FEATURES OF CLINICAL COURSE OF GASTROESOPHAGEAL REFLUX DISEASE IN NEWLY RECRUITED WITH CONNECTIVE TISSUE UNDIFFERENTIATED DYSPLASIA SYNDROME

    Directory of Open Access Journals (Sweden)

    E.I. Kashkina

    2008-12-01

    Full Text Available The presence of connective tissue undifferentiated dysplasia syndrome against a background of psychological stress at newly recruited can promote the risk of gastroesophageal reflux disease occurrence. To the utmost, correlation between the gastroesophageal reflux disease and such manifestations of connective tissue undifferentiated dysplasia syndrome as asthenic constitution, chest deformation, Gothic palate and hypermobility of joints was found

  20. Improvement in reflux gastroesophagitis in a patient with spinal muscular atrophy after surgical correction of kyphoscoliosis: a case report.

    Science.gov (United States)

    Yang, Jae Hyuk; Kasat, Niraj Sharad; Suh, Seung Woo; Kim, Seung Young

    2011-12-01

    Scoliosis, a three-dimensional deformity, has secondary effects on the gastrointestinal system. Reflux gastroesophagitis with hiatus hernia in patients with scoliosis is difficult to manage. We present a patient in whom primary correction of a spinal deformity was associated with resolution of symptoms of reflux. A 15-year-old girl with severe thoracolumbar kyphoscoliosis visited our scoliosis research institute complaining of back pain, positional imbalance, intermittent respiratory tract infections, and gastrointestinal discomfort such as pain, dysphagia, and heartburn for several years. On preoperative CT, her abdominal organs were in a deviant position, and esophagogastroduodenoscopy revealed severe reflux gastroesophagitis, Los Angeles classification (LA) Grade D, and a sliding hiatus hernia. After kyphoscoliosis correction, the patient's truncal balance and pain improved. Postoperatively, the patient reported abdominal pain and dysphagia that gradually subsided after 3 weeks. At 1 year, the patient had no abdominal complaints secondary to reflux gastroesophagitis, and episodes of recurrent respiratory tract infections were substantially reduced. Postoperative evaluation showed the reflux gastroesophagitis had improved to LA Grade A. Postoperative CT showed the abdominal cavity had expanded and the abdominal organs were more centered. The association between scoliosis and reflux gastroesophagitis is well documented. However, the secondary effects of scoliosis correction on gastrointestinal symptoms caused by reflux gastroesophagitis have not been investigated in detail. This patient illustrates the relationship between spinal deformity and gastrointestinal symptoms. Postural balance correction resulted in the alleviation of reflux gastroesophagitis symptoms secondary to hiatus hernia.

  1. Are clinical, laboratory, and imaging markers suitable predictors of vesicoureteral reflux in children with their first febrile urinary tract infection?

    Science.gov (United States)

    Mahyar, Abolfazl; Ayazi, Parviz; Mavadati, Shiva; Oveisi, Sonia; Habibi, Morteza; Esmaeily, Shiva

    2014-08-01

    This study was conducted to determine the predictive value of clinical, laboratory, and imaging variables for the diagnosis of vesicoureteral reflux in children with their first febrile urinary tract infection. One hundred fifty-three children with their first febrile urinary tract infection were divided into two groups according to the results of voiding cystourethrography: 60 children with vesicoureteral reflux and 93 children without. The sensitivity, specificity, positive and negative predictive value, likelihood ratio (positive and negative), and accuracy of the clinical, laboratory, and imaging variables for the diagnosis of vesicoureteral reflux were determined. Of the 153 children with febrile urinary tract infection, 60 patients (39.2%) had vesicoureteral reflux. There were significant differences between the two groups regarding fever>38℃, suprapubic pain, C-reactive protein quantitative level, number of red blood cells in the urine, and results of renal ultrasound and dimercaptosuccinic acid renal scanning (p38.2℃ and dimercaptosuccinic acid renal scanning and vesicoureteral reflux. Also, there were significant positive correlations between the erythrocyte sedimentation rate, positive urinary nitrite test, hyaline cast, and renal ultrasound and high-grade vesicoureteral reflux. This study revealed fever>38.2℃ and dimercaptosuccinic acid renal scanning as the best predictive markers for vesicoureteral reflux in children with their first febrile urinary tract infection. In addition, erythrocyte sedimentation rate, positive urinary nitrite test, hyaline cast, and renal ultrasound are the best predictive markers for high-grade vesicoureteral reflux.

  2. Does the Presence of a Hiatal Hernia Affect the Efficacy of the Reflux Inhibitor Baclofen During Add-On Therapy?

    NARCIS (Netherlands)

    H. Beaumont; G.E.E. Boeckxstaens

    2009-01-01

    OBJECTIVES: Reflux inhibitors, like the gamma-aminobutyric acid type B (GABA(B)) receptor agonist, baclofen, block transient lower esophageal sphincter relaxations (TLESRs) and are proposed as an add-on therapy in patients with proton pump inhibitor (PPI)-resistant gastroesophageal reflux. However,

  3. Prospective randomized controlled trial of an injectable esophageal prosthesis versus a sham procedure for endoscopic treatment of gastroesophageal reflux disease

    NARCIS (Netherlands)

    P. Fockens; L. Cohen; S.A. Edmundowicz; K. Binmoeller; R.I. Rothstein; D. Smith; E. Lin; N. Nickl; B. Overholt; P.J. Kahrilas; N. Vakil; A.M. Abdel Aziz Hassan; G.A. Lehman

    2010-01-01

    This study aimed to assess whether endoscopic implantation of an injectable esophageal prosthesis, the Gatekeeper Reflux Repair System (GK), is a safe and effective therapy for controlling gastroesophageal reflux disease (GERD). A prospective, randomized, sham-controlled, single-blinded, internation

  4. Proton pump inhibitors for reflux therapy in infants: effectiveness determined by impedance pH monitoring.

    Science.gov (United States)

    Castellani, Christoph; Huber-Zeyringer, Andrea; Bachmaier, Gerhard; Saxena, Amulya K; Höllwarth, Michael E

    2014-04-01

    To evaluate the influence of proton pump inhibitors (PPI) in predominantly milk-fed infants with symptoms of GERD by 24-h pH-multichannel intraluminal impedance (24-h pH-MII). Ten infants (8 males and 2 females) with a mean gestational age of 39 weeks (28-40) were included. 24-h pH-MII was performed before prescription and during intake of PPI. Total acid exposure time, bolus exposure time (acidic/non-acidic/total) and the number of refluxes (acidic/non-acidic/total) were determined. Clinical symptoms were recorded and used to calculate the Reflux Symptom Index (RSI) and the Symptom Severity Index (SSI). There was a significant decrease in the number of acidic refluxes, total acid exposure and acidic bolus exposure time. However, this went along with a significant increase in non-acidic bolus exposure time. The total number of refluxes and the total bolus exposure time remained unchanged. Under PPI, a decrease of SSI and RSI for pain-related symptoms could be observed. For respiratory symptoms and vomiting however no significant changes could be demonstrated. Under PPI, an improvement of pain-related symptoms could be shown. The decrease of acid exposure went along with an increase of non-acidic refluxes resulting in almost constant total reflux numbers. This finding is interpreted as main reason for some persisting symptoms despite adequate PPI dosage. Concluding from our data PPI therapy should only be indicated in case of pain, but has no effect in case of vomiting or recurrent respiratory symptoms.

  5. Biliary reflux detection in anomalous union of the pancreatico-biliary duct patients

    Institute of Scientific and Technical Information of China (English)

    Suk Keu Yeom; Seung Wha Lee; Sang Hoon Cha; Hwan Hoon Chung; Bo Kyung Je; Baek Hyun Kim; Jong Jin Hyun

    2012-01-01

    AIM:To demonstrate the imaging findings of biliopancreatic and pancreatico-biliary reflux in patients with anomalous union of the pancreatico-biliary duct (AUPBD)on gadoxetic acid-enhanced functional magnetic resonance cholangiography (fMRC).METHODS:This study included six consecutive patients (two men and four women; mean age 47.5 years) with AUPBD.All subjects underwent endoscopic retrograde cholangiopancreatography (ERCP); one subject also underwent bile sampling of the common bile duct (CBD) to measure the amylase level because his gadoxetic acidenhanced fMRC images showed evidence of pancreatico-biliary reflux of pancreatic secretions.Of the five patients with choledochal cysts,four underwent pyloruspreserving pancreaticoduodenectomy.RESULTS:The five cases of choledochal cysts were classified as Todani classification I.In three of the six patients with AUPBD,injected contrast media reached the distal CBD and pancreatic duct on delay images,suggesting biliopancreatic reflux.In two of these six patients,a band-like filling defect was noted in the CBD on pre-fatty meal images,which decreased in size on delayed post-fatty meal images,suggesting pancreatico-biliary reflux of pancreatic secretions,and the bile sampled from the CBD in one patient had an amylase level of 113 000 IU/L.In one of the six patients with AUPBD,contrast media did not reach the distal CBD due to multiple CBD stones.CONCLUSION:Gadoxetic acid-enhanced fMRC successfully demonstrated biliopancreatic reflux of bile and pancreatico-biliary reflux of pancreatic secretions in patients with AUPBD with and without choledochal cysts.

  6. Treating gastro-oesophageal reflux disease during pregnancy and lactation: what are the safest therapy options?

    Science.gov (United States)

    Broussard, C N; Richter, J E

    1998-10-01

    Gastro-oesophageal reflux and heartburn are reported by 45 to 85% of women during pregnancy. Typically, the heartburn of pregnancy is new onset and is precipitated by the hormonal effects of estrogen and progesterone on lower oesophageal sphincter function. In mild cases, the patient should be reassured that reflux is commonly encountered during a normal pregnancy: lifestyle and dietary modifications may be all that are required. In a pregnant woman with moderate to severe reflux symptoms, the physician must discuss with the patient the benefits versus the risks of using drug therapy. Medications used for treating gastro-oesophageal reflux are not routinely or vigorously tested in randomised, controlled trials in women who are pregnant because of ethical and medico-legal concerns. Safety data are based on animal studies, human case reports and cohort studies as offered by physicians, pharmaceutical companies and regulatory authorities. If drug therapy is required, first-line therapy should consist of nonsystemically absorbed medications, including antacids or sucralfate, which offer little, if any, risk to the fetus. Systemic therapy with histamine H2 receptor antagonists (avoiding nizatidine) or prokinetic drugs (metoclopramide, cisapride) should be reserved for patients with more severe symptoms. Proton pump inhibitors are not recommended during pregnancy except for severe intractable cases of gastrooesophageal reflux or possibly prior to anaesthesia during labour and delivery. In these rare situations, animal teratogenicity studies suggests that lansoprazole may be the best choice. Use of the least possible amount of systemic drug needed to ameliorate the patient's symptoms is clearly the best for therapy. If reflux symptoms are intractable or atypical, endoscopy can safely be performed with conscious sedation and careful monitoring the mother and fetus.

  7. Inhibitory Effect of Nasal Intermittent Positive Pressure Ventilation on Gastroesophageal Reflux.

    Directory of Open Access Journals (Sweden)

    Danny Cantin

    Full Text Available Non-invasive intermittent positive pressure ventilation can lead to esophageal insufflations and in turn to gastric distension. The fact that the latter induces transient relaxation of the lower esophageal sphincter implies that it may increase gastroesophageal refluxes. We previously reported that nasal Pressure Support Ventilation (nPSV, contrary to nasal Neurally-Adjusted Ventilatory Assist (nNAVA, triggers active inspiratory laryngeal closure. This suggests that esophageal insufflations are more frequent in nPSV than in nNAVA. The objectives of the present study were to test the hypotheses that: i gastroesophageal refluxes are increased during nPSV compared to both control condition and nNAVA; ii esophageal insufflations occur more frequently during nPSV than nNAVA. Polysomnographic recordings and esophageal multichannel intraluminal impedance pHmetry were performed in nine chronically instrumented newborn lambs to study gastroesophageal refluxes, esophageal insufflations, states of alertness, laryngeal closure and respiration. Recordings were repeated without sedation in control condition, nPSV (15/4 cmH2O and nNAVA (~ 15/4 cmH2O. The number of gastroesophageal refluxes recorded over six hours, expressed as median (interquartile range, decreased during both nPSV (1 (0, 3 and nNAVA [1 (0, 3] compared to control condition (5 (3, 10, (p < 0.05. Meanwhile, the esophageal insufflation index did not differ between nPSV (40 (11, 61 h-1 and nNAVA (10 (9, 56 h-1 (p = 0.8. In conclusion, nPSV and nNAVA similarly inhibit gastroesophageal refluxes in healthy newborn lambs at pressures that do not lead to gastric distension. In addition, the occurrence of esophageal insufflations is not significantly different between nPSV and nNAVA. The strong inhibitory effect of nIPPV on gastroesophageal refluxes appears identical to that reported with nasal continuous positive airway pressure.

  8. Technical problems produced by the Bravo pH test in nonerosive reflux disease patients

    Institute of Scientific and Technical Information of China (English)

    Andrés; de; Hoyos; Edgar; Alain; Esparza

    2010-01-01

    AIM: To evaluate the technical failures of the Bravo pH test in a population with nonerosive gastroesophageal reflux disease. METHODS: Over the course of a year, we prospectively studied a population of 66 nonerosive reflux disease patients who received a Bravo pH test. The number and frequency of all technical failures were documented, quantified and analyzed. RESULTS: A total of 66 patients, with a mean age of 41.7 years, were studied. Technical failures occurred in 15.15% of the sample. The most frequent...

  9. Current Diagnosis and Management of Suspected Reflux Symptoms Refractory to Proton Pump Inhibitor Therapy.

    Science.gov (United States)

    Richter, Joel E

    2014-09-01

    Suspected reflux symptoms that are refractory to proton pump inhibitors (PPIs) are rapidly becoming the most common presentation of gastroesophageal reflux disease (GERD) in patients seen in gastroenterology clinics. These patients are a heterogeneous group, differing in symptom frequency and severity, PPI dosing regimens, and responses to therapy (from partial to absent). Before testing, the physician needs to question the patient carefully about PPI compliance and the timing of drug intake in relation to meals. Switching PPIs or doubling the dose is the next step, but only 20% to 25% of the group refractory to PPIs will respond. The first diagnostic test should be upper gastrointestinal endoscopy. In more than 90% of cases, the results will be normal, but persistent esophagitis may suggest pill esophagitis, eosinophilic esophagitis, or rarer diseases, such as lichen planus, Zollinger-Ellison syndrome, or genotype variants of PPI metabolism. If the endoscopy results are normal, esophageal manometry and especially reflux testing should follow. Whether patients should be tested on or off PPI therapy is controversial. Most physicians prefer to test patients off PPIs to identify whether abnormal acid reflux is even present; if it is not, PPIs can be stopped and other diagnoses sought. Testing patients on PPI therapy allows nonacid reflux to be identified, but more than 50% of patients have a normal test result, leaving the clinician with a conundrum-whether to stop PPIs or continue them because the GERD is being treated adequately. Alternative diagnoses in patients with refractory GERD and normal reflux testing include achalasia, eosinophilic esophagitis, gastroparesis, rumination, and aerophagia. However, more than 50% will be given the diagnosis of functional heartburn, a visceral hypersensitivity syndrome. Treating patients with PPI-refractory GERD-like symptoms can be difficult and frustrating. Any of the following may help: a histamine-2 receptor antagonist at

  10. Prevalence of chronic rhinosinusitis in a population of patients with gastroesophageal reflux disease

    DEFF Research Database (Denmark)

    Bohnhorst, Idar; Jawad, Samir; Lange, Bibi;

    2015-01-01

    BACKGROUND: An increased coexistence of gastroesophageal reflux disease (GERD) and chronic rhinosinusitis (CRS) has been reported in epidemiologic and register studies, and reflux has been shown more frequently in patients with CRS in studies using esophagus pH manometry compared to participants....... The results were compared with those of a randomly assigned control group from the general Danish population. METHOD: In this case-control study, 82 patients with GERD were examined for CRS using the European Position Paper on Rhinosinusitis and Nasal Polyps criteria, which combine patient history...

  11. Functional dyspepsia and nonerosive reflux disease: clinical interactions and their implications.

    Science.gov (United States)

    Keohane, John; Quigley, Eamonn M M

    2007-08-08

    Functional dyspepsia or nonulcer dyspepsia, and nonerosive reflux disease (NERD) or endoscopy-negative reflux disease, are common reasons for referral to a gastroenterologist. Although there is much confusion with regard to definition, recent research would suggest that these 2 conditions are linked and may represent components in the spectrum of the same disease entity, in terms of both symptoms and pathophysiology. Several theories have been proposed regarding the etiology of these disorders, including acid exposure, visceral hypersensitivity, impaired fundal accommodation, delayed gastric emptying, and Helicobacter pylori infection.

  12. Screening for vesicoureteral reflux in children using real-time sonography.

    Science.gov (United States)

    Schneider, K; Jablonski, C; Wiessner, M; Kohn, M; Fendel, H

    1984-01-01

    One hundred and ten children, ages 6 days to 14 years, were investigated for vesicoureteral reflux (VUR) using ultrasound before voiding cystourethrography (VCU). Sonographically a VUR was assumed if a retrovesical dilated ureter and/or an increase of the separation of the central renal echo complex (CRC) could be detected. By means of sonography VUR grades III and IV were seen in 100%, grade II in 84% of all cases. There was a false positive rate of 10%. Sonographic reflux study is a sensitive and specific screening and follow-up procedure for VUR.

  13. Total Reflux Operation of Multivessel Batch Distillation for Separation of Binary Mixtures

    Institute of Scientific and Technical Information of China (English)

    唐克; 白鹏; 李广忠

    2014-01-01

    Multivessel batch distillation (MVBD) is mainly used to separate mixtures with more than two compo-nents. In this article, a new operation mode with MVBD is proposed for separation of binary mixtures under total reflux. A mathematic model is setup for the simulation. The proposed operation policy and the regular operation with constant reflux are compared theoretically and experimentally. The results show that the new operation mode has great advantages in time saving and operation flexibility. MVBD presents great potential for separation with high efficiency.

  14. Controversies in the treatment of gastroesophageal reflux and achalasia

    Institute of Scientific and Technical Information of China (English)

    Kurt E Roberts; Andrew J Duffy; Robert L Bell

    2006-01-01

    The immense success of laparoscopic surgery as an effective treatment of gastroesophageal reflux disease (GERD) and achalasia has established minimal invasive surgery as the gold standard for these two conditions with lower morbidity and mortality, shorter hospital stay,faster convalescence, and less postoperative pain. One controversy in the treatment of GERD evolves around laparoscopic antireflux surgery (LAR S) as the preferred treatment for Barrett's esophagus and the procedure's potential to reduce the risk of adenocarcinoma of the esophagus.GERD has also been associated with respiratory symptoms, asthma and laryngeal injury, and a second controversy prompts discussions about whether total or partial fundoplication is the more appropriate treatment for GERD. A new and promising alternative in the treatment of GERD is endoluminal therapy. Three types of this new treatment option will be discussed: radiofrequency energy delivered to the lower esophageal sphincter, the creation of a mechanical barrier at the gastroesophageal junction, and the direct endoscopic tightening of the lower esophageal sphincter.Laparoscopic surgery is discussed not only as a very effective treatment for GERD but also as permanent cure for achalasia. This review analyzes the three most important treatment options for achalasia: medications,pneumatic dilatation, and surgical therapy. Medications as the only true non-invasive option in the treatment of achalasia are not as effective as LARS because of their short half-life and variable absorption due to the poor esophageal emptying. The second treatment option,pneumatic dilatation, involves the stretching of the lower esophagus and is still considered the most effective non-surgical treatment for achalasia. Finally, surgical therapy for achalasia and the two major controversies concerning this laparoscopic treatment are discussed. The first involves the extent to which the myotomy is extended onto the stomach, and the second concerns the

  15. Anterior urethral valve, a rare cause of bilateral vesicoureteral reflux in a two year old boy: A case report and a review of the literature

    Directory of Open Access Journals (Sweden)

    Amit Sharma

    2016-04-01

    Full Text Available Anterior urethral valve (AUV is a rare cause of obstructive uropathy in children. These are much rarer than posterior urethral valves. We report a case of a child with AUV and high grade bilateral vesicoureteric reflux. He was managed by transurethral laser ablation. The left sided reflux resolved after ablation. The right sided reflux persisted. The child is awaiting ureteric reimplantation.

  16. Numerical analysis of seawater circulation in carbonate platforms: II. The dynamic interaction between geothermal and brine reflux circulation

    Science.gov (United States)

    Jones, G.D.; Whitaker, F.F.; Smart, P.L.; Sanford, W.E.

    2004-01-01

    Density-driven seawater circulation may occur in carbonate platforms due to geothermal heating and / or reflux of water of elevated salinity. In geothermal circulation lateral contrasts in temperature between seawater and platform groundwaters warmed by the geothermal heat flux result in upward convective flow, with colder seawater drawn into the platform at depth. With reflux circulation, platform-top waters concentrated by evaporation flow downward, displacing less dense underlying groundwaters. We have used a variable density groundwater flow model to examine the pattern, magnitude and interaction of these two different circulation mechanisms, for mesosaline platform-top waters (50???) and brines concentrated up to saturation with respect to gypsum (150???) and halite (246???). Geothermal circulation, most active around the platform margin, becomes restricted and eventually shut-off by reflux of brines from the platform interior towards the margin. The persistence of geothermal circulation is dependent on the rate of brine reflux, which is proportional to the concentration of platform-top brines and also critically dependent on the magnitude and distribution of permeability. Low permeability evaporites can severely restrict reflux whereas high permeability units in hydraulic continuity enhance brine transport. Reduction in permeability with depth and anisotropy of permeability (kv < < kh) focuses flow laterally in the shallow subsurface (<1 km), resulting in a horizontally elongated brine plume. Aquifer porosity and dispersivity are relatively minor controls on reflux. Platform brines can entrain surficial seawater when brine generating conditions cease but the platform-top remains submerged, a variant of reflux we term "latent reflux". Brines concentrated up to gypsum saturation have relatively long residence times of at least 100 times the duration of the reflux event. They thus represent a long-term control on post-reflux groundwater circulation, and

  17. Assessment of vesical-ureteral reflux in transplant patients using radionuclide cystography; Exploration scintigraphique des reflux vesico-renaux chez les patients transplantes renaux

    Energy Technology Data Exchange (ETDEWEB)

    Wampach, H.; Gibold, C.; Loboguerrero, A.; Bouchard, A.; Lepailleur, A.; Liehn, J.C. [Centre Regional de Lutte Contre le Cancer, 51 - Reims (France); Canivet, E.; Toupance, O.; Chanard, J.; Brandt, B.; Lardennois, B. [Centre Hospitalier Universitaire, 51 - Reims (France)

    1995-12-31

    Direct radionuclide cystography is known to be sensitive and safe in children with suspected vesical-ureteral reflux. In this study we have investigated the utility of direct radionuclide cystography in renal transplant recipients with a recent history of pyelonephritis or recurrent urinary infections. Direct radionuclide cystography is a simple test, however it requires a rigorous methodology in order to obtain images during fill-in as well as during voiding in both men and women. The images must be interpreted using a rigorous image display methodology. Twenty-eight radionuclide cystographies were performed in 17 patients. Among the 17 tests performed for the initial diagnosis of reflux , 12 were positive. Four patients with positive results and four patients with negative results were also investigated by radiologic cystography. Similar results were obtained in those patients. Nine scintigraphies were done after treatment by surgery or teflon injection ; six of them were negative. Direct radionuclide cystography is a simple, safe and sensitive test which demonstrates a vesical-ureteral reflux. Such a defect has been documented in some 70% of real transplant recipients with a recent history of urinary tract infection. (authors). 14 refs., 1 fig., 1 tab.

  18. Relationships between air swallowing, intragastric air, belching and gastro-oesophageal reflux

    NARCIS (Netherlands)

    Bredenoord, AJ; Weusten, BLAM; Timmer, R; Akkermans, LMA; Smout, AJPM

    Background: With each swallow a certain amount of air is transported to the stomach. The stomach protects itself against excessive distention by swallowed air through belching (gas reflux). The mechanism of belching (transient lower oesophageal sphincter relaxation) is also one of the mechanisms

  19. Reasons of PEG failure to eliminate gastroesophageal reflux in mechanically ventilated patients

    Institute of Scientific and Technical Information of China (English)

    Emmanuel E Douzinas; Ilias Andrianakis; Olga Livaditi; Dimitrios Bakos; Katerina Flevari; Nikos Goutas; Dimitrios Vlachodimitropoulos; Marios-Konstantinos Tasoulis; Alex P Betrosian

    2009-01-01

    AIM: To investigate factors predicting failure of percutaneous endoscopic gastrostomy (PEG) to eliminate gastroesophageal reflux (GER).METHODS: Twenty-nine consecutive mechanically ventilated patients were investigated.Patients were evaluated for GER by pH-metry pre-PEG and on the 7th post-PEG day.Endoscopic and histologic evidence of reflux esophagitis was also carried out.A beneficial response to PEG was considered when pH-metry on the 7th post-PEG day showed that GER was below 4%.RESULTS: Seventeen patients responded (RESP group) and 12 did not respond (N-RESP) to PEG.The mean age, sex, weight and APACHE Ⅱ score were similar in both groups.GER (%) values were similar in both groups at baseline, but were significantly reduced in the RESP group compared with the N-RESP group on the 7th post-PEG day [2.5 (0.6-3.8) vs 8.1 (7.4-9.2, P < 0.001)].Reflux esophagitis and the gastroesophageal flap valve (GEFV) grading differed significantly between the two groups ( P = 0.031 and P = 0.020, respectively).Histology revealed no significant differences between the two groups.CONCLUSION: Endoscopic grading of GEFV and the presence of severe reflux esophagitis are predisposing factors for failure of PEG to reduce GER in mechanically ventilated patients.

  20. CHRONOBIOLOGICAL APPROACH TO ESTIMATION OF CLINICAL COURSE AND TREATMENT OF GASTROESOPHAGEAL REFLUX DISEASE

    Directory of Open Access Journals (Sweden)

    R.V. Lyakisheva

    2008-09-01

    Full Text Available The article presents analysis of ratio of biorhythm in patients with gastroesophageal reflux disease and time of clinical symptoms appearance. Itwas determined thatcircadian rhythm, estimated according to Kerdo index, is correlated with appearance of disease symptoms in 24 hours. Taking into consideration its characteristics while managing drug therapy allows to raise therapy’s efficacy.

  1. Combination therapy versus monotherapy for gastroesophageal reflux in children with difficult-to-treat bronchial asthma

    Directory of Open Access Journals (Sweden)

    Adel Salah Bediwy

    2014-01-01

    Conclusions: Combination of domperidone and esomeprazole was more effective in improving the endoscopic reflux score, childhood-asthma control test (C-ACT and FEV1 (% of predicted and significantly reduced the sputum SP than the use of esomeprazole only in children with difficult-to-treat asthma.

  2. Endoscopic pH Monitoring for Patients with Suspected or Refractory Gastroesophageal Reflux Disease

    Directory of Open Access Journals (Sweden)

    Brian G Turner

    2007-01-01

    Full Text Available BACKGROUND: Wireless pH studies can offer prolonged pH monitoring, which may potentially facilitate the diagnosis and management of patients with gastroesophageal reflux disease (GERD. The aim of the present study was to evaluate the detection rate of abnormal esophageal acid exposure using prolonged pH monitoring in patients with suspected or refractory GERD symptoms.

  3. The Association Between Gastroesophageal Reflux Disease and Recurrent Respiratory Papillomatosis : A Systematic Review

    NARCIS (Netherlands)

    San Giorgi, Michel R. M.; Helder, Herman M.; Lindeman, Robbert-Jan S.; de Bock, Geertruida H.; Dikkers, Frederik G.

    2016-01-01

    Objectives/Hypothesis: Antireflux therapy is incorporated in many treatment protocols for recurrent respiratory papillomatosis (RRP) because gastroesophageal reflux (GERD) is thought to worsen the disease course of RRP. It is unclear if GERD really aggravates the disease course. The aims of this sys

  4. The association between gastroesophageal reflux disease and recurrent respiratory papillomatosis : A systematic review

    NARCIS (Netherlands)

    San Giorgi, Michel R M; Helder, Herman M; Lindeman, Robbert-Jan S; de Bock, Geertruida H; Dikkers, Frederik G

    2016-01-01

    OBJECTIVES/HYPOTHESIS: Antireflux therapy is incorporated in many treatment protocols for recurrent respiratory papillomatosis (RRP) because gastroesophageal reflux (GERD) is thought to worsen the disease course of RRP. It is unclear if GERD really aggravates the disease course. The aims of this sys

  5. Corpus gastritis in patients with endoscopic diagnosis of reflux oesophagitis and Barrett's oesophagus.

    NARCIS (Netherlands)

    Laheij, R.J.F.; Rossum, L.G.M. van; Boer, W.A. de; Jansen, J.B.M.J.

    2002-01-01

    BACKGROUND: A high level of gastric acid secretion is considered to be a risk factor for reflux oesophagitis or Barrett's oesophagus. Corpus gastritis may have a protective effect on the oesophagus, because of decreased gastric acid output. AIM: To determine if corpus gastritis is associated with re

  6. Corpus gastritis in patients with endoscopic diagnosis of reflux oesophagitis and Barrett's oesophagus.

    NARCIS (Netherlands)

    Laheij, R.J.F.; Rossum, L.G.M. van; Boer, W.A. de; Jansen, J.B.M.J.

    2002-01-01

    BACKGROUND: A high level of gastric acid secretion is considered to be a risk factor for reflux oesophagitis or Barrett's oesophagus. Corpus gastritis may have a protective effect on the oesophagus, because of decreased gastric acid output. AIM: To determine if corpus gastritis is associated with

  7. Induced viscosity fibre system for the treatment or prevention of gastro-oesophageal reflux (gor)

    NARCIS (Netherlands)

    Belle, F.N.; Harthoorn, L.F.; Venema, P.; Choi, W.M.C.

    2014-01-01

    The invention pertains to the use of pectin and alginate in the manufacture of a liquid nutritional composition in the treatment or prevention of gastro-oesophageal reflux in a patient, said composition comprising pectin and alginate, said composition exhibiting a maximum gel strength at a pH in the

  8. Reflux heat-pipe solar receivers for dish-electric systems

    Science.gov (United States)

    Andraka, Charles E.; Diver, Richard B.

    1988-04-01

    The feasibility of competitive, modular bulk electric power from the sun may be greatly enhanced by the use of a reflux heat pipe receiver to combine a heat engine with a paraboloidal dish concentrator. This combination represents a potential improvement over previous successful demonstrations of dish-electric technology in terms of enhanced performance, lower cost, longer life, and greater flexibility in engine design. In the reflux (i.e., gravity assisted) heat pipe receiver, concentrated solar radiation causes liquid metal (sodium, potassium, or NaK) to evaporate. The vapor flows to the engine interface heat exchanger, where it condenses and releases the latent heat. The condensate is returned to the receiver absorber by gravity (refluxing), and distributed over the surface by gravity and/or capillary forces in a wick lining the receiver. It is essentially an adaptation of heat pipe technology to the peculiar requirements of concentrated solar flux, and provides many advantages over conventional heated tub receiver technology. This overview paper describes the current status and future plans for the U.S. Solar Thermal Program reflux receiver development program at Sandia National Laboratories. Current work includes conventional mesh wick receivers, sintered metal wicks, and pool boiler receivers. The relative design merits and concerns of the different approaches and technology development test plans are discussed.

  9. Diagnosis of Gastroesophageal Reflux Disease Using Real-time Magnetic Resonance Imaging.

    Science.gov (United States)

    Zhang, Shuo; Joseph, Arun A; Gross, Lisa; Ghadimi, Michael; Frahm, Jens; Beham, Alexander W

    2015-07-15

    A small angle (His angle) between the oesophagus and the fundus of the stomach is considered to act as flap valve and anti-reflux barrier. A wide angle results in dysfunction of the oesophagogastric junction and subsequently in gastroesophageal reflux disease (GERD). Here, we used real-time magnetic resonance imaging (MRI) at 50 ms resolution (20 frames per second) in 12 volunteers and 12 patients with GERD to assess transport of pineapple juice through the oesophagogastric junction and reflux during Valsalva. We found that the intra-abdominal part of the oesophagus was bended towards the left side resulting in an angle of 75.3 ± 17.4, which was significantly larger during Valsava (P = 0.017). Reflux and several underlying pathologies were detected in 11 out of 12 patients. Our data visualize oesophagogastric junction physiology and disprove the flap valve hypothesis. Further, non-invasive real-time MRI has considerable potential for the diagnosis of causative pathologies leading to GERD.

  10. Kosten en effecten van esomeprazol in de behandeling van reflux ziekte

    NARCIS (Netherlands)

    I. Buijt; M.J. Al (Maiwenn); F.F.H. Rutten (Frans)

    2002-01-01

    textabstractDoel. Het bepalen van de kosten-effectiviteit van esomeprazol (Nexium(r)) ten opzichte van alle andere in Nederland geregistreerde protonpomp remmers in de behandeling van reflux ziekte. Voor de effectiviteit vormt het hebben van voldoende controle over de symptomen het uitgangspunt. Per

  11. Effects of adjustable gastric banding on gastroesophageal reflux and esophageal motility : a systematic review

    NARCIS (Netherlands)

    de Jong, J. R.; Besselink, M. G. H.; van Ramshorst, B.; Gooszen, H. G.; Smout, A. J. P. M.

