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Sample records for familial vesicoureteral reflux

  1. Vesicoureteric reflux and pyelonephritis

    International Nuclear Information System (INIS)

    Wikstad, I.; Aperia, A.; Broberger, O.; Ekendren, K.

    1979-01-01

    The effects of gross vesicoureteric reflux in combination with urinary tract infection on the area of the renal parenchyma was analysed in 8, non-selected, girls during 3 to 6 years. A progressive significant decrease of the relative size of the kidneys with vesicoureteric reflux occurred as compared with that of kidneys with normal ureters. The decrease was mainly due to scars in the upper and lower poles. A positive correlation was found between the reduction of parenchyma and the number of episodes of pyelonephritis. (Auth.)

  2. Vesicoureteral reflux and reflux nephropathy

    International Nuclear Information System (INIS)

    Thomsen, H.S.

    1985-01-01

    Vesicoureteral reflux (VUR) is mainly a primary phenomenon due to incompetence 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.)

  3. 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.

  4. [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.

  5. Contemporary Management of Vesicoureteral Reflux.

    Science.gov (United States)

    Hajiyev, Perviz; Burgu, Berk

    2017-04-01

    Vesicoureteral reflux (VUR) remains the most interesting topic of pediatric urology due to the dynamic nature of recent controversial publications. Starting from the need for a diagnosis to the necessity and effectiveness of treatment in preventing scars, VUR remains in the mist. Although recent strong evidence helped as fog lights in this blurriness, more data are required for achieving crystal clearance. This article aims to summarize and discuss the current state of the evidence regarding VUR management. To provide a comprehensive synthesis of the main evidence in the literature on the current and contemporary management of VUR in children; to discuss conservative management with continuous antibiotic prophylaxis (CAP), especially its effectiveness and safety; and to review the current evidence regarding contemporary surgical techniques. We conducted a nonsystematic review of the literature using the recent guidelines and PubMed database regarding surveillance, CAP, endoscopic, open, laparoscopic, and robot-assisted ureteral surgical treatment. Despite the striking results of previous studies revealing the ineffectiveness of CAP, more recent studies and their two fresh meta-analyses revealed a positive role for CAP in the contemporary management of VUR. One of the most interesting findings is the redundant rising of endoscopic correction and its final settlement to real indicated cases. Patient individualization in the contemporary management of VUR seems to be the keyword. The evidence in the literature showed a safe and effective use of laparoscopic and robot-assisted laparoscopic reimplantations. The goal of VUR treatment is to prevent the occurrence of febrile urinary tract infections and formation of scars in the renal parenchyma. The approach should be risk adapted and individualized according to current knowledge. Individual risk is influenced by the presentation age, sex, history of pyelonephritis and renal damage, grade of reflux, bladder bowel

  6. Bladder Dysfunction and Vesicoureteral Reflux

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    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.

  7. Have we Overtreated Children with Vesicoureteric Reflux?

    African Journals Online (AJOL)

    mn

    ABSTRACT. Urinary tract infections (UTI) are the most common serious bacterial infections in young children. These UTIs have a high association with vesicoureteric reflux (VUR). The pathophysiology of. VUR's renal sequelae, its investigation and management is presently undergoing a reassessment. This review ...

  8. Vesicoureteral reflux and continuous prophylactic antibiotics

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    Ted Lee

    2017-06-01

    Full Text Available Vesicoureteral reflux (VUR management must be tailored based on the risk for further infections and renal scarring, gender, likelihood of spontaneous resolution, and parental preferences. Because we now understand that sterile VUR is benign and most reflux spontaneously resolves over time, the initial approach in majority of children is non-surgical with continuous antibiotic prophylaxis (CAP and correction of bladder and bowel dysfunction. Despite increasing utilization of CAP over the past four decades, the efficacy of antibiotic prophylaxis has been questioned due to conflicting results of studies plagued with design flaws and inadequate subject sample size. The Randomized Intervention for Children with Vesicoureteral Reflux (RIVUR trial, which was designed to address many of the limitations from previous studies, provided much needed answers. In this review, we sought to describe the controversy surrounding VUR management, highlight the results of RIVUR trial, and discuss how the RIVUR findings impact our understanding of CAP in the management of VUR.

  9. [Urinary tract infection caused by Enterobacteriaceae and its relationship with vesicoureteral reflux].

    Science.gov (United States)

    Díaz Álvarez, Manuel; Acosta Batista, Bárbara; Pérez Córdova, Rodolfo; Hernández Robledo, Ernesto

    The first urinary tract infection can be a marker of a urinary tract anomaly, mainly vesicoureteral reflux. The aim of this work was to determine the association between isolated enterobacteria with the presence and grade of vesicoureteral reflux in neonatal patients with their first urinary tract infection. A retrospective, observational and analytic study of newborns, who were admitted to the Neonatal Department, University Pediatric Hospital "Juan Manuel Márquez," in Havana, Cuba, from 1992 to 2013 was conducted. The causal microorganism of urinary tract infection was from the Enterobacteriaceae family. They were evaluated by radio imaging. The association between the presence and grade of vesicoureteral reflux with the causal microorganism of the urinary tract infection was analyzed. Newborn infants with urinary tract infection (450) were studied. Bacterial isolations in the urine cultures corresponded to E. coli in 316 cases (70.2%). The prevalence of vesicoureteral reflux was 18.2%. The presence of bacteria corresponding to the Enterobacteriaceae family (other than E. coli) had significant risk association with vesicoureteral reflux (OR: 2.02; p urinary tract infection. However, an association between the isolation of a microorganism of the Enterobacteriaceae family different to E. coli with the presence of vesicoureteral reflux and mainly with higher grades of vesicoureteral reflux exists. Copyright © 2017 Hospital Infantil de México Federico Gómez. Publicado por Masson Doyma México S.A. All rights reserved.

  10. Grading of vesicoureteral reflux by radionuclide cystography

    Energy Technology Data Exchange (ETDEWEB)

    Fretzayas, A.; Karpathios, T.; Dimitriou, P.; Nicolaidou, P.; Matsaniotis, N.

    1984-03-01

    Thirty-six children with urinary tract infection aged 6 months to 14 years (mean age 4 1/2 years) were studied sequentially using direct radionuclide (RNC) and conventional voiding cystourethrography (VCU). Vesicoureteral reflux (VUR) was detected equally well by both methods. Twenty-seven refluxing ureters were foand by RNC, 23 by VCU and 22 by both methods. Radiologic grade of reflux may be determined approximately with the isotope technique from the volume of regurgitating urine und duration of reflux, at a much decreased radiation exposure. Residual urine was also measured by RNC and found to be higher in children with VUR. RNC is a reliable method for detecting and grading VUR and should effectively replace VCU as the follow-up examination of choice.

  11. Management of vesicoureteral reflux in neurogenic bladder

    Directory of Open Access Journals (Sweden)

    Charlotte Q. Wu

    2017-06-01

    Full Text Available Vesicoureteral reflux (VUR is a significant risk factor for pyelonephritis and renal scarring. VUR can occur through a defective ureterovesical junction (UVJ or an overwhelmed normal UVJ mechanism such as in bladder dysfunction of congenital, acquired, or behavioral etiology. There are numerous causes for the development of a neurogenic bladder from spinal dysraphisms to spinal cord trauma and even centrally based abnormalities in children with apparently normal motor function (inappropriately termed nonneurogenic neurogenic bladder. The foundation of managing reflux in these neurogenic bladders is to maintain low bladder pressures which will commonly mean that compliance will be normal as well. There have been several publications that have shown that if bladder pressures are lowered simply with clean intermittent catheterization and medications that the reflux can resolve spontaneously. Alternatively, the patients that are in need of bladder augmentation can have spontaneous resolution of their reflux with the resulting increase in capacity. Surgical intervention is called for when bladder capacity is adequate and the reflux persists or if it is part of a larger operation to increase capacity and to manage outlet resistance. In some instances, reimplantation is necessary because the ureters interfere with the bladder neck procedure. Aside from open and robotic surgical intervention the use of endoscopic injectable agents is beginning to become more popular especially when combined with intravesical botulinum toxin A injections. Great strides are being made in the management of patients with neurogenic bladders and we are seeing more choices for the urologist to be able to manage these patients.

  12. Endoscopic treatment of vesicoureteral reflux: Current status

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    Goran Lackgren

    2009-01-01

    Full Text Available Vesicoureteral reflux (VUR affects around 1% of all children. It carries an increased risk of febrile urinary tract infections (UTIs and is associated with impaired renal function. Endoscopic treatment with NASHA/Dx gel (dextranomer microspheres in a stabilized hyaluronic acid-based gel of nonanimal origin is minimally invasive, well tolerated and provides cure rates approaching those of open surgery: ~90% in several studies. It has also been shown to be effective in a variety of ′complicated′ cases. Endoscopic treatment is therefore considered preferable to open surgery and long-term antibiotic prophylaxis. Nontreatment of VUR is being discussed as an alternative option, whereby children are treated with antibiotics only when UTIs occur. Considering all the available evidence, however, active intervention with endoscopic treatment remains preferable. A new approach to managing VUR may nevertheless be considered, with treatment decisions based not only on the grade of reflux, but also factors such as age, sex, renal scarring, and bladder dysfunction. Open surgery would be reserved for use only in the ~10% of children not responding to endoscopic treatment, and patients with refluxing primary megaureter.

  13. Vesicoureteral refluxed volume and renal function

    International Nuclear Information System (INIS)

    Markovic, V.; Capkun, V.; Eterovic, D.; Stanicic, A.; Saraga, M.

    1994-01-01

    The therapeutical approach to vesicoureteral reflux (VUR) depends on assessment of the renal involvement. The effective renal plasma flow (ERPF) and parenchymal mean transit time of radiotracer (pMTT) of the affected kidney are sensitive functional parameters. We investigated the association of these functional indices with the volume of refluxed urine. In 64 children (mean age 6.4 yrs) the presence of VUR was confirmed with direct radionuclide cystography in 80 ureters (48 unilateral and 32 bilateral) and the maximal volume of refluxed urine (MVRU) was determined for each uretero-renal unit. All patients also underwent dynamic renal scintigraphy with I-131-hippuran, providing the values of pMTT and relative renal hippuran clearances of the respective kidneys by deconvolution analysis. In 37 of the affected kidneys ERPF was also determined by combining the latter results with total ERPF, determined by plasma clearance of hippuran. Using the borderline value of MVRU of 4 ml, the group with higher MVRU exhibited significantly lower ERPF of the affected kidney (194±93 vs. 270±77 ml/min/1.73 m2, p=.002) and significantly higher proportion of pMTT's over 3.5 min (31/33 vs. 17/47, p=.003). The negative linear correlation between MVRU and ERPF was found (r=-.45, p=.006). We conclude that quantitative radionuclide cystography, aside from diagnosis and follow-up of VUR, may also provide insight in the function of the affected kidney and thus contribute in designing the therapeutical approach. (author)

  14. HISTORICAL ASPECTS OF THE VESICOURETERAL REFLUX STUDY AMONG CHILDREN

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    A.V. Ryabtseva

    2008-01-01

    Full Text Available Vesicoureteral reflux is one of the most widely spread lower urinary tract diseases among children, which is the primary reason for the disturbed urodynamics and development of the chronic pyelonephritis. As a consequence, the contamination of the urinary tracts may be the reason for further development of the chronic kidney disease, renal hypertonia and may inevitably lead to disability. The modern diagnostics of the vesi coureteral reflux is very important for the adequate conservative and operative treatment. In the given article, the authors highlight the diagnostics development stages of this disease and provide comparative characteristics of different diagnostic methods.Key words: vesicoureteral reflux, urodynamics, diagnostics, children.

  15. Primary vesicoureteral reflux in Sudanese children

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    El-Tigani M. A. Ali

    2014-01-01

    Full Text Available Vesicoureteral reflux (VUR is a common congenital renal tract anomaly in children. Reports from Sudan are scanty. We report the characteristics, presentation and outcome of primary VUR in a tertiary care hospital. The records of 30 patients (16 males; 53% followed-up between January 2004 and December 2010 were reviewed. The mean age at the time of diagnosis was 4 ± 3.9 years and 47% were <2 years of age. Renal ultrasound scan (USS failed to predict VUR in 17% of the patients. On voiding cysturethrogram (VCUG, VUR was bilateral in 57% and severe grade in 64%. Grades were not significantly associated with age, gender or site of VUR. Initial dimercaptosuccinic acid radionuclide scan showed renal damage in 61.5% of the patients. Renal damage was significantly associated with female gender and severe VUR, but not with age of onset or history of urinary tract infection (UTI. Thirteen patients (43.3% presented with acute UTI, eight (26.6% with non-specific urinary tract symptoms and nine (30% with persistently elevated serum creatinine. Urine cultures were positive in 73% of patients, and E. coli was the most common pathogen. Renal impairment at presentation was significantly associated with bilateral severe VUR and history of UTI but not age or gender. After a mean follow-up period of 1.78 years (6 months to 5 years, 70% of patients remained with normal renal function and 30% progressed to chronic kidney disease; two of them died. In conclusion, our data is different from many studies. Features of primary VUR in Sudanese children are late age of onset, equal gender affection and predominance of severe grade. Presentation is associated with a high rate of UTI, renal damage and advanced renal impairment. Measures to improve early detection and treatment of VUR may reduce the risk of kidney damage.

  16. High incidence of vesicoureteric reflux in asymptomatic siblings of children with known reflux

    International Nuclear Information System (INIS)

    Treves, S.T.; Van den Abbeele, A.D.; Davis, R.T.; Rosen, P.; Bauer, S.; Retik, A.; Colodny, A.

    1985-01-01

    A significant occurrence of vesicoureteric reflux in siblings of children with reflux has been previously suggested. The purpose of this study was to evaluate the incidence of vesicoureteric reflux in asymptomatic siblings of children with vesicoureteric reflux using radionuclide voiding cystography (RNC). A random group of 52 siblings was studied. Their ages were from 2 mos. to 13 yrs. (mean 4 yrs.). Seventy-one percent were female and 29% male, RNC was performed with the patients supine, and Tc-99m pertechnetate (2mCi/1) was infused into the bladder by catheter. A computerized gamma camera recorded the filling and voiding phase of the study at 1 frame/5 sec. Reflux was detected in 40% of the patients. It was bilateral in 17% and unilateral in 23% of the patients. Reflux was identified to the renal pelves in half of the patients. In two of these patients Tc-99m DMSA scans were obtained which revealed significant renal scarring. This study demonstrates the high incidence of reflux of various degrees in these asymptomatic siblings on high risk of developing significant renal disease. Identification and proper treatment of asymptomatic children with vesicoureteric reflux may help prevent the development of renal damage

  17. MICTURATION DISORDERS IN CHILDREN WITH VESICOURETERAL REFLUX

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    Sasa Zivic

    2003-10-01

    Full Text Available Micturation disorders associated with VUR disable reflux resolution and treatment in-creasing renal damage and reflux nephropathy. Recent data consider recurrent infection in addition to bladder dysfunction and genetic succesibility in develop reflux nephropaty. According to their potential damage to upper tract they are classified into mild, moderate and severe.Typ staccato or lazy bladder is often associated with renal damage.Most severe dysfunction/non-neurogenic neurogenic bladder can be associated with renal insufficiency. Monosymptomatic nocturnal enuresis has no rise for development nephropathy.

  18. 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...... of patients with VUR and impaired renal function compared to: (1) reflux patients with bilateral normal renal function; and (2) "normal" controls. Patients with normal bilateral renal and bladder function had a low risk of urinary tract infection during the period of follow-up (1 to 6 years). Early urodynamic...

  19. 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.)

  20. Childhood vesicoureteral reflux studies: registries and repositories sources and nosology.

    Science.gov (United States)

    Chesney, Russell W; Patters, Andrea B

    2013-12-01

    Despite several recent studies, the advisability of antimicrobial prophylaxis and certain imaging studies for urinary tract infections (UTIs) remains controversial. The role of vesicoureteral reflux (VUR) on the severity and re-infection rates for UTIs is also difficult to assess. Registries and repositories of data and biomaterials from clinical studies in children with VUR are valuable. Disease registries are collections of secondary data related to patients with a specific diagnosis, condition or procedure. Registries differ from indices in that they contain more extensive data. A research repository is an entity that receives, stores, processes and/or disseminates specimens (or other materials) as needed. It encompasses the physical location as well as the full range of activities associated with its operation. It may also be referred to as a biorepository. This report provides information about some current registries and repositories that include data and samples from children with VUR. It also describes the heterogeneous nature of the subjects, as some registries and repositories include only data or samples from patients with primary reflux while others also include those from patients with syndromic or secondary reflux. Copyright © 2012 Journal of Pediatric Urology Company. All rights reserved.

  1. [Urodynamic disturbances among children with vesico-ureteral reflux (VUR)].

    Science.gov (United States)

    Piechuta, Leszek; Bieniaś, Beata; Wieczorkiewicz-Płaza, Anna; Borzecka, Halina; Zajaczkowska, Małgorzata

    2008-01-01

    Lower urinary tract dysfunction plays significant role in patogenesis of vesicoureteral reflux (VUR). Thus, urodynamic assessment is very useful in diagnosis and treatment of VUR. Assessment of the incidence of urodynamic disturbances among children with VUR. Retrospective assessment of 125 children with VUR including 93 assessed urodymically. Urodynamic disturbances were found in 58 patients (70.9% of examined children), of which--detrussor hyperactivity in 25 (43.1% of children with urodynamic disturbances), detrussor hyperactivity with subvesical obstruction or dysfunctional voiding in 6 (10.3%), dysfunctional voiding in 17 (29.3%), anatomical subvesical obstruction in 9 (15.5%), detrussor hypotony in 1 (1.7%). No disturbances were found in 27 (29.1% of examined children). Children with detrussor overactivity were the prevalent group among all children with lower urinary tract dysfunction. Children with lower urinary tract dysfunction constitute a significant part of children with VUR.

  2. Endoscopic treatment of vesicoureteral reflux in pediatric patients

    Directory of Open Access Journals (Sweden)

    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.

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

    OpenAIRE

    Turk,Akif; Selimoglu,Ahmet; Demir,Kadir; Celik,Osman; Saglam,Erkin; Tarhan,Fatih

    2014-01-01

    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 cyst...

  4. Complications following endoscopic treatment of vesicoureteric reflux with Deflux® – two case studies

    OpenAIRE

    Życzkowski, 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.

  5. A case of solitary pelvic kidney with vesicoureteral reflux and neurogenic bladder dysfunction

    OpenAIRE

    滝内, 秀和; 桜井, 勗; 辻本, 幸夫; 菅尾, 英木; 中村, 正広

    1987-01-01

    A case of solitary pelvic kidney with neurogenic bladder dysfunction with vesicoureteral reflux is presented. The patient was a 15-year-old boy with sacral vertebral dysplasia and hare-lip, and he has been complaining of recurrent fever episodes and urinary incontinence since 11 years old. Renal anomaly was confirmed by DIP, CT and angiography, and grade IV vesicoureteral reflux was demonstrated by voiding cystourethrography. On cystometrography, low compliance bladder which had a 70 ml capac...

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

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    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.

  7. Results of biofeedback treatment on reflux resolution rates in children with dysfunctional voiding and vesicoureteral reflux.

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    Kibar, Yusuf; Ors, Onder; Demir, Erkan; Kalman, Suleyman; Sakallioglu, Onur; Dayanc, Murat

    2007-09-01

    It is well known that a relationship exists between vesicoureteral reflux (VUR) and dysfunctional voiding, and the spontaneous resolution rate in older children is lower than the rate in younger children. In this study, we analyzed our experience with biofeedback treatment in older children with confirmed voiding dysfunction and VUR and investigated the effect of this treatment on the reflux resolution rates in these children. A total of 78 children, 5 to 14 years old (mean age 9), with voiding dysfunction and VUR detected by voiding cystourethrography were treated with biofeedback therapy. Voiding cystourethrography was performed 6 months after completion of the biofeedback program to determine the reflux status. The treatment results were also documented as subjective and objective improvements. The reflux in 98 units (20 bilateral) was grade 1 in 26, grade 2 in 32, grade 3 in 28, and grade 4 in 12. At 6 months of follow-up, VUR had resolved on voiding cystourethrography in 62 units (63%), the grade had improved in 28 units (29%), and the reflux had remained unchanged in 8 units (8%). Among the older children treated with biofeedback, we also observed improvements in nocturnal enuresis (82%), daytime wetting (70%), constipation (78%), frequency (76%), infrequency (64%), urgency (71%), staccato voiding (81%), flattened voiding (81%), bladder overactivity (82%), detrusor sphincter dyssynergia (77%), spinning top urethra (67%), and urinary tract infection (80%). Biofeedback therapy is applicable in older children with dysfunctional voiding and VUR and yields greater resolution rates than the historical resolution rates.

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

    International Nuclear Information System (INIS)

    Awais, Muhammad; Rehman, Abdul; Nadeem, Naila; Zaman, Maseeh Uz

    2015-01-01

    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.)

  9. 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.)

  10. Evaluation of renal function in children with vesicoureteral reflux

    International Nuclear Information System (INIS)

    Hioki, Takuichi

    1993-01-01

    Renal uptake rate was calculated by 99m Tc-dimercaptosuccinic acid (DMSA) scintigraphy in 100 kidneys from 58 patients with pediatric vesicoureteral reflux (VUR) to assess kidney function quantitatively for treatment selection and surgical timing. The conservatively treated group consisted of 42 patients (75 kidneys) who underwent DMSA renal scintigraphy twice at intervals of 2 years during their management. The surgically treated group consisted of 16 patients (25 kidneys) who underwent DMSA renal scintigraphy before and 2 years after surgery, Urine samples were collected at the time of initial DMSA renal scintigraphy for the simultaneous measurement of β 2 -microglobulin (β 2 -MG), α 1 -microglobulin and N-acetyl-β-glucosaminidase. Renal uptake ratio of DMSA did not differ in VUR grades during a 2-year follow-up period in the conservative group. In the age group of patients aged 2 or less, renal uptake ratio decreased 2 years later, with significant difference with that in the other age groups. According to VUR grade, there was no significant difference in DMSA renal kidney ratios between the conservative group and the surgical group. According to age, significant difference in renal uptake ratio was observed between the two groups; i.e., patients aged 2 or less had a significantly decreased renal uptake ratio in the conservative group than the surgical group. However, the renal uptake ratio did not differ in the other age groups. For patients aged 2 or less, surgery was considerd necessary to prevent reflux when urinary β 2 -MG indexes are increased. For those aged 3 years or more, on the other hand, conservative treatment was considered optimal regardless of VUR grades; surgery was considered recommended in the case of repeated urinary infection and decreased renal function. (N.K.)

  11. 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.

  12. 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.

  13. A Correlation between Renal Anomalies and Vesicoureteral Reflux

    International Nuclear Information System (INIS)

    Kim, Seung Soo; Kim, Young Tong; Kim, Il Young; Shin, Hyeong Cheol

    2011-01-01

    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.

  14. 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.

  15. 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.

  16. Renal damage in vesicoureteral reflux associated to duplex systems

    International Nuclear Information System (INIS)

    Orellana, P.; Velasquez, C.; Baquedano, P.

    2002-01-01

    Duplex system (DS) is a common occurrence and it can be associated to a range of ureteral and renal anomalies draining the two poles of the duplex kidneys, as vesicoureteral reflux (VUR) in the lower moiety and ureterocele in the upper moiety. The VUR in a duplex system can be primary or secondary (associated to an ureterocele). The assessment of parenchymal uptake and function of the whole and separate parts of the kidneys is important for therapeutical decisions. Objective: To determine the presence of renal damage, by dimercaptosuccinic acid (DMSA) scintigraphy in children with a refluxing DS and if there any difference between primary and secondary reflux. Patients and Methods: 36 children; 23 girls and 13 boys, with VUR into completely duplicated collecting systems was studied retrospectively (37 RU with DS, 35 unilateral and 1 bilateral), with a mean age of 2.43 y.o. (range: 1 month-11y.o.). All of the children underwent ultrasonography, voiding cystourethrogram and renal static scintigraphy. Among the 37 RU with VUR, 25 had primary VUR and 12 had VUR secondary to the presence of an ureterocele. Ten out of the 36 children (27.8%) were evaluated due to antenatal diagnosis and the remaining 26 (72.2%) after urinary tract infection (UTI). Results: Seventy percent of the 37 RU with VUR into completely duplicated collecting systems had renal damage demonstrated by renal static scintigraphy. Among the 25 RU with primary VUR, 19 (76%) had renal damage, 6 with a complete absence of function in the lower moiety. In this group, 80% of children was studied due to an UTI at a mean age of 3.3 y.o. In the group of children with secondary VUR, we observed a lower moiety with renal damage in 6/12 (50%), in 4 of them associated with an abnormal upper moiety. 7 out of 12 children (58.3%) had an abnormal upper moiety, 4 of them with a damage in lower moiety too. One children presented with renal exclusion. Half of these children were studied due to UTI, at a mean age of 1 y

  17. Efficacy of endoscopic treatment for primary vesico-ureteric reflux in children

    International Nuclear Information System (INIS)

    Khawaja, M.A.; Jamil, M.I.; Muhammad, S.; Rehman, A.U.; Akhtar, S.

    2015-01-01

    Vesicoureteral reflux (VUR) is a common anomaly affecting 1-3% of all children and 30-50% of those with urinary tract infection (UTI). In the past febrile vesicoureteric reflux on chronic antibiotic prophylaxis were treated by open surgery. Now a day's endoscopic injection of a bulking material has replaced open surgical procedure in cases of primary VUR. Our objective was to assess the efficacy of endoscopic treatment for primary vesico-ureteric reflux in children. Methods: This was a descriptive case series. One hundred and five patients with either unilateral or bilateral VUR (181 ureters) underwent endoscopic treatment for primary VUR between January 2011 and January 2014. Children from 1 to 12 years of age with grade-II to IV reflux on preoperative voiding cystourethrogram (VCUG) were enrolled through consecutive non-probability sampling. Efficacy of treatment was evaluated at three months post injection by a standard VCUG. Ureters with no or grade-I reflux were considered successful treatment. Results: Out of 105 patients 76 had bilateral while 29 had unilateral reflux. Mean age was 5.7 years (SD±.7). Among 181 refluxing ureters, 116 (64%) were free of reflux, while 49 (27%) showed down gradation and 16 (8.8%) showed no response to treatment on postoperative VCUG. Conclusion: Endoscopic treatment for VUR is a viable option for patients with primary VUR and may be considered in management of such cases. (author)

  18. Modeling the detectability of vesicoureteral reflux using microwave radiometry

    International Nuclear Information System (INIS)

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

    2010-01-01

    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 (f c ), frequency band (Δf) and aperture radius (r 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 (η). The power ratio of the theoretical antenna is used to design a microstrip log spiral antenna with directional radiation pattern over f c ± 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 (δT B ) for 15-25 mL urine refluxes at 40-42 0 C located 35 mm from the skin surface. Theoretical antenna simulations indicate maximum η over 1.1-1.6 GHz for r a = 30-40 mm. Simulations of the 35 mm radius tapered log spiral yielded a higher power ratio over f c ± Δf/2 for the 35-40 mm deep targets in the presence of an optimal matching layer. Radiometric temperature calculations indicate δT B ≥ 0.1 K for the 15 mL urine at 40 0 C and 35 mm depth. Higher η and δT B 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

  19. 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

  20. The prognosis of posterior urethral valves, associated to vesicoureteral reflux in children.

    Science.gov (United States)

    Masca, Aurelia; Indrei, L L; Brânzaniuc, Klara

    2011-01-01

    Posterior urethral valves represent a congenital barrier at the level of the posterior urethra, which opposes miction. They are located near the prostatic urethra, originating at the verumontanum level, affecting male patients. The ureters are inconstantly dilated; vesicoureteral reflux is met in 2/3 of the cases. The reflux can be secondary to the sub-bladder barrier, but it can also be considered primitive, determined by the intra bladder ectopy of the ureter. The presence of the reflux is interpreted as a severe associated factor. Semiology is rather unusual, positive diagnosis is based on early discovery or antenatally of the impairment, by fetal echography starting from the 28th week of pregnancy, postnatal echography followed by miction cystography, retrograde urethrography and creatinine dosage complete the diagnosis. The treatment is surgical: endoscopic ablation of the valves (in the absence of renal failure), percutaneous pyelostomy, high lateral ureterostomy, and in severe cases vesicostomy and renal transplant. Prognosis depends on how early the impairment is detected, on the degree of pulmonary hypoplasia, on the presence of the vesicoureteral reflux and the possibility of recovering renal function; 1/3 of the newborns develop in time Chronic Renal Failure which requires renal transplant. The studied group comprised male children diagnosed with vesicoureteral reflux their ages ranking between 0 -18 years, admitted to the Pediatric Clinic, Tg. Mures during the last 10 years and children diagnosed and operated with posterior urethra valves at the Surgical Clinic of the "M. S. Curie" Hospital, Bucharest during the last 20 years. Our results show that out of the total number of studied children 25 presented posterior urethra valves and 9 children presented vesicoureteral reflux. We can conclude that the presence of the vesicoureteral reflux is an unfavorable prognosis regarding the degree of renal failure.

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

    Science.gov (United States)

    Turk, Akif; Selimoglu, Ahmet; Demir, Kadir; Celik, Osman; Saglam, Erkin; Tarhan, Fatih

    2014-01-01

    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. 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. 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). The effectiveness of two bulking agents was similar in treatment of vesicoureteral reflux disease in adult patients and patients with chronic renal failure.

  2. Retrograde cystography US. A new ultrasound technique for the diagnosis and staging of vesicoureteral reflux

    International Nuclear Information System (INIS)

    Farina, R.; Arena, C.; Pennisi, F.; Di Benedetto, V.; Politi, G.; Di Benedetto, A.

    1999-01-01

    The authors investigated the accuracy of a new US (ultrasound) investigation technique, called retrograde cystography US, in the early diagnosis and staging of vesicoureteral reflux. 5 patients, aged 3 months to 10 years, suffering from hydronephrosis and/or pyelonephritis, were examined using retrograde cystography US followed by conventional retrograde cystography. Retrograde cystography US consists in the transcatheter introduction of a contrast agent into the bladder and a subsequent color Doppler examination to show or exclude the presence of reflux. Superpubic scanning of bladder, ureters and pyelocaliceal cavity was performed after echo contrast agent introduction to assess the reflux grade. US was performed with an Esaote AU 590 asynchronous scanner with a 3.5 MHz convex probe. The total agreement of conventional and US findings seems to confirm the importance of the US method for the diagnosis and staging of vesicoureteral reflux [it

  3. Unusual encapsulated collection of urine (urinoma) in an infant with vesicoureteral reflux

    Energy Technology Data Exchange (ETDEWEB)

    Passas, V.; Brountzos, E.; Grilias, D.; Vasilakos, P.

    1987-07-01

    We describe an unusual case of encapsulated collection of urine (urinoma) in a 7-month-old female infant. The clinical diagnosis was urinary tract infection. The retrograde cysto-urethrogram revealed grade III vesicoureteral reflux, which we believe was the cause of the urinoma. The investigation was completed with isotope and ultrasound studies. High pressure reflux was the cause of the urine extravasation in the perirenal space.

  4. [Voiding urosonography with SonoVue and fluoroscopic voiding cystourethrography in evaluation of vesicoureteral reflux: a comparative study].

    Science.gov (United States)

    Deng, Jinsong; Zhou, Luyao; Zeng, Sihui; Zhang, Chunli; Zeng, Guangsui; Wang, Jie; Chen, Qingkang

    2013-10-01

    To assess the value of voiding urosonography (VUS) with SonoVue in evaluation of vesicoureteral reflux. Thirty-six pediatric patients (72 pyeloureter units [PUUs]) suspected of vesicoureteral reflux underwent both VUS and fluoroscopic voiding cystourethrography (VCUG). The sensitivity of VUS and VCUG and their consistency in detecting vesicoureteral reflux as well as in grading vesicoureteral reflux were compared. Vesicoureteral reflux was detected in 26 of the 72 PUUs (36.1%) by VUS while in 21 PUUs (29.2%) by VCUG (P=0.347). The two modalities yielded the same results for 65 PUUs (κ=0.843), showing a very good consistency between them. VUS also detected post-urethral valve in 2 patients via transperineal scans. VUS with Sonovue has at least comparable, if not better, sensitivity in detecting vesicoureteral reflux with VCUG, and therefore should serve as the primary screening and follow-up modality for vesicoureteral reflux. In addition, transperineal VUS can be helpful in evaluation of post-urethral lesions.

  5. Learning from the learning curve: factors associated with successful endoscopic correction of vesicoureteral reflux using dextranomer/hyaluronic acid copolymer.

    Science.gov (United States)

    Dave, Sumit; Lorenzo, Armando J; Khoury, Antoine E; Braga, Luis H P; Skeldon, Sean J; Suoub, Mohammed; Farhat, Walid; Pippi Salle, João L; Bägli, Darius J

    2008-10-01

    Conflicting reports exist regarding the parameters guiding successful correction of vesicoureteral reflux using dextranomer/hyaluronic acid copolymer. We performed logistic regression analysis to evaluate the effect of injected volume while adjusting for other factors potentially associated with success following dextranomer/hyaluronic acid copolymer injection. Between July 2003 and June 2006, 126 consecutive patients (34 boys and 92 girls) with a mean +/- SD age of 6.5 +/- 3.7 years with primary vesicoureteral reflux (196 refluxing ureters) underwent injection for febrile urinary tract infections. Success was defined as complete reflux resolution. Age, gender, laterality, preoperative vesicoureteral reflux grade, surgeon experience, dextranomer/hyaluronic acid copolymer volume, time to surgery from initial presentation and preoperative treatment for lower urinary tract symptoms were analyzed. Vesicoureteral reflux grade was I to V in 7 (3.5%), 53 (27%), 91 (46.4%), 30 (15.3%) and 15 renal units (7.6%), respectively. The success rate after 1 injection was 50% by patient and 59.2% by ureter. Mean injected volume was 0.9 +/- 0.27 ml in those who had a successful injection vs 0.67 +/- 0.24 ml in those in whom injection failed (p hyaluronic acid copolymer compared to 31.7% with less than 0.8 ml. Multivariate analysis confirmed that higher dextranomer/hyaluronic acid copolymer volume (p = 0.001), lower preoperative grade (p = 0.013), surgeon experience (p = 0.025) and treatment for lower urinary tract symptoms (p = 0.009) were associated with successful correction of vesicoureteral reflux. Our analysis strengthens the previously reported association of surgeon experience and vesicoureteral reflux grade with successful endoscopic vesicoureteral reflux correction. The data also revealed an association between injected volume and vesicoureteral reflux correction even while controlling for other variables, highlighting its importance as a true success modifier.

  6. Rationale and Design Issues of the Randomized Intervention for Children With Vesicoureteral Reflux (RIVUR) Study

    Science.gov (United States)

    Keren, Ron; Carpenter, Myra A.; Hoberman, Alejandro; Shaikh, Nader; Matoo, Tej K.; Chesney, Russell W.; Matthews, Ranjiv; Gerson, Arlene C.; Greenfield, Saul P.; Fivush, Barbara; McLurie, Gordon A.; Rushton, H. Gil; Canning, Douglas; Nelson, Caleb P.; Greenbaum, Lawrence; Bukowski, Timothy; Primack, William; Sutherland, Richard; Hosking, James; Stewart, Dawn; Elder, Jack; Moxey-Mims, Marva; Nyberg, Leroy

    2010-01-01

    OBJECTIVE Our goal is to determine if antimicrobial prophylaxis with trimethoprim/sulfamethoxazole prevents recurrent urinary tract infections and renal scarring in children who are found to have vesicoureteral reflux after a first or second urinary tract infection. DESIGN, PARTICIPANTS, AND METHODS The Randomized Intervention for Children With Vesicoureteral Reflux (RIVUR) study is a double-blind, randomized, placebo-controlled trial. Six hundred children aged 2 to 72 months will be recruited from both primary and subspecialty care settings at clinical trial centers throughout North America. Children who are found to have grades I to IV vesicoureteral reflux after the index febrile or symptomatic urinary tract infection will be randomly assigned to receive daily doses of either trimethoprim/sulfamethoxazole or placebo for 2 years. Scheduled follow-up contacts include in-person study visits every 6 months and telephone interviews every 2 months. Biospecimens (urine and blood) and genetic specimens (blood) will be collected for future studies of the genetic and biochemical determinants of vesicoureteral reflux, recurrent urinary tract infection, renal insufficiency, and renal scarring. RESULTS The primary outcome is recurrence of urinary tract infection. Secondary outcomes include time to recurrent urinary tract infection, renal scarring (assessed by dimercaptosuccinic acid scan), treatment failure, renal function, resource utilization, and development of antimicrobial resistance in stool flora. CONCLUSIONS The RIVUR study will provide useful information to clinicians about the risks and benefits of prophylactic antibiotics for children who are diagnosed with vesicoureteral reflux after a first or second urinary tract infection. The data and specimens collected over the course of the study will allow researchers to better understand the pathophysiology of recurrent urinary tract infection and its sequelae. PMID:19018048

  7. 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.

  8. Prospective study of polydimethylsiloxane vs dextranomer/hyaluronic acid injection for treatment of vesicoureteral reflux.

    Science.gov (United States)

    Moore, Katherine; Bolduc, Stéphane

    2014-12-01

    Endoscopic injection of a bulking agent is becoming a first-line treatment for low grade vesicoureteral reflux. We prospectively compared the efficacy of 2 such products commercially available in Canada. A total of 275 patients with documented grade I to V vesicoureteral reflux were prospectively enrolled in a comparative study between April 2005 and February 2011 to be randomly treated endoscopically with either polydimethylsiloxane (Macroplastique®) or dextranomer/hyaluronic acid copolymer (Deflux®). Of the ureters 202 were treated with polydimethylsiloxane and 197 with dextranomer/hyaluronic acid copolymer. Patients were followed with voiding cystourethrography at 3 months and renal ultrasonography at 3 months and at 1 year. Median followup was 4.3 years. The primary outcome was surgical success (resolution vs nonresolution), and secondary outcomes included occurrence of adverse events. Vesicoureteral reflux was fully corrected in 182 of 202 ureters (90%) treated with polydimethylsiloxane, compared to 159 of 197 (81%) treated with dextranomer/hyaluronic acid copolymer (p injection of polydimethylsiloxane resulted in a better success rate than dextranomer/hyaluronic acid copolymer. The rate of resolution obtained with the latter is lower than those previously published due to the inclusion of high grade reflux. Copyright © 2014 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  9. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

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

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    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.)

  12. Predicting the Risk of Breakthrough Urinary Tract Infections: Primary Vesicoureteral Reflux.

    Science.gov (United States)

    Hidas, Guy; Billimek, John; Nam, Alexander; Soltani, Tandis; Kelly, Maryellen S; Selby, Blake; Dorgalli, Crystal; Wehbi, Elias; McAleer, Irene; McLorie, Gordon; Greenfield, Sheldon; Kaplan, Sherrie H; Khoury, Antoine E

    2015-11-01

    We constructed a risk prediction instrument stratifying patients with primary vesicoureteral reflux into groups according to their 2-year probability of breakthrough urinary tract infection. Demographic and clinical information was retrospectively collected in children diagnosed with primary vesicoureteral reflux and followed for 2 years. Bivariate and binary logistic regression analyses were performed to identify factors associated with breakthrough urinary tract infection. The final regression model was used to compute an estimation of the 2-year probability of breakthrough urinary tract infection for each subject. Accuracy of the binary classifier for breakthrough urinary tract infection was evaluated using receiver operator curve analysis. Three distinct risk groups were identified. The model was then validated in a prospective cohort. A total of 252 bivariate analyses showed that high grade (IV or V) vesicoureteral reflux (OR 9.4, 95% CI 3.8-23.5, p urinary tract infection (OR 5.3, 95% CI 1.1-24.7, p = 0.034) and female gender (OR 2.6, 95% CI 0.097-7.11, p urinary tract infection. Subgroup analysis revealed bladder and bowel dysfunction was a significant risk factor more pronounced in low grade (I to III) vesicoureteral reflux (OR 2.8, p = 0.018). The estimation model was applied for prospective validation, which demonstrated predicted vs actual 2-year breakthrough urinary tract infection rates of 19% vs 21%. Stratifying the patients into 3 risk groups based on parameters in the risk model showed 2-year risk for breakthrough urinary tract infection was 8.6%, 26.0% and 62.5% in the low, intermediate and high risk groups, respectively. This proposed risk stratification and probability model allows prediction of 2-year risk of patient breakthrough urinary tract infection to better inform parents of possible outcomes and treatment strategies. Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights

  13. Augmentation enterocystoplasty without reimplantation for patients with neurogenic bladder and vesicoureteral reflux

    OpenAIRE

    Zhang, Han-Chao; Yang, Jin; Ye, Xin; Hu, Hai-Feng

    2016-01-01

    The objective of this study was to assess the clinical outcome of vesicoureteral reflux (VUR) after augmentation cystoplasty alone in patients with a hypocompliant neurogenic bladder. Between January 2009 and December 2014, 29 patients with a hypocompliant bladder associated with VUR confirmed by videourodynamics (VUD) preoperatively were recruited in this study. All patients had undergone bladder augmentation with a generous detubularized segment of bowel at our institution. No effort had be...

  14. Endoscopic Treatment of Vesicoureteral Reflux with Dextranomer/Hyaluronic Acid in Children

    OpenAIRE

    Cerwinka, Wolfgang H.; Scherz, Hal C.; Kirsch, Andrew J.

    2008-01-01

    Purpose. The goal of this review is to present current indications, injectable agents, techniques, success rates, complications, and potential future applications of endoscopic treatment for vesicoureteral reflux (VUR) in children. Materials and Methods. The endoscopic method currently achieving one of the highest success rates is the double hydrodistention-implantation technique (HIT). This method employs dextranomer/hyaluronic acid copolymer, which has been used in pediatric urology for ove...

  15. Variation among internet based calculators in predicting spontaneous resolution of vesicoureteral reflux.

    Science.gov (United States)

    Routh, Jonathan C; Gong, Edward M; Cannon, Glenn M; Yu, Richard N; Gargollo, Patricio C; Nelson, Caleb P

    2010-04-01

    An increasing number of parents and practitioners use the Internet for health related purposes, and an increasing number of models are available on the Internet for predicting spontaneous resolution rates for children with vesicoureteral reflux. We sought to determine whether currently available Internet based calculators for vesicoureteral reflux resolution produce systematically different results. Following a systematic Internet search we identified 3 Internet based calculators of spontaneous resolution rates for children with vesicoureteral reflux, of which 2 were academic affiliated and 1 was industry affiliated. We generated a random cohort of 100 hypothetical patients with a wide range of clinical characteristics and entered the data on each patient into each calculator. We then compared the results from the calculators in terms of mean predicted resolution probability and number of cases deemed likely to resolve at various cutoff probabilities. Mean predicted resolution probabilities were 41% and 36% (range 31% to 41%) for the 2 academic affiliated calculators and 33% for the industry affiliated calculator (p = 0.02). For some patients the calculators produced markedly different probabilities of spontaneous resolution, in some instances ranging from 24% to 89% for the same patient. At thresholds greater than 5%, 10% and 25% probability of spontaneous resolution the calculators differed significantly regarding whether cases would resolve (all p calculators. For certain patients, particularly those with a lower probability of spontaneous resolution, these differences can significantly influence clinical decision making. Copyright (c) 2010 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  16. Reflux nephropathy

    Science.gov (United States)

    ... Personal or family history of vesicoureteral reflux Repeat urinary tract infections Symptoms Some people have no symptoms of reflux nephropathy. ... kidney tests are done for other reasons. If symptoms do occur, they might be similar to those of: Chronic kidney ... and Tests Reflux nephropathy is often found ...

  17. 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.

  18. Outcome analysis of mini-ureteroneocystostomy versus dextranomer/hyaluronic acid copolymer injection for unilateral vesicoureteral reflux.

    Science.gov (United States)

    Ashley, Richard; Vandersteen, David

    2008-10-01

    Injecting dextranomer/hyaluronic acid copolymer has gained popularity as first line treatment for vesicoureteral reflux. However, ureteroneocystostomy has typically been more successful than endoscopic treatments. We evaluated the outcome of dextranomer/hyaluronic acid copolymer injection vs that of extravesical ureteroneocystostomy via a 2 cm inguinal incision (mini-ureteroneocystostomy) for unilateral vesicoureteral reflux. The records were analyzed of all patients from 2003 to 2007 with unilateral vesicoureteral reflux who underwent mini-ureteroneocystostomy or dextranomer/hyaluronic acid copolymer injection. Mini-ureteroneocystostomy was performed via a 2 cm inguinal incision. Of the injections 66% were delivered via an intraureteral tunnel technique. Statistical analysis was done to compare differences in clinical features and success rates. All p values were 2-sided with significance at p hyaluronic acid copolymer injection and 57 via mini-ureteroneocystostomy. There were no significant differences between the groups in terms of preoperative clinical or anatomical variables except for higher preoperative reflux grade in the mini-ureteroneocystostomy cohort (p hyaluronic acid copolymer cohort, while 2 children required intervention for complications after mini-ureteroneocystostomy. This study details that the 2 procedures may be successfully performed in the outpatient setting, and yet even for more advanced vesicoureteral reflux mini-ureteroneocystostomy achieves greater overall success. This procedure has become our standard of care for unilateral vesicoureteral reflux.

  19. Voiding cystourethrogram in the diagnosis of vesicoureteric reflux in children with antenatally diagnosed hydronephrosis

    Directory of Open Access Journals (Sweden)

    R B Nerli

    2008-12-01

    Full Text Available R B Nerli, S S Amarkhed, I R RavishDepartment of Urology, Kles Kidney Foundation, Nehru Nagar, Belgaum, IndiaAbstract: Prenatal ultrasonography has revolutionized the detection and management of many urological abnormalities. Vesicoureteric reflux (VUR which develops in 10% to 15% of cases of prenatal hydronephrosis, is difficult to predict prenatally. While all children with prenatal hydronephrosis should undergo ultrasonography within the first few weeks of life, there seems to be controversy regarding the role of voiding cystourethrogram (VCUG in the assessment of these children.Materials and methods: Neonates with antenatally diagnosed unilateral hydronephrosis were prospectively assessed with sonography on day 3–7, and VCUG and isotope imaging at three months.Results: Seven (16.6% children of the 42 children with Society of Fetal Urology grade 0/I/II hydronephrosis on postnatal sonography had evidence of VUR on VCUG. 44.4% of the refluxing ureters identified involved high grade disease and two (28.5% children required reimplantation.Conclusions: Children with fetal reflux may be diagnosed prior to urinary tract infection and in whom further renal injury may be prevented. VCUG when performed properly is safe and presents with little risk of infectious and noninfectious complications. VCUG should be done in children in whom hydronephrosis is detected prenatally to restrict the use of VCUG to diagnose VUR. Two patients had infection.Keywords: antenatal hydronephrosis, voiding cystourethrogram, vesicoureteric reflux

  20. Prediction of vesico-ureteral reflux in children from intravenous urography films

    International Nuclear Information System (INIS)

    Lanning, P.; Seppaenen, U.; Huttunen, N.P.; Uhari, M.

    1979-01-01

    Intravenous urography and voiding urethrocystography were performed on 255 children with urinary tract infection. Eighty-six (34%) of these children has some kind of abnormality of the urinary tract. Vesico-ureteral reflux was observed to 96 ureters (19%) in 69 children (27%). The prediction of vesic-ureteral reflux by two radiologists from urography films only gave 46 (48%) and 51 (53%) false negative results respectively. In cases of clinically important reflux (III to V 0 ), however, the rate of false negative prediction was 0/18 and 1/18 (6%) respectively. The rate for false positive predictions were 45/413 (11%) for both radiologist. In view of the number of pathological findings in this series i.v. urography is recommended as a routine in children undergoing urological work-up after their first urinary tract infection. As the clinically important vesico-ureteral reflux seems to be predictable from urography films alone, voiding urethrocystography seems not to be justified in children with negative i.v. urography, and can be postponed and carried out later if the urinary tract infection recurs. (author)

  1. Usefulness of concomitant autologous blood and dextranomer/hyaluronic acid copolymer injection to correct vesicoureteral reflux.

    Science.gov (United States)

    Kajbafzadeh, Abdol-Mohammad; Tourchi, Ali

    2012-09-01

    We present the long-term results of a new modification of endoscopic treatment of vesicoureteral reflux involving concomitant injection of autologous blood following the standard hydrodistention injection technique to prevent bulking agent leakage immediately after the procedure. A total of 341 children underwent endoscopic implantation of dextranomer/hyaluronic acid for vesicoureteral reflux. A subset of 171 patients underwent hydrodistention autologous blood injection, while 170 underwent classic hydrodistention injection. Frequency of symptomatic urinary tract infection after endoscopic treatment was recorded. Success was defined as absence of vesicoureteral reflux on postoperative voiding cystourethrography. A total of 523 ureters in 214 girls and 127 boys were treated. In patients undergoing hydrodistention autologous blood injection mean age was 39.48 months, mean maximal reflux grade was 3.02 and success rate was 93.6% after the first injection (98.0% in patients with grade II, 92.1% with grade III, 93.3% with grade IV and 85.7% with grade V reflux). In patients who underwent classic hydrodistention injection mean age was 36.12 months, mean maximal reflux grade 3.05 and success rate was 81.8% after the first injection (91.5% in patients with grade II, 89.4% with grade III, 74.4% with grade IV and 44.4% with grade V reflux). The success rate was significantly higher (p = 0.001) in patients undergoing hydrodistention autologous blood injection vs classic hydrodistention injection. Of the patients 1.7% in the hydrodistention autologous blood injection group and 2.9% in the classic hydrodistention injection group reported symptomatic urinary tract infection during followup. Immediate injection of autologous blood following dextranomer/hyaluronic acid injection to create a blood clot and barricade against bulking agent leakage is more effective than pure dextranomer/hyaluronic acid implantation. This novel modification stabilizes the subureteral implant mount and

  2. Augmentation enterocystoplasty without reimplantation for patients with neurogenic bladder and vesicoureteral reflux.

    Science.gov (United States)

    Zhang, Han-Chao; Yang, Jin; Ye, Xin; Hu, Hai-Feng

    2016-06-01

    The objective of this study was to assess the clinical outcome of vesicoureteral reflux (VUR) after augmentation cystoplasty alone in patients with a hypocompliant neurogenic bladder. Between January 2009 and December 2014, 29 patients with a hypocompliant bladder associated with VUR confirmed by videourodynamics (VUD) preoperatively were recruited in this study. All patients had undergone bladder augmentation with a generous detubularized segment of bowel at our institution. No effort had been made to correct the existing reflux. Preoperative assessment included urinalysis, kidney function tests, ultrasonography, and videourodynamic evaluation. All patients had various degrees of VUR. The status of VUR and bladder function were studied by VUD. The mean follow-up period was 2.2 years (range 0.5-5.5 years). The VUD manifested a significant improvement of bladder capacity, diminution of intravesical pressure, and resolution of reflux after bladder augmentation. After the surgery, 24/29 (83%) no longer had reflux, 3/29 (10%) showed improvement in reflux, and 2/29 (7%) demonstrated no change in reflux. In addition, 16/21 (76%) patients had reflux Grades I-III; 100% patients with reflux Grades IV and V had complete cessation of reflux. Only one patient had symptomatic urinary infection after the surgery. Augmentation enterocystoplasty without ureteral reimplantation is thus effective and adequate for patients with high-pressure and hypocompliant neurogenic bladder. Therefore, ureteral reimplantation is not necessary when augmentation enterocystoplasty is recommended for patients with high-pressure, low-compliant bladder and VUR. Copyright © 2016. Published by Elsevier Taiwan.

  3. Augmentation enterocystoplasty without reimplantation for patients with neurogenic bladder and vesicoureteral reflux

    Directory of Open Access Journals (Sweden)

    Han-Chao Zhang

    2016-06-01

    Full Text Available The objective of this study was to assess the clinical outcome of vesicoureteral reflux (VUR after augmentation cystoplasty alone in patients with a hypocompliant neurogenic bladder. Between January 2009 and December 2014, 29 patients with a hypocompliant bladder associated with VUR confirmed by videourodynamics (VUD preoperatively were recruited in this study. All patients had undergone bladder augmentation with a generous detubularized segment of bowel at our institution. No effort had been made to correct the existing reflux. Preoperative assessment included urinalysis, kidney function tests, ultrasonography, and videourodynamic evaluation. All patients had various degrees of VUR. The status of VUR and bladder function were studied by VUD. The mean follow-up period was 2.2 years (range 0.5–5.5 years. The VUD manifested a significant improvement of bladder capacity, diminution of intravesical pressure, and resolution of reflux after bladder augmentation. After the surgery, 24/29 (83% no longer had reflux, 3/29 (10% showed improvement in reflux, and 2/29 (7% demonstrated no change in reflux. In addition, 16/21 (76% patients had reflux Grades I-III; 100% patients with reflux Grades IV and V had complete cessation of reflux. Only one patient had symptomatic urinary infection after the surgery. Augmentation enterocystoplasty without ureteral reimplantation is thus effective and adequate for patients with high-pressure and hypocompliant neurogenic bladder. Therefore, ureteral reimplantation is not necessary when augmentation enterocystoplasty is recommended for patients with high-pressure, low-compliant bladder and VUR.

  4. Laparoscopic surgery of vesicoureteral reflux: an experience in 42 patients with the Lich-Gregoir extravesical technique.

    Science.gov (United States)

    Castillo, O A; Zubieta, R; Yañez, R

    2013-01-01

    Vesico-ureteral reflux (VUR) is a common congenital anomaly of the urinary tract in the pediatric population, existing controversy regarding its management. Patients selected for treatment options are offered, from endoscopic injection of substances sub-ureteral to ureteral reimplantation surgery. To evaluate the use of the laparoscopic surgical technique for the treatment of vesico-ureteral reflux, with an analysis of the procedure, results and complications. We evaluated a series of 50 ureteral units in 42 patients, who undergoing laparoscopic transperitoneal ureteral reimplant, using the classic technique of Lich-Gregoir detrusorrafia. The mean operative time was 74 min. There were no intraoperative nor immediate postoperative. At longer follow-up VUR was cured in all cases. Laparoscopic surgery is an effective alternative in the surgical treatment of vesico-ureteral reflux, with results comparable to open surgery techniques and over sub-ureteral injection techniques. Copyright © 2013 AEU. Published by Elsevier Espana. All rights reserved.

  5. Relationship among bacterial virulence, bladder dysfunction, vesicoureteral reflux and patterns of urinary tract infection in children.

    Science.gov (United States)

    Storm, Douglas W; Patel, Ashay S; Horvath, Dennis J; Li, Birong; Koff, Stephen A; Justice, Sheryl S

    2012-07-01

    We hypothesized that virulence levels of Escherichia coli isolates causing pediatric urinary tract infections differ according to severity of infection and also among various uropathies known to contribute to pediatric urinary tract infections. We evaluated these relationships using in vitro cytokine interleukin-6 elicitation. E. coli isolates were cultured from children presenting with urinary tract infections. In vitro cytokine (interleukin-6) elicitation was quantified for each isolate and the bacteria were grouped according to type of infection and underlying uropathy (neurogenic bladder, nonneurogenic bowel and bladder dysfunction, primary vesicoureteral reflux, no underlying etiology). A total of 40 E. coli isolates were collected from children with a mean age of 61.5 months (range 1 to 204). Mean level of in vitro cytokine elicitation from febrile urinary tract infection producing E. coli was significantly lower than for nonfebrile strains (p = 0.01). The interleukin-6 response to E. coli in the neurogenic bladder group was also significantly higher than in the vesicoureteral reflux (p = 0.01) and no underlying etiology groups (p = 0.02). In vitro interleukin-6 elicitation, an established marker to determine bacterial virulence, correlates inversely with clinical urinary tract infection severity. Less virulent, high cytokine producing E. coli were more likely to cause cystitis and were more commonly found in patients with neurogenic bladder and nonneurogenic bowel and bladder dysfunction, whereas higher virulence isolates were more likely to produce febrile urinary tract infections and to affect children with primary vesicoureteral reflux and no underlying etiology. These findings suggest that bacteria of different virulence levels may be responsible for differences in severity of pediatric urinary tract infections and may vary among different underlying uropathies. Copyright © 2012 American Urological Association Education and Research, Inc. Published by

  6. Progression of chronic kidney disease in children with vesicoureteral reflux: the North American Pediatric Renal Trials Collaborative Studies Database.

    Science.gov (United States)

    Novak, Thomas E; Mathews, Ranjiv; Martz, Karen; Neu, Alicia

    2009-10-01

    We describe a cohort of children with chronic kidney disease due to vesicoureteral reflux. We compared the rate of progression to end stage renal disease in those patients to the rate in children with another cause of chronic kidney disease and identified potential risk factors for progression. We performed a retrospective cohort study using data from the North American Pediatric Renal Trials and Collaborative Studies Registry. Patients with vesicoureteral reflux as a cause of chronic kidney disease were compared to 2 other diagnostic cohorts. The 3 groups were compared with respect to baseline characteristics and progression to end stage renal disease based on diagnostic category. Multivariate analysis was performed to identify risk factors for progression to end stage renal disease using Cox proportional hazards regression model. Data on 6,981 patients were available for analysis. Patients with vesicoureteral reflux as a cause of chronic kidney disease had a significantly slower rate of progression to end stage renal disease than patients with renal aplasia, hypoplasia or dysplasia and all other causes (log rank p renal disease in patients with vesicoureteral reflux as the cause of chronic kidney disease we found that, in addition to older age and more advanced chronic kidney disease stage, a history of urinary tract infection at registration was significantly associated with an increased risk of progression. Children with vesicoureteral reflux had a slower rate of progression to end stage renal disease than children with another cause of chronic kidney disease even after controlling for multiple possible confounders. In children with vesicoureteral reflux as the cause of chronic kidney disease older age, higher chronic kidney disease stage and history of urinary tract infection are significantly associated with the risk of progression to end stage renal disease.

  7. Diagnosis and management of urinary tract infection and vesicoureteral reflux in the neonate.

    Science.gov (United States)

    Baracco, Rossana; Mattoo, Tej K

    2014-09-01

    Urinary tract infection (UTI) is the most common bacterial infection in febrile newborns, particularly those born prematurely and with a low birth weight. Vesicoureteral reflux (VUR) predisposes to UTI and renal scarring. Half of neonates with UTI may have only low-grade fever or no fever. Jaundice in the absence of any other symptoms or signs may be the only clinical manifestation of UTI in neonates. The urinalysis may be negative in a significant number of neonates with UTI. Newborns with UTI have a high incidence of congenital anomalies of kidney and urinary tract anomalies, and hence should undergo renal imaging. Copyright © 2014 Elsevier Inc. All rights reserved.

  8. Extravasation of Urine Associated with Bilateral Complete Ureteral Duplication, Vesicoureteral Reflux and Benign Prostatic Hyperplasia

    Directory of Open Access Journals (Sweden)

    Issei Suzuki

    2017-02-01

    Full Text Available 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.

  9. 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.

  10. Urinary tract infection following successful dextranomer/hyaluronic acid injection for vesicoureteral reflux.

    Science.gov (United States)

    Chi, Andrew; Gupta, Amit; Snodgrass, Warren

    2008-05-01

    The incidence of symptomatic urinary tract infection following reflux resolution by endoscopic injection is unclear. We determined the occurrence of febrile and nonfebrile urinary tract infections, and factors relating to development of infection after reflux correction with dextranomer/hyaluronic acid injection. We identified 175 patients with more than 6 months of followup after successful dextranomer/hyaluronic acid injection by one of us (WS) to resolve vesicoureteral reflux. Of these patients data regarding post-injection symptomatic urinary tract infection could be obtained from parents and/or primary care physicians and urological records in 167, who comprised the study group. All patient reported infections were additionally verified by review of medical records. Univariate and multivariate logistic regression analyses were done, evaluating factors including gender, age, voiding dysfunction, reflux grade, unilateral vs bilateral reflux, number of pretreatment infections, number of infections within 12 months of injection and febrile vs nonfebrile urinary tract infection in predicting the likelihood of post-injection urinary tract infection. Urinary tract infection occurred in 159 patients (95%) before injection, and was febrile in 82%. With a median followup after reflux correction of 32 months (range 7 to 53) symptomatic infections developed in 40 children (24%), of which half were febrile. Multivariate analysis showed that the number of preoperative urinary tract infections best predicted the likelihood of infection after dextranomer/hyaluronic acid injection. Nearly half of the patients with febrile urinary tract infection undergoing followup cystography had recurrent reflux. Patients with more than 3 pre-injection infections were 8.5 times more likely than those with 1 pre-injection infection to have post-injection symptomatic urinary tract infection. Overall rates of symptomatic and febrile infections after dextranomer/hyaluronic acid reflux resolution

  11. Does the presence of vesicoureteral reflux affect in vitro uropathogenic E. coli growth rate in urine?

    Science.gov (United States)

    Soylu, Alper; Karaman, Meral; Alaygut, Demet; Çamlar, Seçil Arslansoyu; Türkmen, Mehmet; Kavukçu, Salih

    2016-02-01

    Uroepithelial molecules like uroplakins are involved both in the development of urinary tract and in colonization, attachment and invasion of uropathogenic Escherichia coli (UPEC). Uroplakin disorders are also associated with vesicoureteral reflux (VUR). We hypothesized that urine contents, as well as urinary flow, may be altered in VUR, and aimed to determine whether in vitro UPEC growth is increased in urine from the refluxing systems. Children evaluated by voiding cystourethrography for UTI were enrolled. Groups 1 and 2 included children with and without VUR, respectively. Sterile urine samples were obtained from all patients, and 2 × 10(2) cfu/mL UPEC suspension was inoculated into these samples. After incubation for 24 h, colony counts were assessed. Both groups were compared for UPEC growth and colony counts. Forty-two urine samples were included (21 in each group). UPEC was cultured in 9 (43 %) and 3 (14 %) samples in Groups 1 and 2, respectively (p = 0.040, OR 4.5). Colony counts were similar in both groups (log x; 2.36 ± 0.25 vs. 2.37 ± 0.12, p = 0.923). Inoculation of 2 × 10(2) cfu UPEC resulted in growth in almost half of the urine samples from refluxing systems, while UPEC growth was inhibited in most urine samples from non-refluxing systems suggesting that urine contents in refluxing units change in such a way that UPEC growth is facilitated.

