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Sample records for prevent wellbore refluxing

  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. Wellbore Integrity Network

    Energy Technology Data Exchange (ETDEWEB)

    Carey, James W. [Los Alamos National Laboratory; Bachu, Stefan [Alberta Innovates

    2012-06-21

    In this presentation, we review the current state of knowledge on wellbore integrity as developed in the IEA Greenhouse Gas Programme's Wellbore Integrity Network. Wells are one of the primary risks to the successful implementation of CO{sub 2} storage programs. Experimental studies show that wellbore materials react with CO{sub 2} (carbonation of cement and corrosion of steel) but the impact on zonal isolation is unclear. Field studies of wells in CO{sub 2}-bearing fields show that CO{sub 2} does migrate external to casing. However, rates and amounts of CO{sub 2} have not been quantified. At the decade time scale, wellbore integrity is driven by construction quality and geomechanical processes. Over longer time-scales (> 100 years), chemical processes (cement degradation and corrosion) become more important, but competing geomechanical processes may preserve wellbore integrity.

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

    NARCIS (Netherlands)

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

    2014-01-01

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

  4. Inflammation-Related Carcinogenesis and Prevention in Esophageal Adenocarcinoma Using Rat Duodenoesophageal Reflux Models

    International Nuclear Information System (INIS)

    Fujimura, Takashi; Oyama, Katsunobu; Sasaki, Shozo; Nishijima, Koji; Miyashita, Tomoharu; Ohta, Tetsuo; Koichi, Miwa; Takanori, Hattori

    2011-01-01

    Development from chronic inflammation to Barrett's adenocarcinoma is known as one of the inflammation-related carcinogenesis routes. Gastroesophageal reflux disease induces regurgitant esophagitis, and esophageal mucosa is usually regenerated by squamous epithelium, but sometimes and somewhere replaced with metaplastic columnar epithelium. Specialized columnar epithelium, so-called Barrett's epithelium (BE), is a risk factor for dysplasia and adenocarcinoma in esophagus. Several experiments using rodent model inducing duodenogastroesophageal reflux or duodenoesophageal reflux revealed that columnar epithelium, first emerging at the proliferative zone, progresses to dysplasia and finally adenocarcinoma, and exogenous carcinogen is not necessary for cancer development. It is demonstrated that duodenal juice rather than gastric juice is essential to develop esophageal adenocarcinoma in not only rodent experiments, but also clinical studies. Antireflux surgery and chemoprevention by proton pump inhibitors, nonsteroidal anti-inflammatory drugs, selective cyclooxygenase-2 inhibitors, green tea, retinoic acid and thioproline showed preventive effects on the development of Barrett's adenocarcinoma in rodent models, but it remains controversial whether antireflux surgery could regress BE and prevent esophageal cancer in clinical observation. The Chemoprevention for Barrett's Esophagus Trial (CBET), a phase IIb, multicenter, randomized, double-masked study using celecoxib in patients with Barrett's dysplasia failed to prove to prevent progression of dysplasia to cancer. The AspECT (Aspirin Esomeprazole Chemoprevention Trial), a large multicenter phase III randomized trial to evaluate the effects of esomeprazole and/or aspirin on the rate of progression to high-grade dysplasia or adenocarcinoma in patients with BE is now ongoing

  5. Inflammation-Related Carcinogenesis and Prevention in Esophageal Adenocarcinoma Using Rat Duodenoesophageal Reflux Models

    Energy Technology Data Exchange (ETDEWEB)

    Fujimura, Takashi, E-mail: tphuji@staff.kanazawa-u.ac.jp; Oyama, Katsunobu; Sasaki, Shozo; Nishijima, Koji; Miyashita, Tomoharu; Ohta, Tetsuo [Gastroenterologic Surgery, Kanazawa University Hospital, Kanazawa, Japan, 13-1 Takaramachi, Kanazawa, Ishikawa 920-8641 (Japan); Koichi, Miwa [Houju Memorial Hospital, Nomi, Japan, 11-71 Midorigaoka, Nomi, Ishikawa 923-1226 (Japan); Takanori, Hattori [Division of Molecular and Diagnostic Pathology, Shiga University of Medical Science, Otsu, Japan, Seta Tsukinowa-cho, Otsu, Shiga 520-2192 (Japan)