    2010-01-01

    P>Controversial opinions exist concerning the effect of laparoscopic adjustable gastric banding on gastroesophageal reflux. MEDLINE and EMBASE databases were searched for relevant studies on patients undergoing adjustable gastric banding. Data are expressed in mean (range). Twenty studies were ident

  12. IT IS GASTROESOPHAGEAL REFLUX DISEASE,NOT ASTHMA: A CASE REPORT

    Institute of Scientific and Technical Information of China (English)

    Zhong-gao Wang

    2006-01-01

    @@ THE incidence of gastroesophageal reflux disease (GERD) is high in Western nations. Its extraesophageal manifestations such as asthma, paroxysmal laryngospasm, and excessive throat phlegm, chronic cough, laryngal disorders, postnasal drip, and other lesser ear, nose, and throat symptoms, have been widely recognized and reported.

  13. Validation and Diagnostic Usefulness of Gastroesophageal Reflux Disease Questionnaire in a Primary Care Level in Mexico

    Science.gov (United States)

    Zavala-Gonzáles, Miguel Angel; Azamar-Jacome, Amyra Ali; Meixueiro-Daza, Arturo; de la Medina, Antonio Ramos; Reyes-Huerta J, Job; Roesch-Dietlen, Federico; Remes-Troche, José María

    2014-01-01

    Background/Aims Different non-invasive diagnostics strategies have been used to assess patients with gastroesophageal reflux. Gastroesophageal reflux disease (GERD) questionnaire (GerdQ) is a 6-item, easy to use questionnaire that was developed primarily as a diagnostic tool for GERD in primary care. Our aim was to validate and assess diagnostic utility of GerdQ questionnaire in Mexican patients in the primary care setting. Methods The study was performed in 3 phases: (1) a questionnaire translation and comprehension study (n = 20), (2) are a reproducibility and validation study (50 patients and 50 controls) and (3) a study to assess the clinical utility in 252 subjects with GERD symptoms. Diagnostic accuracy was calculated using endoscopy and/or pH-metry as the gold standard. Results Internal consistency measured by the Cronbach’s α coefficient was 0.81 for patients and 0.90 for healthy controls, with a mixed coefficient of 0.93. Reproducibility for GerdQ was very good and its discriminating validity was 88%. Most of the patients with erosive reflux and non-erosive reflux with abnormal pH-metry had scores > 8, meanwhile most of the patients with functional heartburn and hypersensitive esophagus had < 8. Sensitivity, specificity and positive predictive value of GerdQ com -pared to the gold standard were 72%, 72% and 87%, respectively. Conclusions In Mexico, the GerdQ questionnaire Spanish validated version is useful for GERD diagnosis in the primary care setting. PMID:25273118

  14. Surgical Reimplantation for the Correction of Vesicoureteral Reflux following Failed Endoscopic Injection

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    Boris Chertin

    2011-01-01

    Full Text Available Purpose. In recent years, endoscopic injection became the procedure of choice for the correction of vesicoureteral reflux in the majority of the centers. Unfortunately, endoscopic treatment is not always successful and sometimes requires more than one trial to achieve similar results to that of an open reimplantation surgery. Our aim of this study is to evaluate the feasibility and success rate of open ureteral reimplantation following failed endoscopic procedure. Patients and Methods. During 2004–2010, we evaluated 16 patients with persistent vesicoureteral reflux (grades II–IV following failed endoscopic treatment. All patients underwent open ureteral reimplantation. All patients were followed with an ultrasound 6 weeks following surgery and every 6 months thereafter for an average of 22 months. Voiding cystography was performed at 3 months after surgery. Results. During unilateral open ureteral reimplantation, the implanted deposit from previous procedures was either excised, drained, or incorporated into the neotunnel with the ureter. Vesicoureteral reflux was resolved in all patients with 100% success rate. No new hydronephrosis or signs of obstruction developed in any of the patients. qDMSA renal scan was available in 8 patients showing improvement of function in 5 and stable function in 3, and no new scars were identified. Conclusions. Open ureteral reimplantation is an excellent choice for the correction of failed endoscopic treatment in children with vesicoureteral reflux.

  15. The Role of Vegetative Dysfunction and Its Correction in Gastroesophageal Reflux Disease

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    G.V. Osyodlo

    2014-06-01

    Full Text Available The article analyzes the findings regarding the effect of vegetative dysfunction on the course of gastroesophageal reflux disease, the expediency of autonomic imbalance correction by phenibut on the background of antisecretory therapy with pantoprazole is shown, it helps to improve the immediate and long-term results.

  16. Radionuclide scintigraphy in the evaluation of gastroesophageal reflux in symptomatic and asymptomatic pre-term infants

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    Morigeri, C.; Mukhopadhyay, K.; Narang, A. [Postgraduate Institute of Medical Education and Research (PGIMER), Division of Neonatology, Department of Paediatrics, Chandigarh (India); Bhattacharya, A.; Mittal, B.R. [Postgraduate Institute of Medical Education and Research (PGIMER), Department of Nuclear Medicine, Chandigarh (India)

    2008-09-15

    Gastroesophageal reflux (GER) is very common in pre-term infants. The diagnosis based on symptoms is always questionable. The incidence of GER in symptomatic babies varies from 22% to 85%, but literature regarding the incidence of reflux in asymptomatic pre-term infants is lacking. We used radionuclide scintigraphy to evaluate the incidence of GER in symptomatic as well as asymptomatic pre-term neonates and to assess whether symptoms have any relation with positive scintigraphy. We studied 106 pre-term infants (52 symptomatic, 54 asymptomatic) of less than 34 weeks of gestation, who fulfilled the eligibility criteria. Babies were considered symptomatic in the presence of vomiting, regurgitation, apnea, de-saturations, unexplained bradycardia and recurrent lung collapses. Radionuclide scintigraphy was conducted at post-conceptional age of 32-34 weeks when they were clinically stable for 72 h. Feeding was avoided for 2 h preceding the study. {sup 99m}Tc sulphur colloid was administered in a dose of 1.85 MBq (0.05 mCi) in 1 ml, followed by milk (full feed) through an orogastric tube, prior to imaging under a gamma camera. Reflux was graded as low or high, and reflux episodes during the study were counted. The incidence of GER in the symptomatic group was 71.2% and in asymptomatic babies 61.1% (p=0.275). High-grade reflux was more common (71.4%) than low-grade (28.6%) in both groups (p=0.449). Mean number of reflux episodes in 20 min was 4.4{+-}2.4 in symptomatic babies and 4.9 {+-}2.2 in asymptomatic babies (p=0.321). Babies with positive scintigraphy were similar in birth weight, gestation, time to achieve full feeds, weight and age at discharge to those with negative scintigraphy. GER is common in pre-term infants of less than 34 weeks gestation. The incidence of positive scintigraphy and grade of reflux is not significantly different in symptomatic vs. asymptomatic babies. Though radionuclide scintigraphy is a simple, quick and non-invasive investigation in

  17. Radionuclide scintigraphy in the evaluation of gastroesophageal reflux in symptomatic and asymptomatic pre-term infants.

    Science.gov (United States)

    Morigeri, C; Bhattacharya, A; Mukhopadhyay, K; Narang, A; Mittal, B R

    2008-09-01

    Gastroesophageal reflux (GER) is very common in pre-term infants. The diagnosis based on symptoms is always questionable. The incidence of GER in symptomatic babies varies from 22% to 85%, but literature regarding the incidence of reflux in asymptomatic pre-term infants is lacking. We used radionuclide scintigraphy to evaluate the incidence of GER in symptomatic as well as asymptomatic pre-term neonates and to assess whether symptoms have any relation with positive scintigraphy. We studied 106 pre-term infants (52 symptomatic, 54 asymptomatic) of less than 34 weeks of gestation, who fulfilled the eligibility criteria. Babies were considered symptomatic in the presence of vomiting, regurgitation, apnea, de-saturations, unexplained bradycardia and recurrent lung collapses. Radionuclide scintigraphy was conducted at post-conceptional age of 32-34 weeks when they were clinically stable for 72 h. Feeding was avoided for 2 h preceding the study. (99m)Tc sulphur colloid was administered in a dose of 1.85 MBq (0.05 mCi) in 1 ml, followed by milk (full feed) through an orogastric tube, prior to imaging under a gamma camera. Reflux was graded as low or high, and reflux episodes during the study were counted. The incidence of GER in the symptomatic group was 71.2% and in asymptomatic babies 61.1% (p = 0.275). High-grade reflux was more common (71.4%) than low-grade (28.6%) in both groups (p = 0.449). Mean number of reflux episodes in 20 min was 4.4 +/- 2.4 in symptomatic babies and 4.9 +/- 2.2 in asymptomatic babies (p = 0.321). Babies with positive scintigraphy were similar in birth weight, gestation, time to achieve full feeds, weight and age at discharge to those with negative scintigraphy. GER is common in pre-term infants of less than 34 weeks gestation. The incidence of positive scintigraphy and grade of reflux is not significantly different in symptomatic vs. asymptomatic babies. Though radionuclide scintigraphy is a simple, quick and non-invasive investigation in

  18. A causal relationship between cough and gastroesophageal reflux disease (GERD) has been established: a pro/con debate.

    Science.gov (United States)

    Kahrilas, Peter J; Smith, Jaclyn A; Dicpinigaitis, Peter V

    2014-02-01

    Along with upper airway cough syndrome (formerly, postnasal drip syndrome) and eosinophilic airway inflammation (asthma, nonasthmatic eosinophilic bronchitis), gastroesophageal reflux disease (GERD) is generally considered among the most common etiologies of chronic cough. Indeed, cough management guidelines published by numerous respiratory societies worldwide recommend evaluation and treatment of GERD as an integral component of the diagnostic/therapeutic algorithm for the management of chronic cough. However, a significant number of patients with chronic cough presumed due to GERD do not report improvement despite aggressive acid-suppressive therapy. Some of these refractory cases may be due to the recently appreciated entity of nonacid or weakly acidic reflux. Further contributing to the controversy are recent studies that demonstrate that patients with chronic cough do not have excessive reflux events relative to healthy volunteers. Although a temporal relationship between cough and reflux events has been suggested by studies utilizing impedance-pH monitoring of reflux events and objective cough recording, consensus is lacking in terms of whether this temporal relationship proves a causal link between reflux and cough. The fourth American Cough Conference (New York, June 2013) provided an ideal forum for the debate of this issue between two internationally recognized experts in the field of reflux and chronic cough.

  19. Severity of gastroesophageal reflux disease influences daytime somnolence:A clinical study of:t34 patients underwent upper panendoscopy

    Institute of Scientific and Technical Information of China (English)

    Pál Demeter; Katalin Várdi Visy; N(o)ra Gyulai; R(o)bert Sike; Tamás G T(o)th; János Novák; Pál Magyar

    2004-01-01

    AIM: To asses the relationship between severity of gastroesophageal refluxe disease and Epworth sleepiness scale as an indicator of daytime somnolence.METHODS: One hundred and thirty-four patients underwent an upper panendoscopy as indicated by the typical reflux symptoms and were also investigated with regard to somnolence. Sleepiness was evaluated by Epworth Sleepiness Scale, which was compared to the severity of endoscopic findings (Savary-Miller/modified by Siewert). Patients with psychiatric disorders or being on sedato-hypnotics as well as shift workers were excluded from the study. The relationship between the severity of the reflux disease and daytime somnolence was analyzed with the help of multivariate regression analysis.RESULTS: A positive tendency was found between the severity of the reflux disease and the corresponding Epworth Sleepiness Scale. In the case of the more severe type -Savary-Miller Ⅲ - at least a mild hypersomnia was found.For this group daytime somnolence was significantly higher than in the case of the non-erosive type of Gastroesophageal Reflux Disease representing the mildest stage of reflux disease.CONCLUSION: The severity of Gastroesophageal Reflux Disease influences daytime somnolence.

  20. Endoscopic treatment of vesico-ureteral reflux: Experience of 99 ureteric moieties

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    Minu Bajpai

    2013-01-01

    Full Text Available Aims: To study the outcome of endoscopic hyaluronic acid/dextranomer injection in patients with vesico-ureteric reflux (VUR. Materials and Methods: Sixty-three children were evaluated with a median follow up of 18 months (12-55 months before injecting hyaluronic acid/dextranomer in a total of 99 ureteric moieties. Median age at presentation was 24 months (6-72 months. Primary VUR was the main presenting diagnosis in 60%. Patients were monitored for urinary tract infection (UTI, glomerular filtration rate (GFR, renal scarring, persistence, or appearance of contra-lateral reflux. Results: Grade III VUR was the most common (38% followed by Grade IV (24%, Grade V (17%, Grade II (14%, and Grade I (7%. Most common cause for VUR was Primary (60%, followed by posterior urethral valve (PUV (19%, bladder exstrophy (5%, anorectal malformation (ARM, epispadias, and duplex system. Analysis of patients characteristics at presentation revealed renal scarring (40%, split renal functions 1.4 mg/dL (10%. Complete resolution (100% of Grade I and Grade II VUR was achieved after single injection. For Grade III VUR, single injection resolved reflux in 85.5% ureters, 100% resolution was seen after 2 nd injection. In Grade IV VUR, 1 st injection resolved VUR in 83.3% ureters, 95.8% ureters were reflux free after 2 nd injection, and 100% resolution was seen after 3 rd injection. In Grade V VUR, 94% ureters showed absent reflux after three injections. Conclusion: Hyaluronic acid/dextranomer injection holds promise even in higher grades of VUR.

  1. Gastro-oesophageal reflux and gastric aspiration in idiopathic pulmonary fibrosis patients.

    Science.gov (United States)

    Savarino, Edoardo; Carbone, Roberto; Marabotto, Elisa; Furnari, Manuele; Sconfienza, Luca; Ghio, Massimo; Zentilin, Patrizia; Savarino, Vincenzo

    2013-11-01

    The aim of the study was to characterise gastro-oesophageal reflux (GOR) in idiopathic pulmonary fibrosis (IPF). 40 consecutive IPF patients underwent pulmonary high-resolution computed tomography (HRCT) scan and impedance-pH monitoring while off antisecretory therapy. The presence of pulmonary fibrosis was assessed using validated HRCT scores. Reflux features included distal oesophageal acid exposure, number of acid/weakly acidic reflux episodes and their proximal migration. 40 consecutive patients with interstitial lung disease other than IPF (non-IPF patients) and 50 healthy volunteers were also enrolled. IPF patients had significantly higher (p<0.01) oesophageal acid exposure (median (interquartile range (IQR)) 9.25 (4.7-15.4)% versus 3.3 (1.4-7.4)% versus 0.7 (0.2-4.2)%, number of acid (median (IQR) 45 (23-55) versus 32 (19-44) versus 18 (10-31)), weakly acidic (median (IQR) 34 (19-43) versus 21 (11-33) versus 18 (15-28)) and proximal reflux (median (IQR) 51 (26.5-65.5) versus 20 (9.5-34.5) versus 9 (5-20)) events compared to non-IPF patients and healthy volunteers, respectively. Pulmonary fibrosis HRCT scores correlated well with reflux episodes in both the distal (r(2)=0.567) and proximal (r(2)=0.6323) oesophagus. Patients with IPF had more bile acids and pepsin (p<0.03) in bronchoalveolar lavage fluid (BALF) (62% and 67%, respectively) and saliva (61% and 68%, respectively) than non-IPF patients (25% and 25% in BALF, and 33% and 36%, respectively, in saliva) and controls (0% and 0% in BALF and saliva, respectively). Acid GOR is common in IPF, but weakly acidic GOR may also occur. Patients with IPF had a risk of pulmonary aspiration of gastric contents. Outcome studies with intense antireflux therapy are needed.

  2. The potential therapeutic effect of melatonin in gastro-esophageal reflux disease

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    El-Gendy Ahmed A

    2010-01-01

    Full Text Available Abstract Background Gastro-Esophageal Reflux Disease (GERD defined as a condition that develops when the reflux of stomach contents causes troublesome symptoms and/or complications. Many drugs are used for the treatment of GERD such as omeprazole (a proton pump inhibitor which is a widely used antiulcer drug demonstrated to protect against esophageal mucosal injury. Melatonin has been found to protect the gastrointestinal mucosa from oxidative damage caused by reactive oxygen species in different experimental ulcer models. The aim of this study is to evaluate the role of exogenous melatonin in the treatment of reflux disease in humans either alone or in combination with omeprazole therapy. Methods 36 persons were divided into 4 groups (control subjects, patients with reflux disease treated with melatonin alone, omeprazole alone and a combination of melatonin and omeprazole for 4 and 8 weeks Each group consisted of 9 persons. Persons were subjected to thorough history taking, clinical examination, and investigations including laboratory, endoscopic, record of esophageal motility, pH-metry, basal acid output and serum gastrin. Results Melatonin has a role in the improvement of Gastro-esophageal reflux disease when used alone or in combination with omeprazole. Meanwhile, omeprazole alone is better used in the treatment of GERD than melatonin alone. Conclusion The present study showed that oral melatonin is a promising therapeutic agent for the treatment of GERD. It is an effective line of treatment in relieving epigastric pain and heartburn. However, further studies are required to confirm the efficacy and long-term safety of melatonin before being recommended for routine clinical use. Trial Registration QA13NCT00915616

  3. Cornelia de Lange syndrome - characteristics and laparoscopic treatment modalities of reflux based on own material.

    Science.gov (United States)

    Szyca, Robert; Leksowski, Krzysztof

    2011-09-01

    Cornelia de Lange syndrome (typus degenerativus amstelodamensis, CdLS, Brachmann syndrome) is a complex, congenital, multi-gene anomaly characterized by mental retardation. Its features include growth inhibition, hirsutism, structural anomalies of the limbs and abnormal development of osseous structures of the face. Independent of the phenotype of the disease, 85% of patients are assumed to have symptoms of gastroesophageal reflux disease (GERD). Aspiration pneumonia is one of the complications of GERD and a main cause of death in these patients. Patients not responding to medical treatment qualify for surgery. Until recently, anti-reflux procedures for GERD in CdLS patients were performed solely via laparotomy. The contemporary gold standard is a procedure performed laparoscopically. There are a few case reports of patients with CdLS operated on for GERD with laparoscopy available in the literature. The goal of this paper is to present two cases of Cornelia de Lange syndrome treated with laparoscopic antireflux procedures. We have performed two such procedures in 14 and 16 year-old girls with typical symptoms of the syndrome, i.e. developmental and mental retardation, hirsutism, structural limb anomalies and abnormal face development. The main indications for surgery in both cases were ineffective medical treatment and persistent aspiration pneumonia and its complications as a result of the gastroesophageal reflux. Oesophageal hiatus hernia and reflux were confirmed with accessory tests in both cases. During 36 months of follow-up, according to Barents, no episode of oesophageal reflux with acidic gastric content was noted. The treated children slept well during the night and did not need hospitalization for aspiration pneumonia. Neither of them required proton pump inhibitors. It should be concluded that laparoscopic Nissen fundoplication is a safe and effective method of GERD treatment in children with CdLS.

  4. Cornelia de Lange syndrome – characteristics and laparoscopic treatment modalities of reflux based on own material

    Directory of Open Access Journals (Sweden)

    Robert Szyca

    2011-09-01

    Full Text Available Cornelia de Lange syndrome (typus degenerativus amstelodamensis, CdLS, Brachmann syndrome is a complex, congenital,multi-gene anomaly characterized by mental retardation. Its features include growth inhibition, hirsutism,structural anomalies of the limbs and abnormal development of osseous structures of the face. Independent of thephenotype of the disease, 85% of patients are assumed to have symptoms of gastroesophageal reflux disease(GERD. Aspiration pneumonia is one of the complications of GERD and a main cause of death in these patients.Patients not responding to medical treatment qualify for surgery. Until recently, anti-reflux procedures for GERD inCdLS patients were performed solely via laparotomy. The contemporary gold standard is a procedure performedlaparoscopically. There are a few case reports of patients with CdLS operated on for GERD with laparoscopy availablein the literature. The goal of this paper is to present two cases of Cornelia de Lange syndrome treated with laparoscopicantireflux procedures. We have performed two such procedures in 14 and 16 year-old girls with typical symptomsof the syndrome, i.e. developmental and mental retardation, hirsutism, structural limb anomalies and abnormalface development. The main indications for surgery in both cases were ineffective medical treatment and persistentaspiration pneumonia and its complications as a result of the gastroesophageal reflux. Oesophageal hiatus herniaand reflux were confirmed with accessory tests in both cases. During 36 months of follow-up, according to Barents,no episode of oesophageal reflux with acidic gastric content was noted. The treated children slept well during thenight and did not need hospitalization for aspiration pneumonia. Neither of them required proton pump inhibitors. Itshould be concluded that laparoscopic Nissen fundoplication is a safe and effective method of GERD treatment in childrenwith CdLS.

  5. Carcinogenic potential of duodenal reflux juice from patients with long-standing postgastrectomy

    Institute of Scientific and Technical Information of China (English)

    Zhe Fu Ma; Zhong Yu Wang; Jun Ran Zhang; Peng Gong; Hai Long Chen

    2001-01-01

    AIM To determine, whether study on thecarcinogenic potential of reflux juice frompatients with remote gastrectomy could clarifythe inherent relationship between duodenalreflux and gastric stump cancer.METHODS A total of 37 reflux juice samples(13 Billroth T, 24 Billroth Ⅱ ) were employed inthe present study. A two- stage transformationassay using BALB/c 3T3 cells was carried out totest the initiating or promoting activity of thesesamples.RESULTS Two of 18 (11.1%) reflux samplesexerted initiating activities, whereas 9/19(47.4%) samples enhanced the MNNG-initiafingcell transformation, suggesting the duodenalreflux juice might more frequently possess thetumor-promoter activity (P = 0. 029). In addition,there was no difference in initiating activities ofthe samples irrespective of surgical procedures(P=0.488), while Billroth Ⅱ samples exhibitedstronger tumor-promoter activity than Billroth Ⅰsamples (P = 0.027). Furthermore, the promoteractivities were well correlated with thehistological changes of the stomas (rs = 0.625,P = 0.004), but neither their cytotoxicities norinitiating activities had this correlation( Probabilities were 0.523 and 0.085,respectively).CONCLUSION The duodenal reflux juice frompatients with remote postgastrectomy did havecarcinogenic potential, and suggested thattumor-promoting activity should principallyaccount for the high incidence of gastric cancerin gastrectomy patients. In contrast, it isdifficult to explain the high stump-cancerincidence with the "N-nitroso compounds"theory-a popular theory for the intact stomachcarcinogenesis, and it seemed to be justified tofocus chemoprevention of this cancer on thetumor-promoting potential of reflux juice.

  6. Detection of Gastroesophageal Reflux Esophagitis Using 2-fluoro-2-deoxy-d-glucose Positron Emission Tomography

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    Min-Kuei Tsai

    2012-01-01

    Full Text Available Background. Gastroesophageal reflux disease (GERD is a common disease and a major upper gastrointestinal problem. The purpose of the present study is to evaluate the use of noninvasive 2-fluoro-2-deoxy-d-glucose positron emission tomography (FDG-PET to detect gastroesophageal reflux esophagitis. Materials and Methods. This is a retrospective study reviewing 408 healthy check-up subjects (169 females and 239 men, who underwent both FDG-PET and upper gastrointestinal endoscopy during September 2008 to December 2009. Quantitative analysis of FDG uptake in the distal part of the esophagus was performed by calculating the maximum standard uptake value (SUVmax. This indicated the degree of esophagitis. FDG-PET findings were compared with endoscopic (modified version of the Los Angeles classification diagnoses as the gold standard. Results. The SUVmax ranged from 1.30 to 3.40 in normal subjects and from 1.30 to 4.00 in subjects with gastroesophageal reflux esophagitis. In the esophagitis group, the SUVmax was 2.13±0.42 in subjects with modified LA grade M, 2.21±0.45 in subjects with LA grade A, and 2.48±0.44 in subjects with LA grade B and C gastroesophageal reflux esophagitis. One-way ANOVA and post-hoc comparison with Bonferroni correction (P value = 0.003 identified statistical differences between the three groups. Conclusion. Noninvasive FDG-PET may be useful in the detection and evaluation of various degrees of gastroesophageal reflux esophagitis.

  7. Comparison of reflux esophagitis and its complications between African Americans and non-Hispanic whites

    Institute of Scientific and Technical Information of China (English)

    Kenneth J Vega; Sian Chisholm; M Mazen Jamal

    2009-01-01

    AIM: To determine the effect of ethnicity on the severity of reflux esophagitis (RE) and its complications. METHODS: A retrospective search of the endoscopy database at the University of Florida Health Science Center/Jacksonville for all cases of reflux esophagitis and its complications from January 1 to March 31, 2001 was performed. Inclusion criteria were endoscopic evidence of esophagitis using the LA classification, reflux related complications and self-reported ethnicity. The data obtained included esophagitis grade, presence of a hiatal hernia, esophageal ulcer, stricture and Barrett's esophagus, and endoscopy indication. RESULTS: The search identified 259 patients with RE or its complications, of which 171 were non-Hispanic whites and 88 were African Americans. The mean ages and male/female ratios were similar in the two groups. RE grade, esophageal ulcer, stricture and hiatal hernia frequency were likewise similar in the groups. Barrett's esophagus was present more often in non-Hispanic whites than in African Americans (15.8% vs 4.5%; P < 0.01). Heartburn was a more frequent indication for endoscopy in non-Hispanic whites with erosive esophagitis than in African Americans (28.1% vs 7.9%; P < 0.001). CONCLUSION: Distribution of RE grade and frequency of reflux-related esophageal ulcer, stricture and reflux-related esophageal ulcer, stricture and hiatal hernia are similar in non-Hispanic whites and African Americans. Heartburn was more frequently and nausea/vomiting less frequently reported as the primary endoscopic indication in non-Hispanic whites compared with African Americans with erosive esophagitis or its complications. African Americans have a decreased prevalence of Barrett's esophagus compared with non-Hispanic whites.

  8. Effect of omeprazole and domperidone on adult asthmatics with gastroesophageal reflux

    Institute of Scientific and Technical Information of China (English)

    Bhavneesh Sharma; Manisha Sharma; Mradul Kumar Daga; Gopal Krishan Sachdev; Elliott Bondi

    2007-01-01

    AIM: To study the effect of combined omeprazole(Ome) and domperidone(Dom) therapy on asthma symptoms and pulmonary function in asthmatics with gastroesoph ageal reflux.METHODS: We selected 198 asthmatics with gastro esophageal reflux diagnosed by 24-h esophageal pH moni toring to receive Ome 20 mg twice daily and Dom 10 mg three times daily or placebo for 16 wk (1:1 double-blind randomization). Spirometry was done at baseline and af ter 16 wk of treatment. The primary outcome measures were: mean daily daytime and nighttime asthma symp tom scores. Mean daily reflux symptom scores, albuterol use as rescue medication (number of puffs), daytime and nighttime peak expiratory flow rate (PEFR), postbroncho dilator forced expiratory volume in 1 second (FEV1) and postbronchodilator forced vital capacity (FVC) were sec ondary outcome measures.RESULTS: Comparison of mean change from baseline between antireflux therapy and placebo groups revealed significant reduction in daytime asthma symptom score (17.4% vs 8.9 %), nighttime asthma symptom score (19.6% vs 5.4%), reflux symptom score (8.7% vs 1.6%) and rescue medication use (23.2% vs 3.1%) after antire flux therapy compared to mean change in placebo group (P < 0.001). There was significant improvement in morn ing PEFR (7.9% vs 0.2%), evening PEFR (9.8% vs 0.5%), FEV1 (11.1% vs 3.78%) and FVC (9.3% vs 1.52%) in the antireflux therapy group compared to placebo on comparing the mean change from baseline after 16 wk (P < 0.01).CONCLUSION: Combined therapy with Ome and Dom in adult asthmatics with gastroesophageal reflux may be beneficial by reducing asthma symptoms, rescuing medi cation use, and improving pulmonary function.

  9. Rabeprazole is effective for bile reflux oesophagitis after total gastrectomy in a rat model

    Institute of Scientific and Technical Information of China (English)

    Naoki; Hashimoto

    2015-01-01

    AIM:To elucidate the effect of a proton pump inhibitor(PPI,rabeparazole)on oesophageal bile reflux in oesophagitis after total gastrectomy.METHODS:Twenty-one 8-week-old male Wistar rats were studied.They were performed oesophagoduodenostomy of total gastrectomy to induce oesophageal reflux of biliary and pancreatic juice.Five rats were performed the sham operation(Sham).On post-operative day 7,they were treated with saline(Control)(n=8)or PPI(rabeprazole,30 mg/kg per day,ip)(n=8)for 2 wk.On post-operative 21,all rats were sacrificed and each oesophagus was evaluated histologically.Oesophageal injury was evaluated by macroscopic and microscopic findings as well as the expression of cyclooxygenase-2(COX2).We measured bile acid in the oesophageal lumen and the common bile duct.RESULTS:At 3 wk after surgery,a histological study analysis revealed an increase in the thickness of the epithelium,elongation of the lamina propria and basal cell hyperplasia in the oesophageal mucosa.The macroscopic ulcer score and microscopic ulcer length of the control group were significantly higher compared to those of the rabeprazole-treated group.The expression of COX2 was significantly increased according to the immunostaining in the control group compared to rabeprazole-treated group.Although there was no difference between the control and PPI groups in the total bile acid in the common bile duct,the bileacid activity in the oesophageal lumen was significantly decreased in the rabeprazole-treated group due to augmentation of the duodenal motor complex.CONCLUSION:With this model,rabeprazole is good effect for reflux esophagitis after total gastrectomy from bile reflux.Bile acid is an important factor in the mucosal lesion induced by duodenal reflux.

  10. Optimization of the reflux ratio for a stage distillation column based on an improved particle swarm algorithm

    DEFF Research Database (Denmark)

    Ren, Jingzheng; Tan, Shiyu; Dong, Lichun

    2010-01-01

    the searching ability of basic particle swarm algorithm significantly. An example of utilizing the improved algorithm to solve the mathematical model was demonstrated; the result showed that it is efficient and convenient to optimize the reflux ratio for a distillation column by using the mathematical model......A mathematical model relating operation profits with reflux ratio of a stage distillation column was established. In order to optimize the reflux ratio by solving the nonlinear objective function, an improved particle swarm algorithm was developed and has been proved to be able to enhance...

  11. Effects of reflux ratio and feed conditions for the purification of bioethanol in a continuous distillation column

    Science.gov (United States)

    Dasan, Y. K.; Abdullah, M. A.; Bhat, A. H.

    2014-10-01

    Continuous distillation column was used for the purification of bioethanol from fermentation of molasses using Saccharomyces cerevisia. Bioethanol produced was at 8.32% (v/v) level. The efficiency of continuous distillation process was evaluated based on reflux ratio, and feed condition. The lab results were validated using COFE simulation Software. The analyses showed that both reflux ratio and feed condition had significant effects on the distillation process. Stages increased from 1.79 to 2.26 as the reflux ratio was decreased from 90% to 45% and the saturated feed produced lower mole fraction of desired product. We concluded that the lower reflux ratio with cold feed condition was suitable for higher mole fraction of top product.

  12. Gastric greater curvature plication combined with Nissen fundoplication in the treatment of gastroesophageal reflux disease and obesity

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    Oral Ospanov

    2016-01-01

    Conclusions: LNFGP took significantly longer time to perform, but resulted in significantly higher weight reduction and remission/improvement of comorbidities. Both procedures produced similar anti-reflux effect.

  13. Fatal Renal Failure in a Spinal Cord Injury Patient with Vesicoureteric Reflux Who Underwent Repeated Ureteric Reimplantations Unsuccessfully: Treatment Should Focus on Abolition of High Intravesical Pressures rather than Surgical Correction of Reflux

    Directory of Open Access Journals (Sweden)

    Subramanian Vaidyanathan

    2012-01-01

    Full Text Available A 29-year-old man developed paraplegia at T-10 level due to road traffic accident in 1972. Both kidneys were normal and showed good function on intravenous urography. Division of external urethral sphincter was performed in 1973. In 1974, cystogram showed retrograde filling of left renal tract, which was hydronephrotic. Left ureteric reimplantation was performed. Following surgery, cystogram revealed marked retrograde filling of left renal tract as before. Penile sheath drainage was continued. In 1981, intravenous urography revealed bilateral severe hydronephrosis. Left ureteric reimplantation was performed again in 1983. Blood pressure was 220/140 mm Hg; this patient was prescribed atenolol. Cystogram showed gross left vesicoureteral reflux. Intermittent catheterisation was commenced in 2001. In 2007, proteinuria was 860 mg/day. This patient developed progressive renal failure and expired in 2012. In a spinal cord injury patient with vesicoureteral reflux, the treatment should focus on abolition of high intravesical pressures rather than surgical correction of vesicoureteric reflux. Detrusor hyperactivity and high intravesical pressures are the basic causes for vesicoureteral reflux in spinal cord injury patients. Therefore, it is important to manage spinal cord injury patients with neuropathic bladder by intermittent catheterisations along with antimuscarinic drug therapy in order to abolish high detrusor pressures and prevent vesicoureteral reflux. Angiotensin-converting enzyme inhibitors or angiotensin-receptor-blocking agents should be prescribed even in the absence of hypertension when a spinal cord injury patient develops vesicoureteral reflux and proteinuria.