  12. Recent trends in the surgical management of primary vesicoureteral reflux in the era of dextranomer/hyaluronic acid.

    Science.gov (United States)

    Herbst, Katherine W; Corbett, Sean T; Lendvay, Thomas S; Caldamone, Anthony A

    2014-05-01

    Since its inception as a technology in the United States, endoscopic correction of vesicoureteral reflux has become a popular treatment option in children with vesicoureteral reflux with reported wide use. We determined whether the increasing trend in use in the United States after the introduction of dextranomer/hyaluronic acid has been sustained. We abstracted data on pediatric patients treated with ureteral reimplantation or dextranomer/hyaluronic acid intervention for vesicoureteral reflux from 2004 to 2011 from the PHIS (Pediatric Health Information System) database. Patients with coding data indicating diagnoses other than primary vesicoureteral reflux and hospitals reporting less than 80% of ambulatory surgery cases by CPT code were excluded from study. We identified 14,430 patients (17,826 procedures), of whom 49% underwent reimplantation and 51% underwent dextranomer/hyaluronic acid injection. Of the patients 83% were female with a median age at surgery of 4.7 years (IQR 2.5-7.2). Linear regression showed a significant downward trend in the average total number of antireflux operations per institution during the study period. This was attributable to a decrease in the average rate of dextranomer/hyaluronic acid interventions because the average reimplantation rate remained stable during this time. At freestanding pediatric hospitals enrolled in the PHIS database there is a trend toward decreasing intervention for primary vesicoureteral reflux, which appears to be due to decreased use of injection therapy. This may reflect a philosophical change in reflux management by injection therapy. Copyright © 2014 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  13. Daño renal congénito asociado a reflujo vesicoureteral CONGENITAL RENAL DAMAGE ASSOCIATED WIHT VESICOURETERAL REFLUX

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    Sandalio Durán Álvarez

    2005-03-01

    Full Text Available Se realizó uretrocistografía miccional a 71 niños (48 varones en los que el estudio ultrasonográfico materno-fetal había detectado una dilatación pélvica renal y esta alteración se confirmó en el ultrasonido renal posnatal. Se encontró reflujo vesicoureteral (RVU en 16 (22,5 % y unidades renales refluentes (URR en 23 (16 %. El estudio gammagráfico estático (Tc 99 m-DMSA demostró alteración de la función renal diferencial en 6 pacientes, 1 con RVU de grado II y 5 con RVU de grados IV y V. El grado de afectación funcional varió de ligero hasta esencialmente afuncional. En uno de estos pacientes había el antecedente de una infección urinaria en el período neonatal y en los 5 restantes no existía historia de infección urinaria. Estos datos apoyan el criterio de que en el RVU, sobre todo en los grados IV y V, el riñón puede afectarse antes del nacimiento.Miction uretrocystography was performed in 71 children (48 boys, among whom the maternofetal ultrasonographic study had detected a pelvic renal dilation that was confirmed in the postnatal renal ultrasound. Vesicoureteral reflux (VUR was found in 16 (22.5 % and renal reflowing units (RRU in 23 (16 %. The static gammagraphic study (Tc 99m-DMSA showed alteration of the differential renal function in 6 patients, 1 with degree II VUR and 5 with degree IV and V VUR. The degree of functional affectation varied from mild to essentially nonfunctional. One of these patients had history of urinary infection in the neonatal period, whereas the other five did not. These data support the criterion that in VUR, mainly in IV and V degrees, the kidney may be affected before birth.

  14. Endoscopic treatment with stabilized nonanimal hyaluronic acid/dextranomer gel is effective in vesicoureteral reflux associated with bladder dysfunction.

    Science.gov (United States)

    Läckgren, Göran; Sköldenberg, Erik; Stenberg, Arne

    2007-03-01

    Endoscopic injection of stabilized nonanimal hyaluronic acid/dextranomer gel is an established treatment for vesicoureteral reflux in children. We performed a subgroup analysis to assess this treatment in reflux associated with bladder dysfunction. Of 308 consecutive children treated endoscopically with stabilized nonanimal hyaluronic acid/dextranomer gel for dilating vesicoureteral reflux 54 were observed retrospectively to have bladder dysfunction. Initial followup consisted of voiding cystourethrogram at 3 and 12 months after injection, with positive response defined as reflux grade 0 or I. At 7 to 12 years following treatment patient charts were checked for urinary tract infections and bladder dysfunction, and a followup survey (postal questionnaire) was administered. A positive response to therapy (cure) was observed in 45 children (83%) after 1 to 3 endoscopic treatments. Concurrently, bladder dysfunction had resolved in 32 patients (59%). After the last stabilized nonanimal hyaluronic acid/dextranomer gel implantation 45 patients (83%) were free of urinary tract infections. Questionnaire results were similar to chart based findings. Stabilized nonanimal hyaluronic acid/dextranomer gel implantation was well tolerated, with no associated complications. Endoscopic treatment with stabilized nonanimal hyaluronic acid/dextranomer gel appears to be similarly effective in patients with vesicoureteral reflux with and without bladder dysfunction. These data indicate that bladder dysfunction should not be considered a contraindication to endoscopic treatment for reflux.

  15. Voiding Urosonography with Second-Generation Ultrasound Contrast Agent for Diagnosis of Vesicoureteric Reflux: First Local Pilot Study

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    Dafina Kuzmanovska

    2017-04-01

    CONCLUSIONS: Contrast-enhanced voiding urosonography using intravesical second generation ultrasound contrast agent could be recommend  as a valid alternative diagnostic modality for detecting vesicoureteral reflux and evaluation of the distal urinary tract in children, based on its radiation-free, highly efficacious, reliable, and safe characteristics.

  16. Is age at toilet training associated with the presence of vesicoureteral reflux or the occurrence of urinary tract infection?

    Science.gov (United States)

    Chen, John J; Ahn, Hyeong Jun; Steinhardt, George F

    2009-07-01

    We sought to determine whether age at toilet training is influenced by a history of vesicoureteral reflux or urinary tract infection. We reviewed records on 1,184 patients treated at a pediatric urology practice. All patients had information available regarding age at toilet training, renal sonography and voiding cystourethrography, and presence or absence of urinary tract infection. We evaluated possible associations between vesicoureteral reflux and urinary tract infection, and age at toilet training. Of 1,184 patients 280 had unilateral reflux, 339 had bilateral reflux and 565 had normal anatomy. Also, 926 patients had urinary tract infections. Girls tended to be toilet trained 3 months earlier than boys (p toilet trained at similar ages. However, timing of the first urinary tract infection seemed to be associated with age at toilet training. For girls a urinary tract infection occurring earlier tended to delay toilet training, while earlier toilet training seemed to be associated with a later urinary tract infection (p toilet training seems to be independent of the presence of vesicoureteral reflux. Urinary tract infection itself is not necessarily associated with age at toilet training. However, timing of the first urinary tract infection seems to be related to age at toilet training.

  17. 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

  18. Renal ultrasound studies after endoscopic injection of dextranomer/hyaluronic acid copolymer for vesicoureteral reflux.

    Science.gov (United States)

    Yu, Richard N; Jones, Eric A; Roth, David R

    2006-10-01

    To examine the outcomes of renal ultrasound studies after subureteral injection of dextranomer/hyaluronic acid copolymer and provide recommendations for postoperative management of vesicoureteral reflux (VUR). Pediatric patients aged 15 years or younger with uncomplicated primary VUR were recruited for endoscopic treatment with dextranomer/hyaluronic acid gel. After undergoing the procedure, patients were instructed to continue prophylactic antibiotic treatment until a follow-up voiding cystourethrogram was obtained 2 weeks or more after treatment. VUR resolution was defined as grade 0. Repeat endoscopic injection was offered to patients with persistent VUR. Postoperative renal ultrasound scans were obtained on the same day as the voiding cystourethrogram. Of 120 patients treated, 6 were lost to follow-up and 14 had not yet undergone the posttreatment evaluation. The 100 remaining patients (efficacy population) had a mean age of 4.2 years (range 0.5 to 15), and the median reflux grade was 2 (range 1 to 5). The overall VUR resolution rate for the patients was 87% after endoscopic injection. Of 100 patients, 88 achieved complete resolution after a single injection and 19 required a repeat injection. Of the 100 patients who underwent postoperative ultrasound examination, none demonstrated renal ultrasound changes consistent with significant ureteral obstruction or renal parenchymal changes. Renal ultrasound studies after endoscopic treatment with dextranomer/hyaluronic acid gel are unnecessary after determination of reflux resolution by voiding cystourethrography.

  19. Single center experience with endoscopic subureteral dextranomer/hyaluronic acid injection as first line treatment in 1,551 children with intermediate and high grade vesicoureteral reflux.

    Science.gov (United States)

    Puri, Prem; Kutasy, Balazs; Colhoun, Eric; Hunziker, Manuela

    2012-10-01

    In recent years the endoscopic injection of dextranomer/hyaluronic acid has become an established alternative to long-term antibiotic prophylaxis and the surgical management of vesicoureteral reflux. We determined the safety and effectiveness of the endoscopic injection of dextranomer/hyaluronic acid as first line treatment for high grade vesicoureteral reflux. Between 2001 and 2010, 1,551 children (496 male, 1,055 female, median age 1.6 years) underwent endoscopic correction of intermediate and high grade vesicoureteral reflux using dextranomer/hyaluronic acid soon after the diagnosis of vesicoureteral reflux on initial voiding cystourethrogram. Vesicoureteral reflux was unilateral in 761 children and bilateral in 790. Renal scarring was detected in 369 (26.7%) of the 1,384 patients who underwent dimercapto-succinic acid imaging. Reflux grade in the 2,341 ureters was II in 98 (4.2%), III in 1,340 (57.3%), IV in 818 (34.9%) and V in 85 (3.6%). Followup ultrasound and voiding cystourethrogram were performed 3 months after the outpatient procedure, and renal ultrasound was performed annually thereafter. Patients were followed for 3 months to 10 years (median 5.6 years). Vesicoureteral reflux resolved after the first, second and third endoscopic injection of dextranomer/hyaluronic acid in 2,039 (87.1%), 264 (11.3%) and 38 (1.6%) ureters, respectively. Febrile urinary tract infections developed during followup in 69 (4.6%) patients. None of the patients in the series needed reimplantation of ureters or experienced any significant complications. Our results confirm the safety and efficacy of the endoscopic injection of dextranomer/hyaluronic acid in the eradication of high grade vesicoureteral reflux. We recommend this 15-minute outpatient procedure as the first line of treatment for high grade vesicoureteral reflux. Copyright © 2012 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  20. Long-term followup after endoscopic treatment of vesicoureteral reflux with dextranomer/hyaluronic acid copolymer in patients with neurogenic bladder.

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    Polackwich, A S; Skoog, S J; Austin, J C

    2012-10-01

    Subureteral injection of dextranomer/hyaluronic acid copolymer is a minimally invasive method to treat vesicoureteral reflux. We report short and long-term success in treating secondary vesicoureteral reflux in patients with neurogenic bladder dysfunction or severe voiding dysfunction. We performed a retrospective chart review of all subureteral injection procedures done to identify patients with neurogenic bladder or severe voiding dysfunction. Short (less than 12 months) and long-term vesicoureteral reflux results for patients and ureters were recorded. Preoperative urodynamics and radiographic findings were reviewed. Preoperative factors were evaluated to identify patients with greater chances of success. A total of 12 patients (17 ureters) were identified (10 with neurogenic bladder and 2 with Hinman syndrome). Short-term success (no vesicoureteral reflux) was achieved in 50% of patients and 58% of ureters. At a median followup of 4.5 years (range 1 to 9) success decreased to 35% of ureters. Overall, long-term success was found in 25% of patients who were free of vesicoureteral reflux and required no additional surgery. Of the patients 41% required additional urological surgery for vesicoureteral reflux or related conditions. With long-term followup many patients who had initial improvement in vesicoureteral reflux ultimately experienced treatment failure and recurrence of reflux. At a median of 4.5 years 25% of patients with neurogenic bladder and vesicoureteral reflux were successfully treated with endoscopic injection of dextranomer/hyaluronic acid copolymer. Copyright © 2012 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  1. Value of sonography in the diagnosis of mild, moderate and severe vesicoureteral reflux in children

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    Atoosa Adibi

    2013-01-01

    Full Text Available This study was conducted to determine the positive predictive value (PPV of gray scale sonography in the diagnosis of mild, moderate and severe vesicoureteral reflux (VUR. This cross-sectional descriptive analytic study was conducted in the University Clinic of Isfahan University of Medical Sciences in 2008. The study was performed on children aged two to 12 years; female children with febrile urinary tract infection (UTI and clinical suspicion of VUR and males with history of UTI and VUR who attended follow-up during the six months study period were selected. Non-cooperative patients were excluded from the study. A total of 90 patients were studied. The data gathering method was sequential. The following sonographic parameters were assessed in all the study patients: antero-posterior pelvic diameter, distal ureteric diameter and stasis of urinary system, which were measured at rest and during and after the Valsalva maneuver. Also, the vesicoureteral junction distance and distance of vesicoureteral junction to the midline were measured on both sides at rest. We then referred them for radionuclide cystography (RNC and the results of the two methods were compared. Data were analyzed with SPSS program and t-test and chi square formulas were used. The sensitivity of ultrasound in the diagnosis of VUR was 70.9% and the specificity was 51.4%. Thus, the PPV was 69.64% and the negative predictive value was 52.94%. Although the most definite diagnosis of VUR is made with micrurating cystoureterography or RNC, sonography may be used as the first step in evaluation for VUR, especially in high-grade VUR.

  2. Vesicoureteral Reflux

    Science.gov (United States)

    ... Kidney Disease Weight Management Liver Disease Urologic Diseases Endocrine Diseases Diet & Nutrition Blood Diseases Diagnostic Tests La información ... Kidney Disease Weight Management Liver Disease Urologic Diseases Endocrine Diseases Diet & Nutrition Blood Diseases Diagnostic Tests La información ...

  3. 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

  4. Strengths and Pitfalls of Meta-Analysis Reports in Vesicoureteral Reflux

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    K. Afshar

    2008-01-01

    Full Text Available There are many ongoing controversies surrounding vesicoureteral reflux (VUR. These include variable aspects of this common congenital anomaly. Lack of evidence-based recommendations has prolonged the debate. Systematic reviews (SRs and meta-analysis (MA are considered high-level evidence. The purpose of this review article is to summarize and critically appraise the available SR/MA pertaining to VUR. We also discuss the strength and pitfalls of SR/MA in general. A thorough literature search identified 9 SRs/MAs relevant to VUR. Both authors critically reviewed these articles for contents and methodological issues. There are many concerns about the quality of the studies included in these SRs. Clinical heterogeneity stemming from different patient selection criteria, interventions, and outcome definitions is a major issue. In spite of major advances in understanding different aspects of VUR in the last few decades, there is a paucity of randomized controlled trials in this field.

  5. Primary vesicoureteral reflux in Blacks with posterior urethral valves: Does it occur?

    International Nuclear Information System (INIS)

    Nancarrow, P.A.; Lebowitz, R.L.

    1988-01-01

    Primary vesicoureteral reflux (VUR) is thought to be largely independent of obstruction. Therefore, in patients with urethral obstruction due to posterior urethral valves (PUV) the occurrence of VUR is coincidental. In addition, primary VUR is reported to be uncommon in black children. If these two premises are correct, then primary VUR should be rare in black males with PUV. To test this hypothesis, we reviewed the medical records and radiographs of 43 males with PUV. Twenty-one of the 37 non-black males with PUV had VUR, of which 67% was primary and 33% was secondary. Three of the six Blacks with PUV had VUR of which none was primary and all was secondary. Thus, Blacks with PUV lend credence to the theory that primary VUR is not caused by obstruction and support the observation that primary VUR is rare in black children, even those with PUV. (orig.)

  6. Comparison of "Direct" and "Indirect" Nuclear Cystography in the Diagnosis of Vesicoureteric Reflux

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    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.

  7. Poly(vinyl pyrrolidone)-Chitosan implant for endoscopic treatment of vesicoureteral reflux

    International Nuclear Information System (INIS)

    Relleve, Lorna S.; Abad, Lucille V.; Aranilla, Charito T.; Dela Rosa, A.M.; Bolong, David T.; Bisnar, Carlo C.

    2008-01-01

    Radiation-crosslinked poly(vinyl pyrrolidone) (PVP)-Chitosan was prepared as a potential injectable implant for endoscopic treatment of vesicoureteral reflux (VUR). The physical and histological properties of PVP-Chitosan implant in comparison with the commercial dextranomer/hyaluronic acid copolymer (Deflux) have been evaluated in vivo by subcutaneous and abdominal injection in rats over a period of 6 months. The PVP-Chitosan implant was easily injected through 26-gauge needle. Monthly gross examination of the implanted sites showed no significant decrease in volume of implant and no local inflammatory reaction. Histological findings indicated no evidence of migration to the distant organs after 6 months of implantation. Results of this study indicated that PVP-Chitosan implant has properties of a good tissue augmenting substance such as stability, biocompatibility and non-migration but long-term studies are needed to evaluate its therapeutic efficiency. (author)

  8. 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.

  9. Evaluation of vesico-ureteral reflux in children with renal scarring by radionuclide imaging

    International Nuclear Information System (INIS)

    Zeng Jihua; Zhao Ruifang; Ji Zhiying; Lu Xiaomei; Gu Fanlei

    2002-01-01

    Objective: To determine the relationship between vesico-ureteral reflux (VUR) and acute pyelonephritis (APN), renal scarring and to evaluate the radionuclide imaging in children with urinary tract infection (UTI). Methods: The study included 48 children with upper urinary tract infection (UUTI) proven for the first time clinically. All children were diagnosed as with APN by 99 Tc m -dimercaptosuccinic acid (DMSA) renal cortical scintigraphy. Within 10 d after renal imaging, all cases underwent direct radionuclide cystography (DRC) for evaluating the presence of VUR. Results: 1) Of 48 children with APN, 29.2%(14/48) had renal scarring, and also 47.9%(23/48) patients and 44.8%(30/67) involved kidneys had VUR. 2) The incidence (85.7%) of VUR in patients with renal scarring was significantly higher than that (32.4%) in patients without scarring (P<0.01). The incidence (88.2%) of VUR in kidneys with scarring was also higher than that (30.0%) in kidneys without scarring (P<0.01). 3) Of 30 kidneys with VUR, the incidence of scarring was 73.3% in kidneys with severe reflux, but was 11.5% in kidneys without reflux, or with mild or moderate reflux (P<0.01). Conclusions: The association between VUR and scarring is documented. The VUR may be one of the risk factors in predisposing the post-pyelonephritis to renal scarring. DRC is a sensitive, practical and much lower radiation exposure technique for detecting VUR and especially suitable for children

  10. Dextranomer/hyaluronic acid endoscopic injection is effective in the treatment of intermediate and high grade vesicoureteral reflux in patients with complete duplex systems.

    Science.gov (United States)

    Hunziker, Manuela; Mohanan, Nochiparambil; Puri, Prem

    2013-05-01

    Endoscopic subureteral injection of dextranomer/hyaluronic acid has become an established alternative to long-term antibiotic prophylaxis or surgical treatment for vesicoureteral reflux. We evaluated the effectiveness of endoscopic injection of dextranomer/hyaluronic acid in intermediate and high grade vesicoureteral reflux in patients with complete duplex collecting systems. A total of 123 children underwent endoscopic correction of intermediate or high grade vesicoureteral reflux using injection of dextranomer/hyaluronic acid into complete duplex systems between 2001 and 2010. Vesicoureteral reflux was diagnosed by voiding cystourethrogram, and dimercapto-succinic acid scan was performed to evaluate the presence of renal scarring. Followup ultrasound and voiding cystourethrogram were performed 3 months after the outpatient procedure and renal ultrasound thereafter every 2 years. Mean followup was 6.7 years. Complete duplex systems were unilateral in 110 patients and bilateral in 13. Reflux severity in the 136 refluxing units was grade II in 1 (0.7%), III in 52 (38.2%), IV in 61 (44.9%) and V in 22 (16.2%). Dimercapto-succinic acid scan revealed renal functional abnormalities in 63 children (51.2%). Vesicoureteral reflux resolved after the first endoscopic injection of dextranomer/hyaluronic acid in 93 ureters (68.4%), after a second injection in 35 (25.7%) and after a third injection in 8 (5.9%). Febrile urinary tract infection developed in 5 patients (4.1%) during followup. No patient required ureteral reimplantation or experienced significant complications. Our results confirm the safety and efficacy of endoscopic injection of dextranomer/hyaluronic acid in eradicating intermediate and high grade vesicoureteral reflux in patients with complete duplex systems. We recommend this minimally invasive, 15-minute outpatient procedure as a viable option for treating intermediate and high grade vesicoureteral reflux in patients with complete duplex collecting systems

  11. Treatment of pediatric vesicoureteral reflux using endoscopic injection of hyaluronic acid/dextranomer gel: intermediate-term experience by a single surgeon.

    Science.gov (United States)

    Hsieh, Michael H; Madden-Fuentes, Ramiro J; Lindsay, Nicholas E; Roth, David R

    2010-07-01

    Endoscopic injection of non-animal-stabilized hyaluronic acid/dextranomer gel is an increasingly recognized treatment option for vesicoureteral reflux. The procedure is minor compared with open surgery and, when successful, avoids the need for long-term antibiotic prophylaxis. We present data from 3 years of using non-animal-stabilized hyaluronic acid/dextranomer gel to treat children with vesicoureteral reflux. Pediatric patients aged 16 years with uncomplicated primary vesicoureteral reflux were recruited for endoscopic treatment with non-animal-stabilized hyaluronic acid/dextranomer gel. A follow-up voiding cystourethrogram was scheduled at 2 weeks after treatment, and vesicoureteral reflux resolution was defined as grade 0. Repeat non-animal-stabilized hyaluronic acid/dextranomer gel treatment was offered to patients with persistent vesicoureteral reflux. Of 178 patients treated, 12 were lost to follow-up or yet to undergo post-treatment voiding cystourethrogram. The 166 remaining patients (efficacy population) had a mean age of 4.21 years (range: 0-16), and the median reflux grade was 3 (range: 1-5). Vesicoureteral reflux was resolved in 81.9% of patients and 86.4% of ureters after initial endoscopic treatment with non-animal-stabilized hyaluronic acid/dextranomer gel. The overall reflux resolution rate for patients increased to 89.6% after a second treatment in 19 patients, and 90.2% after a third treatment in 1 patient. No adverse events were reported. Five patients underwent open ureteral reimplantation after failed endoscopic injections. Endoscopic treatment with non-animal-stabilized hyaluronic acid/dextranomer gel is effective in a high proportion of children with vesicoureteral reflux and, in our opinion, should be considered as a first-line treatment option. Copyright 2010 Elsevier Inc. All rights reserved.

  12. Endoscopic Treatment of Vesicoureteral Reflux in Infants. Can We Do It and Should We Do It?

    Science.gov (United States)

    Fuentes, Sara; Gómez-Fraile, Andrés; Carrillo-Arroyo, Isabel; Tordable-Ojeda, Cristina; Cabezalí-Barbancho, Daniel

    2017-12-01

    To evaluate the outcomes of endoscopic treatment of vesicoureteral reflux (VUR) performed on infants, and to discuss the possible role of this approach in selected cases. A retrospective analysis was conducted on the patients who underwent endoscopic injection of a bulking substance for VUR in our institution, and a comparison was made with patients treated during infancy and those treated later in life. A total of 463 ureteral units were included (296 children), of whom 47 were patients less than 1 year of age (infants, INF group); the remaining 416 were included in a second group (children, CHL). In this study, the percentage of high-grade VUR and presence of reflux nephropathy were significantly higher in younger patients. Both early failure and recurrence rate were significantly higher in the INF group when compared with the CHL group. No complications were observed in the INF group. Endoscopic treatment of VUR is feasible in patients less than 1 year of age. The effectiveness is lower than when patients are treated at a later age but was still over 80% in our series. There were no complications reported related to the procedure itself or to the general anesthesia. Once it is known that endoscopic treatment of VUR can be performed, controversy arises about the indication of treating patients with VUR. Careful selection of VUR cases that are less likely to spontaneously resolve, presence of breakthrough infections, and parental preference, all play a role in the decision-making process. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. Voiding urosonography with ultrasound contrast agents for the diagnosis of vesicoureteric reflux in children

    Science.gov (United States)

    2007-01-01

    Voiding urosonography (VUS) encompasses examination of the urinary tract with intravesical administration of US contrast agent (UCA) for diagnosis of vesicoureteric reflux (VUR). The real breakthrough for US examination of VUR came with the availability of stabilized UCAs in the mid-1990s. This article presents a comprehensive review of various procedural aspects of VUS. Different US modalities are available for detecting the echogenic microbubbles: fundamental mode, colour Doppler US, harmonic imaging and dedicated contrast imaging with multiple display options. The reflux is graded (1 to 5) in a similar manner to the system used in voiding cystourethrography (VCUG). The most commonly used UCA for VUS, Levovist, is galactose-based and contains air-filled microbubbles. The recommended concentration is 300 mg/ml at a dose of 5–10%, or less than 5%, of the bladder filling volume when using fundamental or harmonic imaging modes, respectively. There are preliminary reports of VUS using a second-generation UCA, SonoVue. Here the UCA volume is less than 1% of the bladder filling volume. There is no specific contraindication to intravesical administration of UCA. The safety profile of intravesical Levovist is very high with no reports of side effects over a decade of use in VUS. PMID:17618429

  14. Effect of movement and developmental factors in growth and evolution in children with vesicoureteral reflux.

    Science.gov (United States)

    Yousefichaijan, Parsa; Dorreh, Fatemeh; Rafiei, Mohammad; Nouri-Kopaei, Simin; Shariatmadari, Fakhreddin; Pakniyat, Abdolghader; Naziri, Mahdyieh

    2015-01-01

    Vesicoureteral reflux (VUR) is a backward flow of urine from bladder to ureter or kidney. Potential reflux is harmful because of kidney being faced with the hemodynamic high-pressure during urination. This project was carried out for high prevalence of VUR and delay in growth of children with chronic diseases. In case of growth disorder in children with this disease and its difference with healthy person, treatment can be tried by treating the growth disorder. The purpose of this study is survey of children with VUR about growth and developmental impairment. All patients who performed voiding cystourethrogram (VCUG)because of UTI, divided into 2 groups, healthy and sick. History and checklist filled, patients' height and weight measured in a standard way and ASQ questionnaires adjusted to age, used for the studying development effect. The height and weight of children measured by standard meter and scale and used the curves adjusted to age and sex. Control group entered the study with the same characteristics of case group without VUR, however, their height and weight were recorded. The way of evolution studied according to Nelsons evolution table and ASQ questionnaire. The both groups (total of 150 studied children) in the area of development of fine motor, gross motor and indicators of mean and percentile of height and weight and parents' literacy, had a significant difference (PChildren with VUR, in terms of height and weight growth and index of gross and fine movements and communicate were better than normal children.

  15. Vesico-ureteral reflux: diagnosis and staging with voiding color doppler US Preliminary experience

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    Farina, Renato; Arena, Carmela; Pennisi, Francesco; Di Benedetto, Vincenzo; Politi, Guido; Di Benedetto, Aurelio

    2000-07-01

    Introduction: The aim of this study is to assess the accuracy of a new US examination: 'voiding color Doppler US ' in the early diagnosis and staging of vesico-ureteral reflux (VUR). The contrast agent US was SH U 508A (Levovist, Schering, Berlin), which produces a chromatic accentuation of the signals picked up by the color Doppler US. Eighteen patients (10 females, eight males) were recruited for the study. In two patients a second examination was performed for follow-up after a VUR conservative therapy. All patients were taken under examination for the evaluation of possible VUR. In all patients the voiding color Doppler US was followed by voiding cystourethrography (VCUG) and the data obtained were compared. Materials and methods: A total of 18 patients aged between 3 months and 10 years, were recruited for the study. The results of the examination were the following: urinary tract infections, follow-up of VUR after conservative or surgical therapy, miscellaneous indications. Voiding color Doppler US was performed, followed by a VCUG. The voiding color Doppler US consists in the trans-catheter introduction of a contrast agent SHU 508 A (Levovist, Schering, Ag. Berlin) into the bladder and a subsequent test with the color Doppler US to show or exclude the presence of reflux into the ureters and/or into the pyelo-caliceal cavity of the kidneys. After the introduction of the contrast agent US the ultrasound scanning of the bladder, the ureters and the pyelo-caliceal cavity was performed to examine the reflux degree. The ultrasonographic investigations were perfomed with AU 590 asyncronus US (Esaote Biomedica, Genova) with a 3.5 MHz convex probe. Results: After the trans-catheter introduction of the contrast agent US, vesico-ureteral reflux occured in 13 patients (77.2%). The reflux degree was also measured by means of ultrasound and was later confirmed by VCUG. The mean times of each examination were as follows: initial US, 10 min; catheterization, 8 min

  16. Urosepsis in infants with vesicoureteral reflux masquerading as the salt-losing type of congenital adrenal hyperplasia

    Energy Technology Data Exchange (ETDEWEB)

    Vaid, Y.N.; Lebowitz, R.L.

    1989-08-01

    Three male infants with vomiting, dehydration, hyponatremia, hyperkalemia and metabolic acidosis were found to have vesicoureteral reflux (VUR) and urinary tract infection. Two were initially thought to have the salt-losing form of congenital adrenal hyperplasia. Although prompt diagnosis of this potentially fatal condition is critical, its mimicry by urosepsis in infants with VUR is actually more common. Infection probably causes unresponsiveness of the distal renal tubules to aldoterone. (orig.).

  17. Frequency determination of HLA-DRB1 and HLA-DQB1 alleles in children with primary vesicoureteral reflux

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    Mohammadreza Bazrafshani

    2014-12-01

    Conclusion: The HLA cluster might affect on susceptibility to vesicoureteral reflux es-pecially by locus which located close to HLA-DRB1 and HLA-DQB1 genes. This study demonstrates for the first time in Iran. However, further extensive researches with a large number of samples from different populations and ethnicities are required to val-idate the results obtained in this study.

  18. Augmentation cystoplasty and simultaneous ureteral reimplantation reduce high-grade vesicoureteral reflux in children with neurogenic bladder

    OpenAIRE

    Jen-Bin Wang; Chin-Su Liu; Shin-Lin Tsai; Chou-Fu Wei; Tai-Wai Chin

    2011-01-01

    Background: To compare the incidence of residual high-grade vesicoureteral reflux (HVUR) (≥Grade III) in neurogenic bladder patients receiving augmentation cystoplasty alone or with simultaneous ureteral reimplantation. Furthermore, we also tried to find the risk factors of residual VUR and febrile urinary tract infection. Methods: Between 1999 and 2009, urinary bladder augmentation was performed in 21 children with neurogenic bladder. Seventeen of these patients had VUR on preoperative vo...

  19. Endoscopic treatment of vesicoureteral reflux in children with subureteral dextranomer/hyaluronic acid injection: a single-centre, 7-year experience

    Science.gov (United States)

    Biočíc, Mihovil; Todoríc, Jakov; Budimir, Dražen; Roíc, Andrea Cvitkovíc; Pogorelíc, Zenon; Juríc, Ivo; Šušnjar, Tomislav

    2012-01-01

    Background The goals of medical intervention in patients with vesicoureteral reflux are to allow normal renal growth, prevent infections and pyelonephritis, and prevent renal failure. We present our experience with endoscopic treatment of vesicoureteral reflux in children by subureteral dextranomer/hyaluronic acid copolymer injection. Methods Under cystoscopic guidance, dextranomer/hyaluronic acid copolymer underneath the intravesical portion of the ureter in a subureteral or submucosal location was injected in patients undergoing endoscopic correction of vesicoureteral reflux. Results A total of 282 patients (120 boys and 162 girls) underwent the procedure. There were 396 refluxed ureters altogether. The mean age of patients was 4.9 years. The mean overall follow-up period was 44 months. Among the 396 ureters treated, 76% were cured with a single injection. A second and third injection raised the cure rate to 93% and 94%, respectively. Twenty-two (6%) ureters failed all 3 injections, and were converted to open surgery. Conclusion Endoscopic treatment of vesicoureteral reflux can be recommended as a first-line therapy for most cases of vesicoureteral reflux, because of the short hospital stay, absence of complications and the high success rate. PMID:22854114

  20. Elucidation of Renal Scars in Children With Vesicoureteral Reflux Using Contrast-Enhanced Ultrasound: A Pilot Study

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    David S. Hains

    2017-05-01

    Discussion: This study represents the first report of using CEUS to characterize renal scars in children with reflux nephropathy. We conclude that CEUS is a highly sensitive, rapid, and cost-effective diagnostic imaging modality for detecting and monitoring renal scars in children with vesicoureteral reflux.

  1. Is There Any Association between Spina bifida occulta and Primary Vesicoureteral Reflux?

    Science.gov (United States)

    Mehdizadeh, Mehrzad; Roohi, Azadeh; Hemami, Mohsen; Esfahani, Seyed-Taher

    2010-09-01

    Spina bifida occulta (SBO) has been largely considered a benign entity without clinical significance; however, there has been dispute among various authorities, and some believe that the lesion may be linked with various neurologic conditions like urologic dysfunctions. Vesicoureteral reflux (VUR) and lower urinary tract dysfunction are closely related. We examined whether the existence of SBO is related to the prevalence and severity of VUR in children. We investigated 359 children, 2-14 years old, referred to radiology department for obtaining voiding cystourethrogram after the first attack of febrile urinary tract infection. After treatment of infection, with written order of responsible physicians all underwent a standard voiding cystourethrogram to detect VUR and other lower urinary tract anomalies. The patients were divided into two groups: group1 patients who had not SBO and group 2 patients with SBO in postvoiding or KUB films. In each group the presence and severity of VUR was determined in relation to the location of SBO. Out of 359 children, 228 (63.5%) had normal spine and 131 (36.5%) had SBO. Fifty four (23.7%) out of 228 children with normal spine had VUR and 40 (30.5%) out of 131 children with SBO had VUR. The prevalence of VUR in children without SBO and children with SBO was not statistically different. Also we compared the severity of VUR between the two groups and there was no significant difference or trend between presence of SBO and severity of reflux (Chi(2) for trend). VUR was more common in children with SBO in L5-S1 (38.3%). There was no significant relation between location of SBO and prevalence of VUR. Location of SBO and prevalence of VUR are not related.

  2. Renal tissue oxygenation in children with chronic kidney disease due to vesicoureteral reflux.

    Science.gov (United States)

    Chehade, Hassib; Milani, Bastien; Ansaloni, Annalisa; Anex, Christiane; Bassi, Isabelle; Piskunowicz, Maciej; Stuber, Matthias; Cachat, Francois; Burnier, Michel; Pruijm, Menno

    2016-11-01

    Vesicoureteral reflux (VUR) is a frequent cause of chronic kidney disease (CKD) in children. Using blood oxygenation level-dependent magnetic resonance imaging (BOLD-MRI), we measured cortical and medullary oxygenation in children with CKD due to VUR and compared the results to those obtained on healthy controls. The study population comprised 37 children (19 with CKD due to VUR and 18 healthy age-matched controls). BOLD-MRI was performed before and after furosemide treatment. MR images were analyzed with the region-of-interest (ROI) technique to assess the mean R2* values (=1/T2*) of the cortex and medulla of each kidney and with the concentric object (CO) technique that divides renal parenchyma in 12 equal layers. R2* values were significantly lower (corresponding to higher oxygenation) in the cortex and medulla of kidneys of children with CKD due to VUR than in those of the healthy controls (cortex 16.4 ± 1.4 vs. 17.2 ± 1.6 s(-1) , respectively; medulla 28.4 ± 3.2 vs. 30.3 ± 1.9 s(-1) , respectively; P children with a history of unilateral reflux (n = 9), the non-affected contralateral kidneys presented similar R2* values as the diseased kidneys, but their response to furosemide was significantly larger (-7.4 ± 3.2 vs. -5.7 ± 3.0, respectively; P = 0.05). Chronic kidney disease due to VUR is not associated with kidney tissue hypoxia in children. The significantly larger furosemide-induced decrease in medullary R2* levels in the healthy group and unaffected contralateral kidneys of the VUR group points towards more intense renal sodium transport in these kidneys.

  3. Reflujo vesicoureteral asociado a dilatación del tracto urinario fetal Vesicoureteral reflux associated with dilation of fetal urinary tract

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    Sandalio Durán Álvarez

    2009-03-01

    á presente en el 20 % de los casos. Muchos de estos pacientes pueden tener afectación renal congénita.INTRODUCTION: The aim of present study was to shows percentages of vesicoureteral reflux found in children presenting with dilation of upper urinary tract during fetal period in follow-up of normal a pregnancy. METHODS: In children with a severe o moderate dilation, confirmed after birth, we carried out a micturition urethra-cystography to set existence of vesicoureteral reflux as cause of prenatal dilation. When it was impossible to measure pelvis in prenatal USs, and only "dilation" reported, we made study considering results of first renal US. In slight dilations a micturition cystoureterogram if the child was infected, if dilation progressed or if there were associated symptoms signaling a probable lower urinary obstruction. In case of bilateral dilations we studied kidney units with slight dilations, if in contralateral kidney dilation was of a greater degree. RESULTS: Between January 2002 and December 2007, 119 children were referred to Nephrology consulting room in which by means of a ultrasonic follow-up of normal pregnancy, it was detected an expansive anomaly of urinary tract. Ten children left follow-up before specify exactly the diagnosis, and 109 were studied. In 119 children referred it was found 187 dilated units, since 78 had a prenatal bilateral dilation. Of 109 children studied, 69 were of male sex with 118 dilated kidney units, and 40 were of female sex presenting with dilation in 69 units. We found vesicoureteral reflux in 22 patients (20, 1% and 33 flowed back units, since in 11 children reflux was bilateral. There was a predominance of high degree reflux (IV and V. CONCLUSIONS: Among dilations of urinary tract followed in prenatal period, it is necessary to find a possible vesicoureteral reflux, which is present in 20% of cases. Many of these patients may to have congenital renal affection.

  4. Do Routine Preoperative and Intraoperative Urine Cultures Benefit Pediatric Vesicoureteral Reflux Surgery?

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    Daniel R. Hettel

    2017-01-01

    Full Text Available Objective. To determine if routine preoperative and intraoperative urine cultures (UCx are necessary in pediatric vesicoureteral (VUR reflux surgery by identifying their association with each other, preoperative symptoms, and surgical outcomes. Materials and Methods. A retrospective review of patients undergoing ureteral reimplant(s for primary VUR at a tertiary academic medical center between years 2000 and 2014 was done. Preoperative UCx were defined as those within 30 days before surgery. A positive culture was defined as >50,000 colony forming units of a single organism. Results. A total of 185 patients were identified and 87/185 (47.0% met inclusion criteria. Of those, 39/87 (45% completed a preoperative UCx. Only 3/39 (8% preoperative cultures returned positive, and all of those patients were preoperatively symptomatic. No preoperatively asymptomatic patients had positive preoperative cultures. Intraoperative cultures were obtained in 21/87 (24.1% patients; all were negative. No associations were found between preoperative culture results and intraoperative cultures or between culture result and postoperative complications. Conclusions. In asymptomatic patients, no associations were found between the completion of a preoperative or intraoperative UCx and surgical outcomes, suggesting that not all patients may require preoperative screening. Children presenting with symptoms of urinary tract infection (UTI prior to ureteral reimplantation may benefit from preoperative UCx.

  5. Ureteral diameter in low-risk vesicoureteral reflux in infancy and childhood

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    Hellstroem, M.; Hjaelmaas, K.; Jacobsson, B.; Jodal, U.

    In order to improve the accuracy of the grading of vesicoureteral reflux (VUR), reference values for ureteral diameter at micturition cystourethrography (MCUG) were established in infants and children with low-risk VUR. Low-risk VUR was defined as VUR not associated with infection, obstruction, calculi, duplication, malformations (except for hypospadia) or neurogenic bladder disturbances. Forty-six children (age 1 day - 14 years) were selected by examining the records of 12000 MCUG:s performed 1960-1983. Ureteral diameter was measured at the widest point of the ureter on the films from MCUG:s and urographies. Ureteral diameter was slightly larger at MCUG than at urography in the same individuals but the difference was not significant. The ureteral diameter at MCUG also correlated closely to normal values at urography in a previous study. It is proposed that the reference values obtained at MCUG in the present investigation can be used for the differentiation between dilatation and no dilatation in the grading of VUR.

  6. Endoscopic Treatment of Vesicoureteral Reflux with Dextranomer/Hyaluronic Acid in Children

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    Andrew J. Kirsch

    2008-06-01

    Full Text Available Purpose. The goal of this review is to present current indications, injectable agents, techniques, success rates, complications, and potential future applications of endoscopic treatment for vesicoureteral reflux (VUR in children. Materials and Methods. The endoscopic method currently achieving one of the highest success rates is the double hydrodistention-implantation technique (HIT. This method employs dextranomer/hyaluronic acid copolymer, which has been used in pediatric urology for over 10 years and may be at present the first choice injectable agent due to its safety and efficacy. Results. While most contemporary series report cure rates of greater than 85% for primary VUR, success rates of complicated cases of VUR may be, depending on the case, significantly lower. Endoscopic treatment offers major advantages to patients while avoiding potentially complicated open surgery. As the HIT method continues to be applied to complex cases of VUR and more outcome data become available, the indication for endoscopic treatment may exceed the scope of primary VUR. Conclusions. Endoscopic injection is emerging as the treatment of choice for VUR in children.

  7. Ureteroneocystostomy after failed dextranomer/hyaluronic acid copolymer injection for vesicoureteral reflux treatment.

    Science.gov (United States)

    Moreira-Pinto, João; Osório, Angélica; Pereira, Joana; Sousa, Catarina; de Castro, João Luís Ribeiro; Réis, Armando

    2013-10-01

    To report our experience of open ureteroneocystostomy after failed endoscopic treatment. Clinical charts of 787 children who entered our dextranomer/hyaluronic acid copolymer (DxHA) endoscopic injection program for vesicoureteral reflux (VUR) treatment between May 2000 and December 2009 were reviewed. Fifty-one of these patients were submitted to open ureteroneocystostomy for complete resolution of VUR. Twenty-eight patients (55%) were female. Median age at surgery was 65 months (range: 26-182). Median time going from first endoscopic injection until open surgery was 13 months (range 1-58). Surgical ureteral reimplantation was bilateral in 62.7% of the cases. Of a total of 83 operated ureters, nine were duplex ureters, nine were megaureters, six were ectopic, and two had periureteral diverticulum. Mean operative time was 70 min (range 45-120 min). There were no intra-operative complications. Follow-up VCUG showed complete resolution of VUR in 98% of patients. There was only one right-sided grade III VUR that persisted after bilateral reimplantation. It resolved with a single subureteral DxHA injection. Ureteroneocystostomy after a failed endoscopic treatment can achieve successful results in a high percentage of patients with minimal complications. Copyright © 2012 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

  8. Can we rely on the presence of dextranomer-hyaluronic acid copolymer mounds on ultrasound to predict vesicoureteral reflux resolution after injection therapy?

    Science.gov (United States)

    Zamilpa, Ismael; Koyle, Martin A; Grady, Richard W; Joyner, Byron D; Shnorhavorian, Margarett; Lendvay, Thomas S

    2011-06-01

    We determined whether the presence or absence of dextranomer-hyaluronic acid copolymer mounds on bladder ultrasound coincides with voiding cystourethrogram results after injection therapy in children with primary vesicoureteral reflux. We retrospectively reviewed consecutive cases of dextranomer-hyaluronic acid copolymer injection for primary vesicoureteral reflux. The primary outcome investigated was the appearance of dextranomer-hyaluronic acid copolymer mounds on ultrasound and their association with voiding cystourethrogram results postoperatively. An intramural dextranomer-hyaluronic acid copolymer mound on ultrasound was considered a negative test result for vesicoureteral reflux. A total of 187 cases were identified, of which 132 had imaging available for evaluation. Intramural mounds were seen on ultrasound in 86 cases postoperatively, of which 34 (40%) had a positive voiding cystourethrogram. Of 46 cases in which no mound was identified 21 (46%) had a positive voiding cystourethrogram. The sensitivity of ultrasound to determine the presence or absence of vesicoureteral reflux was 38%, specificity was 67%, accuracy was 55%, the positive predictive value was 46% and the negative predictive value was 60%. Our results indicate poor correlation of dextranomer-hyaluronic acid copolymer mound appearance on ultrasound with voiding cystourethrogram results after injection. To adequately evaluate for the resolution of vesicoureteral reflux a voiding cystogram or nuclear medicine cystogram needs to be performed after injection therapy. Copyright © 2011 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  9. Histology proved malpositioning of dextranomer/hyaluronic acid in submucosal ureter in patients after failed endoscopic treatment of vesicoureteral reflux.

    Science.gov (United States)

    Ben-Meir, David; Morgenstern, Sara; Sivan, Bezalel; Efrat, Rachel; Livne, Pinhas M

    2012-07-01

    We histologically investigated the cause of failed endoscopic treatment of vesicoureteral reflux with dextranomer/hyaluronic acid injections in children. A total of 192 children underwent dextranomer/hyaluronic acid injection at our institution between January 2008 and September 2010. The study population consisted of 13 children (22 ureters) with vesicoureteral reflux who underwent ureteroneocystostomy following failed endoscopic injections (1 to 2) of dextranomer/hyaluronic acid. In all cases the dextranomer/hyaluronic acid was implanted in the mucosa of the mid to distal ureteral tunnel following hydrodistention of the ureter. The medical records were reviewed, and specimens of the archived distal ureters removed during surgery were examined histologically. Mean patient age was 4.1 years. Mean dose of dextranomer/hyaluronic acid was 0.9 ml (both treatments) and mean lag between treatments was 13.4 months. Indications for open surgery were recurrent urinary tract infections and/or residual or aggravated reflux grade IV or higher. Histological study revealed that the dextranomer/hyaluronic acid was malpositioned in 21 of 22 ureters, residing in the muscle fibers in 2, adventitia in 14 and periureteral space in 5. This is the first known study to provide a histologically proved cause of failure of endoscopic treatment of vesicoureteral reflux with dextranomer/hyaluronic acid injections in children. Malpositioning of the material outside the submucosal ureter was identified in a high percentage of cases. Larger studies are needed to corroborate these findings. Copyright © 2012 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  10. Spontaneous Resolution of Vesicoureteral Reflux (VUR in Iranian Children, a Single Center Experience in 533 Cases

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    M Sharifian

    2012-05-01

    Full Text Available

    Background and Objectives

    Experience with vesicoureteral reflux (VUR differs in different centers and there are lots of controversies surrounding this issue. The aim of this study was to evaluate Spontaneous resolution and prognosis of the disease among Iranian children.

     

    Methods

    In this case series study, 1278 children with urinary tract infection and visited at pediatric nephrology clinic in Tehran, Iran during 1999-2007 were studied. Primary VUR was found in 533 Patients. Following the diagnosis, the patients received prophylactic antibiotic and were annually followed with radionucleo cystography (RNC. Patients underwent surgery in case the medical treatment failed (breakthrough infection or new renal scar formation.

     

    Results

    533 patients with VUR were studied. Patients’ mean age with VUR was 3.7±2.4 years (range: 2 days to 18 years old. During an average follow-up duration of 3.3+2.2 years, spontaneous resolution was observed in 40% of 279 patients who had follow-up RNCs. The mean interval between VUR diagnosis and spontaneous resolution was 1.5+ 1 years (range: 2 months to 6 years. The resolution rate was decreased with increment of reflux grade so that for grades I to V, VUR was resolved in 63%, 57%, 27%, 22% and 10% of the cases, respectively. Anti reflux surgery was performed in 27(10% of patients during follow-up.

     

    Conclusion

    Based on the excellent results obtained from clinical therapy using low dose antibiotics, it is recommended that VUR grades 1 to 4 be managed medically with low-dose oral antibiotic prophylaxis and close follow-ups.

  11. Endoscopic correction of vesicoureteral reflux simulator curriculum as an effective teaching tool: Pilot study.

    Science.gov (United States)

    Soltani, Tandis; Hidas, Guy; Kelly, Maryellen S; Kaplan, Adam; Selby, Blake; Billimek, John; Wehbi, Elias; McDougall, Elspeth; McAleer, Irene; McLorie, Gordon; Khoury, Antoine E

    2016-02-01

    It has been well recognized that simulators are effective tools to teach and evaluate technical skills in laparoscopic surgery. Endoscopic injection for the correction of vesicourteral reflux has a definite learning curve. Surgeon experience has also been demonstrated to have an important role in the outcome of the procedure. Simulated training allows for practice in a realistic setting without the inherent risk of harm to the patient. This stress free environment allows the trainee to focus on the acquisition of surgical skills without worry about surgical outcome. The aim was to validate a porcine bladder simulator curriculum for training and assessment of the surgical skills for the endoscopic correction of vesicoureteral reflux. We developed a porcine bladder-based dextranomer/hyaluronic acid (Dx/HA) injection simulator consisting of a dissected ex vivo porcine bladder in a polystyrene box with the distal ureters and urethra secured (Figure). We performed content validation by five experienced pediatric urologists. We then organized a simulator curriculum, which included lecture, demonstration, and a 2-h hands-on training on the simulator. Content, discriminant, and concurrent validation of the simulator curriculum were carried out using 11 urology trainees at different levels of expertise. All the trainees were evaluated for each step of the procedure of both their first and last performances on the simulator. Overall, the model demonstrated good content validity by all experts (mean questionnaire score 92%). The simulator curriculum demonstrated a significant improvement in the performance of the trainees between their first and last evaluations (56-92%; p = 0.008). Specific parts of the procedure that showed significant improvement (p tool to improve the performance of the surgeon carrying out the procedure. This teaching tool may be used to help improve the performance of the surgeon carrying out the procedure. This teaching curriculum may shorten the early

  12. Acute and delayed vesicoureteral obstruction after endoscopic treatment of primary vesicoureteral reflux with dextranomer/hyaluronic acid copolymer: why and how to manage.

    Science.gov (United States)

    García-Aparicio, L; Rodo, J; Palazon, P; Martín, O; Blázquez-Gómez, E; Manzanares, A; García-Smith, N; Bejarano, M; de Haro, I; Ribó, J M

    2013-08-01

    To present our cases of ureteral obstruction after endoscopic treatment of vesicoureteral reflux (VUR) with dextranomer/hyaluronic acid (Dx/HA). We collected data from patients who had suffered ureteral obstruction after endoscopic treatment of VUR with Dx/HA in our institution. From April 2002 to April 2011 we treated endoscopically 475 ureters with VUR, and detected 5 ureteral obstructions. Median age at reflux treatment was 39 months. Reflux grade before treatment was III in one patient and IV in four. Three ureterovesical junctions (UVJ) were blocked after a second endoscopic treatment. The median of Dx/HA injected was 1 ml (0.6-1.1). In two patients ureteral obstruction presented acutely and was treated with a ureteral stent. In the other three, the ureteral obstruction appeared gradually and was detected by ultrasound scans and MAG3 diuretic renogram; one underwent nephrectomy because of poor renal function, and the other two were treated with endoscopic dilatation of the UVJ. In all these patients both reflux and obstructions have resolved. On preoperative cystography, three of the patients had a narrowed distal ureter, and probably had a refluxing and obstructive megaureter. Other causes are not clear, except for those patients with acute presentation in whom edema of the UVJ was found. Ureteral obstruction after endoscopic treatment of VUR is rare. Endoscopic intervention such as ureteral stent placement or high-pressure balloon dilatation of the UVJ has good results as a treatment of acute and delayed obstruction. Copyright © 2013 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

  13. Early discontinuation of antibiotic prophylaxis in patients with persistent primary vesicoureteral reflux initially detected during infancy: outcome analysis and risk factors for febrile urinary tract infection.

    Science.gov (United States)

    Moriya, Kimihiko; Mitsui, Takahiko; Kitta, Takeya; Nakamura, Michiko; Kanno, Yukiko; Kon, Masafumi; Nishimura, Yoko; Shinohara, Nobuo; Nonomura, Katsuya

    2015-02-01

    We retrospectively assessed the incidence of and risk factors for febrile urinary tract infection in children during active surveillance after early discontinuation of antibiotic prophylaxis. We retrospectively evaluated 9 females and 61 uncircumcised males diagnosed with primary vesicoureteral reflux before age 1 year who had persistent reflux on followup voiding cystourethrogram and were subsequently followed under active surveillance without continuous antibiotic prophylaxis. Patients with secondary vesicoureteral reflux or associated urological abnormality were excluded. Clinical outcomes, including incidence of febrile urinary tract infection and new scar formation, were evaluated. Risk factors for febrile urinary tract infection were also analyzed. Mean age at stopping continuous antibiotic prophylaxis was 21 months, and mean followup was 61 months. During active surveillance 21 patients had febrile urinary tract infection, and the 5-year infection-free rate under active surveillance was 67.5%. One or 2 foci of minimal new scarring developed in 4 of 16 patients who underwent followup dimercapto-succinic acid scan after febrile urinary tract infection. On multivariate analysis dilated vesicoureteral reflux on followup voiding cystourethrogram was the only significant risk factor for febrile urinary tract infection. This study revealed that about two-thirds of patients with persistent vesicoureteral reflux were free of febrile urinary tract infection during 5 years of active surveillance. Those with dilated vesicoureteral reflux on followup voiding cystourethrogram are at significantly greater risk for febrile urinary tract infection. Accordingly active surveillance, especially in patients with nondilated vesicoureteral reflux on followup voiding cystourethrogram, seems to be a safe option even in children who have not yet been toilet trained. Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights

  14. Voiding Urosonography with Second-Generation Ultrasound Contrast Agent for Diagnosis of Vesicoureteric Reflux: First Local Pilot Study.

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    Kuzmanovska, Dafina; Risteski, Aleksandar; Kambovska, Margarita; Trpcevski, Tase; Sahpazova, Emilija; Petrovski, Mile

    2017-04-15

    Vesicoureteric reflux (VUR) is an important association of paediatric urinary tract infection (UTI) found in 30-50% of all children presenting with first UTI. Contrast-enhanced voiding ultrasonography (ceVUS) has become an important radiation-free method for VUR detection in children. Its sensitivity in detecting VUR has greatly improved due to the development of the contrast-specific ultrasound techniques and the introduction of the second-generation ultrasound contrast agent, superseding the diagnostic accuracy of standard radiological procedures. This article aimed to summarise the current literature and discuss the first local pilot study performed in our institution on detection of vesicoureteric reflux by contrast-enhanced voiding ultrasonography with second- generation agent (SonoVue, Bracco, Italy). Retrospective review of the first 31 ceVUS (24 girls, 7 boys) was presented. Age range was 2 months to 18 years (mean = 6.4 ± 4.9). All examinations were well tolerated without any adverse incident. VUR was shown in 20 (64.5%) children in 32/62 (51.6) nephroureteral units (NUUs). In 18 NUUs, VUR was grade II/V, in 11 Grade III/V and in 3 grade IV/V, respectively. Urethra was shown in 19/31 children and in all boys, without pathological finding. In two girls spinning top urethra has been detected. Subsequent urodynamic studies revealed functional bladder problem in both. Contrast-enhanced voiding urosonography using intravesical second generation ultrasound contrast agent could be recommend as a valid alternative diagnostic modality for detecting vesicoureteral reflux and evaluation of the distal urinary tract in children, based on its radiation-free, highly efficacious, reliable, and safe characteristics.

  15. Reappraisal of Tc-99m DMSA scintigraphy for follow up in children with vesicoureteral reflux

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    Tsukamoto, Eriko; Morita, Koichi; Katoh, Chietsugu; Nakada, Kunihiro; Nonomura, Katsuya; Kakizaki, Hidehiro; Koyanagi, Tomohiko; Tamaki, Nagara [Hokkaido Univ., Sapporo (Japan). School of Medicine; Itoh, Kazuo

    1999-12-01

    We reviewed Tc-99m DMSA scintigraphy in children with vesicoureteral reflux (VUR) in order to assess whether repeated Tc-99m DMSA scans are necessary for the follow up of these patients. Ninety-seven children who were followed up for more than one year (1-7.4 years, average 2.8 years) after the first DMSA scan were included in the study. Fifty-one patients had been diagnosed as primary VUR and 46 as secondary VUR. Age at the first examination ranged from 0 to 14 years (average 5.1 years). Planar images were taken 2 hours after injection. The % renal uptake per injected dose (% RU) was calculated from posterior images. Kidneys in 11 patients (11.3%) changed morphologically during the follow up. Of these, new photon deficient areas (PD) were detected in only 4 patients (4.1%). All of these 4 patients had neurogenic bladder and were managed with self-catheterization. Of the remaining 7 patients, cortical thinning progressed in 5 patients (5.2%) and PDs resolved in 3 patients (3.1%). In one of these 7 patients, PD resolved in one kidney and cortical thinning progressed in the contralateral kidney. Of 97 patients reviewed, % RU decreased more than 20% during the follow up in 6 patients (6.2%). All were diagnosed as secondary VUR due to neurogenic bladder. % RU decreased only in the contracted kidneys at the initial scan. Two of them underwent renal transplantation because of severe renal failure. In conclusion, new PD rarely developed and % RU decreased in only a few patients during the follow up of children with VUR. Repeated Tc-99m DMSA scintigraphy therefore seems to have little benefit in the follow up of children with VUR. It should be performed in selected patients with high risk of urinary tract infection or renal failure. (author)

  16. Does routine ultrasound change management in the follow-up of patients with vesicoureteral reflux?

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    Rudzinski, Jan K; Weber, Bryce; Wildgoose, Petra; Lorenzo, Armando; Bagli, Darius; Farhat, Walid; Harvey, Elizabeth; Salle, Joao Luiz Pippi

    2013-01-01

    Children with vesicoureteral reflux (VUR) usually need a renal ultrasound (RUS). There is little data on the role of follow-up RUS in VUR. We evaluated the impact of follow-up RUS on the change in clinical management in patients with VUR. We prospectively analyzed children with a previous diagnosis of VUR seen in the outpatient clinic with a routine follow-up RUS within 4 months. Variables collected included: demographic data, VUR history, dysfunctional voiding symptoms and concurrent ultrasound findings. Change in management was defined as addition of new medication, nurse counselling, surgery or further investigations. The study included 114 consecutive patients. The mean patient age was 4.5 years old, mean age of VUR diagnosis was 1.7 years, with average follow-up of 2.8 years. A change in management with stable RUS occurred in 14 patients, in which the change included ordering a DMSA in 9, nurse counselling for dysfunctional voiding in 3, and booking surgery in 2 patients. Change on RUS was seen in 4 patients. Multivariable analysis showed that history of urinary tract infection (UTI) since the last follow-up visit was more significant than RUS findings. The RUS findings in most patients followed for VUR remain stable or with minimal changes. The variable showing a significant effect on change in management in our study was history of UTI since the last follow-up visit rather than RUS findings. The value of follow-up RUS for children with VUR may need to be revisited.

  17. EVALUATION OF TWO SURGICAL TREATMENTS OF PRIMARY VESICOURETERAL REFLUX AMONG CHILDREN: A 15 YEARS EXPERIENCE

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    Memeti Shaban

    2016-07-01

    Full Text Available Aim: aim of the study was to evaluate the efficiency of two different surgical treatments of vesicoureteral reflux (VUR on succesfull rate and patient outcome. Methods: Retrospective study on children with primary VUR and their surgical treatment from 1999 to 2014 in the University Clinic for Pediatric Surgery in Skopje. A total of 76 children (114 ureters with VUR ranging from second to fifth grade were treated surgically, 44 patients (67 ureters with an open surgical technique and 32 patients (47 ureters with endoscopic treatment ”STING” procedure. The following parameters were analyzed: duration of the intervention, duration of the hospitalization, the need for antibiotics and analgesic therapy and the need for blood and blood derivatives transfusion. The result of the surgical treatment was also validated. A good result was considered when reduction of VUR by 2 degrees with the endoscopic method or by 3 degrees in the open surgical technique was noticed. Results: Using open surgical technique, patients were hospitalized for an average of 9 days (range from 5 to 13 days. All children received double antibiotic therapy. The need for analgesics lasted for 3 to 4 days. 90% of treated children needed blood and/or blood derivatives transfusion. Success rate with this method was 93.8%. Endoscopic procedure was performed as a one-day surgical procedure. The average duration was 15 minutes. Single, prophylactic dose of antibiotic was ordinated. There was no need for blood and/or blood derivatives transfusion. The overall success of the treatment was about 70%. Conclusion: Open surgical procedure is used for more complicated cases, VUR grade IV-V or by previously failed. Endoscopic, “STING” procedure was commonly used for patients with VUR grade greater than 2, after previously failed conservative treatment, febrile urinary infection despite antibiotic prophylaxis and/or emergence of new scarring in the renal parenchyma. Patient assessment and

  18. Meaning of ureter dilatation during ultrasonography in infants for evaluating vesicoureteral reflux

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    Park, Yae-won, E-mail: yaewonpark@yuhs.ac [Department of Radiology and Research Institute of Radiological Science, Severance Children' s Hospital, Yonsei University College of Medicine, 120-752 Seoul (Korea, Republic of); Kim, Myung-Joon, E-mail: mjkim@yuhs.ac [Department of Radiology and Research Institute of Radiological Science, Severance Children' s Hospital, Yonsei University College of Medicine, 120-752 Seoul (Korea, Republic of); Han, Sang Won, E-mail: swhan58@yuhs.ac [Department of Pediatric Urology, Severance Children' s Hospital, Yonsei University College of Medicine, 120-752 Seoul (Korea, Republic of); Kim, Dong Wook, E-mail: kimdw@yuhs.ac [Biostatistics Collaboration Unit, Yonsei University, College of Medicine, 120-752 Seoul (Korea, Republic of); Lee, Mi-Jung, E-mail: mjl1213@yuhs.ac [Department of Radiology and Research Institute of Radiological Science, Severance Children' s Hospital, Yonsei University College of Medicine, 120-752 Seoul (Korea, Republic of)

    2015-02-15

    Purpose: To investigate the meaning of ureter dilatation during ultrasonography (US) in infants for evaluating vesicoureteral reflux (VUR). Materials and methods: We retrospectively reviewed abdominal US images of infants who were diagnosed with urinary tract infection (UTI group) or only hydronephrosis without UTI (control group). Hydronephrosis (graded 0–4) and ureter dilatation (present or absent) were evaluated on each side with US. Voiding cystourethrography (VCUG) within 3 months time interval with US was also reviewed and VUR was graded (0–5) on each side. Hydronephrosis, ureter dilatation, and VUR were then compared between the two groups. Results: Four hundred and three infants (142 in the UTI group and 261 in the control group) were included and VCUG was performed in 129 infants (68 in UTI and 61 in control groups). VUR grades were not different between the two groups (p = 0.252). Hydronephrosis grade was not related to VUR in either group (p > 0.05). However, ureter dilatation had a significant relationship with VUR in the UTI group (p = 0.015), even among patients with a high-grade VUR (p = 0.005). Whereas, ureter dilatation was not associated with VUR in the control group (p = 0.744). The relationship between ureter dilatation and VUR was different between the two groups for both all grades (p = 0.014) and high-grade (p = 0.004) VUR. Ureter dilatation had 66.7% sensitivity, 80.3% specificity, and 79.4% accuracy for evaluating high-grade VUR in the UTI group. Conclusion: Ureter dilatation on US can be a helpful finding for detecting VUR in infants with UTI, but not infants without UTI.

  19. Current trends in dextranomer hyaluronic acid copolymer (Deflux) injection technique for endoscopic treatment of vesicoureteral reflux.