  14. Bladder volume at onset of vesicoureteral reflux is an independent risk factor for breakthrough febrile urinary tract infection.

    Science.gov (United States)

    Alexander, Siobhan E; Arlen, Angela M; Storm, Douglas W; Kieran, Kathleen; Cooper, Christopher S

    2015-04-01

    Improved identification of children with vesicoureteral reflux at risk for recurrent febrile urinary tract infection may impact management decisions. We hypothesized that reflux occurring earlier during bladder filling increases the duration of exposure of the kidneys to bacteria, and, therefore, increases the risk of pyelonephritis. Children with vesicoureteral reflux and detailed voiding cystourethrogram data were identified. Bladder volume at onset of reflux was normalized for age. Demographics, reflux grade, laterality, presence/absence of bladder-bowel dysfunction and breakthrough febrile urinary tract infections were assessed. Median followup was 24 months (IQR 12 to 52). A total of 208 girls and 47 boys were analyzed with a mean ± SD age at diagnosis of 3.1 ± 2.6 years. On univariate analysis history of febrile urinary tract infection (HR 2.17, 95% CI 1.33-2.85, p = 0.01), dilating vesicoureteral reflux (HR 1.6, 95% CI 1.05-2.42, p = 0.03) and bladder-bowel dysfunction (HR 1.66, 95% CI 0.99-2.75, p = 0.05) were associated with an increased risk of breakthrough febrile urinary tract infection. Median bladder volume at onset of reflux in children with breakthrough febrile urinary tract infection was significantly less (33.1%) than in those without infection (49.5%, p = 0.003). Reflux onset at 35% predicted bladder capacity or less was associated with a significantly increased risk of breakthrough febrile urinary tract infection on multivariate analysis (HR 1.58, 95% CI 1.05-2.38, p = 0.03). Children with early filling vesicoureteral reflux are at increased risk for breakthrough febrile urinary tract infection independent of reflux grade. Bladder volume at onset of reflux should be recorded during cystograms since it provides additional prognostic information about the risk of pyelonephritis and resolution, and may assist with counseling and clinical decision making. Copyright © 2015 American Urological Association Education and Research, Inc. Published by

  15. Factors confusing the diagnosis of laryngopharyngeal reflux: the role of allergic rhinitis and inter-rater variability of laryngeal findings.

    Science.gov (United States)

    Eren, Erdem; Arslanoğlu, Seçil; Aktaş, Ayşe; Kopar, Aylin; Ciğer, Ejder; Önal, Kazım; Katılmiş, Hüseyin

    2014-04-01

    The objective of the study was to determine the inter-rater variability in assessment of laryngeal findings and whether diagnosing laryngopharyngeal reflux based on the laryngeal findings and history alone without considering allergic rhinitis leads to the overdiagnosis and overtreatment of laryngopharyngeal reflux. Patients with positive and negative skin prick tests were recruited from an allergy clinic in a tertiary teaching university hospital. All subjects completed the Reflux Symptom Index (RSI) and underwent laryngeal examinations by three physicians blinded to the skin prick test results and the Reflux Finding Score (RFS) was determined. RFS >7 or RSI >13 was considered reflux positive. Fleiss' kappa (κ) was used to measure inter-rater agreement. The inter-rater agreement was low for pseudosulcus vocalis (κ = 0.078), ventricular obliteration (κ = 0.206), diffuse laryngeal edema (κ = 0.204), and posterior laryngeal hypertrophy (κ = 0.27), intermediate for laryngeal erythema/hyperemia (κ = 0.42) and vocal fold edema (κ = 0.42), and high for thick endolaryngeal mucus (κ = 0.61). Although the frequency of allergy was high, there was no significant difference between allergy-positive and laryngopharyngeal reflux-positive patients. On logistic regression analysis, thick endolaryngeal mucus was a significant predictor of allergy (p = 0.012, odds ratio 0.264, 95 % confidence interval 0.093-0.74). The laryngeal examination for reflux is subject to marked inter-rater variability and allergic laryngitis was not misdiagnosed as laryngopharyngeal reflux. The presence of thick endolaryngeal mucus should alert physicians to the possibility of allergic rhinitis/laryngitis.

  16. Refractory gastroesophageal reflux disease Doença do refluxo gastroesofágico refratária

    OpenAIRE

    Joaquim Prado P. Moraes-Filho

    2012-01-01

    CONTEXT: Gastroesophageal reflux disease (GERD) is a condition which develops when the reflux of stomach contents causes troublesome symptoms and/or complications. Its pathophysiology, diagnosis and treatment have frequently been analyzed but it is interesting to review some aspects of the GERD refractory patients to the proton pump inhibitors treatment. The treatment encompasses behavioral measures and pharmacological therapy. The majority of the patients respond well to proton pump inhibito...

  17. The role of dexlansoprazole modified-release in the management of gastroesophageal reflux disease

    Science.gov (United States)

    Fass, Ronnie; Frazier, Rosita

    2017-01-01

    Dexlansoprazole modified-release (MR) is the R-enantiomer of lansoprazole and is currently the only proton-pump inhibitor (PPI) with a novel dual delayed release (DDR) formulation. Overall, dexlansoprazole MR demonstrates a similar safety and side-effect profile as lansoprazole. Dexlansoprazole MR has been shown to be highly efficacious in healing erosive esophagitis, maintaining healed esophageal mucosa in patients with erosive esophagitis and controlling symptoms of patients with nonerosive reflux disease (NERD). Recent studies have also demonstrated that dexlansoprazole MR is highly effective in improving nocturnal heartburn, gastroesophageal reflux disease (GERD) related sleep disturbances and bothersome regurgitation. Dexlansoprazole MR is well tolerated and can be taken without regard to food. PMID:28203282

  18. Pulmonary Disease Secondary to Reflux Mimicking Interstitial Pneumonia in Systemic Sclerosis: Case Report and Literature Review

    Directory of Open Access Journals (Sweden)

    Ricardo Azêdo de Luca Montes

    2016-01-01

    Full Text Available Systemic sclerosis is a complex disease due to the variety of clinical presentations, often superimposed on other conditions, related or not to the connective tissue. We report a 43-year-old Brazilian woman with limited systemic sclerosis and pulmonary symptoms secondary to gastroesophageal reflux disease, with a clinical presentation similar to a diffuse interstitial lung disease. Because of the frequency of interstitial lung injury due to systemic sclerosis, this was an important differential diagnosis, which could be excluded after optimized treatment of reflux disease, with clinical and radiological improvement. Clinical management of patients with collagen diseases requires clinician skills to identify the natural history and understand its nuances. This is a common situation in clinical practice, but with a few discussions in international literature.

  19. [Relationship between Helicobacter pylori status and the development of reflux esophagitis or Barrett's esophagus].

    Science.gov (United States)

    Watari, Jiro; Tomita, Toshihiko; Oshima, Tadayuki; Fukui, Hirokazu; Miwa, Hiroto

    2013-08-01

    To date, there are many studies on the association between Helicobacter pylori (H. pylori) infection and gastroesophageal reflux disease. Here we reviewed the relationship between H. pylori status and the development of reflux esophagitis (RE) or Barrett's esophagus (BE). According to many case-controlled studies, H. pylori infection may play a protective role in the development of RE. However, the frequency of RE development does not increase following successful H. pylori treatment based on the previous studies including meta-analysis and systematic review. Even though RE newly develops after H. pylori eradication, endoscopic findings reveal mild such as grade A or B according to the Los Angeles Classification System. With regard to BE, there is an inverse significant relationship. Since there are few studies indicating that BE increases after treatment of H. pylori, the eradication should be recommended for patients with H. pylori infection irrespective of the presence of RE or BE even in terms of the prevention of gastric cancer.

  20. De novo MEIS2 mutation causes syndromic developmental delay with persistent gastro-esophageal reflux.

    Science.gov (United States)

    Fujita, Atsushi; Isidor, Bertrand; Piloquet, Hugues; Corre, Pierre; Okamoto, Nobuhiko; Nakashima, Mitsuko; Tsurusaki, Yoshinori; Saitsu, Hirotomo; Miyake, Noriko; Matsumoto, Naomichi

    2016-09-01

    MEIS2 aberrations are considered to be the cause of intellectual disability, cleft palate and cardiac septal defect, as MEIS2 copy number variation is often observed with these phenotypes. To our knowledge, only one nucleotide-level change-specifically, an in-frame MEIS2 deletion-has so far been reported. Here, we report a female patient with a de novo nonsense mutation (c.611C>G, p.Ser204*) in MEIS2. She showed severe intellectual disability, moderate motor/verbal developmental delay, cleft palate, cardiac septal defect, hypermetropia, severe feeding difficulties with gastro-esophageal reflux and constipation. By reviewing this patient and previous patients with MEIS2 point mutations, we found that feeding difficulty with gastro-esophageal reflux appears to be one of the core clinical features of MEIS2 haploinsufficiency, in addition to intellectual disability, cleft palate and cardiac septal defect.

  1. Similar symptom patterns in gastroesophageal reflux patients with and without hiatal hernia.

    Science.gov (United States)

    Antoniou, S A; Koch, O O; Antoniou, G A; Asche, K U; Kaindlstorfer, A; Granderath, F A; Pointner, R

    2013-07-01

    Gastroesophageal reflux disease is a common clinical entity in Western societies. Its association with hiatal hernia has been well documented; however, the comparative clinical profile of patients in the presence or absence of hiatal hernia remains mostly unknown. The aim of the present study was to delineate and compare symptom, impedance, and manometric patterns of patients with and without hiatal hernia. A cumulative number of 120 patients with reflux disease were enrolled in the study. Quality of life score, demographic, symptom, manometric, and impedance data were prospectively collected. Data comparison was undertaken between patients with and without hiatal hernia. A P-value hiatal hernia tended to be older than patients without hernia (52.3 vs. 48.6 years, P hiatal hernia (78.3% vs. 93.9%, P hiatal hernia on manometric and impedance studies. Distinct functional characteristics in patients with and without hiatal hernia may suggest a tailored therapeutic management for these diverse patient groups.

  2. Neuro-regulation of lower esophageal sphincter function as treatment for gastroesophageal reflux disease

    Institute of Scientific and Technical Information of China (English)

    Anupender Singh Sidhu; George Triadafilopoulos

    2008-01-01

    The junction between the esophagus and the stomach is a specialized region,composed of lower esophageal sphincter (LES) and its adjacent anatomical structures,the gastric sling and crural diaphragm.Together these structures work in a coordinated manner to allow ingested food into the stomach while preventing reflux of gastric contents across the esophago-gastric junction (EGJ) into the esophagus.The same zone also permits retrograde passage of air and gastric contents into esophagus during belching and vomiting.The precise coordination required to execute such a complicated task is achieved by a finely-regulated high-pressure zone.This zone keeps the junction between esophagus and stomach continuously closed,but is still able to relax briefly via input from inhibitory neurons that are responsible for its innervation.Alterations of the structure and function of the EGJ and the LES may predispose to gastroesophageal reflux disease (GERD).

  3. Improvements in ion reflux: An electrodialytic eluent generation and suppression device for ion chromatography.

    Science.gov (United States)

    Elkin, Kyle; Riviello, John; Small, Hamish

    2015-07-17

    This work describes a membrane based electrodialytic ion reflux device (IRD), which uses water as the pumped phase and integrates isocratic and gradient eluent generation and suppression. The current design incorporates several ion exchange membranes to create discrete chambers for suppression and eluent generation, while isolating the electrodes from the analytical stream. A small volume of recycled water can be used as the pumped phase while continuously refluxing the eluent ions. This current design permits electronically controlled eluent generation of at least 16.4μeq KOHmin(-1), while maintaining low suppressed background conductivity (<0.5μS/cm). The device was operated in gradient or isocratic mode continuously for up to 6 weeks. During this period, over 500 gradient and isocratic injections were performed, showing peak retention time precision below 1.5% RSD.

  4. [An association between adenoid hypertrophy and exstra-gastroesophageal reflux disease].

    Science.gov (United States)

    Ren, Jianjun; Zhao, Yu; Ren, Xue

    2015-08-01

    Adenoid hypertrophy is a disease that mostly occurs among children of 3-5 years old. It is caused by repeated inflammation and infection of nasopharynx and its adjoin parts, or the adenoid itself, which will finally leads to pathological hyperplasia of adenoid. With so much information we have acquired about this disease, its specific mechanism remains unknown. In recent years, some researches have indicated that adenoid hypertrophy may have something to do with extra-gastroesophageal reflux, in which pepsin plays a very important role, and pepsin will do a series of pathological damages to the upper airway as it reaches the upper respiratory tract. Based on relative domestic and foreign literature, this paper attempts to make a review about the relationship between gastroesophageal reflux and adenoid hypertrophy.

  5. Color-Doppler sonographic tissue perfusion measurements reveal significantly diminished renal cortical perfusion in kidneys with vesicoureteral reflux.

    Science.gov (United States)

    Scholbach, T M; Sachse, C

    2016-01-01

    Vesicoureteral reflux (VUR) and its sequelae may lead to reduced renal perfusion and loss of renal function. Methods to describe and monitor tissue perfusion are needed. We investigated dynamic tissue perfusion measurement (DTPM) with the PixelFlux-software to measure microvascular changes in the renal cortex in 35 children with VUR and 28 healthy children. DTPM of defined horizontal slices of the renal cortex was carried out. A kidney was assigned to the "low grade reflux"-group if the reflux grade of the voiding cystourethrogram was 1 to 3 and to the "high grade reflux"-group if the reflux grade was 4 to 5. Kidneys with VUR showed a significantly reduced cortical perfusion. Compared to healthy kidneys, this decline reached in low and high grade refluxes within the proximal 50% of the cortex: 3% and 12 %, in the distal 50% of the cortex: 21% and 44 % and in the most distal 20 % of the cortex 41% and 44%. DTPM reveals a perfusion loss in kidneys depending on the degree of VUR, which is most pronounced in the peripheral cortex. Thus, DTPM offers the tool to evaluate microvascular perfusion, to help planning treatment decisions in children with VUR.

  6. [Acid gastroesophageal reflux in the child with intubation, artificial respiration and continuous nutrition. Apropos of 28 cases].

    Science.gov (United States)

    Nicolas, E; Roy, P; Descos, B; Bergeat, M A; Lachaux, A; Floret, D; Hermier, M

    1988-01-01

    Continuous monitoring of distal oesophageal pH and oesophagoscopy were performed in 28 children aged 15 days to 12 years (mean: 14 months) intubated and ventilated for bronchiolitis (7), pneumonia (8), epiglotitis (2), neurological distress (8), whooping cough (2) or recurrent apneic spells (1). Esophageal pH was studied 2-8 days (mean: 2 days) after intubation; its duration was 12-23 h 50 min (M: 22 h). An abnormal gastroesophageal reflux was presumed when the percent of total monitoring time during which the esophageal pH fell below 4.0 was above 5.2%. The esophagoscopy was carried out on the day following the pH monitoring. All children were in the supine position and fed a pH 7 diet infused continuously with a nasogastric tube; 15 children were under pancuronium. An abnormal gastroesophageal reflux was found in 4 children, associated with a benign esophagitis in 2. A benign esophagitis without gastroesophageal reflux was found in 3 cases. One child had a peptic ulcer of the bulb without gastroesophageal reflux nor oesophagitis. 21 children had no abnormality. Only one of the 15 children under pancuronium had an abnormal gastroesophageal reflux. We conclude that in intubated children fed continuously with a nasogastric tube, gastroesophageal reflux is unfrequent and, when present, appears to have little consequences.

  7. Esophagogastric junction contractile integral and morphology: Two high-resolution manometry metrics of the anti-reflux barrier.

    Science.gov (United States)

    Ham, Hyoju; Cho, Yu Kyung; Lee, Han Hee; Yoon, Seung Bae; Lim, Chul-Hyun; Kim, Jin Su; Park, Jae Myung; Choi, Myung-Gyu

    2017-08-01

    We evaluated associations of esophagogastric junction (EGJ) metrics as an anti-reflux barrier with impedance-pH, endoscopic esophagitis, and lower esophageal sphincter (LES) metrics. We reviewed high-resolution manometry data from consecutive patients with gastroesophageal reflux disease (GERD) symptoms who underwent impedance-pH and endoscopy, and asymptomatic volunteers. The EGJ contractile integral (CI) was calculated as the mean contractile integral/second during three respiratory cycles. EGJ morphology was classified according to LES-crural diaphragm (CD) separation. In total, 137 patients (65 male, age 55 years) and 23 (9 male, age 33 years) controls were enrolled. Twenty-five patients had erosive reflux disease (ERD), 16 had non-erosive reflux disease (NERD), 5 had reflux hypersensitivity, and 91 were not GERD. EGJ-CI were lower in patients with GERD (22.6 [13.8-29.2] mmHg cm) than non-GERD (50.3 [31-69.9] mmHg cm, P integral showed good diagnostic accuracy with high specificity in predicting GERD. LES-CD separation is associated with an increase in acid reflux, but EGJ-CI was associated more strongly with GERD than was EGJ morphology. © 2017 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

  8. Evidence-based appraisal in laparoscopic Nissen and Toupet fundoplications for gastroesophageal reflux disease

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

    AIM: To demonstrate the optimal surgical procedure for gastroesophageal reflux disease. METHODS: The electronic databases of Medline, Elsevier, Springerlink and Embase over the last 16 years were searched. All clinical trials involved in the outcomes of laparoscopic Nissen fundoplication (LNF) and laparoscopic Toupet fundoplication (LTF) were identified. The data of assessment in benefits and adverse results of LNF and LTF were extracted and compared using metaanalysis. RESULTS: We ultimately identified a t...

  9. Salivary parameters and teeth erosions in patients with gastroesophageal reflux disease

    Directory of Open Access Journals (Sweden)

    Maria Carolina Canteras Scarillo Falotico Corrêa

    2012-09-01

    Full Text Available CONTEXT: In the gastroesophageal reflux disease (GERD, a highly prevalent digestive disorder, gastric content may return to the esophagus and reach the mouth, thus leading to a small number of carious lesions and high incidence of dental erosion. Since saliva plays a major role in oral homeostasis, evaluating salivary parameters is necessary in attempting to explain such outcome. OBJECTIVES: This study aimed at analyzing salivary parameters (salivary flow, pH and buffering capacity, bacterial count, caries index and dental erosion in patients with GERD. MATERIALS: Sixty patients were studied, and of these, 30 had GERD (group 1, and 30 were controls (group 2. Gastroesophageal reflux disease diagnosis confirmation was achieved by means of endoscopy, manometry and pH metric esophageal monitoring. The above mentioned salivary parameters were evaluated in patients from groups 1 and 2. RESULTS: The number of erosions in patients with GERD (group 1 was larger than in controls (P<0.001. The number of carious teeth was smaller in group 1 than in group 2 (P<0.001. Salivary flow (non-stimulated and stimulated and pH did not show differences between the 2 groups (P = 0.49; P = 0.80 and P = 0.85, respectively. Salivary buffering capacity in patients with GERD showed lower values in controls (P = 0.018. The number of bacteria (Lactobacilli and Streptococci was smaller in patients with gastroesophageal reflux disease than in controls (P = 0.0067 and P = 0.0017, respectively. CONCLUSION: It was concluded that the large number of erosions must be a result of GERD patients reduced salivary buffering capacity. The reduced number of caries of patients in group 1 can be explained by the low prevalence of bacteria (Lactobacilli and Streptococci, observed in the saliva of patients with chronic reflux.

  10. Association Between Halitosis Diagnosed by a Questionnaire and Halimeter and Symptoms of Gastroesophageal Reflux Disease

    OpenAIRE

    LEE, Hyo-Jung; Kim, Hee Man; Kim, Nayoung; Oh, Jane C; Jo, Hyun Jin; Lee, Jung-Tae; Chang, Hee-Yung; Chang, Na-Hee; Ahn, Soyeon; Lee, Jeong-Yun

    2014-01-01

    Background/Aims The relationship between halitosis and gastroesophageal reflux disease (GERD) remains controversial. The aim of this study was to investigate an association between subjective and objective halitosis and GERD. Methods The subjects were enrolled from participants who visited a health promotion center at Seoul National University Bundang Hospital. For diagnosis of halitosis, a questionnaire was requested, and volatile sulfur compounds (VSCs) were measured by Halimeter. Self-cons...

  11. Characteristics of belching, swallowing, and gastroesophageal reflux in belching patients based on Rome III criteria.

    Science.gov (United States)

    Li, Jianbo; Xiao, Yinglian; Peng, Sui; Lin, Jinkun; Chen, Minhu

    2013-08-01

    Belching is a common disorder with undetermined pathogenesis. With the combined multichannel intraluminal impedance pH monitoring, two different models of belching have been defined: gastric belching (GB) and supragastric belching (SB). The aim of this study was to assess whether SB was associated with air swallowing as compared with GB or healthy volunteers based on Rome III criteria. Consecutive patients who presented with troublesome repetitive belching were recruited. Both upper endoscopy and multichannel intraluminal impedance pH monitoring were performed. Patients were divided into two groups: SB and GB groups according to the percentage of the predominant belching types. Twenty volunteers were enrolled as healthy controls. The number of air swallowing, regular swallowing, and gastroesophageal reflux profile was compared among the three groups. Thirty-seven patients were included in the study: 25 in the SB group and 12 in GB group. SB patients presented more belching events than GB patients (P 0.05). No significant difference was found among the three groups in regard with the reflux parameters (P > 0.05). The number of gas-containing reflux episodes were 33.0 (20.0, 48.0), 39.5 (29.5, 47.5), and 30.5 (27.0, 41.8) among SB, GB, and healthy volunteers (P = 0.383), respectively. SB patients presented with more belching events compared with GB patients. However, air swallowing and reflux profile were similar among the SB, GB patients, and normal controls. © 2013 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd.

  12. Relationship among symptoms, mucosal injury, and acid exposure in gastroesophageal reflux disease

    Institute of Scientific and Technical Information of China (English)

    XU Ding-ting; FENG Gui-jian; ZHAO Li-li; LIU Yu-lan

    2013-01-01

    Background Symptoms,endoscopy,and pH monitoring form the basis of diagnosis of gastroesophageal reflux disease (GERD).Their relationship was meaningful for primary care physicians,but still unclear.Our research aimed to compare questionnaire,endoscopy,and pH monitoring and to analyze their correlations.Methods Three hundred patients who underwent the Reflux Disease Questionnaire (RDQ),endoscopy,and esophageal 24-hour pH monitoring from March 2007 to December 2010 in Peking University People's Hospital were enrolled.We analyzed the characteristics of different investigations and their relationships.Results Male (OR for mild reflux esophagitis (RE) =2.433,severe RE =8.386),body mass index (BMI) (OR for mild RE =1.222,severe RE =1.297),and hernia (OR for mild RE =6.059,severe RE =17.547),were found to be the risk factors for RE; age (OR=1.074) was correlated with severe RE.The consistency of questionnaire,endoscopy,and pH monitoring was poor:RDQ did not agree well with pH monitoring (K=0.061),nor with endoscopy (K=0.044); pH monitoring did not agree well with endoscopy (K=0.316).However,the severity of mucosa injury in RE was associated with pathological acid exposure (PAE):reflux episodes of >5 minutes (P=0.035),the percentage time pH <4 (P=0.017),and the DeMeester score (P=0.016) increased significantly in patients with severe RE.Chest pain had poor relationship with RE or PAE.Conclusions Male,age,BMI,and hernia were probably risk factors for esophagitis.RDQ,endoscopy,and pH monitoring have their own focus and reinforce each other in diagnosis.Of the GERD symptoms,chest pain had negative correlation with RE or PAE.

  13. Histological evaluation of esophageal mucosa in children with acid gastroesophageal reflux.

    OpenAIRE

    Maciej Kaczmarski; Janusz Semeniuk; Mirosława Uścinowicz; Maria Sobaniec-Łotowska

    2009-01-01

    AIM
    histological evaluation of esophageal mucosa in children, with regard to the duration of primary acid gastroesophageal reflux (GER) and acid GER secondary to cow's milk allergy and/or other food allergy (CMA/FA) (prospective study).

    MATERIAL AND METHODS
    264 children of both sexes suspected of GER were enrolled in the study. The age of examined children was 1.5-102 months, mean age 20.78+...

  14. Comparison of "Direct" and "Indirect" Nuclear Cystography in the Diagnosis of Vesicoureteric Reflux

    OpenAIRE

    Khriesat Imad; Khriesat Sameer; Hazza Issa

    2001-01-01

    This study was undertaken to compare "direct" and "indirect" nuclear cystography for the detection of vesicoureteral reflux (VUR). Forty-five children (15 males and 30 females), ranging in age from 5 months to 10 years, were studied at the King Hussein Medical Center, Amman, Jordan between January 1998 and December 1999, using both direct (catheter) and indirect techniques of nuclear cystography (NC). Of the 82 ureters that could be compared, 32 ureters were positive for VUR on the direct tec...

  15. Heartburn during sleep: a clinical marker of gastro-oesophageal reflux disease in morbidly obese patients.

    Science.gov (United States)

    Fornari, F; Madalosso, C A S; Callegari-Jacques, S M; Gurski, R R

    2009-02-01

    Gastro-oesophageal reflux disease (GORD) and morbid obesity are entities with increasing prevalence. New clinical strategies are cornerstones for their management. The aim of this study was to assess the prevalence of heartburn during sleep (HDS) and whether this symptom predicts the presence of objective GORD parameters and increased heartburn perception in morbidly obese patients. Ninety-one consecutive morbidly obese patients underwent clinical evaluation, upper gastrointestinal endoscopy and oesophageal pH monitoring. HDS was characterized when patients replied positively to the question, 'Does heartburn wake you from sleep?'. A General Score for Heartburn (GSH) ranging between 0 and 5 was assessed with the question 'How bad is your heartburn?'. HDS was reported by 33 patients (36%). More patients with HDS had abnormal acid contact time or reflux oesophagitis than patients without HDS (94%vs 57%, P HDS had a positive predictive value of 94% (0.95 CI 82-98), sensitivity of 48% (0.95 CI 37-60%) and specificity of 93% (0.95 CI 77-98%) for detection of GORD. A higher proportion of patients with HDS perceived heartburn preceded by acid reflux in diurnal (39%vs 9%; P HDS patients showed higher GSH (2.4 +/- 0.5 vs 1.7 +/- 0.4; P HDS but reported diurnal heartburn. HDS occurs in a significant minority of patients with morbid obesity and has high positive predictive value for GORD. Symptomatic reflux during the sleep seems to be a marker of increased heartburn perception in this population.

  16. Laparoscopic Nissen (total) versus anterior 180° fundoplication for gastro-esophageal reflux disease

    Science.gov (United States)

    Du, Xing; Wu, Ji-Min; Hu, Zhi-Wei; Wang, Feng; Wang, Zhong-Gao; Zhang, Chao; Yan, Chao; Chen, Mei-Ping

    2017-01-01

    Abstract Background: Laparoscopic Nissen fundoplication (LNF) has been the gold standard for the surgical management of Gastro-esophageal reflux disease (GERD). Laparoscopic anterior 180° fundoplication (180° LAF) is reported to reduce the incidence of postoperative complications while obtaining similar control of reflux. The present meta-analysis was conducted to confirm the value of the 2 techniques. Methods: PubMed, Medline, Embase, Cochrane Library, Springerlink, and China National Knowledge Infrastructure Platform databases were searched for randomized controlled trials (RCTs) comparing LNF and 180° LAF. Data regarding the benefits and adverse results of 2 techniques were extracted and compared using a meta-analysis. Results: Six eligible RCTs comparing LNF (n = 266) and 180° LAF (n = 265) were identified. There were no significant differences between LNF and 180° LAF with regard to operating time, perioperative complications, length of hospital stay, patient satisfaction, willingness to undergo surgery again, quality of life, postoperative heartburn, proton pump inhibitor (PPI) use, postoperative DeMeester scores, postoperative lower esophageal sphincter (LES) pressure, postoperative gas-bloating, unable to belch, diarrhea, or overall reoperation. LNF was associated with a higher prevalence of postoperative dysphagia compared with 180° LAF, while 180° LAF was followed by more reoperation for recurrent reflux symptoms. Conclusion: LNF and 180° LAF are equally effective in controlling reflux symptoms and obtain a comparable prevalence of patient satisfaction. 180° LAF can reduce the incidence of postoperative dysphagia while this is offset by a higher risk of reoperation for recurrent symptoms. The risk of recurrent symptoms should need to be balanced against the risk of dysphagia when surgeons choose surgical procedures for each individual with GERD. PMID:28906412

  17. Positioning the instillation of contrast at the ureteral orifice cystography can be useful to predict postoperative contralateral reflux in children with unilateral vesicoureteral reflux.

    Science.gov (United States)

    Matsumoto, Fumi; Shimada, Kenji; Matsui, Futoshi; Itesako, Toshihiko

    2011-01-01

    The aim of the present study was to evaluate the usefulness of positioning the instillation of contrast at the ureteral orifice (PIC) cystography in prediction of postoperative contralateral reflux in patients with unilateral vesicoureteral reflux (VUR) undergoing ureteral reimplantation. Between January 2007 and March 2009, 34 children (20 boys and 14 girls) had antireflux surgery for unilateral primary VUR. This was diagnosed by conventional fluoroscopic voiding cystourethrography (VCUG) in all patients. After induction of general anesthesia, PIC cystography was carried out immediately before ureteral reimplantation by instilling contrast material at the ureteral orifice. Patients with positive PIC cystogram on the contralateral side underwent bilateral ureteral reimplantation via the Cohen technique. VCUG was repeated at 6-12 months postoperatively. Of the 34 patients, 16 (47%) showed VUR on the contralateral side on PIC cystography and underwent bilateral reimplantation. The remaining 18 patients (53%) with negative PIC cystogram underwent unilateral reimplantation, and no VUR was detected by postoperative VCUG in all ureters. None of the 34 patients had surgical complications or recurrent urinary tract infections. In conclusion, PIC cystography represents a useful tool to predict new onset contralateral VUR in patients with unilateral VUR on conventional VCUG.

  18. Urethro-vesical Reflux%尿道膀胱反流的临床研究

    Institute of Scientific and Technical Information of China (English)

    魏辉; 刘唐彬

    1999-01-01

    Objective The study aims to evaluate if urethro-vesical reflux occur in children.Methods Nine children with recurrent urinary tract infection underwent imaging study by 99m technetium-labeled sulfur colloid.The image was captured with GCA-901A digital gamma camera system and processed with GMS-55u computer system.Results Urinary tract abnormality and spasm of external urethral sphincter may lead to urethro-vesical reflux.Conclusions Urethro-vesical reflux in turn contributes to urinary tract infection and a protracted course.%目的 探讨人体是否存在尿道膀胱反流及其临床意义.方法 首次应用同位索检查方法 对9例反复下尿路感染患儿和正常对照组3例儿童进行研究.结果 证实人体中尿道膀胱反流(UVR)的存在.结论 尿道器质或功能性异常所引起的尿流改变及尿道外括约肌(EUS)异常收缩是产生UVR的重要机制.UVR不但能诱发尿道感染(UTI),并且是UTI迁延不愈的重要因素.

  19. Effect of decaffeination of coffee or tea on gastro-oesophageal reflux.

    Science.gov (United States)

    Wendl, B; Pfeiffer, A; Pehl, C; Schmidt, T; Kaess, H

    1994-06-01

    Coffee and tea are believed to cause gastro-oesophageal reflux; however, the effects of these beverages and of their major component, caffeine, have not been quantified. The aim of this study was to evaluate gastro-oesophageal reflux induced by coffee and tea before and after a decaffeination process, and to compare it with water and water-containing caffeine. Three-hour ambulatory pH-metry was performed on 16 healthy volunteers, who received 300 ml of (i) regular coffee, decaffeinated coffee or tap water (n = 16), (ii) normal tea, decaffeinated tea, tap water, or coffee adapted to normal tea in caffeine concentration (n = 6), and (iii) caffeine-free and caffeine-containing water (n = 8) together with a standardized breakfast. Regular coffee induced a significant (P Decaffeination of coffee significantly (P decaffeination of tea or addition of caffeine to water had no effect. Coffee adapted to normal tea in caffeine concentration significantly (P decaffeination. Caffeine does not seem to be responsible for gastro-oesophageal reflux which must be attributed to other components of coffee.