    Science.gov (United States)

    Kirsch, Andrew J; Arlen, Angela M; Lackgren, Goran

    2014-08-01

    To determine the current preferred injection technique(s) for endoscopic management of pediatric vesicoureteral reflux (VUR). Since the approval of dextranomer hyaluronic acid copolymer (Dx/HA) in 2001, injection methods have evolved and now include the hydrodistention implantation technique (HIT) and double HIT as well as subureteral transurethral injection (STING) method. In July 2012, 278 pediatric urologists in the United States were contacted to complete a 15-question survey regarding Dx/HA injection technique(s) currently used in their practice. Fifty board-certified pediatric urologists completed the survey for a response rate of 18%. Most respondents (60%) were in a single-specialty group practice, and 12% were affiliated with an academic- or university-based practice. Respondents reported seeing a mean of 159 pediatric patients (range, 40-400 patients) with VUR annually, and 94% used Dx/HA ≥4 times in the past year. Forty-seven respondents (94%) reported using double HIT over the course of their career compared with 36 (72%) for STING and 30 (60%) for HIT (P injection techniques. A significantly higher percentage currently perform double HIT (92%) compared with either STING (24%) or HIT (34%; P <.001). Respondents reported the use of double HIT 15 times more often than STING technique and 5 times more often than HIT during the past 12 months (P <.001). The double HIT method is currently the most commonly performed technique for endoscopic correction of VUR by pediatric urologists in the United States. Copyright © 2014 Elsevier Inc. All rights reserved.

  20. Reappraisal of Tc-99m DMSA scintigraphy for follow up in children with vesicoureteral reflux

    International Nuclear Information System (INIS)

    Tsukamoto, Eriko; Morita, Koichi; Katoh, Chietsugu; Nakada, Kunihiro; Nonomura, Katsuya; Kakizaki, Hidehiro; Koyanagi, Tomohiko; Tamaki, Nagara; Itoh, Kazuo

    1999-01-01

    We reviewed Tc-99m DMSA scintigraphy in children with vesicoureteral reflux (VUR) in order to assess whether repeated Tc-99m DMSA scans are necessary for the follow up of these patients. Ninety-seven children who were followed up for more than one year (1-7.4 years, average 2.8 years) after the first DMSA scan were included in the study. Fifty-one patients had been diagnosed as primary VUR and 46 as secondary VUR. Age at the first examination ranged from 0 to 14 years (average 5.1 years). Planar images were taken 2 hours after injection. The % renal uptake per injected dose (% RU) was calculated from posterior images. Kidneys in 11 patients (11.3%) changed morphologically during the follow up. Of these, new photon deficient areas (PD) were detected in only 4 patients (4.1%). All of these 4 patients had neurogenic bladder and were managed with self-catheterization. Of the remaining 7 patients, cortical thinning progressed in 5 patients (5.2%) and PDs resolved in 3 patients (3.1%). In one of these 7 patients, PD resolved in one kidney and cortical thinning progressed in the contralateral kidney. Of 97 patients reviewed, % RU decreased more than 20% during the follow up in 6 patients (6.2%). All were diagnosed as secondary VUR due to neurogenic bladder. % RU decreased only in the contracted kidneys at the initial scan. Two of them underwent renal transplantation because of severe renal failure. In conclusion, new PD rarely developed and % RU decreased in only a few patients during the follow up of children with VUR. Repeated Tc-99m DMSA scintigraphy therefore seems to have little benefit in the follow up of children with VUR. It should be performed in selected patients with high risk of urinary tract infection or renal failure. (author)

  1. Genes in the ureteric budding pathway: association study on vesico-ureteral reflux patients.

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    Albertien M van Eerde

    Full Text Available Vesico-ureteral reflux (VUR is the retrograde passage of urine from the bladder to the urinary tract and causes 8.5% of end-stage renal disease in children. It is a complex genetic developmental disorder, in which ectopic embryonal ureteric budding is implicated in the pathogenesis. VUR is part of the spectrum of Congenital Anomalies of the Kidney and Urinary Tract (CAKUT. We performed an extensive association study for primary VUR using a two-stage, case-control design, investigating 44 candidate genes in the ureteric budding pathway in 409 Dutch VUR patients. The 44 genes were selected from the literature and a set of 567 single nucleotide polymorphisms (SNPs capturing their genetic variation was genotyped in 207 cases and 554 controls. The 14 SNPs with p<0.005 were included in a follow-up study in 202 cases and 892 controls. Of the total cohort, ~50% showed a clear-cut primary VUR phenotype and ~25% had both a duplex collecting system and VUR. We also looked for association in these two extreme phenotype groups. None of the SNPs reached a significant p-value. Common genetic variants in four genes (GREM1, EYA1, ROBO2 and UPK3A show a trend towards association with the development of primary VUR (GREM1, EYA1, ROBO2 or duplex collecting system (EYA1 and UPK3A. SNPs in three genes (TGFB1, GNB3 and VEGFA have been shown to be associated with VUR in other populations. Only the result of rs1800469 in TGFB1 hinted at association in our study. This is the first extensive study of common variants in the genes of the ureteric budding pathway and the genetic susceptibility to primary VUR.

  2. Diffusion weighted magnetic resonance imaging of kidneys in children with vesicoureteral reflux

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    Koçyiğit, Ali, E-mail: alkoc@yahoo.com [Pamukkale University Faculty of Medicine, Department of Radiology, Denizli (Turkey); Bayram, Recep [Pamukkale University Faculty of Medicine, Department of Radiology, Denizli (Turkey); Yüksel, Selçuk [Pamukkale University Faculty of Medicine, Department of Pediatric Nephrology, Denizli (Turkey); Yılmaz, İsmail; Karabulut, Nevzat [Pamukkale University Faculty of Medicine, Department of Radiology, Denizli (Turkey)

    2014-01-15

    Purpose: The apparent diffusion coefficient (ADC) which obtain from diffusion-weighted magnetic resonance imaging (DWI), is a quantitative parameter representing the renal function and parenchymal damage in some renal disorders. The primary aim of this study was to investigate whether renal tissue alterations associated with vesicoureteral reflux (VUR) can be displayed by DWI. The secondary aim was to assess how ADC values change with age in kidneys with and without VUR. Materials and methods: This prospective study included 46 patients (8 boys, 38 girls; mean age 7.3 ± 4.2; range 1–15 years) with VUR and 54 control subjects (21 boys, 33 girls; mean age 7.7 ± 5.2; range 1–17 years). All subjects underwent DWI of the kidneys using b value of 600 s/mm{sup 2} in addition to MR urography. The ADC values of 71 kidneys with VUR were compared with those of 81 kidneys without VUR. Results: The mean ADC values were (1.93 ± 0.36) × 10{sup −3} mm{sup 2}/s, (1.97 ± 0.24) × 10{sup −3} mm{sup 2}/s, (1.83 ± 0.37) × 10{sup −3} mm{sup 2}/s, (1.98 ± 0.20) × 10{sup −3} mm{sup 2}/s and (2.08 ± 0.42) × 10{sup −3} mm{sup 2}/s in normal kidneys, and in those with grade 1, grade 2, grade 3 and grade 4 VUR, respectively. There was no significant difference in ADC values between kidneys with and without VUR. There was a significant positive correlation between the age and ADC values both in kidneys with and without VUR (r = 0.79, p < 0.001 and r = 0.82; p < 0.001, respectively). Conclusion: DWI does not reveal probable parenchymal alterations in reflux nephropathy. ADC values increase with age during childhood not only in normal kidneys but also in kidneys with VUR.

  3. Symptomatic bilateral delayed partial ureteral obstruction after bilateral endoscopic correction of vesicoureteral reflux with dextranomer/hyaluronic acid polymer.

    Science.gov (United States)

    Nseyo, Unwanaobong; Mancini, John G; Wiener, John S

    2013-01-01

    Endoscopic correction of vesicoureteral reflux using dextranomer/hyaluronic acid copolymer (Deflux) is a widely used technique. Complications are uncommon, and ureteral obstruction occurs particularly infrequently. We present a case of delayed symptomatic partial bilateral ureteral obstruction after bilateral high-volume (>1.0 mL) Deflux injections that required surgical repair 16 months after injection (Clavien classification IIIb.) Bilateral delayed obstruction after endoscopic correction of vesicoureteral reflux has not been previously reported. Previous reports of immediate and delayed ureteral obstruction after Deflux injection are reviewed. Copyright © 2013 Elsevier Inc. All rights reserved.

  4. Is there a learning curve for subureteric injection of dextranomer/hyaluronic acid in the treatment of vesicoureteral reflux?

    Science.gov (United States)

    Bennett, Stephen D; Foot, Laura M; Abel, E Jason; Snow, Brent W; Cartwright, Patrick C; Devries, Catherine R; Wallis, M Chad

    2010-04-01

    To answer the question: 'Is there a learning curve associated with a subureteric injection of Deflux(®)?' We retrospectively reviewed charts of patients who received subureteric injection of dextranomer/hyaluronic acid (Deflux(®){AQ2}) (225 procedures) for treatment of vesicoureteral reflux (VUR) by four surgeons. The study included 55 patients, 82 ureters, who had postoperative follow-up with a voiding cystogram or nuclear medicine cystogram. Exclusion criteria were prior anti-refluxing procedures, duplicated collecting systems, and non-achievement of a negative intraoperative cystogram. Patients were divided into two groups based on whether or not they received an intraoperative cystogram after the injection. The two groups were compared for VUR resolution rates on follow-up imaging. Twenty patients underwent an intraoperative cystogram (Group 1, 33 ureters) and 35 did not (Group 2, 49 ureters). The two groups were similar in age, preoperative reflux grade, amount of Deflux injected into each ureter, and time to postoperative studies. In Group 1, 11 ureters (33.3%) and also, in Group 2, 11 ureters (22.4%) had reflux on follow-up imaging. There was no improvement in VUR resolution rate following subureteric injection of Deflux(®) when an intraoperative cystogram demonstrated no reflux to be present immediately after injection. Of ureters that did not reflux on intraoperative cystograms, one-third displayed return of reflux on follow-up imaging, which suggests no learning curve and that failures are not likely to be caused by poor surgical technique. Copyright © 2009 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

  5. Harmonic US imaging of vesicoureteric reflux in children: usefulness of a second generation US contrast agent.

    Science.gov (United States)

    Ascenti, Giorgio; Zimbaro, Giovanni; Mazziotti, Silvio; Chimenz, Roberto; Fede, Carmelo; Visalli, Carmela; Scribano, Emanuele

    2004-06-01

    Contrast-enhanced voiding urosonography (VUS) is largely accepted both for the diagnosis and follow-up of vesicoureteric reflux (VUR) in children. To evaluate the usefulness of contrast-enhanced second-harmonic VUS in the diagnosis and grading of VUR, using a second-generation contrast agent. Eighty consecutive children were prospectively studied with contrast-enhanced second-harmonic VUS. All children received a second-generation contrast medium, constituted by phospholipid-stabilized microbubbles of sulphur-hexafluoride (SonoVue, Bracco, Milan, Italy). US monitoring of the bladder, of the retrovesical space and of the kidneys was performed using, alternatively, both tissue-harmonic and contrast-harmonic modes. In those young boys where VUR was depicted at VUS, examination was completed with transperineal, sagittal urethral exploration during micturition. VUR was graded in five steps and diagnoses were compared with voiding cystourethrography (VCUG). VUR was diagnosed in 52 reno-ureteral units with VUS. In 49 of these reno-ureteral units, VCUG confirmed the presence of VUR. In comparison to VUS, sensitivity and negative predictive value of VCUG were inferior. The grade of VUR detected at VUS was higher than that detected at VCUG in three units. In no case was the grade of VUR detected at VCUG higher than the one detected at VUS. The differences between VUS and VCUG in grading VUR were statistically significant (p=0.02). Imaging of the normal posterior urethra was skilfully demonstrated with US in 15 young boys with VUR. No statistically significant differences were found between tissue-harmonic and contrast-harmonic mode (p=0.102). Contrast-enhanced second-harmonic VUS is a sensitive and easy technique for the evaluation of VUR. A second-generation US contrast medium such as SonoVue, if available, should be the first choice as the dose required for one examination is much lower and consequently significant reduction of contrast agent cost is possible. Copyright

  6. Factors that impact the outcome of endoscopic correction of vesicoureteral reflux: a multivariate analysis.

    Science.gov (United States)

    Kajbafzadeh, Abdol-Mohammad; Tourchi, Ali; Aryan, Zahra

    2013-02-01

    To identify independent factors that may predict vesicoureteral reflux (VUR) resolution after endoscopic treatment using dextranomer/hyaluronic acid copolymer (Deflux) in children free of anatomical anomalies. A retrospective study was conducted in our pediatric referral center from 1998 to 2011 on children with primary VUR who underwent endoscopic injection of Deflux with or without concomitant autologous blood injection (called HABIT or HIT, respectively). Children with secondary VUR or incomplete records were excluded from the study. Potential factors were divided into three categories including preoperative, intraoperative and postoperative. Success was defined as no sign of VUR on postoperative voiding cystourethrogram. Univariate and multivariate logistic regression models were constructed to identify independent factors that may predict success. Odds ratio (OR) and 95 % confidence interval (95 % CI) for prediction of success were estimated for each factor. From 485 children received Deflux injection, a total of 372 with a mean age of 3.10 years (ranged from 6 months to 12 years) were included in the study and endoscopic management was successful in 322 (86.6 %) of them. Of the patients, 185 (49.7 %) underwent HIT and 187 (50.3 %) underwent HABIT technique. On univariate analysis, VUR grade from preoperative category (OR = 4.79, 95 % CI = 2.22-10.30, p = 0.000), operation technique (OR = 0.33, 95 % CI = 0.17-0.64, p = 0.001) and presence of mound on postoperative sonography (OR = 0.06, 95 % CI = 0.02-0.16, p = 0.000) were associated with success. On multivariate analysis, preoperative VUR grade (OR = 4.85, 95 % CI = 2.49-8.96, p = 0.000) and identification of mound on postoperative sonography (OR = 0.07, 95 % CI = 0.01-0.18, p = 0.000) remained as independent success predictors. Based on this study, successful VUR correction after the endoscopic injection of Deflux can be predicted with respect to preoperative VUR grade and presence of mound after operation.

  7. COMPARATIVE ANALYSIS OF EFFICACY OF URETERAL REIMPLANTATION AT VESICOURETERAL REFLUX AND URETEROVESICAL JUNCTION OBSTRUCTION USING VESICOSCOPIC APPROACH IN CHILDREN

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    A. V. Pirogov

    2017-01-01

    Full Text Available Rationale. Implementation of vesicoscopic (transvesical, pneumovesicoscopic approach (VA in the treatment of abnormalities and diseases of vesico-ureteral junction and a urinary bladder as alternative to the open surgery makes it relevant to study efficacy of such approach in the treatment of vesicoureteral reflux (VUR and ureterovesical junction obstruction (UVJO.Aim. To study efficacy of vesicoscopic reimplantation in vesicoureteral reflux and ureterovesical junction obstruction.Materials and methods. From April, 2013 to July 2017 we carried out vesicoscopic surgery in 134 patients with VUR (177 ureters and 24 patients with UVJO (25 ureters, 158 children at the age of 2 months-18 years in total. To determine indications to the surgery USI, excretory urography, retrograde voiding cystourethrography were used.Results. Average duration of the surgery with use of VA in all patients was 128.6±50.0 min, in patients with VUR - 121.6±44.1 min, that slightly less than in children with UVJO – 168.9±62.4 min. Duration of postoperative period was 6.3±2.4 days, in the VUR group – 5.9±2.1 days, in the UVJO group – 8.1±3.1days. In patients with VUR reflux was repaired in 131 patients (97.7 %, in the UVJO group obstruction was eliminated in 23 patients (95.8%. Postoperative complications developed in 25 cases (15.8% and assessed according to Clavien-Dindo classification. Relapses developed in 3 patients from the VUR group and in 1 patient from the UVJO group. We had to use conversion in 3 (1.8% cases: once in the UVJO group (4.1% and twice - in the VUR group (1.5%.Conclusions. In the VUR group the percent of complications was significantly lower than in the UVJO group, that may be due to older age of the patients with reflux and as a result due to large bladder volume and space for surgeon manipulation. Total efficacy of the procedure is comparable to the results of the open surgery in both groups. But the percent of complications remains enough

  8. Can Surgical Technique Affect the Success of Endoscopic Treatment in Children with Vesicoureteral Reflux and Overactive Bladder Syndrome?

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    Ahmet Şahan

    2015-09-01

    Full Text Available Objective “Traditional subureteral transurethral injection” (STING and “Double hydrodistention-implantation” (Double-HIT injection techniques for vesicoureteral reflux (VUR treatment are a less invasive, yet very effective options. The influence of injection techniques in treatment success is not adequately searched in children with overactive bladder syndrome (OAB. The objective of this study to compare the short-term success rates of STING and Double-HIT techniques in children with OAB-VUR complex. Materials and Methods Children who underwent endoscopic injection for VUR between 2010 and 2013 were retrospectively evaluated. Patients were grouped into two groups according to the surgical techniques (STING or Double-HIT. Success of the treatment was defined with a negative voiding cystourethrogram at the 6th postoperative week. Patients were evaluated according to sex, age, pre- and postoperative reflux grades, laterality, type and volume of bulking agent and presence of OAB. Results Both groups were similar in terms of sex, age, lower urinary tract dysfunction, reflux grade and success rates. Surgical technique, score of pediatric lower urinary tract symptom questionnaire, age, sex, laterality of reflux and type of the bulking agent found to have no effect on the overall success rates (p>0.05. Presence of OAB and/or a high grade reflux were identified as statistically significant predictive factors that could affect the treatment results. Conclusion The short-term surgical success of the double-HIT and STING techniques showed no difference in children with OAB. The presence of a high grade reflux and/or OAB seemed to be the main factors for overall success in endoscopic VUR surgery.

  9. Effect of ureteral reimplantation on prevention of urinary tract infection and renal growth in infants with primary vesicoureteral reflux

    International Nuclear Information System (INIS)

    Matsumoto, Fumi; Tohda, Akira; Shimada, Kenji

    2004-01-01

    We retrospectively reviewed the results of ureteral reimplantation in infants with primary vesicoureteral reflux (VUR) to evaluate the effect on prevention of urinary tract infection (UTI) and renal growth. From July 1991 to December 2001, a total of 205 infants (180 boys and 25 girls) with primary VUR underwent ureteral reimplantation at the Department of Urology, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan. Indications for surgery were high-grade reflux (grade IV-V), breakthrough UTI and non-compliance of medical treatment. Age at surgery raged from 1 to 11 months (mean, 6.4 months). Ureteral reimplantation was performed according to Cohen's method. Only two of 336 refluxing ureters required ureteral tailoring. Follow-up ranged from 12 to 110 months (mean, 64 months). Surgical outcome, frequency of UTI and individual renal growth measured by 99m Tc-dimercaptosuccinic acid (DMSA) scintigraphy was evaluated. Postoperative ultrasound and voiding cystourethrography showed neither residual reflux nor ureterovesical obstruction. Contralateral low grade reflux occurred in six of 74 patients (8.1%) who had unilateral reflux preoperatively. After reimplantation, 10 patients documented 13 febrile UTI. Eleven of the 13 episodes occurred early in the postoperative period (<6 months). Frequency of febrile UTI reduced from 0.23538 before surgery to 0.00894 and 0.00081 per patient per month at 6 and 12 months after surgery, respectively. No development of renal scarring was seen in postoperative DMSA scan. Changes of differential renal function was <0.05 in all patients. The present results show ureteral reimplantation in infants is safe and very effective for the prevention of UTI. After surgical treatment in infancy, individual renal growth of children with primary VUR is stable. (authors)

  10. Estudo do jato urinário intravesical com Doppler colorido em pacientes com e sem refluxo vesicoureteral Study of the ureterovesical jet by means of color Doppler in patients with and without vesicoureteral reflux

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    Makoto Sakate

    2006-12-01

    Full Text Available OBJETIVO: O presente estudo teve como objetivo comparar os achados da uretrocistografia miccional com o ultra-som Doppler duplex colorido, em pacientes com suspeita de refluxo vesicoureteral. MATERIAIS E MÉTODOS: A pesquisa foi realizada através do estudo dos ângulos dos jatos urinários intravesicais, nos planos axial e longitudinal. Foi analisada, também, a distância (em centímetros entre os meatos ureterais. RESULTADOS: Do total de 32 pacientes estudados (com média de idade de 5 anos e 2 meses, 18 pacientes apresentaram refluxo vesicoureteral (10 com refluxo unilateral, sendo 4 no lado direito e 6 no lado esquerdo, e 8 com refluxo bilateral e 14 pacientes não apresentaram refluxo. Os valores angulares dos jatos urinários intravesicais e as distâncias entre os meatos ureterais foram obtidos para todos os pacientes e foram calculados a média, o desvio-padrão e o coeficiente de variação. CONCLUSÃO: Os dados evidenciaram tendência de que a lateralização do meato ureteral seja sinal de predisposição ao refluxo vesicoureteral. A análise estatística não-paramétrica de Mann-Whitney não evidenciou diferenças significativas (p > 0,05 entre os grupos (ângulos de inclinação dos jatos urinários intravesicais e distância entre os meatos ureterais.OBJECTIVE: The present study had as its objective to compare the findings of voiding cystourethrography with those of duplex color Doppler in patients with suspected vesicoureteral reflux. MATERIALS AND METHODS: The research was developed through the study of ureterovesical jet angles, both in axial and longitudinal planes. Also, the distance (in cm between ureteral meatuses was analyzed. RESULTS: From a total sample of 32 patients (mean age of five years and two months, 18 presented with vesicoureteral reflux (10 with unilateral reflux - 4 right-sided and 6 left-sided -, and 8 with bilateral reflux and 14 patients did not presented with reflux. The angles of ureterovesical jet and

  11. Vesicoureteral reflux in young children: a study of radiometric thermometry as detection modality using an ex vivo porcine model.

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    Jacobsen, Svein; Klemetsen, Øystein; Birkelund, Yngve

    2012-09-07

    Microwave radiometry is evaluated for renal thermometry tailored to detect the pediatric condition of vesicoureteral urine reflux (VUR) from the bladder through the ureter into the kidney. Prior to a potential reflux event, the urine is heated within the bladder by an external body contacting a hyperthermia applicator to generate a fluidic contrast temperature relative to normal body temperature. A single band, miniaturized radiometer (operating at 3.5 GHz) is connected to an electromagnetic-interference-shielded and suction-coupled elliptical antenna to receive thermal radiation from an ex vivo porcine phantom model. Brightness (radiometric) and fiberoptic temperature data are recorded for varying urine phantom reflux volumes (20-40 mL) and contrast temperatures ranging from 2 to 10 °C within the kidney phantom. The kidney phantom itself is located at 40 mm depth (skin-to-kidney center distance) and surrounded by the porcine phantom. Radiometric step responses to injection of urine simulant by a syringe are shown to be highly correlated with in situ kidney temperatures measured by fiberoptic probes. Statistically, the performance of the VUR detecting scheme is evaluated by error probabilities of making a wrong decision. Laboratory testing of the radiometric system supports the feasibility of passive non-invasive kidney thermometry for the detection of VUR classified within the two highest grades.

  12. Influence of vesicoureteral reflux and urinary tract infection on renal growth in children with upper urinary tract duplication

    International Nuclear Information System (INIS)

    Hannerz, L.; Wikstad, I.; Celsi, G.; Aperia, A.; St. Goeran's Children's Hospital, Stockholm

    1989-01-01

    The growth of the renal parenchyma was examined in children with duplicated outflow systems, vesicoureteral reflux (VUR), urinary tract infection (UTI) and no sign of obstruction. Ten patients with reflux occurring only in the caudal system (group A) and 4 patients with reflux both to the caudal and the apical system (group B) were studied shortly after their first UTI (study 1) and then 1.5 to 9 years later (study 2). The frequency of UTI was relatively high during the follow-up period. At urography, renal length and renal area were normal in group A in studies 1 and 2. Parenchymal thickness of the apical pole (APT/L) did not differ from normal values in any of the studies. Parenchymal thickness of the caudal pole (CPT/L) was significantly smaller than normal in both studies. There was also a significant decrease in CPT/L between study 1 and 2. UTI during the first year of life was associated with a greater reduction in CPT/L. The determination of renal length and renal area in children with a duplicated ureter, VUR and UTI, does not identify subjects at risk of developing renal growth retardation while serial determinations of parenchymal thickness appear to be an appropriate method. (orig.)

  13. Endoscopic Injection of Dextranomer/Hyaluronic Acid as First-Line Treatment in 851 Consecutive Children with High-Grade Vesicoureteral Reflux: Efficacy and Long-Term Results.

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    Friedmacher, Florian; Colhoun, Eric; Puri, Prem

    2018-03-15

    Endoscopic injection of dextranomer/hyaluronic is widely acknowledged as first-line treatment of lower grade vesicoureteral reflux. Our objective was to demonstrate its long-term efficacy and safety in eradicating high-grade reflux. Eight-hundred-fifty-one children (518 girls, 333 boys), median age 2.3 years (2 months-13.7 years), underwent endoscopic correction of high-grade vesicoureteral reflux using dextranomer/hyaluronic acid. Reflux was unilateral in 415 cases and bilateral in 436, comprising 1,287 refluxing units: grade IV in 1,153 (89.6%) and grade V in 134 (10.4%). 99m technetium-dimercaptosuccinic acid imaging identified renal scarring in 317 (37.3%) patients. Follow-up ultrasound and voiding cystourethrogram were performed 3 months post intervention and renal ultrasound annually thereafter. Median follow-up was 8.5 years (6 months-16 years). Overall resolution rate after the first endoscopic injection was 895/1,287 (69.5%): 70.4% in grade IV and 61.9% in grade V, respectively. Reflux resolved after a second injection in 259 (20.1%) and after a third in 133 (10.4%). Persistent reflux after initial treatment was significantly more common in infants injection of dextranomer/hyaluronic acid. Endoscopic injection of dextranomer/hyaluronic acid is an efficient and safe long-term treatment for grade IV and V vesicoureteral reflux, which can be easily repeated in cases of failure with a high subsequent resolution rate. Copyright © 2018 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  14. Aggressive diagnosis and treatment for posterior urethral valve as an etiology for vesicoureteral reflux or urge incontinence in children.

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    Nakai, Hideo; Hyuga, Taiju; Kawai, Shina; Kubo, Taro; Nakamura, Shigeru

    2017-06-01

    Vesicoureteral reflux (VUR) is one of the most common diseases in pediatric urology and classified into primary and secondary VUR. Although posterior urethral valve (PUV) is well known as a cause of the secondary VUR, it is controversial that minor urethral deformity recognized in voiding cystourethrography represents mild end of PUV spectrum and contributes to the secondary VUR. We have been studying for these ten years congenital urethral obstructive lesions with special attention to its urethrographic and endoscopic morphology as well as therapeutic response with transurethral incision. Our conclusion to date is that congenital obstructive lesion in the postero-membranous urethra is exclusively PUV (types 1 and 3) and that severity of obstruction depends on broad spectrum of morphological features recognized in PUV. Endoscopic diagnostic criteria for PUV are being consolidated.

  15. Aggressive diagnosis and treatment for posterior urethral valve as an etiology for vesicoureteral reflux or urge incontinence in children

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    Hideo Nakai

    2017-06-01

    Full Text Available Vesicoureteral reflux (VUR is one of the most common diseases in pediatric urology and classified into primary and secondary VUR. Although posterior urethral valve (PUV is well known as a cause of the secondary VUR, it is controversial that minor urethral deformity recognized in voiding cystourethrography represents mild end of PUV spectrum and contributes to the secondary VUR. We have been studying for these ten years congenital urethral obstructive lesions with special attention to its urethrographic and endoscopic morphology as well as therapeutic response with transurethral incision. Our conclusion to date is that congenital obstructive lesion in the postero-membranous urethra is exclusively PUV (types 1 and 3 and that severity of obstruction depends on broad spectrum of morphological features recognized in PUV. Endoscopic diagnostic criteria for PUV are being consolidated.

  16. Renal Impairment in 79 Pediatric Patients (158 Renal Units) With Repeated Urinary Tract Infection in Relation to Vesicoureteric Reflux

    International Nuclear Information System (INIS)

    Moustafa, H.; Amin, A.; El-Haddad, Sh.; Moustafa, B.; Wageeh, Sh.; Soliman, N.

    1998-01-01

    Seventy nine patients with repeated urinary tract infection were evaluated for detection of vesico-ureteric reflux (VUR) by direct (DRC) and indirect (IRC) radionuclide cystography as well as assessment of renal scarring using 99 mTc-DMSA. Positive VUR was evident in 38 patients (59 renal units), 50%, patients had history of recurrent urinary tract infection. Patients kidneys were divided into 2 groups: group A with normal if kidneys (74 renal units), but still they have high grade VUR in 20 renal units (20.6%.Group B with scarred kidneys (84 renal Units) with high grade VUR in 36 renal units (42.9%) with significant difference between both groups (P 99 mTc-DMSA with VUR assessment are essential in pediatric patients with urinary tract infection for detection of high grade VUR which may contribute to renal scarring and damage

  17. The Value of PIC Cystography in Detecting De Novo and Residual Vesicoureteral Reflux after Dextranomer/Hyaluronic Acid Copolymer Injection

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    B. W. Palmer

    2011-01-01

    Full Text Available The endoscopic injection of Dx/HA in the management of vesicoureteral reflux (VUR has become an accepted alternative to open surgery. In the current study we evaluated the value of cystography to detect de novo contralateral VUR in unilateral cases of VUR at the time of Dx/HA injection and correlated the findings of immediate post-Dx/HA injection cystography during the same anesthesia to 2-month postoperative VCUG to evaluate its ability to predict successful surgical outcomes. The current study aimed to evaluate whether an intraoperatively performed cystogram could replace postoperative studies. But a negative intraoperative cystogram correlates with the postoperative study in only 80%. Considering the 75–80% success rate of Dx/HA implantation, the addition of intraoperative cystograms cannot replace postoperative studies. In patients treated with unilateral VUR, PIC cystography can detect occult VUR and prevent postoperative contralateral new onset of VUR.

  18. The cost-effectiveness of dextranomer/hyaluronic acid copolymer for the management of vesicoureteral reflux. 2. Reflux correction at the time of diagnosis as a substitute for traditional management.

    Science.gov (United States)

    Benoit, Ronald M; Peele, Pamela B; Cannon, Glenn M; Docimo, Steven G

    2006-12-01

    The use of dextranomer/hyaluronic acid copolymer has become increasingly popular as an alternative to ureteral reimplantation in the treatment of vesicoureteral reflux. We compared the cost-effectiveness of performing dextranomer/hyaluronic acid injection at the time of diagnosis of reflux to that of traditional management. A model to estimate the costs of managing vesicoureteral reflux has previously been created. We updated the model to compare the costs of managing vesicoureteral reflux by traditional methods with the costs of managing reflux if dextranomer/hyaluronic acid injection is performed at the time of diagnosis. The success rate required for dextranomer/hyaluronic acid injection at diagnosis to be as cost effective as traditional management was estimated. We used 2 models of dextranomer/hyaluronic acid injection at diagnosis-injection at diagnosis proceeding to traditional management if injection failed (scenario 1), and injection at diagnosis proceeding to ureteral reimplantation if injection failed (scenario 2). If reflux is stratified by grade in scenario 1, for grades III, IV and V respective success rates of 88.5%, 66.6%, and 55.6% for unilateral reflux and 97.5%, 89.7% and 91.4% for bilateral reflux must be achieved to have equal cost-effectiveness to traditional management, while grades I and II reflux can never achieve equal cost-effectiveness. Stratified by grade for scenario 2, for grades III, IV and V respective success rates of 86.9%, 70.8% and 55.8% for unilateral reflux, and 97.6%, 89.8% and 89.8% for bilateral reflux must be achieved to attain equal cost-effectiveness compared to traditional management. In scenario 2 dextranomer/hyaluronic acid injection at diagnosis for grades I and II unilateral and bilateral reflux can never achieve equal cost-effectiveness compared to traditional management. Based on the results of this study, in most clinical situations dextranomer/hyaluronic acid injection at the time of diagnosis is unlikely to be

  19. [Endoscopic treatment of primary vesicoureteral reflux in childhood. Review of 989 cases in a 9 years period].

    Science.gov (United States)

    Nortes Cano, L; Zambudio Carmona, G; Guirao Piñera, M J; Ruiz Jiménez, J I

    2008-07-01

    The primary vesicoureteral reflux (PVUR) is the most common urologic pathology during childhood and affects from 1 to 3% of newborn. It causes acute pyelonephritis (APN) and renal damage in addition to hospital visits with high economic and social costs. Nowadays the endoscopic treatment (ETR) seems to be the most suitable one for the reflux, due to its lower biological cost and its good results. We report our experience in the endoscopic treatment of the primary vesicoureteral reflux (ETR) in Murcia Pediatric Hospital from 1998 to 2007. We present a retrospective study describing 989 patients (1498 ureters) treated by means of ETR. All patients were treated with chemoprophylaxis since the moment of the diagnosis. ETR was fulfilled by the surgeon in an ambulatory way and with Sevofluorano. Deflux, Macroplastique and Coaptite were used. Age, stade, number of ETR, material, chemoprophylaxis, ureterocistoneostomy and ETR costs were evaluated. One-thousand four-hundred and ninty-eight ureteral units, corresponding to 989 patients, (51,2% males), at ages from 4 months to 21-years-old, have been treated by means of ETR. The average age was 4-years-old. Grade III reflux was the most common of all, with 801 ureters affected. Deflux was used in 777 patients, Macroplastique in 203 and Coaptite in 9. No problems in early post-operation happened and the average length was shorter than 2 hours. Forty-eight hours after, 7 patients had to be treated due to APN. Four patients showed late litiasis related to ETR. Two suffered litotomy. The 89.9% of the patients were cured at first ETR. The 11.2% needed a second ETR, with 2.12% of failure (21 patients). Six cured with the third injection and 2 needed a fourth ETR. Thirteen children were treated with ureterocistoneostomy. Radiological correction have not relation with PVUR level and does not show significant differences. Failure regarding the used material was around 9% for Deflux, 11.8% for Macroplastique and 66.6% for Coaptite. The

  20. Febrile urinary tract infections after ureteroneocystostomy and subureteral injection of dextranomer/hyaluronic acid for vesicoureteral reflux--do choice of procedure and success matter?

    Science.gov (United States)

    Dwyer, Moira E; Husmann, Douglas A; Rathbun, Suzanne R; Weight, Christopher J; Kramer, Stephen A

    2013-01-01

    Despite success rates favoring ureteroneocystostomy over subureteral injection of dextranomer/hyaluronic acid for correction of vesicoureteral reflux, the reported incidence of postoperative febrile urinary tract infection favors the latter. We evaluated contemporary treatment cohorts for an association between correction of vesicoureteral reflux and risk of postoperative febrile urinary tract infection. We retrospectively reviewed the records of 396 consecutive patients who underwent ureteroneocystostomy or subureteral injection of dextranomer/hyaluronic acid between 1994 and 2008. Time to event multivariate analyses included preoperative grade of vesicoureteral reflux and bladder/bowel dysfunction. Of 316 patients meeting study criteria 210 underwent ureteroneocystostomy (356 ureters) and 106 underwent subureteral injection of dextranomer/hyaluronic acid (167). Median patient age was 5.7 years (IQR 3.4 to 8.3). Median followup was 28 months (IQR 8 to 61). Ureteral success was significantly greater after ureteroneocystostomy (88%, 314 of 356 cases) vs subureteral injection of dextranomer/hyaluronic acid (74%, 124 of 167, p = 0.0001). When controlling for preoperative grade of vesicoureteral reflux and bladder/bowel dysfunction, the risk of persistent reflux was 2.8 times greater after subureteral injection of dextranomer/hyaluronic acid (95% CI 1.7-4.7, p injection of dextranomer/hyaluronic acid (4%, 4 of 106; HR 1.96, 95% CI 0.64-5.9, p = 0.24) even when controlling for preoperative grade of vesicoureteral reflux, a predictor of postoperative febrile urinary tract infection on multivariate analysis (HR 2.2 per increase in grade, 95% CI 1.3-3.6, p = 0.0022). Persistent reflux was not a predictor of postoperative febrile urinary tract infection (HR 0.81, 95% CI 0.22-2.9, p = 0.75 for ureteroneocystostomy vs HR 1.8, 95% CI 0.2-17.3, p = 0.6 for subureteral injection of dextranomer/hyaluronic acid and HR 1.8, 95% CI 0.3-3.3, p = 0.6 for both). The incidence of

  1. Augmentation cystoplasty and simultaneous ureteral reimplantation reduce high-grade vesicoureteral reflux in children with neurogenic bladder.

    Science.gov (United States)

    Wang, Jen-Bin; Liu, Chin-Su; Tsai, Shin-Lin; Wei, Chou-Fu; Chin, Tai-Wai

    2011-07-01

    To compare the incidence of residual high-grade vesicoureteral reflux (HVUR) (≥Grade III) in neurogenic bladder patients receiving augmentation cystoplasty alone or with simultaneous ureteral reimplantation. Furthermore, we also tried to find the risk factors of residual VUR and febrile urinary tract infection. Between 1999 and 2009, urinary bladder augmentation was performed in 21 children with neurogenic bladder. Seventeen of these patients had VUR on preoperative voiding cystourethrography, of whom 11 patients (14 ureters) received augmentation alone (Group A) and 6 patients (8 ureters) received simultaneously ureteral reimplantation (Group B). Univariate logistic regression analysis and Fisher exact test were used for statistical analysis. Six patients (8 ureters) had residual HVURs in Group A, but none in Group B. The incidences of residual HVUR were 57.14% and 0%, respectively. Seven patients had febrile UTIs after operation, 6 of them had residual HVURs. In risk factor analysis, postoperative follow-up duration less than 12 months and lack of anti-reflux operation were significant risk factors for residual HVUR; the residual HVUR was the significant risk factor for febrile urinary tract infection. Simultaneous ureteral reimplantation reduces postop HVUR significantly. We recommend augmentation and simultaneous ureteral reimplantation in children with HVUR and neurogenic bladder if technically feasible. Copyright © 2011. Published by Elsevier B.V.

  2. Delayed-onset ureteral obstruction after endoscopic dextranomer/hyaluronic acid copolymer (Deflux) injection for treatment of vesicoureteral reflux in children: a case series.

    Science.gov (United States)

    Rubenwolf, Peter C; Ebert, Anne-Karoline; Ruemmele, Petra; Rösch, Wolfgang H

    2013-03-01

    We report 4 patients with upper urinary tract (UUT) obstruction requiring ureteric reimplantation at 1, 7, 28, and 63 months after dextranomer/hyaluronic acid copolymer (Dx/HA) injection for vesicoureteric reflux. Histopathologic evaluation of ureteric segments revealed extensive foreign body formation in all cases. We conclude that UUT obstruction is a rare but serious complication after Dx/HA injection that can occur even years after surgery. The incidence of delayed-onset UUT obstruction may be higher than previously noted. Long-term follow-up and a critical reappraisal of the method are needed to assess the late sequelae of Dx/HA injection therapy for vesicoureteric reflux. Copyright © 2013 Elsevier Inc. All rights reserved.

  3. Is intraoperative surgeon's opinion an accurate tool to assess the outcome of endoscopic treatment for vesicoureteral reflux?

    Science.gov (United States)

    Parente, Alberto; Tardáguila, Ana-Rosa; Romero, Rosa; Burgos, Laura; Rivas, Susana; Angulo, José-María

    2013-12-01

    Our experience in the endoscopic treatment of vesicoureteral reflux (VUR) has significantly increased during the last decade. To help develop diagnostic tests to check the success of this procedure, we evaluated the accuracy of surgeons' intraoperative observations as a predictor of treatment results. We performed a prospective study of patients with VUR who were endoscopically treated during 1 year (106 renal units). Patients' age and gender, laterality, material used, grade of reflux, presence of ureteral duplication or associated pathology, and morphology of ureteral orifice were recorded as predictive factors related to the success rate. Surgeon and assistant indicated at the end of the endoscopic procedure whether the VUR was cured or not for each renal unit. These estimations were compared with postoperative voiding cystourethrogram results. Overall cure rate was 75.5%. Positive predictive value (PPV) for surgeon's opinion was 0.79 and negative predictive value (NPV) was 0.40. Statistical analysis demonstrated that the association between the surgeon's opinion and the cure rate was low with a Kappa value of 0.171 (p = 0.30). PPV of assistant's opinion was 0.80 and NPV was 0.40, with a Kappa value of 0.2 (p = 0.13). Concordance of surgeon and assistant's opinion resulted in PPV of 0.79 and NPV of 0.53 (Kappa = 0.261). Kappa value did not improve when surgeon's opinion was related to other factors such as the material employed, grade of reflux, presence of ureteral duplication or associated pathology and morphology of the ureteral orifice. In our experience, surgeon's opinion is not an accurate tool to predict the outcome of endoscopic treatment of VUR. Copyright © 2013 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

  4. Ureteroneocystostomy in primary vesicoureteral reflux: critical retrospective analysis of factors affecting the postoperative urinary tract infection rates

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    Hasan Serkan Dogan

    2014-08-01

    Full Text Available Introduction To determine the parameters affecting the outcome of ureteroneocystostomy (UNC procedure for vesicoureteral reflux (VUR. Materials and Methods Data of 398 patients who underwent UNC procedure from 2001 to 2012 were analyzed retrospectively. Different UNC techniques were used according to laterality of reflux and ureteral orifice configuration. Effects of several parameters on outcome were examined. Disappearance of reflux on control VCUG or absence of any kind of UTI/symptoms in patients without control VCUG was considered as clinical improvement. Results Mean age at operation was 59.2 ± 39.8 months and follow-up was 25.6 ± 23.3 months. Grade of VUR was 1-2, 3 and 4-5 in 17, 79, 302 patients, respectively. Male to female ratio was 163/235. UNC was performed bilaterally in 235 patients and intravesical approach was used in 373 patients. The frequency of voiding dysfunction, scar on preoperative DMSA, breakthrough infection and previous surgery was 28.4%, 70.7%, 49.3% and 22.4%, respectively. Twelve patients (8.9% with postoperative contralateral reflux were excluded from the analysis. Overall clinical improvement rate for UNC was 92%. Gender, age at diagnosis and operation, laterality and grade of reflux, mode of presentation, breakthrough infections (BTI under antibiotic prophylaxis, presence of voiding dysfunction and renal scar, and operation technique did not affect the surgical outcome. However, the clinical improvement rate was lower in patients with a history of previous endoscopic intervention (83.9% vs. 94%. Postoperative UTI rate was 27.2% and factors affecting the occurrence of postoperative UTI were previous failed endoscopic injection on univariate analysis and gender, preoperative BTI, postoperative VUR state, voiding dysfunction on multivariate analysis. Surgery related complication rate was 2% (8/398. These were all low grade complications (blood transfusion in 1, hematoma under incision in 3 and prolonged

  5. Extravesical (modified Gregoir Lich versus intravesical (Cohen′s ureteric reimplantation for vesicoureteral reflux in children: A single center experience

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    Krishnamoorthy Sriram

    2016-01-01

    Full Text Available Introduction: There are multiple techniques for surgical correction of vesicoureteral reflux (VUR. We compared the outcomes of extravesical versus Cohen′s reimplantation for VUR in children. Methods: Records of all children (n = 118 who underwent reimplantation for VUR between 2003 and 2014 were analyzed (male: female = 43:75. Children with secondary VUR, duplication anomalies, and ectopic ureter were excluded from our study. Extravesical reimplantation (EVR was performed bilateral in 32 children (Group 1a and unilateral in 19 (Group 1b, while bilateral Cohen′s reimplantation was performed in 67 (Group 2. Parameters compared were length of the surgical procedure, average duration of stay in the hospital, postoperative bladder spasms, significant hematuria >72 h, and long-term complications. Results: The mean age at operation was 15 months in Group 1, and 36 months in Group 2. The mean duration of surgery was significantly less (P = 0.0001 in Group 1a (n = 32; mean 104 min; standard deviation [SD] 18 min compared to Group 2 (n = 67; mean 128 min; SD 15 min. The mean (SD postoperative stay was significantly lower (P = 0.0001 at 4.5 (1.5 days in Group 1a compared to 6.5 (0.5 days in Group 2. Postoperative bladder spasms were significantly lower (P = 0.03 at 10/32 in Group 1a compared to 37/67 in Group 2. All patients responded well with anticholinergics. Postoperative hematuria and bladder spasms were significantly lower (P = 0.03 in Group 1a compared to Group 2. There was no significant difference in persistent VUR between Group 1 and Group 2. At 1 year follow, none of them had any evidence of ureteral obstruction. Conclusions: EVR has lower operative time, less postoperative discomfort and shorter hospital stay compared to Cohen′s reimplantation. Both techniques are equally effective in treating reflux.

  6. Results of Treatment of Grades IV and V Vesicoureteral Reflux with Endoscopic Injection of Polyacrylate Polyalcohol Copolymer.

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    De Badiola, Francisco Ignacio; Soria, Ricardo; Vagni, Roberto Luis; Ormaechea, María Nieves; Moldes, Juan Manuel; Benmaor, César

    2013-01-01

    Here we report the results of a review of a prospectively maintained database of the use polyacrylate polyalcohol copolymer (PPC) injection to correct grades IV and V VUR. All children with grades IV and V primary VUR that presented with febrile urinary tract infection while on prophylaxis, in a 3-year period, were treated with a sub-ureteral injection of PPC. Institutional ethical approval was obtained. Exclusion criteria were incomplete bladder emptying documented on videourodynamic study, ureteral duplication, paraureteral diverticula, and poor ureteral emptying observed during fluoroscopy and previous open surgical or endoscopic treatment. Pre- and post-operative evaluation included urinalysis, renal and bladder ultrasonography, DMSA scan, and videourodynamic studies. Thirty-three children [36 renal units (RU)] were included with a median age of 57 months (range 7-108). There were 18 boys and 15 girls. Thirty RU had grade IV and 6 grade V VUR. Median follow-up time was 32 months (range 7-58). Reflux was cured in 32/36 RU with the first injection, but another two patients were reimplanted because of dilatation. Complications included early urinary tract infection in seven children, transient lower urinary tract symptoms in five children. Progressive ureteral dilatation was noted in four children and was treated with insertion of a double J stent. Two of these children eventually required an ureteroneocystostomy. The use of PPC to treat grades IV and V vesicoureteral reflux in young children has an overall success rate of 83.3%. Persistent ureteral dilatation was present in 11% associated with high injection volume. Future studies will attempt to maintain a high success rate reducing the volume of injection and the incidence of dilatation.

  7. Posterior urethral valve with unilateral vesicoureteral reflux and patent urachus: A rare combination of urinary tract anomaliess

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    Mutiu O Atobatele

    2015-01-01

    Full Text Available Posterior urethral valve (PUV is a common cause of lower urinary tract obstruction in male infants with an incidence of 1:5000-8000. PUV continues to be a significant cause of morbidity and ongoing renal damage in infants and children. It can coexist with vesicoureteral reflux (VUR in about 50% of cases and also with patent urachus in about one-third of cases. It is a case of a 22-day-old full-term male child who presented with poor urinary stream and progressive abdominal distension of 5-day duration as well as leakage of clear fluid from umbilicus of 1-day duration. Abdominopelvic ultrasonography showed bilateral hydronephrosis. Micturating cystourethrogram also showed features of bladder outlet obstruction and PUV. In addition, a grade V left VUR and a fistulous tract between the dome of the urinary bladder and the umbilicus, which was consistent with a patent urachus was demonstrated. In conclusion, this case demonstrates a rare combination of congenital urinary tract anomalies involving PUV, left VUR and patent urachus.

  8. Clinical Significance of Renal Pelvic Dilatation less than 10 mm in Neonates: Correlation with Urinary Tract Infection and Vesicoureteral Reflux

    International Nuclear Information System (INIS)

    Lee, Woong Hee; Kim, Young Tong; Jo, Sung Sik; Kim, Sang Won; Shin, Hyung Cheol; Kim, Il Young

    2009-01-01

    We wanted to evaluate the correlation of mild renal pelvic dilatation (RPD) that is observed to be less than 10 mm on ultrasound (US) with urinary tract infection (UTI) and vesicoureteral reflux (VUR) in neonates. We reviewed 137 kidneys of 107 neonates who had RPD less than 10 mm on US. All the kidneys were divided into two groups: Group I (RPD ≤ 5.0 mm) and Group II (RPD > 5.0 mm), and we statistically analyzed the RPD change according to UTI and VUR. Seven neonates had VUR (5.1%), and there was no statistical significance between Group I (6 neonates, 5.6%) and Group II (1 neonate, 3.3%). Thirty seven cases (27%) had UTI and there was no statistical significance between Group I (30 cases, 28.0%) and Group II (7 cases, 23.3%). The RPD did not change in 81.8% of the cases, it increased in 4.4% of the cases and it decreased in 13.9% of the cases on follow up US. The incidence of VUR and UTI were not different according to the change of RPD. There were no statistical differences between the changes of RPD and the incidences of UTI and VUR in neonates with mild RPD less than 10 mm. Most of RPD did not change on the follow up US

  9. Clinical Significance of Renal Pelvic Dilatation less than 10 mm in Neonates: Correlation with Urinary Tract Infection and Vesicoureteral Reflux

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Woong Hee; Kim, Young Tong; Jo, Sung Sik; Kim, Sang Won; Shin, Hyung Cheol; Kim, Il Young [Cheonan Hospital, Soonchunhyang University, Cheonan (Korea, Republic of)

    2009-12-15

    We wanted to evaluate the correlation of mild renal pelvic dilatation (RPD) that is observed to be less than 10 mm on ultrasound (US) with urinary tract infection (UTI) and vesicoureteral reflux (VUR) in neonates. We reviewed 137 kidneys of 107 neonates who had RPD less than 10 mm on US. All the kidneys were divided into two groups: Group I (RPD <= 5.0 mm) and Group II (RPD > 5.0 mm), and we statistically analyzed the RPD change according to UTI and VUR. Seven neonates had VUR (5.1%), and there was no statistical significance between Group I (6 neonates, 5.6%) and Group II (1 neonate, 3.3%). Thirty seven cases (27%) had UTI and there was no statistical significance between Group I (30 cases, 28.0%) and Group II (7 cases, 23.3%). The RPD did not change in 81.8% of the cases, it increased in 4.4% of the cases and it decreased in 13.9% of the cases on follow up US. The incidence of VUR and UTI were not different according to the change of RPD. There were no statistical differences between the changes of RPD and the incidences of UTI and VUR in neonates with mild RPD less than 10 mm. Most of RPD did not change on the follow up US

  10. Should simultaneous ureteral reimplantation be performed during sigmoid bladder augmentation to reduce vesicoureteral reflux in neurogenic bladder cases?

    Science.gov (United States)

    Zhang, Peng; Yang, Yong; Wu, Zhi-jin; Zhang, Ning; Zhang, Chao-hua; Zhang, Xiao-dong

    2015-05-01

    To assess the necessity of performing simultaneous collateral reimplantation during sigmoid bladder augmentation (SBA) to reduce vesicoureteral reflux (VUR) in low-compliance neuropathic bladder with associated VUR. We retrospectively identified 31 patients who underwent SBA alone or with simultaneous ureteral reimplantation at our hospital. The video urodynamics data, VUR status, renal function, and clinical symptoms were studied during follow-up. The mean follow-up time was 57 months (range 12-117). All patients displayed significantly increased safe cystometric capacity (P bladder compliance (P bladder volumes due to augmentation. The patients' improving renal function benefited most from the enlarged bladder and partly from increased antireflux resistance of vesico-ureter anastomosis. Twelve (38.7%) had recurrent febrile urinary tract infection after SBA, and one (3.2%) suffered from vesico-ureter anastomosis contracture after ureteral reimplantation. A preoperative intravesical VUR pressure of 20 cmH2O is not an effective cutoff point for whether ureteral reimplantation should be simultaneously performed during SBA. Augmentation appears to be more important than reimplantation for protecting kidney from damage due to febrile urinary tract infection after SBA. Simultaneous reimplantation may be not necessary during SBA in neurogenic bladder.

  11. Presence of dextranomer-hyaluronic acid (DxHA) mound on postoperative ultrasound does not predict resolution of vesicoureteral reflux.

    Science.gov (United States)

    Ellsworth, Pamela I; Yates, Jennifer K; Caldamone, Anthony A

    2011-08-01

    Dextranomer-hyaluronic acid (DxHA) injection is an accepted treatment for vesicoureteral reflux (VUR), with success rates as high as 85-90% in selected patients. The DxHA mound can often be seen on postoperative ultrasound. We sought to determine whether the presence or absence of this mound on ultrasound can predict resolution of VUR on voiding cystourethrogram (VCUG). A retrospective study evaluating patients who underwent cystoscopy and injection of DxHA from 2003 to the present was performed. Demographic variables, laterality and grade of VUR, postoperative ultrasound findings, and presence of VUR on postoperative VCUG were recorded. Fifty-one patients (95 ureters) underwent DxHA injection and had a postoperative ultrasound and VCUG for review. Five patients with persistent voiding dysfunction were excluded, leaving 46 patients and 86 ureters for review. The mean age at time of injection was 5.2 years (range 0.75-11 years) and mean grade of VUR was 2.5 (range 1-5). After DxHA injection, 75% of the ureters showed resolution of VUR, while 25% demonstrated persistent VUR. No correlation was made between the presence of DxHA mound and resolution of VUR on VCUG. In this series, the presence of a DxHA mound on initial postoperative ultrasound does not predict resolution of VUR. A larger prospective study is needed to evaluate additional parameters. Copyright © 2010 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

  12. The outcomes of two different bulking agents (dextranomer hyaluronic acid copolymer and polyacrylate-polyalcohol copolymer in the treatment of primary vesico-ureteral reflux

    Directory of Open Access Journals (Sweden)

    Hakan Taşkinlar

    2016-06-01

    Full Text Available ABSTRACT Purpose Subureteral injection of bulking agents in the endoscopic treatment of vesicoureteral reflux is widely accepted therapy with high success rates. Although the grade of vesicoureteric reflux and experience of surgeon is the mainstay of this success, the characteristics of augmenting substances may have an effect particularly in the long term. In this retrospective study, we aimed to evaluate the clinical outcomes of the endoscopic treatment of vesicoureteric reflux (VUR with two different bulking agents: Dextranomer/hyaluronic acid copolymer (Dx/HA and Polyacrylate polyalcohol copolymer (PPC. Materials and Methods A total 80 patients (49 girls and 31 boys aged 1-12 years (mean age 5.3 years underwent endoscopic subureteral injection for correction of VUR last six years. The patients were assigned to two groups: subureteral injections of Dx/HA (45 patients and 57 ureters and PPC (35 patients and 45 ureters. VUR was grade II in 27 ureters, grade III in 35, grade IV in 22 and grade V in 18 ureters. Results VUR was resolved in 38 (66.6% of 57 ureters and this equates to VUR correction in 33 (73.3% of the 45 patients in Dx/HA group. In PPC group, overall success rate was 88.8% (of 40 in 45 ureters. Thus, Thus, this equates to VUR correction in 31 (88.5% of the 35 patients. Conclusions Our short term data show that two different bulking agent injections provide a high level of reflux resolution and this study revealed that success rate of PPC was significantly higher than Dx/HA with less material.

  13. The grade of vesicoureteral reflux in voiding cystourethrography: comparison with ultrasonography and Tc99m-DMSA renal scintigraphy

    International Nuclear Information System (INIS)

    1998-01-01

    To evaluate the prevalence of abnormalities seen on sonography and renal scintigraphy, according to the grade of vesicoureteral reflux (VUR) on in voiding cystourethrography(VCUG). One hundred and forty-nine patients (age range: 1 months-10 years) with urinary tract infection underwent sonography, VCUG, and renal scans, and 32 showed VUR on VCUG. We retrospectively evaluated the frequency and characteristic findings of sonographic abnormalities according to the grade of VUR, and also the frequency of cortical defects seen on renal scans of 32 patients with VUR. The remaining 117 patients without VUR were also evaluated for the frequency of abnormal findings seen on sonography and renal scans. Among 32 patients (49 kidneys) with VUR, abnormal findings were not detected in 17 (29 kidneys) on sonography; thus, findings were abnormal in 15 (20 kidneys, 41%). Among these 20 kidneys, renal calyceal and/or pelvic dilatation and dilatation of distal ureter were seen in 11, all of which were grade 4-5 VUR. Renal pelvic dilatation only was noted in eight kidneys; two were grade 1-3 and six were grade 4-5 VUR. Nineteen patients (24 kidneys, 49%) showed focal cortical defects on renal scintigraphy. Six kidneys were grade 1-3, and 18 kidneys were grade 4-5 VUR. Of 117 patients without VUR, 34 patients (29%) showed renal pelvic dilatation on sonography and in 14 patients (12%), cortical defects were seen on renal scintigraphy. Among 32 patients with VUR, 41% showed abnormal sonographic findings and in 49%, cortical defects were seen on renal scintigraphy. With a higher grade of VUR, the prevalence of abnormalities increased on both sonography and renal scintigraphy. Sonographic demonstration of renal caliceal and/or pelvic dilatation associated with ipsilateral distal ureteric dilatation was the characteristic finding in high grade VUR.=20

  14. Long-term outcome of vesicoureteral reflux associated chronic renal failure in children. Data from the ItalKid Project.

    Science.gov (United States)

    Ardissino, Gianluigi; Avolio, Luigi; Dacco, Valeria; Testa, Sara; Marra, Giuseppina; Viganò, Sara; Loi, Silvana; Caione, Paolo; De Castro, Roberto; De Pascale, Salvatore; Marras, Efisia; Riccipetitoni, Giovanna; Selvaggio, Giorgio; Pedotti, Paola; Claris-Appiani, Aldo; Ciofani, Antonio; Dello Strologo, Luca; Lama, Giuliana; Montini, Giovanni; Verrina, Enrico

    2004-07-01

    The nephropathy associated with vesicoureteral reflux (VUR) is one of the leading causes of chronic renal failure (CRF) in children. We describe the clinical course of the disease based on information available in the ItalKid Project database, and analyze the predictive value of baseline renal function, age at VUR diagnosis and urinary protein excretion in relation to the risk of progressive renal failure. As of December 31, 2001 the registry included a total of 343 patients (261 males) with a diagnosis of primary VUR, which was the leading single cause of CRF, accounting for 25.4% of all patients with CRF. The estimated risk of end stage renal disease (ESRD) by age 20 years was 56%. The patients with a creatinine clearance (Ccr) of less than 40 ml per minute at baseline had an estimated 4-fold greater risk of ESRD developing in comparison with those whose Ccr was 40 to 75 ml per minute. No significant difference in probability of disease progression to ESRD was found between subjects diagnosed with VUR at age 6 months or less and those diagnosed later (older than 6 months). Furthermore, children with normal urinary protein excretion (a urinary protein [uPr]/urinary creatinine [uCr] ratio of less than 0.2 in 36 patients) and low grade proteinuria (uPr/uCr 0.2 to 0.8 in 34 patients) at baseline showed a significantly slower decrease in mean Ccr than those with moderate proteinuria (uPr/uCr greater than 0.8 in 34 patients). Hypertension and/or antihypertensive treatment (including antiprogressive drugs) were reported in 29.1% of patients. The results of the present study define the long-term risk of ESRD in a large population of children with CRF and VUR, and provide some critical information for identifying the prognosis.

  15. A blind-ending ureter with infection due to vesicoureteric reflux with associated renal agenesis: A rare cause of pain abdomen

    Directory of Open Access Journals (Sweden)

    Vinita Rathi

    2011-01-01

    Full Text Available We report a 12-year-old male child with an unusual cause of abdominal pain, i.e. a blind-ending ureter with vesicoureteral reflux. The pain improved with antibiotic therapy, implying infection as the cause of pain. This entity is difficult to diagnose clinically, thereby affecting management. Usually, a blind-ending ureter is not filled on intravenous urography (IVU and the diagnosis is confirmed by retrograde pyelography, which is an invasive procedure. We illustrate the contribution of IVU and computerized tomographic cystography, which has not been reported earlier, in the evaluation of such cases.

  16. Delayed Obstruction With Asymptomatic Loss of Renal Function After Dextranomer/Hyaluronic Acid Copolymer (Deflux) Injection for Vesicoureteral Reflux: A Close Look at a Disturbing Outcome.

    Science.gov (United States)

    Papagiannopoulos, Dimitri; Rosoklija, Ilina; Cheng, Earl; Yerkes, Elizabeth

    2017-03-01

    Dextranomer/hyaluronic acid copolymer (Deflux) first received Food and Drug Administration approval in 2001 for endoscopic injection in children with grade II-IV vesicoureteral reflux VUR. As experience has grown, Deflux has been used more liberally with encouraging results. We report 3 cases where Deflux was used in off-label fashion, resulting in delayed ureteral obstruction and loss of renal function (range 18-52 months postoperatively). We now place increased emphasis on the need for long-term follow-up after Deflux in both routine and complex cases, particularly in situations of off-label use. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. Asymptomatic chronic partial obstruction of a normal ureter following dextranomer/hyaluronic acid copolymer (Deflux®) injection for grade I vesicoureteral reflux.

    Science.gov (United States)

    Arlen, Angela M; Pakalniskis, Brittany L; Cooper, Christopher S

    2012-06-01

    Endoscopic management of vesicoureteral reflux with dextranomer/hyaluronic copolymer (Deflux(®), Oceana Therapeutics, Inc., Edison, NJ, USA) has gained widespread acceptance with increasing success rates and minimal morbidity. Formation of a pseudocapsule and calcification are known histologic changes at the injection site. Postoperative ureteral obstruction has been reported in cases of severe voiding dysfunction, neurogenic bladder and abnormal ureteral anatomy. We present a case of chronic asymptomatic obstruction in a normal ureter following injection of 0.7 ml Deflux. Copyright © 2011 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

  18. The impact of obesity on febrile urinary tract infection and renal scarring in children with vesicoureteral reflux.

    Science.gov (United States)

    Byun, H J; Ha, J Y; Jung, W; Kim, B H; Park, C H; Kim, C I

    2017-02-01

    It has become clear that obesity is associated with a variety of infectious diseases, including urinary tract infection (UTI) and renal scarring. The aim of this study was to evaluate the association between obesity and the degree of febrile UTI (fUTI) and renal scarring in children with vesicoureteral reflux (VUR), and to stratify the results into obesity subcategories. A total of 186 patients were diagnosed with VUR between January 2002 and December 2008. This study retrospectively reviewed the medical records of 72 children with primary VUR who had recurrent fUTI (more than twice). Overweight or obese status of the patients aged children, body mass index (BMI) percentile-for-age was used. They were divided into three groups as follows; standard (obese (≥95%). The following clinical variables were compared: age at diagnosis of primary VUR (months), sex, VUR grade, hydronephrosis grade, presence of renal scarring, surgical treatment, and degree of inflammation during fUTI. In the overweight and obese groups, VUR was diagnosed at a young age (P = 0.05), the degree of renal scarring was more severe (P = 0.006), and serum white blood cell count, C-reactive protein, and erythrocyte sedimentation rate (ESR) levels were significantly higher (P children (35%). Cortical defects occurred more frequently in children with obesity, and they were associated with a higher grade of reflux and serum ESR levels (P = 0.007, P = 0.042, and P = 0.021, respectively). Among these risk factors, high-grade VUR (OR = 9.93, 95% CI = 1.13-86.71), and being overweight and obese (OR = 5.26, 95% CI = 1.75-15.82) were associated with increased renal scarring. However, ESR was not associated with renal scarring (OR = 1.01, 95% CI = 0.95-1.07). The relationships between obesity and UTI are controversial. Some studies have shown positive results; however, other studies have shown opposite results. The main limitations of this study were the retrospective data collection

  19. The significance of the not direct renal angiography in scintigraphy researches at children with vesicoureteral reflux

    International Nuclear Information System (INIS)

    Romanenko, G.O.

    2015-01-01

    In the article the possibilities of the not direct radionuclide renal angiography are shown - for the detection and dynamic observation of changes in the kidneys blood supply of children that have VUR with graded severity. According to the data of our observations it was discovered that the lesion degree of renal hemodynamics is in direct dependence on the reflux severity, the duration of its influence on the kidney and the activity of VUR process. The objective evaluation of the renal hemodynamic should be applied for updating of disease activity, efficiency of the treatment, determination of subclinical signs of pathological process chroniation, prognosis for a further disease clinical course of children with various kidneys diseases that are accompanied by VUR

  20. The increased incidence of the RET p.Gly691Ser variant in French-Canadian vesicoureteric reflux patients is not replicated by a larger study in Ireland.

    LENUS (Irish Health Repository)

    Darlow, John M

    2012-02-01

    The p.Gly691Ser variant of the RET protein, resulting from the \\'A\\' allele of the SNP rs1799939 in exon 11 of the RET gene, was recently found to be present in a high proportion of primary vesicoureteric reflux (pVUR) patients in Quebec. We have determined the genotype of this SNP in 221 unrelated index cases of pVUR from the Irish population, in 190 full siblings of 160 of the index cases, and in 592 healthy controls. We found no significant difference in genotype or allele frequencies in patients and controls, and no tendency of affected siblings to share the same genotype. We also found no difference in the presence of additional phenotypic features such as duplex kidneys, between patients with and without the \\'A\\' allele, and no difference in grade of reflux. We find no evidence of any influence of RET SNP rs1799939 on pVUR phenotype.

  1. Comparative study between intravenous urography and renal scintigraphy with DMSA for the diagnosis of renal scars in children with vesicoureteral reflux

    Directory of Open Access Journals (Sweden)

    Clarissa B. Araújo

    2003-12-01

    Full Text Available PURPOSE: To assess the value of intravenous urography (IVU in detecting and grading the renal scar, comparing its results with those of scintigraphy with dimercaptosuccinic acid (DMSA. MATERIALS AND METHODS: The study included 43 children investigated by DMSA and IVU, who had vesicoureteral reflux diagnosed and classified through voiding cystourethrography. RESULTS: Among the kidneys with reflux, there was agreement between the results of DMSA and IVU concerning the presence and the absence of scars in 82.4% of the cases. Based on the results obtained, IVU would have a sensitivity of 66.6%, specificity of 94.4%; accuracy of 82.5%; positive predictive value (PPV of 90% and negative predictive value (NPV of 79%, when compared with DMSA results. Our data also confirm the close relation between the reflux grade and the presence of renal scar, since 75% of the kidneys with grade IV and V reflux presented scars. In relation to the grading of nephropathy, in 78% of patients the classification of the scar by both methods was identical. The highest disagreement was verified in the group with segmental scar on DMSA, where 41.6% of the kidneys were classified as normal on IVU. CONCLUSION: The data obtained confirm that the scintigraphy with DMSA is essential in the investigation of patients with renal scar, and cannot be replaced by IVU, due to its low sensitivity and lower ability of satisfactory grading.

  2. Comparative study between intravenous urography and renal scintigraphy with DMSA for the diagnosis of renal scars in children with vesicoureteral reflux.

    Science.gov (United States)

    Araújo, Clarissa B; Barroso, Ubirajara; Barroso, Vivian A; Vinhaes, Antonio J; Jacobino, Modesto; Calado, Adriano; Filho, M Zerati

    2003-01-01

    To assess the value of intravenous urography (IVU) in detecting and grading the renal scar, comparing its results with those of scintigraphy with dimercaptosuccinic acid (DMSA). The study included 43 children investigated by DMSA and IVU, who had vesicoureteral reflux diagnosed and classified through voiding cystourethrography. Among the kidneys with reflux, there was agreement between the results of DMSA and IVU concerning the presence and the absence of scars in 82.4% of the cases. Based on the results obtained, IVU would have a sensitivity of 66.6%, specificity of 94.4%; accuracy of 82.5%; positive predictive value (PPV) of 90% and negative predictive value (NPV) of 79%, when compared with DMSA results. Our data also confirm the close relation between the reflux grade and the presence of renal scar, since 75% of the kidneys with grade IV and V reflux presented scars. In relation to the grading of nephropathy, in 78% of patients the classification of the scar by both methods was identical. The highest disagreement was verified in the group with segmental scar on DMSA, where 41.6% of the kidneys were classified as normal on IVU. The data obtained confirm that the scintigraphy with DMSA is essential in the investigation of patients with renal scar, and cannot be replaced by IVU, due to its low sensitivity and lower ability of satisfactory grading.

  3. The method of urine sampling is not a valid predictor for vesicoureteral reflux in children after febrile urinary tract infections.

    Science.gov (United States)

    Haid, Bernhard; Roesch, Judith; Strasser, Christa; Oswald, Josef

    2017-10-01

    The likelihood of detecting vesicoureteral reflux (VUR) after febrile urinary tract infections (UTI) in children logically should correlate with the correct diagnosis of the UTI. Beneath the unspecific symptoms of fever urine analysis is the main diagnostic criterion for the exact diagnosis of febrile UTIs in children. Use of inadequate urine sampling techniques during diagnosis may lead to impaired accuracy in UTI diagnosis. This could lead to the assumption that children, having diagnosed their UTI by the use of possibly inadequate urine sampling techniques should not be evaluated as consequently compared to those, where the diagnosis relied on sterile urine sampling techniques. We hypothesized that children with possibly contaminated urine samples during the initial diagnosis may show a lower rate of VUR in subsequent VCUGs because of a wrong diagnosis initially compared to children, where accurate urine sampling techniques were used. Between 2009 and 2014, a total of 555 patients underwent a primary VCUG at our department indicated because of febrile UTIs. Patients with urine collection methods other than bag urine and catheter/suprapubic aspiration (SPA) were excluded from this study (mid-stream urine, potty urine, n = 149). We evaluated 402 patients (male/female 131/271, mean age 1.91 years), VUR rates and grades were compared between patients where urine was sampled by the use of a urine bag only at the time of diagnosis (n = 296, 73.6%) and those where sterile urine sampling (catheter, suprapubic puncture) was performed (n = 106, 26.3%). 4 patients were excluded due to equivocal data on urine sampling. VUR rate in children after sterile urine sampling using a catheter or SPA accounted to 31.1%. In those where urine samples acquired by the use of urine bags were used, 33.7% showed VUR on subsequent VCUG (p = 0.718). There were no significant differences as to VUR grades or gender, although VUR was much more commonly diagnosed in female patients (37

  4. 2D/3D/4D contrast-enhanced voiding urosonography in the diagnosis and monitoring of treatment of vesicoureteral reflux in children – can it replace voiding cystourethrography?

    Directory of Open Access Journals (Sweden)

    Magdalena Maria Woźniak

    2013-12-01

    Full Text Available Introduction: Vesicoureteral reflux appears in 20–50% of pediatric patients with recurrent urinary tract infections. The most common method of diagnosing this disease is voiding cystourethrography. However, contemporary pediatric radiology does not favor this method due to exposure to X-radiation. Aim: The aim of this study was to assess the usefulness of 2D/3D/4D contrast-enhanced voiding urosonography in the diagnosis and treatment monitoring of vesicoureteral reflux in children and the possibility of using contrast-enhanced voiding urosonography to replace voiding cystourethrography. Material and methods: Voiding cystourethrography and contrast-enhanced voiding urosonography were conducted in 80 pediatric patients in order to assess sensitivity, specificity, positive and negative predictive values as well as the number of vesicoureteral refluxes detected by each of the two methods. The second stage of the study involved performing voiding urosonography in an extended protocol in 58 children in order to determine the usefulness of three-dimensional (3D/4D examinations in the assessment of vesicoureteral reflux and the ability to assess the urethra. Results: The concordance between the two methods was 86.95%. The sensitivity of voiding urosonography was 84.51%, specificity – 90.99%, positive predictive value – 85.71% and negative predictive value – 90.17%. A 3D/4D assessment of the urinary bladder and transperineal 2D morphological assessment of the urethra were possible in all patients (100%. Assessment of the urethra during micturition with the use of 2D/3D/4D techniques was possible in all patients in whom voiding was elicited (95.83%, and 3D/4D assessment of vesicoureteral reflux was possible in all patients with reflux (100%. Although the application of 3D/4D techniques allowed accurate specification of the grade of reflux in all cases (100%, it appeared particularly useful in differentiating between grades II and III (70

  5. Comparison of results of endoscopic correction of vesicoureteral reflux in children using two bulking substances: Dextranomer/hyaluronic acid copolymer (Deflux) versus polyacrylate-polyalcohol copolymer (Vantris).

    Science.gov (United States)

    Warchol, Stanislaw; Krzemien, Grazyna; Szmigielska, Agnieszka; Bombinski, Przemyslaw; Brzewski, Michal; Dudek-Warchol, Teresa

    2016-08-01

    Endoscopic correction of vesicoureteral reflux (VUR) in children offers minimally invasive management and is widely used as a first-line procedure for all grades of reflux. However, there is debate about which tissue-augmenting substance is the best to use. The aim of this study was to evaluate the efficacy of two bulking substances, Deflux (Dx/HA) and Vantris (PPC), for endoscopic treatment of VUR in children. From 2009 to 2012, 65 children (50 girls and 15 boys) aged 1.45-9.9 years (mean 4.85 ± 2.52) underwent endoscopic correction of VUR using Deflux. VUR was unilateral in 31 patients and bilateral in 34 patients, comprising 108 renal refluxing units (RRUs) grades: II in 52, III in 47, IV in 7, and V in 2. From 2012, 68 children (43 girls and 25 boys) aged 0.6-17.9 years (mean 4.89 ± 3.46) were treated with Vantris. VUR was unilateral in 33 and bilateral in 35 patients, comprising 109 RRUs grades: II in 48, III in 29, IV in 13, and V in 19. Voiding cystourethrogram was done 3 months after procedure. All patients completed follow-up (summary Table). With Deflux, reflux resolved in almost 93% of RRUs after two procedures (in 63% after first injection), with Vantris, VUR was corrected in the same percentage after one procedure. The success rate with Deflux ranges between 68% and 92% (only 50-70% after single injection). The reported possibility of reflux recurrence after successful Deflux treatment, and the need for repeated injection led to introduction of the new substance Vantris. The results of a multi-centre survey published in 2014 showed that reflux is corrected in more than 90% of cases after single PPC injection. Our results with PPC confirm a high level of reflux resolution. Our data show that Vantris injection is a safe and effective procedure for treating all grades of VUR with good clinical outcome, and provides a higher and almost complete level of reflux resolution after first injection compared with Deflux. Copyright © 2016. Published by

  6. Vesicoureteral Reflux (VUR)

    Science.gov (United States)

    ... often first detected when a child has a urinary tract infection (UTI) with a fever. Symptoms of a UTI include: lower tract infection (in ... kidneys are functioning and check for signs of infection or damage to the ... to create images of the urinary tract and may reveal a defect or blockage ...

  7. [Reflux nephropathy].

    Science.gov (United States)

    Sabra, R

    1990-08-01

    A corticopapillary scar is a frequent finding on urography in patients with vesicoureteral reflux. It is considered a typical sign of so-called reflux nepropathy. It develops most frequently in children aged 5-7 years and has a negative impact on the growth of the kidney. In its development three factors participate: ureterovesical reflux, intrarenal reflux associated with so-called refluxing papillas and urinary infection. The inflammatory cicatrical process may affect the whole kidney--small shrivelled kidney--or only a portion of the kidney. The development of scars is explained by the so-called bing-bang theory according to which all refluxing papillae are affected at the same time by the first urinary infection. This position develops in particular in case of inadequate treatment of acute pyelonephritis, Deformity of normal papillae caused by various factors explains, however, the development of renal scars in children aged 8-12 years or even in adults. The growing kidney tolerates poorly not only urinary infections and scar formation but also hydrodynamic disorders associated with vesicoureteral reflux. Therefore it is important to diagnose and treat vesicoureteral reflux already at an early age. For the time being it is important o consider asymptomatic bacteriuria and any urinary infection in children a clinical marker calling for examination for the possible presence of vesicoureteral reflux.

  8. Endoscopic Bulking Materials for the Treatment of Vesicoureteral Reflux: A Review of Our 20 Years of Experience and Review of the Literature

    Science.gov (United States)

    Chertin, Boris; Kocherov, Stanislav; Chertin, Leonid; Natsheh, Alaeddin; Farkas, Amicur; Shenfeld, Ofer Z.; Halachmi, Sarel

    2011-01-01

    Purpose. We reviewed our 20 years of experience and the current literature regarding the long-term outcome of endoscopic treatment of vesicoureteric reflux (VUR) using the different tissue bulking substances with a special emphasis on the long-term efficacy. Material and Methods. Our own experience and the current literature on the long-term results after endoscopic treatment using various bulking agents were reviewed. Results. Short-term data following endoscopic treatment of VUR is similar to the various substances and comparable in the majority of the series to the success rate following open surgery. Recently, a relatively high recurrence rate was noticed especially with the use of dextranomer hyaluronic acid (Dx/HA) as a tissue augmenting material which raises the need for further search for alternative substances. Conclusions. Unfortunately, there is a significant shortage of evidence-based literature on the long-term followup after endoscopic correction of reflux with various substances. No doubt, there is a high recurrence rate during long-term followup after Dx/HA injection, and there is probably lack of proper evaluation regarding the long-term efficacy of other bulking materials. These facts demand long-term close observation and long-term studies beyond the routine protocols following endoscopic treatment of VUR and the correct parental counseling upon the endoscopic correction. PMID:21603212

  9. Endoscopic Bulking Materials for the Treatment of Vesicoureteral Reflux: A Review of Our 20 Years of Experience and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Boris Chertin

    2011-01-01

    Full Text Available Purpose. We reviewed our 20 years of experience and the current literature regarding the long-term outcome of endoscopic treatment of vesicoureteric reflux (VUR using the different tissue bulking substances with a special emphasis on the long-term efficacy. Material and Methods. Our own experience and the current literature on the long-term results after endoscopic treatment using various bulking agents were reviewed. Results. Short-term data following endoscopic treatment of VUR is similar to the various substances and comparable in the majority of the series to the success rate following open surgery. Recently, a relatively high recurrence rate was noticed especially with the use of dextranomer hyaluronic acid (Dx/HA as a tissue augmenting material which raises the need for further search for alternative substances. Conclusions. Unfortunately, there is a significant shortage of evidence-based literature on the long-term followup after endoscopic correction of reflux with various substances. No doubt, there is a high recurrence rate during long-term followup after Dx/HA injection, and there is probably lack of proper evaluation regarding the long-term efficacy of other bulking materials. These facts demand long-term close observation and long-term studies beyond the routine protocols following endoscopic treatment of VUR and the correct parental counseling upon the endoscopic correction.

  10. Ectopia renal cruzada con fusión, reflujo vesicoureteral y riñón ectópico afuncional:: informe de un caso Crossed renal ectopia with fusion, vesicoureteral reflux and dysfunctional ectopic kidney:: A case report

    Directory of Open Access Journals (Sweden)

    Sandalio Durán Álvarez

    2010-03-01

    Full Text Available Se presenta el caso de un niño cuyo ultrasonido materno-fetal de la semana 20 de la gestación no detectó alteraciones, pero el de la semana 23,6 mostró un riñón pélvico derecho. A los 22 días de nacido el ultrasonido renal mostró un riñón derecho de tamaño y posición normal y dilatación pélvica moderada, e inmediatamente por debajo del polo inferior de éste, un bolsón hidronefrótico que parecía corresponder a una ectopia renal cruzada con hidronefrosis grave. El padre padeció reflujo vesicoureteral derecho que desapareció espontáneamente. A pesar de la profilaxis con cefalexina, hubo una infección urinaria que se trató satisfactoriamente con ceftriaxona. Investigaciones ultrasonográficas y radioisotópicas arrojaron la existencia de una anomalía congénita dada por dilatación pélvica no obstructiva del riñón derecho, ectopia renal cruzada con fusión del riñón izquierdo afuncional y reflujo vesicoureteral bilateral, de grado II del riñón derecho y de grado V del izquierdo ectópico cruzado. A los 11 meses de edad se le realizó una lumbotomía y se comprobó la fusión del bolsón hidronefrótico con el polo inferior del riñón derecho. Se resecó el bolsón y se realizó una ligadura baja del uréter.This is the case of a child whose maternal-fetus ultrasound (US at twenty weeks pregnancy not detected alterations, but at the 23, 6 weeks it showed the presence of a right pelvic kidney. At twenty two days the renal US showed a right kidney with a normal size and location as well as a moderate pelvic dilation and immediately beneath its lower pole a hydronephrosis big sac in correspondence with a crossed renal ectopia with severe hydronephrosis. His father had right vesiculorectal reflux disappeared spontaneously. Despite the prophylaxis with Cephalexin there was a urinary infection adequately treated with Cephtriaxone. Ultrasonography and radioisotope researches demonstrated the presence of a congenital anomaly

  11. Robot-assisted extravesical ureteral reimplantation (revur) for unilateral vesico-ureteral reflux in children: results of a multicentric international survey.

    Science.gov (United States)

    Esposito, Ciro; Masieri, Lorenzo; Steyaert, Henri; Escolino, Maria; Cerchione, Raffaele; La Manna, Angela; Cini, Chiara; Lendvay, Thomas S

    2018-03-01

    This multicentric international retrospective study aimed to report the outcome of robot-assisted extravesical ureteral reimplantation (REVUR) in patients with unilateral vesico-ureteral reflux (VUR). The medical records of 55 patients (35 girls, 20 boys) underwent REVUR in four international centers of pediatric robotic surgery for primary unilateral VUR were retrospectively reviewed. Patients' average age was 4.9 years. The preoperative grade of reflux was III in 12.7%, IV in 47.3% and V in 40%. Twenty-six patients (47.3%) presented a loss of renal function preoperatively and 10 (18.1%) had a duplex system. Average robot docking time was 16.2 min (range 5-30). Average total operative time was 92.2 min (range 50-170). No conversions or intra-operative complications were recorded. All patients had a bladder Foley catheter for 24 h post-operatively. Average hospital stay was 2 days (range 1-3). Average follow-up length was 28 months (range 9-60). We recorded three (5.4%) postoperative complications: 1 small urinoma resolved spontaneously (II Clavien) and 2 persistent reflux, only one requiring redo-surgery using endoscopic injection (IIIb Clavien). REVUR is a safe and effective technique for treatment of primary unilateral VUR. The procedure is easy and fast to perform thanks to the 6° of freedom of robotic arms. The learning curve is short and it is useful to begin the robotics experience with a surgeon expert in robotic surgery as proctor on the 2nd robot console. The high cost and the diameter of instruments remain the main challenges of robotics applications in pediatric urology.

  12. Endoscopic Subureteral Injection for the Treatment of Vesicoureteral Reflux in Children: Polydimethylsiloxane (Macroplastique®) versus Dextranomer/Hyaluronic Acid Copolymer (Deflux®)

    Science.gov (United States)

    Bae, Young Dae; Park, Min Gu; Oh, Mi Mi

    2010-01-01

    Purpose The aim of this study was to compare cure rates and complications of polydimethylsiloxane (Macroplastique®) and dextranomer/hyaluronic acid copolymer (Deflux®) in the treatment of vesicoureteral reflux (VUR). Materials and Methods From April 2001 to March 2008, 29 boys and 42 girls (total of 115 ureters) with a mean age of 6 years who had undergone endoscopic subureteral transurethral injection for VUR were enrolled. A single subureteral injection of Macroplastique was performed in 31 ureters in 23 children (group I; grade II: 4; grade III: 12; grade IV: 9; grade V: 6), and a single subureteral injection of Deflux was performed in 84 ureters in 48 children (group II; grade II: 24; grade III: 14; grade IV: 25; grade V: 21). Renal ultrasound was done 1 day after injection, and voiding cystourethrography (VCUG) was done at 3 months. Successful reflux correction was defined as absent or grade I reflux on follow-up VCUG. Results No significant difference in success rates was observed between group I and group II [80.6% (25/31) vs. 78.6% (66/84), respectively, p>0.05]. The following postoperative complications developed: ureteral obstruction in 2 ureters of group I and 3 ureters of group II, asymptomatic urinary tract infection in 3 patients of group I and 2 patients of group II, and bladder calcification by erosion or mucosal necrosis in 2 patients of group I. Conclusions Despite differences in material properties, both Macroplastique and Deflux were safe for the treatment of children with VUR. Because of the risk of bladder mucosal necrosis and substantial decreases in volume after implantation, long-term follow-up is required. PMID:20414426

  13. The reliability of VCUG performed within 24 hours after injection of dextranomer/hyaluronic acid in patients with vesico-ureteral reflux.

    Science.gov (United States)

    Oh, Mi Mi; Park, Min Gu; Kim, Jin Wook; Yoo, Kee Hwan; Lee, Jung Won; Yoon, Cheol Yong; Park, Hong Seok; Moon, Du Geon

    2014-01-01

    To assess the reliability and negative predictive value of voiding cystourethrogram (VCUG) performed within 24 hours postoperatively. Forty patients (56 ureters) who underwent first injection of dextranomer/hyaluronic acid (Dx/HA) because of vesicoureteral reflux (VUR) were enrolled. Patients with previous reflux operation or neurogenic disorders were excluded. All patients underwent the hydrodistention implantation technique (HIT). Patients underwent VCUG within 24 hours postoperatively and after 6 months. Grade 0 and grade 1 were considered to be cured. Negative predictive values of VCUG performed within 24 hours postoperatively were assessed. The mean age of the patient was 98 ± 45.8 months. Twenty-seven patients were male and 13 patients were female. The number of refluxing ureters was 4, 12, 14, 12, and 14 in ascending order of VUR grade. Overall success rate of single injection therapy was 66.07%. Only 2 ureters with grade IV and 1 patient with grade V VUR showed failure on 24-hour VCUG. The success rates on 6 months VCUG were 100%, 83.3%, 78.57%, 50%, and 42.85% according to ascending order of VUR grade.The negative predictive value of 24-hour VCUG were 100%, 83.3%, 78.57%, 60.0%, and 46.15% according to ascending order of VUR grade. VUR grade was the only factor associated with the discrepancy. Positive but weak correlation was noted between the preoperative grade of VUR and the rate of discrepancy on Spearman correlation analysis (Spearman correlation coefficient = 0.303, P value = .018). Twenty-four hour VCUG cannot replace follow-up VCUG usually performed beyond 3 months postoperatively. Further studies are needed for confirmation of cure. Copyright © 2014 Elsevier Inc. All rights reserved.

  14. [sup 99m]Tc-DMSA scintigraphy in children with vesico-ureteral reflux and previous urinary tract infections. Ergebnisse der [sup 99m]Tc-DMSA-Szintigraphie bei Kindern mit vesiko-ureterorenalem Reflux und vorausgegangenen Harnwegsinfektionen

    Energy Technology Data Exchange (ETDEWEB)

    Tamminen-Moebius, T. (Kinderklinik, Universitaetsklinikum Essen (Germany)); Piepsz, A. (Klinik und Poliklinik fuer Nuklearmedizin, Universitaetsklinikum Essen (Germany)); Reiners, C. (Hospital St. Pierre, Dept. of Radioisotopes, Brussels (Belgium) Koordinationszentrum ' International Reflux Study in Children' , Universitaetskinderklinik Essen (Germany))

    1994-04-01

    401 children were studied the correlation between [sup 99m]TcDMSA-scintigraphy and intravenous urogram in with vesicoureteric reflux and previous urinary tract infections (time interval from infection more than 4 weeks). Scintigraphy, together with differential uptake percentage, is an exellent method for the detection and followup of regional functional kidney abnormalities. It should however be associated with other imaging techniques. Comparing scintigraphy with intravenous urography, there is, in most cases, a good agreement of the presence of lesions with both methods. The divergences are related to the characteristics of both techniques, the scintigraphy detecting functional alterations, while intravenous urography describing the morphological changes, like kidney scars or parenchymal thinning. Although the differential diagnosis between scar and thinning was not possible by scintigraphy, the scintigram showed regional changes which were not present or recognized on the intravenous urogram. In 20% of children scintigraphic changes were observed in radiologically normal kidneys with vesicoureral reflux (past or present) and 10% of children with scars or thin areas of renal parenchyma had normal DMSA scintigram and normal uptake %. (orig./MG)

  15. Routine delayed voiding cystourethography after initial successful endoscopic treatment with Dextranomer/Hialuronic Acid Copolimer (Dx/HA) of vesicoureteral reflux (VUR). Is it necessary?

    Science.gov (United States)

    García-Aparicio, L; Blázquez-Gómez, E; Vila Santandreu, A; Camacho Diaz, J A; Vila-Cots, J; Ramos Cebrian, M; de Haro, I; Martin, O; Tarrado, X

    2016-12-01

    Some guidelines recommend an early voiding cystourethrography (VCUG) after endoscopic treatment of vesicoureteral reflux (VUR), but there's no consensus if it's necessary a long-term follow-up in these patients. The aim of our study is analyze if it's necessary a delayed VCUG after initial successful treatment with Dx/HA. We have reviewed all medical charts of patients that underwent Dx/HA treatment from 2006 to 2010. We have selected patients with initial successful treatment and more than 3 years of radiological and clinical follow-up. We have analyzed late clinical and radiological outcomes. One hundred and sixty children with 228 refluxing ureters underwent Dx/HA endoscopic treatment with a mean follow-up of 52.13 months. Early VCUG was performed in 215 ureters with an initial successful rate of 84.1%. The group of study was 94/215 ureters with more than 3 years of follow-up with a delayed VCUG. VUR was still resolved in 79,8% of the ureters. Clinical success rate was 91.7%. The incidence of febrile urinary tract infection in those patients with cured VUR and those with a relapsed VUR was 8 and 15%, respectively; but there were no significant differences. We have not found any variable related with relapsed VUR except those ureters that initially received 2 injections (P<.05). If our objective in the treatment of VUR is to reduce the incidence of febrile urinary tract infection it is not necessary to perform a delayed VCUG even though the long-term radiological outcomes is worse than clinical outcome. Copyright © 2016 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  16. Endoscopic treatment of grades IV and V vesicoureteral reflux with two bulking substances: Dextranomer hyaluronic acid copolymer versus polyacrylate polyalcohol copolymer in children.

    Science.gov (United States)

    Kocaoglu, Canan

    2016-10-01

    We aimed at evaluating the efficacy and complications of two bulking substances: dextranomer/hyaluronic acid copolymer(Dx/Ha;Dexell®) versus polyacrylate polyalcohol copolymer(PPC;Vantris®) in subureteric injection treatment of children with high grades (grades IV-V) vesicoureteral reflux(VUR). Data of patients undergoing endoscopic treatment of high grade VUR (January 2009-August 2015) were retrospectively investigated. Patients with high grade VUR caused by posterior urethral valve, duplex system, paraureteral diverticula and neurogenic bladder were excluded. Classical subureteric injection method (STING) was used. Seventy-three children (45 girls and 28 boys) who had 88 refluxing renal units (RRUs) with grades IV-V VUR (n=64/n=24) underwent endoscopic treatment using Dx/Ha (n=63 RRUs) and PPC (n=25 RRUs). Mean age of patients in Dx/Ha and PPC groups were 6 (3) and 6 (3.75) year (p=0.81), and volumes of these substances given were 1.3 (1) and 1 (0.5) mL (p=0.003), respectively. Overall, for the first endoscopic injection, success rate of grades IV-V VUR per RRU was 53.9% with Dx/Ha, compared to 80% in PPC-injected group, (p=0.024). Late ureterovesical junction obstruction developed only in one patient in PPC-injected group. No ureteral obstruction was observed in Dx/Ha-injected group. Endoscopic injection of PPC resulted in significantly higher success rate, compared to Dx/Ha in subureteric injection treatment of children with high grade VUR. However, the development of late ureterovesical junction obstruction should also be taken into account in PPC injection. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. The management of vesicoureteral reflux in the setting of posterior urethral valve with emphasis on bladder function and renal outcome: a single center cohort study.

    Science.gov (United States)

    Tourchi, Ali; Kajbafzadeh, Abdol-Mohammad; Aryan, Zahra; Ebadi, Maryam

    2014-01-01

    To represent our experience in the management of posterior urethral valves and concomitant vesicoureteral reflux (VUR). A total of 326 children with posterior urethral valve who had underwent valve ablation/bladder neck incision were studied, and those who had persistent VUR and were categorized under 3 main groups were followed up. Group 1 (n = 71) received prophylactic antibiotic, group 2 (n = 50) underwent Deflux injection (2a) (n = 28): Deflux injection alone, group 2b (n = 22) Deflux with concomitant autologous blood injection (HABIT), and group 3 (n = 19) underwent ureteroneocystostomy before referral and was followed up conservatively. VUR resolution, incidence of urinary tract infections (UTI), and bladder function were assessed. Mean duration of follow-up was 3.8 years; VUR resolution occurred in 66.1%, 86.0%, and 94.0% of groups 1-3, respectively (P = .013). Resolution rate in group 2b was significantly higher than group 2a (90.9% vs 78.5%). Patients in group 2 experienced a longer UTI-free period compared with others (P <.05). Urodynamic studies demonstrated significant decrease in maximum voiding detrusor pressure and detrusor overactivity in all groups (P <.001). Children in group 3 ended up with lower compliance compared with others (P <.001). After toilet training, only 2.8%, 21.4%, 13.6%, and 27% children were diagnosed with lower urinary tract dysfunction in groups 1-3, respectively (P = .027). Myogenic failure developed only in 3 boys in group 3. Ablation/bladder neck incision leads to significant improvement in VUR status in part because of improvement in bladder function. After successful valve removal, conservative therapy can be regarded as the mainstay of reflux treatment, whereas HABIT is recommended for high grade VUR associated with febrile UTI or deterioration in renal function. Copyright © 2014 Elsevier Inc. All rights reserved.

  18. Single photon emission computed tomography with Tc-99m-dimercaptosuccinic acid in patients with upper urinary tract infection and/or vesicoureteral reflux

    Energy Technology Data Exchange (ETDEWEB)

    Itoh, Kazuo; Asano, Yoshihumi; Tsukamoto, Eriko (Hokkaido Univ., Sapporo (Japan). School of Medicine) (and others)

    1991-03-01

    By means of Tc-99m dimercaptosuccinic acid (DMSA) scintigraphy, an established method for assessing renal cortical damage, we evaluated the pick-up rate for renal defects (scars) by single photon computed tomography (SPECT) and planar images of 10 normal volunteers, and 58 patients (70 scintigrams) with upper urinary tract infections, most of whom had a history of vesicoureteral reflux (VUR). The positive study rate for renal defects depended on the severity of VUR. The overall positive rates for renal cortical defects obtained by DMSA SPECT imaging and DMSA planar imaging were 60% and 43%, respectively, and the difference between these was significant (p<0.005). The mean absolute individual renal uptake(/injected dose) at 2 hours post-injection was decreased in the kidneys with defects detected by SPECT alone. The positive study rate for intravenous urography (IVU) depended on the grade of VUR and was 15% overall. DMSA SPECT imaging detects renal cortical defects at greater frequency than previously achieved. (author).

  19. Application of the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement to publications on endoscopic treatment for vesicoureteral reflux.

    Science.gov (United States)

    Farrugia, M K; Kirsch, A J

    2017-06-01

    Following an increasing number of submissions on endoscopic treatment of vesicoureteral reflux (VUR), the Journal of Pediatric Urology sought to establish a quality guideline that would enable reviewers to select the best papers for publication in the journal. The "Strengthening the Reporting of Observational Studies in Epidemiology" (STROBE) Statement, established in 2007, is a 22-item checklist designed to assist with clear reporting of observational studies. This checklist includes a description of methodological items and instructions on how to use them to transparently report observational studies. The aim of the present study was to apply the STROBE principle to observational studies about endoscopic management of VUR, and to establish a "check-list" to assist authors with good-quality submissions. The 22 STROBE criteria were listed and applied to publications on endoscopic treatment by utilizing examples from the current literature, with additional suggestions about how future studies could build upon the information already published on the subject. Based on this strategy, a checklist that is particular to endoscopic treatment studies was produced as a guideline for authors and reviewers. Application of the STROBE statement principles, in combination with key VUR data, will allow better quality submissions and a higher chance of positive reviews and acceptance rates. Copyright © 2017 Journal of Pediatric Urology Company. All rights reserved.

  20. Postoperative vesicoureteral reflux after high-pressure balloon dilation of the ureterovesical junction in primary obstructive megaureter. Incidence, management and predisposing factors.

    Science.gov (United States)

    García-Aparicio, Luis; Blázquez-Gómez, Eva; de Haro, Irene; Garcia-Smith, Natalie; Bejarano, Miguel; Martin, Oriol; Rodo, Joan

    2015-12-01

    To describe the incidence, predisposing factors and management of postoperative vesicoureteral reflux (VUR) after high-pressure balloon dilation to treat primary obstructive megaureter (POM). We have reviewed patients that underwent endoscopic treatment for POM from May 2008 to November 2013. All patients were evaluated with renal ultrasound, voiding cystourethrography and diuretic renogram. Endoscopic treatment was done with high-pressure balloon dilation of the ureterovesical junction under general anesthesia; a double-J stenting was done in all patients. Follow-up was performed with ultrasonography, voiding cystourethrography and a diuretic renogram in all patients. Fifteen boys and five girls with a mean age of 14.18 months (3-103) were reviewed. A total of 22 ureters underwent HPBD to treat POM. Ureterohydronephrosis improves in 19 ureters. After endoscopic treatment, six ureters developed VUR. Four ureters were managed surgically, and in the other two, VUR disappeared in a second cystogram. The presence of parameatal diverticulum in the preoperative cystography and those patients with bilateral POM are factors related to postoperative VUR (p < 0.05). Urinary tract infection after HPBD was observed in four patients, but only one of them was affected with VUR.

  1. Early effect of American Academy of Pediatrics Urinary Tract Infection Guidelines on radiographic imaging and diagnosis of vesicoureteral reflux in the emergency room setting.

    Science.gov (United States)

    Arlen, Angela M; Merriman, Laura S; Kirsch, Jared M; Leong, Traci; Scherz, Hal C; Smith, Edwin A; Broecker, Bruce H; Kirsch, Andrew J

    2015-05-01

    In 2011 the AAP revised practice parameters on febrile urinary tract infection in infants and children 2 to 24 months old. New imaging recommendations invigorated the ongoing debate regarding the diagnosis and management of vesicoureteral reflux. We compared evaluations in these patients with febrile urinary tract infection before and after guideline publication. During 2 separate 6-month periods 350 patients 2 to 24 months old were evaluated in the emergency room setting. Demographics, urine culture, renal-bladder ultrasound, voiding cystourethrogram and admission status were assessed. A total of 172 patients presented with initial febrile urinary tract infection in 2011, of whom 47 (27.3%) required hospitalization, while 42 of 178 (23.6%) were admitted in 2012. Admission by year did not significantly differ (p = 0.423). After guideline revision 41.2% fewer voiding cystourethrograms were done (72.1% of cases in 2011 vs 30.9% in 2012, p urinary tract infection. We found no relationship between renal-bladder ultrasound and abnormal voiding cystourethrogram, consistent with previous findings that call ultrasound into question as the determinant for additional imaging. Whether forgoing routine voiding cystourethrogram results in increased morbidity is the subject of ongoing study. Copyright © 2015. Published by Elsevier Inc.

  2. An all-endo Approach to Complete Ureteral Duplications Complicated by Ureterocele and/or Vesicoureteral Reflux: Feasibility, Limitations, and Results

    Directory of Open Access Journals (Sweden)

    A. Calisti

    2011-01-01

    Full Text Available Purpose. Totally endoscopic management (all-endo of patients with a duplicated renal system (DS associated with severe vesicoureteral reflux (VUR or obstructive ureterocele (UC is an attractive alternative to traditional open procedures. The authors discuss feasibility and results of an all-endo approach on a consecutive series of patients. Methods. From 1999 to 2009, all patients with a complete DS associated with UC and/or VUR were proposed for primary all-endo approach. UC puncture was performed using a 3 Fr Bugbee electrode. Deflux (dextranomer/hyaluronic acid copolymer injection was administered for VUR. The need for secondary surgery was evaluated on followup. Results. Of the 62 patients recruited, 46 were treated using a primary all-endo approach and 16 patients received no treatment. Of the 46 treated patients with 56 affected renal units, 32 (97% UCs collapsed following puncture and 29 (63% VURs were resolved or downgraded. Secondary VUR occurred in 13 (39% renal units. Secondary surgery was performed on 23 (41% renal units. Conclusion. The all-endo approach for VUR in DS is an effective therapeutic option. UC collapse was achieved by puncture in most of the patients; secondary VUR was the main complication in a small group of extravesical UC.

  3. Outcomes of vesicoureteral reflux in children with non-neurogenic lower urinary tract dysfunction treated with dextranomer/hyaluronic acid copolymer (Deflux).

    Science.gov (United States)

    Van Batavia, Jason P; Nees, Shannon N; Fast, Angela M; Combs, Andrew J; Glassberg, Kenneth I

    2014-06-01

    There has been hesitancy to use dextranomer/hyaluronic acid copolymer (DHXA, Deflux for vesicoureteral reflux (VUR) in the setting of lower urinary tract (LUT) dysfunction because of the limited number of published studies, the possibility of less success, and the manufacturer's recommendations contraindicating its use in patients with active LUT dysfunction. We report on our experience using DXHA in this subset of patients whose VUR persisted despite targeted therapy for their LUT condition. We reviewed patients diagnosed with both a LUT condition and VUR who underwent subureteric DXHA while still undergoing treatment for their LUT dysfunction. Persistence of VUR was confirmed by videourodynamic studies (VUDS)/VCUG (voiding cystourethrogram) and all patients were on targeted treatment (TT) and antibiotic prophylaxis prior to and during DXHA injection. VUR was reassessed post-injection. Fifteen patients (22 ureters; 21F,1M) met inclusion criteria (mean age 6.1 years, range 4-12). Following one to three DXHA injections, VUR resolved in 17 ureters (77%) including eight of nine ureters in dysfunctional voiding (DV) patients, five of nine in idiopathic detrusor overactivity disorder (IDOD), and four of four in detrusor underutilization disorder (DUD) patients. DXHA is safe and effective in resolving VUR in children with associated LUT dysfunction, even before their LUT condition has fully resolved. Highest resolution rates were noted in patients with either DV or DUD or who were least symptomatic prior to injection. Copyright © 2013 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

  4. Endoscopic treatment of vesicoureteric reflux with dextranomer/hyaluronic acid copolymer (Deflux: Single-surgeon experience with 48 ureters

    Directory of Open Access Journals (Sweden)

    V. V. S. Chandrasekharam

    2013-01-01

    Full Text Available Purpose: VUR is a common urologic problem in children. Cystoscopic injection of bulking agents (most commonly Deflux has gained popularity as the first line treatment in the west. However, primarily due to cost factors, it has not gained much popularity in our country. We present our initial experience with cystoscopic Deflux injection for VUR. Materials and Methods: We reviewed our 3-yr experience with the use of Dx/HA (Deflux for correction of VUR in children and adolescents. All children were evaluated with Ultrasound, MCUG and DMSA renal cortical scan. The indications for surgical correction of VUR included breakthrough infections while on antibiotic prophylaxis, persistent high-grade VUR beyond 3 yrs of age, and presence of significant renal damage on DMSA at diagnosis (in those children presenting with UTI. All children underwent cystoscopic Deflux injection using the standard technique of subureteral injection (0.4-1 ml per ureter. All children received antibiotic prophylaxis for 3-6 months after the injection. USG was done at 1 month and MCUG at 3-6 months after the injection. Results: 33 patients (48 ureters underwent cystoscopic Deflux injection for correction of VUR. Mean age was 4.5 yrs (1-17 yrs; there were 12 boys and 21 girls. Thirteen children had antenatally diagnosed HDN, while 20 children presented with febrile UTI. All children had primary VUR except one child with persistent VUR 4 yrs after PUV fulguration. The VUR was grade 1-2 in 8, grade 3-4 in 37, and grade 5 in 3 ureters. Every child had at least one ureter with dilating reflux (grades 3,4 or 5. When present, low grade VUR (grade 1or 2 was always on the contralateral side. Only one child received a 2 nd injection after 6 months. Follow-up MCUG was done in 28 children (41 ureters. Complete reflux resolution was achieved in 27 ureters (65%, and the reflux was downgraded in 2 (5%. There were no complications of Deflux injection. Conclusions: Endoscopic correction of VUR in

  5. Diagnostic Value of Technetium-99m-Dimercaptosuccinic Acid Scintigraphy in Prediction of Vesicoureteral Reflux in Children with First-time Febrile Urinary Tract Infection

    Directory of Open Access Journals (Sweden)

    Fatemeh Ataei

    2017-11-01

    Full Text Available Background: Imaging modalities such as voiding cystourethrography (VCUG, direct radionuclide cystography (DRNC, and renal cortical scintigraphy (RCS with technetium-99m dimercaptosuccinic acid (Tc-99mDMSA, are helpful in detecting possible abnormalities of urinary tract such as vesicoureteral reflux (VUR. However, there are confounding data regarding the preference of these modalities. In the present study, we aimed to assess the role of Tc-99mDMSA scan in prediction of possible VUR and the subsequent need for VCUG or DRNC. Materials and Methods: Three hundred fifty seven children under 14 years old with first-time febrile urinary tract infection (UTI who were admitted between April 2004 and February 2017 were enrolled. Data regarding to VCUG or DRNC in order to evaluate the presence of possible VUR were recorded. Finally, accuracy of Tc-99mDMSA scans in prediction of VUR were assessed. Results: Analyses showed a sensitivity and specificity of 95.65% and 14.72%, respectively for Tc-99mDMSA scan in detection of VUR. Patients with mild renal involvement in Tc-99mDMSA scans had a 3.5-fold greater risk of having VUR than those with a normal scans (odds ratio=3.5; 95% confidence interval [CI]: 1.4-8.58; p=0.007. In addition, the risk of VUR is up to 7.0-fold greater in children with moderate renal involvement (odds ratio=7.0; 95% CI: 2.6-13.2; p

  6. The effectiveness of ureteric reimplantation during bladder augmentation for high-grade vesicoureteric reflux in patients with neurogenic bladder: long-term outcome.

    Science.gov (United States)

    Hayashi, Yutaka; Kato, Yoshifumi; Okazaki, Tadaharu; Lane, Geoffrey J; Kobayashi, Hiroyuki; Yamataka, Atsuyuki

    2007-12-01

    The outcome of ureteric reimplantation (UR) during bladder augmentation (BA) for high-grade vesicoureteric reflux (HVUR) in patients with neurogenic bladder was assessed to determine the effectiveness of UR. A literature review of HVUR and BA was also performed. Twenty-two consecutive sigmoidocolocystoplasty patients were reviewed retrospectively; 10 had unilateral HVUR only, 3 had bilateral HVUR, and 9 had unilateral HVUR associated with low-grade VUR in the contralateral renal unit (RU). Preoperatively, VUR was grade V in 3 RU, grade IV in 22 RU, grade III in 5 RU, and grade II in 4 RU. Ureteric reimplantation was performed in the native bladder in 24 RU (16 patients) and in the colon cap in 10 RU (6 patients). Mean age at sigmoidocolocystoplasty/UR was 8.5 years (range, 2-15 years). Mean follow-up was 12.8 years (range, 2-22 years). Postoperatively, cystourethrography showed residual VUR (grade IV to grade III) in only 1 RU (3%); diethylenetriamine pentaacetic acid scintigraphy showed no obstruction in all RU; (99m)Tc-dimercaptosuccinic acid was improved in 13 RU, unchanged in 18 RU, and worsened in 3 RU; and serum creatinine remained normal in 20 patients and worsened in 2. Urinary tract infection, universal preoperatively, was seen postoperatively in only 2 patients. In the literature, 0% to 16.7% of HVUR persisted after BA alone, and no long-term data were available. Ureteric reimplantation during BA is safe and effective for treating HVUR in patients with neurogenic bladder.

  7. Long-term ultrasound appearance of concomitant autologous blood and dextranomer/hyaluronic acid copolymer implants: is it associated with successful correction of vesicoureteral reflux?

    Science.gov (United States)

    Kajbafzadeh, Abdol-Mohammad; Aryan, Zahra; Tourchi, Ali; Alizadeh, Houman

    2013-02-01

    To find the association between mound appearance on ultrasound imaging and successful correction of vesicoureteral reflux (VUR). We retrospectively reviewed the ultrasound and voiding cystourethrogram (VCUG) results of patients who underwent dextranomer/hyaluronic acid injection via the hydrodistention injection technique (HIT) or HIT with concomitant autologous blood injection (HABIT) for 5 years postoperatively. VUR resolution at postoperative VCUG was considered as a success. Retained volumes of implants were measured and compared between HABIT and HIT and successful and failed treatments. Presence of mound on ultrasound imaging was also evaluated as a predictor of VUR resolution on VCUG. Measured mound volume was significantly higher in treatments that were successful than in those that were failures (P <.05). During 5-year follow-up, measured mound volumes in the HABIT group were significantly higher than in the HIT group (P <.05). Sensitivity, specificity, positive predictive value, and negative predictive value of mound visualization on the first-month sonography to predict success were 97.7%, 21.5%, 89.6%, and 60%, respectively. These results were dramatically changed for the 50 patients with further VCUG after 1 year of follow-up, with 95.7% sensitivity, 37.0% specificity, 54.0% positive predictive value, and 90.9% negative predictive value. Reduction or absence of the mound after implantation is more frequent among failed treatments in which visualization of the mound on postoperative sonography can predict VUR resolution. Autologous blood injection concomitant with dextranomer/hyaluronic acid implantation results in better immediate and long-term mound preservation, which could possibly be the reason for the higher success rate in HABIT group. Copyright © 2013 Elsevier Inc. All rights reserved.

  8. Analysis of the IL-10, IL-12, and TNF-α Gene Polymorphisms in Patients With Vesicoureteral Reflux Among the Southeast Iranian Population.

    Science.gov (United States)

    Kordi Tamandani, Dor Mohammad; Naeimi, Nasim; Ghasemi, Ali; Baranzahi, Taybe; Sadeghi-Bojd, Simin

    2016-03-01

    Vesicoureteral reflux (VUR) is a common childhood disorder that is characterized by the abnormal movement of urine from the bladder into the ureters or kidneys. The aim of this study was to determine whether the genetic polymorphisms of the IL-10, IL-12, and TNF-α genes are involved in the development of VUR. The tetra amplification mutation refractory system-polymerase chain reaction (Tetra-ARMS PCR) was applied to analyze the four polymorphic sites of the IL-10AG-1082, IL-10CA597, IL-12CA1188, and TNF308GA genes in 124 VUR children and 110 healthy controls. A significant, highly increased risk of VUR disease was found for the CA, AA, and combined genotypes of IL-10CA597 (OR = 5.2, 95% CL: 1.80 - 18.25; P = 0.0006, OR = 9.1, 95% CL: 1.11 - 122.75; P = 0.02, OR = 5.3, 95% CL: 1.82 - 18.61; P = 0.00052, respectively); the AG, GG, and AG + GG genotypes of IL-10AG-1082 (OR = 12.8, 95% CL; 2.9 - 113.9; P = 0.00003, OR = 12.62, 95% CL: 2.93 - 114.53; P = 0.00003, respectively); and the AA genotype of IL-12 (AA, OR = 0.19, 95% CL: 0.5 - 0.55; P = 0.0006). The frequency of the C allele in both IL-10CA and IL-12CA was greater in patients with VUR than in the healthy controls. No association was found between TNF308GA and the risk of VUR. The results demonstrated significant associations between the IL-10 (AG-1089, IL-10CA) and IL-12 (AA) gene polymorphisms and a highly increased risk of VUR.

  9. [Impact of reflux on the kidney].

    Science.gov (United States)

    Mollard, P; Louis, D; Basset, T

    1984-03-01

    Description of the reflux nephropathy. Pyelonephritis lesions are undoubtedly linked to the vesico-ureteric reflux. The role of the intra-renal reflux ( Hodson ) and the Big Bang Theory ( Ransley ) are discussed as the data from animal experiments. The role of the sterile reflux and of the segmental hypoplasia is relatively less important. The actual management of vesico-ureteric reflux treatment is questioned.

  10. Deletion of fibroblast growth factor receptor 2 from the peri-wolffian duct stroma leads to ureteric induction abnormalities and vesicoureteral reflux.

    Directory of Open Access Journals (Sweden)

    Kenneth A Walker

    Full Text Available Pax3cre-mediated deletion of fibroblast growth factor receptor 2 (Fgfr2 broadly in renal and urinary tract mesenchyme led to ureteric bud (UB induction defects and vesicoureteral reflux (VUR, although the mechanisms were unclear. Here, we investigated whether Fgfr2 acts specifically in peri-Wolffian duct stroma (ST to regulate UB induction and development of VUR and the mechanisms of Fgfr2 activity.We conditionally deleted Fgfr2 in ST (Fgfr2(ST-/- using Tbx18cre mice. To look for ureteric bud induction defects in young embryos, we assessed length and apoptosis of common nephric ducts (CNDs. We performed 3D reconstructions and histological analyses of urinary tracts of embryos and postnatal mice and cystograms in postnatal mice to test for VUR. We performed in situ hybridization and real-time PCR in young embryos to determine mechanisms underlying UB induction defects.We confirmed that Fgfr2 is expressed in ST and that Fgfr2 was efficiently deleted in this tissue in Fgfr2(ST-/- mice at embryonic day (E 10.5. E11.5 Fgfr2(ST-/- mice had randomized UB induction sites with approximately 1/3 arising too high and 1/3 too low from the Wolffian duct; however, apoptosis was unaltered in E12.5 mutant CNDs. While ureters were histologically normal, E15.5 Fgfr2(ST-/- mice exhibit improper ureteral insertion sites into the bladder, consistent with the ureteric induction defects. While ureter and bladder histology appeared normal, postnatal day (P 1 mutants had high rates of VUR versus controls (75% versus 3%, p = 0.001 and occasionally other defects including renal hypoplasia and duplex systems. P1 mutant mice also had improper ureteral bladder insertion sites and shortened intravesicular tunnel lengths that correlated with VUR. E10.5 Fgfr2(ST-/- mice had decreases in Bmp4 mRNA in stromal tissues, suggesting a mechanism underlying the ureteric induction and VUR phenotypes.Mutations in FGFR2 could possibly cause VUR in humans.

  11. Vesicoureteral reflux: A historical perspective

    African Journals Online (AJOL)

    K.N. DeCotiis

    2016-12-28

    Dec 28, 2016 ... J.Penna@dartmouth.edu (F.J. Penna), martin.koyle@sickkids.ca. (M.A. Koyle), ACaldamone@lifespan.org (A.A. Caldamone). Peer review under responsibility of Pan African Urological Surgeons'. Association. the years based on changing concepts of VUR and its inherent risks. One needs only to consider ...

  12. Hidronefrosis prenatal secundaria a reflujo vesicoureteral

    Directory of Open Access Journals (Sweden)

    Sandalio Durán Álvarez

    2003-09-01

    Full Text Available Se realizó uretrocistografía miccional a 54 niños (37 varones a los que mediante ultrasonido materno-fetal se les había detectado dilatación de una o ambas pelvis renales (20 tenían dilatación bilateral. En 12 (22,2 % de los 54 niños se demostró reflujo vesicoureteral; 9 (75 % de ellos varones. Los 9 varones tenían 12 unidades renales refluyentes y en 2 de las 3 niñas el reflujo era bilateral. De los 7 reflujos de alto grado (IV y V 6 correspondieron al sexo masculino. El estudio gammagráfico estático (Tc 99m-DMSA demostró afectación de 4 riñones con reflujo de alto grado y en 1, grado II sin antecedentes de infección en ninguno de ellos. La función renal relativa de estos riñones osciló entre 40 y 9 %. Se demostró reflujo vesicoureteral de bajo grado (I y II en 2 pacientes que no mostraban dilatación pélvica en la unidad renal con estos reflujos. Todos los reflujos de alto grado se correspondieron con dilataciones hidronefróticas severas.Cystourethrography was performed on 54 children of whom 37 were males, who had been previously detected dilatation of one or both renal pelvis through maternal-fetal ultrasound (20 had bilateral dilatation. The test detected vesicoureteral reflux in 12 of the 54(12 %; 9 of them were males. The 9 boys had 12 refluxed renal units and 2 of the 3 girls presented with bilateral reflux. Six of the 7 high grade (IV and V refluxes corresponded to boys. The static scintigraphic study (TC 99m-DMSA showed that four kidneys were affected with high grade reflux and one with grade II reflux, without having history of infections of any kind. The relative renal function of these kidneys ranged from 9 to 40 %. Low grade vesicoureteral reflux (I and II was present in two patients who did not show pelvic dilatation in the renal unit with these refluxes. All high grade refluxes corresponded to severe hydronephrotic dilatations.

  13. Randomized clinical trial comparing endoscopic treatment with dextranomer hyaluronic acid copolymer and Cohen's ureteral reimplantation for vesicoureteral reflux: long-term results.

    Science.gov (United States)

    Garcia-Aparicio, L; Rovira, J; Blazquez-Gomez, E; García-García, L; Giménez-Llort, A; Rodo, J; Morales, L

    2013-08-01

    To compare efficacy of Cohen's ureteral reimplantation and endoscopic treatment with Dx/HA in patients with primary VUR grades II, III and IV. From April 2002 to June 2004, patients over 1 year old with VUR grade I, II, III or IV were included. Patients were randomized into two groups: endoscopic treatment (ET) or ureteral reimplantation (UR). In the ET group, an ultrasonography study was performed 24 h and 1 month after surgery, and two voiding cystourethrographies at 3 and 6 months post treatment. In the UR group, an ultrasonography study was done 7 days and 1 month after surgery and a micturial cystography 6 months post surgery. A postoperative nuclear direct cystogram was performed 5 years later in both groups. A total of 41 patients were included in this study: in ET 22 patients with 35 refluxing ureters and in UR 19 patients with 32 refluxing ureters. The VUR grades in ET were: 16 grade II, 16 grade III and 3 grade IV; and in UR: 15 grade II, 12 grade III and 5 grade IV. VUR was resolved in 91% (32/35) of ET (28% of ureters needed a second injection), and in 100% of UR group. Five years after the procedure, VUR was still resolved in 30/32 of ET and 32/32 of UR. Short- and long-term follow up shows that multiple endoscopic treatment of VUR grades II, III and IV with Dx/HA is as effective as ureteral reimplantation. Copyright © 2013 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

  14. Características clínicas del reflujo vesicoureteral en niños atendidos en el Hospital Universitario San Vicente de Paúl de Medellín,1960-2004 Clinical characteristics of vesicoureteral reflux in children at a university hospital in Medellín, Colombia. 1960-2004.

    Directory of Open Access Journals (Sweden)

    José William Cornejo Ochoa

    2006-01-01

    estudio más temprano y un mejor tratamiento de estos niños. A total of 4.129 children with the diagnosis of urinary tract infection (UTI were attended at Hospital Universitario San Vicente de Paúl in Medellín, Colombia, between 1960 and 2004. Vesicoureteral reflux (VUR, the commonest anomaly associated to UTI, was found in 1.309 children (31.7% who presented 1.914 cases of affected renal units (605 patients had bilateral reflux. This is a descriptive, retrospective work, carried out with information registered at the pediatric nephrology service by one of the authors (VPE on children younger than 17 years, with the diagnosis of VUR. The most important registered characteristics were reviewed, and the findings were as follows: 61.1% of children were women, 29.2% had the diagnosis of VUR made during the first year of life, and 41.4% had other associated anomalies; 72.4% of children had VUR of either III or IV grades, 53.8% had unilateral reflux, 23.8% had spontaneous resolution, and 36.1% required surgical correction. In 582 (44.5% out of 1.309 of these patients, studies for renal scarring were carried out, and it was found in 371 (63.7%; 2.3% had high blood pressure, 7.4% developed chronic renal failure; 0.9% received kidney transplantation, and 2.4% died. Our findings, similar to those reported by other authors, allow us to insist on the need for adequate management of children with VUR, because of the risk of developing high blood pressure and chronic renal failure. Better diagnostic systems for VUR and renal scarring, the progress of information diffusion, and the medical interest on this subject are opportunities for making earlier diagnoses, and opportune and proper treatment of these children.

  15. Intra-renal reflux: A new cause of medullary hyperechogenicity

    Energy Technology Data Exchange (ETDEWEB)

    Diard, F.; Nicolau, A.; Bernard, S.

    1987-02-01

    A 5-month-old infant with untreated severe urinary tract infection and bilateral vesico-ureteral reflux, had diffuse intrarenal reflux and hyperechogenicity of the medulla of two normal sized kidneys. We discuss the hyperechogenicity of the medulla in relationship to the intrarenal reflux.

  16. Clinical and neurophysiologic characterization of an European family with hereditary sensory neuropathy, paroxysmal cough and gastroesophageal reflux

    Directory of Open Access Journals (Sweden)

    Pedro Barros

    2014-04-01

    Full Text Available In 2002, Spring et al reported a family with an autosomal dominant form of hereditary sensory neuropathy; patients also presented adult onset of gastroesophageal reflux and cough. Since then, no further families have been described. Objective: To study a new Portuguese family with these characteristics. Method: To describe the clinical and neurophysiologic characteristics of one family with features of sensory neuropathy associated with cough and gastroesophageal erflux. Results: Three of five siblings presented a similar history of paroxysmal cough (5th decade. About a decade later they experienced numbness and paraesthesia in the feets and in all cases there was evidence of an axonal sensory neuropathy. A history of gastroesophageal reflux of variable severity and age of onset was also present. Discussion: Molecular genetic studies have demonstrated genetic heterogeneity between the hereditary sensory neuropathy type 1 subtypes. The identification of these families is of major importance because further work is required to identify the underlying genetic defect.

  17. Spontaneous vesicoureteral refl ux resolution in children: A ten-year ...

    African Journals Online (AJOL)

    Background/Aim: To evaluate the spontaneous resolution rate in infants and young children with vesicoureteral reflux (VUR). Patients and Methods: Paediatric patients with VUR treated in our hospital from January 2000 to December 2010 were retrospectively analyzed. Only patients with pretreatment and followup voiding ...

  18. Evaluación de la mutación a3243g en mtDNA, en familias de pacientes diagnosticados con el síndrome Melas Clinical characteristics of vesicoureteral Reflux in children at a University Hospital in Medellín, Colombia. 1960-2004.

    Directory of Open Access Journals (Sweden)

    Andrés Ruiz

    2003-01-01

    Full Text Available

    Las citopatías mitocondriales constituyen un variado grupo de desórdenes generados por déficits de la producción de energía en la mitocondria (1, proceso llevado a cabo a través de cinco complejos multienzimáticos ubicados en la membrana interna mitocondrial. Las subunidades que conforman estos complejos son codificadas por genoma nuclear y mitocondrial (mtDNA. Hasta el momento se ha identificado un gran cantidad de citopatías causadas por mutaciones en mtDNA; la más frecuente es MELAS (Mitochondrial Encephalomyopathy with Lactic acidosis and Stroke-like episodes (2, de ésta, el 80% de los casos poseen la mutación A3243G en el gen del tRNALeu (3. En dicha mutación se ha encontrado hasta un 95% de heteroplasmia (4, lo cual hace que la variación en el fenotipo
    sea muy amplia.


    En este trabajo se evaluó la mutación A3243G en pacientes con diagnóstico de MELAS así como a sus familiares.

    A Total of 4.129 children with the diagnosis of urinary tract infection (UTI were attended at Hospital Universitario San Vicente de Paúl in Medellín, Colombia, between 1960 and 2004. Vesicoureteral reflux (VUR, the commonest anomaly associated to UTI, was found in 1.309 children (31.7% who presented 1.914 cases of affected renal units (605 patients had bilateral reflux. This is a descriptive, retrospective work, carried out with information registered at the pediatric nephrology service by one of the authors (VPE on children younger than 17 years, with the diagnosis of VUR. The most important registered characteristics were reviewed, and the findings were as follows: 61.1% of children were women, 29.2% had the diagnosis of VUR made during the first year of life, and 41.4% had other associated anomalies; 72.4% of children had VUR of either III or IV grades, 53.8% had unilateral reflux, 23.8% had spontaneous resolution, and 36.1% required surgical correction. In 582 (44.5% out of 1.309 of these patients, studies for renal

  19. Miturition cystourethrography using X-ray or scintigraphy in children with reflux

    Energy Technology Data Exchange (ETDEWEB)

    Brendstrup, L.; Carlsen, N.; Nielsen, S.L.; Dyrbye, M.; Eiken, M.; Krasilnikoff, P.A.; Gertz, T.C. (Gentofte Hospital, University of Copenhagen (Denmark))

    1983-01-01

    Thirty children with first time urinary tract infection were investigated for vesicoureteral reflux after bladder catheterization. Micturition cystourethrography with X-ray was compared to scintigraphy because scintigraphy gives less than 10% radiation dose by fluoroscopy. Reflux to the renal pelvis was observed more frequently with scintigraphy, otherwise the nosographic sensitivity and the preditive value of a negative test were about the same (0.90). Scintigraphy is therefore recommended for routine control of reflux children.

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

    African Journals Online (AJOL)

    M.C. Arya

    2016-12-26

    Dec 26, 2016 ... Observation: A 9-year-old child was admitted with complaints of right renal pain. After workup a diagnosis of retrocaval ureter with ... pain for one month with no urinary complaints or fever in May 2015. Physical examination was ... Type 1 is fish hook or s-shaped. Ureter passes behind the inferior vena cava ...

  1. How reflux causes symptoms: reflux perception in gastroesophageal reflux disease.

    Science.gov (United States)

    Weijenborg, Pim W; Bredenoord, Albert J

    2013-06-01

    In gastroesophageal reflux disease (GERD) symptoms arise due to reflux of gastric content into the oesophagus. However, the relation between magnitude and onset of reflux and symptom generation in GERD patients is far from simple; gastroesophageal reflux occurs several times a day in everyone and the majority of reflux episodes remains asymptomatic. This review aims to address the question how reflux causes symptoms, focussing on factors leading to enhanced reflux perception. We will highlight esophageal sensitivity variance between subtypes of GERD, which is influenced by peripheral sensitization of primary afferents, central sensitization of spinal dorsal horn neurons, impaired mucosal barrier function and genetic factors. We will also discuss the contribution of specific refluxate characteristics to reflux perception, including acidity, and the role of bile, pepsin and gas and proximal extent. Further understanding of reflux perception might improve GERD treatment, especially in current partial responders to therapy. Copyright © 2013 Elsevier Ltd. All rights reserved.