  20. Role of the Teflon deposit in the recurrence of vesicoureteral reflux.

    Science.gov (United States)

    Oberritter, Zsolt; Somogyi, Reka; Juhasz, Zsolt; Pinter, Andrew B

    2008-05-01

    A relationship between the Teflon deposit, visible with ultrasound, and long-term success of subureteric Teflon injection (STING) treatment was investigated. The study included only those patients with primary vesicoureteral reflux (VUR), in whom the reflux had disappeared and the Teflon deposits were visible 6 weeks following STING treatment. Cessation of VUR was proven by voiding cysto-urethrography (VCUG) in 99 patients (143 ureters). Average follow-up time was 9 (4-12) years. Patients were divided into two groups: group I, deposits visible with ultrasound [deposit (+)], and group II, no visible deposits at the end of the follow-up period [deposit (-)]. Reflux recurrence, the occurrence of urinary tract infection (UTI), and pyelonephritis were investigated, and technetium scintigraphy scans were examined. The deposit (+) group included 43 patients (65 ureters), and the deposit (-) group contained 56 patients (78 ureters). In the deposit (+) group there were no recurrences of VUR; however, 17 recurrences were found in the deposit (-) group (P Teflon deposit and the recurrence of VUR. Disappearance of the Teflon deposit and repeated bacteriuria is a warning sign of the recurrence of VUR; therefore, VCUG might be warranted for these patients.

  1. Risk factors for renal scarring in children with primary vesicoureteral reflux disease

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    Sevgi Mir

    2013-01-01

    Full Text Available To determine the incidence of renal scarring among patients with primary vesicoureteral reflux (VUR and the possible risk factor(s, we studied 90 children (60 girls and 30 boys with VUR followed in the Pediatric Nephrology Unit at the Ege University Hospital from 1998 to 2003. All the patients were assessed for VUR grade by voiding cystoureterography and for presence of renal scarring by (99 m technetium dimercapto-succinic acid scintigraphy. All infants with VUR were given low-dose prophylactic antibiotics and followed-up until resolution of the reflux. Grade of reflux and number of urinary tract infection (UTI episodes (≥3 were found to be statistically significant risk factors for renal scarring (P 0.05. Similarly, there was no statistically significant difference of frequency of renal scarring among the different age groups (P >0.05. We conclude that recurrences of UTI and VUR severity are significant risk factors for renal scarring in children with VUR. Therefore, identification of VUR at an early age may offer the opportunity to prevent episodes of UTI and possible formation of renal scars that may result in end-stage renal failure.

  2. Ranitidine and placebo in the treatment of reflux oesophagitis. A double-blind randomized trial.

    Science.gov (United States)

    Goy, J A; Maynard, J H; McNaughton, W M; O'Shea, A

    1983-11-26

    A study was carried out to assess the effectiveness of ranitidine in the short-term treatment of reflux oesophagitis. In a double-blind randomized trial of 37 outpatients with symptomatic, endoscopically proven, moderate or severe reflux oesophagitis, 18 patients received ranitidine (150 mg twice a day) and 19 patients received identical-looking placebo tablets for a period of six weeks. Clinical, laboratory, and endoscopic assessments were made initially, and at the end of six weeks. Two patients withdrew during the trial. Endoscopic evidence of improvement was found in 15 of 17 ranitidine-treated and in five of 18 placebo-treated patients. This difference was significant (P less than 0.01). Antacid consumption was significantly lower in the ranitidine-treated group (P less than 0.01). Improvement in histological findings, and the relief of retrosternal pain, regurgitation, dysphagia, and epigastric pain did not achieve levels of statistical significance. No adverse clinical or laboratory changes occurred in patients in either group. It is concluded that, as judged by endoscopic evidence, ranitidine is an effective drug for the short-term treatment of reflux oesophagitis.

  3. Neutronic analysis of the 1D and 1E banks reflux detection system

    Energy Technology Data Exchange (ETDEWEB)

    Blanchard, A.

    1999-12-21

    Two H Canyon neutron monitoring systems for early detection of postulated abnormal reflux conditions in the Second Uranium Cycle 1E and 1D Mixer-Settle Banks have been designed and built. Monte Carlo neutron transport simulations using the general purpose, general geometry, n-particle MCNP code have been performed to model expected response of the monitoring systems to varying conditions.The confirmatory studies documented herein conclude that the 1E and 1D neutron monitoring systems are able to achieve adequate neutron count rates for various neutron source and detector configurations, thereby eliminating excessive integration count time. Neutron count rate sensitivity studies are also performed. Conversely, the transport studies concluded that the neutron count rates are statistically insensitive to nitric acid content in the aqueous region and to the transition region length. These studies conclude that the 1E and 1D neutron monitoring systems are able to predict the postulated reflux conditions for all examined perturbations in the neutron source and detector configurations. In the cases examined, the relative change in the neutron count rates due to postulated transitions from normal {sup 235}U concentration levels to reflux levels remain satisfactory detectable.

  4. Changing epidemiology of gastroesophageal reflux disease in the Asian-Pacific region: an overview.

    Science.gov (United States)

    Goh, K L

    2004-09-01

    Gastroesophageal reflux disease (GERD) is a common disease in the West, which now appears to be also increasing in prevalence in the Asian Pacific region. The reasons for this changing epidemiology are two-fold: an increased awareness among doctors and patients, and/or a true increase in the prevalence of the disease. Prevalence rates of reflux esophagitis (RE) of up to 16% and prevalence of GERD symptoms of up to 9% have been reported in the Asian population. However, the frequency of strictures and Barrett's esophagus remain very low. Non-erosive reflux disease (NERD) appears to be the most common form of GERD among Asian patients accounting for 50-70% of cases with GERD. Among Asian patients differences can also be discerned among different ethnic groups. For example, in Malaysia where a multiracial society exists, RE is significantly more common among Indians compared to Chinese and Malays whereas NERD is more frequently seen in the Indian and Malays compared to the Chinese. The reasons for these differences are not known but may indicate both genetic factors and environmental factors peculiar to the particular racial group. GERD has also been increasing in the region demonstrating a time-lag phenomenon compared to the West. Differing predisposition to GERD among different ethnic groups would mean that such an increase would be more prominent among certain racial groups.

  5. [Prolonged esophageal pH monitoring utilization in the diagnosis of pathologic reflux in neonates

    Science.gov (United States)

    Mezzacappa, M A; Collares, E F

    1999-01-01

    OBJECTIVES: To present indications and results of prolonged esophageal pH monitoring in diagnosing pathologic gastroesophageal reflux in newborns during their stay in the neonatal unit. METHODS: This retrospective descriptive-analytical study of 85 prolonged esophageal pH monitoring in neonates was performed, between October 1995 and March 1998, in a tertiary intensive care unity. A Digitrapper MKIII device, pH probes with one or two channels, and antimony electrodes were utilized. The probe was placed 3 cm above the gastroesophageal junction. RESULTS: The main indications of this esophageal pH study were hypoxemia episodes demanding supplemental oxygen, and caffeine resistant apnea. The means -/+ SD of birth-weight and gestational age in the patients evaluated were, respectively, 1,204-/+460 g and 30.5 -/+ 2.9 weeks. There was no statistical difference observed in newborns with and without pathologic gastroesophageal reflux according to clinical manifestations and monitoring conditions. Forty-eight newborns (56.4%) presented 17.6-/+9.1% of the whole examination time with a pH below 4. Of these patients, 31.1% presented birth-weight below 1,000 g. Duodenogastroesophagic was diagnosed in two cases. Of the studied premature with chronic lung disease, 66.7% presented pathologic reflux. CONCLUSION: Prolonged pH esophageal monitoring is helpful in the differential diagnosis of the unspecific and very frequent clinic manifestations in very low birth-weight infants.

  6. Influence of halothane, isoflurane, and sevoflurane on gastroesophageal reflux during anesthesia in dogs.

    Science.gov (United States)

    Wilson, Deborah V; Boruta, Daniel T; Evans, A Tom

    2006-11-01

    To determine whether maintenance of anesthesia with halothane or sevoflurane is associated with a lower incidence of gastroesophageal reflux (GER) than the use of isoflurane in dogs undergoing orthopedic surgery. 90 dogs. Dogs were evaluated during elective orthopedic surgery. Dogs with a history of vomiting or that had received any drugs that would alter gastrointestinal tract function were excluded from the study. The anesthetic protocol used was standardized to include administration of acepromazine maleate and morphine prior to induction of anesthesia with thiopental. Dogs were allocated to receive halothane, isoflurane, or sevoflurane to maintain anesthesia. A sensor-tipped catheter was placed to measure esophageal pH during anesthesia. Gastroesophageal reflux was defined as an esophageal pH 7.5. 51 dogs had 1 or more episodes of acidic GER during anesthesia. Reflux was detected in 14 dogs receiving isoflurane, 19 dogs receiving halothane, and 18 dogs receiving sevoflurane. In dogs with GER, mean +/- SD time from probe placement to onset of GER was 36 +/- 65 minutes and esophageal pH remained surgery or moving a dog on or off the surgery table. Dogs that developed GER soon after induction of anesthesia were more likely to regurgitate. Maintenance of anesthesia with any of the 3 commonly used inhalant agents is associated with a similar risk for development of GER in dogs.

  7. Helicobacter pylori in the tonsillar tissue: a possible association with chronic tonsillitis and laryngopharyngeal reflux.

    Science.gov (United States)

    Siupsinskiene, N; Katutiene, I; Jonikiene, V; Janciauskas, D; Vaitkus, S

    2017-06-01

    To identify Helicobacter pylori infection in tonsillar tissue samples from patients undergoing tonsillectomy for chronic tonsillitis versus tonsillar hypertrophy, and to assess the possible relationships between H pylori and patients' sociodemographic data and laryngopharyngeal reflux. In this prospective study, 97 patients who underwent tonsillectomy were divided into the following 2 groups: patients with chronic tonsillitis (n = 62) and patients with tonsillar hypertrophy (control group; n = 35). H pylori infection in the tonsillar biopsy samples was identified using histochemical and rapid urease tests. The incidence of H pylori infection was significantly higher in the chronic tonsillitis group (56.5 per cent) compared to the control group (31.4 per cent). Similar findings were obtained for both subgroups of adults (68.6 vs 42.3 per cent) and children (40.7 vs 0.0 per cent). Significant relationships between a positive H pylori finding and laryngopharyngeal reflux related signs of vocal fold oedema, diffuse laryngeal oedema and hypertrophy of the posterior commissure were revealed. H pylori infection may be related to chronic tonsillitis and laryngopharyngeal reflux.

  8. Impact of hiatal hernia on histological pattern of non-erosive reflux disease

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    Lyratzopoulos Nikolaos

    2005-01-01

    Full Text Available Abstract Background Hiatus hernia (HH has major pathophysiological effects favoring gastroesophageal reflux and hence contributing to esophageal mucosa injury, especially in patients with severe gastroesophageal disease. However, prospective studies investigating the impact of HH on the esophageal mucosa in non-erosive reflux disease (NERD are lacking. This study evaluated the association between the presence of (HH and the histological findings in symptomatic patients with NERD. Methods Fifty consecutive patients with gastroesophageal reflux disease (GERD were enrolled. After conventional endoscopy, Lugol solution was applied and biopsy specimens were obtained. Histological parameters including basal zone hyperplasia, papillary length and cellular infiltration were evaluated. The chi-square test with Yates' correlation was used for comparing discrete parameters between groups. However, Fisher's exact probability test was used where the expected frequencies were lower than 5. Wilcoxon's test for unpaired samples was preferred in cases of semi-quantitative parameters. Results The presence of HH along with more severe findings (0.01 P P Conclusion The presence of HH is correlated with more severe endoscopy findings, and predisposes for severe histological abnormality in cases of NERD.

  9. Nissen fundoplication for gastro-oesophageal reflux disease: long-term results.

    Science.gov (United States)

    Luostarinen, M

    1995-01-01

    Since its introduction by Rudolph Nissen in 1956, fundoplication has become the most commonly used antireflux procedure. Following fundoplication the majority (80 to 90%) of the patients become symptomfree or have only mild and occasional reflux symptoms in the long run. With a short and loose fundic wrap postoperative dysphagia is not a clinical problem, providing that preoperative manometry shows adequate peristalsis. Flatus is increased after fundoplication, but rarely to a disturbing extent. Patients who have problems with flatus preoperatively are also prone to have complaints postoperatively. Bloating is decreased rather than increased after fundoplication. At endoscopy as intact seen fundic wrap (the main determinant of the long-term outcome) is observed in 70% to 80% of the cases 10 to 20 years after the operation. Oesophageal 24-hour pH-recording is normal and oesophagitis cured in similar number of patients. In conclusion, Nissen fundoplication gives effective cure of symptoms of gastro-oesophageal reflux disease and reliably corrects reflux oesophagitis. Postoperative adverse effects are rare and well tolerable and do not detract from the success of the operation in correctly selected patients.

  10. Reflux esophagitis triggered after Helicobacter pylori eradication: a noteworthy demerit of eradication therapy among the Japanese?

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    Katsunori eIijima

    2015-06-01

    Full Text Available In the February 2013 Revision of Insured Medical Treatment, bacterial eradication for all Helicobacter pylori-positive individuals in Japan was covered under the insurance scheme. However, reflux esophagitis is believed to occur in approximately 10% of Japanese patients who undergo eradication therapy. Hence, the risk of reflux esophagitis among such cases should be carefully considered, particularly in the treatment for H. pylori-positive patients who are otherwise healthy. The eradication of Helicobacter pylori in cases of H. pylori-positive gastritis markedly suppresses gastric inflammation, and inhibits gastric mucosal atrophy and its progression to intestinal metaplasia. In a long-term follow-up study (10-20 years, eradication treatment was found to reduce the risk of subsequent gastric cancer. However, the fact that eradication-induced reflux esophagitis could increase the long-term risk of Barrett’s esophagus and esophageal adenocarcinoma should also be considered in the Japanese population. Appropriate treatment with proton pump inhibitors should be taken into consideration for patients undergoing eradication therapy in clinical practice.

  11. [The treatment of reflux esophagitis in patients with a Helicobacter infection of the gastric mucosa].

    Science.gov (United States)

    Chakŭrski, I; Prodanova, M; Penkova, M; Todorova, K

    1999-01-01

    Among the pathogenetic mechanisms for the occurrence of gastroesophageal reflux disease, Helicobacter pylori infection is indicated. The conclusions are absolutely opposite. The object of our work was to assume ex juvantibus to what extent the eradication of the Helicobacter pylori infection would accelerate the healing of patients with reflux oesophagitis and would reduce the number of relapses. To investigation were submitted 42 patients with reflux oesophagitis with confirmed Helicobacter pylori infection, classified according to Savary-Miller. A group of 22 patients was treated 10 days with triple drug combination of omeprazole, amoxillin and metronidazol with the purpose of eradication of the infection, after which they continued with ranitidin up to 30 days, and a second group of 20 patients treated only with ranitidine for 30 days. The subjective complaints, endoscopic finding and present infection were followed up. A considerably higher number of recovered patients after eradication of the Helicobacter infection was established and the number of relapses for the six-month period of observation was considerably reduced.

  12. Managing peptic ulcer and gastroesophageal reflux disease in elderly Chinese patients – focus on esomeprazole

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    Tang RS

    2013-10-01

    Full Text Available Raymond SY Tang, Justin CY Wu Institute of Digestive Disease, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong Abstract: Peptic ulcer disease (PUD and gastroesophageal reflux disease (GERD are not uncommon in elderly patients. Clinical presentations of these acid-related disorders may be atypical in the geriatric population. Older individuals are at increased risk for poor outcomes in complicated PUD and for development of GERD complications. Multiple risk factors (eg, Helicobacter pylori [HP], use of nonsteroidal anti-inflammatory drugs [NSAIDs], aspirin contribute to the development of PUD. Recent data has shown that HP-negative, NSAID-negative idiopathic peptic ulcers are on the rise and carry a higher risk of recurrent ulcer bleeding and mortality. Effective management of PUD in the geriatric population relies on identification and modification of treatable risk factors. Elderly patients with GERD often require long-term acid suppressive therapy. Proton pump inhibitors (PPI including esomeprazole are effective in the treatment of reflux esophagitis, maintenance of GERD symptomatic control, and management of PUD as well as its complications. Potential safety concerns of long-term PPI use have been reported in the literature. Clinicians should balance the risks and benefits before committing elderly patients to long-term PPI therapy. Keywords: elderly patients, peptic ulcer disease, gastroesophageal reflux disease, proton pump inhibitor, esomeprazole

  13. Correlation between glycemic variability and gastroesophageal reflux in adolescentswith type 1 diabetes mellitus

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    I L Alimova

    2013-03-01

    Full Text Available Aims. To estimate an impact of glycemic variability on the development of gastroesophageal reflux disease (GERD in adolescents with type 1 diabetes mellitus (T1DM.Materials and methods. We enrolled 33 patients with T1DM aged from 12 to 17 years. 24-h pH-monitoring was performed with “Gas- troskan 24” system (Istok-Sistema, Fryazino; 24-h continuous glucose monitoring utilized CGMS MMT-7310 (Medtronic Minimed, USA with subsequent night-time analysis.Results. As compared to stable night-time glycemia controls (SD <2.0 mmol/L, patients with higher night-time glycemic variability (SD>2.0 mmol/L showed longer period of esophageal acidification (17% [2–58]; p<0.001, higher incidence of acid reflux events with duration above 5 min (2 ev. [1-10]; p<0.001, longer period of most protracted acid reflux event (63 min [5–132]; p<0.001, as well as higher prevalence of pathologic acid GER events (76.4%; χ2=17.11; p<0.001 during night-time. Increase in glycemic in- stability positively correlated with incidence and severity of acid GER events. 6-8 months follow-up supported these findings. Conclusion. Glycemic variability in adolescents with T1DM is a significant risk factor for development of GERD with hypomotor dys- function according to pH-monitoring.

  14. Comparison of Medical and Voice Therapy for reflux Laryngitis Based on Acoustic and Laryngeal Characteristics

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    Abbas Dehestani Ardakani

    2011-12-01

    Full Text Available Background and Aim: Reflux laryngitis is extremely common among patients with voice disorder. Medical therapy approaches are not efficient enough. The main goal of this study is to assess the acoustic and laryngeal characteristics of patients with dysphonia before and after medical or voice therapy, and to evaluate the effectiveness of each.Methods: In this retrospective study, 16 reflux laryngitis patients were assessed. Five received complete voice therapy, tow ceased voice therapy and nine received medication. Perceptual voice evaluation was performed by a speech-language pathologist, the severity of voice problem was calculated, based on the affected acoustic and laryngeal characteristics pre- and post-treatment.Results: Post-treatment evaluation in patients who received complete voice therapy indicates 80 percent improvement in the severity of disorder and 100 percent improvement in the perceptual voice evaluation. After medical therapy, we observed that voice disorder and perceptual voice evaluation are improved 44 and 66 percent respectively. The improvement was statistically significant in both treatment approaches: complete voice therapy (P=0.039 and medical therapy (p=0.017.Conclusion: In patients with reflux laryngitis, most acoustic and laryngeal characteristics were normal and satisfying after the treatment. It can be concluded that the proficiency of voice therapy in improving the acoustic and laryngeal characteristics is comparable to medical therapy

  15. Impact of gastro-oesophageal reflux on microRNA expression, location and function

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    Smith Cameron M

    2013-01-01

    Full Text Available Abstract Background Ulceration of the oesophageal squamous mucosa (ulcerative oesophagitis is a pathological manifestation of gastro-oesophageal reflux disease, and is a major risk factor for the development of Barrett’s oesophagus. Barrett’s oesophagus is characterised by replacement of reflux-damaged oesophageal squamous epithelium with a columnar intestinal-like epithelium. We previously reported discovery of microRNAs that are differentially expressed between oesophageal squamous mucosa and Barrett’s oesophagus mucosa. Now, to better understand early steps in the initiation of Barrett’s oesophagus, we assessed the expression, location and function of these microRNAs in oesophageal squamous mucosa from individuals with ulcerative oesophagitis. Methods Quantitative real-time PCR was used to compare miR-21, 143, 145, 194, 203, 205 and 215 expression levels in oesophageal mucosa from individuals without pathological gastro-oesophageal reflux to individuals with ulcerative oesophagitis. Correlations between microRNA expression and messenger RNA differentiation markers BMP-4, CK8 and CK14 were analyzed. The cellular localisation of microRNAs within the oesophageal mucosa was determined using in-situ hybridisation. microRNA involvement in proliferation and apoptosis was assessed following transfection of a human squamous oesophageal mucosal cell line (Het-1A. Results miR-143, miR-145 and miR-205 levels were significantly higher in gastro-oesophageal reflux compared with controls. Elevated miR-143 expression correlated with BMP-4 and CK8 expression, and elevated miR-205 expression correlated negatively with CK14 expression. Endogenous miR-143, miR-145 and miR-205 expression was localised to the basal layer of the oesophageal epithelium. Transfection of miR-143, 145 and 205 mimics into Het-1A cells resulted in increased apoptosis and decreased proliferation. Conclusions Elevated miR-143, miR-145 and miR-205 expression was observed in

  16. Markers of Chronic Kidney Disease in Children with Obstructive Uropathy or Vesicoureteral Reflux

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    E. M. Chichuga

    2015-01-01

    Full Text Available Background. Identification of markers of chronic kidney disease and its progression in the early stages of the disease is important, however, the most of research concerns late (3–5 stages of the disease.Objective. Identification of the markers of chronic kidney disease (CKD and its progression in the early stages of the disease in children with obstructive uropathy and vesicoureteral reflux.Methods. Prospective follow-up (for 5 years of 92 children with obstructive and reflux uropathies (1st to 4th stages of CKD. All patients had episodes of urinary tract infections, mostly pyelonephritis, minimum once a year.Results. High prevalence of proteinuria (60.9%, reduced renal functional reserve (88.7% and disorders of cortical renal blood flow (by Doppler Color Flow Imaging (69.6% were found in children with 1st stage of CKD. Groups of children with proteinuria and a reduced renal functional reserve had a higher level of systolic and diastolic blood pressure in comparison with the patients without proteinuria and the reduced renal functional reserve (p < 0.05. In patients with 2–4 stages of CKD the glomerular filtration rate (GFR correlated with atypical flora in the etiology of urinary tract infections (rpb = 0.66; n = 23; p = 0.0006, sex (boys had lower levels of GFR, rpb = 0.61; n = 23; p = 0.001, bilateral renal abnormalities (rpb = -0.53; n = 23; p = 0.009 the level of hemoglobin (r = 0.45; n = 23; p = 0.02. Conclusion. Markers of CKD of children with obstructive and reflux uropathies are: proteinuria, arterial hypertension, reduction of renal functional reserve and the impaired cortical renal blood flow (by Doppler Color Flow Imaging. The importance of arterial hypertension and proteinuria as markers of the progression of CKD of children with urinary tract obstruction and vesicoureteral reflux was confirmed. Additional markers for the progression of CKD in children with obstructive and reflux uropaties might be: male sex

  17. The influence of Helicobacter pylori infection on the occurrence of gastroesophageal reflux in patients with renal insufficiency

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    Stolić Radojica

    2007-01-01

    Full Text Available Introduction/Aim. Gastric acid is a key factor in the pathophysiology of gastroesophageal reflux disease. A plausible mechanism by which the Helicobacter pylori infection might protect against reflux disease is by its propensity to produce atrophic gastritis. The aim of the study was to establish the influence of Helicobacter pylori infection on the occurrence of gastroesophageal reflux in patients with different stages of renal insufficiency. Methods. The examination was organized as a prospective, clinical study and involved 68 patients − 33 patients with preterminal stage of renal failure and 35 patients with terminal renal insufficiency. Due to dyspeptic difficulties, in all the patients there was preformed upper esophagogastroscopy and Helicobacter pylori infection was found by ureasa test. Results. The patients with preterminal renal insufficiency were significantly younger than patients with terminal renal failure (53.4±11.1 vs. 65.4±12.3 years; p = 0.014. There was found a statistically significant difference between the groups in Helicobacter pylori infection (p = 0.03, hiatal hernia (p = 0.008, gastroesophageal reflux disease (p = 0.007, and duodenal ulcer (p = 0.002. Using the multiple non-parametric correlative analysis there was confirmed a negative correlation between Helicobacter pylori infection and gastro-esophageal reflux disease (Kendal τB = -0.523; p = 0.003 and hiatal hernia (Kendal τB = 0.403; p = 0.021, while there was found a positive correlation between gastro-esophageal reflux disease and hiatal hernia (Kendal τB = 0.350; p = 0.044. Conclusion. Helicobacter pylori infection is a significant protective parameter of the incidence of gastro-esophageal reflux disease in patients with both pre-terminal and terminal renal insufficiency.

  18. Residence of liquids in the infra-junctional portion of the proximal stomach in patients with gastroesophageal reflux disease

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    Barbieri C.L.A.

    2005-01-01

    Full Text Available Patients with gastroesophageal reflux disease may have disturbances of gastric motility, which could play a role in the pathophysiology of the disease. Recent studies have suggested that the gastric region just below the gastroesophageal junction may have a distinct physiological behavior. We determined whether patients with gastroesophageal reflux disease have abnormal residence of food in the infra-junctional portion of the stomach after ingesting a liquid nutrient meal. Fasted adult patients with reflux disease (N = 11 and healthy volunteers (N = 10 ingested a liquid meal (320 ml; 437 kcal labeled with 99m technetium-phytate and their total gastric emptying half-time and regional emptying from the stomach infra-junctional region were determined. In 8 patients, episodes of postprandial acidic reflux to the esophagus were measured for 2 h using pH monitoring. There were no differences between reflux patients and controls regarding total gastric emptying time (median: 68 min; range: 39-123 min vs 65 min and 60-99 min, respectively; P > 0.50. Food residence in the infra-junctional area was similar for patients and controls: 23% (range: 20-30 vs 27% (range: 19-30%; P = 0.28 and emptying from this area paralleled total gastric emptying (Rs = 0.79; P = 0.04. There was no correlation between residence of food in the infra-junctional area and episodes of gastroesophageal reflux (Rs = 0.06; P = 0.88. We conclude that it is unlikely that regional motor disturbances involving the infra-junctional region of the stomach play a relevant role in the pathogenesis of acidic gastroesophageal reflux.

  19. Background factors of reflux esophagitis and non-erosive reflux disease: a cross-sectional study of 10,837 subjects in Japan.

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    Chihiro Minatsuki

    Full Text Available BACKGROUND: Despite the high prevalence of gastroesophageal reflux disease (GERD, its risk factors are still a subject of controversy. This is probably due to inadequate distinction between reflux esophagitis (RE and non-erosive reflux disease (NERD, and is also due to inadequate evaluation of adjacent stomach. Our aim is therefore to define background factors of RE and NERD independently, based on the evaluation of Helicobacter pylori infection and gastric atrophy. METHODS: We analyzed 10,837 healthy Japanese subjects (6,332 men and 4,505 women, aged 20-87 years who underwent upper gastrointestinal endoscopy. RE was diagnosed as the presence of mucosal break, and NERD was diagnosed as the presence of heartburn and/or acid regurgitation in RE-free subjects. Using GERD-free subjects as control, background factors for RE and NERD were separately analyzed using logistic regression to evaluate standardized coefficients (SC, odds ratio (OR, and p-value. RESULTS: Of the 10,837 study subjects, we diagnosed 733 (6.8% as RE and 1,722 (15.9% as NERD. For RE, male gender (SC = 0.557, OR = 1.75, HP non-infection (SC = 0.552, OR = 1.74, higher pepsinogen I/II ratio (SC = 0.496, OR = 1.64, higher BMI (SC = 0.464, OR = 1.60, alcohol drinking (SC = 0.161, OR = 1.17, older age (SC = 0.148, OR = 1.16, and smoking (SC = 0.129, OR = 1.14 are positively correlated factors. For NERD, HP infection (SC = 0.106, OR = 1.11, female gender (SC = 0.099, OR = 1.10, younger age (SC = 0.099, OR = 1.10, higher pepsinogen I/II ratio (SC = 0.099, OR = 1.10, smoking (SC = 0.080, OR = 1.08, higher BMI (SC = 0.078, OR = 1.08, and alcohol drinking (SC = 0.076, OR = 1.08 are positively correlated factors. Prevalence of RE in subjects with chronic HP infection and successful HP eradication denotes significant difference (2.3% and 8.8%; p<0.0001, whereas that of NERD shows no difference (18.2% and 20.8%; p = 0.064. CONCLUSIONS: Significantly associated factors of NERD are considerably

  20. Evaluation of laryngopharyngeal reflux in pediatric patients with asthma using a new technique of pharyngeal pH-monitoring.

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    Banaszkiewicz, A; Dembinski, L; Zawadzka-Krajewska, A; Dziekiewicz, M; Albrecht, P; Kulus, M; Radzikowski, A

    2013-01-01

    There is a debate about the association between asthma and gastroesophageal and/or laryngopharyngeal reflux (LPR). Pharyngeal pH-monitoring is a new technique that allows a physician to assess whether reflux passes the upper esophageal sphincter barrier. The aim of the study was to assess the prevalence of LPR in children with difficult-to-treat asthma. The present study was an open, prospective one. A total of 21 subjects of the mean age 12.7 years were enrolled in the study. All children were asked to fill out a Reflux Symptoms Index questionnaire and a 24-h pharyngeal pH monitoring was performed, using the Dx-pH Measurement System. The LPR was diagnosed in 13 (61.9%) children. There was a positive correlation between LPR diagnosis and the degree of asthma control. The LPR was more frequent in children treated with a higher than lower doses of fluticasone (p = 0.019, OR = 17.3) and in those using montelukast compared with non-users (p = 0.008, OR = 19.0). The mean Reflux Symptoms Index score was almost twice greater in children with LPR than in those without it (13.2 vs. 6.8, respectively, p = 0.003). We conclude that the prevalence of laryngopharyngeal reflux in children with difficult-to-treat asthma is substantial.

  1. Associations of anterior accessory or thigh posterior tributary and great saphenous reflux patterns in early stages of chronic venous valvular insufficiency

    Directory of Open Access Journals (Sweden)

    Carlos Alberto Engelhorn

    2014-07-01

    Full Text Available Varicose veins are a common disorder. Extensive ultrasound (US mapping of lower extremity chronic venous valvular insufficiency includes the great saphenous vein (GSV, anterior accessory saphenous vein (AASV and thigh posterior tributary to GSV such as the posterior accessory saphenous vein (PTSV, PASV. The aim of this study was to determine associations between GSV-AASV-PTSV (including PASV reflux in a specific sample population of Southern Brazilian women, mostly euro descendents, with telangiectasias, reticular veins, varices and/or intermittent edema. US performed in 1016 extremities of 513 women, 43±18 (18-81 years old were included. Women with previous venous thrombosis, surgery, suspicion of pelvic congestion syndrome, and men were excluded. Small saphenous vein and related thigh veins were excluded from analysis. GSV-AASV-PTSV reflux patterns were analyzed; prevalence was compared using χ2 statistics. Reflux prevalence in AASV and/or thigh PTSV was 5.8% (59/1016: 1.3% at PTSV (n=13 and 4.5% at AASV (n=46, significantly lower than GSV reflux: 72% (n=727 (P<0.001. AASV and/or PTSV reflux was associated with GSV reflux (81%, n=48/59; common pattern was diffuse reflux, starting at AASV/PTSV saphenous junctions (56%, n=33/59; otherwise, short, non-diffuse reflux was noted in part of the AASV/PTSV evaluated. Isolated AASV or PTSV reflux was rare (1%, n=11/1016: 9 at the AASV, and 2 at the PTSV. US mapping of AASV/PTSV in early stages of disease, in women without pelvic congestion syndrome, increased reflux detection by 1%, and improved definition of reflux patterns in about 6% of the extremities.