  2. Laryngopharyngeal reflux

    Directory of Open Access Journals (Sweden)

    Maja Šereg-Bahar

    2007-01-01

    Full Text Available Background: In 4–10 % of patients with gastroesophageal reflux (GER some atypical symptoms are found (cough, hoarseness, globus pharyngeus, dyspnea which are characteristic for laryngopharyngeal reflux (LPR. The signs of LPR can be detected in more than 50 % of dysphonic patients. In the diagnostics of LPR, a meticulous history and a videoendoscopy of the larynx and pharynx are the most important procedures. The diagnosis of LPR can be confirmed by the 24-hour double probe pH monitoring and the treatment test with proton pump inhibitors. The best diagnostic results can be obtained with a combination of several diagnostic procedures.Conclusions: An otorhinolaryngologist can start a treatment test with proton pump inhibitors in a patient in whom a laryngopharyngeal reflux is suspected on the basis of history and laryngopharyngeal endoscopy. A successful treatment requires at least 12 weeks regimen with high doses 20 mg twice a day. In the case of alarm signs and unsuccessful treatment a gastroenterologic intervention is necessary.

  3. Evaluation of reflux nephropathy, pyelonephritis and renal dysplasia

    International Nuclear Information System (INIS)

    Grattan-Smith, J.D.; Little, Stephen B.; Jones, Richard A.

    2008-01-01

    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.)

  4. 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.)

  5. 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.)

  6. Salvage dextranomer-hyaluronic acid copolymer for persistent reflux after ureteral reimplantation: early success rates.

    Science.gov (United States)

    Bar-Yosef, Yuval; Castellan, Miguel; Joshi, Devandra; Labbie, Andrew; Gosalbez, Rafael

    2011-06-01

    Endoscopic injection of dextranomer-hyaluronic acid copolymer is an accepted initial procedure to correct vesicoureteral reflux. Less data are available on its role in treating failed ureteral reimplantation. We retrospectively reviewed the charts from 2002 to 2008 and identified 21 patients (26 ureteral units) with persistent reflux after reimplantation. Mean age was 7 years (range 2 to 13). Mean followup was 2 years (range 10 to 46 months). Of the 17 patients with a single system ureteral reimplantation was extravesical in 9 and intravesical in 8 with tapering performed in 5. Three patients underwent reimplantation of duplex systems and 1 underwent reimplantation due to ureterocele. Residual reflux grade was 1 to 4 in 3 (11%), 17 (65%), 3 (11%) and 3 ureteral units (11%), respectively. Dextranomer-hyaluronic acid copolymer was injected transurethrally. The mean volume injected was 1.2 ml (range 0.7 to 3). After 1 injection reflux resolved in 15 patients (71%) or a total of 20 ureteral units (77%), including 12 of 14 (86%) extravesically and 8 of 12 (66%) intravesically reimplanted units. The resolution rate improved to 84% after multiple injections. Two of the 6 patients with reflux after 1 injection had a single system, 2 had an obstructive megaureter with tapered reimplantation, 1 had a duplicated system and 1 had a ureterocele. Three of the 5 patients with persistent reflux underwent revision surgery. Ureteral abnormalities other than reflux and tapered reimplantation were associated with a statistically significant inferior success rate. Dextranomer-hyaluronic acid copolymer injection is an efficacious salvage procedure for persistent reflux after ureteral reimplantation. The success rate is inferior for ureteral abnormalities other than primary vesicoureteral reflux and after tapering. Copyright © 2011 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  7. 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)

  8. A Review of the Effect of Injected Dextranomer/Hyaluronic Acid Copolymer Volume on Reflux Correction Following Endoscopic Injection

    Directory of Open Access Journals (Sweden)

    Sumit Dave

    2008-01-01

    Full Text Available The current literature suggests that multiple variables affect vesicoureteric reflux (VUR resolution rates following dextranomer/hyaluronic acid copolymer (Dx/HA injection. This article reviews the evidence pertaining to the effect of injected Dx/HA volume on success rates following endoscopic correction. Lack of prospective studies which use injected volume as a continuous variable coupled with a nonstandardized injection technique and endpoint hinders the ability to reach a definite conclusion.

  9. A Review of the Effect of Injected Dextranomer/Hyaluronic Acid Copolymer Volume on Reflux Correction Following Endoscopic Injection

    OpenAIRE

    Dave, Sumit; Bägli, Darius J.

    2008-01-01

    The current literature suggests that multiple variables affect vesicoureteric reflux (VUR) resolution rates following dextranomer/hyaluronic acid copolymer (Dx/HA) injection. This article reviews the evidence pertaining to the effect of injected Dx/HA volume on success rates following endoscopic correction. Lack of prospective studies which use injected volume as a continuous variable coupled with a nonstandardized injection technique and endpoint hinders the ability to reach a definite concl...

  10. A Review of the Effect of Injected Dextranomer/Hyaluronic Acid Copolymer Volume on Reflux Correction Following Endoscopic Injection

    Science.gov (United States)

    Dave, Sumit; Bägli, Darius J.

    2008-01-01

    The current literature suggests that multiple variables affect vesicoureteric reflux (VUR) resolution rates following dextranomer/hyaluronic acid copolymer (Dx/HA) injection. This article reviews the evidence pertaining to the effect of injected Dx/HA volume on success rates following endoscopic correction. Lack of prospective studies which use injected volume as a continuous variable coupled with a nonstandardized injection technique and endpoint hinders the ability to reach a definite conclusion. PMID:18827895

  11. Tc-99m-DTPA renal scintigraphy and detection of intrarenal reflux

    International Nuclear Information System (INIS)

    Poropat, M.; Basic, M.; Dodig, D.; Batinic, D.; Nizic, Lj.

    1994-01-01

    The intrarenal reflux plays the key role in the etiology of reflux nephropathy and its detection is of utmost importance in evaluating possible damage in kidney with reflux. In 176 kidneys (113 children) with different degree of vesicoureteric reflux (VUR), dynamic renal scintigraphy with Tc-99m-DTPA in zoom mode was performed. From each study 6 functional images of mean time were generated, kidney contour superimposed on each, and time activity curves (TAC) over possible areas of increased mean time were generated. In these study we analyzed only areas of increased mean time over the outer contour of the kidney which corresponds to the renal parenchyma. In later functional images of the mean time we found 53 focal retentions over the part of the kidney which corresponds to the renal cortex (33 in upper, 5 in middle and 15 in lower part of the kidney). TAC-s generated over these areas exhibited a sharp increase of activity on the descending part of the curves. We propose that the return of activity from the collecting system to the kidney cortex represents intrarenal reflux. In our opinion, analysis of functional images of the mean time could be a method for more accurate detection of intrarenal reflux and indicating the children with high risk to acquire renal scarring. (author)

  12. Is the appearance of the dextranomer/hyaluronic acid mound predictive of reflux resolution?

    Science.gov (United States)

    Hidas, Guy; Soltani, Tandis; Watts, Blake; Pribish, Maryellen; Khoury, Antoine E

    2013-05-01

    After endoscopic correction of vesicoureteral reflux, we correlated the appearance of the Deflux® mound with the outcome. We created an online survey based on 11 primary vesicoureteral reflux cases, including 6 failed and 9 successful procedures in a total of 15 renal units. Cases were selected randomly from our video library. All cases were performed by a single surgeon using the double hydrodistention implantation technique until a satisfactory mound was achieved and corrected. An online survey questionnaire was e-mailed to 234 members of the Society for Pediatric Urology. Each survey question contained a preoperative voiding cystourethrogram image as well as images of the ureteral orifice before and after injection. Respondents were asked to predict whether they thought that the appearance of the Deflux mound would be associated with successful reflux resolution on voiding cystourethrogram 3 months postoperatively. We analyzed the percent of correctly answered questions as well as the sensitivity, specificity and predictive value of the ability of experts to predict the outcome. A total of 104 pediatric urologists responded to the survey. Overall, 66.4% of respondents predicted reflux resolution based on mound appearance, including 66% and 67% who correctly predicted success and failure, respectively. Mean outcome predictability per respondent was 66% (range 26% to 86%). The appearance of the Deflux mound and lack of hydrodistention at the completion of the procedure are not reliable predictors of outcome. Based on this experience, postoperative voiding cystourethrogram is still required to truly determine reflux resolution. Copyright © 2013 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  13. Gastroesophageal reflux disease - children

    Science.gov (United States)

    Peptic esophagitis - children; Reflux esophagitis - children; GERD - children; Heartburn - chronic - children; Dyspepsia - GERD - children ... GERD. Certain factors can lead to GERD in children, including: Birth defects, such as hiatal hernia , a ...

  14. Radiodiagnosis of vesicoureteral reflux in the early postoperative period after adenomectomy of the prostate

    International Nuclear Information System (INIS)

    Gytlan, I.D.; Shekhter, A.I.; Vinarov, A.Z.; Uskov, I.A.

    1988-01-01

    Altogether 204 patients aged 43 to 81 were examined in the early postoperative period after adenomectomy of the prostate. Passive VUR was detected by means of routine cystography, X-ray TV cystography, direct radionuclide cystography and ultrasonic investigation. The presence of VUR in ultrasonic investigation was established by the signs of dilatation of renal pelves and calycles in filling in of the bladder with antiseptic solution. Ultrasonic investigation made it possible to diagnose VUR of 3-4 degree. Active VUR was detected by miction cystography and X-ray TV miction cystography on the day of removal of drainage tubes from the bladder. Unlike the radionuclide and ultrasonic methods, these two methods made it possible to assess the state of the bladder cervix and urethra. The authors proposed an optimum sequence of the use of diagnostic methods for early detection of VUR and prevention of severe complications

  15. Histopathological changes associated with dextranomer/hyaluronic acid injection for pediatric vesicoureteral reflux.

    Science.gov (United States)

    Routh, Jonathan C; Ashley, Richard A; Sebo, Thomas J; Vandersteen, David R; Slezak, Jeffrey; Reinberg, Yuri

    2007-10-01

    Few studies have examined the medium and long-term histological changes associated with periureteral injection of dextranomer/hyaluronic acid copolymer (Deflux(R)). We present the results of a histological review of a series of distal ureteral excisions in patients undergoing ureteroneocystostomy after failed dextranomer/hyaluronic acid injection. All patients undergoing ureteroneocystostomy after failed dextranomer/hyaluronic acid injection(s) at 1 institution were eligible for this study. Excised ureteral segments were histologically examined by a single urological pathologist. An immunohistochemical battery was used for each specimen, including hematoxylin and eosin, CD3, CD20, MIB-1 and trichrome stains. Pathological criteria included the presence, location and intensity of fibrosis, giant cell reaction, chronic inflammation, free dextranomer/hyaluronic acid, and CD3, CD20 and MIB-1 staining. Pathological features were correlated with the time from injection to surgical excision. The ureters of 16 children with a mean age of 4.5 years were examined. Median time from injection to implant excision was 8 months. Giant cell reaction was present in 94% of patients and it was typically located in the serosa. No histological or immunophenotypical feature correlated with the duration of implantation except CD3+ and CD20+ lymphocyte counts, which increased with time from injection (p = 0.06 and 0.02, respectively). Dextranomer/hyaluronic acid appears to be stable and safe for use after 3 to 22 months of followup of subureteral injection. The periureteral inflammatory reaction increases with time, although no increases in nuclear turnover or fibrosis were detected.

  16. Observation of vesicoureteral reflux (VUR) by means of the RI technique

    International Nuclear Information System (INIS)

    Ito, Shigemitsu; Kato, Ruriko; Asano, Yoshizo

    1982-01-01

    VUR was observed in relation to intravesical pressure using a renogram apparatus and a disposable CVP manometer set. It was found that, in addition to the classification having low pressure and high pressure types of VUR, another classification consisting of transient, reversible, and persistent types should be introduced. In the patient with reversible low-pressure VUR, compression on his abdomen caused persistent, high-pressure VUR. This suggested the difference of the two types in mechanism. The persistent VUR seems to take an important roll in the development of renal injury. With only an apparatus of renogram, this method can be applied to children, and it can be used on cystography. As the exposure dose was less than that of renogram, this method is considered to be useful as a means of screening and follow-up. (Ueda, J.)

  17. Distribution of renal scars and intrarenal reflux in children with a past history of urinary tract infection

    International Nuclear Information System (INIS)

    Hannerz, L.; Wikstad, I.; Johansson, L.; Broberger, O.; Aperia, A.

    1987-01-01

    The distribution of renal scars in children with vesicoureteral reflux (VUR) and a past history of urinary tract infection was studied to see whether a correlation existed between renal scaring and intrarenal reflux. In 37 children with one or more scars in one or both kidneys, scarring was significantly more frequent in the polar areas than in the lateral area. In 7 children with intrarenal reflux (IRR), the distribution of IRR was almost identical with that of renal scarring. When children with marked VUR (grade IV-V) were analyzed separately, a uniform distribution of scars was found. It was concluded that fused papillae, which normally are most frequent in the polar area, are a prerequisite for the development of IRR/renal scars. (orig.)

  18. Pediatric Urinary Tract Infections and Vesicoureteral Refl ux: What ...

    African Journals Online (AJOL)

    It has been nearly 50 years since Victor Politano and Wyland Leadbetter developed the first reliable operation for the surgical correction of vesicoureteral refl ux (VUR). It dispelled the notion of bladder outlet obstruction as the primary cause of refl ux. One might argue, however, since the operation was so reproducible that ...

  19. Reflux and aerodigestive tract diseases

    NARCIS (Netherlands)

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

    2013-01-01

    Gastroesophageal reflux disease can present with a wide variety of extraesophageal symptoms. In particular, the type of disease characterized predominately by laryngopharyngeal reflux may be difficult to diagnose because of the absence of regurgitation or heartburn. The available battery of

  20. Reflux.pm6

    African Journals Online (AJOL)

    Adele

    reflux related aspects of life, such as problems with food and drink (3.5), emotional distress (3.6), impaired vitality (3.7), sleep disturbance (3.8) and impaired ... sions: emotional distress, sleep disturbance, vitality, food/ drink problems and .... acute coronary events.40 These aspects of patients' lives are impaired whether or ...

  1. Refractory gastrooesophageal reflux disease

    NARCIS (Netherlands)

    Bredenoord, Albert J.; Smout, André J.

    2008-01-01

    The introduction of proton pump inhibitors (PPIs) has facilitated the treatment of gastrooesophageal reflux disease (GORD) enormously; however, treatment of GORD still fails in a small proportion of patients. This small proportion of therapy-resistant patients encompasses a substantial part of the

  2. Refractory gastrooesophageal reflux disease

    NARCIS (Netherlands)

    Bredenoord, Albert J.; Smout, Andre J.

    The introduction of proton pump inhibitors (PPIs) has facilitated the treatment of gastrooesophageal reflux disease (GORD) enormously; however, treatment of GORD still fails in a small proportion of patients. This small proportion of therapy-resistant patients encompasses a substantial part of the

  3. [Update on gastroesophageal reflux disease].

    Science.gov (United States)

    Serra Pueyo, Jordi

    2014-02-01

    Gastroesophageal reflux disease is a highly frequent disorder classically characterized by the presence of heartburn and/or acid regurgitation that improves with drug therapy that reduces acid content in the stomach. However, especially in patients with non-erosive disease, response to proton pump inhibitors is unsatisfactory in approximately 1 out of 3 patients, and consequently, in these patients, it is important to establish a definitive diagnosis and an alternative therapeutic strategy. In the last few years, advances have been made in knowledge of the physiopathology of reflux, such as identification of the role of the acid pocket in producing reflux, technological advances that allow differentiation among acid reflux, non-acid reflux and slightly acid reflux, and advances in the treatment of reflux with drugs that attempt to act on the barrier function of the esophagogastric junction. Copyright © 2013 Elsevier España, S.L. and AEEH y AEG. All rights reserved.

  4. Reflux and GERD (in Children)

    Science.gov (United States)

    ... Distinctions and Management Video Teen GERD Video Medical Animation Video Pediatric GERD PBS Episode AUDIO Infant Reflux and GERD: Distinctions and Management Supporters Support for the NASPGHAN Foundation's Pediatric Reflux and GERD Education Campaign was provided by AstraZeneca LP and Takeda ...

  5. Therapieresistentie van gastro-oesofageale refluxklachten: zure reflux, niet-zure reflux of geen reflux

    NARCIS (Netherlands)

    Bredenoord, A. J.; Smout, A. J. P. M.

    2008-01-01

    The introduction of proton pump inhibitors (PPIs) was a huge step forward in the treatment of gastric acid-related disorders such as reflux disease and gastric ulcers. Despite the strong effectiveness of PPIs, in a small number of patients reflux symptoms are not adequately relieved by these drugs.

  6. Accuracy of cystosonography in the diagnosis of vesicourethral reflux in children

    Directory of Open Access Journals (Sweden)

    Hasan Otukesh

    2011-01-01

    Full Text Available Vesicoureteric reflux (VUR is found in 1% of all children and in 30%-50% of those with urinary tract infection. Furthermore, VUR in childhood is the main reason for pyelonephritis, hypertension and chronic kidney disease. Recently, a variety of procedures with low radiation have been recommended for diagnosis of VUR. Therefore, in this study, voiding urosonography (VUS or cystosonography was performed for evaluation of VUR and for comparing it with radio nucleotide cystography (RNC. We studied 25 children admitted with initial diagnosis of VUR in our center in the year 2007. Simultaneously, RNC and VUS were performed for all the patients. VUR was detected in eight patients with the VUS procedure and in nine children with RNC. Another patient was diagnosed only by RNC, and two other patients by only VUS. The two methods were concordant in detection and exclusion of urinary reflux in 87% (P: 0.000, r: 0.728. Furthermore, the diagnosis of various grades of reflux by these two schemes were comparable (P: 0.0000, r: 0.724. Sensitivity and specifity of VUS was determined as 87% and 88%, respectively, with a 94% positive predictive value and a 77% negative predictive value. We conclude that VUS is a highly accurate, safe and inexpensive tool for the screening, diagnosis and follow-up of VUR.

  7. Closed loop reflux system

    International Nuclear Information System (INIS)

    De Witt, R.; Jepson, B.E.; Schwind, R.A.

    1975-01-01

    Sulfur isotopes are continuously separated and enriched using a closed loop reflux system wherein sulfur dioxide (SO 2 ) is reacted with sodium hydroxide (NaOH) or the like to form sodium hydrogen sulfite (NaHSO 3 ). Heavier sulfur isotopes are preferentially attracted to the NaHSO 3 , and subsequently reacted with sulfuric acid (H 2 SO 4 ) forming sodium hydrogen sulfate (NaHSO 4 ) and SO 2 gas, which contains increased concentrations of the heavier sulfur isotopes. This heavy isotope enriched SO 2 gas is subsequently separated and the NaHSO 4 is reacted with NaOH to form sodium sulfate (Na 2 SO 4 ), which is subsequently decomposed in an electrodialysis unit to form the NaOH and H 2 SO 4 components, which are used in the aforesaid reactions thereby effecting sulfur isotope separation and enrichment without objectionable loss of feed materials. (U.S.)

  8. What is LPR (Laryngopharyngeal Reflux)

    Science.gov (United States)

    ... press registration and more below. Please direct any interview requests or policy questions to our media and public relations staff at newsroom@entnet.org . Insight into the diagnosis, prevention, and treatment of laryngopharyngeal reflux (LPR) What ...

  9. Parenchymal reflux in renal dysplasia

    International Nuclear Information System (INIS)

    Pinckney, L.E.; Currarino, G.; Weinberg, A.G.

    1981-01-01

    Primitive ducts, tubules, and cysts often communicate with the pelvocalyceal systems of dysplastic kidneys, and may sometimes be filled in retrograde fashion with radiographic contrast material. Their size, shape, and distribution provide a variable radiographic appearance that must be distinguished from other causes of intrarenal reflux. When reflux filling of dysplastic structures is incomplete, the radiographic findings do not fully represent the severity of anatomic abnormality

  10. Gastroesophageal reflux after esophageal surgery

    International Nuclear Information System (INIS)

    Nishimura, Osamu; Yokoi, Hideki; Maebeya, Shinji

    1989-01-01

    By means of esophageal transit scintigram using 99m Tc-DTPA, 15 patients (13 esophageal carcinomas and 2 cardia carcinomas) were studied, in whom esophagogastric anastomosis was done according to the posterior invagination anastomosis technique we had devised. In all 8 patients with anastomosis at cervical region, gastroesophageal reflux was not seen on both scintigrams before and after meals, and the average pressure gradient of high pressure zone at anastomosis was 39.8 cmH 2 O. In 2 of 7 patients with intrathoracic anastomosis, the scintigram before meals showed severe reflux. and the endoscopic findings showed diffuse and moderate erosion in the esophageal mucosa. The average pressure gradient across the anastomosis was 6.5 cmH 2 O. In these 2 patients, the new fornix with a sharp angle of His was not formed. In the remaining 5 patients with intrathoracic anastomosis, reflux was not seen on the scintigram before meals. However, in 2 of them, the scintigram after meal and endoscopic examination revealed mild reflux and mild esophagitis respectively. Furthermore in one patient very mild reflux was observed only on the scintigram after meals but the endoscopic findings showed the normal esophageal mucosa. In these 5 patients, the average pressure gradient across the anastomosis was 17.0 cmH 2 O, which was significantly higher (p<0.01) than that in 2 patients with severe reflux and was significantly lower (p<0.01) than the mean value of high pressure zone in 8 patients with cervical anastomosis. In conclusion, it is presumed that the formation of a large fornix enough to store food and a sharp angle of His are important factors in maintaining an anti-reflux mechanism. The esophageal transit scintigram was proved to be an excellent technique in detecting and evaluating quantitatively gastroesophageal reflux. (author)

  11. 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.

  12. Pediatric GERD (Gastro-Esophageal Reflux Disease)

    Science.gov (United States)

    ... Doctor Near You Pediatric GERD (Gastro-Esophageal Reflux Disease) Pediatric GERD (Gastro-Esophageal Reflux Disease) Patient Health ... pH probe: A small wire with an acid sensor is placed through the nose down to the ...

  13. Qualitative evaluation of the enterogastric reflux

    Energy Technology Data Exchange (ETDEWEB)

    Jimenez Garcia, A.; Ortega Bevia, J.M.; Garcia Fernandez, S.; Bonet Padilla, R.; Jimenez Garcia, E.; Rodrigues de Quesada, B. (Hospital Universitario da Faculdade de Medicina, Sevilla (Spain)); Szego, T. (Sao Paulo Univ. (Brazil). Faculdade de Medicina)

    Using Tc/sup 99/ - labeled HIDA, enterogastric reflux was studied in 24 subjects - six asymptomatic individuals and 18 previously submitted to gastric surgery for ulcers, through truncular vagotomy + pyloroplasty, gastrectomy with either BI or BII reconstruction. In the control group there was no evidence of reflux. In the subject group, seven of the 18 patients showed clearly enterogastric reflux. It is concluded that method is readily performed, without morbidity in these series, with a clear picture of the enterogastric reflux.

  14. Determinants of reflux-induced chronic cough

    NARCIS (Netherlands)

    Herregods, Thomas V. K.; Pauwels, Ans; Jafari, Jafar; Sifrim, Daniel; Bredenoord, Albert J.; Tack, Jan; Smout, André J. P. M.

    2017-01-01

    Objective Gastro-oesophageal reflux is considered to be an important contributing factor in chronic unexplained cough. It remains unclear why some reflux episodes in the same patient causes cough while others do not. To understand more about the mechanism by which reflux induces cough, we aimed to

  15. Morphine-augmented cholescintigraphy enhances duodenogastric reflux

    Energy Technology Data Exchange (ETDEWEB)

    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).

  16. Augmentation cystoplasty and simultaneous ureteral reimplantation reduce high-grade vesicoureteral reflux in children with neurogenic bladder

    Directory of Open Access Journals (Sweden)

    Jen-Bin Wang

    2011-07-01

    Conclusion: Simultaneous ureteral reimplantation reduces postop HVUR significantly. We recommend augmentation and simultaneous ureteral reimplantation in children with HVUR and neurogenic bladder if technically feasible.

  17. A Comparison of Calcium Hydroxyapatite and Dextranomer/Hyaluronic Acid for the Endoscopic Treatment of Vesicoureteral Reflux

    OpenAIRE

    Ngo, Tin C.; Wong, Ilene Yi-Zhen; Kennedy, William A.

    2013-01-01

    Purpose. Minimal data exists comparing dextranomer/hyaluronic acid (Dx/HA) and calcium hydroxyapatite (CaHA) for the endoscopic treatment of VUR in the hands of a single user. Materials and Methods. We reviewed our consecutive single-user case series of 27 children (42 ureters) receiving endoscopic treatment with CaHA and 21 children (33 ureters) who received Dx/HA injection. Children receiving CaHA injections were divided into two groups of 13 and 14 patients (Coaptite I and II) to assess th...

  18. A Comparison of Calcium Hydroxyapatite and Dextranomer/Hyaluronic Acid for the Endoscopic Treatment of Vesicoureteral Reflux

    Science.gov (United States)

    Ngo, Tin C.; Wong, Ilene Yi-Zhen; Kennedy, William A.

    2013-01-01

    Purpose. Minimal data exists comparing dextranomer/hyaluronic acid (Dx/HA) and calcium hydroxyapatite (CaHA) for the endoscopic treatment of VUR in the hands of a single user. Materials and Methods. We reviewed our consecutive single-user case series of 27 children (42 ureters) receiving endoscopic treatment with CaHA and 21 children (33 ureters) who received Dx/HA injection. Children receiving CaHA injections were divided into two groups of 13 and 14 patients (Coaptite I and II) to assess the learning curve effects. Postoperatively, RBUS and VCUG were performed. Multiple regression analysis was performed to assess statistical significance of success rates. Results. The total CaHA group had a per-ureter success rate (Grade 0) of 52% after one injection. When separated into two cohorts, the single injection per-ureter success rates were 43% for Coaptite I and 62% for Coaptite II. In contrast, the Dx/HA series had a single injection per-ureter success rate (Grade 0) of 78%. Conclusions. Our consecutive case experience shows improved results for Dx/HA compared to CaHA, though the learning curve effects and evolution of injection technique likely played a role in the improved outcomes in the Dx/HA cohort. A randomized controlled multicenter trial would provide the most accurate data comparing these two agents. PMID:24235969

  19. A Comparison of Calcium Hydroxyapatite and Dextranomer/Hyaluronic Acid for the Endoscopic Treatment of Vesicoureteral Reflux

    Directory of Open Access Journals (Sweden)

    Tin C. Ngo

    2013-01-01

    Full Text Available Purpose. Minimal data exists comparing dextranomer/hyaluronic acid (Dx/HA and calcium hydroxyapatite (CaHA for the endoscopic treatment of VUR in the hands of a single user. Materials and Methods. We reviewed our consecutive single-user case series of 27 children (42 ureters receiving endoscopic treatment with CaHA and 21 children (33 ureters who received Dx/HA injection. Children receiving CaHA injections were divided into two groups of 13 and 14 patients (Coaptite I and II to assess the learning curve effects. Postoperatively, RBUS and VCUG were performed. Multiple regression analysis was performed to assess statistical significance of success rates. Results. The total CaHA group had a per-ureter success rate (Grade 0 of 52% after one injection. When separated into two cohorts, the single injection per-ureter success rates were 43% for Coaptite I and 62% for Coaptite II. In contrast, the Dx/HA series had a single injection per-ureter success rate (Grade 0 of 78%. Conclusions. Our consecutive case experience shows improved results for Dx/HA compared to CaHA, though the learning curve effects and evolution of injection technique likely played a role in the improved outcomes in the Dx/HA cohort. A randomized controlled multicenter trial would provide the most accurate data comparing these two agents.

  20. Endoscopic management is the preferred treatment modality for a Grade III vesicoureteric reflux with breakthrough infections in a young girl

    Directory of Open Access Journals (Sweden)

    S S Joshi

    2008-01-01

    Full Text Available Endoscopic injection treatment for VUR appears to have less success rate than open surgical treatment, even in Gr 3 VUR. Economics of use of deflux injection and its success rate do not suit Indian milieu. To achieve high success rate of Atlanta group in endoscopic injection treatmnent , requires a longer learning curve and yet it has not achieved success rate of 96-98% achieved by open surgical techniques. Recent addition of modified extravesical reimplantation technique has reduced significantly the post operative pain and patient can be discharged within 2 days from the hospital.

  1. Rational use of CT in acute pyelonephritis: findings and relationships with reflux

    Energy Technology Data Exchange (ETDEWEB)

    Dacher, J.N. (Dept. of Pediatric Radiology, Hopital Charles Nicolle, University Hospital, Rouen (France)); Boillot, B. (Dept. of Pediatric Surgery, Hopital Charles Nicolle, University Hospital, Rouen (France)); Eurin, D. (Dept. of Pediatric Radiology, Hopital Charles Nicolle, University Hospital, Rouen (France)); Marguet, C. (Dept. of Pediatrics, Hopital Charles Nicolle, University Hospital, Rouen (France)); Mitrofanoff, P. (Dept. of Pediatric Surgery, Hopital Charles Nicolle, University Hospital, Rouen (France)); Le Dosseur, P. (Dept. of Pediatric Radiology, Hopital Charles Nicolle, University Hospital, Rouen (France))

    1993-07-01

    Enhanced renal CT scanners were performed in 38 children (82% girls) to rule out acute pyelonephritis. Patients were divided in 2 groups on the basis of clinical presentation and bacteriology data. In patients of group A (n = 16, preliminary study), upper urinary tract infection (UTI) was certain. CT confirmed the diagnosis in all but 3 patients (a 2-year-old child and 2 patients with UTI developed on prior obstruction). In subsequently studied patients of group B (n = 22), clinical findings or bacteriology data were negative or questionable. CT made the diagnosis of acute pyelonephritis in 11 patients. As well as DMSA scintigraphy, CT scanner can help to diagnose or to rule out upper UTIs in difficult cases. In all boys of both groups, ipsilateral vesico-ureteric reflux (VUR) was found by subsequent voiding cystourethrography (VCUG) on the side of pyelonephritis. In girls, this correlation was shown in only 7 of the 25 kidneys with pyelonephritis. This result supports the hypothesis of a gender-dependent contamination. We believe that absence of radiologic reflux cannot exclude the possibility of bacterial crossings of ureteric meatus capable to lead to genuine upper UTIs. (orig.)

  2. Rational use of CT in acute pyelonephritis: findings and relationships with reflux

    International Nuclear Information System (INIS)

    Dacher, J.N.; Boillot, B.; Eurin, D.; Marguet, C.; Mitrofanoff, P.; Le Dosseur, P.

    1993-01-01

    Enhanced renal CT scanners were performed in 38 children (82% girls) to rule out acute pyelonephritis. Patients were divided in 2 groups on the basis of clinical presentation and bacteriology data. In patients of group A (n = 16, preliminary study), upper urinary tract infection (UTI) was certain. CT confirmed the diagnosis in all but 3 patients (a 2-year-old child and 2 patients with UTI developed on prior obstruction). In subsequently studied patients of group B (n = 22), clinical findings or bacteriology data were negative or questionable. CT made the diagnosis of acute pyelonephritis in 11 patients. As well as DMSA scintigraphy, CT scanner can help to diagnose or to rule out upper UTIs in difficult cases. In all boys of both groups, ipsilateral vesico-ureteric reflux (VUR) was found by subsequent voiding cystourethrography (VCUG) on the side of pyelonephritis. In girls, this correlation was shown in only 7 of the 25 kidneys with pyelonephritis. This result supports the hypothesis of a gender-dependent contamination. We believe that absence of radiologic reflux cannot exclude the possibility of bacterial crossings of ureteric meatus capable to lead to genuine upper UTIs. (orig.)

  3. Determinants of reflux-induced chronic cough.

    Science.gov (United States)

    Herregods, Thomas V K; Pauwels, Ans; Jafari, Jafar; Sifrim, Daniel; Bredenoord, Albert J; Tack, Jan; Smout, André J P M

    2017-12-01

    Gastro-oesophageal reflux is considered to be an important contributing factor in chronic unexplained cough. It remains unclear why some reflux episodes in the same patient causes cough while others do not. To understand more about the mechanism by which reflux induces cough, we aimed to identify factors which are important in triggering cough. In this multicentre study, 49 patients with reflux-associated chronic cough were analysed using 24-hour pH-impedance-pressure monitoring. The characteristics of reflux episodes that were followed by cough were compared with reflux episodes not associated with cough. The majority (72.4%) of the reflux episodes were acidic (pHcough, reflux episodes that were followed by a cough burst were associated with a higher proximal extent (p=0.0001), a higher volume clearance time (p=0.002) and a higher acid burden in the preceding 15 min window (p=0.019) and higher reflux burden in the preceding 30 min window (p=0.044). No significant difference was found between the two groups when looking at the nadir pH, the pH drop, the acid clearance time or the percentage of reflux episodes which were acidic. The presence of a larger volume of refluxate and oesophageal exposure to reflux for a longer period of time seems to play an important role in inducing cough, while the acidity of the refluxate seems to be less relevant. This helps explain the observation that most patients with chronic cough tend not to benefit from acid inhibitory treatment. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  4. [Vesico-renal reflux and pregnancy].

    Science.gov (United States)

    Barbe, Y P; Ratajczak, A; Coadou, Y; Guille, F; Lobel, B

    1985-01-01

    By modifying the anatomical location of the bladder and ureter, and by favoring urinary stasis and pyuria, pregnancy may reveal or aggravate an existing vesico-renal reflux. In reporting six cases of vesico-renal reflux in pregnant women, revealed by attacks of feverish lombalgia, or mictional disorders associated with pyuria, and confirmed postpartum by intravenous urography, retrograde cystography and cystoscopy, the authors recall the factors associated with pregnancy which favor the appearance of a reflux, mechanical, hormonal and metabolic action. Surgical correction of refluxes associated with pyuria and detected during pregnancy would seem indicated.

  5. Gastroesophageal reflux and gastric emptying

    International Nuclear Information System (INIS)

    Rosen, P.; Treves, S.T.

    1985-01-01

    Gastroesophageal reflux (GER) may be defined as a dysfunction of the distal esophagus causing return of gastric contents into the esophagus. GER is a rather common problem during infancy, with an incidence estimated as 1 in 500 infants. Several methods are available to diagnose and quantitate GER. These include fluoroscopy after barium feedings, in conjunction with an upper gastrointestinal series; esophageal manometry; endoscopy; pH probe monitoring, in conjunction with a Tuttle Test; and extended pH probe evaluation for a 24-h period. Gastroesophageal scintigraphy has been advocated as an alternative noninvasive study requiring no sedation. Scintigraphy offers the advantages of prolonged observation, high sensitivity, and low radiation exposure

  6. Gastroesophageal Reflux Disease (GERD) (For Teens)

    Science.gov (United States)

    ... Feelings Expert Answers Q&A Movies & More for Teens Teens site Sitio para adolescentes Body Mind Sexual Health ... English Español Gastroesophageal Reflux Disease (GERD) KidsHealth / For Teens / Gastroesophageal Reflux Disease (GERD) What's in this article? ...

  7. 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.

  8. Caliceal clubbing and adjacent parenchymal scarring (always reflux nephropathy) as a cause of end-stage renal failure

    International Nuclear Information System (INIS)

    Thomsen, H.S.; Dorph, S.; Copenhagen Univ., Herlev

    1986-01-01

    Various clinical and laboratory aspects in 15 kidney transplanted patients with urographic evidence of caliceal clubbing and adjacent parenchymal scarring in their native kidneys are reported. These lesions were found in 16 per cent of our series of kidney transplantations; below 35 years of age it was the second most frequent disease. In 9 of these patients severe vesicoureteral reflux had been demonstrated. In the remaining 6 patients reflux nephropathy was only a tentative diagnosis based on a striking similarity in the radiographs and in several clinical findings. Nine patients had symptoms (mainly related to urinary tract infection) from 1 to 17 years before diagnosis/urography, in 5 as early as the first year of life. Recurrent urinary tract infection and renal impairment were the most frequent disorders leading to the diagnosis. Replacement therapy was initiated at an average age of 32.7 years. Following renal transplantation urinary tract infection was documented in 37 per cent of patients whether the patient had been bilaterally nephrectomized or not. (orig)

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

    African Journals Online (AJOL)

    Heartburn, gastro-oesophageal reflux disease and non-erosive reflux disease. Haley Smith. Abstract. Reflux is a normal process that occurs in healthy infants, children and adults. Most episodes are short-lived and do not cause bothersome symptoms of complications. Gastro-oesophageal reflux disease (GORD) develops ...

  10. [A family history of renal lithiasis in children diagnosed of urinary tract infection by Escherichia coli].

    Science.gov (United States)

    García Nieto, Víctor; Sotoca Fernández, Jorge; O'Hagan, Monica; Arango Sancho, Pedro; Luis Yanes, Maria Isabel

    2018-04-01

    Urinary tract infections (UTI) caused by Escherichia coli (E. coli) are common in patients with idiopathic hypercalciuria. As both UTI and hypercalciuria (prelithiasis) have a genetic basis, we wanted to know whether the family history of urolithiasis is more common in children with UTIs caused by E. coli. Secondarily, we wondered if the renal scars are more common in children with prelithiasis. Ambispective study with collected data from 104 patients (40 male, 64 female) followed after having been diagnosed of UTI by E. coli at least once. These patients were asked about the existence of urolithiasis in relatives. The calcium and citrate urinary elimination was qunatified in 80 children. In the total sample, family history was positive for urolithiasis in a significantly higher frequency in those children (n=71; 68.3%) than in the control population in our area (29.7%; previously published data). Prelithiasis frequency in children with UTI was 47.5% (38/80). An association was observed between the diagnosis of prelithiasis both with family history of urolithiasis (P=.030) and the diagnosis of vesicoureteral reflux (P=.034). Children who developed renal scarring had an increased risk of prelithiasis (OR 5.3; P=.033). The frequency of family history of urolithiasis in children with UTI caused by E. coli is very high. Based on our results we hypothesize that the predisposition to lithiasis can involve a constitutively altered defense to E. coli and, therefore, a greater possibility for renal scars. Copyright © 2017 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

  11. [Surgical treatment for gastroesophageal reflux disease (GERD)].

    Science.gov (United States)

    Iida, Atsushi; Yamaguchi, Akio

    2007-05-01

    Proton pump inhibitor (PPI) is major treatment for acid reflux. It reduces major symptom of GERD and effective. However, the cause of GERD is the insufficiency of anti-reflux mechanism of cardia. Only surgical treatment can care for hiatal hernia as the main cause of the disruption. Redundant reflux against conservative treatment or obvious hiatal hernia is indication for laparoscopic Nissen fundoplication. Late diagnosis might request radical operation, so we need to know the indication for laparoscopic treatment. For the safer laparoscopic procedure, we perform curtain retraction technique and Floppy Nissen -short cuff method. The former contribute to prevent hemorrhage or pneumothorax, and the latter can reduce the post-operative disphagia.

  12. Cystic Fibrosis and gastroesophageal reflux disease.

    Science.gov (United States)

    Maqbool, Asim; Pauwels, Ans

    2017-11-01

    Gastroesophageal reflux is common in children and adults with cystic fibrosis (CF). Pathological gastroesophageal reflux disease (GERD) is also frequent in patients of all ages with CF. This article reviews the pathophysiology, diagnostic work-up, management options, complications, and future directions in the evaluation and management of GERD - unique to and pertinent for - patients with CF in particular. Copyright © 2017 European Cystic Fibrosis Society. Published by Elsevier B.V. All rights reserved.

  13. Reflux-cough syndrome: Assessment of temporal association between reflux episodes and cough bursts

    NARCIS (Netherlands)

    Herregods, T. V. K.; Pauwels, A.; Tack, J.; Smout, A. J. P. M.; Bredenoord, A. J.

    2017-01-01

    BackgroundGastro-esophageal reflux can be the cause of chronic cough. In the assessment of the temporal association between reflux and cough, previous studies have used a two-minute time window, based on studies in patients with heartburn. However, it remains unclear whether the optimal time window

  14. 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.

  15. Postprandial gastro-oesophageal reflux demonstrated by radiology

    International Nuclear Information System (INIS)

    Pedersen, P.R.; Mohr Madsen, K.; Naeser, A.; Thommesen, P.

    1991-01-01

    An investigation to detect food-stimulated gastro-oesophageal (GE) reflux was carried out in 54 consecutive fasting patients, 35 of whom experienced reflux while 19 did not. All patients then received a standard meal (566 kcal), and the investigation was repeated 1 h afterward. Of the 35 with GE reflux in the fasting state, 33 also had GE reflux in the postprandial state, and 17 of the 19 patients with no GE reflux while fasting also had none in the postprandial state. It is concluded that the radiological method can identify most patients in whom food-stimulated GE reflux could be of clinical significance. (orig.) [de

  16. Postprandial gastro-oesophageal reflux demonstrated by radiology

    Energy Technology Data Exchange (ETDEWEB)

    Pedersen, P.R.; Mohr Madsen, K.; Naeser, A.; Thommesen, P. (Aarhus Univ. (Denmark). Dept. of Diagnostic Radiology)

    1991-05-01

    An investigation to detect food-stimulated gastro-oesophageal (GE) reflux was carried out in 54 consecutive fasting patients, 35 of whom experienced reflux while 19 did not. All patients then received a standard meal (566 kcal), and the investigation was repeated 1 h afterward. Of the 35 with GE reflux in the fasting state, 33 also had GE reflux in the postprandial state, and 17 of the 19 patients with no GE reflux while fasting also had none in the postprandial state. It is concluded that the radiological method can identify most patients in whom food-stimulated GE reflux could be of clinical significance. (orig.).

  17. [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.

  18. 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.

  19. Gastroesophageal Reflux Disease and Alkaline Reflux: the Mechanisms of the Development and Therapeutic Approach

    Directory of Open Access Journals (Sweden)

    T.D. Zviahintseva

    2016-11-01

    Full Text Available The article deals with gastroesophageal reflux disease (GERD — a pathology, which occupies a leading place among all acid-related diseases. The main mechanism of GERD is a violation of the motor-evacuation function of the stomach — slowing gastric emptying and duodenogastric reflux. Slow gastric emptying contributes to more frequent reflux, and the presence of duodenal contents in refluxate — alkaline reflux — is aggressive for the esophageal mucosa (EM. This is due to the presence of bile acids, lysolecithin and pancreatic enzymes in the esophageal refluxate. A long existing contact of aggressive factors in the stomach and the esophagus leads to the development of inflammatory and destructive lesions of the mucous membrane of these organs. According to many researchers, bile acids play a key role in the pathogenesis of the damaging effects on the EM. Drug correction of GERD with alkaline reflux includes, along with the administration of proton pump inhibitors, prokinetics (itopride hydrochloride and ursodeoxycholic acid preparations.

  20. Vesical-ureteral reflux in children

    International Nuclear Information System (INIS)

    Desvignes, V.; Palcoux, J.B.; Cochat, P.

    1995-01-01

    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

  1. Gastroesophageal scintigraphy for diagnosis of gastroesophageal reflux

    International Nuclear Information System (INIS)

    Ishihara, Michiomi; Aoki, Nobuhiko; Imura, Souichi; Eguchi, Hiroyuki; Tamamoto, Humihiko

    1995-01-01

    99m Tc-DTPA is a sensitive technique for the detection of gastro-esophageal reflux in children. Forty-eight children with gastro-esophageal reflux are scored by the results of the time activity curve of gastro-esophageal scintiscanning and the 24 hr esophageal pH tests. The score of gastro-esophageal scintiscanning is compared with the 24 hr esophageal pH score. There is a correlation in the score between the gastro-esophageal scintiscanning and the 24 hr esophageal pH test. (author)

  2. PRIMARY PREVENTION OF POSTOPERATIVE REFLUX DISEASE

    Directory of Open Access Journals (Sweden)

    V. L. Martynov

    2015-01-01

    Full Text Available Creation of anastomoses between hollow organs of the abdominal cavity, retroperitoneal space and the small intestine always raises the question of the prevention of reflux from the small intestine into the cavity drained the esophagus, stomach, gallbladder, liver outer duct cysts of the liver and pancreas. After surgery, any reflux becomes pathological. Reflux – is an obligate precancer. So, throw the bile and pancreatic juices in the stomach, the stump of the stomach, esophagus contributes to reflux esophagitis, reflux gastritis, ulcers and gastric cancer, or a stump. After an internal drainage of cavity formation in the small intestine develops postoperative reflux disease, which is caused by the actions of the surgeon who tried sincerely to help the patient. It is possible to give the definition of such states “Iatrogenic Postoperative Reflux Disease”.The aim of this work was to develop and put into practice a “cap” on the afferent loop of the small intestine, do not migrate into the gut lumen, with an internal cavity drainage structures of the abdominal cavity and retroperitoneal space and to evaluate clinical outcomes. As a result, the authors have developed a way to create a “cap” on a loop of the small intestine, which is used for the drainage of cavity formation, conducted research on its safety, proper functioning, accessibility, analyzed the clinical situation offers. For drainage of cavernous fistula formation impose between him and a loop of small intestine 40–50 cm from the Treitz ligament. Form a intestine anastomosis by Brown.Above this junction length leads to the formation of the drained portion of the small intestine is about 10 cm, in the middle of which impose a “stub”. Length of discharge from the drainage area of education of the small intestine to interintestinal Brownian anastomosis is about 30 cm. To form a “plug” free land use of the greater omentum, through which by puncture-poke perform

  3. Systematic review: role of acid, weakly acidic and weakly alkaline reflux in gastro-oesophageal reflux disease

    NARCIS (Netherlands)

    Boeckxstaens, G. E.; Smout, A.

    2010-01-01

    The importance of weakly acidic and weakly alkaline reflux in gastro-oesophageal reflux disease (GERD) is gaining recognition. To quantify the proportions of reflux episodes that are acidic (pH <4), weakly acidic (pH 4-7) and weakly alkaline (pH >7) in adult patients with GERD, and to evaluate their

  4. Review article: acidity and volume of the refluxate in the genesis of gastro-oesophageal reflux disease symptoms

    NARCIS (Netherlands)

    Sifrim, D.; Mittal, R.; Fass, R.; Smout, A.; Castell, D.; Tack, J.; Gregersen, H.

    2007-01-01

    BACKGROUND: A number of mechanisms, other than acid reflux, may be responsible for the symptoms of gastro-oesophageal reflux disease. AIM: To assess the importance of non-acid reflux mechanisms. METHODS: This review is based on presentations and discussion at a workshop, where specialists in the

  5. Scintimetric objectification of the pathological gastro-oesophageal reflux

    International Nuclear Information System (INIS)

    Strobl, R.

    1981-01-01

    In this investigation, the author initially made animal experiments to find out: - if and how the gastro-oesophageal reflux in a cardiac insufficiency caused by cardiomyotomy could be proven quantitatively by scintiscanning as often as wanted and how the course of the arising oesophagitis correlated with the findings of the scintiscanning. For the clinical examinations, he referred to patients complaining the reflux difficulties or patients who had had a Balanced Operation because of a reflux disease. The main concern was to clarify the special characteristics and the reliability of reflux scintiscanning and to compare them to conventional methods of radiological and endoscopic reflux diagnostics. (orig./MG) [de

  6. Emerging drugs for gastroesophageal reflux disease

    NARCIS (Netherlands)

    Boeckxstaens, G. E.

    2009-01-01

    Proton pump inhibitors (PPIs) are very effective and safe drugs for the treatment of erosive and non-erosive gastroesophageal reflux disease (GERD). Nevertheless, a significant proportion of GERD patients (30 - 40%) continue to suffer from symptoms during PPI treatment, which has stimulated the

  7. [Analysis of anti-reflux surgery failure].

    Science.gov (United States)

    Cano Novillo, I; Benavent Gordo, M I; Portela Casalod, E; Delgado Muñoz, M D; Aguado Roncero, P; Vilariño Mosquera, A; Berchi García, F J

    2000-01-01

    Recurrent gastroesophageal reflux following fundoplication is a challenging problem, because it is usually refractory to medical treatment and a second, technically difficult, antireflux operation is required. Different factors that may contribute to surgery failure have been identified in children. We present 8 cases who underwent redofundoplication after failed procedures, from a total number of 96 patients operated on due to gastroesophageal reflux. Four patient's had their initial fundoplication performed at our institution. Six patients were neurologically impaired, six had chronic pulmonary disease, and two had esophageal atresia. The main presenting symptoms were recurrent vomiting (n = 8) and aspiration (n = 4). Gastroesophageal reflux was confirmed by barium swallow and endoscopy. Operative findings showed wrap breakdown in two cases, warp breakdown associated with hiatal hernia in five, wrap breakdown associated with paraesophageal hernia in two cases, and paraesophageal hernia with normal wrap in one. A second Nissen procedure were performed in five cases, whereas a Collis-Nissen gastroplasty was realized in three with a short esophagus. Six patients had a successful outcome remaining symptom free, one has severe disphagia, and one has recurrent vomiting. In our experience, patients with recurrent gastroesophageal reflux disease should undergo an antireflux procedure tailored to specific anatomic or functional abnormalities.

  8. Traditional reflux parameters and not impedance monitoring predict outcome after fundoplication in extraesophageal reflux.

    Science.gov (United States)

    Francis, David O; Goutte, Marion; Slaughter, James C; Garrett, C Gaelyn; Hagaman, David; Holzman, Michael D; Vaezi, Michael F

    2011-09-01

    Fundoplication is considered in patients with refractory extraesophageal reflux symptoms. However, postoperative symptom resolution is inconsistent. This analysis investigates which presenting symptoms and preoperative objective parameters predict postoperative symptom improvement. Retrospective cohort study. A total of 237 patients referred for extraesophageal reflux symptoms refractory to medical therapy underwent esophageal function testing. Fundoplication was performed in 27 patients with objective evidence of gastroesophageal reflux disease. Symptomatic improvement was assessed at postoperative intervals. Logistic regression determined which symptoms and objective parameters predicted improvement of the presenting extraesophageal reflux symptom. Overall, 59% of patients reported at least partial improvement of their presenting extraesophageal symptom after fundoplication. Predictors of symptomatic improvement were the presence of heartburn with or without regurgitation concomitant to their primary presenting symptom (odds ratio [OR], 6.6; 95% confidence interval [CI], 0.97-44.9; P = .05) and pH < 4 more than 12% of a 24-hour period (OR, 10.5; 95% CI, 1.36-81.1; P = .02). Probability of postoperative extraesophageal reflux symptom improvement was 90% if both conditions were present. Both heartburn with or without regurgitation and esophageal pH < 4 more than 12% of a 24-hour period predicted postfundoplication resolution of the presenting extraesophageal reflux symptom. Copyright © 2011 The American Laryngological, Rhinological, and Otological Society, Inc.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

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

    International Nuclear Information System (INIS)

    Lee, Kang Wook; Lee, Heon Young

    1995-01-01

    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.

  11. [Gastroesophageal reflux disease and connective tissue dysplasia in aspect of premorbid and comorbid disorders].

    Science.gov (United States)

    Dzhulaĭ, G S; Sekareva, E V; Dzhulaĭ, T E

    2014-01-01

    To investigate the phenotypic and visceral signs of connective tissue dysplasia (CTD) and comorbid diseases of the digestive system in gastroesophageal reflux disease (GERD) patients with different types of esophageal reflux as the predictors of its variants. In 124 patients with GERD the clinical features, phenotypic and visceral signs of undifferentiated CTD were studied in details. In 82.0% of patients with GERD associated with gastroesophageal type of reflux (GER) phenotypic and especially visceral signs of STD were detected, mainly in the form of cardiochalasia and hiatal hernia. In patients with duodenogastroesophageal reflux symptoms (DGER) the signs of STD were marked in 42.0% of cases, mostly in the form of biliary tract structure abnormalities. The risk of GERD associated with prevalence of GER, was 11.9 times higher in the presence of diagnostically meaningful combination of 6 or more signs of STD than in patients with DGER. Realization of predictor options in GER occurs in the preference of sharp, acidic foods, spices, taking medications that reduce lower esophageal sphincter tone. GERD, associated with DGER, is formed in patients with family history of diseases of the biliary tract and in the preference of food rich of calories. Study of STD symptoms as predictors of structural development of GERD and its variants is prospective to predict disease, choice of profession and eating behavior, primarily in young adults.

  12. 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.

  13. Anterior urethral valves without diverticulum, a rare cause of infravesical obstruction and vesicoureteral reflux in children: Report of two cases and literature review

    Directory of Open Access Journals (Sweden)

    Jyoti Bothra

    2017-09-01

    Full Text Available Congenital anterior urethral valve is a rare condition causing significant obstructive uropathy in pediatric age group. It is much rarer than posterior urethral valve. However, the clinical course is similar. We present two cases of anterior urethral valves in children

  14. A homozygous missense variant in VWA2, encoding an interactor of the Fraser-complex, in a patient with vesicoureteral reflux

    Science.gov (United States)

    van der Ven, Amelie T.; Kobbe, Birgit; Kohl, Stefan; Shril, Shirlee; Pogoda, Hans-Martin; Imhof, Thomas; Ityel, Hadas; Vivante, Asaf; Chen, Jing; Hwang, Daw-Yang; Connaughton, Dervla M.; Mann, Nina; Widmeier, Eugen; Taglienti, Mary; Schmidt, Johanna Magdalena; Nakayama, Makiko; Senguttuvan, Prabha; Kumar, Selvin; Tasic, Velibor; Kehinde, Elijah O.; Mane, Shrikant M.; Lifton, Richard P.; Soliman, Neveen; Lu, Weining; Bauer, Stuart B.; Hammerschmidt, Matthias; Wagener, Raimund

    2018-01-01

    Congenital anomalies of the kidney and urinary tract (CAKUT) are the most common cause (40–50%) of chronic kidney disease (CKD) in children. About 40 monogenic causes of CAKUT have so far been discovered. To date less than 20% of CAKUT cases can be explained by mutations in these 40 genes. To identify additional monogenic causes of CAKUT, we performed whole exome sequencing (WES) and homozygosity mapping (HM) in a patient with CAKUT from Indian origin and consanguineous descent. We identified a homozygous missense mutation (c.1336C>T, p.Arg446Cys) in the gene Von Willebrand factor A domain containing 2 (VWA2). With immunohistochemistry studies on kidneys of newborn (P1) mice, we show that Vwa2 and Fraser extracellular matrix complex subunit 1 (Fras1) co-localize in the nephrogenic zone of the renal cortex. We identified a pronounced expression of Vwa2 in the basement membrane of the ureteric bud (UB) and derivatives of the metanephric mesenchyme (MM). By applying in vitro assays, we demonstrate that the Arg446Cys mutation decreases translocation of monomeric VWA2 protein and increases translocation of aggregated VWA2 protein into the extracellular space. This is potentially due to the additional, unpaired cysteine residue in the mutated protein that is used for intermolecular disulfide bond formation. VWA2 is a known, direct interactor of FRAS1 of the Fraser-Complex (FC). FC-encoding genes and interacting proteins have previously been implicated in the pathogenesis of syndromic and/or isolated CAKUT phenotypes in humans. VWA2 therefore constitutes a very strong candidate in the search for novel CAKUT-causing genes. Our results from in vitro experiments indicate a dose-dependent neomorphic effect of the Arg446Cys homozygous mutation in VWA2. PMID:29351342

  15. A homozygous missense variant in VWA2, encoding an interactor of the Fraser-complex, in a patient with vesicoureteral reflux.

    Directory of Open Access Journals (Sweden)

    Amelie T van der Ven

    Full Text Available Congenital anomalies of the kidney and urinary tract (CAKUT are the most common cause (40-50% of chronic kidney disease (CKD in children. About 40 monogenic causes of CAKUT have so far been discovered. To date less than 20% of CAKUT cases can be explained by mutations in these 40 genes. To identify additional monogenic causes of CAKUT, we performed whole exome sequencing (WES and homozygosity mapping (HM in a patient with CAKUT from Indian origin and consanguineous descent. We identified a homozygous missense mutation (c.1336C>T, p.Arg446Cys in the gene Von Willebrand factor A domain containing 2 (VWA2. With immunohistochemistry studies on kidneys of newborn (P1 mice, we show that Vwa2 and Fraser extracellular matrix complex subunit 1 (Fras1 co-localize in the nephrogenic zone of the renal cortex. We identified a pronounced expression of Vwa2 in the basement membrane of the ureteric bud (UB and derivatives of the metanephric mesenchyme (MM. By applying in vitro assays, we demonstrate that the Arg446Cys mutation decreases translocation of monomeric VWA2 protein and increases translocation of aggregated VWA2 protein into the extracellular space. This is potentially due to the additional, unpaired cysteine residue in the mutated protein that is used for intermolecular disulfide bond formation. VWA2 is a known, direct interactor of FRAS1 of the Fraser-Complex (FC. FC-encoding genes and interacting proteins have previously been implicated in the pathogenesis of syndromic and/or isolated CAKUT phenotypes in humans. VWA2 therefore constitutes a very strong candidate in the search for novel CAKUT-causing genes. Our results from in vitro experiments indicate a dose-dependent neomorphic effect of the Arg446Cys homozygous mutation in VWA2.

  16. Long-term preservation of dextranomer/hyaluronic acid copolymer implants after endoscopic treatment of vesicoureteral reflux in children: a sonographic volumetric analysis.

    Science.gov (United States)

    McMann, Leah P; Scherz, Hal C; Kirsch, Andrew J

    2007-01-01

    We compared injected volume of dextranomer/hyaluronic acid with sonographic volumes obtained 2 weeks to 36 months postoperatively to evaluate the amount of volume retention with time and to correlate volume retention with voiding cystourethrogram results. We retrospectively reviewed sonographic volume measurements of dextranomer/hyaluronic acid implants in children at 2 weeks to 36 months postoperatively. Hydronephrosis and percentage of dextranomer/hyaluronic acid retained at each interval were recorded. Average change in volume at each interval was used to compare volume retention with time. The fraction of dextranomer/hyaluronic acid retained was compared to voiding cystourethrogram at 3 months. No patient had new or worsened hydronephrosis. Volumetric data were available for 296, 150, 42, 23 and 20 ureters at 2, 3, 6 and 12 weeks, and 24 to 36 months postoperatively, respectively. Percentage of dextranomer/hyaluronic acid retained was 79% at 2, 74% at 3, 70% at 6 and 78% at 12 weeks, and 65% at 24 to 36 months (p >0.05). While there was no significant difference in mean volume retained between cures (74%) and treatment failures (67%), the 94% cure rate with mega-implants (greater than anticipated volume retention) was higher than that with micro-implants (75%) or nonvisualized implants (70%). After the initial volume reduction at 2 weeks dextranomer/hyaluronic acid implants remained durable with insignificant volume reduction for up to 36 months postoperatively. Although overall mean volume retention did not correlate with cure, mega-implants were associated with high cure rates and may justify elimination of postoperative voiding cystourethrography.

  17. Enterogastric reflux in normal subjects and patients with Bilroth II gastroenterostomy. Measurement of enterogastric reflux.

    Science.gov (United States)

    Tolin, R D; Malmud, L S; Stelzer, F; Menin, R; Makler, P T; Applegate, G; Fisher, R S

    1979-11-01

    Initially, scintigraphy was established as a valid method for detecting and quantitating enterogastric reflux. A new, tubeless technique for the measurement of enterogastric reflux was developed. 99mTc bound to [(2,6 dimethylphenylcarbamoylmethyl) iminodiacetic acid] (5 mCi) was administered intravenously to visualize the liver and biliary tract. One hour later, a standard liquid meal labeled with 111In bound to diethylene-triamine penta-acetic acid (250 microCi) was given. The 99mTc and 111In activities were recorded simultaneously for 1-min periods at 15-min intervals for 2 hr over liver, gallbladder, and gastric areas of interest. Enterogastric reflux indices were determined. Ten normal subjects and 13 patients with vagotomy, hemigastrectomy, and Bilroth II gastrojejunostomy were evaluated. The enterogastric reflux index in asymptomatic postsurgical patients was increased significantly to 24.6 +/- 4.7 compared with 8.2 +/- 6.0 (P less than 0.01) in normal subjects. In postsurgical patients with the syndrome of alkaline gastritis, the enterogastric reflux index was increased significantly to 86.3 +/- 7.1 (P less than 0.01) compared with asymptomatic postsurgical patients.

  18. 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.

  19. 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.

  20. The effect of the speed of eating on acid reflux and symptoms of patients with gastroesophageal reflux disease.

    Science.gov (United States)

    Valitova, Elen R; Bayrakçı, Berna; Bor, Serhat

    2013-01-01

    There is a general belief that gastroesophageal reflux attacks appear more frequently after quick meal, which is without powerful scientific basis, and the general advise to patients is to eat slowly. We aimed to determine whether the speed of eating has an impact on reflux attacks and symptoms in gastroesophageal reflux disease patients. 24-h intraesophageal pH monitoring was performed to 60 patients with frequent gastroesophageal reflux disease symptoms (39 women) in a tertiary referral center. One hour after placing the pH probe, the patients were asked to have the same meal (744 kcal: 37,6% of carbohydrate, 21,2% of protein, and 41,2% of fat) within 5 or 30 minutes in random order for two consecutive days without extubating. The number of reflux episodes, acid exposure time, and the symptoms of 3-h postprandial period were analyzed. Thirty-eight patients had normal and 22 patients had pathologic pH monitoring for a total of 28 hours of measurement period. The number of reflux episodes increased in the 2 nd hour. The fast eating group had less reflux attacks and lower total reflux time in the 1 st hour and an insignificant increase in the 2 nd and 3 rd hours. The number of symptoms was higher following slow eating (113 vs. 100) without reaching significance. Speed of food intake has no significant impact on acidic reflux attacks in patients with gastroesophageal reflux disease. The classical advice "eat slowly" may not have any scientific basis. However, a similar study on patients with gastroesophageal reflux disease should be performed by combined multichannel intraluminal impedance and pH to evaluate the place of nonacid or weak acid reflux.

  1. Dental approach to erosive tooth wear in gastroesophageal reflux ...

    African Journals Online (AJOL)

    2014-06-02

    Jun 2, 2014 ... Abstract. Background: The duration of gastro-esophageal reflux disease (GERD), the frequency of reflux, the pH and type of acid, and the quality and quantity of saliva affect the severity of dental erosion due to GERD. Objective: To ... Some medications cause salivary hypofunction and dental erosion; drugs ...

  2. Respiratory repercussions of gastroesophageal reflux and cine-esophagogastroscintigraphy

    International Nuclear Information System (INIS)

    Guillemeteau, C.; Saudubray, F.; Guillet, J.