  2. 隐性胰胆反流75例分析%Occult pancreatobiliary reflux

    Institute of Scientific and Technical Information of China (English)

    钟征翔; 邬万新; 赵凤庆; 邹洪兴; 俞方荣; 周俊; 许浏; 徐鹿平; 孙建良

    2008-01-01

    目的 研究隐性胰胆反流的发生率及其对胆囊上皮不典型增生和癌变的影响.方法 对2006年7月至2008年2月期间择期行胆道手术或行ERCP检查的956例患者常规作胆汁淀粉酶测定,对手术切除胆囊标本行病理检查,观察不典型增生和癌变的发生率.结果 754例患者中发现隐性胰胆反流75例,发生率为9.9%.反流组和对照组胆汁淀粉酶分别为(7701±20 378)IU/L和(16±51)IU/L,差异有统计学意义(P<0.01).反流组中胆囊癌及不典型增生发生率分别为3.4%(2/58)和31.0%(18/58),均高于对照组(P<0.05).反流组中伴有癌变和不典型增生病例的胆汁淀粉酶值高于不伴有癌变和不典型增生的病例(9194±10 399 IU/L vs.2388±2745 IU/L,P<0.01).结论 在胆胰管汇合正常者中隐性胰胆反流是客观存在的,它促进了胆囊不典型增生和癌变的发生.%Objective To investigate the incidence of occult pancreatobiliary reflux and to evaluate its relation to gallbladder epithelial dysplasia and cancer. Methods From July 2006 to Feb 2008,956 cases underwent selective biliary procedure or preoperative endoscopic retrograde cholangiopanereatography (ERCP), bile was collected and amylase was measured. All removed gallbladders were pathologically examined for dysplasia and cancer. Results Occult pancreatobihary reflux was found in 75 of 754 patients in this study, with an incidence of 9. 9%. The biliary amylase values in the patients with occult pancreatobiliary reflux and in controls were 7701±20 378 IU/L and 16±51 IU/L, respectively ( P <0. 01 ).Gallbladder dysplasia and cancer were found in 31.0% and 3.4% of the patients with occult pancreatobiliaryreflux, respectively, and both were higher than those in the patients without pancreatobiliary reflux ( P <0. 05). In the patients with occult pancreatobiliary reflux, the biliary amylase level with gallbladder dysplasia or cancer was 2388 ± 2745 IU/L and was higher than those without gallbladder

  3. The effects of tegaserod (HTF 919) on oesophageal acid exposure in gastro-oesophageal reflux disease.

    Science.gov (United States)

    Kahrilas, P J; Quigley, E M; Castell, D O; Spechler, S J

    2000-11-01

    Tegaserod (HTF 919), a 5-HT4 receptor partial agonist, has prokinetic effects that might be useful in decreasing acid reflux in gastro-oesophageal reflux disease (GERD). To investigate the potential clinical utility of tegaserod in GERD, a five-period crossover study (balanced Latin square) was designed to evaluate the efficacy of 4 b.d. doses of tegaserod vs. placebo. Four-hour manometry (1 h fasting and 3 h postprandial) with continuous recording of lower oesophageal sphincter pressure and distal oesophageal pH, was performed at the end of each 2-week treatment period in 19 patients with mild-to-moderate GERD. Recordings were scored for mean lower oesophageal sphincter pressure, number of transient lower oesophageal sphincter relaxations, and distal oesophageal acid exposure. Tegaserod (1 mg/day and 4 mg/day) caused a more than 50% decrease in acid exposure in the postprandial period in patients with abnormal acid exposure, although only the 1 mg/day tegaserod treatment elicited statistically significant decreasing (P < 0.05) for the entire treatment group (percentage time for which pH < 4: placebo=13%; 1 mg/day dose=5%; 4 mg/day dose=8%). A decreased number of reflux episodes was demonstrated with both the 1 mg/day and 4 mg/day tegaserod doses. There was no apparent effect on mean lower oesophageal sphincter pressure, whilst transient lower oesophageal sphincter relaxations frequency decreased in the 1-2.5 h post-dose. Tegaserod in a dose of 1 mg/day causes a significant decrease in postprandial oesophageal acid exposure. The reduction in oesophageal acid exposure with tegaserod treatment may result from enhanced oesophageal acid clearance, improved gastric emptying, and/or reduced transient lower oesophageal sphincter relaxations.

  4. Halimeter ppb Levels as the Predictor of Erosive Gastroesophageal Reflux Disease.

    Science.gov (United States)

    Kim, Jung Gon; Kim, Yoon Jae; Yoo, Seung Hee; Lee, So Jung; Chung, Jun Won; Kim, Min Ho; Park, Dong Kyun; Hahm, Ki-Baik

    2010-09-01

    In a previous issue published in Gut and Liver, we found that erosive changes in the esophagogastroduodenal mucosa were strongly correlated with increased levels of volatile sulfur-containing compounds (VSC), suggesting that halitosis could be a symptom reflecting the erosive status of the upper gut mucosa. Together with other studies showing a possible association between halitosis and gastroesophageal reflux disease (GERD), under the premise that halitosis could be one of extraesophageal manifestations of erosive GERD (ERD), we investigated the significance of Halimeter ppb levels on ERD compared to non-erosive gastroesophageal reflux disease (NERD). Subjects were assigned to the NERD group if there was no evidence of esophageal erosive changes on endoscopy, despite reflux symptoms, and to the ERD group if they had GERD A, B, C, or D (according to the Los Angeles classification). The VSC levels were measured in all patients with either a Halimeter (before endoscopy) or by gas chromatography of the gastric juices aspirated during endoscopy. The VSC level differed significantly between the NERD and ERD groups (p24 kg/m(2) was significantly associated with ERD, there was no correlation with Halimeter ppb levels. Minimal-change lesions exhibited the highest VSC levels, signifying that minimal change lesions can be classified as ERD based on our finding that halimeter ppb levels were descrimitive of erosive change. Erosive changes in the esophageal mucosa were strongly associated with VSC levels, supporting the hypothesis that halitosis can be a potential biomarker for the discrimination between ERD and NERD, reflecting the presence of erosive change in the lower esophagogastric junction.

  5. The Incidence of Lesions of Different Systems and Organs in Children with Gastroesophageal Reflux Disease

    Directory of Open Access Journals (Sweden)

    O.Z. Gnateyko

    2016-11-01

    Full Text Available Introduction. Gastroesophageal reflux disease (GERD — a chronic recurrent disease caused by the disturbances of the motor-evacuating function of the gastroesophageal zone and is characterized by spontaneous and/or regular reflux of the gastric or duodenal fluid that leads to the damage of the distal part of the esophagus. GERD is one of the most frequent diseases that affect the esophagus. Taking into the account the huge amount of the causes, which may lead to GERD, its etiology is still not well defined, and the contribution of each factor requires further analysis. The aim of the study was to analyze the peculiarities and the incidence of GERD association with other organ and system pathologies.Materials and methods. Clinical analysis of 73 cases of GERD in school-aged children has been performed. The incidence of GERD combination with other system and organ pathologies has been evaluated using thorough anamnesis and patient’s medical history analysis. Results. In 66 % of children with GERD, the association of this pathology with other digestive tract diseases has been revealed, in 50.7 % — with lesions of musculoskeletal system, in 12.3 % — with urinary tract pathology. Almost one third of children with GERD suffered from congenital defects of different organs and systems, such as dolichosigmoid, mitral valve prolapse, nephroptosis/rotation of the kidneys/pyelectasis/bladder-pelvic reflux, gallbladder deformities. The article presents the analysis of a clinical case of the combination of cardiovascular, digestive and urinary lesions that enables us to assume the presence of possible common etiology factor of the diagnosed diseases. The analyzed data regarding the association of GERD with other organ and system pathologies, as well as the results of other research groups indicate a probable common component in their etiology. The common factor in the described cases of the combination of pathologies may be a violation of the

  6. Gene expression in rats with Barrett's esophagus and esophageal adenocarcinoma induced by gastroduodenoesophageal reflux

    Institute of Scientific and Technical Information of China (English)

    Peng Cheng; Jun Gong; Tao Wang; Jie Chen; Gui-Sheng Liu; Ru Zhang

    2005-01-01

    AIM: To study the different gene expression profiles in rats with Barrett's esophagus (BE) and esophageal adenocarcinoma (EA) induced by gastro-duodenoesophageal reflux.METHODS: Esophagoduodenostomy was performed in 8-wk old Sprague-Dawley rats to induce gastro-duodenoesophageal reflux, and a group of rats that received sham operation served as control. Esophageal epithelial pathological tissues were dissected and frozen in liquid nitrogen immediately. The expression profiles of 4 096genes in EA and BE tissues were compared to normal esophagus epithelium in normal control (NC) by cDNA microarray.RESULTS: Four hundred and forty-eight genes in BE were more than three times different from those in NC, including 312 upregulated and 136 downregulated genes. Three hundred and seventy-seven genes in EA were more than three times different from those in NC, including 255upregulated and 142 downregulated genes. Compared to BE, there were 122 upregulated and 156 downregulated genes in EA. In the present study, the interested genes were those involved in carcinogenesis. Among them, the upregulated genes included cathepsin C, aminopeptidase M, arachidonic acid epoxygenase, tryptophan-2,3-dioxygenase, ubiquitin-conjugating enzyme, cyclic GMP-stimulated phosphodiesterase, tissue inhibitor of metalloproteinase-1, betaine-homocysteine methyltransferase, lysozyme, complement 4b binding protein,complement 9 protein, insulin-like growth factor binding protein, UDP-glucuronosyltransferase, tissue inhibitor of metalloproteinase-3, aldolase B, retinoid X receptor gamma, carboxylesterase and testicular cell adhesion molecule 1. The downregulated genes included glutathione synthetase, lecithin-cholesterol acyltransferase, p55CDC,heart fatty acid binding protein, cell adhesion regulator and endothelial cell selectin ligand.CONCLUSION: Esophageal epithelium exposed excessively to harmful ingredients of duodenal and gastric reflux may develop into BE and even EA gradually. The gene

  7. Scintigraphy in laryngopharyngeal and gastroesophageal reflux disease: a definitive diagnostic test?

    Science.gov (United States)

    Falk, Gregory L; Beattie, John; Ing, Alvin; Falk, S E; Magee, Michael; Burton, Leticia; Van der Wall, Hans

    2015-03-28

    To investigate the utility of scintigraphic studies in predicting response to laparoscopic fundoplication (LF) for chronic laryngopharyngeal reflux symptoms. Patients with upper aero-digestive symptoms that remained undiagnosed after a period of 2 mo were studied with conventional pH and manometric studies. Patients mainly complained of cough, sore throat, dysphonia and globus. These patients were imaged after ingestion of 99m-technetium diethylene triamine pentaacetic acid. Studies were quantified with time activity curves over the pharynx, upper and lower oesophagus and background. Late studies of the lungs were obtained for aspiration. Patients underwent LF with post-operative review at 3 mo after surgery. Thirty four patients (20 F, 14 M) with an average age of 57 years and average duration of symptoms of 4.8 years were studied. Twenty four hour pH and manometry studies were abnormal in all patients. On scintigraphy, 27/34 patients demonstrated pharyngeal contamination and a rising or flat pharyngeal curve. Lung aspiration was evident in 50% of patients. There was evidence of pulmonary aspiration in 17 of 34 patients in the delayed study (50%). Pharyngeal contamination was found in 27 patients. All patients with aspiration showed pharyngeal contamination. In the 17 patients with aspiration, graphical time activity curve showed rising activity in the pharynx in 9 patients and a flat curve in 8 patients. In those 17 patients without pulmonary aspiration, 29% (5 patients) had either a rising or flat pharyngeal graph. A rising or flat curve predicted aspiration with a positive predictive value of 77% and a negative predictive value of 100%. Over 90% of patients reported a satisfactory symptomatic response to LF with an acceptable side-effect profile. Scintigraphic reflux studies offer a good screening tool for pharyngeal contamination and aspiration in patients with gastroesophageal reflux disease.

  8. Study on the preventive effects of different drugs on reflux esophagitis in rats

    Institute of Scientific and Technical Information of China (English)

    WANG Tao; GONG Jun; CHEN Jie; CHENG Peng; CHANG Yin; WANG Jin-hai

    2004-01-01

    Objective: To observe the damage of mixed reflux to the rat esophageal mucosa, and investigate the preventive effects of cisapride, nabumetone and hydrotalcite on the damaged esophageal mucosa. Methods: Three hundred sixty-eight Sprague-Dawley rats were treated as esophagoduodenostomy and divided into four groups in random. Group Y: operation + saline as positive controls; Group P: operation + cisapride; Group R: operation + nabumetone; Group D: operation + hydrotalcite. Different drugs were perfused in the 1 st week after operation. The lesions of esophageal mucosa were observed in the 5th, 9th, 13th, 17th, 22nd, 28th, 35th and 40th week respectively, and evaluated the preventive effects of these drugs. Results: The lesions of esophageal mucosa in group Y were more severe than other three groups in different time (P < 0.05), and the incidence of Barrett's esophagus(BE), severe atypical hyperplasia and esophageal adenocarcinoma (EAC) in group Y were higher than others. After 22 weeks, the lesions in group P were more severe than group R and D, and there were obvious differences in different time ( P < 0.05); but the incidence of BE, severe atypical hyperplasia and EAC in group P had no significant difference with group R and group D( P > 0.05). Conclusion: BE, severe atypical hyperplasia and EAC could occur because of severe reflux esophagitis for a long term. Cisapride, nabumetone and hydrotalcite could reduce mucosa injury in reflux esophagitis and resist the development of BE, severe atypical hyperplasia and EAC.In addition, the curative effects of nabumetone and hydrotalcite were better than cisapride.

  9. Gastroesophageal reflux leads to esophageal cancer in a surgical model with mice

    Directory of Open Access Journals (Sweden)

    Chen Xiaoxin

    2009-07-01

    Full Text Available Abstract Background Esophago-gastroduodenal anastomosis with rats mimics the development of human Barrett's esophagus and esophageal adenocarcinoma by introducing mixed reflux of gastric and duodenal contents into the esophagus. However, use of this rat model for mechanistic and chemopreventive studies is limited due to lack of genetically modified rat strains. Therefore, a mouse model of esophageal adenocarcinoma is needed. Methods We performed reflux surgery on wild-type, p53A135V transgenic, and INK4a/Arf+/- mice of A/J strain. Some mice were also treated with omeprazole (1,400 ppm in diet, iron (50 mg/kg/m, i.p., or gastrectomy plus iron. Mouse esophagi were harvested at 20, 40 or 80 weeks after surgery for histopathological analysis. Results At week 20, we observed metaplasia in wild-type mice (5%, 1/20 and p53A135V mice (5.3%, 1/19. At week 40, metaplasia was found in wild-type mice (16.2%, 6/37, p53A135V mice (4.8%, 2/42, and wild-type mice also receiving gastrectomy and iron (6.7%, 1/15. Esophageal squamous cell carcinoma developed in INK4a/Arf+/- mice (7.1%, 1/14, and wild-type mice receiving gastrectomy and iron (21.4%, 3/14. Among 13 wild-type mice which were given iron from week 40 to 80, twelve (92.3% developed squamous cell carcinoma at week 80. None of these mice developed esophageal adenocarcinoma. Conclusion Surgically induced gastroesophageal reflux produced esophageal squamous cell carcinoma, but not esophageal adenocarcinoma, in mice. Dominant negative p53 mutation, heterozygous loss of INK4a/Arf, antacid treatment, iron supplementation, or gastrectomy failed to promote esophageal adenocarcinoma in these mice. Further studies are needed in order to develop a mouse model of esophageal adenocarcinoma.

  10. Cell proliferation of esophageal squamous epithelium in erosive and non-erosive reflux disease

    Institute of Scientific and Technical Information of China (English)

    Carlo Calabrese; Davide Trerè; Lorenzo Montanaro; Giuseppina Liguori; Elisa Brighenti; Mauela Vici; Paolo Gionchetti; Fernando Rizzello; Massimo Campieri; Massimo Derenzini

    2011-01-01

    AIM: To elucidate cell proliferation in erosive reflux disease (ERD) and non-erosive reflux disease (NERD), we evaluated markers in squamous epithelial cells. METHODS: Thirty-four consecutive patients with gastroesophageal- reflux-disease-related symptoms (21 NERD and 13 ERD) were evaluated for the enrolment into the study. All patients underwent 24-h pH monitoring, standard endoscopy, and biopsy for histological evaluation. The expression of cyclins D and A was evaluated by real-time reverse transcription polymerase chain reaction (RT-PCR) from isolated epithelial cells. In all samples, analysis of the isolated cell population revealed the presence of epithelial cells only. RESULTS: Real-time RT-PCR showed that, in patients with ERD, the relative expression of cyclin D1 mRNA in esophageal epithelium was strongly decreased in comparison with NERD patients. The mean value of relative expression of cyclin D1 mRNA in NERD patients was 3.44 ± 1.9, whereas in ERD patients, it was 1.32 ± 0.87 (P = 0.011). Real-time RT-PCR showed that, in patients with ERD, relative expression of cyclin A mRNA in esophageal epithelium was decreased in comparison with that in NERD patients (2.31 ± 2.87 vs 0.66 ± 1.11). The mean bromodeoxyuridine labeling index in the NERD patients was 5.42% ± 1.68%, whereas in ERD patients, it was 4.3% ± 1.59%. CONCLUSION: We confirmed reduced epithelial proliferation in ERD compared with NERD patients, and that individuals who develop ERD are characterized by weaker epithelial cell proliferation.

  11. Influence of irritable bowel syndrome on treatment outcome in gastroesophageal reflux disease

    Institute of Scientific and Technical Information of China (English)

    Hubert M(o)nnikes; Robert C Heading; Holger Schmitt; Hubert Doerfler

    2011-01-01

    AIM: To investigate the influence of irritable bowel syndrome (IBS)-like symptoms on treatment outcomes with pantoprazole in gastroesophageal reflux disease (GERD) in a real life setting. METHODS: For this prospective, open-label, multinational, multicentre study, 1888 patients assessed by the investigators as suffering from GERD were recruited. The patients were additionally classified as with or without IBS-like symptoms at baseline. They were treated with pantoprazole 40 mg once daily and completed the Reflux Questionnaire? (ReQuest?) short version daily. Response rates and symptom scores were compared after 4 and 8 wk of treatment for subgroups defined by the subclasses of GERD [erosive(ERD) and non-erosive reflux disease (NERD)] and the presence of IBS-like symptoms. RESULTS: IBS-like symptoms were more prevalent in NERD than in ERD (18.3% vs 12.7%, P = 0.0015). Response rates after 4 and/or 8 wk of treatment were lower in patients with IBS-like symptoms than in patients without IBS-like symptoms in both ERD (Week 4: P < 0.0001, Week 8: P < 0.0339) and NERD (Week 8: P = 0.0088). At baseline, ReQuest? "lower abdominal complaints" symptom scores were highest in NERD patients with IBS-like symptoms. Additionally, these patients had the strongest symptom improvement after treatment compared with all other subgroups. CONCLUSION: IBS-like symptoms influence treatment outcome and symptom burden in GERD and should be considered in management. Proton pump inhibitors can improve IBS-like symptoms, particularly in NERD.

  12. Influence of irritable bowel syndrome on treatment outcome in gastroesophageal reflux disease

    Institute of Scientific and Technical Information of China (English)

    HubertM6nnikes; RobertCHeading; HolgerSchmitt; HubertDoerfler

    2011-01-01

    AIM: To investigate the influence of irritable bowel syndrome (IBS)-like symptoms on treatment outcomes with pantoprazole in gastroesophageal reflux disease (GERD) in a real life setting. METHODS: For this prospective, open-label, multinational, multicentre study, 1888 patients assessed by the investigators as suffering from GERD were recruited. The patients were additionally classified as with or without IBS-like symptoms at baseline. They were treated with pantoprazole 40 mg once daily and completed the Reflux Questionnaire (ReQuest) short version daily. Response rates and symptom scores were compared after 4 and 8 wk of treatment for subgroups defined by the subclasses of GERD [erosive(ERD) and non-erosive reflux disease (NERD)] and the presence of IBS-like symptoms. RESULTS: IBS-like symptoms were more prevalent in NERD than in ERD (18.3% vs 12.7%, P = 0.0015). Response rates after 4 and/or 8 wk of treatment were lower in patients with IBS-like symptoms than in patients without IBS-like symptoms in both ERD (Week 4: P 〈 0.0001, Week 8: P 〈 0.0339) and NERD (Week 8: P = 0.0088). At baseline, ReQuest "lower abdominal com- plaints" symptom scores were highest in NERD patients with IBS-like symptoms. Additionally, these patients had the strongest symptom improvement after treatment compared with all other subgroups. CONCLUSION: IBS-like symptoms influence treatment outcome and symptom burden in GERD and should be considered in management. Proton pump inhibitors can improve IBS-like symptoms, particularly in NERD.

  13. Influence of irritable bowel syndrome on treatment outcome in gastroesophageal reflux disease.

    Science.gov (United States)

    Mönnikes, Hubert; Heading, Robert C; Schmitt, Holger; Doerfler, Hubert

    2011-07-21

    To investigate the influence of irritable bowel syndrome (IBS)-like symptoms on treatment outcomes with pantoprazole in gastroesophageal reflux disease (GERD) in a real life setting. For this prospective, open-label, multinational, multicentre study, 1888 patients assessed by the investigators as suffering from GERD were recruited. The patients were additionally classified as with or without IBS-like symptoms at baseline. They were treated with pantoprazole 40 mg once daily and completed the Reflux Questionnaire™ (ReQuest™) short version daily. Response rates and symptom scores were compared after 4 and 8 wk of treatment for subgroups defined by the subclasses of GERD [erosive (ERD) and non-erosive reflux disease (NERD)] and the presence of IBS-like symptoms. IBS-like symptoms were more prevalent in NERD than in ERD (18.3% vs 12.7%, P = 0.0015). Response rates after 4 and/or 8 wk of treatment were lower in patients with IBS-like symptoms than in patients without IBS-like symptoms in both ERD (Week 4: P < 0.0001, Week 8: P < 0.0339) and NERD (Week 8: P = 0.0088). At baseline, ReQuest™ "lower abdominal complaints" symptom scores were highest in NERD patients with IBS-like symptoms. Additionally, these patients had the strongest symptom improvement after treatment compared with all other subgroups. IBS-like symptoms influence treatment outcome and symptom burden in GERD and should be considered in management. Proton pump inhibitors can improve IBS-like symptoms, particularly in NERD.

  14. LATE EVALUATION OF PATIENTS OPERATED FOR GASTROESOPHAGEAL REFLUX DISEASE BY NISSEN FUNDOPLICATION

    Science.gov (United States)

    RIBEIRO, Maxwel Capsy Boga; de ARAÚJO, Amanda Bueno; TERRA-JÚNIOR, Juverson Alves; CREMA, Eduardo; ANDREOLLO, Nelson Adami

    2016-01-01

    ABSTRACT Background: Surgical treatment of GERD by Nissen fundoplication is effective and safe, providing good results in the control of the disease. However, some authors have questioned the efficacy of this procedure and few studies on the long-term outcomes are available in the literature, especially in Brazil. Aim: To evaluate patients operated for gastro-esophageal reflux disease, for at least 10 years, by Nissen fundoplication. Methods: Thirty-two patients were interviewed and underwent upper digestive endoscopy, esophageal manometry, 24 h pH monitoring and barium esophagogram, before and after Nissen fundoplication. Results: Most patients were asymptomatic, satisfied with the result of surgery (87.5%) 10 years after operation, due to better symptom control compared with preoperative and, would do it again (84.38%). However, 62.5% were in use of some type of anti-reflux drugs. The manometry revealed lower esophageal sphincter with a mean pressure of 11.7 cm H2O and an average length of 2.85 cm. The average DeMeester index in pH monitoring was 11.47. The endoscopy revealed that most patients had a normal result (58.06%) or mild esophagitis (35.48%). Barium swallow revealed mild esophageal dilatation in 25,80% and hiatal hernia in 12.9% of cases. Conclusion: After at least a decade, most patients were satisfied with the operation, asymptomatic or had milder symptoms of GERD, being better and with easier control, compared to the preoperative period. Nevertheless, a considerable percentage still employed anti-reflux medications. PMID:27759771

  15. Inflammation-Related Carcinogenesis and Prevention in Esophageal Adenocarcinoma Using Rat Duodenoesophageal Reflux Models

    Energy Technology Data Exchange (ETDEWEB)

    Fujimura, Takashi, E-mail: tphuji@staff.kanazawa-u.ac.jp; Oyama, Katsunobu; Sasaki, Shozo; Nishijima, Koji; Miyashita, Tomoharu; Ohta, Tetsuo [Gastroenterologic Surgery, Kanazawa University Hospital, Kanazawa, Japan, 13-1 Takaramachi, Kanazawa, Ishikawa 920-8641 (Japan); Koichi, Miwa [Houju Memorial Hospital, Nomi, Japan, 11-71 Midorigaoka, Nomi, Ishikawa 923-1226 (Japan); Takanori, Hattori [Division of Molecular and Diagnostic Pathology, Shiga University of Medical Science, Otsu, Japan, Seta Tsukinowa-cho, Otsu, Shiga 520-2192 (Japan)

    2011-08-10

    Development from chronic inflammation to Barrett's adenocarcinoma is known as one of the inflammation-related carcinogenesis routes. Gastroesophageal reflux disease induces regurgitant esophagitis, and esophageal mucosa is usually regenerated by squamous epithelium, but sometimes and somewhere replaced with metaplastic columnar epithelium. Specialized columnar epithelium, so-called Barrett's epithelium (BE), is a risk factor for dysplasia and adenocarcinoma in esophagus. Several experiments using rodent model inducing duodenogastroesophageal reflux or duodenoesophageal reflux revealed that columnar epithelium, first emerging at the proliferative zone, progresses to dysplasia and finally adenocarcinoma, and exogenous carcinogen is not necessary for cancer development. It is demonstrated that duodenal juice rather than gastric juice is essential to develop esophageal adenocarcinoma in not only rodent experiments, but also clinical studies. Antireflux surgery and chemoprevention by proton pump inhibitors, nonsteroidal anti-inflammatory drugs, selective cyclooxygenase-2 inhibitors, green tea, retinoic acid and thioproline showed preventive effects on the development of Barrett's adenocarcinoma in rodent models, but it remains controversial whether antireflux surgery could regress BE and prevent esophageal cancer in clinical observation. The Chemoprevention for Barrett's Esophagus Trial (CBET), a phase IIb, multicenter, randomized, double-masked study using celecoxib in patients with Barrett's dysplasia failed to prove to prevent progression of dysplasia to cancer. The AspECT (Aspirin Esomeprazole Chemoprevention Trial), a large multicenter phase III randomized trial to evaluate the effects of esomeprazole and/or aspirin on the rate of progression to high-grade dysplasia or adenocarcinoma in patients with BE is now ongoing.

  16. Esomeprazole regimens for reflux symptoms in Chinese patients with chronic gastritis.

    Science.gov (United States)

    Sun, Jing; Yuan, Yao-Zong; Hou, Xiao-Hua; Zou, Duo-Wu; Lu, Bin; Chen, Min-Hu; Liu, Fei; Wu, Kai-Chun; Zou, Xiao-Ping; Li, Yan-Qing; Zhou, Li-Ya

    2015-06-14

    To compare symptom control with esomeprazole regimens for non-erosive reflux disease and chronic gastritis in patients with a negative endoscopy. This randomized, open-label study was designed in line with clinical practice in China. Patients with typical reflux symptoms for ≥ 3 mo and a negative endoscopy who had a Gastroesophageal Reflux Disease Questionnaire score ≥ 8 were randomized to initial treatment with esomeprazole 20 mg once daily either for 8 wk or for 2 wk. Patients with symptom relief could enter another 24 wk of maintenance/on-demand treatment, where further courses of esomeprazole 20 mg once daily were given if symptoms recurred. The primary endpoint was the symptom control rate at week 24 of the maintenance/on-demand treatment period. Secondary endpoints were symptom relief rate, success rate (defined as patients who had symptom relief after initial treatment and after 24 wk of maintenance treatment), time-to-first-relapse and satisfaction rate. Based on the data collected in the modified intention-to-treat population (MITT; patients in the ITT population with symptom relief after initial esomeprazole treatment, n = 262), the symptom control rate showed a small but statistically significant difference in favor of the 8-wk regimen (94.9% vs 87.3%, P = 0.0473). Among the secondary endpoints, based on the data collected in the ITT population (n = 305), the 8-wk group presented marginally better results in symptom relief after initial esomeprazole treatment (88.3% vs 83.4%, P = 0.2513) and success rate over the whole study (83.8% vs 72.8%, P = 0.0258). The 8-wk regimen was found to provide a 46% reduction in risk of relapse vs the 2-wk regimen (HR = 0.543; 95%CI: 0.388-0.761). In addition, fewer unscheduled visits and higher patient satisfaction supported the therapeutic benefits of the 8-wk regimen over the 2-wk regimen. Safety was comparable between the two groups, with both regimens being well tolerated. Chinese patients diagnosed with chronic

  17. Does gastric banding for morbid obesity reduce or increase gastroesophageal reflux?

    Science.gov (United States)

    Tolonen, Pekka; Victorzon, Mikael; Niemi, Risto; Mäkelä, Jyrki

    2006-11-01

    Conflicting results regarding the influence of laparoscopic adjustable gastric banding (LAGB) on gastroesophageal reflux disease (GERD) have been published. A prospective follow-up study was conducted in 31 patients (male/female 5/26, mean age 44 +/- 11 SD years) with 24-hour pH and manometry recordings, symptom assessment, and upper GI endoscopy. Total number of reflux episodes decreased from a mean value of 44.6 +/- 23.7 SD preoperatively to 22.9 +/- 17.1 postoperatively (P=0.0006), after a median follow-up time of 19 months (range 7-32 months). Total reflux time decreased from 9.5% +/- 6.2% to 3.5% +/- 3.7%, P=0.0009, and DeMeester score decreased from 38.5 +/- 24.9 to 18.6 +/- 20.4, P=0.03. Symptomatic patients decreased from 48.4% preoperatively to 16.1% postoperatively (P=0.01), medication for GERD decreased from 35.5% to 12.9% (P=0.05), and the diagnosis of GERD on 24-hour pH recordings decreased from 77.4% to 37.5% (P=0.01). There were no pouch enlargements seen on upper GI endoscopy. Esophageal motility was unchanged, but 36% of the patients had incomplete relaxation of the lower esophageal sphincter following the operation (P<0.0001). Mean BMI decreased from 46.0 +/- 5.46 to 38.4 +/- 6.45 (P<0.0001), excess weight from 60.0 kg +/- 18.58 kg, 44.9% +/- 6.56% to 38.4 kg +/- 20.27 kg, 28.4% +/- 10.97% (P<0.0001). No association between the postoperative diagnosis of GERD and the amount of weight loss could be found. The correctly placed gastric band is an effective anti-reflux barrier in the short term. Long-term results have to be awaited.

  18. Extravasation of Urine Associated with Bilateral Complete Ureteral Duplication, Vesicoureteral Reflux and Benign Prostatic Hyperplasia.

    Science.gov (United States)

    Suzuki, Issei; Kaga, Kanya; Takei, Kohei; Tokura, Yuumi; Sakamoto, Kazumasa; Nishihara, Daisaku; Mizuno, Tomoya; Yuki, Hideo; Betsunoh, Hironori; Abe, Hideyuki; Yashi, Masahiro; Fukabori, Yoshitatsu; Yamanishi, Tomonori; Kamai, Takao

    2017-02-01

    We report a rare case of extravasation of urine, which may be associated with bilateral complete ureteral duplication, vesicoureteral reflux (VUR), and benign prostatic hyperplasia (BPH). A 71-year-old male presented with a complaint of right abdominal pain. An extravasation of urine was noted, and was improved by indwelling urethral catheterization. Transurethral resection of the prostate and the endoscopic subureteral injection of dextanomer/hyaluronic acid were performed for the treatment of BPH and VUR, respectively. The post-surgery recovery was successful.

  19. Colonic fermentation influences lower esophageal sphincter function in gastroesophageal reflux disease

    DEFF Research Database (Denmark)

    Piche, Thierry; des Varannes, Stanislas Bruley; Sacher-Huvelin, Sylvie

    2003-01-01

    3 weeks. On day 7, esophageal motility and pH were recorded in fasting conditions and after a test meal containing 6.6 g of FOS or placebo. Breath hydrogen concentrations (reflecting colonic fermentation) and plasma concentrations of glucagon-like peptide 1 (GLP-1), peptide YY, and cholecystokinin...... were monitored. RESULTS: Compared with placebo, FOS led to a significant increase in the number of transient lower esophageal sphincter relaxations (TLESRs) and reflux episodes, esophageal acid exposure, and the symptom score for GERD. The integrated plasma response of GLP-1 was significantly higher...

  20. Overlapping gastroesophageal reflux disease and irritable bowel syndrome:Increased dysfunctional symptoms

    Institute of Scientific and Technical Information of China (English)

    Shadi; Sadeghi; Yarandi; Siavosh; Nasseri-Moghaddam; Pardis; Mostajabi; Reza; Malekzadeh

    2010-01-01

    AIM:To investigate the association of gastroesophageal reflux disease (GERD) and irritable bowel syndrome (IBS) in Iranian patients and examine the prevalence of functional symptoms of the gastrointestinal tract in patients presenting with either IBS, GERD or both.METHODS: Six thousand four hundred and seventy six patients presented to the Gastro-intestinal (GI) clinic with symptoms of functional dysfunction of GI tract, 1419 patients (62.0% women, 38.0% men; mean age: 37.4±11.5 years) met Rome or Rome crit...

  1. Urinary tract infection in the setting of vesicoureteral reflux [version 1; referees: 2 approved

    Directory of Open Access Journals (Sweden)

    Michael L. Garcia-Roig

    2016-06-01

    Full Text Available Vesicoureteral reflux (VUR is the most common underlying etiology responsible for febrile urinary tract infections (UTIs or pyelonephritis in children. Along with the morbidity of pyelonephritis, long-term sequelae of recurrent renal infections include renal scarring, proteinuria, and hypertension. Treatment is directed toward the prevention of recurrent infection through use of continuous antibiotic prophylaxis during a period of observation for spontaneous resolution or by surgical correction. In children, bowel and bladder dysfunction (BBD plays a significant role in the occurrence of UTI and the rate of VUR resolution. Effective treatment of BBD leads to higher rates of spontaneous resolution and decreased risk of UTI.

  2. Electrical stimulation therapy of the lower oesophageal sphincter for refractory gastro-oesophageal reflux disease - interim results of an international multicentre trial

    NARCIS (Netherlands)

    Kappelle, W.F.; Bredenoord, A.J.; Conchillo, J.M.; Ruurda, J.P.; Bouvy, N.D.; Henegouwen, M.I. van Berge; Chiu, P.W.; Booth, M.; Hani, A.; Reddy, D.N.; Bogte, A.; Smout, A.J.P.M.; Wu, J.C.; Escalona, A.; Valdovinos, M.A.; Torres-Villalobos, G.; Siersema, P.D.

    2015-01-01

    BACKGROUND: A previous single-centre study showed that lower oesophageal sphincter electrical stimulation therapy (LES-EST) in gastro-oesophageal reflux disease (GERD) patients improves reflux symptoms and decreases oesophageal acid exposure. AIM: To evaluate safety and efficacy of LES-EST in GERD p

  3. The position of the acid pocket as a major risk factor for acidic reflux in healthy subjects and patients with GORD

    NARCIS (Netherlands)

    H. Beaumont; R.J. Bennink; J. de Jong; G.E. Boeckxstaens

    2010-01-01

    Gastro-oesophageal reflux occurs twice as much during transient lower oesophageal sphincter relaxations (TLOSRs) in patients with gastro-oesophageal reflux disease (GORD) compared to healthy volunteers (HVs). Our aim was to assess whether the localisation of the postprandial acid pocket and its inte

  4. Reproducibility of 24-hour combined multiple intraluminal impedance (MII) and pH measurements in infants and children. Evaluation of a diagnostic procedure for gastroesophageal reflux disease

    DEFF Research Database (Denmark)

    Dalby, Kasper; Nielsen, Rasmus G; Markoew, Simone;

    2007-01-01

    without dietary restrictions. Bland-Altman difference versus mean plots and calculation of the limits of agreement (LOA) were used for assessment of the reproducibility of the total number of acidic and nonacidic reflux episodes. LOA for the number of acidic reflux episodes on day 2 were 0.2-5.3 times...

  5. [The binomial symptom index for the evaluation of temporal association between cardiorespiratory symptoms and gastroesophageal reflux in neonates].

    Science.gov (United States)

    Barriga-Rivera, Alejandro; Moya, María José; Lopez-Alonso, Manuel

    2016-11-01

    The evaluation of symptom association between gastroesophageal reflux and cardiorespiratory events in preterm infants remains unclear. This paper describes a conservative approach to decision-making of anti-reflux surgery through symptom association analysis. Forty-three neonates with potentially reflux-related cardiorespiratory symptoms underwent synchronized esophageal impedance-pH and cardiorespiratory monitoring. Three indices were considered to evaluate symptom association, the symptom index (SI), the symptom sensitivity index (SSI) and the symptom association probability (SAP). A conservative strategy was adopted regarding the decision of anti-reflux surgery, and therefore, patients were scheduled for laparoscopic Nissen fundoplication if the three indices showed a positive assessment of symptom association. Retrospectively, these indices and the binomial symptom index (BSI) were contrasted against the decision of anti-reflux surgery using different windows of association. Thirteen patients showed positive symptom association but only two underwent anti-reflux surgery. The SI and the SSI showed an increasing trend with the width of the window of association. The SAP was affected randomly by slightly altering the windowing parameters. The BSI showed the best performance with the two-minute window (κ =0.78) CONCLUSIONS: The pathology under study is known to improve with maturity. However, the severity of cardiorespiratory symptoms may threaten the neonate's life and therefore, in some occasions, invasive treatments must be considered to protect life. The BSI provides a good prediction of a combination of positive SI, SSI and SAP, which may improve clinical decisions. However, further clinical studies are required to prove the BSI as an optimal predictor of clinical outcomes. Copyright © 2015 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

  6. Therapeutic efficacy of digital music gastric electrical pacing for refractory functional dyspepsia concomitant with non-erosive reflux disease

    Directory of Open Access Journals (Sweden)

    Ya-mei RAN

    2015-04-01

    Full Text Available Objective To study the clinical efficacy of digital music gastric electrical pacing for refractory functional dyspepsia concomitant with non-erosive reflux disease, and its effects on mental health and life-quality of the patients. Methods According to the Rome Ⅲ criteria and Montreal consensus in diagnosis of gastroesophageal reflux disease, 50 patients with concomitant refractory functional dyspepsia and non-erosive reflux disease were recruited. The clinical efficacy of digital music gastric electrical pacing were evaluated using the score of clinical symptoms before treatment and 15 days after treatment, and the mental health and life-quality of patients were assessed using symptom checklist 90. Results Main symptoms, including upper abdominal pain, abdominal fullness, early satiety, belching, hiccup, nausea, heartburn, acid reflux (daytime, nocturnal acid reflux, loss of appetite and sleep, were significantly improved 15 days after treatment compared with those of pre-treatment, and there were statistically significant differences (all P<0.005. The significant response rate/response rate (efficacy rate were 59.0%/100.0%, 59.3%/96.3%, 47.0%/94.1%, 61.3%/96.8 %, 86.7%/100.0%, 80.0%/100.0%, 64.3%/92.9%, 73.7%/89.5%, 64.3%/85.7%, 90.0%/90.0%, 36.7%/93.3% respectively. After treatment for 15 days, the overall response rate of symptom relief was 94.4% in patients and the overall significant response rate was 65.7%. The symptom scores of somatization, obsessive-compulsiveness, depression, and anxiety were significantly improved, and the differences were statistically significant (all P<0.01. Conclusion The clinical efficacy of digital music gastric electrical pacing is significant for refractory functional dyspepsia concomitant with nonerosive reflux disease, and it is expected to be a new option for the treatment of this disease complex. DOI: 10.11855/j.issn.0577-7402.2015.03.08

  7. Comorbidities in severe asthma: frequency of rhinitis, nasal polyposis, gastroesophageal reflux disease, vocal cord dysfunction and bronchiectasis

    Directory of Open Access Journals (Sweden)

    Carla Bisaccioni

    2009-01-01

    Full Text Available OBJECTIVES: Severe asthma is found in approximately 10% of patients with asthma. Some factors associated with worse asthma control include rhinitis, gastroesophageal reflux disease, vocal cord dysfunction (VCD, nasal polyposis and bronchiectasis. Therefore, we evaluated the prevalence of these illnesses in patients with severe asthma. METHODS: We conducted a retrospective analysis of data obtained from electronic medical records of patients with severe asthma between January 2006 and June 2008. Symptoms of rhinitis and gastroesophageal reflux disease were evaluated as well as intolerance to nonsteroidal anti-inflammatory drugs. We evaluated the results of esophagogastroduodenoscopy, videolaryngoscopy and CT scans of the chest in order to confirm gastroesophageal reflux disease, nasal polyposis, vocal cord dysfunction and bronchiectasis. RESULTS: We evaluated 245 patients. Rhinitis symptoms were present in 224 patients (91.4%; 18 (7.3% had intolerance to nonsteroidal anti-inflammatory drugs, and 8 (3.3% had nasal polyposis. Symptoms of gastroesophageal reflux disease were reported for 173 (70.6% patients, although the diagnosis of gastroesophageal reflux disease was confirmed based on esophagogastroduodenoscopy or laryngoscopy findings in just 58 (33.6% patients. Vocal cord dysfunction was suspected in 16 (6.5% and confirmed through laryngoscopy in 4 (1.6%. The patient records provided CT scans of the chest for 105 patients, and 26 (24.8% showed bronchiectasis. DISCUSSION: Rhinitis and gastroesophageal reflux disease were the most common comorbidities observed, in addition to bronchiectasis. Therefore, in patients with severe asthma, associated diseases should be investigated as the cause of respiratory symptoms and uncontrolled asthma.

  8. Comparative study of omeprazole, lansoprazole,pantoprazole and esomeprazole for symptom relief in patients with reflux esophagitis

    Institute of Scientific and Technical Information of China (English)

    Ri-Nan Zheng

    2009-01-01

    AIM: To clarify whether there is any difference in the symptom relief in patients with reflux esophagitis following the administration of four Proton pump inhibitors (PPIs).METHODS: Two hundred and seventy-four patients with erosive reflux esophagitis were randomized to receive 8 wk of 20 mg omeprazole ( n = 68), 30 mg of lansoprazole ( n = 69), 40 mg of pantoprazole ( n= 69), 40 mg of esomeprazole ( n = 68) once a day in the morning. Daily changes in heartburn and acid reflux symptoms in the first 7 d of administration were assessed using a six-point scale (0: none; 1: mild; 2:mild-moderate; 3: moderate; 4: moderate-severe; 5:severe).RESULTS: The mean heartburn score in patients treated with esomeprazole more rapidly decreased than those receiving other PPI. Complete resolution of heartburn was also more rapid in patients treated with esomeprazole for 5 d compared with omeprazole ( P = 0.0018, P = 0.0098, P = 0.0027, P = 0.0137, P = 0.0069,respectively), lansoprazole ( P = 0.0020, P = 0.0046, P= 0.0037, P = 0.0016, P = 0.0076, respectively), and pantoprazole ( P = 0.0006, P = 0.0005, P = 0.0009, P =0.0031, P = 0.0119, respectively). There were no significant differences between the four groups in the rate of endoscopic healing of reflux esophagitis at week 8.CONCLUSION: Esomeprazole may be more effective than omeprazole, lansoprazole, and pantoprazole for the rapid relief of heartburn symptoms and acid reflux symptoms in patients with reflux esophagitis.

  9. Bladder distension: An unusual cause of reflux of blood and hemodynamic changes (autonomic dysreflexia during endovascular coiling

    Directory of Open Access Journals (Sweden)

    D P Sharma

    2011-01-01

    Full Text Available Autonomic dysreflexia due to distended bladder is well known. Reflux of blood during endovascular procedure is also a common observation. It happens due to difference in pressure gradient between arterial pressure and that of infusing solution. Generally it happens when the infusion bottle is empty or the pressure in infusion bottles fall. We present an uncommon situation where distended bladder mechanically resulted in reflux of blood into endovascular catheters as well as alteration in hemodynamic parameters. Both settled once the bladder was empty.

  10. Risk Factors on the Development of New-Onset Gastroesophageal Reflux Symptoms. A Population-Based Prospective Cohort Study

    DEFF Research Database (Denmark)

    Hallan, Andreas; Bomme, M.; Hveem, K.

    2015-01-01

    -2009 in Nord-Trondelag County, Norway. All inhabitants from 20 years of age were invited. Risk factors of new-onset heartburn or acid regurgitation were examined using logistic regression, providing odds ratios (OR) and 95% confidence intervals (CI). RESULTS: A total of 29,610 individuals were included (61......OBJECTIVES: Gastroesophageal reflux disease (GERD) is a highly prevalent disorder. This study assessed the risk factors of new-onset gastroesophageal reflux symptoms (GERS). METHODS: The study was based on the HUNT study, a prospective population-based cohort study conducted in 1995-1997 and 2006...

  11. Efficacy of esomeprazole and flupentixol and melitracen in treatment of non-erosive gastroesophageal reflux disease with depression and anxiety

    Institute of Scientific and Technical Information of China (English)

    钟英强

    2006-01-01

    Objective To investigate the efficacy of esomeprazole (Esomeprazole) and flupentixol and melitracen (Deanxit) in treatment of non-erosive gastroesophageal reflux disease (NERD) with depression and anxiety. Methods The diagnosis of NERD was based on the results of esomeprazole scale (reflux diagnostic questionnaires, RDQ) and endoscopy, the degree and frequency of symptoms were graded and scored. Hamilton depression scale was used to evaluate depression and anxiety status. Sixty-three patients were randomly divided into group A (esomeprazole 20 mg qd),B (Deanxit 1 tab

  12. Use of 24 h Esophageal pH Monitoring to Demonstrate Alkaline Reflux as a Complication of Gastric Bypass Surgery

    Directory of Open Access Journals (Sweden)

    J Patrick Shoenut

    1994-01-01

    Full Text Available A 35-year-old female who had previously undergone a gastric stapling procedure for morbid obesity presented with a persistent nocturnal cough that was treated over a three-year period as a gastric acid reflux complication of the bypass surgery. A barium swallow demonstrated gastroesophageal reflux, but the symptoms did not resolve after treatment with omeprazole and cisapride. Twenty-four hour esophageal pH monitoring subsequently found alkaline reflux in excess of 17% of the total time, with no acid reflux demonstrated. Surgical revision of the bypass Leaving the hiatus alone corrected the reflux complication and the symptoms resolved without further treatment. The diagnostic capability of pH monitoring is illustrated in a patient with an unusual surgical complication.

  13. High prevalence of gastroesophageal reflux disease with minimal mucosal change in asthmatic patients.

    Science.gov (United States)

    Shimizu, Yasuo; Dobashi, Kunio; Kobayashi, Setsuo; Ohki, Ichiro; Tokushima, Masahiko; Kusano, Motoyasu; Kawamura, Osamu; Shimoyama, Yasuyuki; Utsugi, Mitsuyoshi; Mori, Masatomo

    2006-08-01

    It is known that the prevalence of gastroesophageal reflux disease (GERD) in asthmatic patients is high. Although an endoscopic diagnosis of GERD based on the established Los Angeles (LA) classification requires the detection of erosive mucosal breaks, there are patients with GERD who have prominent erythema of the esophageal membrane without erosive mucosal breaks. Non-erosive mucosal change denotes the minimal change of the discoloring type of reflux esophagitis. This study was undertaken to determine the prevalence of GERD in asthmatic patients using the LA classification with the inclusion of minimal change, compared to the prevalence determined using the established LA classification without minimal change. The presence of GERD in asthmatic patients (n = 78), non-asthmatic disease control patients (n = 56), and healthy subjects (n = 150) was evaluated by endoscopic examination. The frequency of GERD in asthmatic patients based on the LA classification with minimal change was higher (54/78, 69.2%) than in asthmatic patients based on the LA classification without minimal change (37/78, 47.4%) (p disease control patients (17/56, 30.4%) and healthy subjects (27/150, 18.0%) based on the LA classification with minimum change. These data indicate that asthmatic patients have a high frequency of GERD. In addition, without the inclusion of minimum change to the diagnosis of GERD, the prevalence of GERD appears to be underestimated in asthmatic patients. Therefore, physicians should carefully observe asthmatic patients with minimal change on endoscopy.

  14. Influence of bouncing and assisted autogenic drainage on acid gastro-oesophageal reflux in infants.

    Science.gov (United States)

    Van Ginderdeuren, Filip; Vandenplas, Yvan; Deneyer, Michel; Vanlaethem, Sylvie; Buyl, Ronald; Kerckhofs, Eric

    2017-08-01

    To determine the influence of modern airway clearance techniques using assisted autogenic drainage (AAD), whether or not combined with bouncing, on acid gastro-oesophageal reflux (GOR) in infants <1 year. In this controlled trial with intra-subject design infants were studied using oesophageal pH monitoring over 24 h, during which they received one 15 min session of bouncing, AAD or bouncing combined with AAD (BAAD). The number of reflux episodes (RE) and the refluxindex (RI) were the outcome measures. The results obtained during (T15) and 15 min after the intervention (T30) were compared to a period of 15 min before treatment (T0). The results of 150 infants, evenly distributed over the three treatment groups, were analyzed. No significant differences were found in number of RE at T15 and T30 compared to T0 in the bouncing group (P = 0.42), the AAD group (P = 0.14), and the BAAD group (P = 0.91). RI was significantly lower in the AAD group at T15 compared to T0 (P < 0.01). No differences in RI were found in the bouncing group (P = 0.28), nor in the BAAD group (P = 0.81). Bouncing, AAD and BAAD do not induce, nor aggravate acid GOR in infants under the age of 1 year. © 2017 Wiley Periodicals, Inc.

  15. [Oesophageal diseases: gastroesophageal reflux disease, Barrett's disease, achalasia and eosinophilic oesophagitis].

    Science.gov (United States)

    Calvet, Xavier

    2015-09-01

    The most important novel findings presented on oesophageal disease in DDW 2015 were the following: 1) GERD: a) hypervigilance seems to be a key pathogenic factor in reflux symptoms refractory to PPI; b) post-reflux swallowing-induced peristaltic waves could be an excellent diagnostic criterion for GERD; c) laryngeal pH-metry is not useful in the diagnosis of extra-oesophageal symptoms; d) the recommendation of weight loss adequately recorded in the clinical reports of patients with GERD and obesity or overweight is an excellent quality indicator and is associated with better outcomes. 2) Barrett's oesophagus: a) persistent low-grade dysplasia in more than one endoscopy and a diagnosis of "indefinite for dysplasia" are associated with a high risk of neoplastic progression; b) narrow-band imaging allows areas of dysplasia on Barrett's oesophagus to be identified with high sensitivity and specificity; c) initial endoscopy fails to identify a high percentage of advanced neoplasms in Barrett's oesophagus. Early re-endoscopy should be considered; d) endoscopists specialized in Barret's oesophagus obtain a much higher yield in the diagnosis of advanced lesions. Patients at high risk-men, older patients, smokers and those with long-segment Barrett's oesophagus-could benefit from follow-up in a referral center. 3) Achalasia: POEM seems safe and effective, independently from patient characteristics (age, comorbidity) and the technical variations used. 4) Eosinophilic esophagitis: topical budesonide and exclusion diets are reasonably effective in PPI non-responders.

  16. The effect of bile reflux on the intragastric pH

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    Oblective To observe the effect of bile reflux on the intragastric pH. Methods We used ambulatory intragastric pH monitoring along with simultaneous Bilitec 2000 to measure the pH and absorbance of the mixed gastric juice diluted with bile with increasing bilirubin concentration in vitro and the yellow and clear gastric juice aspirated under endoscopy. In vivo,we studied 20 functional dispepsia patients for 24 h with simultaneous intragastric pH and bilirubin monitoring. Results In vitro dilutions,the absorbance value reached to 0. 900 while the concentration was only 20% ,but when the pH of the solution was more than 4,it′s concentration was already up to 60%. The mean absorbance of the yellow gastric juice(0. 348± 0. 131) was significantly higher than that of the clear juice (0. 008 ± 0. 003)(P<0.05). The pH of 80% yellow gastric juice was less than 4, the percentage was not significantly different from the clear samples (81%) (P>0. 05). The pH showed no correlation with the absorbance in the yellow and clear groungs. Eight of the 12 patients with the spontaneous nocturnal episcodes of alkalinization had simultaneous increase of absorbance,4 of the 8 subjects with no aikalinization had increase of absorbance. Gonclusion In some concentration,bile reflux affect little on the intragastric pH.

  17. Vesicoureteral Reflux Detected with 99mTc-DTPA Renal Scintigraphy during Evaluation of Renal Function

    Directory of Open Access Journals (Sweden)

    Nevena Manevska

    2015-12-01

    Full Text Available BACKGROUND: Radionuclide techniques, as direct radionuclide cystography and 99mTc-DMSA scintigraphy, have been used in evaluation of vesicoureteral reflux (VUR and reflux nephropathy (RN in children. Dynamic 99mTc-DTPA scintigraphy is reserved for evaluation of differential renal function and obstruction in children, where hydronephrosis is detected by ultrasonography (US pre- or postnatally. CASE REPORT: Six year old boy was prenatally diagnosed with bilateral hydronephrosis. Postnatal, severe bilateral VUR was detected by voiding urethrocytography. US and 99mTc-DTPA scintigraphy performed in the first month of life showed small left kidney that participated with 2% in the global renal function. Bilateral cutaneous ureterostomy has been performed in order to obtain good renal drainage and promote optimal renal growth. Twelve months later, classic antireflux procedure was done. Control 99mTc-DTPA scintigraphy, 5 ys after antireflux surgery, revealed persisting radioactivity during the diuretic phase, in the left kidney that indicated antireflux procedure failure with VUR reappearance. CONCLUSION: 99mTc-DTPA scintigraphy is the first method of choice for long-term monitoring of individual kidney function in children with VUR and other congenital urinary tract anomalies. Additionally, it can be used as indirect radionuclide cystography when rising of radioactivity in the kidney region, during the diuretic phase can indicate presence of VUR.

  18. Vesicoureteral Reflux Detected with 99mTc-DTPA Renal Scintigraphy during Evaluation of Renal Function

    Science.gov (United States)

    Manevska, Nevena; Stojanoski, Sinisa; Majstorov, Venjamin; Pop-Gjorcheva, Daniela; Zdraveska, Nikolina; Kuzmanovska, Dafina

    2016-01-01

    BACKGROUND: Radionuclide techniques, as direct radionuclide cystography and 99mTc-DMSA scintigraphy, have been used in evaluation of vesicoureteral reflux (VUR) and reflux nephropathy (RN) in children. Dynamic 99mTc-DTPA scintigraphy is reserved for evaluation of differential renal function and obstruction in children, where hydronephrosis is detected by ultrasonography (US) pre- or postnatally. CASE REPORT: Six year old boy was prenatally diagnosed with bilateral hydronephrosis. Postnatal, severe bilateral VUR was detected by voiding urethrocytography. US and 99mTc-DTPA scintigraphy performed in the first month of life showed small left kidney that participated with 2% in the global renal function. Bilateral cutaneous ureterostomy has been performed in order to obtain good renal drainage and promote optimal renal growth. Twelve months later, classic antireflux procedure was done. Control 99mTc-DTPA scintigraphy, 5 ys after antireflux surgery, revealed persisting radioactivity during the diuretic phase, in the left kidney that indicated antireflux procedure failure with VUR reappearance. CONCLUSION: 99mTc-DTPA scintigraphy is the first method of choice for long-term monitoring of individual kidney function in children with VUR and other congenital urinary tract anomalies. Additionally, it can be used as indirect radionuclide cystography when rising of radioactivity in the kidney region, during the diuretic phase can indicate presence of VUR. PMID:27275347

  19. Lipid aspiration pneumonia due to gastroesophageal reflux. An unusual radiographic appearance

    Energy Technology Data Exchange (ETDEWEB)

    Wolfson, B.J.; Allen, J.L.; Panitch, H.B.; Karmazin, N.

    1989-08-01

    The development of lipid aspiration pneumonia after chronic nasopharyngeal installation of mineral oil was first described in 1925 by Laughlin. Since that time this entity has been well recognized and numerous substances have been identified or implicated as the aspirated material. The classic radiographic appearance of severe chronic lipid aspiration pneumonia has been described as consisting of intense perihilar infiltrates. However, the radiographic findings are more often non-specific and usually consist of varying degrees of diffuse interstitial infiltrates that tend to be more prominent in the perihilar regions and the right lung. We are reporting a case of biopsy-proven lipid aspiration pneumonia in an infant with known gastro-esophageal reflux (GER) who had medium-chain triglyceride oil administered via nasogastric tube. Serial roentgenograms demonstrated a changing pulmonary pattern from diffuse bilateral interstitial infiltrates initially to a diffuse alveolar pattern at the time of the lung biopsy. Modern medicine has developed new methods for providing nourishment to sick newborns and infants to improve their nutritional status and help them to grow. One such method involves the administration of medium-chain triglycerides (MCT oil) into the GI tract via a nasogastric or nasoenteral tube. The purpose of this report is to describe a significant complication of this method of providing nutrition to an infant with gastroesophageal reflux (GER) and the diagnostic dilemma it presented. (orig.).

  20. Esophageal dysphagia and reflux symptoms before and after oral IQoro(R) training.

    Science.gov (United States)

    Hägg, Mary; Tibbling, Lita; Franzén, Thomas

    2015-06-28

    To examine whether muscle training with an oral IQoro(R) screen (IQS) improves esophageal dysphagia and reflux symptoms. A total of 43 adult patients (21 women and 22 men) were consecutively referred to a swallowing center for the treatment and investigation of long-lasting nonstenotic esophageal dysphagia. Hiatal hernia was confirmed by radiologic examination in 21 patients before enrollment in the study (group A; median age 52 years, range: 19-85 years). No hiatal hernia was detected by radiologic examination in the remaining 22 patients (group B; median age 57 years, range: 22-85 years). Before and after training with an oral IQS for 6-8 mo, the patients were evaluated using a symptom questionnaire (esophageal dysphagia and acid chest symptoms; score 0-3), visual analogue scale (ability to swallow food: score 0-100), lip force test (≥ 15 N), velopharyngeal closure test (≥ 10 s), orofacial motor tests, and an oral sensory test. Another twelve patients (median age 53 years, range: 22-68 years) with hiatal hernia were evaluated using oral IQS traction maneuvers with pressure recordings of the upper esophageal sphincter and hiatus canal as assessed by high-resolution manometry. Esophageal dysphagia was present in all 43 patients at entry, and 98% of patients showed improvement after IQS training [mean score (range): 2.5 (1-3) vs 0.9 (0-2), P dysphagia and reflux symptoms in adults, likely due to improved hiatal competence.

  1. Weight Loss Can Lead to Resolution of Gastroesophageal Reflux Disease Symptoms: A Prospective Intervention Trial

    Science.gov (United States)

    Singh, Mandeep; Lee, Jaehoon; Gupta, Neil; Gaddam, Srinivas; Smith, Bryan K.; Wani, Sachin B.; Sullivan, Debra K.; Rastogi, Amit; Bansal, Ajay; Donnelly, Joseph E.; Sharma, Prateek

    2013-01-01

    Objective Weight gain is an important risk factor for gastroesophageal reflux disease (GERD); however, whether weight loss can lead to resolution of GERD symptoms is not clear. Our aim was to measure the impact of weight loss on GERD symptoms. Design and Methods In a prospective cohort study at a tertiary referral center, overweight/obese subjects (BMI 25-39.9 kg/m2) were enrolled in a structured weight loss program. Weight loss strategies included dietary modifications, increased physical activity and behavioral changes. At baseline and at 6 months, BMI and waist circumference were measured and all participants completed a validated reflux disease questionnaire. Results A total of 332 adult subjects, mean age 46 years and 66% women were prospectively enrolled. At baseline, the mean body weight, BMI, and waist circumference were 101 (±18) kg, 35 (±5) kg/m2 and 103 (±13) cm. At 6 months, majority of the subjects (97%) lost weight (average weight loss: 13 ± 7.7 kg) and as compared with baseline, there was a significant decrease in the overall prevalence of GERD (15 vs. 37%; P weight loss and reduction in GERD symptom scores (r = 0.17, P weight loss program can lead to complete resolution of GERD symptoms in the majority of these subjects. PMID:23532991

  2. Bronchial reacutization and gastroesophageal reflux: is there a potential clinical correlation?

    Science.gov (United States)

    Mauroner, Luisa; Paiano, Simona; Assante, Luca Rosario; Bertolaccini, Luca; Ruffo, Giacomo; Mainardi, Paride; Bocus, Paolo; Geccherle, Andrea; Albanese, Sergio Ivan; Ciaffoni, Stefano

    2016-01-01

    Background Pepsin plays a role in gastroesophageal reflux (GER). Aims of this study were to verify if pepsin could be the cause of frequent bronchial exacerbations and to check if the persistence of chronic respiratory symptoms were correlated with pre-existing respiratory diseases. Methods From January to May 2016, 42 patients underwent a diagnostic bronchoscopy. All patients had a history of at least one bronchial exacerbation during the previous year. Bronchial lavage fluid specimens were obtained. A semiquantitative assessment of pepsin in the samples was carried out based on the intensity of the test sample. Results Pepsin was present in 37 patients (88%), but in patients with bronchial asthma and chronic obstructive pulmonary disease (COPD), the finding of pepsin in the bronchoalveolar fluid was 100%. There was a strong positive statistical correlation between pepsin detection and radiological signs of GER (ρ=0.662), and between pepsin detection and diagnosis (ρ=0.682). No correlation was found between the bacteriology and the presence of pepsin in the airways (ρ=0.006). Conclusions The presence of pepsin in the airways shows the occurrence of reflux. The persistence of respiratory symptoms by at least 2 months suggest an endoscopic bronchial examination. This straightforward test confirms the cause possible irritation of the airways and may prevent further diagnostic tests, such as an EGD or pH monitoring esophageal. PMID:27668224

  3. Evidence-based appraisal in laparoscopic Nissen and Toupet fundoplications for gastroesophageal reflux disease

    Science.gov (United States)

    Shan, Cheng-Xiang; Zhang, Wei; Zheng, Xiang-Min; Jiang, Dao-Zhen; Liu, Sheng; Qiu, Ming

    2010-01-01

    AIM: To demonstrate the optimal surgical procedure for gastroesophageal reflux disease. METHODS: The electronic databases of Medline, Elsevier, Springerlink and Embase over the last 16 years were searched. All clinical trials involved in the outcomes of laparoscopic Nissen fundoplication (LNF) and laparoscopic Toupet fundoplication (LTF) were identified. The data of assessment in benefits and adverse results of LNF and LTF were extracted and compared using meta-analysis. RESULTS: We ultimately identified a total of 32 references reporting nine randomized controlled trials, eight prospective cohort trials and 15 retrospective trials. These studies reported a total of 6236 patients, of whom 4252 (68.18%) underwent LNF and 1984 (31.82%) underwent LTF. There were no differences between LNF and LTF in patients’ satisfaction, perioperative complications, postoperative heartburn, reflux recurrence and re-operation. Both LNF and LTF enhanced the function of lower esophageal sphincter and improved esophagitis. The postoperative dysphagia, gas-bloating syndrome, inability to belch and the need for dilatation after LNF were more common than after LTF. Subgroup analyses showed that dysphagia after LNF and LTF was similar in patients with normal esophageal peristalsis (EP), but occurred more frequently in patients with weak EP after LNF than after LTF. Furthermore, patients with normal EP after LNF still had a higher risk of developing dysphagia than did patients with abnormal EP after LTF. CONCLUSION: Compared with LNF, LTF offers equivalent symptom relief and reduces adverse results. PMID:20572311

  4. Electrical stimulation for gastroesophageal reflux disease: current state of the art

    Directory of Open Access Journals (Sweden)

    Kim SE

    2016-01-01

    Full Text Available Sharon E Kim, Edy Soffer Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA Abstract: Patients with gastroesophageal reflux disease (GERD who are not satisfied with acid suppression therapy can benefit primarily from fundoplication, a surgical intervention. Fundoplication has been the standard surgical procedure for GERD. It is effective but is associated with adverse effects, resulting in a declining number of interventions, creating a need for alternative interventions that are effective, yet have a better adverse effect profile. One such alternative involves the application of electrical stimulation to the lower esophageal sphincter. A number of animal studies showed that such stimulation can increase resting lower esophageal sphincter pressure. An acute human study confirmed this effect, and was followed by two open-label studies, with a follow-up of up to 3 years. Results thus far show that the therapy is associated with a significant improvement in symptoms, a significant reduction in esophageal acid exposure, and a very good safety profile. This review will describe the evolution of electrical stimulation therapy for GERD, as well as the safety and efficacy of this intervention. Keywords: gastroesophageal reflux disease, lower esophageal sphincter, health-related quality of life

  5. Role of Laryngopharyngeal Reflux in the Pathogenesis of Otitis Media with Effusion.

    Science.gov (United States)

    Doğru, Mehmet; Kuran, Gökhan; Haytoğlu, Süheyl; Dengiz, Ramazan; Arıkan, Osman Kürşat

    2015-04-01

    To determine whether there is an association between otitis media with effusion and laryngopharyngeal reflux in children. This study included 31 children with otitis media with effusion. The pepsinogen level in the middle ear fluid of all patients was measured by sandwich enzyme-linked immunosorbent assay. Each patient's middle ear fluid was investigated for Helicobacter pylori (H. pylori) using the Campylobacter-like organism (CLO) test. The middle ear pepsinogen levels were compared with those in the serum. The correlation between pepsinogen levels and H. pylori positivity in the middle ear fluid was investigated. The mean middle ear pepsinogen level (211.69 ng/mL) was significantly higher than that in the serum (24.18 ng/mL) in patients with otitis media with effusion. The middle ear aspirates of six patients (19%) were positive for H. pylori, and the correlation between H. pylori positivity and increased pepsinogen levels in the middle ear fluid was statistically significant in patients with otitis media with effusion. We detected higher pepsinogen levels and H. pylori positivity rates in the middle ear fluid than in the serum of patients with otitis media with effusion. These results support the role of laryngopharyngeal reflux in the pathogenesis of otitis media with effusion.

  6. National consensus on the management of gastroesophageal reflux disease in Indonesia.

    Science.gov (United States)

    2014-07-01

    Gastroesophageal reflux disease (GERD) is a disorder, which gastric content repeatedly reflux into the esophagus causing disturbing symptoms and/or complications. Various epidemiological studies show that there is regional difference on the aspect of prevalence and clinical manifestation. Regional data also demonstrates increased incidence of complications such as the Barret's Esophagus and adenocarcinoma. In response to the situation, the Asia-Pacific GERD experts, including Indonesia, had published a consensus on the management of GERD in 2004, which was subsequently revised in 2008. Advances in medical technology, especially on gastrointestinal endoscopy technique and other diagnostic instruments such as 24-hour pH-metry and manometry, have improved the capacity of management of GERD. On the other hand, we feel that adequate knowledge and skills of doctors, both for general physicians and specialists of internal medicine in our country are not well-distributed. Moreover, the availability of instruments for diagnostic and therapeutical supports differs from one region to the others. The Organizing Committee of Indonesian Society of Gastroenterology or Pengurus Besar Perkumpulan Gastroenterologi Indonesia (PB PGI) considers that it is important to revise the National Consensus on the Management of GERD in Indonesia 2004, which is expected to be the guideline of GERD management.