    1985-01-01

    Asthma and recurrent bronchopneumopathies in children are often associated with gastroesophageal reflux. Cine-esogastroscintigraphy is proposed for demonstrating reflux and establishing its direct or indirect responsibility in respiratory disease. 133 patients aged 5 months to 16 years were studied. Reflux was found in 65.5% of cases, either severe (44.4% of cases) or minor (21.1%). Episodes of reflux produced respiratory manifestations in 7% of patients. Inhalation of refluxed material was proved in 3% by demonstration of pulmonary contamination. Sensitivity of cine-esophagogastroscintigraphy is comparable to that of esophageal pH measurement for detection of reflux. It does not require positioning of a probe in the esophageal lumen. It provides quantitative parameters on esophageal transit, reflux and gastric voiding, and demonstrates pulmonary contamination. It is easy to perform and can be readily included in an outpatient clinic workup. Its sensitivity and reliability make it a useful tool for evaluation of therapeutic efficiency. The interlocking of various physiopathologic factors contributes to the polymorphism of respiratory manifestations of reflux [fr

  3. Respiratory repercussions of gastroesophageal reflux and cine-esophagogastroscintigraphy

    International Nuclear Information System (INIS)

    Guillemeteau, C.; Saudubray, F.; Guillet, J.

    1984-01-01

    Asthma and recurrent bronchopneumopathies in children are often associated with gastroesophageal reflux. Cine-esogastroscintigraphy is proposed for demonstrating reflux and establishing its direct or indirect responsibility in respiratory disease. 133 patients aged 5 months to 16 years were studied. Reflux was found in 65.5% of cases, either severe (44.4% of cases) or minor (21.1%). Episodes of reflux produced respiratory manifestations in 7% of patients. Inhalation of refluxed material was proved in 3% by demonstration of pulmonary contamination. Sensitivity of cine-esophagogastroscintigraphy is comparable to that of esophageal pH measurement for detection of reflux. It does not require positioning of a probe in the esophageal lumen. It provides quantitative parameters on esophageal transit, reflux and gastric voiding, and demonstrates pulmonary contamination. It is easy to perform and can be readily included in an outpatient clinic workup. Its sensitivity and reliability make it a useful tool for evaluation of therapeutic efficiency. The interlocking of various physiopathologic factors contributes to the polymorphism of respiratory manifestations of reflux [fr

  4. Laparoscopic surgery for gastro-esophageal acid reflux disease

    NARCIS (Netherlands)

    Schijven, Marlies P.; Gisbertz, Suzanne S.; van Berge Henegouwen, Mark I.

    2014-01-01

    Gastro-esophageal reflux disease is a troublesome disease for many patients, severely affecting their quality of life. Choice of treatment depends on a combination of patient characteristics and preferences, esophageal motility and damage of reflux, symptom severity and symptom correlation to acid

  5. Review article: the pathophysiology of gastro-oesophageal reflux disease

    NARCIS (Netherlands)

    Boeckxstaens, G. E. E.

    2007-01-01

    BACKGROUND: Gastro-oesophageal reflux disease (GERD) is a common condition that develops when the reflux of stomach contents causes troublesome symptoms and/or complications. AIM: To review the current knowledge on the underlying factors contributing to GERD, with particular emphasis on the most

  6. Dental approach to erosive tooth wear in gastroesophageal reflux ...

    African Journals Online (AJOL)

    Background: The duration of gastro-esophageal reflux disease (GERD), the frequency of reflux, the pH and type of acid, and the quality and quantity of saliva affect the severity of dental erosion due to GERD. Objective: To summarize the diagnostic protocol and treatment of dental erosion due to GERD. Methods: A Medline ...

  7. Proton Pump Inhibitors in Gastroesophageal Reflux Disease: Friend or Foe.

    Science.gov (United States)

    Gyawali, C Prakash

    2017-09-01

    Proton pump inhibitor (PPI) use in gastroesophageal reflux disease (GERD) has been redefined, in light of recent advances highlighting GERD phenotypes that respond to PPIs, and fresh revelations of potential risks of long-term PPI therapy. Erosive esophagitis predicts excellent response to PPI therapy, but non-erosive reflux disease (NERD) with abnormal reflux parameters on ambulatory reflux monitoring also demonstrates a similar response. In contrast, response is suboptimal in the absence of abnormal reflux parameters. In this setting, if an alternate appropriate indication for PPI therapy does not coexist, risks may outweigh benefits of PPI therapy. Adverse events from long-term PPI therapy continue to be reported, most based on association rather than cause-and-effect. Appropriate indications need to be established before embarking on long-term PPI therapy. Future research will define true risks of long-term PPI therapy, and develop alternate management options for acid peptic diseases.

  8. Multicenter assessment of venous reflux by duplex ultrasound.

    Science.gov (United States)

    Lurie, Fedor; Comerota, Anthony; Eklof, Bo; Kistner, Robert L; Labropoulos, Nicos; Lohr, Joann; Marston, William; Meissner, Mark; Moneta, Gregory; Neglén, Peter; Neuhardt, Diana; Padberg, Frank; Welsh, Harold J

    2012-02-01

    This prospective multicenter investigation was conducted to define the repeatability of duplex-based identification of venous reflux and the relative effect of key parameters on the reproducibility of the test. Repeatability was studied by having the same technologist perform duplicate tests, at the same time of the day, using the same reflux-provoking maneuver and with the patient in the same position. Reproducibility was examined by having two different technologists perform the test at the same time of the day, using the same reflux-provoking maneuver and with the patient in the same position. Facilitated reproducibility was studied by having two different technologists examine the same patients immediately after an educational intervention. Limits of agreement between two duplex scans were studied by changing three elements of the test: time of the day (morning vs afternoon), patient's position (standing vs supine), and reflux initiation (manual vs automatic compression-decompression). The study enrolled 17 healthy volunteers and 57 patients with primary chronic venous disease. Repeatability of reflux time measurements in deep veins did not significantly differ with the time of day, the patient's position, or the reflux-provoking maneuver. Reflux measurements in the superficial veins were more repeatable (P ultrasound detection of venous reflux. Reports should include information on the time of the test, the patient's position, and the provoking maneuver used. Adopting a uniform cut point of 0.5 second for pathologic reflux can significantly improve the reliability of reflux detection. Implementation of a standard protocol should elevate the minimal standard for agreement between repeated tests from the current 70% to at least 80% and with more rigid standardization, to 90%. Copyright © 2012 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

  9. Pilot plant trial of the reflux classifier

    Energy Technology Data Exchange (ETDEWEB)

    Galvin, K.P.; Doroodchi, E.; Callen, A.M.; Lambert, N.; Pratten, S.J. [University of Newcastle, Callaghan, NSW (Australia). Dept. of Chemical Engineers

    2002-01-01

    The Ludowici LMPE Reflux Classifier is a new device designed for classifying and separating particles on the basis of size or density. This work presents a series of experimental results obtained from the first pilot scale study of the reflux classifier (RC). The main focus of the investigation was to assess the particle gravity separation and throughput performance of the device. In this study, the classifier was used to separate coal and mineral matter less than 2 mm in size. The experimental results were then compared with the performance data on a teetered bed separator (TBS). It was concluded that the classifier could offer an excellent gravity separation at a remarkably high solids throughput of 47 t/m{sup 2}h more than 3 times higher than for a TBS. The separation performance of the RC was also better, with significantly less variation in the D-50 with particle size. A simple theoretical model providing an explanation of the separation performance is also presented.

  10. 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-reflux s...

  11. Scintigraphic evaluation of duodenogastric reflux. Problems, pitfalls, and technical review.

    Science.gov (United States)

    Drane, W E; Karvelis, K; Johnson, D A; Silverman, E D

    1987-05-01

    Bile reflux has been implicated in the pathogenesis of gastritis, gastric ulcer, and esophagitis. Radionuclide techniques provide the only non-invasive method to detect duodenogastric reflux. To analyze the problems that occur with attempts at quantitation, 55 patients were prospectively evaluated (45 patients with reflux esophagitis or Barrett's esophagus and ten patients with clinical symptoms of bile reflux, four of whom had Bilroth II surgery) with Tc-99m DISIDA, using a fasting technique with gallbladder stimulation by sincalide. Visual duodenogastric reflux occurred in 16 of 55 patients. Overlap of small bowel with the stomach is the major problem for accurate quantitation and occurred in 20 of 55 patients (36%). Overlap of left lobe of the liver occurred in 40 of 55 patients (73%), but its contribution to gastric activity was slight and could be easily subtracted. Reflux was intermittent in six of the 16 positive studies (38%), and continuous computer acquisition is needed to detect its maximum value. Primarily because of the problem of small bowel overlap, scintigraphic evaluation of duodenogastric reflux is only, at best, semi-quantitative. A review of the technical variables used in this examination, as well as potential problems that can occur, is provided.

  12. [Intraesophageal pH in children with suspected reflux].

    Science.gov (United States)

    Calva-Rodríguez, R; García-Aranda, J A; Bendimez-Cano, A; Estrada-Saavedra, R

    1989-05-01

    We study 22 children with clinical symptoms of gastroesophageal reflux. The main manifestations were: frequent vomiting, failure to thrive and repetitive pneumonia. In all of them we perform barium esophagogram (SEGD) with fluoroscopy, esophageal manometry (EM) and a four hours intraesophageal pH measurement. Thirteen of the twenty two children present a pathologic reflux (ERGE); in 16 we found SEGD that show reflux; three of them had an abnormal EM, the other 13 were normal. Seven patients showed alteration of the intraesophageal pH measurement. In conclusion the intraesophageal pH measurement in short period of time (4 hours) is a good method in the diagnosis of patients with ERGE.

  13. Sleeve Gastrectomy and Gastroesophageal Reflux Disease

    Directory of Open Access Journals (Sweden)

    Michael Laffin

    2013-01-01

    Full Text Available Bariatric surgery, when combined with lifestyle and medical interventions, is a common and successful treatment modality in the obese patient. Laparoscopic sleeve gastrectomy is one such procedure that has increased in popularity as a definitive bariatric operation. Although laparoscopic sleeve gastrectomy has been shown to be effective in producing weight loss and improving type 2 diabetes mellitus, its effect on gastroesophageal reflux disease (GERD has been inconsistent. This paper aims to summarize the available literature regarding GERD prevalence following laparoscopic sleeve gastrectomy, 8 studies demonstrate increased GERD prevalence, and 5 demonstrate decreased GERD prevalence following laparoscopic sleeve gastrectomy. The relationship between GERD and SG is complex and no clear relationship exists. The anatomic and physiologic changes caused by laparoscopic sleeve gastrectomy are discussed in the context of these inconsistent results.

  14. [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.

  15. Laparoscopic sleeve gastrectomy and gastroesophageal reflux

    Science.gov (United States)

    Stenard, Fabien; Iannelli, Antonio

    2015-01-01

    Bariatric surgery is the only effective procedure that provides long-term sustained weight loss. Sleeve gastrectomy (SG) has emerged over the last few years to be an ideal bariatric procedure because it has several advantages compared to more complex bariatric procedures, including avoiding an intestinal bypass. However, several published follow-up studies report an increased rate of gastroesophageal reflux (GERD) after a SG. GERD is described as either de novo or as being caused by aggravation of preexisting symptoms. However, the literature on this topic is ambivalent despite the potentially increased rate of GERDs that may occur after this common bariatric procedure. This article reviews the mechanisms responsible for GERD in obese subjects as well as the results after a SG with respect to GERD. Future directions for clinical research are discussed along with the current surgical options for morbidly obese patients with GERD and undergoing bariatric surgery. PMID:26420961

  16. Laparoscopic sleeve gastrectomy and gastroesophageal reflux.

    Science.gov (United States)

    Stenard, Fabien; Iannelli, Antonio

    2015-09-28

    Bariatric surgery is the only effective procedure that provides long-term sustained weight loss. Sleeve gastrectomy (SG) has emerged over the last few years to be an ideal bariatric procedure because it has several advantages compared to more complex bariatric procedures, including avoiding an intestinal bypass. However, several published follow-up studies report an increased rate of gastroesophageal reflux (GERD) after a SG. GERD is described as either de novo or as being caused by aggravation of preexisting symptoms. However, the literature on this topic is ambivalent despite the potentially increased rate of GERDs that may occur after this common bariatric procedure. This article reviews the mechanisms responsible for GERD in obese subjects as well as the results after a SG with respect to GERD. Future directions for clinical research are discussed along with the current surgical options for morbidly obese patients with GERD and undergoing bariatric surgery.

  17. Gastric dysrhythmias occur in gastro-oesophageal reflux disease complicated by food regurgitation but not in uncomplicated reflux

    OpenAIRE

    Leahy, A; Besherdas, K; Clayman, C; Mason, I; Epstein, O

    2001-01-01

    AIM—To investigate gastric pacemaker activity in gastro-oesophageal reflux disease using the electrogastrogram.
PATIENTS—Forty patients with gastro-oesophageal reflux disease (20 with acid reflux, 20 with the additional symptom of food regurgitation) and 30 asymptomatic controls.
METHODS—Patients were studied using an electrogastrogram, oesophageal manometry, and 24 hour ambulatory oesophageal pH analysis.
RESULTS—An abnormal electrogastrogram was recorded in two (7%) controls, two (10%) pati...

  18. Secretin-stimulating MRCP. The diagnosis of pancreaticobiliary reflux

    International Nuclear Information System (INIS)

    Motosugi, Utaroh; Ichikawa, Tomoaki; Araki, Tsutomu

    2003-01-01

    Pancreaticobiliary maljunction is a clinically important condition that may cause the occurrence of biliary malignancies. It is widely accepted that continuous reflux of the pancreatic juice into the common bile duct (CBD) and/or gallbladder is essential as an etiology of biliary malignancies. It has been also mentioned that reflux of the pancreatic juice into the CBD/gallbladder is observed regardless of the presence of pancreaticobiliary maljunction. Secretin-stimulating MRCP may demonstrate not only outflow of the pancreatic juice to the duodenum but also the phenomenon of reflux of the pancreatic juice into the CBD/gallbladder as enlargement of the CBD/gallbladder. We investigated whether secretin-stimulating MRCP can diagnose pancreaticobiliary reflux. (author)

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

    Science.gov (United States)

    Saberi-Firoozi, Mehdi; Khademolhosseini, Farnaz; Yousefi, Maryam; Mehrabani, Davood; Zare, Najaf; Heydari, Seyed Taghi

    2007-11-07

    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. 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. 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%). 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.

  20. Serum Gastrin Levels in Patients with Reflux Gastritis

    Directory of Open Access Journals (Sweden)

    Yu.M. Stepanov

    2014-04-01

    Full Text Available The article presents the results of investigation of basal gastrin serum level and its relationships at chronic reflux gastritis. It has been established that gastrin level was increased in 100 % of patients. It was directly dependent on the biliary acid concentration in gastric acid, H.pylori-infection, stomach alkalization. Thus, duodenogastrical reflux causes hypergastrinemia that can result in chronic gastritis development.

  1. 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

    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

  2. Usefulness of gastroesophageal reflux scintigraphy using the knee-chest position for the diagnosis of gastroesophageal reflux disease

    International Nuclear Information System (INIS)

    Asakura, Yasushi; Imai, Yukinori; Ota, Shinichi; Fujiwara, Kenji; Miyamae, Tatsuya

    2005-01-01

    The aim of this study is to evaluate the usefulness of gastroesophageal reflux (GER) scintigraphy using the knee-chest (KC) position for the diagnosis of gastroesophageal reflux disease (GERD). The study subjects were 37 patients with GERD and 8 healthy volunteers (control group). Endoscopically observed esophageal mucosal breaks were evaluated with the Los Angeles classification. For GER scintigraphy, the subjects ingested liquid yogurt labeled with 99m Tc-diethylene triamine pentaacetic acid ( 99m Tc-DTPA) and water. Imaging was performed in the supine and KC position, and GER was graded as 1-4 according to the extent of GER assessed by scintigraphy. GER scintigraphy revealed no reflux in the control group (specificity: 100%). In the supine position, gastroesophageal reflux was observed in 49% of the patients with GERD, compared to 76% in the KC position. 21 of 23 (91%) patients with erosive esophagitis were shown to have GER with scintigraphy. GER scintigraphy revealed severe reflux (grade 3 or 4) (83%, 10/12) in the patients who had severe mucosal breaks (the Los Angels classification grade C or D). GER scintigraphy detected grade 1 or 2 reflux in 7 of the 14 patients who were endoscopically negative. There was a correlation between the endoscopically determined severity of mucosa and the reflux grade which was determined with GER scintigraphy. GER scintigraphy can detect gastroesophageal reflux with a high sensitivity in the KC position and might be a useful method in the screening and assessment of the severity of this disease. This method would be useful for the diagnosis of GERD in endoscopically negative patients. (author)

  3. Lower pH values of weakly acidic refluxes as determinants of heartburn perception in gastroesophageal reflux disease patients with normal esophageal acid exposure.

    Science.gov (United States)

    de Bortoli, N; Martinucci, I; Savarino, E; Franchi, R; Bertani, L; Russo, S; Ceccarelli, L; Costa, F; Bellini, M; Blandizzi, C; Savarino, V; Marchi, S

    2016-01-01

    Multichannel impedance pH monitoring has shown that weakly acidic refluxes are able to generate heartburn. However, data on the role of different pH values, ranging between 4 and 7, in the generation of them are lacking. The aim of this study was to evaluate whether different pH values of weakly acidic refluxes play a differential role in provoking reflux symptoms in endoscopy-negative patients with physiological esophageal acid exposure time and positive symptom index and symptom association probability for weakly acidic refluxes. One hundred and forty-three consecutive patients with gastroesophageal reflux disease, nonresponders to proton pump inhibitors (PPIs), were allowed a washout from PPIs before undergoing: upper endoscopy, esophageal manometry, and multichannel impedance pH monitoring. In patients with both symptom index and symptom association probability positive for weakly acidic reflux, each weakly acidic reflux was evaluated considering exact pH value, extension, physical characteristics, and correlation with heartburn. Forty-five patients with normal acid exposure time and positive symptom association probability for weakly acidic reflux were identified. The number of refluxes not heartburn related was higher than those heartburn related. In all distal and proximal liquid refluxes, as well as in distal mixed refluxes, the mean pH value of reflux events associated with heartburn was significantly lower than that not associated. This condition was not confirmed for proximal mixed refluxes. Overall, a low pH of weakly acidic reflux represents a determinant factor in provoking heartburn. This observation contributes to better understand the pathophysiology of symptoms generated by weakly acidic refluxes, paving the way toward the search for different therapeutic approaches to this peculiar condition of esophageal hypersensitivity. © 2014 International Society for Diseases of the Esophagus.

  4. Reflux condensation behavior in SBLOCA tests of ATLAS facility

    International Nuclear Information System (INIS)

    Kim, Yeon-Sik; Park, Hyun-Sik; Cho, Seok; Choi, Ki-Yong; Kang, Kyoung-Ho

    2017-01-01

    Highlights: • Behavior of a reflux condensation heat transfer was investigated for SBLOCA tests. • Behavior of the reflux condensate in HL, SG inlet plenum, and U-tubes were evaluated. • Concept of a steam moisturizing phenomenon was introduced and discussed. • Test data and MARS calculations were compared and discussed on the reflux condensate. - Abstract: The behavior of the reflux condensation heat transfer in a hot side steam generator (SG) U-tubes during a cold leg (CL) pipe and a direct vessel injection (DVI) line break in small break loss-of-coolant accident (SBLOCA) tests of the ATLAS facility was investigated including MARS code calculations. Among the SBLOCA tests, a 6″-CL pipe and 50%-DVI line break SBLOCA test were selected to investigate the behavior of the reflux condensation. A reflux condensation heat transfer seemed to occur from the time the SG U-tubes were half-empty to near the loop seal clearing (LSC). It was found that a transition regime existed between the reflux condensation heat transfer and reverse heat transfer. The remaining reflux condensate in SG U-tubes owing to the counter-current flow limit (CCFL) phenomenon and a separating effect of liquid carry-over and/or entrainment with steam moisturizing seemed to affect the thermal-hydraulic behavior of the transition regime. It was also found that the steam flowrate of the loop pipings and SG U-tubes seemed to have a strong effect on the duration time of the transition regime, e.g., a larger steam flowrate results in a longer duration. From a comparison of the reflux condensation behavior between the ATLAS tests and MARS code calculations, overall qualitative agreements were found between the two cases. The largest discrepancies were found in the SG inlet plenum water level between the two cases, and the authors suggest that the combination effects of the remaining reflux condensate in SG U-tubes and a separating effect of liquid carry-over and/or entrainment with steam

  5. Gastroesophageal Reflux Disease: Medical or Surgical Treatment?

    Directory of Open Access Journals (Sweden)

    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.

  6. Gastric emptying in gastroesophageal reflux disease

    International Nuclear Information System (INIS)

    Li Lin; Yang Xiaochuan; Kuang Anren; Li Lixia; Ouyang Qin

    2000-01-01

    Objective: The relationship between gastroesophageal reflux disease (GERD) and gastric emptying rate was investigated. Results of endoscopy, 24-hour esophageal pH monitoring were also evaluated. Methods: 15 patients were evaluated with endoscopy, pH monitoring and radionuclide gastric emptying. The results were compared with that of 17 control subjects. Correlations of gastric emptying rate and esophagitis, 24-hour pH monitoring between GERD patients and control subjects were also analyzed. Results: Liquid gastric emptying rate of GERD patients was significantly lower than that of control subjects at 15 and 30 min (P 0.05), but there exhibited a linear correlation between 50% solid emptying time and esophagus pH total score (r=0.643, P<0.05). Conclusions: The results indicate a delayed liquid and solid gastric emptying in GERD patients. There is a linear correlation between 50% solid emptying time and esophagus pH total score. Delayed gastric emptying may be an important factor in the pathogenesis of GERD

  7. Airway Hypersensitivity, Reflux, and Phonation Contribute to Chronic Cough

    Science.gov (United States)

    Francis, David O.; Slaughter, James C.; Ates, Fehmi; Higginbotham, Tina; Stevens, Kristin L.; Garrett, C. Gaelyn; Vaezi, Michael F.

    2015-01-01

    Background & Aims Although chronic cough is a common, its etiology is often elusive, making patient management a challenge. Gastroesophageal reflux and airway hypersensitivity can cause chronic cough. We explored the relationship between reflux, phonation, and cough in patients with idiopathic chronic cough. Methods We performed a blinded, cross-sectional study of non-smoking patients with chronic cough (duration > 8 weeks) refractory to reflux treatment referred to the Digestive Disease Center at Vanderbilt University. All underwent 24-hour acoustic recording concurrently and temporally synchronized with ambulatory pH-impedance monitoring. Cough, phonation, and pH-impedance events were recorded. We evaluated the temporal relationship between cough and phonation or reflux events using Poisson and logistic regression. Results Seventeen patients met the inclusion criteria (88% female; 100% Caucasian; median age, 63 years and interquartile age range, 52–66 years; mean body mass index, 30.6 and interquartile range 27.9–34.0); there were 2048 analyzable coughing events. The probability of subsequent coughing increased with higher burdens of preceding cough, reflux, or phonation. Within the first 15 min after a cough event, the cough event itself was the main trigger of subsequent cough events. After this period, de novo coughing occurred with increases of 1.46-fold in association with reflux alone (95% confidence interval, 1.17–1.82; Pcough events in patients with idiopathic chronic cough. Reflux events were more strongly associated with increased rate of coughing. Our findings support the concept that airway hypersensitivity is a cause of chronic cough, and that the vocal folds may be an effector in chronic cough. ClinicalTrials.gov number, NCT01263626. PMID:26492842

  8. Sex and Gender Differences in Gastroesophageal Reflux Disease

    Science.gov (United States)

    Kim, Young Sun; Kim, Nayoung; Kim, Gwang Ha

    2016-01-01

    It is important to understand sex and gender-related differences in gastroesophageal reflux disease (GERD) because gender-related biologic factors might lead to better prevention and therapy. Non-erosive reflux disease (NERD) affects more women than men. GERD symptoms are more frequent in patients with NERD than in those with reflux esophagitis. However, men suffer pathologic diseases such as reflux esophagitis, Barrett’s esophagus (BE), and esophageal adenocarcinoma (EAC) more frequently than women. The prevalence of reflux esophagitis is significantly increased with age in women, especially after their 50s. The mean age of EAC incidence in women is higher than in men, suggesting a role of estrogen in delaying the onset of BE and EAC. In a chronic rat reflux esophagitis model, nitric oxide was found to be an aggravating factor of esophageal injury in a male-predominant way. In addition, the expression of esophageal occludin, a tight junction protein that plays an important role in the esophageal defense mechanism, was up-regulated in women. This explains the male predominance of reflux esophagitis and delayed incidence of BE or EAC in women. Moreover, the symptoms such as heartburn, regurgitation, and extra-esophageal symptoms have been more frequently reported by women than by men, suggesting that sex and gender play a role in symptom perception. Differential sensitivity with augmented symptoms in women might have diagnostic and therapeutic influence. Furthermore, recent studies have suggested that hormone replacement therapy has a protective effect against esophageal cancer. However, an anti-inflammatory role of estrogen remains compelling, which means further study is necessary in this area. PMID:27703114

  9. Enterogastric reflux and gastric clearance of refluxate in normal subjects and in patients with and without bile vomiting following peptic ulcer surgery

    International Nuclear Information System (INIS)

    Mackie, C.; Hulks, G.; Cuschieri, A.

    1986-01-01

    A noninvasive scintigraphic technique was used to estimate enterogastric reflux and subsequent gastric evacuation of refluxate in 35 normal, healthy subjects and 55 patients previously treated by vagotomy or partial gastrectomy. Reflux was provoked by a milk drink and quantitated by counting 99Tcm-EHIDA activity within the gastric area during gamma camera imaging. Seven normal subjects (20%) showed reflux of 5-18% of initial activity (mean: 10%), with peak values occurring at 5-30 minutes (mean: 14 minutes) following the milk. Gastric evacuation of activity in these subjects was monoexponential (r = 0.993, T1/2 = 24.1 minutes). Reflux occurred more frequently than normal in patients with truncal vagotomy and drainage (22/28 patients) and partial gastrectomy (20/21 patients). All of 16 patients with Billroth II anastomoses exhibited reflux, which was excessive compared with refluxing normal subjects (mean: 25%; p less than 0.01) and occurred later into the study (mean: 34 minutes; p less than 0.01). Ten of 11 asymptomatic patients showed reflux of similar amounts of activity (mean: 21%) compared with 16 patients who complained of bile vomiting (mean: 22%). However, asymptomatic patients exhibited gastric evacuation of refluxate at a rate similar to that of refluxing normal subjects, while bile vomiters showed significant gastric retention of refluxate at 25-30 minutes following peak gastric activity (p less than 0.05). This result confirms that post-operative bile vomiting is essentially a problem of gastric emptying

  10. Optimization and validation of high-performance liquid chromatography method for individual curcuminoids in turmeric by heat-refluxed extraction.

    Science.gov (United States)

    Kim, Young-Jun; Lee, Hyong Joo; Shin, Youngjae

    2013-11-20

    Turmeric is a plant in the Zingiberaceae family which contains curcuminoids as anticancer agents and has been widely used as a main ingredient in curry powder. However, there is a lack of suitable high performance liquid chromatography-diode array detection (HPLC-DAD) methods for reducing sample preparation time and peak resolution improvement of curcuminoids (bisdemethoxycurcumin, demethoxycurcumin, and curcumin). No significant differences in yield concentrations were observed after 60 min of heat-refluxed extraction (p turmeric samples (n = 107, range 2.70-4.41 g/100 g, total curcuminoids 3.58 g/100 g). These results show that heat-refluxed extraction can be carried out easily with excellent precision and accuracy of total curcuminoids in turmeric samples.

  11. Gastro-oesophageal reflux, eosinophilic airway inflammation and chronic cough.

    Science.gov (United States)

    Pacheco, Adalberto; Faro, Vicenta; Cobeta, Ignacio; Royuela, Ana; Molyneux, Ian; Morice, Alyn H

    2011-08-01

    Patients with eosinophilic airway inflammation (EAI) often show a therapeutic response to corticosteroids. Non-invasive methods of diagnosing EAI are potentially useful in guiding therapy, particularly in conditions such as chronic cough, for which corticosteroids may not be the first-line treatment. The value of exhaled nitric oxide (ENO) in the diagnosis of EAI was prospectively investigated in a cohort of 116 patients with chronic cough of varying aetiology. An optimum cut-off value was derived for differentiating between EAI and non-EAI causes of chronic cough. As the diagnosis was gastro-oesophageal reflux in 70 patients (60.3% of the total), the possible relationship between ENO and EAI in the presence or absence of reflux was subsequently investigated. The optimum value of ENO for differentiating EAI (32% of patients) from non-EAI causes of cough was 33 parts per billion (sensitivity 60.5%, specificity 84.6%). In the subgroup of patients with reflux, ENO was highly specific for the diagnosis of EAI (sensitivity 66%, specificity 100%). Conversely, in the patients without reflux, ENO did not discriminate between cough due to EAI or other causes (sensitivity 100%, specificity 28.9%). These results suggest that the presence or absence of reflux should be taken into consideration when interpreting ENO measurements in the diagnosis of chronic cough associated with EAI. © 2011 The Authors. Respirology © 2011 Asian Pacific Society of Respirology.

  12. The diagnosis of gastroesophageal reflux disease in children

    International Nuclear Information System (INIS)

    El-Mouzan, Mohammad I.; Abdullah, Asaad M.

    2002-01-01

    Gastroesophageal reflux disease is a common disorder affecting children worldwide. The objective of this study is to report our experience on the accuracy of tests used for the diagnosis ofgastroesophageal reflux disease with emphasis on the advantages and disadvantages of each of them. This study took place in the Pediatric Gastroenterology Division, Department of Pediatrics, College of Medicine and King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia, during the period of 1994 through to 1999. Results of barium meal, 24-hour esophageal pH monitoring, endoscopy, and gastrointestinal scintigraphy are analyzed and compared in children with and without gastroesophageal reflux disease. One hundred and forty-four children were investigated. The diagnosis was confirmed in 85 and excluded in 59 children, who will be considered as patients without gastroesophageal reflux disease. The results of barium meal, 24 hour pH monitoring, endoscopy, and gastrointestinal scintigraphy were positive in 80%, 78%, 92%, and 70% of the patients with gastroesophageal disease. The same studies were falsely positive in 29%, 9%, 19%, and 0% of those without gastroesophageal reflux disease. Esophageal pH was the most specific diagnostic study (91%), whereas endoscopy was the most sensitive (92%) and had the best positive predictive value (95%). The results of this study are similar to reports from other parts of the world. It is stressed that all procedures have important advantages and disadvantages indicating that the selection of procedures should be individualized and based on the clinical situation. (author)

  13. Gastric emptying of solid food in patients with gastroesophageal reflux

    International Nuclear Information System (INIS)

    Shay, S.; Eggli, D.; Van Nostrand, D.; Johnson, L.

    1985-01-01

    While delayed solid gastric emptying (GE) has been reported in patients with gastroesophageal reflux (GER), the relationship of GE to daytime and/or nighttime reflux patterns, and the severity of endoscopic esophagitis are unknown. The authors measured GE in a study population of symptomatic patients (n=33) with abnormal 24 hour pH monitoring (24 hr pH). The study population was divided into two groups by esophagoscopy; those with (E+=22); and 2) those without (E-=11) erosive esophagitis and/or Barrett's esophagus. GE was measured in all patients and in 15 normal volunteers (NL) by the in vivo labelling of chicken liver with Tc-99m-SC, which was in turn diced into 1 cm. cubes and given in 7 1/2 oz. of beef stew. Upright one minute anterior and posterior digital images were obtained every 15 min. for 2.5 hours. 24 hour pH was divided into daytime (upright) and nighttime (supine) segments, and acid exposure was defined as % time pH < 4 for that posture. There was no correlation between GE T 1/2 and acid exposure, daytime or nighttime, for the patient population as a whole. However, patients with the longest GE T1/2 tended to have severe daytime reflux. The authors rarely found delayed solid food gastric emptying in patients with reflux; moreover, they found no association between GE and either diurnal reflux patterns on 24 hr pH or the severity of endoscopic esophagitis

  14. Gastroplasty and fundoplication in the management of complex reflux problems.

    Science.gov (United States)

    Pearson, F G; Cooer, J D; Nelems, J M

    1978-11-01

    Between 1963 and 1976, 220 patients with complex reflux problems were managed by combining a modified Collis gastroplasty with a Belsey type of partial fundoplication. All patients had one or more of the following complicating conditions considered indications for the combined operation: peptic stricture (104), esophagitis and shortening without stricture (25), one or more prior hiatal repairs (65), massive herniation (33), and motor disorders associated with reflux (26). Ninety-six percent of the patients were evaluated by personal interview from 1 to 15 years after repair. The operative mortality rate was 0.5 percent. The incidence of significant symptomatic reflux requiring medical therapy was 3 percent and the incidence of troublesome dysphagia was 11 percent. No patient has required further operation for the relief of recurrent symptomatic reflux. Two patients required additional operation for severe residual dysphagia. Twenty patients managed by this repair were evaluated by preoperative, intraoperative, and sequential postoperative esophageal pressure studies. The mean postoperative pressure of 21.4 mm. Hg was more than double the preoperative value. Two publications from other centers reported on similar groups of patients managed by gastroplasty and partial fundoplication, evaluated by preoperative and postoperative esophageal pressures. In these latter publications, the percentage increase in postoperative lower esophageal pressure was significantly less than in our study, and a much higher incidence of symptomatic reflux was recorded. We suggest that the differences in postoperative pressures observed in account for the pronounced differences in the quality of results obtained.

  15. Italian survey on general pediatricians' approach to children with gastroesophageal reflux symptoms.

    Science.gov (United States)

    Quitadamo, Paolo; Miele, Erasmo; Alongi, Angelo; Brunese, Francesco Paolo; Di Cosimo, Maria Elisabetta; Ferrara, Dante; Gambotto, Silvia; Lamborghini, Adima; Mercuri, Maddalena; Pasinato, Angela; Sansone, Renato; Vitale, Concetta; Villani, Alberto; Staiano, Annamaria

    2015-01-01

    The aim of the present study was to investigate the current approach of Italian general pediatricians to children with gastroesophageal reflux (GER) symptoms, evaluating the implementation of the 2009 North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN)-European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) guidelines. One hundred randomly identified Italian general pediatricians were asked to complete a case report-structured questionnaire investigating their approach to infants, children, and adolescents with symptoms suggestive of GER. Only 2 % of them showed complete adherence to the guidelines. Thirty-nine percent of them diagnosed GER disease based on clinical symptoms, irrespective of the age of the child; 56 % prescribed proton pump inhibitors (PPIs) in infants with unexplained crying and/or distressed behavior and 38 % in infants with uncomplicated recurrent regurgitation and vomiting; 57 % prescribed PPIs in children younger than 8-12 years of age with vomiting and heartburn, without specific testing; and 54 % discontinued PPI therapy abruptly. The overall rate of pediatricians over-prescribing PPIs was 79 %. According to our findings, most Italian general pediatricians do not seem to follow the recommendations of the 2009 NASPGHAN-ESPGHAN reflux guidelines and often prescribe PPIs despite a lack of efficacy for the symptoms being treated. We are well aware that the guidelines address the average situation and that the evaluation of individual patients may frequently reveal reasons for opening criteria for exceptions. Nevertheless, the over-diagnosis of gastroesophageal reflux disease (GERD) places undue burden on both families and national health system which has not been impacted by the publication of international guidelines.

  16. Effectiveness of a transluminal endoscopic fundoplication for the treatment of pediatric gastroesophageal reflux disease.

    Science.gov (United States)

    Chen, Stephanie; Jarboe, Marcus D; Teitelbaum, Daniel H

    2012-03-01

    Although laparoscopic Nissen fundoplication is the standard surgical treatment for gastroesophageal reflux disease (GERD), surgical complications and post-operative pain are not uncommon, especially for those patients who are neurologically impaired (NI) or undergoing re-operative procedures. To address this challenge, we utilized the transoral incisionless fundoplication (TIF) procedure to treat GERD via an endoscopic approach. Eleven TIF patients were included with an average age of 16.5 ± 5.1 years and weight of 45.7 ± 13.3 kg. NI was present in nine patients (82%), including a predominant number of patients with a history of seizures and gastrostomy tube feeding. Five patients had a history of a previous failed fundoplication requiring a re-operative procedure (45%). A retrospective chart review evaluated patient outcomes and post-operative complications. The length of the TIF procedure was 113.3 ± 31.3 min with minimal blood loss. The length of stay was 1.2 ± 0.4 days, although one TIF patient was re-admitted for endoscopic clipping for gastric bleeding. At a follow-up of 8.2 ± 4.2 months, TIF effectively resolved GERD in 10 out of 11 children. A few of the patient's families reported complaints of gagging or dysphagia (30%, 3/11); however it was difficult to determine if complaints were due the procedures itself or baseline NI. All patients who had a follow-up upper GI or pH probe study showed no evidence of reflux. One TIF patient had no recurrent reflux but required an esophago-gastric disconnection for retching. The TIF procedure can complement the current surgically and medically available options for children with GERD, especially in complicated patients such as those with NI. However, complications including hemorrhage emphasize the potential risk of the procedure. Further studies with more patients and a longer follow-up course must be conducted to better assess efficacy.

  17. Clinical pathology of primary bile reflux gastritis

    Directory of Open Access Journals (Sweden)

    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.

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

    International Nuclear Information System (INIS)

    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%

  19. 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.

  20. [Laparoscopic treatment of gastro-esophageal reflux by fundoplication].

    Science.gov (United States)

    Hidraoui, Khalid; Chehab, Farid; Khaiz, Driss; Lakhloufi, Ali; Bouzidi, Abdelmjid

    2003-05-01

    The aim of this retrospective study was to evaluate the results of the laparoscopic fundoplication for gastroesophageal reflux disease. From January 1997 to February 2001, we performed 8 laparoscopic fundoplication. They are 5 men and 3 women with mean age of 45 [30-67 years]. The delay of apparition the symptoms varied from 6 months to 14 years. Seven patients had a heart burn. The preoperative evaluation included endoscopy, gastrointestinal contrast radiography, 24 hour pH monitoring and esophageal manometry. The surgical procedures were partial fundoplication (Toupet) in 7 cases and complete fundoplication (Nissen) in 1 case. There was no postoperative mortality. Two patients had a postoperative dysphagia. Two patients had persistent epigastric pain without gastroesophageal reflux in endoscopy and esophageal manometry. Laparoscopic fundoplication for treatment of gastroesophageal reflux disease is a safe and effective procedure with satisfying results.

  1. Evaluation of Current Operations for the Prevention of Gastroesophageal Reflux

    Science.gov (United States)

    Demeester, Tom R.; Johnson, Lawrence F.; Kent, Alfred H.

    1974-01-01

    A prospective randomized study was done on 45 patients to evaluate the effectiveness of the Hill, Nissen or Belsey anti-reflux procedure. All patients had symptoms of GE reflux unresponsive to medical therapy, a + standard acid reflux test (SART), and esophagitis (38/45) or + Burnstein test (7/45). Esophageal symptomatic, radiographic, manometric and pH (SART and 24-hr monitoring) evaluation was done pre- and 154 days (ave.) postsurgery. All procedures improved the symptoms of pyrosis. The best improvement was seen after the Nissen repair. All procedures increased the distal esophageal sphincter (DES) pressures over preoperative levels. The Nissen and Belsey increased it more than the Hill. Sphincter length and dynamics remained unchanged. The Nissen procedure placed more of the manometric sphincter below the respiratory inversion point in the positive pressure environment of the abdomen. The esophageal length was increased by the Nissen and Hill repairs. This was thought to account for the high incidence of temporary postsurgery dysphagia following the Nissen and Hill repairs and the lower incidence following the Belsey repair. Reflux was most effectively prevented by the Nissen repair, as shown by the SART and the 24-hr esophageal pH monitoring, a sensitive measurement of frequency and duration of reflux. The average length of hospital stay was 20 days for Belsey and 12 days for both Nissen and Hill procedure. Postsurgery complications were more common following the thoracic than the abdominal approach. Ability to vomit postrepair was greatest with the Hill and least with the Belsey and Nissen repair. All procedures temporarily increased amount of flatus. It is concluded that the Nissen repair best controls reflux and its symptoms by providing the greatest increase in DES pressure and placing more of the sphincter in the positive abdominal environment. This is accomplished with the lowest morbidity but at the expense of temporary postoperative dysphagia and a 50

  2. Gastroesophageal and extraesophageal reflux symptoms: similarities and differences.

    Science.gov (United States)

    Drinnan, Michael; Powell, Jason; Nikkar-Esfahani, Ali; Heading, Robert C; Doyle, Jill; Griffin, S Michael; Leslie, Paula; Bradley, Paula T; James, Peter; Wilson, Janet A

    2015-02-01

    The association between extraesophageal reflux (EER) and symptoms of gastroesophageal reflux disease (GERD) is inadequately understood. We used the Comprehensive Reflux Symptom Scale (CReSS) to evaluate EER and reflux-symptom prevalence in gastroenterology and otolaryngology outpatients and symptom awareness among UK gastroenterologists. Cross-sectional cohort survey. Six hundred thirty-nine participants were surveyed: 103 controls, 359 patients undergoing esophagogastroduodenoscopy (EGD), and 177 otolaryngology clinic patients with throat symptoms. Participants completed the CReSS questionnaire. The study was undertaken in the Endoscopy Unit and the Department of Otolaryngology-Head and Neck Surgery, Newcastle upon Tyne Hospitals, Newcastle-upon-Tyne, United Kingdom. Registered members of the British Gastroenterology Society were asked to rate how frequently reflux patients might complain of each CReSS item. The median CReSS total in volunteers (4) was significantly lower (P 15% of ENT patients and 28% of EGD patients. Three major, robust CReSS factors: esophageal, pharyngeal, and upper airway emerged. Of 259 gastroenterologists, >20% scored 8 of the 34 symptoms as never being reported by reflux patients. Endorsement of each EER CReSS item by 28% to 58% of patients with endoscopic evidence of GERD supports the Montreal consensus on an EER-GERD continuum. Gastroenterologists vary considerably in their appreciation of EER symptom relevance. The advantages of CReSS include standardized, comprehensive capture of patient experience; discriminant validity of ENT and GERD patients from volunteers; and discrete esophageal, pharyngeal, and upper airway subscales. 4. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.

  3. The Role of Helicobacter pylori in Laryngopharyngeal Reflux.

    Science.gov (United States)

    Campbell, Ross; Kilty, Shaun J; Hutton, Brian; Bonaparte, James P

    2017-02-01

    Objective The primary objective was to determine the prevalence of Helicobacter pylori among patients with laryngopharyngeal reflux. The secondary objective was determining if H pylori eradication leads to greater symptom improvement in patients with laryngopharyngeal reflux as compared with standard proton pump inhibitor therapy alone. Data Sources EMBASE, Cumulative Index to Nursing and Allied Health Literature, MEDLINE, World Health Organization International Clinical Trials Registry Platform, European Union Clinical Trials Register, Cochrane Library databases of clinical trials, and ClinicalTrials.gov. Review Methods A systematic review was performed of studies assessing the diagnosis or treatment of H pylori among patients with laryngopharyngeal reflux. Randomized controlled trials, cohort studies, case-control studies, and case series were included. A meta-analysis of prevalence data and assessment of heterogeneity was performed on relevant studies. Results Fourteen studies were analyzed in the review, with 13 eligible for the meta-analysis. We determined that the prevalence of H pylori among patients with laryngopharyngeal reflux was 43.9% (95% confidence interval, 32.1-56.5). The heterogeneity of studies was high, with an overall I 2 value of 92.3%. We were unable to quantitatively assess findings for our secondary outcome, since H pylori identification and treatment were not the primary focus of the majority of studies. Conclusion There is a high rate of H pylori infection among patients with laryngopharyngeal reflux. The infection rate in North America and Western Europe has not been adequately studied. There is insufficient evidence to make a recommendation regarding the testing and treatment of H pylori infection among patients with laryngopharyngeal reflux.

  4. Simulated Reflux Decreases Vocal Fold Epithelial Barrier Resistance

    Science.gov (United States)

    Erickson, Elizabeth; Sivasankar, Mahalakshmi

    2010-01-01

    Objectives/Hypothesis The vocal fold epithelium provides a barrier to the entry of inhaled and systemic challenges. However, the location of the epithelium makes it vulnerable to damage. Past research suggests, but does not directly demonstrate, that exposure to gastric reflux adversely affects the function of the epithelial barrier. Understanding the nature of reflux-induced epithelial barrier dysfunction is necessary to better recognize the mechanisms for vocal fold susceptibility to this disease. Therefore, we examined the effects of physiologically relevant reflux challenges on vocal fold transepithelial resistance and gross epithelial and subepithelial appearance. Study Design Ex vivo, mixed design with between-group and repeated-measures analyses. Methods Healthy, native porcine vocal folds (N = 52) were exposed to physiologically relevant acidic pepsin, acid-only, or pepsin-only challenges and examined with electrophysiology and light microscopy. For all challenges, vocal folds exposed to a neutral pH served as control. Results Acidic pepsin and acid-only challenges, but not pepsin-only or control challenges significantly reduced transepithelial resistance within 30 minutes. Reductions in transepithelial resistance were irreversible. Challenge exposure produced minimal gross changes in vocal fold epithelial or subepithelial appearance as evidenced by light microscopy. Conclusions These findings demonstrate that acidic environments characteristic of gastric reflux compromise epithelial barrier function without gross structural changes. In healthy, native vocal folds, reductions in transepithelial resistance could reflect reflux-related epithelial disruption. These results might guide the development of pharmacologic and therapeutic recommendations for patients with reflux, such as continued acid-suppression therapy and patient antireflux behavioral education. PMID:20564752

  5. Laryngopharyngeal reflux: a prospective analysis of a 34 item symptom questionnaire.

    Science.gov (United States)

    Papakonstantinou, L; Leslie, P; Gray, J; Chadwick, T; Hudson, M; Wilson, J A

    2009-10-01

    Laryngopharyngeal reflux is increasingly diagnosed, but both its symptoms and relationship to gastro-oesophageal reflux disease remain confused. (i) To assess symptoms in potential laryngopharyngeal reflux patients according to a comprehensive symptom list based on both a gastro-oesophageal reflux questionnaire and a laryngopharyngeal reflux questionnaire. (ii) To assess whether there are statistically discrete symptom clusters which might map to specific syndromes e.g. globus pharynges. Prospective single cohort questionnaire survey. A 34-item questionnaire comprising all symptoms identifiable on (i) the original 25-item Gastroesophageal Symptom Assessment Scale (GSAS) and (ii) the nine Reflux Symptom Index (RSI) items, 'unbundled' as necessary, were administered to 62 ENT clinic attenders. Descriptive, correlation and cluster analysis was performed. All but two of the combined 34-symptom list were endorsed by at least 20% of 62 patients. Certain symptoms which the Reflux Symptom Index groups as a single item were only weakly correlated. No specific symptom clusters were identified. Neither the most popular 'lower' oesophageal (GSAS) nor the 'throat' reflux (RSI) questionnaire adequately captures the full range of potential reflux symptoms regularly encountered in otolaryngology patients: inadequate evaluation of patients' symptoms may have contributed to the ongoing uncertainty about the role of acid or pepsin suppression. A more comprehensive reflux questionnaire is needed to characterise the true reflux correlations of laryngopharyngeal symptoms, and offer a symptom-specific measure of response to placebo and anti-reflux therapy.

  6. 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, Andŕe 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

  7. Pressure and X-ray recording of reflux into the thoracic stomach

    NARCIS (Netherlands)

    Bemelman, W. A.; Brummelkamp, W. H.; van der Hulst, V. P.; Reeders, J. W.; Roos, C. M.; Klopper, P. J.

    1992-01-01

    Anastomotic leakage, pulmonary aspiration and reflux-esophagitis might be induced or aggravated by the increased duodenogastric reflux observed in the thoracic stomach. In this study, the effect of respiration on the reflux-promoting pressure gradient in the intrathoracally located stomach was

  8. Very Short Gastroesophageal Acid Reflux during the Upright Position Could Be Associated with Asthma in Children

    Directory of Open Access Journals (Sweden)

    Yukinori Yoshida

    2009-01-01

    Conclusions: Reflux during the upright position was associated with asthmatic symptoms. The mean number of acid refluxes/h during the upright position in addition to the reflux index could be useful in the diagnosis of GERD when associated with asthma.

  9. ANTISECRETORY TREATMENT FOR PEDIATRIC GASTROESOPHAGEAL REFLUX DISEASE - A SYSTEMATIC REVIEW

    Directory of Open Access Journals (Sweden)

    Ângelo Zambam de MATTOS

    2017-09-01

    Full Text Available ABSTRACT BACKGROUND: Proton pump inhibitors and histamine H2 receptor antagonists are two of the most commonly prescribed drug classes for pediatric gastroesophageal reflux disease, but their efficacy is controversial. Many patients are treated with these drugs for atypical manifestations attributed to gastroesophageal reflux, even that causal relation is not proven. OBJECTIVE: To evaluate the use of proton pump inhibitors and histamine H2 receptor antagonists in pediatric gastroesophageal reflux disease through a systematic review. METHODS: A systematic review was performed, using MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials databases. The search was limited to studies published in English, Portuguese or Spanish. There was no limitation regarding date of publication. Studies were considered eligible if they were randomized-controlled trials, evaluating proton pump inhibitors and/or histamine H2 receptor antagonists for the treatment of pediatric gastroesophageal reflux disease. Studies published only as abstracts, studies evaluating only non-clinical outcomes and studies exclusively comparing different doses of the same drug were excluded. Data extraction was performed by independent investigators. The study protocol was registered at PROSPERO platform (CRD42016040156. RESULTS: After analyzing 735 retrieved references, 23 studies (1598 randomized patients were included in the systematic review. Eight studies demonstrated that both proton pump inhibitors and histamine H2 receptor antagonists were effective against typical manifestations of gastroesophageal reflux disease, and that there was no evidence of benefit in combining the latter to the former or in routinely prescribing long-term maintenance treatments. Three studies evaluated the effect of treatments on children with asthma, and neither proton pump inhibitors nor histamine H2 receptor antagonists proved to be significantly better than placebo. One study compared

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

    OpenAIRE

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

    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 a...

  11. Radiologic findings after fundoplication compared with a pH reflux test and symptoms

    International Nuclear Information System (INIS)

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

    1986-01-01

    In a follow-up after fundoplication, 61 patients underwent a double contrast examination of the stomach and a radiologic examination to detect any gastro-oesophageal reflux. The radiologic findings were compared with pH reflux test and symptoms. Gastro-oesophageal reflux was found in 7 patients at radiologic examination. None of these patients had an adequate fundoplication at a double contrast examination of the stomach and all had symptoms indicating reflux. Recurrence of gastro-oesophageal reflux may be shown at the radiologic examination and predicted by the morphologic appearances at the double contrast examination. (orig.)

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

    OpenAIRE

    Mei-Jyh Chen; Ming-Shiang Wu; Jaw-Town Lin; Kuang-Yi Chang; Han-Mo Chiu; Wei-Chih Liao; Chien-Chuan Chen; Yo-Ping Lai; Hsiu-Po Wang; Yi-Chia Lee

    2009-01-01

    Although evidence suggests that gastroesophageal reflux disease (GERD) may interrupt sleep, the effects of symptomatic and endoscopically diagnosed GERD remain elusive because the patient population is heterogeneous. Accordingly, we designed a cross-sectional study to assess their association. Methods: Consecutive participants in a routine health examination were enrolled. Definition and severity of erosive esophagitis were assessed using the Los Angeles classification system. Demographic ...

  13. Studying the Psychological Profile of Patients with Laryngopharyngeal Reflux.

    Science.gov (United States)

    Mesallam, Tamer A; Shoeib, Rasha M; Farahat, Mohamed; Kaddah, Fatma-Elzahraa A; Malki, Khalid H

    2015-01-01

    Psychological factors have been claimed to play a role in the predisposition for laryngopharyngeal reflux (LPR) symptoms. The aims of this work were to study the relationship between psychological disorders and LPR and to investigate the effect of potential psychological disorders on patients' self-perception of reflux-related problems. Forty-two patients with symptoms suggestive of LPR were psychologically evaluated using the Social Readjustment Rating Scale, the Symptom Checklist-90 Revised, the Manifest Anxiety Scale of Taylor, the Minnesota Multiphasic Personality Inventory, and the Zung Self-Rating Depression Scale. Oropharyngeal 24-hour pH monitoring was used to diagnose LPR. LPR-related symptoms were assessed using the reflux symptom index (RSI) and the voice handicap index-10 (VHI-10). Patients were divided into groups based on psychiatric evaluation and pH results. Correlations between psychological profile characteristics and LPR-related parameters were also investigated. No significant difference was found between the positive and negative LPR group for any of the assessed psychological disorders. Also, no significant difference was detected between the positive and negative psychological disorder groups regarding RSI, VHI-10, and pH results. Correlations between psychological profile parameters and LPR-related measures were also nonsignificant. It appears that there is no association between psychological disorders and LPR. The psychological background of the LPR patients had no influence on patients' self-perception of their reflux-related problems. © 2015 S. Karger AG, Basel.

  14. 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.

  15. Role of gastroscopy in gastro-oesophageal reflux disease (GORD)

    African Journals Online (AJOL)

    This two-year study is a retrospective analysis of records of patients diagnosed with gastro-oesophageal reflux disease (GORD) at a private medical aid society for the ... diagnosed GORD patients (n = 586) who were on drug therapy were included in the study. These patients were .... thritis and angina pectoris. NSAIDS, cal-.

  16. Additional considerations for gastro-oesophageal reflux disease

    African Journals Online (AJOL)

    Treatment may range from unscheduled self-medication to complicated laparoscopic surgery. This article describes some of the associated factors, revised definitions and the role of surgery in the management of GORD. Keywords: gastro-oesophageal reflux disease, glucocorticoid, GORD, Helicobacter pylori, obstructive ...

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

    African Journals Online (AJOL)

    2010-01-31

    Jan 31, 2010 ... After eating, food is carried from the mouth to the stomach .... Eat smaller meals. Eating large meals may cause the stomach to become over- distended. This increases upward pressure against the oesophageal sphincter causing acid reflux. ... By elevating the head of the bed, the head and shoulders are.

  18. Review article: extra-oesophageal reflux disease in children

    NARCIS (Netherlands)

    Shields, M. D.; Bateman, N.; McCallion, W. A.; van Wijk, M. P.; Wenzl, T. G.

    2011-01-01

    In children, respiratory and ENT disorders are associated with extra-oesophageal reflux. These include asthma, recurrent pneumonia, cough, apnoea, sinusitis, otitis media, laryngomalacia, recurrent croup and recurrent respiratory papillomatosis. The traditional tests of barium swallow, 24 h pH

  19. the pharmacological management of gastro-oesophageal reflux

    African Journals Online (AJOL)

    medicine techniques, such as acupuncture, are controversial, but show some benefit, especially in NORD patients who have failed anti-reflux treatment.9 Allied healthcare professionals, including nurses and pharmacists, are encouraged to treat GORD in the absence of danger signs (weight loss, haematemesis, melaenia.

  20. Extraoesophageal symptoms and signs of gastroesophageal reflux disease

    Directory of Open Access Journals (Sweden)

    Bojan Tepeš

    2006-04-01

    Full Text Available Background Gastroesophageal reflux disease (GERD is very common in developed world, with the prevalence of disease is between 6 and 20%. Pathologic reflux can provoke not only typical symptoms (heartburn and regurgitation but also atypical symptoms and diseases of extraoesophageal organs (pulmonary, ENT, mouth. High prevalence of GERD in patients with unexplained chest pain, asthma, chronic cough, chronic laryngitis, hoarsness and dental erosions is not a proof of causality. GERD can cause these diseases with reflux of acid and pepsin into pharynx, larynx, lungs and mouth (reflux theory or through vasovagal mechanisms (reflex theory. Conclusions Good therapeutic success with medical or operative treatment in early methodologically not well conducted studies has not been completely proven in double-blind placebo controlled studies. GERD is an ethyological reason for these extraoesophageal symptoms and diseases in an approximately one third of patients. With diagnostic modalities that we have now, we cannot clearly define in which patient is GERD is an ethyologic factor or a contributer, before we start the treatment. In patients suspected of having GERD, there is therapeutic option of a trial with high dose of proton pump inhibitor for 3 to 6 months. In other patients with low clinical suspicion of GERD, 24-hour pH testing should be done first.

  1. Use of proton pump inhibitors after anti-reflux surgery

    DEFF Research Database (Denmark)

    Lodrup, A.; Pottegård, Anton; Hallas, J.

    2014-01-01

    Objective Antireflux surgery (ARS) has been suggested as an alternative to lifelong use of proton pump inhibitors (PPI) in reflux disease. Data from clinical trials on PPI use after ARS have been conflicting. We investigated PPI use after ARS in the general Danish population using nationwide...

  2. Comparison of closed-pressurized and open-refluxed vessel ...

    African Journals Online (AJOL)

    Samples of residual fuel oil reference material (SRM 1634c) were mineralized in closed digestion vessels from Milestone Laboratory Systems (MLS) or from PAAR (HPA) or in open-refluxed microwave digestion flasks from Prolabo. The three digestion systems were evaluated in terms of accuracy and precision, reagents ...

  3. 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

  4. Western blotting in the diagnosis of duodenal-biliary and pancreaticobiliary refluxes in biliary diseases.

    Science.gov (United States)

    Xian, Guo-Zhe; Wu, Shuo-Dong; Chen, Chun-Chih; Su, Yang

    2009-12-01

    Currently adopted diagnostic methods for duodenal-biliary and pancreaticobiliary refluxes carry many flaws, so the incidence of the two refluxes demands further larger sample size studies. This study aimed to evaluate Western blotting for the diagnosis of refluxes in biliary diseases. An oral radionuclide 99mTc-DTPA test (radionuclide, RN) was conducted for the observation of duodenal-biliary reflux prior to measuring bile radioactivity and Western blotting for detecting bile enterokinase (EK). Pancreaticobiliary reflux was assessed by biochemical and Western blotting tests for biliary amylase activity and trypsin-1, respectively. In accordance with bile sample origin, our samples were classified into ductal bile and gall bile groups; based on each individual biliary disease, we further classified the ductal bile group into five sub-groups, and the gall bile group into four sub-groups. Western blotting was conducted to assess the two refluxes in biliary diseases. Consistencies were noted between EK and RN tests when diagnosing duodenal-biliary reflux (P0.05); in the common bile duct cyst group, the EK positive rate was significantly lower than the trypsin-1 positive rate (PWestern blotting can accurately reflect duodenal-biliary and pancreaticobiliary refluxes. EK has greater sensitivity than RN for duodenal-biliary reflux. The majority of biliary amylase and lipase comes from the pancreas in all biliary diseases; pancreaticobiliary reflux is the predominant source in the common bile duct cyst group and duodenal-biliary reflux is responsible for the ductal pigment stone group.

  5. 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.

  6. 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

  7. Features of obesity treatment in patients with gastroesophageal reflux disease

    Directory of Open Access Journals (Sweden)

    E I Andreeva

    2018-02-01

    Full Text Available In the past few decades, the worldwide prevalence of such nosological forms as gastroesophageal reflux disease and obesity has been increasing. The combination of these pathologies is more often observed in patients who have nutrition and lifestyle issues, as well as genetic predisposition to these nosologies. Patients with obesity are noted to have predisposition to diaphragmatic hernias and mechanical damage of gastroesophageal junction, which occurs against the background of increased intragastric pressure and increased pressure gradient between the stomach and esophagus, as well as due to extension of the proximal part of the stomach. One of the basic pathogenetic moments of gastroesophageal reflux disease is spontaneous relaxation of the lower esophageal sphincter. According to recent studies, in obesity the frequency of postprandial spontaneous relaxation of the lower esophageal sphincter increases even in the absence of diaphragmatic hernia, non-erosive gastroesophageal reflux disease and reflux esophagitis. The variety of metabolic disorders observed in these patients requires a comprehensive approach to treatment, aimed both at effective reduction of the acid-peptic factor and at correction of excessive body weight. Both non-pharmacological and pharmacological methods are distinguished among the main treatment directions for both components of this combined pathology. An important role in therapy is given to activities that contribute to the maintenance of healthy lifestyle: smoking cessation, weight loss, dietary nutrition, health-improving physical culture. Among medications for patients with gastroesophageal reflux disease and obesity, which allow achieving an optimal acid-reducing effect, specific attention is assigned to a group of proton pump inhibitors (H+/K+-ATPase inhibitors, which have a lower affinity for hepatic cytochrome P450 enzyme system, do not affect its activity and do not clinically significantly cross-react with

  8. Effect of fasting on laryngopharyngeal reflux disease in male subjects.

    Science.gov (United States)

    Hamdan, Abdul-latif; Nassar, Jihad; Dowli, Alexander; Al Zaghal, Zeid; Sabri, Alain

    2012-11-01

    To address the effect of fasting on laryngopharyngeal reflux disease (LPRD). A total of 22 male subjects have been recruited for this study. Subjects with vocal fold pathologies, recent history of upper respiratory tract infection or laryngeal manipulation were excluded. Demographic data included age and history of smoking. All subjects were evaluated while fasting for at least 12 h and non-fasting. By non-fasting we mean that they ate and drank during the day at their discretion with no reservation. The abstention from water and or food intake during the non-fasting period extended from few minutes to 3 h. All subjects were evaluated at the same time during the day. The evaluation consisted of a laryngeal examination and the Reflux Symptom Index (RSI). The Reflux Finding Score (RFS) was used to report on the reflux laryngeal findings. Subjects were considered to have LPRD if either the RSI or the RFS were positive (>9 RSI, >7 RFS). There was a non-significant increase in the total prevalence of LPRD while fasting compared to non-fasting (32 vs. 50 % while fasting, p value 0.361). In the RSI, the most common symptoms while non-fasting and fasting were throat clearing (64 vs. 68 %), postnasal drip (45 vs. 59 %) and globus sensation (36 vs. 50 %). The average score of all the three increased significantly while fasting. For the RFS the most common laryngeal findings in the non-fasting group versus the fasting group were erythema (77 vs. 68 %), thick endolaryngeal mucus (77 vs. 77 %) and posterior commissure hypertrophy (55 vs. 64 %). Fasting results in a nonsignificant increase in laryngopharyngeal reflux disease. The increase can be hypothetically explained on the change in eating habits and the known alterations in gastric secretions during Ramadan. Fasting subjects must be alert to the effect of LPRD on their throat and voice in particular.

  9. An alginate-antacid formulation localizes to the acid pocket to reduce acid reflux in patients with gastroesophageal reflux disease

    NARCIS (Netherlands)

    Rohof, Wout O.; Bennink, Roel J.; Smout, Andre J. P. M.; Thomas, Edward; Boeckxstaens, Guy E.

    2013-01-01

    Alginate rafts (polysaccharide polymers that precipitate into a low-density viscous gel when they contact gastric acid) have been reported to form at the acid pocket, an unbuffered pool of acid that floats on top of ingested food and causes postprandial acid reflux. We studied the location of an

  10. Haemorrhoids are associated with internal iliac vein reflux in up to one-third of women presenting with varicose veins associated with pelvic vein reflux.