  7. Pancreaticobiliary reflux as a high-risk factor for biliarymalignancy: Clinical features and diagnostic advancements

    Institute of Scientific and Technical Information of China (English)

    2015-01-01

    Pancreaticobiliary junction is composed of complexstructure with which biliary duct and pancreatic ductassemble and go out into the ampulla of Vater duringduodenum wall surrounding the sphincter of Oddi.Although the sphincter of Oddi functionally preventsthe reflux of pancreatic juice, pancreaticobiliary reflux(PBR) occurs when function of the sphincter of Oddihalt. The anatomically abnormal junction is termedpancreaticobiliary maljunction (PBM) and is characterizedby pancreatic and bile ducts joining outside of theduodenal wall. PBM is an important anatomical findingbecause many studies have revealed that biliarymalignancies are related due to the carcinogenetic effectof the pancreatic back flow on the biliary mucosa. Onthe other hand, several studies have been published onthe reflux of pancreatic juice into the bile duct withoutmorphological PBM, and the correlation of such caseswith biliary diseases, especially biliary malignancies, isdrawing considerable attention. Although it has longbeen possible to diagnose PBM by various imagingmodalities, PBR without PBM has remained difficult toassess. Therefore, the pathological features of PBRwithout PBM have not been yet fully elucidated. Lately,a new method of diagnosing PBR without PBM hasappeared, and the features of PBR without PBM shouldsoon be better understood.

  8. Assessment of TRACE Condensation Model Against Reflux Condensation Tests with Noncondensable Gases

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Kyung Won; Cheong, Ae Ju; Shin, Andong; Suh, Nam Duk [Korea Institute of Nuclear Safety, Daejeon (Korea, Republic of)

    2015-05-15

    The TRACE is the latest in a series of advanced, best-estimated reactor systems code developed by U.S. Nuclear Regulatory Commission for analyzing transient and steady-state neutronic-thermal-hydraulic behavior in light water reactors. This special model is expected to replace the default model in a future code release after sufficient testing has been completed. This study assesses the special condensation model of TRACE 5.0-patch4 against the counter-current flow configuration. For this purpose, the predicted results of special model are compared to the experimental and to those of default model. The KAST reflux condensation test with NC gases are used in this assessment. We assessed the special model for film condensation of TRACE 5.0-patch4 against the data of the reflux condensation test in the presence of NC gases. The special condensation model of TRACE provides a reasonable estimate of HTC with good agreement at the low inlet steam flow rate.

  9. A proton pump inhibitor, lansoprazole, ameliorates asthma symptoms in asthmatic patients with gastroesophageal reflux disease.

    Science.gov (United States)

    Shimizu, Yasuo; Dobashi, Kunio; Kobayashi, Setsuo; Ohki, Ichiro; Tokushima, Masahiko; Kusano, Motoyasu; Kawamura, Osamu; Shimoyama, Yasuyuki; Utsugi, Mitsuyoshi; Sunaga, Noriaki; Ishizuka, Tamotsu; Mori, Masatomo

    2006-07-01

    Aspiration of acid to the airway causes airway inflammation, and acid stress to the airway caused by gastroesophageal reflux disease (GERD) has been known as a potential mechanism of deteriorated asthma symptoms. However, the efficacy of the acid suppressive drugs, H(2)-receptor blockers (H(2) blocker) and proton pump inhibitors, on asthma symptoms and pulmonary functions remains controversial. We therefore designed the randomized prospective study to determine the efficacy of an H(2) blocker (roxatidine, 150 mg/day) and a proton pump inhibitor (lansoprazole, 30 mg/day) on asthma symptoms of 30 asthmatic patients with GERD. These patients were divided in the two groups (15 patients for each group) and treated with either roxatidine or lansoprazole. The diagnosis of GERD was established by the method of Los Angeles classification including mucosal minimum change of Grade M and questionnaire for the diagnosis of reflux disease (QUEST) score. The efficacy of acid suppressive drugs was evaluated by peak expiratory flow (PEF), asthma control questionnaire (ACQ) that evaluates the improvement of asthma symptoms, and forced expiratory volume in 1 second (FEV(1.0)). Lansoprazole, but not roxatidine, significantly improved PEF and ACQ scores (p < 0.05) with the improved QUEST scores. However, these acid suppressive drugs did not change the pulmonary function of FEV(1.0) in asthmatic patients. In conclusion, treatment with a proton pump inhibitor, lansoprazole, appears to be useful in improvement of asthma symptoms in asthmatic patients with GERD.

  10. Laparoscopic Watson Fundoplication Is Effective and Durable in Children with Gastrooesophageal Reflux

    Directory of Open Access Journals (Sweden)

    Matthew G. Dunckley

    2014-01-01

    Full Text Available Gastroesophageal reflux (GOR affects 2–8% of children over 3 years of age and is associated with significant morbidity. The disorder is particularly critical in neurologically impaired children, who have a high risk of aspiration. Traditionally, the surgical antireflux procedure of choice has been Nissen’s operation. However, this technique has a significant incidence of mechanical complications and has a reoperation rate of approximately 7%, leading to the development of alternative approaches. Watson’s technique of partial anterior fundoplication has been shown to achieve long-lasting reflux control in adults with few mechanical complications, but there is limited data in the paediatric population. We present here short- and long-term outcomes of laparoscopic Watson fundoplication in a series of 76 children and infants, 34% of whom had a degree of neurological impairment including severe cerebral palsy and hypoxic brain injury. The overall complication rate was 27.6%, of which only 1 was classified as major. To date, we have not recorded any incidences of perforation and no revisions. In our experience, Watson’s laparoscopic partial fundoplication can be performed with minimal complications and with durable results, not least in neurologically compromised children, making it a viable alternative to the Nissen procedure in paediatric surgery.

  11. The Reflux Disease Questionnaire: a measure for assessment of treatment response in clinical trials

    Directory of Open Access Journals (Sweden)

    Junghard Ola

    2008-04-01

    Full Text Available Abstract Background Critical needs for treatment trials in gastroesophageal reflux disease (GERD include assessing response to treatment, evaluating symptom severity, and translation of symptom questionnaires into multiple languages. We evaluated the previously validated Reflux Disease Questionnaire (RDQ for internal consistency, reliability, responsiveness to change during treatment and the concordance between RDQ and specialty physician assessment of symptom severity, after translation into Swedish and Norwegian. Methods Performance of the RDQ after translation into Swedish and Norwegian was evaluated in 439 patients with presumed GERD in a randomized, double-blind trial of active treatment with a proton pump inhibitor. Results The responsiveness was excellent across three RDQ indicators. Mean change scores in patients on active treatment were large, also reflected in effect sizes that ranged from a low of 1.05 (dyspepsia to a high of 2.05 (heartburn and standardized response means 0.99 (dyspepsia and 1.52 (heartburn. A good positive correlation between physician severity ratings and RDQ scale scores was seen. The internal consistency reliability using alpha coefficients of the scales, regardless of language, ranged from 0.67 to 0.89. Conclusion The results provide strong evidence that the RDQ is amenable to translation and represents a viable instrument for assessing response to treatment, and symptom severity.

  12. Managing peptic ulcer and gastroesophageal reflux disease in elderly Chinese patients--focus on esomeprazole.

    Science.gov (United States)

    Tang, Raymond S Y; Wu, Justin C Y

    2013-01-01

    Peptic ulcer disease (PUD) and gastroesophageal reflux disease (GERD) are not uncommon in elderly patients. Clinical presentations of these acid-related disorders may be atypical in the geriatric population. Older individuals are at increased risk for poor outcomes in complicated PUD and for development of GERD complications. Multiple risk factors (eg, Helicobacter pylori [HP], use of nonsteroidal anti-inflammatory drugs [NSAIDs], aspirin) contribute to the development of PUD. Recent data has shown that HP-negative, NSAID-negative idiopathic peptic ulcers are on the rise and carry a higher risk of recurrent ulcer bleeding and mortality. Effective management of PUD in the geriatric population relies on identification and modification of treatable risk factors. Elderly patients with GERD often require long-term acid suppressive therapy. Proton pump inhibitors (PPI) including esomeprazole are effective in the treatment of reflux esophagitis, maintenance of GERD symptomatic control, and management of PUD as well as its complications. Potential safety concerns of long-term PPI use have been reported in the literature. Clinicians should balance the risks and benefits before committing elderly patients to long-term PPI therapy.

  13. Incidence of gastroesophageal reflux symptoms in patients with refractory chronic sinusitis upon clinical treatment

    Directory of Open Access Journals (Sweden)

    Oliveira, Marcela Schmidt B. de

    2009-09-01

    Full Text Available Introduction: The chronic rhinosinusitis (CRS is a pathology that has structural and histological alterations. The association between CRS and the gastroesophageal reflux disease (GERD has been widely discussed in the last years. For this relationship to be confirmed, it is necessary to find evidences that the patients with CRS present a major incidence of GERD, that the physiopathology of both diseases explains the association between them and that the GERD treatment cures or improves the CRS' symptoms. Objectives: To evaluate the incidence of GERD in patients with CRS and a level of improvement of the nasosinusal disease symptoms after treatment with protons pump inhibitors. Methods: Retrospective study with 30 patients with CRS refractory to the clinical treatment and/or nasal cavity polypoid pathology with indication of the paranasal sinuses functional endoscopic surgery. We applied a questionnaire for evaluation of the symptomatology and previous treatment for gastroesophageal reflux. The data were submitted to statistical analysis by the Chi-Square test or Fisher's exact test with a significance of 5%. Results: Out of the patients with GERD, 33% had an improvement of the CRS' symptomatology with medications for treatment of the gastric pathology. Conclusion: It is not possible yet to state that the GER is a factor responsible for the CRS and it must be researched as a cofactor or eliciting factor when there is not other evident etiology. However, there are plausible biological mechanisms for such association.

  14. Functional dyspepsia (FD) and non-erosive reflux disease (NERD): overlapping or discrete entities?

    LENUS (Irish Health Repository)

    Quigley, Eamonn M M

    2012-02-03

    As the incidence of both gastric cancer and peptic ulcer disease have declined, that of gastro-oesophageal reflux disease (GORD) and non-ulcer, or functional dyspepsia (FD) have reached virtually epidemic proportions. As we come to appreciate the expression of these disorders in the community, the real spectrum of each disease has become evident. FD and non-erosive reflux disease (NERD), the most prevalent manifestation of GORD, frequently overlap. Where then does GORD end and FD begin? Is it realistic, or even clinically relevant, to attempt a clear separation between these entities? These are more than issues of mere semantics; therapeutic options may be dictated by the classification of the patient as one or the other. Recent work indicates clearly that NERD is a heterogeneous disorder incorporating some patients who may well harbour subtle manifestations of oesophagitis and others who have entirely normal 24-hour pH studies. These differences may be crucial to the concept of NERD\\/FD overlap. While evidence in support of this concept is far from complete, it would appear that this overlap is most relevant to those NERD patients who do not exhibit abnormal esophageal acid exposure. These patients truly belong in the spectrum of functional gastrointestinal disorders rather than in GORD; attempts to shoe-horn these individuals into the spectrum of GORD will result in therapeutic disappointment and surgical disaster.

  15. Background Factors of Reflux Esophagitis and Non-Erosive Reflux Disease: A Cross-Sectional Study of 10,837 Subjects in Japan

    Science.gov (United States)

    Minatsuki, Chihiro; Yamamichi, Nobutake; Shimamoto, Takeshi; Kakimoto, Hikaru; Takahashi, Yu; Fujishiro, Mitsuhiro; Sakaguchi, Yoshiki; Nakayama, Chiemi; Konno-Shimizu, Maki; Matsuda, Rie; Mochizuki, Satoshi; Asada-Hirayama, Itsuko; Tsuji, Yosuke; Kodashima, Shinya; Ono, Satoshi; Niimi, Keiko; Mitsushima, Toru; Koike, Kazuhiko

    2013-01-01

    Background Despite the high prevalence of gastroesophageal reflux disease (GERD), its risk factors are still a subject of controversy. This is probably due to inadequate distinction between reflux esophagitis (RE) and non-erosive reflux disease (NERD), and is also due to inadequate evaluation of adjacent stomach. Our aim is therefore to define background factors of RE and NERD independently, based on the evaluation of Helicobacter pylori infection and gastric atrophy. Methods We analyzed 10,837 healthy Japanese subjects (6,332 men and 4,505 women, aged 20–87 years) who underwent upper gastrointestinal endoscopy. RE was diagnosed as the presence of mucosal break, and NERD was diagnosed as the presence of heartburn and/or acid regurgitation in RE-free subjects. Using GERD-free subjects as control, background factors for RE and NERD were separately analyzed using logistic regression to evaluate standardized coefficients (SC), odds ratio (OR), and p-value. Results Of the 10,837 study subjects, we diagnosed 733 (6.8%) as RE and 1,722 (15.9%) as NERD. For RE, male gender (SC = 0.557, OR = 1.75), HP non-infection (SC = 0.552, OR = 1.74), higher pepsinogen I/II ratio (SC = 0.496, OR = 1.64), higher BMI (SC = 0.464, OR = 1.60), alcohol drinking (SC = 0.161, OR = 1.17), older age (SC = 0.148, OR = 1.16), and smoking (SC = 0.129, OR = 1.14) are positively correlated factors. For NERD, HP infection (SC = 0.106, OR = 1.11), female gender (SC = 0.099, OR = 1.10), younger age (SC = 0.099, OR = 1.10), higher pepsinogen I/II ratio (SC = 0.099, OR = 1.10), smoking (SC = 0.080, OR = 1.08), higher BMI (SC = 0.078, OR = 1.08), and alcohol drinking (SC = 0.076, OR = 1.08) are positively correlated factors. Prevalence of RE in subjects with chronic HP infection and successful HP eradication denotes significant difference (2.3% and 8.8%; p<0.0001), whereas that of NERD shows

  16. Probabilities of Dilating Vesicoureteral Reflux in Children with First Time Simple Febrile Urinary Tract Infection, and Normal Renal and Bladder Ultrasound.

    Science.gov (United States)

    Rianthavorn, Pornpimol; Tangngamsakul, Onjira

    2016-11-01

    We evaluated risk factors and assessed predicted probabilities for grade III or higher vesicoureteral reflux (dilating reflux) in children with a first simple febrile urinary tract infection and normal renal and bladder ultrasound. Data for 167 children 2 to 72 months old with a first febrile urinary tract infection and normal ultrasound were compared between those who had dilating vesicoureteral reflux (12 patients, 7.2%) and those who did not. Exclusion criteria consisted of history of prenatal hydronephrosis or familial reflux and complicated urinary tract infection. The logistic regression model was used to identify independent variables associated with dilating reflux. Predicted probabilities for dilating reflux were assessed. Patient age and prevalence of nonEscherichia coli bacteria were greater in children who had dilating reflux compared to those who did not (p = 0.02 and p = 0.004, respectively). Gender distribution was similar between the 2 groups (p = 0.08). In multivariate analysis older age and nonE. coli bacteria independently predicted dilating reflux, with odds ratios of 1.04 (95% CI 1.01-1.07, p = 0.02) and 3.76 (95% CI 1.05-13.39, p = 0.04), respectively. The impact of nonE. coli bacteria on predicted probabilities of dilating reflux increased with patient age. We support the concept of selective voiding cystourethrogram in children with a first simple febrile urinary tract infection and normal ultrasound. Voiding cystourethrogram should be considered in children with late onset urinary tract infection due to nonE. coli bacteria since they are at risk for dilating reflux even if the ultrasound is normal. Copyright © 2016 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  17. Bile Reflux

    Science.gov (United States)

    ... include: Chamomile, which has anti-inflammatory properties. Chamomile teas are readily available and have a low risk ... Clinic does not endorse any of the third party products and services advertised. Advertising and sponsorship policy ...

  18. Acid Reflux

    Science.gov (United States)

    ... Patient Education & Resource Center GI Health and Disease Recursos en Español What is a Gastroenterologist Video and ... Education & Resource Center Home GI Health and Disease Recursos en Español What is a Gastroenterologist? Podcasts and ...

  19. Reflux nephropathy

    Science.gov (United States)

    ... Chronic kidney disease End-stage kidney disease High blood pressure Kidney transplant Nephrotic syndrome Neurogenic bladder Renal Urinary tract infection - adults Urinary tract infection - children Review Date 9/22/2015 Updated by: Charles Silberberg, ...

  20. Value of gastro-oesophageal scintigraphy in the detection of gastro-oesophageal reflux in the infant

    Energy Technology Data Exchange (ETDEWEB)

    Le Luyer, B.; Texte, D.; Mallet, E.; Menibus, C.H. de (Departement de Pediatrie); Dewald, M. (Service de Radiologie Pediatrique, Hopital Charles Nicolle, 76 - Rouen (France)); Segond, G.; Chauman, J.; Noel, J.P. (Departement de Medecine Nucleaire, Centre Henri Becquerel, 76 - Rouen (France))

    1983-12-01

    50 children with a strong clinical suspicion of gastroesophageal reflux and 10 control patients were evaluated with gastroesophageal scintiscans. 500 ..mu..Ci a 1 mCi of Tc sulfur colloid mixed the patients' routine milk or formula feeding was administred and serial images of the abdomen and thorax were obtained. A positive scintiscan was found in 35 patients (sensitivity 70%) and none of the controls (specificity 100%). A comparison of findings in 34 patients refered for both radiographic and radionucleide studies showed that barium studies were positive in 38% and radionucleide in 64.7%. We found this examination to be more sensitive that the standard barium radiography particularly in patients with respiratory symptoms. We concluded that the GE scintiscan is complementary to barium studies in the diagnosis of GE reflux. Pulmonary aspiration of gastric contents was detected in only a case of the 35 patients with documented GE reflux. A T1/2 emptying gastric longer than 90 minutes (linear calculation) or 105 minutes (exponential calculation) is an indirect GE reflux test. This procedure is simple, safe more physiologic than other available examinations.

  1. The Effects of Baclofen for the Treatment of Gastroesophageal Reflux Disease: A Meta-Analysis of Randomized Controlled Trials

    Directory of Open Access Journals (Sweden)

    Shujie Li

    2014-01-01

    Full Text Available Objectives. Baclofen can relieve gastroesophageal reflux-related symptoms in healthy subjects and gastroesophageal reflux disease (GERD patients by reducing the incidence of transient lower esophageal sphincter relaxation. This meta-analysis aimed to evaluate the efficacy and safety of baclofen for the treatment of GERD. Methods. We systematically searched randomized controlled trials published prior to November 2013 from PubMed, Medline, Embase, ScienceDirect, ClinicalTrials.gov, and the Cochrane Central Register of Randomized Controlled Trials. We performed a meta-analysis of all eligible trials. Results. Nine studies were identified with a total of 283 GERD patients and healthy subjects. Comparative analysis provided high quality data supporting the ability of baclofen to promote a short-term decrease in the number of reflux episodes per patient, the average length of reflux episodes, and the incidence of transient lower esophageal sphincter relaxation. No serious adverse events or death events were reported, and there were no significant differences in the overall adverse events between baclofen and placebo. All reported side effects of baclofen were of mild-to-moderate intensity, and the drug was well tolerated. Conclusion. Abundant evidence suggests that baclofen may be a useful approach for the treatment of GERD patients; however, a larger well-designed research study would further confirm this recommendation.

  2. Diagnostic value of reflux sign in cholescintigraphy after administration of a gallbladder contracting agent. Comparison with X-ray cholangiography

    Energy Technology Data Exchange (ETDEWEB)

    Itoh, Hisao; Shimono, Reiko; Murase, Kenya; Koito, Hikaru; Iio, Atsushi; Hamamoto, Ken.

    1989-01-01

    This study explored the diagnostic value of cholescintigraphy in evaluating biliary passage, focusing on reflux sign in which radioactivity in the left hepatic duct or peripheral intrahepatic duct was increased after intramuscular injection of caerulein. Reflux sign was observed in 28 (12%) of 237 patients examined during the past four years from 1983 to 1987. Twenty five patients simultaneously undergoing X-ray cholangiography were eligible for this study, consisting of four each with common bile duct (CBD) stone, dilated CBD, biliary dyskinesia, and chronic pancreatitis, three with gallbladder stone, two with duodenal ulcer, and one each with adenoma of the CBD, pancreatic pseudocyst, duodenal diverticle, and acute cholangitis. The dilated CBD of 10 mm or more was seen in 13 patients (52%) and CBD stenosis was seen in 6 patients (24%). There was no correlation between reflux sign and gallbladder contraction. Prolonged RI gassage and pooling within the CBD were shown in 17 patients (68%) and 8 patients (28%), respectively. Major reflux sign was considered to reflect the CBD diameter increased by drip infusion of caerulein. It is useful in determining biliary passage in the lower end of the CBD and slight CBD dilatation. (Namekawa, K).

  3. Airway cellularity, lipid laden macrophages and microbiology of gastric juice and airways in children with reflux oesophagitis

    Directory of Open Access Journals (Sweden)

    Lewindon PJ

    2005-07-01

    Full Text Available Abstract Background Gastroesophageal reflux disease (GORD can cause respiratory disease in children from recurrent aspiration of gastric contents. GORD can be defined in several ways and one of the most common method is presence of reflux oesophagitis. In children with GORD and respiratory disease, airway neutrophilia has been described. However, there are no prospective studies that have examined airway cellularity in children with GORD but without respiratory disease. The aims of the study were to compare (1 BAL cellularity and lipid laden macrophage index (LLMI and, (2 microbiology of BAL and gastric juices of children with GORD (G+ to those without (G-. Methods In 150 children aged Results BAL neutrophil% in G- group (n = 63 was marginally but significantly higher than that in the G+ group (n = 77, (median of 7.5 and 5 respectively, p = 0.002. Lipid laden macrophage index (LLMI, BAL percentages of lymphocyte, eosinophil and macrophage were similar between groups. Viral studies were negative in all, bacterial cultures positive in 20.7% of BALs and in 5.3% of gastric aspirates. BAL cultures did not reflect gastric aspirate cultures in all but one child. Conclusion In children without respiratory disease, GORD defined by presence of reflux oesophagitis, is not associated with BAL cellular profile or LLMI abnormality. Abnormal microbiology of the airways, when present, is not related to reflux oesophagitis and does not reflect that of gastric juices.

  4. A randomized, comparative study of three doses of AZD0865 and esomeprazole for healing of reflux esophagitis

    DEFF Research Database (Denmark)

    Kahrilas, Peter J; Dent, John; Lauritsen, Karsten

    2007-01-01

    BACKGROUND & AIMS: AZD0865 belongs to a new class of acid-suppressing agents with rapid onset of action and potent acid inhibition. We evaluated its effectiveness for healing reflux esophagitis. METHODS: One thousand five hundred twenty-one patients with Los Angeles A-D esophagitis and heartburn ...

  5. The endoscopic and clinical characteristics of patients with erosive reflux disease diagnosed in gastroscopy unit of a regional hospital

    Directory of Open Access Journals (Sweden)

    Mustafa Yakut

    2012-06-01

    Full Text Available Objectives: Gastroesophageal reflux disease (GERDis a common gastrointestinal disorder, presenting witha broad spectrum of symptoms and can be associatedwith a variety of complication. It has been defined intothree groups of patients: nonerosive reflux disease, erosiveesophagitis, and Barrett’s esophagus. The aim of thestudy was to evaluate patients with erosive reflux diseasein our endoscopic unit.Materials and methods: All patients underwent gastroscopywere evaluated retrospectively. H.pylori statuseswere evaluated in erosive reflux disease (ERD patients.All patients were evaluated by videoendoscopy. Evaluationwas made by the same operator at single center.Biopsy specimen was taken for H.pylori. Diagnosis ofesophagitis was done based on Los Angeles classificationcriteria.Results: All patients that underwent gastroscopy in ourEndoscopy Unit are evaluated. Endoscopically ERD wasdetected in 104 (13.5% of 773 patients. The mean age ofthe ERD patients evaluated in the study was 43.74±18.79years. Sixty five (62.3% patients were female, and 39(38.7% were male. In 104 patients with ERD, the slidinghiatal hernia and Barrett’s esophagus was seen in 18 and10 patients, respectively. H.pylori was positive in 50.9% of104 ERD patients.Conclusion: GERD is a common gastrointestinal disorderand should always be considered during gastroscopy.J Clin Exp Invest 2012; 3(2: 260-262

  6. Duodenal lipid-induced symptom generation in gastroesophageal reflux disease : role of apolipoprotein A-IV and cholecystokinin

    NARCIS (Netherlands)

    Van Boxel, O. S.; Ter Linde, J. J. M.; Oors, J.; Otto, B.; Feinle-Bisset, C.; Smout, A. J. P. M.; Siersema, P. D.

    2012-01-01

    Background Duodenal lipid intensifies the perception of esophageal acid perfusion. Recently, we showed that genes implicated in lipid absorption were upregulated in the duodenum of fasting gastro-esophageal reflux disease (GERD) patients. This suggests that chylomicron production and secretion may b

  7. Cytochrome P450 1B1 expression in rat esophageal tumorigenesis promoted by gastric and duodenal reflux.

    Science.gov (United States)

    Devlin, Andrea H; McIlroy, Marie; McKeen, Hayley D; Bonde, Pramode; Menezes, A A Carlos; Swarbrick, Christine J; Robson, Tracy; Hirst, David G; Campbell, F Charles; McGuigan, James A; McKeown, Stephanie R

    2009-02-01

    Cytochrome P450 1B1 (CYP1B1) mRNA is constitutively expressed in most normal extra-hepatic tissues; however the protein is not detectable in these tissues but is expressed in a wide variety of tumors. CYP1B1 is responsible for the activation of a number of carcinogens present in tobacco smoke and food. A surgical model of rat esophageal tumorigenesis, promoted by gastric or duodenal reflux was used to determine CYP1B1 expression in premalignant esophageal tissue. Immunohistochemistry was performed using a modified amplified fluorescein tyramide protocol. CYP1B1 was not observed in normal esophageal mucosa, submucosa, or muscularis mucosa. Animals exposed to gastric reflux developed mild hyperplasia. Varying degrees of hyperplasia were observed in the duodenal reflux group. All regions of hyperplasia showed moderate or strong CYP1B1 immunoreactivity. Duodenal reflux induced a small number of premalignant changes: immunoreactivity was absent from the epithelium of squamous dysplasia (0/10), Barrett's esophagus (0/7), and majority of dysplastic Barrett's esophagus (1/4). Moderate or strong immunoreactivity was observed in the majority (7/8) of squamous cell carcinomas (SCCs) in situ. Immunoreactivity was also observed in the lamina propria and submucosa in association with inflammation, regardless of the severity of inflammation. The expression of CYP1B1 in hyperplasia, SCCs in situ, or in association with inflammation may increase the production of carcinogenic metabolites, which may promote esophageal tumorigenesis.

  8. A study on the efficacy of rebamipide for patients with proton pump inhibitor-refractory non-erosive reflux disease.

    Science.gov (United States)

    Adachi, Kyoichi; Furuta, Kenji; Miwa, Hiroto; Oshima, Tadayuki; Miki, Masaharu; Komazawa, Yoshinori; Iwakiri, Katsuhiko; Furuta, Takahisa; Koike, Tomoyuki; Shimatani, Tomohiko; Kinoshita, Yoshikazu

    2012-06-01

    Reflux symptoms in patients with non-erosive reflux disease (NERD) cannot be easily controlled by treatment with proton pump inhibitors (PPI). The anti-inflammatory function of rebamipide may be effective for protecting the esophageal mucosa. This prospective randomized multicenter placebo-controlled study was performed to clarify the efficacy of rebamipide for NERD patients whose reflux symptoms were refractory to PPI treatment. One hundred forty-nine patients were enrolled on the basis of a QUEST score of over 6 and absence of endoscopically proven esophageal mucosal breaks. All the patients were initially administered 15 mg of lansoprazole for 4 weeks, and the symptoms were then assessed using QUEST and GSRS. PPI-refractory patients were randomly assigned to administration of rebamipide or placebo t.i.d. for 4 weeks. Three of the 149 patients were lost to follow-up, and 60 among the remaining 146 patients were found to be PPI-refractory. Among these PPI-refractory patients, 31 were randomly assigned to a rebamipide group and 29 to a placebo group. At the end of drug administration, the QUEST and GSRS scores did not differ between the rebamipide and placebo groups, although a significantly higher proportion of patients in the rebamipide group showed amelioration of abdominal pain and diarrhea. Administration of rebamipide cannot effectively control reflux symptoms in NERD patients whose symptoms are refractory to PPI therapy.

  9. The Benefits of Combination Therapy with Esomeprazole and Rebamipide in Symptom Improvement in Reflux Esophagitis: An International Multicenter Study.

    Science.gov (United States)

    Hong, Su Jin; Park, Soo-Heon; Moon, Jeong Seop; Shin, Woon Geon; Kim, Jae Gyu; Lee, Yong Chan; Lee, Dong Ho; Jang, Jae Young; Kim, Jae J; Lee, Hang-Lak; Lee, Sang Woo; Hwangbo, Young; Xu, Jianming; Wang, Bangmao; Xue, Zhanxiong; Liu, Fei; Yuan, Yaozong; Leelakusolvong, Somchai; Dy, Frederick

    2016-11-15

    To investigate the effects of esomeprazole and rebamipide combination therapy on symptomatic improvement in patients with reflux esophagitis. A total of 501 patients with reflux esophagitis were randomized into one of the following two treatment regimens: 40 mg esomeprazole plus 300 mg rebamipide daily (combination therapy group) or 40 mg esomeprazole daily (monotherapy group). We used a symptom questionnaire that evaluated heartburn, acid regurgitation, and four upper gastrointestinal symptoms. The primary efficacy end point was the mean decrease in the total symptom score. The mean decreases in the total symptom score at 4 weeks were estimated to be -18.1±13.8 in the combination therapy group and -15.1±11.9 in the monotherapy group (p=0.011). Changes in reflux symptoms from baseline after 4 weeks of treatment were -8.4±6.6 in the combination therapy group and -6.8±5.9 in the monotherapy group (p=0.009). Over a 4-week treatment course, esomeprazole and rebamipide combination therapy was more effective in decreasing the symptoms of reflux esophagitis than esomeprazole monotherapy.

  10. Validation of the GSFQ, a Self-Administered Symptom Frequency Questionnaire for Patients with Gastroesophageal Reflux Disease

    Directory of Open Access Journals (Sweden)

    Pierre Paré

    2003-01-01

    Full Text Available BACKGROUND: Although the diagnosis of gastroesophageal reflux disease (GERD is based primarily on symptoms experienced by a patient, relatively little attention has been paid to the development and validation of self-administered questionnaires specific to GERD symptoms. The present article presents the validation of the short, self-administered GERD Symptom Frequency Questionnaire (GSFQ.

  11. A new mechanism of gastroesophageal reflux in hiatal hernia documented by high-resolution impedance manometry: a case report

    Science.gov (United States)

    Torresan, Francesco; Mandolesi, Daniele; Ioannou, Alexandros; Nicoletti, Simone; Eusebi, Leonardo Henry; Bazzoli, Franco

    2016-01-01

    Gastroesophageal reflux disease (GERD) is recognized to be a multifactorial disease and several mechanisms leading to reflux have been described, nevertheless its pathophysiology has not been fully clarified. Hiatus hernia is a known risk factor for GERD since it impairs the esophagogastric junction, leading to: reduction in lower esophageal sphincter pressure; increase in the frequency of the transient lower esophageal sphincter relaxation; and impairment of esophageal clearance. Last generation diagnostic techniques have improved the understanding of these mechanisms. A 72-year-old woman with hiatus hernia and GERD underwent a high resolution impedance manometry (HRIM) after a partial response to treatment with pantoprazole. None of the proposed pathophysiological mechanisms for GERD could explain the presence of reflux: HRIM showed normal lower esophageal sphincter (LES) pressure and contractile integral, complete bolus clearance in all test swallows, and absence of transient LES relaxation. However, after the end of each peristaltic wave, as the LES pressure returned to resting values, a gastroesophageal reflux was detected until the following swallow. We describe an interesting case of a patient with a sliding hiatus hernia, with symptoms suggestive of GERD, in which HRIM revealed a new possible mechanism through which hiatus hernia may lead to GERD. PMID:27708528

  12. Nonerosive gastroesophageal reflux disease and mild degree of esophagitis: Comparison of symptoms endoscopic, manometric and pH-metric patterns

    Directory of Open Access Journals (Sweden)

    Grande Michele

    2012-05-01

    Full Text Available Abstract Background Our aim in the present study was to compare patients presenting with gastroesophageal reflux disease in the presence or absence of mild-grade esophagitis (grade I or II according to the Savary-Miller classification. Methods Between 2005 and 2007, 215 patients with gastroesophageal reflux disease (67 with reflux associated with grade I or II esophagitis and 148 without esophagitis were evaluated at the Department of Surgery, University Hospital Tor Vergata, Rome, and were included in the present study. The evaluations consisted of clinical interviews, endoscopy of the high digestive tract, esophageal manometry and pH monitoring. Results There was no significant difference between the two groups with regard to age, sex or symptoms. The incidence of heartburn associated with noncardiac chest pain was greater in the esophagitis group than in the dysphagia group. The incidence of hiatal hernia was similar in both groups. Although the motor pattern was similar in both groups, the length of the abdominal esophagus was greater in patients without esophagitis (1.6 cm vs 1.1 cm; P  Conclusions Gastroesophageal reflux without esophagitis must be regarded not as a milder form of the disease but as part of a single disease. Furthermore, these patients often demonstrate lower rates of symptom improvement after antireflux treatment in comparison with patients with erosive esophagitis. Therefore, further trials to assess the treatment algorithm for these patients are warranted.

  13. Is the severity of obstructive sleep apnea or the magnitude of respiratory effort associated with gastroesophageal reflux?

    Institute of Scientific and Technical Information of China (English)

    Levent Ozturk; Zerrin Pelin

    2005-01-01

    @@ TO THE EDITOR In a tecent issue of World Journal of Gastroenterology,Demeter et al.[1],reported that in patients having both gastro-esophageal reflux disease(GERD)and obstructive sleep apnea(OSA),there was a positive correlation between endoscopic findings of GERD and the number of apneas and hypopneas per hour,namely apnea hypopnea index.

  14. Linkage study of 14 candidate genes and loci in four large Dutch families with vesico-ureteral reflux

    NARCIS (Netherlands)

    Eerde, A.M. van; Koeleman, B.P.C.; Kamp, J.M. van de; Jong, T.P.V.M. de; Wijmenga, C.; Giltay, J.C.

    2007-01-01

    Vesico-ureteral reflux (VUR) is a major contributing factor to end-stage renal disease in paediatric patients. Primary VUR is a familial disorder, but little is known about its genetic causes. To investigate the involvement of 12 functional candidate genes and two reported loci in VUR, we performed

  15. Review article: the clinical relevance of transient lower oesophageal sphincter relaxations in gastro-oesophageal reflux disease

    NARCIS (Netherlands)

    B.F. Kessing; J.M. Conchillo; A.J. Bredenoord; A.J.P.M. Smout; A.A.M. Masclee

    2011-01-01

    P>Background Transient lower oesophageal sphincter relaxations (TLOSR) are considered the physiological mechanism that enables venting of gas from the stomach and appear as sphincter relaxations that are not induced by swallowing. It has become increasingly clear that most reflux episodes occur duri

  16. Characteristic pathological findings and effects of ecabet sodium in rat reflux esophagitis

    Institute of Scientific and Technical Information of China (English)

    Daisuke Asaoka; Akihito Nagahara; Masako Oguro; Yuko Izumi; Akihiko Kurosawa; Taro Osada; Masato Kawabe; Mariko Hojo; Michiro Otaka; Sumio Watanabe

    2009-01-01

    AIM: To explore the pathological findings in the entire esophagus in rats with reflux esophagitis, and the effects of ecabet sodium (ES). METHODS: A rat model of chronic acid reflux esophagitis was used. In the treatment group, ES was administered after surgery ( n = 16). No drug was administered postoperatively to the esophagitis group ( n = 9). Shamoperated rats were used as a control group ( n = 5). Rats were sacrificed on day 7 after the operation. The epithelial thickness and leukocyte infiltration were examined in the upper, middle and lower areas of the esophagus. The survival rate, incidence of esophageal ulcer, and mean surface area and number of esophageal ulcers were determined in the esophagitis and ES groups. Esophageal histology was assessed in all three groups. RESULTS: Leukocyte infiltration in the esophagitis group was 26.3 ± 22.0 in the middle esophagus and 8.2 ± 4.9 in the upper esophagus, which was significantly greater than that in the controls (1.3 ± 1.1 and 1.4 ± 1.0, respectively) ( P < 0.05). The thickness of the epithelium in the esophagitis group was 210.8 ± 47.7 μm in the lower esophagus and 204.2 ± 60.1 μm in the middle esophagus, which was significantly greater than that in the controls (26.0 ± 5.5 and 21.0 ± 6.5 μm, respectively) ( P < 0.05). The mean number of ulcers per animal in the ES group in the entire esophagus was 5.4 ± 2.5, which was significantly less than that in the esophagitis group (9.0 ± 3.5) ( P < 0.05). The epithelial thickness in the ES group was 97.5 ± 32.2 μm in the lower esophagus, which was decreased compared with that in the esophagitis group (210.8 ± 47.7 μm) ( P < 0.05). CONCLUSION: Mucosal inflammation extended to the upper esophagus close to the hypopharynx. Our study suggested that ES may have a useful defensive role in reflux esophagitis.

  17. Characteristic pathological findings and effects of ecabet sodium in rat reflux esophagitis

    Science.gov (United States)

    Asaoka, Daisuke; Nagahara, Akihito; Oguro, Masako; Izumi, Yuko; Kurosawa, Akihiko; Osada, Taro; Kawabe, Masato; Hojo, Mariko; Otaka, Michiro; Watanabe, Sumio

    2009-01-01

    AIM: To explore the pathological findings in the entire esophagus in rats with reflux esophagitis, and the effects of ecabet sodium (ES). METHODS: A rat model of chronic acid reflux esophagitis was used. In the treatment group, ES was administered after surgery (n = 16). No drug was administered postoperatively to the esophagitis group (n = 9). Sham-operated rats were used as a control group (n = 5). Rats were sacrificed on day 7 after the operation. The epithelial thickness and leukocyte infiltration were examined in the upper, middle and lower areas of the esophagus. The survival rate, incidence of esophageal ulcer, and mean surface area and number of esophageal ulcers were determined in the esophagitis and ES groups. Esophageal histology was assessed in all three groups. RESULTS: Leukocyte infiltration in the esophagitis group was 26.3 ± 22.0 in the middle esophagus and 8.2 ± 4.9 in the upper esophagus, which was significantly greater than that in the controls (1.3 ± 1.1 and 1.4 ± 1.0, respectively) (P < 0.05). The thickness of the epithelium in the esophagitis group was 210.8 ± 47.7 μm in the lower esophagus and 204.2 ± 60.1 μm in the middle esophagus, which was significantly greater than that in the controls (26.0 ± 5.5 and 21.0 ± 6.5 μm, respectively) (P < 0.05). The mean number of ulcers per animal in the ES group in the entire esophagus was 5.4 ± 2.5, which was significantly less than that in the esophagitis group (9.0 ± 3.5) (P < 0.05). The epithelial thickness in the ES group was 97.5 ± 32.2 μm in the lower esophagus, which was decreased compared with that in the esophagitis group (210.8 ± 47.7 μm) (P < 0.05). CONCLUSION: Mucosal inflammation extended to the upper esophagus close to the hypopharynx. Our study suggested that ES may have a useful defensive role in reflux esophagitis. PMID:19630101

  18. A New Pathologic Assessment of Gastroesophageal Reflux Disease: The Squamo-Oxyntic Gap.

    Science.gov (United States)

    Chandrasoma, Parakrama; DeMeester, Tom

    Diagnosis of gastroesophageal reflux disease (GORD) is delayed by the lack of uniform histopathologic criteria for diagnosis. The only practical value of pathology is the assessment of columnar lined esophagus (CLO). As a result, GORD is treated with acid suppressive drug therapy until there is a failure to control symptoms and/or advanced adenocarcinoma develops. The reasons why there is a failure of pathologic diagnosis are two false dogmas that result in two widely believed fundamental errors. These are the belief that cardiac epithelium normally lines the proximal stomach (1) and that the gastroesophageal junction (GOJ) is defined by the proximal limit of rugal folds (2). When these false dogmas are eradicated by existing powerful evidence, the pathology of GERD falls into the following stages, all defined by histology: (a) The normal state where the esophageal squamous epithelium transitions at the GOJ to gastric oxyntic epithelium with no intervening cardiac epithelium; (b) cardiac metaplasia of the squamous epithelium due to exposure to gastric juice results in cephalad movement of the squamo-columnar junction (SCJ). This creates the squamo-oxyntic gap and the dilated distal esophagus, which is distal to the endoscopic GOJ. The length of the squamo-oxyntic gap in the dilated distal esophagus is concordant with the shortening of the abdominal segment of the lower esophageal sphincter (LOS); (c) in the early stages, the gap is gap increases in length, concordant with the amount of shortening of the LOS, which becomes increasingly incompetent. At a gap length of 5-15 mm, reflux is sufficient to cause symptoms, but in most patients, symptoms are controllable and the patients are normal at endoscopy. The gap is entirely within the dilated distal esophagus, which is mistaken by present criteria for proximal stomach. (e) The last stage of GORD is when the squamo-oxyntic gap is >15 mm. In these patients, reflux is severe with increasingly uncontrollable symptoms and

  19. Self-Perception of Swallowing-Related Problems in Laryngopharyngeal Reflux Patients Diagnosed with 24-Hour Oropharyngeal pH Monitoring

    Directory of Open Access Journals (Sweden)

    Tamer A. Mesallam

    2016-01-01

    Full Text Available Background and Objectives. Swallowing difficulty is considered one of the nonspecific symptoms that many patients with laryngopharyngeal reflux complain of. However, the relationship between laryngopharyngeal reflux and swallowing problems is not clear. The purpose of this work is to explore correlation between swallowing-related problems and laryngopharyngeal reflux (LPR in a group of patients diagnosed with oropharyngeal pH monitoring and to study the effect of laryngopharyngeal reflux on the patients’ self-perception of swallowing problems. Methods. 44 patients complaining of reflux-related problems were included in the study. Patients underwent 24-hour oropharyngeal pH monitoring and were divided into positive and negative LPR groups based on the pH monitoring results. All patient filled out the Dysphagia Handicap Index (DHI and Reflux Symptom Index (RSI questionnaires. Comparison was made between the positive and negative LPR groups regarding the results of the DHI and RSI ratings. Also, correlation between DHI scores, RSI scores, and pH monitoring results was studied. Results. Significant difference was reported between positive and negative LPR groups regarding DHI scores, RSI scores, and overall rating of swallowing difficulty. There was significant correlation demonstrated between DHI scores, RSI scores, and 24-hour oropharyngeal pH results. Conclusion. Laryngopharyngeal reflux appears to have a significant impact on patients’ self-perception of swallowing problems as measured by DHI.

  20. Correlation between severity of endoscopic findings and apnea-hypopnea index in patients with gastroesophageal reflux disease and obstructive sleep apnea

    Institute of Scientific and Technical Information of China (English)

    P(a)l Demeter; Katalin V(a)rdi Visy; P(a)l Magyar

    2005-01-01

    AIM: To assess the relationship between severity of gastroesophageal reflux disease and apnea-hypopnea index (AHI) as an indicator of the severity of obstructive sleep apnea.METHODS: Data of 57 patients with proven obstructive sleep apnea and gastroesophageal reflux disease were analyzed. Patients were divided into two groups according to severity of the sleep apnea: "mild-moderate" (A)-AHI ≥5-30, n = 27, "severe" (B)-AHI >30, n = 30. All patients underwent apnea monitoring during the night, upper panendoscopy and were asked about typical reflux symptoms.RESULTS: All examined patients in both groups showed a significant overweight and there was a positive correlation between body mass index and the degree of sleep apnea (P = 0.0002). The occurence of erosive reflux disease was significantly higher in "severe" group (P = 0.0001).Using a logistic regression analysis a positive correlation was found between the endoscopic severity of reflux disease and the AHI (P = 0.016). Forty-nine point five percent of the patients experienced the typical symptoms of reflux disease at least three times a week and there was no significant difference between the two groups.CONCLUSION: A positive correlation can be found between the severity of gastroesophageal reflux disease and obstructive sleep apnea.

  1. Associations between respiratory symptoms, lung function and gastro-oesophageal reflux symptoms in a population-based birth cohort

    Directory of Open Access Journals (Sweden)

    Herbison G Peter

    2006-12-01

    Full Text Available Abstract Background Several studies have reported an association between asthma and gastro-oesophageal reflux, but it is unclear which condition develops first. The role of obesity in mediating this association is also unclear. We explored the associations between respiratory symptoms, lung function, and gastro-oesophageal reflux symptoms in a birth cohort of approximately 1000 individuals. Methods Information on respiratory symptoms, asthma, atopy, lung function and airway responsiveness was obtained at multiple assessments from childhood to adulthood in an unselected birth cohort of 1037 individuals followed to age 26. Symptoms of gastro-oesophageal reflux and irritable bowel syndrome were recorded at age 26. Results Heartburn and acid regurgitation symptoms that were at least "moderately bothersome" at age 26 were significantly associated with asthma (odds ratio = 3.2; 95% confidence interval = 1.6–6.4, wheeze (OR = 3.5; 95% CI = 1.7–7.2, and nocturnal cough (OR = 4.3; 95% CI = 2.1–8.7 independently of body mass index. In women reflux symptoms were also associated with airflow obstruction and a bronchodilator response to salbutamol. Persistent wheezing since childhood, persistence of asthma since teenage years, and airway hyperresponsiveness since age 11 were associated with a significantly increased risk of heartburn and acid regurgitation at age 26. There was no association between irritable bowel syndrome and respiratory symptoms. Conclusion Reflux symptoms are associated with respiratory symptoms in young adults independently of body mass index. The mechanism of these associations remains unclear.

  2. Voiding urosonography with second-generation ultrasound contrast versus micturating cystourethrography in the diagnosis of vesicoureteric reflux.

    Science.gov (United States)

    Wong, L S; Tse, K S; Fan, T W; Kwok, K Y; Tsang, T K; Fung, H S; Chan, W; Lee, K W; Leung, M W Y; Chao, N S Y; Tang, K W; Chan, S C H

    2014-08-01

    Vesicoureteric reflux has been associated with paediatric urinary tract infection. Fluoroscopic micturating cystourethrography (MCU) has been the gold standard of diagnostic test for decades; however, it has been criticized owing to its lower detection rate and radiation dose to children. Therefore, new radiation-free reflux imaging modalities have been developed, in which ultrasound-based contrast-enhanced voiding urosonography (ceVUS) is a good example. However, ultrasonography has been considered as an operator-dependent examination. Therefore, our study aimed to examine the inter-observer agreement of this sonographic technique, which has not been evaluated before. Moreover, the second-generation ultrasound contrast SonoVue has been recently marketed, and the data on its efficacy on intravesical use in ceVUS is relatively scarce. Thus, we also aimed to investigate the diagnostic performance and safety profile of SonoVue-enhanced VUS in the diagnosis of vesicoureteric reflux. Our prospective comparative study compared the diagnostic performance of ceVUS with MCU in young children presenting with first episode of urinary tract infection. We performed sequential ceVUS and MCU examinations in 31 patients (62 pelvi-ureter units). Perfect inter-observer agreement (Cohen’s kappa statistics = 1.0, p MCU as reference, ceVUS had 100 % sensitivity and 84 % specificity and carried higher reflux detection rate than MCU (p < 0.001). There was no complication encountered. Conclusion: Voiding urosonography is a reliable, sensitive, safe and radiation-free modality in the investigation of vesicoureteric reflux in children. It should be incorporated in the diagnostic algorithm in paediatric urinary tract infection.

  3. Systematic review: the effects of carbonated beverages on gastro-oesophageal reflux disease.

    Science.gov (United States)

    Johnson, T; Gerson, L; Hershcovici, T; Stave, C; Fass, R

    2010-03-01

    Carbonated beverages have unique properties that may potentially exacerbate gastro-oesophageal reflux disease (GERD), such as high acidity and carbonation. Cessation of carbonated beverage consumption is commonly recommended as part of lifestyle modifications for patients with GERD. To evaluate the relationship of carbonated beverages with oesophageal pH, oesophageal motility, oesophageal damage, GERD symptoms and GERD complications. A systematic review. Carbonated beverage consumption results in a very short decline in intra-oesophageal pH. In addition, carbonated beverages may lead to a transient reduction in lower oesophageal sphincter basal pressure. There is no evidence that carbonated beverages directly cause oesophageal damage. Carbonated beverages have not been consistently shown to cause GERD-related symptoms. Furthermore, there is no evidence that these popular drinks lead to GERD complications or oesophageal cancer. Based on the currently available literature, it appears that there is no direct evidence that carbonated beverages promote or exacerbate GERD.

  4. Studies of antibacterial efficacy of different biopolymer protected silver nanoparticles synthesized under reflux condition

    Science.gov (United States)

    Su, Chia Hung; Velusamy, Palaniyandi; Kumar, Govindarajan Venkat; Adhikary, Shritama; Pandian, Kannaiyan; Anbu, Periyasamy

    2017-01-01

    In the present study, a simple method to impregnate silver nanoparticles (AgNPs) into carboxymethyl cellulose (CMC) and sodium alginate (SA) is reported for the first time. Single step synthesis of carboxymethyl cellulose (CMC) and sodium alginate (SA) biopolymer protected silver nanoparticles (AgNPs) using aniline as a reducing agent under reflux conditions was investigated. The synthesized nanoparticles were characterized by UV-Vis spectrophotometry, X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FTIR) and field emission scanning electron microscopy (FESEM). The FESEM results of CMC@AgNPs and SA@AgNPs showed the formation of spherical nanoparticles sized 30-60 nm. Testing of the antibiofilm efficacy of the polymer protected AgNPs against different bacterial strains such as Klebsiella pneumoniae MTCC 4032 and Streptococcus pyogenes MTCC 1924 revealed that the biopolymer protected AgNPs had excellent antibiofilm activity.

  5. Incidence of reflux esophagitis and Helicobacter pylori infection in diabetic patients

    Institute of Scientific and Technical Information of China (English)

    Ken Ariizumi; Tomoyuki Koike; Shuichi Ohara; Yoshifumi Inomata; Yasuhiko Abe; Katsunori Iijima; Akira Imatani; Tomoyoshi Oka; Tooru Shimosegawa

    2008-01-01

    AIM:To investigate the incidence of reflux esophagitis (RE) and Hpylori infection in the diabetic patient.METHODS:The incidence of RE and Hpylori infection were investigated in 85 patients with diabetes mellitus and the results were compared with controls.RESULTS:The incidence of RE in diabetic patients was 17.6%.Although this tended to be higher in diabetic patients,there were no statistically significant differences between diabetic patients and controls.The incidence of Hpylori infection in diabetic patients was 53.7% but no statistically significant difference was seen between diabetic patients and controls in the incidence of Hpylori infection.CONCLUSION:No significant differences could be seen between diabetic patients and controls in the incidence of RE and Hpylori infection.

  6. Experimental human pain models in gastro-esophageal reflux disease and unexplained chest pain

    Institute of Scientific and Technical Information of China (English)

    Asbj(φ)rn Mohr Drewes; Lars Arendt-Nielsen; Peter Funch-Jensen; Hans Gregersen

    2006-01-01

    Methods related to experimental human pain research aim at activating different nociceptors, evoke pain from different organs and activate specific pathways and mechanisms. The different possibilities for using mechanical, electrical, thermal and chemical methods in visceral pain research are discussed with emphasis of combinations (e.g., the multimodal approach). The methods have been used widely in assessment of pain mechanisms in the esophagus and have contributed to our understanding of the symptoms reported in these patients. Hence abnormal activation and plastic changes of central pain pathways seem to play a major role in the symptoms in some patients with gastro-esophageal reflux disease and in patients with functional chest pain of esophageal origin. These findings may lead to an alternative approach for treatment in patients that does not respond to conventional medical or surgical therapy.

  7. Quality of life scales for patients with gastroesophageal reflux disease: A literature review

    Directory of Open Access Journals (Sweden)

    Xiao-Li Guan

    2015-03-01

    Full Text Available Gastroesophageal reflux disease (GERD is a common chronic disease of the gastrointestinal tract that occurs in 3.1% of the Chinese population [1]. Heartburn, acid regurgitation and epigastric pain are typical clinical symptoms of GERD. These symptoms can affect patients' work productivity, sleep, diet and daily activities, thus resulting in a reduced quality of life (QOL [2]. Although patient QOL is increasingly being considered as a medical outcome index in the evaluation of the impact of GERD symptoms on patients' health status, measuring patient QOL in clinical trials can be challenging due to the lack of a standard assessment tool. Therefore, we aim to review the commonly used generic, disease-specific and hybrid QOL questionnaires to evaluate patients with GERD to provide a reference for clinical nursing work.

  8. Cross-fused renal ectopia associated with vesicoureteral reflux; a case report

    Science.gov (United States)

    Naseri, Mitra

    2016-01-01

    Crossed renal ectopia is a rare urinary system anomaly which mostly is asymptomatic and is diagnosed incidentally. Urinary obstruction, infection, and neoplasia of the urinary system and nephrolithiasis are main complications of this anomaly. A 6-year-old boy admitted to the hospital with colicky abdominal pain and nausea. Abdominal examination revealed tenderness in right lower quadrant. Urine analysis and culture were normal. Kidney ultrasonography showed right kidney in pelvis cavity with no kidney tissue in left side. TC 99-DMSA scan demonstrated no radiotracer accumulation in the normal renal area. Radiotracer accumulation was seen in the pelvis area with a deviation to the left. Voiding cystoureterogram revealed right sided grade II vesicoureteral reflux. Severe urological anomalies in children may be asymptomatic or have nonspecific symptoms such as abdominal pain. PMID:27689123

  9. Association between Gastroesophageal Reflux Disease and Appendicitis: A Population-Based Case-Control Study.

    Science.gov (United States)

    Kao, Li-Ting; Tsai, Ming-Chieh; Lin, Herng-Ching; Lee, Cha-Ze

    2016-03-02

    Appendicitis and gastroesophageal reflux disease (GERD) are both prevalent diseases and might share similar pathological mechanisms. The aim of this study was to investigate the association between GERD and appendicitis using a large population-based dataset. This study used administrative claims data from the Taiwan Longitudinal Health Insurance Database 2005. We identified 7113 patients with appendicitis as cases, and 28452 matched patients without appendicitis as controls. This study revealed that GERD was found in 359 (5.05%) cases and 728 (2.56%) controls (p appendicitis were 1.96 (95% CI: 1.56~2.47), 2.36 (95% CI: 1.94~2.88), and 1.71 (95% CI: 1.31~2.22) than controls, respectively. We concluded that patients with appendicitis had higher odds of prior GERD than those without appendicitis regardless of age group.

  10. The Effects of Gastroesophageal Reflux Disease on Forensic Breath Alcohol Testing.

    Science.gov (United States)

    Booker, James L; Renfroe, Kathryn

    2015-11-01

    Fifteen test subjects, 10 of whom were diagnosed with gastroesophageal reflux disease (GERD), were dosed with alcohol to BACs above 0.150 g/dL. Blood and breath assays taken at 20-min intervals for 8 h after dosing demonstrated close agreement between postabsorptive BAC and BrAC values. Three subjects exhibited elevated breath alcohol concentrations up to 0.105 g/dL during the absorptive phase that were apparently due to the passage of gastric alcohol through the lower esophageal sphincter not attributable to eruction or regurgitation. The effect of gastric alcohol was not consistently proportional to the amount of unabsorbed gastric alcohol. Absorption of alcohol in the esophagus explains the nonproportionality. Breath samples contaminated by GERD-related alcohol leakage from the stomach into a breath sample were found only when there was a high concentration of alcohol in the stomach. When contaminated breath samples were encountered, they were irreproducible in magnitude.

  11. Comparison of "direct" and "indirect" nuclear cystography in the diagnosis of vesicoureteric reflux.

    Science.gov (United States)

    Khriesat, I; Khriesat, S; Hazza, I

    2001-01-01

    This study was undertaken to compare "direct" and "indirect" nuclear cystography for the detection of vesicoureteral reflux (VUR). Forty-five children (15 males and 30 females), ranging in age from 5 months to 10 years, were studied at the King Hussein Medical Center, Amman, Jordan between January 1998 and December 1999, using both direct (catheter) and indirect techniques of nuclear cystography (NC). Of the 82 ureters that could be compared, 32 ureters were positive for VUR on the direct technique while only 20 ureters showed VUR on the indirect technique (sensitivity 62%). Nine ureters, which did not show VUR on the direct cystogram, were read as positive on the indirect cystogram (specificity 82%). The false positive results of indirect nuclear cystogram make it invalid for VUR screening program, while the ease of assessment and low radiation dose from the direct NC has made this the recommended test for screening and follow-up of VUR.

  12. Response to air insufflation in patients with non-erosive gastro-oesophageal reflux disease (NERD).

    Science.gov (United States)

    Kira, F; Suzuki, T; Suyama, Y; Nishimura, S; Ogura, K

    2011-01-01

    This study compared changes in intragastric pressure (IGP) in response to a gastric distension stimulus caused by air insufflation in 25 patients with non-erosive gastro-oesophageal reflux disease (NERD) and 34 healthy volunteers (controls). In four NERD patients, IGP responses were also measured before and after oral treatment with 10 mg rabeprazole daily for 2 weeks. The rate of increase in IGP at the start of insufflation was significantly higher in NERD patients than in controls. The time to appearance of symptoms (i.e. time to threshold) was significantly shorter in NERD patients than in controls. Direct measurement of IGP showed that visceral hypersensitivity and impaired fundal relaxation are both characteristic of NERD. Administration of rabeprazole led to a marked prolonging of time to threshold, indicating that treatment could alleviate this hypersensitivity.

  13. Gastroesophageal reflux disease (GERD) and inflammatory bowel disease (IBD): attachment styles and parental bonding.

    Science.gov (United States)

    Ercolani, Mauro; Farinelli, Marina; Agostini, Alessandro; Baldoni, Franco; Baracchini, Federica; Ravegnani, Gianni; Bortolotti, Mauro

    2010-10-01

    The attachment styles and parental bonding by 64 patients (M age = 43.2 yr., SD = 13.3) with Gastroesophageal Reflux Disease (GERD) were compared with those of 64 patients (M age = 42.2 yr., SD = 13.5) with Inflammatory Bowel Disease (IBD) and 126 Healthy participants (M age = 42.2 yr., SD = 12.1). Analysis of scores on the Attachment Style Questionnaire indicated insecure attachment in both the patient and control groups. The Parental Bonding scores indicated perceptions of Affectionless Control by parents in both patient groups. In particular, the mean Father-Protection subscale scores were significantly higher for in the GERD group than in the Healthy and IBD groups.

  14. Experience of antireflux surgery application for the treatment of gastroesophageal reflux disease

    Directory of Open Access Journals (Sweden)

    Tolstokorov A.S.

    2015-12-01

    Full Text Available Purpose of the study: post-hoc analysis of mid-term and late results of various types of antireflux surgery performed to treat hiatal hernia. Material and methods. We have studied results of post-surgery examination of 118 patients diagnosed with hiatal hernia, the examination being performed at various time intervals after surgeries. Results. The only benefits of using laparoscopic treatment include cosmetic effect, shorter terms of hospital stay and recovery of person's capacity to work. Conclusion. Analysis of immediate and late results of surgical treatment of gastroesophageal reflux disease as well as frequency of postsurgical relapses provided no certain evidence of significant beneficial effect for choosing laparoscopic surgical methods over traditional open surgery.

  15. Prosthetic Rehabilitation of a Patient with Gastroesophageal Reflux Disease: 4-Year Followup

    Directory of Open Access Journals (Sweden)

    Ricardo Coelho Okida

    2014-01-01

    Full Text Available The gastroesophageal reflux disease (GERD is one of the main causes of dental erosion. The aim of this case presented is to describe the prosthetic rehabilitation of a patient with GERD after 4 years of followup. A 33-year-old male patient complained about tooth sensitivity. The lingual surface of the maxillary anterior teeth and the cusps of the upper and lower posterior teeth presented wear. It was suspected that the feeling of heartburn reported by the patient associated with the intake of sports supplements (isotonics was causing gastroesophageal changes. The patient was referred to a gastroenterologist and was diagnosed with GERD. Dental treatment was performed with metal-free crowns and porcelain veneers after medical treatment of the disease. With the change in eating habits, the treatment of GERD and lithium disilicate ceramics provided excellent cosmetic results after 4 years and the patient reported satisfaction with the treatment.

  16. Quality of life and cost-effectiveness of combined therapy for reflux esophagitis

    Institute of Scientific and Technical Information of China (English)

    姒健敏; 王良静; 陈淑洁; 赵岚; 戴宁

    2003-01-01

    Objective : To evaluate clinical, Quality of Life (QoL) and medical cost outcomes in patients with symptomatic reflux esophagitis (RE) receiving different "triple combination therapy". Methods: A muhicenter medical effectiveness trial conducted in 10 hospitals of 5 regions in Zhejiang Province. 248 patient-volunteers were assigned to 8 weeks of " triple combination therapy" with Lansoprazole plus Cisapride and Sucralfate or Ranitidine plus Cisapride and Sucralfate. Main outcomes assessment included symptoms scale scores, RE severity, QoL at baseline and 8 weeks. Medical cost data were collected with cost analysis questionnaire. Resuits: (1)More Lansoprazole group patients noted RE symptoms resolution than Ranitidine group(92.3 % vs 78.4%, P 0.05) . (2)RE significantly impaired QoL of patients( P 0.05 ) . Conclusion : RE significantly impaired QoL of patients. "Triple combination therapies" can significantly improve RE symptoms and QoL. Lansoprazole combination therapy was more cost-effective than Ranitidine combination group.

  17. Does a melatonin supplement alter the course of gastroesophageal reflux disease?

    Institute of Scientific and Technical Information of China (English)

    Mariusz; H; Madalinski

    2011-01-01

    Symptomatic gastro-esophageal reflux disease(GERD) is a very common disease.The consequence of GERD is not only erosive esophagitis,but also esophageal stricture,Barrett’s esophagus and extra-esophageal damage(including the lungs,throat,sinuses,middle ear and teeth).GERD and Barrett’s esophagus are also identif ied as major risk factors for esophageal carcinoma.Therapy with melatonin prevents esophageal injury from acid-pepsin and acid-pepsin-bile exposure in animals,then further studies are required in humans to establish whether a melatonin supplement is able to protect the patients with GERD from erosions,Barrett’s and neoplasia.

  18. Comparison of "Direct" and "Indirect" Nuclear Cystography in the Diagnosis of Vesicoureteric Reflux

    Directory of Open Access Journals (Sweden)

    Khriesat Imad

    2001-01-01

    Full Text Available This study was undertaken to compare "direct" and "indirect" nuclear cystography for the detection of vesicoureteral reflux (VUR. Forty-five children (15 males and 30 females, ranging in age from 5 months to 10 years, were studied at the King Hussein Medical Center, Amman, Jordan between January 1998 and December 1999, using both direct (catheter and indirect techniques of nuclear cystography (NC. Of the 82 ureters that could be compared, 32 ureters were positive for VUR on the direct technique while only 20 ureters showed VUR on the indirect technique (sensitivity 62%. Nine ureters, which did not show VUR on the direct cystogram, were read as positive on the indirect cystogram (specificity 82%. The false positive results of indirect nuclear cystogram make it invalid for VUR screening program, while the ease of assessment and low radiation dose from the direct NC has made this the recommended test for screening and follow-up of VUR.

  19. Efficacy of noofen use in the treatment of gastroesophageal reflux disease in schoolchildren

    Directory of Open Access Journals (Sweden)

    S.L. Nyankovskyy

    2017-05-01

    Full Text Available We examined 40 children aged 10–18 years, who were diagnosed with gastroesophageal reflux disease (GERD. According to a survey by O.M. Vein, all patients had manifestations of autonomic dysfunction. The children were divided into 2 groups. The control group consisted of 20 patients, who received standard antisecretory therapy. The main group consisted of 20 children, who received standard antisecretory therapy and phenibut (Noofen®, OlainFarm, Latvia at a dose of 250 mg 2 times a day for 21 days. After 1 month of starting the treatment, an evaluation of its efficacy was conducted. Clinical evaluation of the dynamics of autonomic nervous system status in schoolchildren with GERD suggests that inclusion of Noofen into the complex of therapy for this disease provides good stabilizing effect, which manifests by a restoration of autonomic nervous system balance in schoolchildren.

  20. Management of Vesicoureteral Reflux by Endoscopic Injection of Dextranomer/Hyaluronic Acid in Adults

    Science.gov (United States)

    Stark, Timothy W; Lacy, John M; Preston, David M

    2016-01-01

    A 74-year-old man presented for evaluation after discovery of a left bladder-wall tumor. He underwent transurethral resection of bladder tumor (TURBT) operation for treatment of low-grade, Ta urothelial cancer of the bladder. The patient developed recurrent disease and returned to the operating room for repeat TURBT, circumcision, and administration of intravesical mitomycin C. The patient developed balanitis xerotica obliterans 4 years post-circumcision, requiring self-dilation with a catheter. He subsequently developed 3 consecutive episodes of left-sided pyelonephritis. Further investigation with voiding cystourethrogram (VCUG) revealed Grade 3, left-sided vesicoureteral reflux (VUR). Due to existing comorbidities, the patient elected treatment with endoscopic dextranomer/hyaluronic acid injection. A post-operative VCUG demonstrated complete resolution of left-sided VUR. This patient has remained symptom free for 8 months post-injection, with no episodes of pyelonephritis. PMID:27162514