    Science.gov (United States)

    Holdstock, J M; Dos Santos, S J; Harrison, C C; Price, B A; Whiteley, M S

    2015-03-01

    To determine the prevalence of haemorrhoids in women with pelvic vein reflux, identify which pelvic veins are associated with haemorrhoids and assess if extent of pelvic vein reflux influences the prevalence of haemorrhoids. Females presenting with leg varicose veins undergo duplex ultrasonography to assess all sources of venous reflux. Those with significant reflux arising from the pelvis are offered transvaginal duplex ultrasound (TVS) to evaluate reflux in the ovarian veins and internal Iliac veins and associated pelvic varices in the adnexa, vulvar/labial veins and haemorrhoids. Patterns and severity of reflux were evaluated. Between January 2010 and December 2012, 419 female patients with leg or vulvar varicose vein patterns arising from the pelvis underwent TVS. Haemorrhoids were identified on TVS via direct tributaries from the internal Iliac veins in 152/419 patients (36.3%) and absent in 267/419 (63.7%). The prevalence of the condition increased with the number of pelvic trunks involved. There is a strong association between haemorrhoids and internal Iliac vein reflux. Untreated reflux may be a cause of subsequent symptomatic haemorrhoids. Treatment with methods proven to work in conditions caused by pelvic vein incompetence, such as pelvic vein embolisation and foam sclerotherapy, could be considered. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  11. 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.

  12. Debut of Gastroesophageal Reflux Concomitant with Administration of Sublingual Immunotherapy

    DEFF Research Database (Denmark)

    Juel, J.

    2017-01-01

    Gastroesophageal reflux disease (GORD) is an often debilitating condition characterised by retrograde flow of content from stomach into the oesophagus, where the low pH of the stomach acid irritates the mucosa of the oesophagus. The most dominant symptoms in GORD are pyrosis, regurgitation, and d...... to administration of sublingual immunotherapy for house dust mite in allergic rhinitis. The patient had to stop the SLIT after two weeks of administration due to GORD. The cessation resulted in rapid resolution of symptoms....

  13. 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.

  14. A simple air-cooled reflux condenser for laboratory use

    International Nuclear Information System (INIS)

    Boult, K.A.

    1979-10-01

    This Memorandum describes the design of a simple compact air-cooled reflux condenser suitable for gloveboxes, cells or other locations where the provision of cooling water presents a problem. In a typical application the condenser functioned satisfactorily when used to condense water from a flask heated by a 100 watt mantle. There was no measurable loss of water from the boiling flask in 100 hours. (author)

  15. Association between esophageal dysmotility and gastroesophaeal reflux on barium studies

    International Nuclear Information System (INIS)

    Campbell, Craig; Levine, Marc S.; Rubesin, Stephen E.; Laufer, Igor; Redfern, Gina; Katzka, David A.

    2006-01-01

    Objective: To determine whether there is an association between abnormal primary peristalsis in the esophagus and gastroesophageal reflux (GER) on barium studies. Methods: A computerized search of radiologic reports revealed 151 patients with esophageal dysmotility (characterized by intermittently decreased or absent peristalsis in the esophagus on upper gastrointestinal tract examinations) who fulfilled our study's entry criteria. These 151 patients were stratified into two groups depending on whether this dysmotility was associated with nonperistaltic contractions (NPCs): 92 patients had no NPCs (Dysmotility and No NPCs Group) and 59 had NPCs (Dysmotility and NPCs Group). An age-matched control group of 92 patients with normal motility was also generated from the radiologic reports. The reports were also reviewed for the presence and degree of GER and other complications of GER. The frequency and degree of GER were tabulated for each group, and the data were analyzed using a Pearson chi square test to determine if significant differences were present in the frequency and degree of GER or other findings among the groups. Results: The frequency of GER was significantly higher in patients with abnormal peristalsis and no NPCs than in controls (p = 0.02). When GER was stratified based on the degree of reflux, the frequency of moderate-to-marked GER was significantly higher in patients with abnormal peristalsis and no NPCs than in patients with abnormal peristalsis and NPCs (p = 0.01) or in controls (p = 0.0031). The frequency of reflux esophagitis also was significantly higher in patients with abnormal peristalsis and no NPCs than in controls (p = 0.04). Conclusion: Our findings suggest that patients with esophageal dysmotility characterized by intermittently decreased or absent peristalsis without NPCs have a significantly higher frequency and degree of GER than patients with normal motility. The presence of this specific form of esophageal dysmotility on barium

  16. Association between esophageal dysmotility and gastroesophaeal reflux on barium studies

    Energy Technology Data Exchange (ETDEWEB)

    Campbell, Craig [Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104 (United States); Levine, Marc S. [Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104 (United States)]. E-mail: marc.levine@uphs.upenn.edu; Rubesin, Stephen E. [Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104 (United States); Laufer, Igor [Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104 (United States); Redfern, Gina [Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104 (United States); Katzka, David A. [Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA 19104 (United States)

    2006-07-15

    Objective: To determine whether there is an association between abnormal primary peristalsis in the esophagus and gastroesophageal reflux (GER) on barium studies. Methods: A computerized search of radiologic reports revealed 151 patients with esophageal dysmotility (characterized by intermittently decreased or absent peristalsis in the esophagus on upper gastrointestinal tract examinations) who fulfilled our study's entry criteria. These 151 patients were stratified into two groups depending on whether this dysmotility was associated with nonperistaltic contractions (NPCs): 92 patients had no NPCs (Dysmotility and No NPCs Group) and 59 had NPCs (Dysmotility and NPCs Group). An age-matched control group of 92 patients with normal motility was also generated from the radiologic reports. The reports were also reviewed for the presence and degree of GER and other complications of GER. The frequency and degree of GER were tabulated for each group, and the data were analyzed using a Pearson chi square test to determine if significant differences were present in the frequency and degree of GER or other findings among the groups. Results: The frequency of GER was significantly higher in patients with abnormal peristalsis and no NPCs than in controls (p = 0.02). When GER was stratified based on the degree of reflux, the frequency of moderate-to-marked GER was significantly higher in patients with abnormal peristalsis and no NPCs than in patients with abnormal peristalsis and NPCs (p = 0.01) or in controls (p = 0.0031). The frequency of reflux esophagitis also was significantly higher in patients with abnormal peristalsis and no NPCs than in controls (p = 0.04). Conclusion: Our findings suggest that patients with esophageal dysmotility characterized by intermittently decreased or absent peristalsis without NPCs have a significantly higher frequency and degree of GER than patients with normal motility. The presence of this specific form of esophageal dysmotility on

  17. 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.

  18. [Gastroesophageal reflux disease in preschool children with asthma].

    Science.gov (United States)

    Yoshida, Yukinori; Kameda, Makoto; Nishikido, Tomoki; Takamatu, Isamu; Doi, Satoru

    2008-05-01

    In pediatric intractable asthma, there is occasionally an association with GERD (gastroesophageal reflux disease). It is not clear in which cases GERD should be suspected or how effective the GERD therapy is in treating the asthma. Twenty-seven preschool children (asthma attack in spite of asthma therapy underwent 24-hour esophageal pH monitoring. We examined retrospectively the incidence of GERD and the effectiveness of famotidine in GERD positive patients. 18 of the 27 patients (66.7%) had positive results (GERD positive group). In 12 of the 15 patients (80%) who underwent GERD therapy (famotidine), respiratory symptoms were decreased. In the GERD positive group, the incidence of acid reflux during waking hours was more frequent than during sleeping hours. In 8 of 12 patients (66.7%) in whom famotidine was effective, cough and wheeze often occurred during the daytime and corresponded with the time when acid reflux must commonly occurred. We conclude that children suffering from recurrent asthma attack in spite of asthma therapy must be examined for the presence of GERD.

  19. 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.

  20. 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.

  1. Belching during gastroscopy and its association with gastroesophageal reflux disease.

    Science.gov (United States)

    Lee, B S; Lee, S H; Jang, D K; Chung, K H; Hwang, J H; Jang, S E; Cha, B H; Ryu, J K; Kim, Y-T

    2016-05-01

    Belching may result from transient lower esophageal sphincter relaxation; therefore, it has been proposed that belching may be a manifestation of gastroesophageal reflux disease (GERD). This study was conducted to investigate the frequency of belching during esophagogastroduodenoscopy (EGD) and its association with GERD. A retrospective review was performed on prospectively collected clinical and endoscopic data from 404 subjects who underwent EGD without sedation from December 2012 to May 2013 in a training hospital in Korea. All detectable belching events during endoscopy were counted. Frequency and severity of belching events were compared between the group with and without GERD using an ordinal logistic regression model. There were 145 GERD patients (26 erosive reflux disease and 119 nonerosive reflux disease [NERD]). In the multivariable analysis, GERD was significantly associated with a higher frequency of belching events (odds ratio = 6.59, P GERD severity according to the Los Angeles classification (P GERD, including NERD. Future research should focus on its adjuvant role in the diagnosis of GERD/NERD and the necessity for applying differentiated endoscopy strategies for GERD patients, leading to less discomfort during EGD in patients at risk for intolerability. © 2015 International Society for Diseases of the Esophagus.

  2. Recent advances in diagnostic testing for gastroesophageal reflux disease.

    Science.gov (United States)

    Naik, Rishi D; Vaezi, Michael F

    2017-06-01

    Gastroesophageal reflux disease (GERD) has a large economic burden with important complications that include esophagitis, Barrett's esophagus, and adenocarcinoma. Despite endoscopy, validated patient questionnaires, and traditional ambulatory pH monitoring, the diagnosis of GERD continues to be challenging. Areas covered: This review will explore the difficulties in diagnosing GERD with a focus on new developments, ranging from basic fundamental changes (histology and immunohistochemistry) to direct patient care (narrow-band imaging, impedance, and response to anti-reflux surgery). We searched PubMed using the noted keywords. We included data from full-text articles published in English. Further relevant articles were identified from the reference lists of review articles. Expert commentary: Important advances in novel parameters in intraluminal impedance monitoring such as baseline impedance monitoring has created some insight into alternative diagnostic strategies in GERD. Recent advances in endoscopic assessment of esophageal epithelial integrity via mucosal impedance measurement is questioning the paradigm of prolonged ambulatory testing for GERD. The future of reflux diagnosis may very well be without the need for currently employed technologies and could be as simple as assessing changes in epithelia integrity as a surrogate marker for GERD. However, future studies must validate such an approach.

  3. Thermal-hydraulic phenomena during reflux condensation cooling in steam generator tubes

    International Nuclear Information System (INIS)

    Hae, Yong Jeong; Bum, Nyun Kim; Kwangho, Lee

    1998-01-01

    The transitions of cooling mechanism in steam generator tubes during reflux condensation are studied. It is found that the transitions are closely related to the occurrence of flooding or counter-current flow limitation phenomena in steam generator tubes. As shown in the previous studies of other researchers, the transition from filmwise reflux condensation into total reflux condensation occurs when the flooding criterion suggested by Wallis is met. In this study, it is suggested that the transition from total reflux condensation to complete carry-over occurs depending on the tube height and cooling conditions. It is also shown that the flooding at SG tubes occurs before the flooding at hot leg when a reflux condensation mode is existing in steam generator. Though the thermal-hydraulic conditions during reflux condensation after a small-break loss-of-coolant accident have enough margin to the transition into carry-over, considerations for the prevention of primary coolant relocation should be provided

  4. Quantitative radioisotope measurement of duodenogastric reflux in patients with ulcer or gastrectomized for ulcer

    International Nuclear Information System (INIS)

    Hyoedynmaa, S.; Paeaekkoenen, A.; Laensimies, E.; Korhonen, K.; Paeaekkoenen, M.; Aukee, S.

    1985-01-01

    In this work the duodenogastric reflux was quantified as the amount of radioactivity entering the stomach after an i.v. administration of sup(99m)Tc-HIDA in ulcer patients and in patients who had undergone BI gastrectomy. The results were compared with visual evidence of gastric activity in the gamma camera images and biochemical determination of gastric bile reflux. The method is useful in quantifying the reflux if the activity is above the background activity. It allows the determination of an upper limit for the reflux when the reflux is evident visually. Only two or three images are needed for the quantitation. No correlation was found between biochemical measurements of fasting bile reflux in the stomach and radioisotopic quantification. (orig.) [de

  5. Acid suppressants for managing gastro-oesophageal reflux and gastro-oesophageal reflux disease in infants: a national survey.

    Science.gov (United States)

    Bell, Jane C; Schneuer, Francisco J; Harrison, Christopher; Trevena, Lyndal; Hiscock, Harriet; Elshaug, Adam G; Nassar, Natasha

    2018-02-22

    To evaluate the diagnosis and management of reflux and gastro-oesophageal reflux disease (GORD) in infants aged Overprescribing of acid suppressants to infants may be occurring. In infants, acid-suppressant medicines are no better than placebo and may have significant negative side effects; however, guidelines are inconsistent. Clear, concise and consistent guidance is needed. GPs and parents need to understand what is normal and limitations of medical therapy. We need a greater understanding of the influences on GP prescribing practices, of parents' knowledge and attitudes and of the pressures on parents of infants with these conditions. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  6. Usefulness of assessment of voice capabilities in female patients with reflux-related dysphonia

    OpenAIRE

    Šiupšinskienė, Nora; Adamonis, Kęstutis; Toohill, Robert J

    2009-01-01

    Objectives. To analyze vocal capabilities in patients diagnosed with reflux related dysphonia versus controls with healthy voice with selection of the most informative discriminating quantitative parameters and to assess voice changes following treatment. Material and methods. Six parameters of voice range profile (VRP) and five parameters of speech range profile were taken and analyzed from 60 dysphonic outpatient females with laryngopharyngeal reflux (LPR) diagnosed by reflux-related atypic...

  7. The diagnosis of gastro-esophageal reflux disease cannot be made with barium esophagograms.

    Science.gov (United States)

    Saleh, C M G; Smout, A J P M; Bredenoord, A J

    2015-02-01

    For over 50 years, barium studies have been used to diagnose gastro-esophageal reflux disease (GERD), but the value of this test is controversial. Our study aimed to determine if barium esophagograms can be used to diagnose GERD. Barium esophagograms and pH-impedance measurement were performed in 20 subjects with reflux symptoms. pH-impedance measurements were used as gold standard for the diagnosis of GERD. Gastro-esophageal reflux measured with the barium study was defined as a positive outcome. 50% of patients presented gastro-esophageal reflux on the barium esophagogram. No significant differences were observed in acid exposure time between subjects with (median: 7.4%; interquartile range, IQR: 8.4%) or without reflux at barium esophagography (median: 5.95%; IQR: 13.05%; p > 0.05). Nor did we find differences in median proximal extent of reflux measured with impedance monitoring between patients with a positive (median: 6.7%; IQR: 1.95%) and negative barium study (median: 7.1%; IQR: 0.68%; p > 0.05). Patients with reflux on barium esophagogram did not have a positive symptom association probability more often than those who did not have reflux at barium esophagography. Lastly, there were no differences in numbers of acid, weakly acidic or total reflux episodes between those with positive or negative barium esophagogram (p > 0.05). No correlations were found between the maximum proximal extent of gastro-esophageal reflux during esophagography and pH-impedance parameters. Presence or absence of gastro-esophageal reflux during barium esophagography does not correlate with incidence or extent of reflux observed during 24-h pH-impedance monitoring and is not of value for the diagnosis of GERD. © 2014 John Wiley & Sons Ltd.

  8. 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.

  9. Diagnostic value of the reflux sign in cholescintigraphy

    International Nuclear Information System (INIS)

    Itoh, Hisao

    1990-01-01

    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 μg 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.)

  10. In-vitro comparison of a 1st and a 2nd generation US contrast agent for reflux diagnosis; In-vitro-Vergleich eines Ultraschallkontrastmittels der 1. mit einem der 2. Generation fuer die Refluxdiagnostik

    Energy Technology Data Exchange (ETDEWEB)

    Robrecht, J.; Darge, K. [Klinikum der Univ. Wuerzburg (Germany). Abt. fuer Paediatrische Radiologie

    2007-08-15

    Purpose: Contrast-enhanced sonographic reflux diagnosis, i. e. voiding urosonography (VUS), is gradually becoming an alternative for diagnostic imaging of vesicoureteric reflux (VUR). A limiting factor for the widespread application of VUS is the cost of the US contrast agents. The development of new US contrast agents and the possibility of reducing the administered dose are expected to lower the cost. The aim of this study was an in-vitro comparison of the new US contrast agent (SonoVue {sup registered}) and the routinely used contrast agent Levovist {sup registered}, while taking into consideration the physical-chemical properties relevant for reflux diagnosis. Materials and Methods: The in-vitro experiment setup simulated the in-vivo VUS. The US modalities fundamental and harmonic imaging (THI/ECI, Sonoline Elegra {sup registered}, Siemens) were utilized, the latter with both low and high mechanical indices (MI). SonoVue {sup registered} was tested in concentrations of 0.25 %, 0.5 % and 1 % and Levovist {sup registered} at 5 % volume. The in-vitro contrast duration served as the parameter for comparison. This was defined as the time from the start of the experiment until the time when more than 50 % of the image area was free of microbubbles. Results: The use of different concentrations of SonoVue {sup registered} did not have any impact on the contrast duration. The contrast duration of SonoVue {sup registered} turned out to be significantly longer when the US modality was switched from low to high MI. In the case of THI with high MI as is routinely with Levovist {sup registered}, the contrast duration of Levovist {sup registered} at a concentration of 5 % was 1.1 min, whereas that of SonoVue {sup registered} at a concentration of 1 % reached 7.3 min. This means that despite SonoVue {sup registered} being administered at a dose five times lower than that of Levovist {sup registered}, the in-vitro contrast duration increased by more than 80 %. Moreover, a

  11. The oesophagus and cough: laryngo-pharyngeal reflux, microaspiration and vagal reflexes

    Science.gov (United States)

    2013-01-01

    Gastro-oesophageal reflux disease is generally considered to be one of the commonest causes of chronic cough, however randomised controlled trials of proton pump inhibitors have often failed to support this notion. This article reviews the most recent studies investigating the mechanisms thought to link reflux and cough, namely laryngo-pharyngeal reflux, micro-aspiration and neuronal cross-organ sensitisation. How recent evidence might shed light on the failure of acid suppressing therapies and suggest new approaches to treating reflux related cough are also discussed. PMID:23590893

  12. Gastroesophageal reflux: comparison of barium studies with 24-h pH monitoring

    International Nuclear Information System (INIS)

    Pan, John J.; Levine, Marc S.; Redfern, Regina O.; Rubesin, Stephen E.; Laufer, Igor; Katzka, David A.

    2003-01-01

    Objective: To determine the correlation between massive gastroesophageal reflux (GER) on barium studies and pathologic acid reflux on 24-h pH monitoring. Methods: A search of hospital records from January 1997 to January 2001 revealed 28 patients who underwent both barium studies and 24-h pH monitoring. The radiologic reports were reviewed to determine the presence and degree of GER. Patients with reflux to or above the thoracic inlet either spontaneously or with provocative maneuvers in the recumbent position were classified as having massive reflux, whereas the remaining patients with reflux below the thoracic inlet or no reflux comprised the control group. The pH monitoring reports were also reviewed to determine if pathologic acid reflux was present in the recumbent position. The findings on these studies were then compared to determine the frequency of pathologic acid reflux in the recumbent position on pH monitoring in patients with massive reflux on barium studies compared with the control group. Results: Massive GER was observed on barium studies in 11 (39%) of the 28 patients and reflux below the thoracic inlet or no reflux in the remaining 17 patients (61%) who comprised the control group. All 11 patients (100%) with massive reflux on barium studies had pathologic acid reflux on pH monitoring in the recumbent position compared with six (35%) of 17 patients in the control group (P=0.0009). The pH in the distal esophagus on pH monitoring was less than 4.0 for 13.1% of the recumbent period for patients with massive GER on barium studies compared with 6.2% of the recumbent period for the control group (P=0.0076). Conclusion: Although 24-h pH monitoring remains the gold standard for the detection of GER, our experience suggests that patients with massive reflux on barium studies are so likely to have pathologic acid reflux in the recumbent position that these individuals can be further evaluated and treated for their gastroesophageal reflux disease (GERD

  13. Evaluating outcomes of endoscopic full-thickness plication for gastroesophageal reflux disease (GERD) with impedance monitoring.

    Science.gov (United States)

    von Renteln, Daniel; Schmidt, Arthur; Riecken, Bettina; Caca, Karel

    2010-05-01

    Endoscopic full-thickness plication allows transmural suturing at the gastroesophageal junction to recreate the antireflux barrier. Multichannel intraluminal impedance monitoring (MII) can be used to detect nonacid or weakly acidic reflux, acidic swallows, and esophageal clearance time. This study used MII to evaluate the outcome of endoscopic full-thickness plication. In this study, 12 subsequent patients requiring maintenance proton pump inhibitor therapy underwent endoscopic full-thickness plication for treatment of gastroesophageal reflux disease. With patients off medication, MII was performed before and 6-months after endoscopic full-thickness plication. The total median number of reflux episodes was significantly reduced from 105 to 64 (p = 0.016). The median number of acid reflux episodes decreased from 73 to 43 (p = 0.016). Nonacid reflux episodes decreased from 23 to 21 (p = 0.306). The median bolus clearance time was 12 s before treatment and 11 s at 6 months (p = 0.798). The median acid exposure time was reduced from 6.8% to 3.4% (p = 0.008), and the DeMeester scores were reduced from 19 to 12 (p = 0.008). Endoscopic full-thickness plication significantly reduced total reflux episodes, acid reflux episodes, and total reflux exposure time. The DeMeester scores and total acid exposure time for the distal esophagus were significantly improved. No significant changes in nonacid reflux episodes and median bolus clearance time were encountered.

  14. Phonetic Approaches of Laryngopharyngeal Reflux Disease: A Prospective Study.

    Science.gov (United States)

    Lechien, Jérôme R; Delvaux, Véronique; Huet, Kathy; Khalife, Mohamad; Fourneau, Anne-Françoise; Piccaluga, Myriam; Harmegnies, Bernard; Saussez, Sven

    2017-01-01

    The study aimed to explore the impact of the selection of the analyzed time interval on the significance of acoustic measurements used to investigate laryngopharyngeal reflux (LPR) treatment efficacy, and based on these results to develop an alternative statistical approach in data analysis focusing on individual patient vocal behavior. This is a prospective case series. From September 2013 to July 2015, 41 patients with a reflux finding score (RFS) > 7 and a reflux symptom index (RSI) > 13 were enrolled and treated with pantoprazole 20 mg twice daily and diet behavioral changes for 3 months. Voice recordings were performed at baseline and after 3 months of treatment. Most stable time intervals of 1, 2, 3, 4, and 5 seconds, and a 1-second time interval positioned at mid-production, were subjected to acoustic analysis. Based on the latter, we developed an "informativeness coefficient" for each acoustic parameter that aimed at assessing its sensitivity to clinical resolution in the case of LPR disease. Significant clinical improvement (RSI and RFS) was observed after treatment (P < 0.05). The acoustic analysis revealed that acoustic parameters significantly improving from pre- to posttreatment varied across time intervals. The duration and the position of the analyzed time interval in the production yielded considerable differences in the results. Analysis of the informativeness coefficient indicated that jitter, jitter percent, relative average perturbation (RAP), pitch perturbation quotient (PPQ), shimmer (ShdB), shimmer percent (Shim), amplitude perturbation quotient (APQ), and smoothed amplitude perturbation quotient (sAPQ) were the indices most sensitive to medical treatment efficacy, with a coefficient ranging from 75.86% to 86.21%. Depending on the selection of the time interval over which the acoustic parameters are measured, the potential effect of the treatment may or may not be statistically demonstrated. Future studies are needed to

  15. [Gastroesophageal reflux: clinical, endoscopic characteristics and associated risk factors].

    Science.gov (United States)

    Castelo Vega, Jean Marcel; Olivera Hermoza, Rogers; Páucar Sotomayor, Héctor; Flores Aldea, Juan Carlos

    2003-01-01

    We performed a case control study to describe the clinical and epidemiological characteristics, and identify the risk factors associated to gastroesophageal reflux among patients of the gastroenterology unit at the HNSE EsSalud - Cusco. There were included 645 patients with endoscopic diagnosis of esophagitis between january 1, 1999 and december 31, 2000. Afterwards, we selected a sample of 125 cases and 124 non related matched controls. The statistical profiles about gastroesophageal reflux, the digestive endoscopy service digests and the clinic histories of patients were reviewed; and the case and control samples were interviewed namelessly with their previous consent. Gastroesophageal reflux esophagitis was the diagnosis in 13% of endoscopies at the study period, with a little predominance in males (65%) and a middle age of 51,64. A 39,8% of cases concern of university proffesional patients. The main symptom was dyspepsia (84,18%) followed by the clasic clinical markers pirosis (44%) and regurgitation (30%), and nondigestive symptoms were unfrecuent (9%). Esophagitis was diagnosted mainly at mild stages of the disease (94% of cases) and we demonstrated an statistical association between esophagitis and hiatal hernia in the 32% of cases (pAINES (OR:19,36 and IC: 2,65-396,73) and coffee (OR:4,39 and IC: 1,72-11,65), and overweight (OR: 2,60 and IC: 2,60-6,78); the math associated factors were consumption of cigarretes, alcohol, mint and fatty food, postprandial liying position and taking of drugs such as benzodiacepines, calcium channel blockers and nitrates. The remaining factors have had not any kind of relation.

  16. Practical Aspects of Pathogenetic Therapy for Gastroesophageal Reflux Disease

    Directory of Open Access Journals (Sweden)

    V.P. Shipulin

    2015-02-01

    Full Text Available The article deals with gastroesophageal reflux disease (GERD. Currently, there is being investigated a large number of new drugs, which can improve the treatment of acid-related disea-ses, but the best acid-reducing drugs yet are proton pump inhibitors (PPIs. In connection with this, the issue what drugs from the IPPs group should be preferred was and remains relevant for practitioners. Given the low potential of drug interactions, pantoprazole may be considered the drug of choice for acid-reducing therapy, especially in elderly patients, usually taking quite a lot of drugs; as well as in patients using drugs with a narrow therapeutic window.

  17. Reflux esophagitis revisited: Prospective analysis of radiologic accuracy

    International Nuclear Information System (INIS)

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

    1981-01-01

    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. (orig.) [de

  18. A reflux capsule steam generator for sodium cooled reactors

    International Nuclear Information System (INIS)

    Lantz, E.

    Pressurized water reactor plants at numerous sites have sustained significant leakage through their steam generators. The consequent shutdowns for repairs and replacements have damaged their economics. This experience suggests that if steam generators for liquid metal fast breeder reactors (LMFBR's) continue to be built as presently designed some of them will have similar problems. Because of their larger capital investment, the consequent damage to the economics of LMFBR's could be more serious. Reflux capsules provide a way to separate sodium from water and to reduce thermal stresses in steam generators for sodium cooled reactors. Their use would also eliminate the need for a primary heat exchanger and a secondary sodium loop pump. (author)

  19. Risk Factors for Gastroesophageal Reflux Disease in Saudi Arabia

    OpenAIRE

    Alkhathami, Ali Mesfer; Alzahrani, Abdulrahman Ahmad; Alzhrani, Mohammed Abdullah; Alsuwat, Obaidallah Buraykan; Mahfouz, Mohammad Eid Mahmoud

    2017-01-01

    Background Gastroesophageal reflux disease (GERD) is one of the most prevalent gastrointestinal tract diseases worldwide. GERD has an effect on the patients’ quality of life as well as the health care system that can be prevented by identifying its risk factors among the population. Hence, we applied this study to assess the GERD’s risk factors in Saudi Arabia. Methods A cross-sectional study was designed to assess the GERD’s risk factors among the community of Saudi Arabia. The sample was co...

  20. Reflux disease as an etiological factor of dental erosion

    Directory of Open Access Journals (Sweden)

    Stojšin Ivana

    2010-01-01

    Full Text Available Introduction Gastroesophageal reflux is a frequent disease which has a significant influence on the development of dental erosions. Objective The aim of this research was to determine the frequency of dental erosions among the patients with gastroesophageal reflux, as well as to verify the most common symptoms of gastroesophageal disease. Methods The research comprised of two groups, each consisting of 30 patients aged 18-80 years. The experimental group comprised of patients diagnosed with gastroesophageal reflux disease (GERD, while the control group was composed of patients who were not diagnosed with GERD. Based on the illness history data, all patients of the experimental group were registered to have gastroesophageal and extraesophageal symptoms. Dental erosions were diagnosed during a stomatological inspection by using index system according to Eccles and Jenkins. Data processing was accomplished by the Statgraphics Centurion software package. Results Dental erosions were found in 76.7% of experimental group patients, and in 53.3% of control group patients. Fortynine percent of teeth of the experimental group patients and 31.1% of the control group patients showed erosive changes. On average, the number of teeth with erosions in the experimental group was 15.7 per person and in the control group 10 per person. The teeth of the front region of the upper jaw, as well as the lower first molars had the highest average value of dental erosion index. In the experimental group 12.8% of teeth and 24% of teeth in the control group were diagnosed to have dental erosion index value 1. Furthermore, 23.4% of teeth in the experimental group and 7.1% of teeth in the control group were registered to have dental erosion index value 2. Finally, the dental erosion index value 3 was found in 13.0% of teeth in the experimental group only. The highest average value of regional erosion index in the experimental group was found in the region 13-23 equalling 1

  1. 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.

  2. Effect of elimination of acid reflux on epithelial cell proliferative activity of Barrett esophagus

    NARCIS (Netherlands)

    Peters, F.T.M.; Ganesh, S.; Kuipers, E.J.; Sluiter, W.J.; Karrenbeld, A.; de Jager - Krikken, A.; Klinkenberg-Knol, E.C.; Lamers, C.B.H.W.; Kleibeuker, J.H.

    2000-01-01

    Background: Barrett esophagus (BE) is a premalignant condition resulting from chronic acid gastroesophageal reflux and is associated with increased epithelial cell proliferation. Elimination of acid reflux might decrease cancer risk by affecting cell proliferation in BE. The effect of elimination of

  3. Gastro-oesophageal reflux disease in The Netherlands. Results of a multicentre pH study

    NARCIS (Netherlands)

    Smout, A. J.; Geus, W. P.; Mulder, P. G.; Stockbrügger, R. W.; Lamers, C. B.

    1996-01-01

    Information on the relationships between gastro-oesophageal reflux (GOR), reflux symptoms, hiatal hernia (HH) and oesophagitis, and the response to antisecretory treatment is lacking. In a multicentre study endoscopy, ambulatory 24-h pH monitoring and symptom assessment were carried out in 142

  4. Effect of azithromycin on acid reflux, hiatus hernia and proximal acid pocket in the postprandial period

    NARCIS (Netherlands)

    Rohof, W. O.; Bennink, R. J.; de Ruigh, A. A.; Hirsch, D. P.; Zwinderman, A. H.; Boeckxstaens, G. E.

    2012-01-01

    Background The risk for acidic reflux is mainly determined by the position of the gastric acid pocket. It was hypothesised that compounds affecting proximal stomach tone might reduce gastro-oesophageal reflux by changing the acid pocket position. Objective To study the effect of azithromycin (Azi)

  5. Increased proximal reflux in a hypersensitive esophagus might explain symptoms resistant to proton pump inhibitors in patients with gastroesophageal reflux disease

    NARCIS (Netherlands)

    Rohof, Wout O.; Bennink, Roelof J.; de Jonge, Hugo; Boeckxstaens, Guy E.

    2014-01-01

    Approximately 30% of patients with gastroesophageal reflux disease have symptoms resistant to treatment with proton pump inhibitors (PPIs). Several mechanisms such as esophageal hypersensitivity, increased mucosal permeability, and possibly the position of the gastric acid pocket might underlie a

  6. TREATMENT FOR GASTROESOPHAGEAL REFLUX DISEASE AMONG CHILDREN, SUFFERING FROM JUVENILE ARTHRITIS

    Directory of Open Access Journals (Sweden)

    T.M. Bzarova

    2007-01-01

    Full Text Available The article presents the evaluation results of esomeprazol efficacy in the complex therapy for gastroesophageal reflux disease among 152 children aged between 3 and 18, suffering from juvenile arthritis. The treatment scheme used in treatment induced the remission of gastro esophageal reflux disease among 45% of patients, conduced to considerable decrease of the esophagus affect intensity among 53% of patients, epithelized erosions of the mucous coat of esophagus among 30 of 32 children. The medication did not cause any clinically significant side responses among the cured children (even younger ones and may be applied to treat gastro esophageal reflux disease among the patients, suffering from juvenile arthritis.Key words: gastroesophageal reflux disease, children, treatment, reflux, esomeprazol, esophagitis, juvenile rheumatoid arthritis.

  7. The value of radionuclide cystography in the study of reflux

    International Nuclear Information System (INIS)

    Grechi, G.; Vichi, G.F.; Franchini, F.; La Cava, G.; Moretti, A.; Taddei, I.; Bartolozzi, G.

    1980-01-01

    Reduction of the risk connected with widespread and repeated radiological examinations in children is a purpose to be pursued. Children with urinary tract infection or suspected uropathy have been submitted also to radionuclide cystography (which has the advantage of a minimal radiation dose) to obtain a comparison with micturition cysto-urethrography. The authors' experience is based on 80 examinations performed in 65 children. Results obtained by the combined use of both techniques have revealed a substantial agreement in the evaluation of reflux, but also some important limitations of radionuclide cystography: the technique does not reveal the aspects of pelvis and ureter, of the uretero-vesical junction, of the bladder wall and, lastly, does not allow the study of morphology of function of cervico-uretral structures. On the basis of these limitations, radionuclide cystography can replace the micturition cysto-urethrography only in certain phases of the diagnosis and mostly of the follow-up of reflux in children; for this purpose a diagnostic protocol is proposed [fr

  8. 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.

  9. 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.

  10. Does gastroesophageal reflux cause apnea in preterm infants?

    Science.gov (United States)

    Molloy, Eleanor J; Di Fiore, Juliann M; Martin, Richard J

    2005-01-01

    Gastroesophageal reflux (GER) and apnea are both common occurrences in premature infants but their relationship is controversial. We present the evidence for and against an association between GER and apnea and discuss the merits and limitations of the various methodologies employed in characterizing such a relationship. Overall, GER and apnea do not appear temporally related in preterm infants, despite strong physiologic evidence that stimulation of laryngeal afferents elicits central apnea and laryngeal adduction. In a subpopulation of infants with neurodevelopmental compromise, there may be an increased incidence of both apnea and GER, although the direct association between GER and apnea in this population is unclear. Therefore, we believe there is no evidence to support widespread use of anti-reflux medications in the treatment of apnea in preterm infants. Further studies are needed to clarify the existence of a small subpopulation of infants who may have GER-induced apnea, to identify potential triggering mechanisms, and to document benefit from newer pharmacological approaches. Copyright 2005 S. Karger AG, Basel

  11. Infant Gastroesophageal Reflux Information on the World Wide Web.

    Science.gov (United States)

    Balgowan, Regina; Greer, Leah C; D'Auria, Jennifer P

    2016-01-01

    The purpose of this study was to describe the type and quality of health information about infant gastroesophageal reflux (GER) that a parent may find on the World Wide Web. The data collection tool included evaluation of Web site quality and infant GER-specific content on the 30 sites that met the inclusion criteria. The most commonly found content categories in order of frequency were management strategies, when to call a primary care provider, definition, and clinical features. The most frequently mentioned strategies included feeding changes, infant positioning, and medications. Thirteen of the 30 Web sites included information on both GER and gastroesophageal reflux disease. Mention of the use of medication to lessen infant symptoms was found on 15 of the 30 sites. Only 10 of the 30 sites included information about parent support and coping strategies. Pediatric nurse practitioners (PNPs) should utilize well-child visits to address the normalcy of physiologic infant GER and clarify any misperceptions parents may have about diagnosis and the role of medication from information they may have found on the Internet. It is critical for PNPs to assist in the development of Web sites with accurate content, advise parents on how to identify safe and reliable information, and provide examples of high-quality Web sites about child health topics such as infant GER. Copyright © 2016 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.

  12. Prevalence of Gastroesophageal Reflux Disease in Type II Diabetes Mellitus

    Directory of Open Access Journals (Sweden)

    Huihui Sun

    2014-01-01

    Full Text Available Background/Aims. Patients with type II diabetes mellitus (DM were known to have higher prevalence of gastroesophageal reflux disease (GERD in the Western countries, but data on the impact of GERD on DM patients in our country are scarce. The aim of this study was to evaluate the prevalence of GERD in type II DM patients in Shanghai, China, and to explore its possible risk factors. Methods. 775 type II DM cases were randomly collected. Reflux Disease Questionnaire (RDQ was used to check the presence of GERD. Patients’ characteristics, laboratory data, face-to-face interview, nerve conduction study, and needle electromyogram (EMG test were analyzed. Results. 16% patients were found with typical GERD symptoms. Pathophysiological factors such as peripheral neuropathy, metabolism syndrome, and obesity were found to have no significant differences between GERD and non-GERD type II DM patients in the present study. Conclusion. The prevalence of GERD in type II DM patients is higher than that in adult inhabitants in Shanghai, China. No difference in pathophysiological factors, such as peripheral neuropathy, and metabolism syndrome was found in DM-GERD patients, suggesting that further study and efforts are needed to explore deeper the potential risk factors for the high prevalence rate of GERD in DM patients.

  13. Deep axial reflux, an important contributor to skin changes or ulcer in chronic venous disease.

    Science.gov (United States)

    Danielsson, Gudmundur; Eklof, Bo; Grandinetti, Andrew; Lurie, Fedor; Kistner, Robert L

    2003-12-01

    We undertook this cross-sectional study to investigate the distribution of venous reflux and effect of axial reflux in superficial and deep veins and to determine the clinical value of quantifying peak reverse flow velocity and reflux time in limbs with chronic venous disease. Four hundred one legs (127 with skin changes, 274 without skin changes) in 272 patients were examined with duplex ultrasound scanning, and peak reverse flow velocity and reflux time were measured. Both parameters were graded on a scale of 0 to 4. The sum of reverse flow scores was calculated from seven venous segments, three in superficial veins (great saphenous vein at saphenofemoral junction, great saphenous vein below knee, small saphenous vein) and four in deep veins (common femoral vein, femoral vein, deep femoral vein, popliteal vein). Axial reflux was defined as reflux in the great saphenous vein above and below the knee or in the femoral vein to the popliteal vein below the knee. Reflux parameters and presence or absence of axial reflux in superficial or deep veins were correlated with prevalence of skin changes or ulcer (CEAP class 4-6). The most common anatomic presentation was incompetence in all three systems (superficial, deep, perforator; 46%) or in superficial or perforator veins (28%). Isolated reflux in one system only was rare (15%; superficial, 28 legs; deep, 14 legs; perforator, 18 legs). Deep venous incompetence was present in 244 legs (61%). If common femoral vein reflux was excluded, prevalence of deep venous incompetence was 52%. The cause, according to findings at duplex ultrasound scanning, was primary in 302 legs (75%) and secondary in 99 legs (25%). Presence of axial deep venous reflux increased significantly with prevalence of skin changes or ulcer (C4-C6; odds ratio [OR], 2.7; 95% confidence interval [CI], 1.56-4.67). Of 110 extremities with incompetent popliteal vein, 81 legs had even femoral vein reflux, with significantly more skin changes or ulcer, compared

  14. Factors Affecting the Prevalence of Gastro-oesophageal Reflux in Childhood Corrosive Oesophageal Strictures

    Directory of Open Access Journals (Sweden)

    Serdar H. İskit

    2014-06-01

    Full Text Available Background: Gastro-oesophageal reflux may accompany the corrosive oesophageal damage caused by the ingestion of corrosive substances and affect its treatment. The factors that affect the development of reflux in these cases and their effects on treatment still remain unclear. Aims: Our aim is to investigate the prevalence of gastro-oesophageal reflux in children with corrosive oesophageal strictures, the risk factors affecting this prevalence and the effects of gastro-oesophageal reflux on treatment. Study Design: Case-control study. Methods: We enrolled 52 patients with oesophageal stricture due to corrosive substance ingestion who were referred to our clinic between 2003 and 2010. Groups, which were determined according to the presence of gastro-oesophageal reflux (GER, were compared with each other in terms of clinical findings, results of examination methods, characteristics of the stricture and success of the treatment. Results: The total number of patients in our study was 52; 30 of them were male and 22 of them were female. The mean age of our study population was 4.2±2.88 years. Thirty-three patients had gastro-oesophageal reflux (63.5%. Patients who had strictures caused by the ingestion of alkali substances were 1.6-times more likely to have reflux. There were no differences between patients with or without reflux in terms of number and localisation of strictures. Mean distance of stricture was longer in patients with reflux (3.7±1.8 cm than in patients without (2.2±1.0 cm (p0.05. Conclusion: Corrosive oesophageal stricture was usually accompanied by gastro-oesophageal reflux and the length of stricture is an important risk factor. Negative effects of reflux over dilatation treatment have not yet been demonstrated in the short-term. Nevertheless, this frequent rate of reflux may eventually increase the risk of oesophagitis and Barrett’s oesophagus; therefore, we suggest that these effects should be prospectively evaluated in a

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

    Directory of Open Access Journals (Sweden)

    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.

  16. Liquid-containing Refluxes and Acid Refluxes May Be Less Frequent in the Japanese Population Than in Other Populations: Normal Values of 24- hour Esophageal Impedance and pH Monitoring.

    Science.gov (United States)

    Kawamura, Osamu; Kohata, Yukie; Kawami, Noriyuki; Iida, Hiroshi; Kawada, Akiyo; Hosaka, Hiroko; Shimoyama, Yasuyuki; Kuribayashi, Shiko; Fujiwara, Yasuhiro; Iwakiri, Katsuhiko; Inamori, Masahiko; Kusano, Motoyasu; Hongo, Micho

    2016-10-30

    Twenty-four-hour esophageal impedance and pH monitoring allows detection of all types of reflux episodes and is considered the best technique for identifying gastroesophageal refluxes. However, normative data for the Japanese population are lacking. This multicenter study aimed to establish the normal range of 24-hour esophageal impedance and pH data both in the distal and the proximal esophagus in Japanese subjects. Forty-two healthy volunteers (25 men and 17 women) with a mean ± standard deviation age of 33.3 ± 12.4 years (range: 22-72 years) underwent a combined 24-hour esophageal impedance and pH monitoring. According to the physical and pH properties, distal or proximal esophageal reflux events were categorized. Median 45 reflux events occurred in 24 hours, and the 95th percentile was 85 events. Unlike previous reports, liquid-containing reflux events are median 25/24 hours with the 95th percentile of 62/24 hours. Acidic reflux events were median 11/24 hours with the 95th percentile of 39/24 hours. Non-acidic gas reflux events were median 15/24 hours with the 95th percentile of 39/24 hours. Proximal reflux events accounted for 80% of the total reflux events and were mainly non-acidic gas refluxes. About 19% of liquid and mixed refluxes reached the proximal esophagus. Unlike previous studies, liquid-containing and acidic reflux events may be less frequent in the Japanese population. Non-acidic gas reflux events may be frequent and a cause of frequent proximal reflux events. This study provides important normative data for 24-hour impedance and pH monitoring in both the distal and the proximal esophagus in the Japanese population.

  17. Current concepts of otitis media in adults as a reflux-related disease.

    Science.gov (United States)

    Sone, Michihiko; Kato, Toshinari; Nakashima, Tsutomu

    2013-08-01

    To review the findings of otitis media in adults in relation to supraesophageal reflux of gastrointestinal contents and summarize current concepts. Literature published in English-language journals from 2001 to the present identified by searching electronic databases (MEDLINE and Web of Science). Clinical articles that contained the terms reflux, ear, otitis media, and adult and relevant animal studies. Findings of searchable case reports and results of animal studies were included. Current findings were reviewed for the following points: 1) proposed effect of reflux, 2) prevalence and characteristics, 3) risk factors, and 4) treatment. Published literature concerning reflux and otitis media in adults is limited to clinical case series. Reflux is likely present in a significant number of adult cases with otitis media and may lead to Eustachian tube dysfunction in such subjects. Reflux in adult subjects with otitis media is potentially different from the physiologic events observed in children, but the causal link between them remains unclear. Evaluation of more cases that could be diagnosed as reflux-induced otitis media is necessary for better understanding of the disease entity.

  18. Correlation Between Bile Reflux Gastritis and Biliary Excreted Contrast Media in the Stomach.

    Science.gov (United States)

    Hyun, Jong Jin; Yeom, Suk Keu; Shim, Euddeum; Cha, Jaehyung; Choi, Inyoung; Lee, Seung Hwa; Chung, Hwan Hoon; Cha, Sang Hoon; Lee, Chang Hee

    This study aimed to evaluate the relationship between biliary excreted contrast media in the stomach and the presence of bile reflux gastritis. Consecutive 111 patients who underwent both gadoxetic acid-enhanced magnetic resonance cholangiography (gadoxetic MRC) and gastric endoscopy were included in this study. We performed a review of the gadoxetic-MRC image sets acquired 60 minutes after intravenous injection of contrast media and endoscopic images. We recorded amount of contrast media in the stomach. The sensitivity, specificity, and accuracy of duodenogastric bile reflux diagnosis were evaluated for the gadoxetic MRC. Statistical analysis was performed using the Fisher exact test and the linear-by-linear association test. Among the 111 patients, 39 had 60-minute delayed images showing the presence of contrast media in the stomach. Of these 39 patients, 13 had bile reflux gastritis and 5 showed bile in the stomach without evidence of erythematous gastritis. Of the 72 patients who did not show contrast media in the stomach, none had bile reflux gastritis and 2 patients showed bile staining in the stomach without evidence of erythematous gastritis. Bile reflux gastritis was significantly more frequent in patients with contrast media in the stomach on gadoxetic MRC than in those without. Patients with high-grade extension of contrast media in the stomach had significantly frequent bile reflux gastritis than did those with low-grade extension. Biliary excreted contrast media in the stomach on 60-minute delayed gadoxetic MRC has a correlation with the presence of bile reflux gastritis on endoscopic examination.

  19. Incidence of Biliary Reflux Esophagitis After Laparoscopic Omega Loop Gastric Bypass in Morbidly Obese Patients.

    Science.gov (United States)

    Salama, Tamer M Said; Hassan, Mohamed Ibrahim

    2017-06-01

    Omega loop gastric bypass is a successful bariatric surgery with numerous favorable circumstances as being basic, effective on weight reduction and treatment of obesity associated metabolic disorder, the short expectation to learn and adapt, and the simplicity of correction and inversion. However, there are arguments about the possibility of biliary reflux and/or the potential danger of gastroesophageal malignancy after the procedure. Fifty patients experiencing morbid obesity with body mass index >40 or >35 kg/m 2 with two related comorbidities, for example, diabetes type II, hypertension, or dyslipidemia, underwent omega loop gastric bypass with a follow-up period up to 18 months, investigating for any symptom of reflux infection by upper gastrointestinal tract endoscopy and pH metry. Reflux esophagitis (a gastroesophageal reflux disease) was detected in 3 patients (6%); 2 cases (4%) showed (Grade A) acidic reflux esophagitis at 6 and 12 months postoperatively. Just 1 case (2%) had experienced gastroesophageal biliary reflux esophagitis (Grade A) at 12 months. No metaplasia or dysplasia was detected in the endoscopic biopsies. Omega loop gastric bypass is a safe and effective bariatric procedure with low incidence of postoperative biliary reflux, metaplasia, or dysplasia at the esophagogastric junction, confirmed 18 months after the operation.

  20. Pattern of food intolerance in patients with gastro-esophageal reflux symptoms.

    Science.gov (United States)

    Caselli, Michele; Lo Cascio, Natalina; Rabitti, Stefano; Eusebi, Leonardo H; Zeni, Elena; Soavi, Cecilia; Cassol, Francesca; Zuliani, Giovanni; Zagari, Rocco M

    2017-12-01

    Many food items have been involved in gastro-esophageal reflux disease pathogenesis and dietary modification has been proposed as first-line treatment. Test-based exclusion diets have shown to significantly reduce reflux symptoms. We aimed to assess the patterns of food intolerance in a series of patients with typical gastro-esophageal reflux symptoms (GERS). We retrospectively evaluated all patients with typical reflux symptoms, attending the Centre Study Association on Food Intolerance and Nutrition of Ferrara from January 2010 to October 2015, who resulted positive to at least one food item at the Leucocytotoxic Test. The presence and severity of typical GERS (heartburn and/or acid regurgitation) were assessed using the Gastro-esophageal Reflux Disease Impact Scale (GIS) questionnaire. Only individuals with a GIS Score of at least 5 points were included. Almost all patients (91.1%) were intolerant to at least 5 food items. The most frequent food intolerance (more than 33% of patients) were found for milk (55.4%), lettuce (46.4%), coffee (43.7%), brewer's yeast (42.9%), pork (42.9%), tuna (37.5%), rice (35.7%), sole (34.8%), asparagus (34.8%) and eggs (33.9%). Nine different clusters of food intolerance were detected. Patients with typical gastro-esophageal reflux symptoms seem to have intolerance to multiple food items, some of which (lettuce, brewer's yeast, tuna, rice, sole and asparagus) have not yet been associated to gastro-esophageal reflux disease.

  1. J. Maxwell Chamberlain Memorial Paper. Early fundoplication prevents chronic allograft dysfunction in patients with gastroesophageal reflux disease.

    Science.gov (United States)

    Cantu, Edward; Appel, James Z; Hartwig, Matthew G; Woreta, Hiwot; Green, Cindy; Messier, Robert; Palmer, Scott M; Davis, R Duane

    2004-10-01

    Chronic allograft dysfunction limits the long-term success of lung transplantation. Increasing evidence suggests nonimmune mediated injury such as due to reflux contributes to the development of bronchiolitis obliterans syndrome. We have previously demonstrated that fundoplication can reverse bronchiolitis obliterans syndrome in some lung transplant recipients with reflux. We hypothesized that treatment of reflux with early fundoplication would prevent bronchiolitis obliterans syndrome and improve survival. A retrospective analysis of 457 patients who underwent lung transplantation from April 1992 through July 2003 was conducted. Patients were stratified into four groups: no history of reflux, history of reflux, history of reflux and early (syndrome at 1 and 3 years (100%, 100%) when compared with no fundoplication in patients with reflux (96% +/- 2.5, 60% +/- 7.5; p syndrome and survival. Further research into the mechanisms and treatment of nonalloimmune mediated lung allograft injury is needed to reduce rates of chronic lung failure.

  2. Saliva transit in patients with gastroesophageal reflux disease.

    Science.gov (United States)

    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

  3. A Modern Magnetic Implant for Gastroesophageal Reflux Disease.

    Science.gov (United States)

    Ganz, Robert A

    2017-09-01

    A magnetic implant for the treatment of gastroesophageal reflux disease (GERD) was Food and Drug Administration-approved in 2012 and has been extensively evaluated. The device is a ring of magnets that are placed around the gastroesophageal junction, augmenting the native lower esophageal sphincter and preventing reflux yet preserving lower esophageal sphincter physiologic function and allowing belching and vomiting. Magnetic force is advantageous, being permanent and precise, and forces between magnets decrease with esophageal displacement. Multiple patient cohorts have been studied using the magnetic device, and trials establish consistent, long-term improvement in pH data, GERD symptom scores, and proton-pump inhibitor use. A 5-year Food and Drug Administration trial demonstrated that most patients achieved normal pH scores, 85% stopped proton-pump inhibitors, and GERD health-related quality of life symptom scores improved from 27 to 4 at 5 years. Seven studies have compared magnetic augmentation with laparoscopic Nissen fundoplication and demonstrated that the magnetic device achieved comparable efficacy with regard to proton-pump inhibitor cessation, GERD symptom score improvement, and heartburn and regurgitation scores. However, to date there have been no randomized, controlled trials comparing the 2 techniques, and the study cohorts are not necessarily comparable regarding hiatal hernia size, severity of reflux, body mass index scores, or esophagitis scores. Dysphagia incidence was similar in both groups. Reoperation rates and safety profiles were also comparable, but the magnetic device demonstrated significant beneficial differences in allowing belching and vomiting. The magnetic device is safe, with the main adverse event being dysphagia with an approximate 3%-5% chronic incidence. Device removals in clinical trials have been between 0% and 7% and were uneventful. There have been no erosions, perforations, or infections in FDA clinical trials

  4. The Clinical Value of Deflation Cough in Chronic Coughers With Reflux Symptoms.

    Science.gov (United States)

    Lavorini, Federico; Chellini, Elisa; Bigazzi, Francesca; Surrenti, Elisabetta; Fontana, Giovanni A

    2016-06-01

    Patients with deflation cough (DC), the cough-like expulsive effort(s) evoked by maximal lung emptying during a slow vital capacity maneuver, also present symptoms of gastroesophageal reflux. DC can be inhibited by prior intake of antacids. We wished to assess DC prevalence and association between DC and chemical characteristics of refluxate in patients with gastroesophageal reflux symptoms. A total of 157 consecutive outpatients underwent DC assessment and 24-h multichannel intraluminal impedance pH (MII-pH) monitoring; 93/157 also had chronic cough. Patients performed two to four slow vital capacity maneuvers and DC was detected aurally. Subsequently, they underwent 24-h MII-pH monitoring, the outcomes of which were defined as abnormal when acid or non-acid reflux events were > 73. DC occurred in 46/157 patients, 18 of whom had abnormal MII-pH outcomes; 28 of the remaining 111 patients without DC also had abnormal MII-pH findings. Thus, in the patients as a group, there was no association between DC and MII-pH outcomes. DC occurred in 40/93 of the chronic coughers; 15 of whom had acid reflux. All but 2 of the 53 patients without DC had normal MII-pH outcomes (P < .001), and the negative predictive value of DC for excluding acid reflux was 96.2%. At follow-up, 65% of coughers showed significant improvement after treatment. The overall prevalence of DC was 29%, increasing to 43% in chronic coughers in whom the absence of DC virtually excludes acid reflux. Therefore, DC assessment may represent a useful screening test for excluding acid reflux in chronic coughers with reflux symptoms. Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

  5. 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.

  6. Human leukocyte antigen HLADRB1 determinants susceptibility to gastroesophageal reflux disease

    Directory of Open Access Journals (Sweden)

    Batool Mutar MAHDI

    Full Text Available ABSTRACT BACKGROUND Gastroesophageal reflux disease (GERD is characterized by diverse symptoms. There is an evidence for a genetic component to GERD as supported by familial aggregation of this disease. OBJECTIVE To investigate whether certain human leucocyte antigen genes HLA-DRB1 are associated with GERD. METHODS Patients and controls were prospectively recruited from GIT center at Al-Kindy Teaching Hospital (Baghdad-Iraq between January 2014 and July 2016. Sixty Iraqi Arab Muslims patients with a history of heartburn and dyspepsia compared with 100 Iraqi Arab Muslims controls. All study patients and control groups underwent upper gastrointestinal endoscopic examinations and their serums were analyzed for CagA antibodies Immunoglobulin G (IgG for H. pylori. HLA-DRB1 genotyping were done to both groups. RESULTS A total of 60 patients with erosive gastritis; GERD (Grade II and III were evaluated, together with 100 controls. There is a significant increase of H. pylori infection (P=0.0001 in GERD patients than control group. HLA-DRB1* 15:01 was significantly increased in GERD patients in comparison with control group and an increased frequency of HLADRB1*11:01 in control group compared with patients group. CONCLUSION There is an association between HLA-DRB1 *15:01 in GERD patients with H. pylori positive patients.

  7. [Reflux disease and eating disorders--a case for teamwork].

    Science.gov (United States)

    Imfeld, Carola; Imfeld, Thomas

    2008-02-01

    The term erosion describes tooth wear caused by acids. Erosions can be a consequence of medical problems like gastroesophageal reflux disease or eating disorders which lead to a regular contact of gastric acid with teeth. These, so called intrinsic erosions occur in such typical locations within the dental arches that even in the absence of other symptoms gastric acid can be assumed to be the cause. Dental professionals may thus be the first to discover and diagnose the underlying medical problem. A good cooperation between the physician and the dentist is consequently necessary for a causal treatment of the patient. Parallel to the therapy of the underlying disease practical dental prophylactic measures like chewing gum und fluoride rinses are recommended.

  8. Air column in esophagus and symptoms of gastroesophageal reflux disease

    International Nuclear Information System (INIS)

    Moosavi, Alijavad; Raji, Hanieh; Teimoori, Mojtaba; Ghourchian, Shadi

    2012-01-01

    During imaging of the normal esophagus, air is often detected. The purpose of this study was to determine the correlation between the appearance of air bubbles on imaging and Gastroesophageal Reflux Disease (GERD) symptoms. The cross-sectional imaging study was conducted at Rasole Akram Hospital, Tehran, Iran. A total of 44 patients underwent X-ray computed tomography (CT) scanning; the presence of air in the esophagus and visible on CT imaging was scrutinized. The average age of the subjects was 59 and the male to female ratio was 0.83. We found a significant relationship between the presence of GERD symptoms, the size of air bubbles and esophageal dilation (ED) on the CT scan. Air bubbles in the esophagus may be seen frequently in CT scans, but their size and location can vary. The GERD symptoms can arise when a small diameter air column is present within the esophagus, especially in the middle and lower parts

  9. [Pathophysiology of reflux esophagitis in the elderly patients].

    Science.gov (United States)

    Nakamura, Toshiya; Uetake, Tomoyoshi; Fujino, Masayuki A

    2002-08-01

    Recent reports indicate an increased prevalence of reflux esophagitis(RE) in Japan. There are many factors causing RE, and many kinds of changes associating aging are important in the causes of RE in the elderly patients. Characteristic features of the causes of RE in elderly patients are summarized here. Within the elderly patients, there are cases with persistent gastric acid secretion. Aging affections lead to esophageal motor dysfunctions and to failure of LES function(presbyesophagus). The elderly are complicated by orthopedic degenerative diseases with posture change due to osteoporosis; some pharmaceutical agents such as Ca-channel blockers or NSAIDs. Hiatal hernia is also an aggravating factor. In the future, elderly people with persistent gastric acid secretion will be increased based on declining prevalence of Helicobacter pylori. Therefore further increase in the prevalence and development of RE is foreseen in our country. Pathophysiology of RE in the elderly patients is expected to show various changes in the future.

  10. Neonatal apnea and gastroesophageal reflux (GER): is there a problem?

    Science.gov (United States)

    Abu Jawdeh, Elie G; Martin, Richard J

    2013-06-01

    Apnea of prematurity and gastroesophageal reflux (GER) are both common occurrences in preterm infants and widely perceived to be causally related. We seek in this review to provide a potential guideline for neonatal GER non-pharmacologic and pharmacologic therapy. Available physiologic data suggest that when there is a temporal relationship apnea may be more likely to predispose to GER via esophageal sphincter relaxation than vice versa. Measurement of multiple intraluminal impedance via esophageal catheter in addition to esophageal pH has enhanced our understanding of GER, although it also did not demonstrate a causal relationship between apnea and GER. The incidence of GER may be modified by thickening feeds and position change without adverse effects. In contrast, pharmacotherapy including acid suppression therapy may have adverse effects and should only be used in infants with clear evidence of clinical benefit. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  11. [Current Status of Translational Research on Gastroesophageal Reflux Disease].

    Science.gov (United States)

    Jeong, In Du; Park, Moo In

    2016-09-25

    The prevalence of gastroesophageal reflux disease (GERD) and the incidence of some of its complications have risen strikingly over the last few decades. With the increase in our understanding of the pathophysiology of GERD along with the development of proton pump inhibitors, the diagnostic and therapeutic approaches to GERD have changed dramatically over the past decade. However, GERD still poses a problem to many clinicians since the spectrum of the disease has evolved to encompass more challenging presentations such as refractory GERD and extra-esophageal manifestations. The aim of this article is to provide a review of available current translational research on GERD. This review includes acid pocket, ambulatory pH monitoring, impedance pH monitoring, mucosa impedance, and high resolution manometry. This article discusses current translational research on GERD.

  12. Intrathoracic airway obstruction and gastroesophageal reflux: a canine model.

    Science.gov (United States)

    Bhatia, R; Pagala, M; Vaynblat, M; Marcus, M; Kazachkov, M

    2012-11-01

    Gastroesophageal reflux (GER) is common in children with airway disorders. Previous studies have shown an association between upper airway obstruction and GER in experimental animal models. However, the cause and effect relationship between intrathoracic airway obstruction (IAO) and GER is obscure. The goal of this study is to investigate the association between IAO and GER using the canine model. In sedated dogs, a telemetric implant was placed subcutaneously (with one pressure sensor tip each in intrapleural space and abdomen) to monitor intrapleural pressure (IPP) and intrabdominal pressure (IAP). The IPP and the IAP were monitored intraoperatively and in conscious dogs on the 7th to 10th postoperative days. GER was assessed by determining the reflux index (RI), based on the intraesophageal pH recording performed continuously for a 24 hr period using a pH probe. After 2-3 weeks following placement of the telemetric implant, IAO was surgically created in the dog. After maintaining IAO for 2 weeks, the IPP, IAP, and pH measurements were monitored again following the same protocol as before IAO. After the creation of IAO, there was no significant change observed in the mean RI either in the distal (P = 0.716) or proximal (P = 0.962) esophageal lumens. The IPP became significantly more negative (P = 0.006) and the IAP turned significantly negative (P < 0.001) from being positive compared to the respective values before IAO. However, transdiaphragmatic pressure (Pdi) did not change significantly (P = 0.08). We conclude that moderate IAO does not cause GER in our animal model. It can be explained by the absence of significant change in Pdi after creation of IAO. Copyright © 2012 Wiley Periodicals, Inc.

  13. Gender difference in gastro-esophageal reflux diseases.

    Science.gov (United States)

    Asanuma, Kiyotaka; Iijima, Katsunori; Shimosegawa, Tooru

    2016-02-07

    The incidence of esophageal adenocarcinoma (EAC) has risen sharply in western countries over the past 4 decades. This type of cancer is considered to follow a transitional process that goes from gastro-esophageal reflux disease (GERD) to Barrett's esophagus (BE, a metaplastic condition of the distal esophagus), a precursor lesion and ultimately adenocarcinoma. This spectrum of GERD is strongly predominant in males due to an unidentified mechanism. Several epidemiologic studies have described that the prevalence of GERD, BE and EAC in women is closely related to reproductive status, which suggests a possible association with the estrogen level. Recently, we revealed in an in vivo study that the inactivation of mast cells by the anti-inflammatory function of estrogen may account for the gender difference in the GERD spectrum. Other studies have described the contribution of female steroid hormones to the gender difference in these diseases. Estrogen is reported to modulate the metabolism of fat, and obesity is a main risk factor of GERDs. Moreover, estrogen could confer esophageal epithelial resistance to causative refluxate. These functions of estrogen might explain the approximately 20-year delay in the incidence of BE and the subsequent development of EAC in women compared to men, and this effect may be responsible for the male predominance. However, some observational studies demonstrated that hormone replacement therapy exerts controversial effects in GERD patients. Nevertheless, the estrogen-related endocrine milieu may prevent disease progression toward carcinogenesis in GERD patients. The development of innovative alternatives to conventional acid suppressors may become possible by clarifying the mechanisms of estrogen.

  14. Validation of the Reflux Disease Questionnaire into Greek

    Directory of Open Access Journals (Sweden)

    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.

  15. Is the use of esomeprazole in gastroesophageal reflux disease a cost-effective option in Poland?

    Science.gov (United States)

    Petryszyn, Pawel; Staniak, Aleksandra; Grzegrzolka, Jedrzej

    2016-03-01

    To compare the cost-effectiveness of therapy of gastroesophageal reflux disease with esomeprazole and other proton pump inhibitors (PPIs) in Poland. Studies comparing esomeprazole with other PPIs in the treatment of erosive esophagitis, non-erosive reflux disease and gastroesophageal reflux disease maintenance therapy were systematically reviewed. 9 randomized clinical trials were selected, meta-analyses were conducted. Cost data derived from Polish Ministry of Health and Pharmacies in Wroclaw. In the treatment of erosive esophagitis esomeprazole was significantly more effective than other PPIs. Both for 4- and 8-week therapy respective incremental cost-effectiveness ratio values were acceptably low. Differences in effectiveness of non-erosive reflux disease therapy were not significant. The replacement of pantoprazole 20 mg with more effective esomeprazole 20 mg in the 6-month maintenance therapy was associated with a substantially high incremental cost-effectiveness ratio.

  16. Long-term treatment of gastro-oesophageal reflux disease in primary care

    NARCIS (Netherlands)

    van der Velden, A.W.

    2008-01-01

    Gastro-oesophageal reflux disease (GORD), characterized by heartburn and acid regurgitation, is one of the most common gastrointestinal diseases general practitioners encounter. GORD is effectively treated with acid suppressive medication (ASM), of which proton pump inhibitors (PPIs) are most

  17. 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. Copyright © 2016 Elsevier Ltd. All rights reserved.

  18. Clinical and radiological characteristic of the gastroesophageal reflux disease in children

    International Nuclear Information System (INIS)

    Brankov, O.; Racheva, G.; Totev, M.; Antonova, D.

    2007-01-01

    Gastroesophageal reflux (GER) in children is a normal physiologic process that can progress to gastroesophageal reflux disease (GERD) when pathologic symptoms and complications appear. The pathogenesis of GER is related to a decrease pressure and transient relaxations of the lower esophageal sphincter, which is the most important factors contributing to reflux. If the history and physical examination reveal concerns of GERD further evaluation is necessary: esophageal pH monitoring, endoscopy, barium swallowing. The gold standard for the diagnosis of GERD is the 24-hour pH probe. Barium contrast radiography is useful to detect anatomic abnormalities, such as gaped cardia, reflux of contrast material, hiatal hernia, esophageal stricture and shortened esophagus. When compared to esophageal pH monitoring, the upper Gl series is less sensitive and specific for the diagnosis of GER, but is helpful as widely used first-step diagnosis in cases with symptomatic GERD. (authors)

  19. Restoration of occlusal vertical dimension in dental erosion caused by gastroesophageal reflux: case report.

    Science.gov (United States)

    Reston, Eduardo Galia; Closs, Luciane Quadrado; Busato, Adair Luiz Stefanello; Broliato, Gustavo André; Tessarollo, Fábio Rafael

    2010-01-01

    The authors describe a minimally invasive procedure for occlusal rehabilitation in a young patient presenting with mild mandibular prognathism and loss of occlusal vertical dimension caused by dental erosion from chronic gastroesophageal reflux.

  20. Synthesis of nano sized ZnO by chemical method via refluxing

    Science.gov (United States)

    Najidha, S.; Malik, M. M.; Shastri, Lokesh; Koutu, V.

    2017-06-01

    Recently, nanomaterials have attracted attention of researchers as advanced technological materials because of their unique structural, optical and electrical characteristics. In this work, ZnO nanoparticles were synthesized by chemical reduction method in an aqueous solution via refluxing using Zinc acetate dehydrate and sodium hydroxide as precursors. The synthesized nanoparticles were characterized by X-Ray Diffraction (XRD), Field Emission Scanning Electron Microscopy (FESEM) and Photoluminescence (PL) spectra. The XRD pattern indicates hexagonal wurtzite structure with average grain size of 0.628nm and 0.491nm at refluxing temperatures 90°C and 100°C respectively. The FESEM images reveal that the as-prepared powder shows cubical structures with hexagonal base with an average size of ˜47 nm for 90°C reflux sample and ˜44nm for 100°C reflux sample.

  1. 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.

  2. Exhaled breath concentrations of acetic acid vapour in gastro-esophageal reflux disease

    Czech Academy of Sciences Publication Activity Database

    Dryahina, Kseniya; Pospíšilová, Veronika; Sovová, Kristýna; Shestivska, Violetta; Kubišta, Jiří; Spesyvyi, Anatolii; Pehal, F.; Turzíková, J.; Votruba, J.; Španěl, Patrik

    2014-01-01

    Roč. 8, č. 3 (2014), 037109 ISSN 1752-7155 Institutional support: RVO:61388955 Keywords : SIFT-MS * gastro-esophageal reflux * acetic acid Subject RIV: CF - Physical ; Theoretical Chemistry Impact factor: 4.631, year: 2014

  3. Does the Use of Pacifier Affect Gastro-Esophageal Reflux in Preterm Infants?

    Science.gov (United States)

    Corvaglia, Luigi; Martini, Silvia; Corrado, Maria Francesca; Mariani, Elisa; Legnani, Elena; Bosi, Isabella; Faldella, Giacomo; Aceti, Arianna

    2016-05-01

    This crossover study showed that non-nutritive sucking, provided with a pacifier in 30 preterm infants, had no effect on acid and nonacid gastro-esophageal reflux evaluated by esophageal pH-impedance, and thus may be reasonably used in preterm neonates with symptoms of gastro-esophageal reflux. ClinicalTrials.gov: NCT02023216. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. The Prevalence of Reflux Esophagitis in the Elderly and Its Associated Risk Factors

    Directory of Open Access Journals (Sweden)

    Cosmas Rinaldi A Lesmana

    2016-09-01

    Full Text Available Background: Reflux esophagitis is a common problem in the elderly. Compare to the Western Countries, esophageal cancer where reflux esophagitis is the most predominant risk factor is considered rare in Asia. Many other risk factors have not been well studied especially in most Asian countries. The objective of this study is to evaluate the presence of reflux esophagitis in elderly patients and its associated risk factors. Method: This was a cross-sectional study in elderly patients who underwent upper gastrointestinal endoscopy. Patients who received long-term proton pump inhibitor (PPI therapy, suffered from gastrointestinal malignancies, recently receiving chemotherapy agents, diagnosed with cerebrovascular disease or Helicobacter pylori infection were excluded. Statistical analyses were performed using the SPSS software version 17.00 (SPSS Inc., Chicago, Illinois, USA. Results: A total of 238 elderly patients were enrolled. Patients’ mean age was 69.8 ± 6.8 years old. Reflux esophagitis was found in 22 (9.2% patients. Several comorbidities were found in these patients, such as diabetes, hypertension, coronary artery disease, chronic kidney disease, and liver cirrhosis. The only factor that associated with reflux esophagitis was the presence of hiatus hernia esophagus (p = 0.038. However, reflux esophagitis seemed to be more found in the elderly patients who have history of reflux inducing drugs consumption without any proton pump inhibitor (PPI protection. Conclusion: Reflux esophagitis is still a major problem in the elderly. The presence of hiatus hernia might give an important consideration of upper gastrointestinal endoscopy screening. However, it would be a debate matter with regards to the cost burden and the low risk of esophageal cancer in Asian countries.

  5. The effects of a weakly acidic meal on gastric buffering and postprandial gastro-oesophageal reflux.

    Science.gov (United States)

    Ravi, K; Francis, D L; See, J A; Geno, D M; Katzka, D A

    2011-09-01

    Exclusion of the meal during ambulatory pH monitoring presumes that a meal completely buffers gastric acid and reflux of acidic food content cannot be distinguished from gastric acid. However, the ability of a meal to completely buffer gastric acid remains unclear. To determine the effect of a weakly acid meal on gastric buffering and oesophageal acid exposure. Patients undergoing multichannel intraluminal impedance pH studies were given a standard weakly acidic meal (pH = 5.9). Gastric and oesophageal pH was measured during the meal and in 15 min intervals for 2 h postprandially. The study included 30 patients, with pathological acid reflux detected in 18 patients. Complete gastric buffering occurred in seven patients (23%) and was lost in all patients within 75 min of the meal. Oesophageal acid was detected in 33% of patients within 30 min of the meal and 81% of patients during the 2 h postprandial period. Postprandial oesophageal acid exposure was greater in patients with pathological acid reflux (9 ± 2.7% vs. 1.7 ± 0.8% P = 0.05) with a trend towards more incomplete gastric acid buffering and significant differences when measuring weak acid reflux (pH 4-5). Acid reflux rarely occurred in the absence of gastric acid, with gastric acid present in 74 of 79 (94%) fifteen minute postprandial intervals with acid reflux. The ability of a meal to buffer gastric acid is poor. Early postprandial oesophageal acid reflux occurs in a substantial proportion of patients. Addition of a weakly acidic or pH neutral meal to ambulatory pH monitoring may unmask early postprandial acid reflux and provide data on gastric acid buffering. © 2011 Blackwell Publishing Ltd.

  6. Gastroesophageal reflux after esophageal surgery. Evaluation by means of esophageal transit scintigram

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    Nishimura, Osamu; Yokoi, Hideki; Maebeya, Shinji and others

    1989-04-01

    By means of esophageal transit scintigram using /sup 99m/Tc-DTPA, 15 patients (13 esophageal carcinomas and 2 cardia carcinomas) were studied, in whom esophagogastric anastomosis was done according to the posterior invagination anastomosis technique we had devised. In all 8 patients with anastomosis at cervical region, gastroesophageal reflux was not seen on both scintigrams before and after meals, and the average pressure gradient of high pressure zone at anastomosis was 39.8 cmH/sub 2/O. In 2 of 7 patients with intrathoracic anastomosis, the scintigram before meals showed severe reflux. and the endoscopic findings showed diffuse and moderate erosion in the esophageal mucosa. The average pressure gradient across the anastomosis was 6.5 cmH/sub 2/O. In these 2 patients, the new fornix with a sharp angle of His was not formed. In the remaining 5 patients with intrathoracic anastomosis, reflux was not seen on the scintigram before meals. However, in 2 of them, the scintigram after meal and endoscopic examination revealed mild reflux and mild esophagitis respectively. Furthermore in one patient very mild reflux was observed only on the scintigram after meals but the endoscopic findings showed the normal esophageal mucosa. In these 5 patients, the average pressure gradient across the anastomosis was 17.0 cmH/sub 2/O, which was significantly higher (p<0.01) than that in 2 patients with severe reflux and was significantly lower (p<0.01) than the mean value of high pressure zone in 8 patients with cervical anastomosis. In conclusion, it is presumed that the formation of a large fornix enough to store food and a sharp angle of His are important factors in maintaining an anti-reflux mechanism. The esophageal transit scintigram was proved to be an excellent technique in detecting and evaluating quantitatively gastroesophageal reflux. (author).

  7. Gastroesophageal reflux symptoms not responding to proton pump inhibitor: GERD, NERD, NARD, esophageal hypersensitivity or dyspepsia?

    OpenAIRE

    Bashashati, Mohammad; Hejazi, Reza A; Andrews, Christopher N; Storr, Martin A

    2014-01-01

    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 techniqu...

  8. Oesophageal flap valvuloplasty and wrapping suturing prevent gastrooesophageal reflux disease in dogs after oesophageal anastomosis

    Science.gov (United States)

    Dai, Ji-Gang; Liu, Quan-Xing; Den, Xu-Feng; Min, Jia-Xin

    2014-01-01

    AIM: To examine the efficiency of oesophageal flap valvuloplasty and wrapping suturing technique in decreasing the rate of postoperative gastrooesophageal reflux disease in a dog model. METHODS: We operated on 10 dogs in this study. First, we resected a 5-cm portion of the distal oesophagus and then restored the continuity of the oesophageal and gastric walls by end-to-end anastomosis. A group of five dogs was subjected to the oesophageal flap valvuloplasty and wrapping suturing technique, whereas another group (control) of five dogs was subjected to the stapling technique after oesophagectomy. The symptom of gastrooesophageal reflux was recorded by 24-h pH oesophageal monitoring. Endoscopy and barium swallow examination were performed on all dogs. Anastomotic leakage was observed by X-ray imaging, whereas benign anastomotic stricture and mucosal damage were observed by endoscopy. RESULTS: None of the 10 dogs experienced anastomotic leakage after oesophagectomy. Four dogs in the new technology group resumed regular feeding, whereas only two of the dogs in the control group tolerated solid food intake. pH monitoring demonstrated that 25% of the dogs in the experimental group exhibited reflux and that none had mucosal damage consistent with reflux. Conversely, both reflux and mucosal damage were observed in all dogs in the control group. CONCLUSION: The oesophageal flap valvuloplasty and wrapping suturing technique can improve the postoperative quality of life through the long-term elimination of reflux oesophagitis and decreased stricture formation after primary oesophageal anastomosis. PMID:25516655

  9. Clinical characteristics and effectiveness of lansoprazole in Japanese patients with gastroesophageal reflux disease and dyspepsia.

    Science.gov (United States)

    Kinoshita, Yoshikazu; Miwa, Hiroto; Sanada, Katsuyuki; Miyata, Koji; Haruma, Ken

    2014-04-01

    Patients with gastroesophageal reflux disease (GERD) frequently have symptoms of dyspepsia in addition to reflux symptoms. Treatment options for dyspepsia are not standardized. The aim of this study was to clarify the therapeutic effect of lansoprazole on dyspepsia in Japanese patients with GERD. GERD patients with dyspepsia were enrolled and treated with lansoprazole 15 or 30 mg once daily for 4 weeks. Reflux and dyspeptic symptoms were assessed by questionnaires before treatment, and 2 and 4 weeks after the start of lansoprazole treatment. In the effectiveness analysis set (n = 12,653), heartburn was reported by 91.6 % of patients at study enrollment. Postprandial fullness was the most frequently reported dyspepsia symptom at the start of the study, reported by 79.0 % of enrolled patients. After 4 weeks of lansoprazole treatment, heartburn symptoms were improved in 75.7 % of patients and symptoms of postprandial fullness were improved in 68.7 % of patients. The therapeutic effect of low and high doses of lansoprazole on dyspepsia, as well as on reflux symptoms, was approximately 10 % higher in patients with endoscopy-confirmed erosive esophagitis (60.1-82.2 %), than in patients with non-erosive reflux diseases (53.0-73.3 %). Lansoprazole was well tolerated. In this large-scale clinical study, lansoprazole effectively relieved dyspepsia in addition to reflux symptoms in patients with GERD.

  10. Scintigraphy, pH measurement and radiography in the evaluation of gastroesophageal reflux

    International Nuclear Information System (INIS)

    Kaul, B.; Petersen, H.; Grette, K.; Erichsen, H.; Myrvold, H.E.

    1985-01-01

    Scintigraphy as a diagnostic tool has been explored in 69 patients with gastroesophageal reflux (GER) symptoms and endoscopic esophagitis. In all subjects the presence of reflux was also evaluated by radiography and intraesophageal pH measurements (standard acid reflux test). The overall sensitivity of scintigraphy (85.5%) was significantly higher than those of radiography (27.5%) and pH measurements (69.5%). Scintigraphy was performed with normal saline and with acidified orange juice as the transport medium for the isotope 99mTc. The yield of positive scintigrams was higher (22.3 to 61.1%, depending on the grade of endoscopic esophagitis) with the latter variant. Moreover, demonstration of spontaneous reflux was greatly facilitated by the acid scintigraphy. This was particularly obvious in the grade I esophagitis, in which the freqency of spontaneous reflux with saline method was 3.4% and with acid medium 34/3%. Reflux (induced or spontaneous) was seen in 22 normal control subjects with the saline method, and in 1 subject only with the acid method. On the basis of these findings it is concluded that scintigraphy, especially the acid variant of the technique, is a valuable diagnostic procedure in GER disease

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

    Directory of Open Access Journals (Sweden)

    Jennifer Yourkavitch

    2016-10-01

    Full Text Available 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.

  12. 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.

  13. Oesophageal flap valvuloplasty and wrapping suturing prevent gastrooesophageal reflux disease in dogs after oesophageal anastomosis.

    Science.gov (United States)

    Dai, Ji-Gang; Liu, Quan-Xing; Den, Xu-Feng; Min, Jia-Xin

    2014-12-14

    To examine the efficiency of oesophageal flap valvuloplasty and wrapping suturing technique in decreasing the rate of postoperative gastrooesophageal reflux disease in a dog model. We operated on 10 dogs in this study. First, we resected a 5-cm portion of the distal oesophagus and then restored the continuity of the oesophageal and gastric walls by end-to-end anastomosis. A group of five dogs was subjected to the oesophageal flap valvuloplasty and wrapping suturing technique, whereas another group (control) of five dogs was subjected to the stapling technique after oesophagectomy. The symptom of gastrooesophageal reflux was recorded by 24-h pH oesophageal monitoring. Endoscopy and barium swallow examination were performed on all dogs. Anastomotic leakage was observed by X-ray imaging, whereas benign anastomotic stricture and mucosal damage were observed by endoscopy. None of the 10 dogs experienced anastomotic leakage after oesophagectomy. Four dogs in the new technology group resumed regular feeding, whereas only two of the dogs in the control group tolerated solid food intake. pH monitoring demonstrated that 25% of the dogs in the experimental group exhibited reflux and that none had mucosal damage consistent with reflux. Conversely, both reflux and mucosal damage were observed in all dogs in the control group. The oesophageal flap valvuloplasty and wrapping suturing technique can improve the postoperative quality of life through the long-term elimination of reflux oesophagitis and decreased stricture formation after primary oesophageal anastomosis.

  14. Prospective study on effect of Helicobacter pylori on gastroesophageal reflux disease

    Directory of Open Access Journals (Sweden)

    Sabah Jalal Shareef

    2017-08-01

    Full Text Available Background and objective: The Helicobacter pylori infections role in etiology of peptic ulcer is well known, but its role in gastroesophageal reflux disease is one of the important issues which has to be confirmed. We tried to find out the effect of Helicobacter pylori infection on gastroesophageal reflux disease. Methods: The current study was done on 100 patients with gastroesophageal reflux disease from January 1st to June 30th, 2014 in Rizgary Teaching Hospital, Erbil city. The diagnosis was made by history, clinical examination, and endoscopy. Helicobacter pylori infection was confirmed by gastric biopsy and histopathological examination. We tried to find out the effects of Helicobacter pylori infection in gastroesophageal reflux disease patients and its eradication on their symptoms. The data was analyzed with the statistical package for the social sciences (version 18. Results: The mean age ± SD of participants was 37.13 ± 12.5 (17-75 years. The prevalence of Helicobacter pylori infection was 75%. The endoscopy showed that 50 out of 75 patients had erosive esophagitis and 25 out of 75 patients had normal appearance known as non-erosive esophagitis. The study showed no significance of its eradication on symptoms of gastroesophageal reflux disease. Conclusion: The effect of Helicobacter pylori infection in gastroesophageal reflux disease patients was significant regarding endoscopic finding while inversely related to symptoms severity. The eradication of infection did not cause improvement in symptom severity i.e. triple therapy not advised in the course of treatment.

  15. Pathophysiology of gastroesophageal reflux disease: new understanding in a new era.

    Science.gov (United States)

    Herregods, T V K; Bredenoord, A J; Smout, A J P M

    2015-09-01

    The prevalence of gastroesophageal reflux disease (GERD) has increased in the last decades and it is now one of the most common chronic diseases. Throughout time our insight in the pathophysiology of GERD has been characterized by remarkable back and forth swings, often prompted by new investigational techniques. Even today, the pathophysiology of GERD is not fully understood but it is now recognized to be a multifactorial disease. Among the factors that have been shown to be involved in the provocation or increase of reflux, are sliding hiatus hernia, low lower esophageal sphincter pressure, transient lower esophageal sphincter relaxation, the acid pocket, obesity, increased distensibility of the esophagogastric junction, prolonged esophageal clearance, and delayed gastric emptying. Moreover, multiple mechanisms influence the perception of GERD symptoms, such as the acidity of the refluxate, its proximal extent, the presence of gas in the refluxate, duodenogastroesophageal reflux, longitudinal muscle contraction, mucosal integrity, and peripheral and central sensitization. Understanding the pathophysiology of GERD is important for future targets for therapy as proton pump inhibitor-refractory GERD symptoms remain a common problem. In this review we provide an overview of the mechanisms leading to reflux and the factors influencing perception, in the light of historical developments. It is clear that further research remains necessary despite the recent advances in the understanding of the pathophysiology of GERD. © 2015 John Wiley & Sons Ltd.

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

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    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

  17. Vesicoureteral Reflux

    African Journals Online (AJOL)

    2007-11-07

    Nov 7, 2007 ... for over-prescribing antibiotics among all infections is because of unrealistic patient expectations and insufficient time to discuss the rationale for antibiotic therapy with the patient“. Furthermore, patient expectations can influence physicians to prescribeantibiotic therapy even in the absence of appropriate.

  18. The comparative analyses of different diagnostic approaches in detection of gastroesophageal reflux disease in children.

    Directory of Open Access Journals (Sweden)

    Nina Ristic

    Full Text Available The aim of this study was to compare the different diagnostic approaches in detection of gastroesophageal reflux disease in children presented with symptoms suggesting gastroesophageal reflux disease.The study design was cross sectional. The study retrospectively included all children who underwent combined multiple intraluminal impedance and pH (pH-MII monitoring due to gastrointestinal and/or extraesophageal symptoms suggesting gastroesophageal reflux disease at University Children's Hospital in Belgrade, from July 2012 to July 2016.A total of 218 (117 boys/101 girls, mean age 6.7 years (range 0.06-18.0 years, met the inclusion criteria. Gastroesophageal reflux disease was found in 128 of 218 children (57.4% by pH-MII and in 76 (34.1% children by pH metry alone. Using pH-MII monitoring as gold standard, sensitivity of pH-metry was lowest in infants (22.9%, with tendency to increase in older age groups (reaching 76.4% in children ≥ 9 years. The sensitivity of pH-metry alone in children with extraesophageal symptoms was 38.1%, while the sensitivity of pH-metry in children with gastrointestinal symptoms was 63.8%. Reflux esophagitis was identified in 31 (26.1% of 119 children who underwent endoscopy. Logistic regression analysis showed that best predictors of endoscopic reflux esophagitis are the longest acid episode (OR = 1.52, p<0.05 and DeMeester reflux composite score (OR = 3.31, p<0.05. The significant cutoff values included DeMeester reflux composite score ≥ 29 (AUC 0.786, CI 0.695-0.877, p<0.01 and duration of longest acid reflux ≥ 18 minutes (AUC 0.784, CI 0.692-0.875, p<0.01.The results of our study suggested that compared with pH-metry alone, pH-MII had significantly higher detection rate of gastroesophageal reflux disease, especially in infants. Our findings also showed that pH-MII parameters correlated significantly with the endoscopically confirmed erosive esophagitis.

  19. Relevance between GerdQ score and the severity of reflux esophagitis in Uygur and Han Chinese

    OpenAIRE

    Wang, Man; Zhang, Jing-Zhan; Kang, Xiao-Jing; Li, Li; Huang, Xiao-Ling; Aihemaijiang, Kuerbanjiang; Ayinuer, Aheman; Li, Yue-Xian; He, Xiao-Lei; Gao, Feng

    2017-01-01

    Gastroesophageal reflux disease questionnaire (GerdQ) was used to investigate the inpatients with typical reflux related symptoms in Gastroenterology. According to heartburn, regurgitation, abdominal pain, nausea, sleep disorders, whether taking over the counter (OTC) drugs 6 points to score. Using endoscopy as the gold standard for the diagnosis of reflux esophagitis (RE), and the results were compared with GerdQ score to determine the threshold value for RE, to analyze the distribution of G...

  20. Evaluation of Gastroesophageal Reflux in Anesthetized Dogs with Brachycephalic Syndrome.

    Science.gov (United States)

    Shaver, Stephanie L; Barbur, Laura A; Jimenez, David A; Brainard, Benjamin M; Cornell, Karen K; Radlinsky, MaryAnn G; Schmiedt, Chad W

    Brachycephalic airway syndrome may predispose to gastroesophageal reflux (GER) because of the high negative intrathoracic pressures required to overcome conformational partial upper airway obstruction. To investigate this, 20 dogs presenting for elective correction of brachycephalic airway syndrome (cases) and 20 non-brachycephalic dogs (controls) undergoing other elective surgeries were prospectively enrolled. Dogs underwent a standardized anesthetic protocol, and esophageal pH was monitored. Signalment, body weight, historical gastrointestinal and respiratory disease, complete blood count, serum biochemical values, radiographic findings, and anesthetic and surgical time were compared between cases and controls, and dogs that did and did not have basic (pH > 7.5), acidic (pH dogs were evaluated, dogs with GER had increased creatinine (P = .01), % positive for esophageal fluid on radiographs (P = .05), and body weight (P = .04) compared to those without GER. GER was common in both cases and controls, and cases had lower esophageal pH; however, greater numbers are required to determine if a true difference exists in % GER.

  1. Chronic obstructive pulmonary disease: Association with gastroesophageal reflux disease

    International Nuclear Information System (INIS)

    Kim, Young Chul; Oh, Jae Hee; Byun, Joo Nam

    1992-01-01

    Multiple factors including gastroesophageal reflux disease (GERD) were evaluated for a case-control study in Chonnam area to investigate the causative entity of COPD. Data on the multiple causative factors from hospital records and interview survey were analyzed in three groups of COPD (64 cases as case group), normal lung (83 cases as control group 1) and non-COPD lung disease (45 case as control group 2). Smoking status, history of adulthood pulmonary infection and frequent history of URI, socioeconomic status, and GERD were significant different between COPD group and control group 1. Drinking status, physical height of the subjects and GERD were significant different between COPD group and control group 2. If control group 1 was used, odds ratio of GERD and COPD was 5.68 (95% confidence interval, 95% CI: 2.59-12.45) and 4.81 (95% CI: 1.89-10.53) when adjusted by age and smoking status. If control group 2 was used, odds ratio of GERD and COPD was 4.22 (95% CI: 1.69-10.56) and 4.59 (95% CI: 1.64-12.86) when adjusted by alcohol and adulthood respiratory infection status. In summary, there result suggested that GERD might play a causative role in the development of COPD

  2. 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. Copyright © 2014. Published by Elsevier Ltd.

  3. Debut of Gastroesophageal Reflux Concomitant with Administration of Sublingual Immunotherapy

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    Jacob Juel

    2017-01-01

    Full Text Available Gastroesophageal reflux disease (GORD is an often debilitating condition characterised by retrograde flow of content from stomach into the oesophagus, where the low pH of the stomach acid irritates the mucosa of the oesophagus. The most dominant symptoms in GORD are pyrosis, regurgitation, and dysphagia. Sublingual immunotherapy (SLIT was first described in 1986. Following this description, the use has greatly increased in the treatment of allergic rhinitis, as an alternative to subcutaneously administered immunotherapy. Side effects are commonly of oropharyngeal and gastrointestinal nature, for example, swelling, itching, irritation, ulceration of the oropharynx and nausea, abdominal pain, vomiting, and diarrhoea. More serious side effects are dominated by respiratory tract and systemic manifestations. A 30-year-old male experienced refractory, relentless, and debilitation GORD subsequent to administration of sublingual immunotherapy for house dust mite in allergic rhinitis. The patient had to stop the SLIT after two weeks of administration due to GORD. The cessation resulted in rapid resolution of symptoms.

  4. Kidney size and split renal function in reflux nephropathy

    International Nuclear Information System (INIS)

    Klare, B.

    1980-01-01

    1. According to our study unilateral gross VUR is associated with significant reduction of ERPF and GFR and impaired growth of the corresponding kidney. 2. Compensatory increase in mass or function of the contralateral kidney is only partial and usually only if the latter presents no VUR. 3. The capacity for compensatory growth seems to depend mainly on the integrity of the organ. It seems dangerous to us to interpret changes in kidney size or unilateral function on the basis of so-called 'renal units' without considering the state of the contralateral organ. 4. The overall reduction of renal function seems to be greater than that of renal length. 5. With bilateral gross VUR the reduction in total kidney size and function is more significant than in unilateral gross VUR. However, the differences in values between the more and the less severely affected kidneys are smaller in children with bilateral gross VUR compared with the differences in unilateral cases of VUR. 6. It appears that with longer duration of VUR function is reduced. 7. The correlation between renal length and ERPF in the corresponding kidney is smaller in the presence of gross VUR than in small kidneys without VUR. 8. We believe that repeated determinations of split renal function as well as of kidney size will contribute to predicting early damage produced by reflux nephropathy and to evaluating therapeutic measures. (orig.)

  5. Respiratory complications of gastroesophageal reflux associated with paraesophageal hiatal hernia.

    Science.gov (United States)

    Greub, Gilbert; Liaudet, Lucas; Wiesel, Paul; Bettschart, Vincent; Schaller, Marie-Denise

    2003-08-01

    Gastroesophageal reflux disease (GERD) may be associated with episodes of bronchoaspiration, sometimes leading to life-threatening respiratory complications. GERD is frequently observed in the setting of type 1 (sliding type) hiatal hernia, but only infrequently complicates the course of type 2 (paraesophageal) hernia. We performed a retrospective analysis of 50 patients operated for type 2 hiatal hernia in our hospital, to determine the prevalence of respiratory complaints related to GERD in this setting. We found 7 cases (14%) of type 2 hiatal hernia complicated by pulmonary manifestations as the only symptoms of GERD. These ranged from dyspnea to severe bronchoconstriction and acute respiratory failure. The series is illustrated by the report of 1 patient who experienced acute bronchospasm and cardiopulmonary arrest as a complication of GERD. In all patients, surgical repair of the hiatal hernia, together with an antireflux procedure, resulted in complete resolution of the respiratory complaints for follow-up periods up to 160 months. Our data emphasize the particular prevalence of respiratory involvement in the case of GERD complicating type 2 hiatal hernia, and also the excellent symptomatic results obtained by surgical therapy for this condition.

  6. Gastrostomy and gastroesophageal reflux in neurologically impaired children

    Directory of Open Access Journals (Sweden)

    Giovanni Cappellano

    2003-06-01

    Full Text Available Gastrostomy has been increasingly indicated for daily feeding ofneurologically impaired children with swallowing abnormalitiesthat hinder the use of the mouth. Therefore, the enteral route hasstill been used by means of oral, nasogastric or nasojejunal tube.However it is no longer the preferential method, mainly in cases ofprolonged use. Today gastrostomy is the most often utilizedprocedure, particularly Stamm gastrostomy. Many of thesepatients present pulmonary abnormalities due to a possiblegastroesophageal reflux (GER. After the study by Jolley et al.(1, in1985, fundoplication has become a systematic and routinecomplement to gastrostomy. The neurologically impaired patientshave been submitted to two surgeries, leading to possible andpredictable increase in morbidity and mortality rates. Althougheffective when properly indicated, this simple management hasrecently been very much debated and rejected. Thus, an updatingbased on recent studies is necessary to make pediatric surgeonsand pediatricians aware of other manners to solve this problem,which aim at correctly feeding these children with impairedswallowing and GER and helping them have a better quality of life.The literature reviewed was searched in PubMed/Medline, fromJanuary 1994 to May 2003. Other articles read and mentioned inthis review and published before 1994 were collected based onarticles cited in the references. Thus, we could assess thechronological progression in management of neurologicallyimpaired children who need gastrostomy for their feeding, andcarry out an analysis of current fundoplication and the questionwhether the use of a prophylactic antireflux valve is compulsoryor not.

  7. 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 tolerance to stress and higher 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. © 2012 Copyright the Authors. Journal compilation © 2012, Wiley Periodicals, Inc. and the International Society for Diseases of the Esophagus.

  8. Review of gastroesophageal reflux disease (GERD) in the diabetic patient.

    Science.gov (United States)

    Punjabi, Paawan; Hira, Angela; Prasad, Shanti; Wang, Xiangbing; Chokhavatia, Sita

    2015-09-01

    This article reviews the known pathophysiological mechanisms of comorbid gastroesophageal reflux disease (GERD) in the diabetic patient, discusses therapeutic options in care, and provides an approach to its evaluation and management. We searched for review articles published in the past 10 years through a PubMed search using the filters diabetes mellitus, GERD, pathophysiology, and management. The search only yielded a handful of articles, so we independently included relevant studies from these review articles along with related citations as suggested by PubMed. We found diabetic patients are more prone to developing GERD and may present with atypical manifestations. A number of mechanisms have been proposed to elucidate the connection between these two diseases. Studies involving treatment options for comorbid disease suggest conflicting drug-drug interactions. Currently, there are no published guidelines specifically for the evaluation and management of GERD in the diabetic patient. Although there are several proposed mechanisms for the higher prevalence of GERD in the diabetic patient, this complex interrelationship requires further research. Understanding the pathophysiology will help direct diagnostic evaluation. In our review, we propose a management algorithm for GERD in the diabetic patient. © 2015 Ruijin Hospital, Shanghai Jiaotong University School of Medicine and Wiley Publishing Asia Pty Ltd.

  9. Clinical efficacy and safety of Securflux®, an anti-reflux device for intravenous infusion.

    Science.gov (United States)

    Barreras, Ferran; Cabeza, Manuel; Collantes de Terán, Laura

    2013-01-01

    Catheter obstruction or patency inhibition of the venous access cannula is a frequently experienced problem in patients to whom intravenous (IV) solutions are administered. In this study we assessed the efficacy and safety of Securflux® a disposable device with a back-check valve to prevent reflux in IV infusion sets. A total of 177 adult patients requiring IV medication for at least 24 hours duration were randomized into two groups: with and without the use of Securflux®. Assessments were performed the 10 days after catheter insertion, over three daily visits. The incidence of the onset of reflux (visual/non-visual) and the consequences of reflux for both the patient and healthcare staff were assessed. There were 4577 follow-up (study) visits (53.4% in patients with Securflux® and 46.6% without Securflux®). Venous reflux was observed in 14.2% of all visits, more frequently without Securflux® (21.3% vs. 8.1%; P<.05). Reflux was mostly visual without Securflux® (7.6% vs. 0.7%) and non-visual with Securflux® (13.6% vs. 7.3%). The onset of venous reflux carried more consequences, such as inhibition of the line and patient discomfort, in the infusions without Securflux® (81.1% vs. 73.5% of the visits; P<.05). There were no safety concerns related to Securflux®. Securflux® is effective, safe and useful for the prevention of venous reflux onset in patients administered IV medication.

  10. The impact of the speed of food intake on gastroesophageal reflux events in obese female patients.

    Science.gov (United States)

    Bor, Serhat; Erdogan, Askin; Bayrakci, Berna; Yildirim, Esra; Vardar, Rukiye

    2017-01-01

    Obesity increases the risk of gastroesophageal reflux disease (GERD). The majority of the reflux attacks occur postprandially. The influence of the speed of food intake on gastroesophageal reflux events is unclear in obese patients. To determine the influence of the speed of food intake on intraesophageal reflux events in obese patients with and without GERD. A total of 26 obese female patients were recruited. The patients underwent esophageal manometry to evaluate the upper limit of the lower esophageal sphincter and subsequently placement of a Multichannel intraluminal impedance-pH (MII-pH) catheter. All patients were asked to eat the same standard meal (double cheeseburger, 1 banana, 100 g yogurt and 200 mL water; total energy value, 744 kcal; 37.6% carbohydrates, 21.2% proteins and 41.2% lipids) within 5 or 30 minutes under observation in a random order on two consecutive days. All reflux episodes over a 3-hour postprandial period were manually analyzed and compared. The mean age was 46 ± 12 (18-66) years. The mean body mass index (BMI) was 39.9 ± 8.4 kg/m2. There was no difference between the fast- and slow-eating group in the number of refluxes within the 3-postprandial hours. The patients were divided into 2 groups according to the 24-hour MII-pH monitoring results, that is, 16 subjects with normal MII-pH monitoring and 10 patients with pathologic MII-pH monitoring. There was no effect of the speed of food intake in either the patients with or without GERD. In contrast to the general belief, this study suggested that the speed of food intake does not influence the number of refluxes in obese female patients with or without GERD. © 2016 International Society for Diseases of the Esophagus.

  11. Columnar Metaplasia in Three Types of Surgical Mouse Models of Esophageal RefluxSummary

    Directory of Open Access Journals (Sweden)

    Fabio Terabe

    2017-07-01

    Full Text Available Background and Aims: Esophageal adenocarcinoma develops in the setting of gastroesophageal reflux and columnar metaplasia in distal esophagus. Columnar metaplasia arising in gastroesophageal reflux models has developed in rat; however, gastroesophageal reflux models in mice have not been well-characterized. Methods: One hundred thirty-five C57Bl/6J mice aged 8 weeks old were divided into the following operations: esophagogastrojejunostomy (side-to-side (EGJ, esophageal separation and esophagojejunostomy (end-to-side (EJ, and EJ and gastrectomy (end-to-side (EJ/TG. The animals were euthanized after 40 weeks and the histology of the junction was examined. Immunohistochemistry for p53, PDX-1, and CDX-2 was performed. Results: Metaplasia developed in 15/33 (45.5% of EGJ, 0/38 (0% of EJ, and 6/39 (15.4% of EJ/TG (P < .05 and dysplasia developed 7/33 (21.2% of EGJ, 0% of EJ, and 1/39 (2.6% of EJ/TG. p53 was positive in all of the dysplastic regions, 12/15 (80% metaplasias in the EGJ model, and 1/6 (16.7% metaplasia in the EJ/TG model. CDX-2 was positive in all cases of metaplasias, but decreased in some cases of dysplasia. PDX-1 was positive in 7/8 (88% cases of dysplasia and in 15/21 (71% cases of metaplasia (P < .05. Conclusions: The EGJ model, which causes reflux of gastric acid and duodenal content, developed metaplasia and dysplasia most frequently. No metaplasia developed in the EJ model in which gastric juice and duodenal content mixed before reflux. Thus, duodenal contents alone can induce columnar metaplasia and dysplasia; however, the combination of gastric acid with duodenal content reflux can cause metaplasia and dysplasia more efficiently. Keywords: GERD, Esophageal Reflux, Barrett’s Esophagus, Esophageal Adenocarcinoma

  12. Predicting Time to Reflux of Children With Antenatal Hydronephrosis: A Competing Risks Approach

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    Maryam Nazemipour

    2017-09-01

    Full Text Available The aim of this study was describing methodological aspects and applying a trivariate Weibull survival model using the competing risks concept to predict time to occurrence different types of reflux (unilateral (left, right or bilateral in children with antenatal hydronephrosis. Data from 333 children in Pediatric Urology Research Center of Children’s Hospital Medical Center, affiliated with Tehran University of Medical Sciences was used. The effect of some demographic and clinical factors on child’s reflux was studied. The assumption of independent between times of different types of reflux was evaluated. Of infants 80.5% were boy. The percentage of children experienced right, left and bilateral reflux or have been censored are 15.3%, 14.1%, 60.4% and 10.2% respectively. For the time of left reflux, variables, Week of diagnosis ANH, UC, UA, HUN, HN, APD_Right, Direction of ANH, CA19-9 baby, Urethra were significant. For the time of right reflux, variables, constipation, UC, UA, HUN, APD_Right, Direction and Severity of ANH, Bladder, and finally for the time of bilateral reflux, variables, Week of diagnosis ANH, Gender, UA, HUN, HN, APD_Left, Urethra, and Bladder were significant P<0.05. In the presence of competing risks, it is inappropriate to use the Kaplan-Meier method and standard Cox model which do not take competing risks into account. Trivariate Weibull survival model using competing risks not only is able to calculate the hazard rate of variables with different type of events but also it will be able to compare the hazard rate within the same type of event with different covariates.

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

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    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.

  14. Anatomy of reflux: a growing health problem affecting structures of the head and neck.

    Science.gov (United States)

    Lipan, Michael J; Reidenberg, Joy S; Laitman, Jeffrey T

    2006-11-01

    Gastroesophageal reflux disease (GERD) and laryngopharyngeal reflux (LPR) are sibling diseases that are a modern-day plague. Millions of Americans suffer from their sequelae, ranging from subtle annoyances to life-threatening illnesses such as asthma, sleep apnea, and cancer. Indeed, the recognized prevalence of GERD alone has increased threefold throughout the 1990s. Knowledge of the precise etiologies for GERD and LPR is becoming essential for proper treatment. This review focuses on the anatomical, physiological, neurobiological, and cellular aspects of these diseases. By definition, gastroesophageal reflux (GER) is the passage of gastric contents into the esophagus; when excessive and damaging to the esophageal mucosa, GERD results. Reflux that advances to the laryngopharynx and, subsequently, to other regions of the head and neck such as the larynx, oral cavity, nasopharynx, nasal cavity, paranasal sinuses, and even middle ear results in LPR. While GERD has long been identified as a source of esophageal disease, LPR has only recently been implicated in causing head and neck problems. Recent research has identified four anatomical/physiological "barriers" that serve as guardians to prevent the cranial incursion of reflux: the gastroesophageal junction, esophageal motor function and acid clearance, the upper esophageal sphincter, and pharyngeal and laryngeal mucosal resistance. Sequential failure of all four barriers is necessary to produce LPR. While it has become apparent that GER must precede both GERD and LPR, the head and neck distribution of the latter clearly separates these diseases as distinct entities warranting specialized focus and treatment.

  15. Is pepsin detected in the saliva of patients who experience pharyngeal reflux?

    Science.gov (United States)

    Printza, A; Speletas, M; Triaridis, S; Wilson, J

    2007-07-01

    To investigate if pepsin is detected, with an activity assay, in the saliva of patients with a clinical diagnosis of laryngopharyngeal reflux (LPR) and can therefore be used as a diagnostic marker of laryngopharyngeal reflux. Pilot, prospective study. Adult participants with a clinical diagnosis of LPR collected whole saliva samples on regular intervals for a day, and upon experiencing symptoms attributed to LPR. Patients were selected on the basis of presence of severe symptoms and laryngoscopic findings of laryngopharyngeal reflux and symptoms of gastroesopharyngeal reflux. They reported voice disorders, dysphagia, throat clearing, excessive secretions, breathing difficulties, cough, globus sensation and throat pain. Control participants reported the absence of pharyngeal and laryngeal symptoms and of symptoms of gastroesophageal reflux. Saliva samples were assayed with fibrinogen on an agarose gel plate. The detection of pepsin was based on the presence of peptic activity which was qualitatively evaluated. The control participants had negative assays. No saliva samples from the LPR patients, collected at regular sampling, tested positive for pepsin. All the samples collected at the presence of symptoms and following regurgitation episodes tested negative for pepsin. Saliva samples pH ranged from 7 to 8. Pepsin was not detected, with an activity assay, in the saliva of patients with a clinical diagnosis of LPR. A concentration method might be more sensitive although saliva and swallowing physiology renders the detection of pepsin in the saliva difficult.

  16. Gaviscon and domperidon responsive apnea episodes associated with gastro-esophageal reflux disease in twins.

    Science.gov (United States)

    Bilgin, Huseyin; Eren, Abdulkadir; Kara, Semra

    2015-01-01

    The possible pathophysiology of the relationship between gastro-esophageal reflux disease and apnea of prematurity has been widely investigated. Various physiological protective reflex responses provide a plausible biological link between gastro-esophageal reflux and apnea of prematurity. It is uncertain whether or not there is a causal relationship between the two diseases. PATIENT'S FINDINGS: Twins were admitted to the neonatal intensive care unit due to feeding problems. Physical examination was normal except for reticulated, blueviolet skin changes. Short apneic attacks occurred on the first day in twin 1 and on the second day in twin 2, and these were initially treated by stimulation and increased ambient O2 concentration. Then, we conducted methylxanthine and continuous positive airway pressure treatment. Laboratory and radiological analysis were normal. As gastro-esophageal reflux disease was thought to be the causes of the treatment-refractory apnea, therapy with gaviscon and domperidon was begun for both cases. Apneic attacks did not recur after gaviscon and domperidon therapy. Pharmacological therapy for gastro-esophageal reflux disease has not definitively been shown to be effective in improving symptoms and hence, should be reserved especially for infants with treatment refractory apnea episodes suspected as being gastro-esophageal reflux in premature infants.

  17. Proton pump inhibitor-refractory gastroesophageal reflux disease: challenges and solutions

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    Mermelstein J

    2018-03-01

    Full Text Available Joseph Mermelstein,1 Alanna Chait Mermelstein,2 Maxwell M Chait3 1Gasteroenterology and Nutrition Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; 2Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA; 3Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA Abstract: A significant percentage of patients with gastroesophageal reflux disease (GERD will not respond to proton pump inhibitor (PPI therapy. The causes of PPI-refractory GERD are numerous and diverse, and include adherence, persistent acid, functional disorders, nonacid reflux, and PPI bioavailability. The evaluation should start with a symptom assessment and may progress to imaging, endoscopy, and monitoring of esophageal pH, impedance, and bilirubin. There are a variety of pharmacologic and procedural interventions that should be selected based on the underlying mechanism of PPI failure. Pharmacologic treatments can include antacids, prokinetics, alginates, bile acid binders, reflux inhibitors, and antidepressants. Procedural options include laparoscopic fundoplication and LINX as well as endoscopic procedures, such as transoral incisionless fundoplication and Stretta. Several alternative and complementary treatments of possible benefit also exist. Keywords: PPI failure, resistant GERD, acid-related diseases, gastroesophageal reflux disease, acid reflux, proton pump inhibitors

  18. Gastroesophageal reflux symptoms not responding to proton pump inhibitor: GERD, NERD, NARD, esophageal hypersensitivity or dyspepsia?

    Science.gov (United States)

    Bashashati, Mohammad; Hejazi, Reza A; Andrews, Christopher N; Storr, Martin A

    2014-01-01

    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. PMID:24719900

  19. 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

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

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    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.

  2. 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)

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

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    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.

  4. Reflux of Anterior Spinal Artery Predicts Recurrent Posterior Circulation Stroke in Bilateral Vertebral Artery Disease.

    Science.gov (United States)

    Fukuda, Hitoshi; Hayashi, Kosuke; Handa, Akira; Kurosaki, Yoshitaka; Lo, Benjamin; Yamagata, Sen

    2015-11-01

    Predictive value of reflux of anterior spinal artery for recurrent posterior circulation ischemia in bilateral vertebral arteries steno-occlusive disease was evaluated. We retrospectively reviewed 55 patients with symptomatic posterior circulation stroke caused by bilateral stenotic (>70%) lesions of the vertebral artery. We investigated any correlation of clinical and angiographic characteristics including collateral flow patterns, with recurrent stroke. Risk factors for poor 3-month functional outcome were also evaluated. Recurrent posterior circulation stroke was observed in 15 (27.3%) patients. Multivariable analysis using Cox proportional hazards model showed anterior spinal artery reflux as a significant risk factor for stroke recurrence (adjusted hazard ratio, 19.3 [95% confidence interval, 5.35-69.9]; Pdisease, anterior spinal artery reflux predicted recurrent posterior circulation stroke and poor functional outcome. © 2015 American Heart Association, Inc.

  5. Proton pump inhibitor-responsive chronic cough without acid reflux: a case report

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    Nobata Kouichi

    2007-08-01

    Full Text Available Abstract Background Because 24-h esophageal pH monitoring is quite invasive, the diagnosis of gastroesophageal reflux disease (GERD-associated cough has usually been made based merely on the clinical efficacy of treatment with proton pump inhibitor (PPI. Case presentation We recently encountered two patients with PPI-responsive chronic non-productive cough for whom switching from bronchodilators and glucocorticosteroids to PPI resulted in improvement of cough. The cough returned nearly to pre-administration level a few weeks after discontinuation of PPI. Though GERD-associated cough was suspected, 24-h esophageal pH monitoring revealed that the cough rarely involved gastric acid reflux. Following re-initiation of PPI, the cough disappeared again. Conclusion PPI may improve cough unrelated to gastric acid reflux.

  6. Pathophysiology of gastroesophageal reflux disease in premature infants using a radionuclide method

    International Nuclear Information System (INIS)

    Ishihara, Michiomi

    2001-01-01

    The cases of 36 very low birthweight infants (premature group) and 52 mature infants with birth weights as low as 1500 g (mature group) with gastro-esephageal reflux disease (GERD) were reviewed. These infants received 24 hour pH monitoring, reflux scintigraphy, gastric emptying, and antrum motility measurement. The results of 24-hour pH monitoring of the premature group are not different from these of the mature group. Time required for reflux scintigraphy of the premature group is higher than that of the mature group. Emptying time of premature group is slower than that of the mature group. Dietary management in premature infants with GERD is important. Using a nasoduodenal feeding tube is quite effective. Radionuclide method, in addition to 24-hour pH monitoring, should be used to evaluate total gastroesophageal function. (author)

  7. 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

    (31 vs 21%, P = 0.004), more breathlessness (39 vs 22%, P history of respiratory infections (6.8 vs 1.4%, P disease. Among individuals with COPD and gastro-esophageal reflux disease, those who did......BACKGROUND AND OBJECTIVE: We tested the hypothesis that gastro-esophageal reflux disease is a risk factor for exacerbations in individuals with chronic obstructive pulmonary disease (COPD). METHODS: Among 9622 participants in the Copenhagen City Heart Study, we identified 1259 individuals with COPD...... and information on gastro-esophageal reflux disease and the regular use of acid inhibitory treatment. These individuals were followed for 5 years with regard to medically treated COPD exacerbations, which we defined as a short course treatment with oral corticosteroids alone or in combination with antibiotics. We...

  8. Scintigraphic estimation of the duodeno-gastric reflux in the unclerous disease

    International Nuclear Information System (INIS)

    Kopanski, Z.; Cienciala, A.; Micherdzinski, J.; Brandys, J.; Zastepa, P.; Witkowska, B.

    1993-01-01

    The analysis includes 58 patients with an ulcer in the duodenum, 40 patients with an ulcer in the stomach, and 13 persons making up the control group. In all patients submitted to the ratio-isotopic estimation of the duodeno-gastric reflux as well as to the chromatographic determination of the concentration of bile acids and lysolecithin in the gastric juice, an almost identically frequent occurrence of the reflux of the duodeno gastric contents into the ulcer of the stomach and of the duodenum was confirmed. It was shown that half of the ulcers of the stomach originate without the participation of the duodeno gastric reflux. It was also established that the average total concentrations of bile acids and lysolecithin are very high in the gastric juice, and in some even statistically significant cases, in the ulcer of the stomach in comparison with the remaining analysed groups of patients. (author). 17 refs, 4 figs

  9. Duodeno gastric reflux in peptic ulcer disease: gall bladder emptying provoked by cholecystokinin or a fatty meal

    International Nuclear Information System (INIS)

    Harding, L.K.; Donovan, I.A.; Mosimann, F.; Drumm, J.; Alexander-Williams, J.

    1986-01-01

    A wide range of incidence of diodeno-gastric bile reflux has been reported in patients with duodenal ulcer (DU) or gastric ulcer (GU). Using either 100 units of CCK i/v or a fatty meal of 320 Cal containing 20 g fat to contract the gall bladder, we have investigated the incidence of reflux in 170 subjects: CCK (Control: 20; DU: 60; GU: 19), Meal (Control: 19; DU: 37; GU: 15). The CCK or meal was given in the supine subject 30 minutes after injection of 75 MBq sup(99m)Tc diethyl Hida. Reflux was considered present if labelled bile was seen in the stomach on 3 successive 2 minute gamma camera pictures. The percentage of patients showing reflux was as follows: CCK (Control: 45%; DU: 53%; GU: 58%), Meal (Control: 11%; DU: 24%; GU: 40%). These results have been compared using the Chi-squared test. There was no significant difference in the incidence of reflux between control, DU or GU patients either in the group of patients given CCK or a meal. However, reflux was more common after CCK than the meal in control subjects (p<0.05) and in those with DU (p<0.01) but not in those with GU. We conclude that the stimulus given to contract the gall bladder affects the incidence of reflux, and that any significant difference in reflux incidence of DU or GU patients may become apparent when more patients are studied. (Author)

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

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    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

  11. Concomitant functional dyspepsia and irritable bowel syndrome decrease health-related quality of life in gastroesophageal reflux disease

    NARCIS (Netherlands)

    de Vries, Durk R.; van Herwaarden, Margot A.; Baron, Astrid; Smout, André J. P. M.; Samsom, Melvin

    2007-01-01

    OBJECTIVE: Previous studies have reported an overlap between gastroesophageal reflux symptoms, functional dyspepsia (FD) and irritable bowel syndrome (IBS). The aim of this study was to investigate the prevalence of FD and IBS in gastroesophageal reflux disease (GERD) and the effect on

  12. Ambulatory pH-impedance-pressure monitoring as a diagnostic tool for the reflux-cough syndrome

    NARCIS (Netherlands)

    Herregods, T. V. K.; Pauwels, A.; Jafari, J.; Sifrim, D.; Smout, A. J. P. M.; Bredenoord, A. J.; Tack, J.

    2018-01-01

    Gastroesophageal reflux is considered to be a significant contributing factor to chronic unexplained cough. Patients are often presumed to have reflux-induced cough and are exposed to high-dose and long-term empirical therapy with proton pump inhibitors (PPIs) despite the limited treatment efficacy

  13. 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

    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...

  14. Canadian Digestive Health Foundation Public Impact Series: Gastroesophageal Reflux Disease in Canada: Incidence, Prevalence, and Direct and Indirect Economic Impact

    Directory of Open Access Journals (Sweden)

    Richard N Fedorak

    2010-01-01

    Full Text Available The Canadian Digestive Health Foundation initiated a scientific program to assess the incidence, prevalence, mortality and economic impact of digestive disorders across Canada. The current article presents the updated findings from the study concerning gastroesophageal reflux disease – a condition that develops when the reflux of stomach contents causes troublesome symptoms and/or complications (Montreal definition.

  15. Canadian Digestive Health Foundation Public Impact Series: gastroesophageal reflux disease in Canada: incidence, prevalence, and direct and indirect economic impact.

    Science.gov (United States)

    Fedorak, Richard N; Veldhuyzen van Zanten, Sander; Bridges, Ron

    2010-07-01

    The Canadian Digestive Health Foundation initiated a scientific program to assess the incidence, prevalence, mortality and economic impact of digestive disorders across Canada. The current article presents the updated findings from the study concerning gastroesophageal reflux disease - a condition that develops when the reflux of stomach contents causes troublesome symptoms and/or complications (Montreal definition).

  16. Gastro-oesophageal reflux in obese subjects: Influence of overweight, weight loss and chronic gastric balloon distension

    NARCIS (Netherlands)

    Mathus-Vliegen, E. M. H.; Tygat, G. N. J.

    2002-01-01

    Background: Gastro-oesophageal reflux is an obesity-related health risk assumed to improve after weight loss. Prolonged intragastric balloon distension might oppose this. The purpose of the study was to investigate the prevalence of gastro-oesophageal reflux in untreated obese subjects and to study

  17. Comparative study of omeprazole, lansoprazole, pantoprazole and esomeprazole for symptom relief in patients with reflux esophagitis

    Science.gov (United States)

    Zheng, Ri-Nan

    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. PMID:19248200

  18. 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.

  19. Sleep-related breathing disorders in small children with nocturnal acid gastro-oesophageal reflux.

    Science.gov (United States)

    Wasilewska, J; Kaczmarski, M

    2004-01-01

    Coincidence of gastroesophageal reflux disease with obstructive sleep apnea/hypopnea syndrome has been discussed in recent years. Treatment with nasal continuous positive airway pressure (nCPAP) reduces gastroesophageal reflux (GER) in adult patients with obstructive sleep apnea (OSA). Moreover, treatment of gastroesophageal reflux with omeprazole can reduce the severity of obstructive sleep in selected individuals. The aim of the study was to test the hypothesis that gastroesophageal reflux does not influence sleep quality and breathing pattern during sleep in children. 24 children (14 boys, 10 girls, aged 2 months-3 years) with sleep disturbances indicating GER were studied. Standard polysomnography with parallel recording of 24-h oesophageal monitoring was performed. Apnea/hypopnea index (AHI) in active/REM sleep and quiet/NREM sleep was compared between nocturnal acid GER children (13 children; 7 boys, 6 girls; aged 1.28 +/- 0.95y; FRT-18.63 +/- 11.83%) and nocturnal acid GER-free controls (11 children; 7 boys, 4 girls; aged 1.64 +/- 0.97y; FRT-2.93 +/- 2.08%). Exclusion criteria were: 1. laboratory signs of infection (increasing OB, increasing CRP, increasing alpha2-globulin); 2. clinical symptoms of infection in the respiratory tract, the alimentary tract or in the urinary tract. In children with nocturnal GER higher incidence of obstructive apnea/hypopnea during REM sleep was found: AHI = 23.35/h +/- 19.1; (CI 95%11.81-34.89) vs AHI = 4.99/h +/- 3.12 in children without nocturnal GER. We found no differences between the groups in saturation < 90% time during sleep. The study confirms coincidence of nocturnal gastroesophageal reflux and sleep-related breathing disorders in children. Higher number of apnea/hypopnea during REM sleep was found in children with nocturnal gastroesophageal reflux.

  20. Reduced quality of life in patients with non-erosive gastroesophageal reflux disease

    Directory of Open Access Journals (Sweden)

    Márcia Vargas

    2017-07-01

    Full Text Available Introduction: Gastroesophageal reflux disease (GERD is a highly prevalent condition in the Western world. It is a frequent cause of medical appointments and has a high impact on quality of life (QOL. This study aimed to assess health-related quality of life (HQ-QOL of patients with non-erosive gastroesophageal disease (NERD and compare their scores with the scores of patients with GERD symptoms and non-pathological acid reflux (non-NERD. Methods: We studied 42 patients with GERD symptoms—21 with positive pHmetry for acid reflux (NERD group and 21 with negative pHmetry for acid reflux (non-NERD group. We enrolled patients matched by age and gender. Patient inclusion criteria were based on clinical and endoscopic findings and pHmetry. All other major diseases having an impact on QOL were excluded as well as patients in regular use of proton pump inhibitors, prokinetics, histamine-2 receptor antagonists and anti-depressants. All subjects were asked to fill in a validated translation of the SF-36 questionnaire. We described scores trough median and interquartile range (IQR and assessed the significance of the comparisons through Mann-Whitney test and chi-square test or Student’s t-test when appropriate. Results: We found no significant differences in the eight domains of SF-36 between the two groups. Conclusion: QOL of patients with GERD symptoms was equivalent, regardless of acid reflux at pHmetry. Keywords: SF-36; quality of life; gastroesophageal reflux; pHmetry

  1. Influence of central apnea in the preterm newborn with gastroesophageal reflux disease.

    Science.gov (United States)

    Suárez-Morán, Edgardo; Morales-Fuentes, Gerardo Alfonso; Inzunza-González, Jesús Alejandro; Cedillo-Ley, Ivonne; Gerardo-del Hoyo, Moisés; Silva-Ramírez, Horacio

    2011-01-01

    Gastroesophageal reflux occurs frequently in newborns. A relationship has been suspected between reflux and apnea of prematurity. The objective of this study is to determine this relationship, owing to the fact that premature newborns have immaturity of structures, especially esophageal smooth muscle. We conducted a longitudinal, analytical, comparative, and observational case/control study. The study was carried out at the Neonatal Intensive Care Unit and in the Gastrointestinal Physiology Department of the Hospital Español (Mexico City) between January 2002 and December 2004. We included 22 patients: 11 females and 11 males. Mean age was 17.8 ± 8.4 days. Premature newborns represented 72.72% (n = 16). Mean gestational age was 33.1 ± 4.18 weeks. All cases were suspicious for central apnea except for three patients with a mixed cause of apnea. All were submitted to a 24-h pHmetry and a simultaneous polysomnography. Polysomnography was positive in 59% (n = 13) and pHmetry was positive in 50% (n = 11). Prematurity had a strong positive relation with central apnea of the newborn (odds ratio: 15 (p = 0.0154)). Odds ratio for association of central apnea and gastroesophageal reflux was 3.2 (p = 0.2037). We demonstrate that central apnea in the premature newborn is not a cause of gastroesophageal reflux. However, these patients are more likely to have gastroesophageal reflux in the first days of extrauterine life. It is recommended to exclude pathological gastroesophageal reflux when the newborn presents a clinical scenario compatible with central apnea.

  2. Quantitative measurement of duodeno-gastral reflux with 99mTc-HIDA in the framework of stomach secretion analysis

    International Nuclear Information System (INIS)

    Hauke, U.

    1982-01-01

    99m Tc HIDA was put into use first under standardized conditions in the framework of routinely carried out stomach secretion analyses in order to study the importance of bile reflux in stomach disorders. With this procedure a simple possibility is given in the area of stomach secretion analysis to test if there is a bile reflux to the stomach. Patients with fresh duodenal ulcers had significantly higher reflux rates than those with chronic Ulcus duodeni. After selective proximal vagotomy with submucal pyloro plastic the reflux rates sank in comparison to those before the operation. The color of the aspirate and the reflux values, measured by the here presented procedure, are directly correlated. (TRV) [de

  3. Human radicular veins: regulation of venous reflux in the absence of valves.

    Science.gov (United States)

    van der Kuip, M; Hoogland, P V; Groen, R J

    1999-02-01

    In the literature it is generally assumed that venous reflux within the radicular veins is prevented by the presence of bicuspid valves and narrowing of the transdural part of these vessels. Recently, we performed a human cadaver study of the internal vertebral venous plexus. Surprisingly, a large number of radicular and perimedullary veins appeared to be filled with Araldite CY 221 mixture, after injection of this material into the vertebral venous system, implicating reflux via the radicular veins and suggesting insufficiency of the presumed anti-reflux mechanism. Therefore, it was decided to study the radicular veins in order to determine and to investigate the presence or absence of anti-reflux mechanisms within this system. The vertebral venous systems of ten fresh human cadavers, between 64 and 93 years of age, were injected with Araldite CY 221 mixture. After polymerization, all cadavers were dissected and the spinal nerve sheaths, including nerve roots, radicular veins and epidural veins, were excised as a whole. After macroscopical examination, serial sections (40 microm) were cut on a freezing microtome and stained in Von Gieson medium. Every third section was stained immunohistochemically with smooth muscle antigen (SMA), to visualize smooth muscle cells. In all cadavers, a number of intradural radicular veins was filled with Araldite. Employing microscopical examination, no bicuspid valves were found. However, four structures were encountered that might serve as ananti-reflux-mechanism: 1) intravenous dural folds, 2) meandrous configuration, and 3) narrowing of the radicular veins at the point of penetration of the dura mater, and 4) varying numbers of smooth muscle fibers in the walls of the intradural and extradural parts of the radicular veins. Reflux via the radicular veins seems to be a physiological phenomenon. Structural valves have not been encountered during this study. Intravenous dural folds, meandrous configuration and narrowing of the

  4. Psychometric evaluation of a daily gastro-oesophageal reflux disease sym