    2011-08-10

    Development from chronic inflammation to Barrett's adenocarcinoma is known as one of the inflammation-related carcinogenesis routes. Gastroesophageal reflux disease induces regurgitant esophagitis, and esophageal mucosa is usually regenerated by squamous epithelium, but sometimes and somewhere replaced with metaplastic columnar epithelium. Specialized columnar epithelium, so-called Barrett's epithelium (BE), is a risk factor for dysplasia and adenocarcinoma in esophagus. Several experiments using rodent model inducing duodenogastroesophageal reflux or duodenoesophageal reflux revealed that columnar epithelium, first emerging at the proliferative zone, progresses to dysplasia and finally adenocarcinoma, and exogenous carcinogen is not necessary for cancer development. It is demonstrated that duodenal juice rather than gastric juice is essential to develop esophageal adenocarcinoma in not only rodent experiments, but also clinical studies. Antireflux surgery and chemoprevention by proton pump inhibitors, nonsteroidal anti-inflammatory drugs, selective cyclooxygenase-2 inhibitors, green tea, retinoic acid and thioproline showed preventive effects on the development of Barrett's adenocarcinoma in rodent models, but it remains controversial whether antireflux surgery could regress BE and prevent esophageal cancer in clinical observation. The Chemoprevention for Barrett's Esophagus Trial (CBET), a phase IIb, multicenter, randomized, double-masked study using celecoxib in patients with Barrett's dysplasia failed to prove to prevent progression of dysplasia to cancer. The AspECT (Aspirin Esomeprazole Chemoprevention Trial), a large multicenter phase III randomized trial to evaluate the effects of esomeprazole and/or aspirin on the rate of progression to high-grade dysplasia or adenocarcinoma in patients with BE is now ongoing.

  6. WELLBORE INSTABILITY: CAUSES AND CONSEQUENCES

    Directory of Open Access Journals (Sweden)

    Borivoje Pašić

    2007-12-01

    Full Text Available Wellbore instability is one of the main problems that engineers meet during drilling. The causes of wellbore instability are often classified into either mechanical (for example, failure of the rock around the hole because of high stresses, low rock strength, or inappropriate drilling practice or chemical effects which arise from damaging interaction between the rock, generally shale, and the drilling fluid. Often, field instances of instability are a result of a combination of both chemical and mechanical. This problem might cause serious complication in well and in some case can lead to expensive operational problems. The increasing demand for wellbore stability analyses during the planning stage of a field arise from economic considerations and the increasing use of deviated, extended reach and horizontal wells. This paper presents causes, indicators and diagnosing of wellbore instability as well as the wellbore stresses model.

  7. Establishment of an immunocompetent nipple valve anastomosis to prevent faecal reflux after ileocolic resection in dogs.

    Science.gov (United States)

    Ecker, K W; Pistorius, G; Menger, M D; Feifel, G

    2000-05-01

    To construct an immunocompetent nipple valve anastomosis (NVA) to exclude faecal reflux and compare it with an end-to-end anastomosis to see if it would prevent recurrent inflammation caused by intraluminal bacterial antigens in Crohn's disease. Laboratory study. Teaching hospital, Germany. Two groups of six beagle dogs each of which had NVA or end-to-end anastomosis. Construction of a NVA by stapling the telescoped nipple, and replacing the ileal mucosa on the valve by colonic mucosa; end-to-end anastomosis. Radiological, bacteriological, angiographic, and morphometric results. Absolute retrograde pressure-competence and free orthograde permeability of the NVA resulted in significantly lower intestinal bacterial counts compared with the end-to-end anastomosis (p < 0.05). Transposition of colonic mucosa was successful as demonstrated by revascularisation from the ileal nipple and looked normal on morphometry. If NVA were constructed in patients with Crohn's disease, recurrences should be prevented, which would verify the immunopathogenetic hypothesis of new inflammation.

  8. Efficacy of pectin solution for preventing gastro-esophageal reflux events in patients with percutaneous endoscopic gastrostomy.

    Science.gov (United States)

    Adachi, Kyoichi; Furuta, Kenji; Aimi, Masahito; Fukazawa, Kousuke; Shimura, Shino; Ohara, Shunji; Nakata, Shuji; Inoue, Yukiko; Ryuko, Kanji; Ishine, Junichi; Katoh, Kyoko; Hirata, Toshiaki; Ohhata, Shuzo; Katoh, Setsushi; Moriyama, Mika; Sumikawa, Masuko; Sanpei, Mari; Kinoshita, Yoshikazu

    2012-05-01

    The aim of this study was to determine the efficacy of pectin solution, which increases the viscosity of liquid nutrient, for prevention of gastro-esophageal reflux in comparison with half-solid nutrient. The subjects were 10 elderly patients undergoing percutaneous endoscopic gastrostomy feeding. Twenty-four-hour esophageal multichannel intraluminal impedance and pH testing was performed during intake of half-solid nutrient and a combination of pectin solution and liquid nutrient. During 4 h after delivery, there was no significant difference in the total number of gastro-esophageal reflux events between the feeding of the half-solid nutrient and the combination of pectin solution and liquid nutrient (5.7 ± 1.2 vs 5.3 ± 1.0/4 h). Acidic reflux after delivery of the half-solid nutrient was significantly more frequent than that after delivery of the combination of pectin solution and liquid nutrient (80.7% vs 60.4%, p = 0.018). The incidence of gastro-esophageal reflux reaching the upper portion of the esophagus tended to be higher during delivery of the half-solid nutrient than during delivery of the combination of pectin solution and liquid nutrient (47.4% vs 34.0%, p = 0.153). In conclusion, the usage of pectin solution combined with liquid nutrient is effective for preventing acidic gastro-esophageal reflux and gastro-esophageal reflux reaching the upper portion of the esophagus.

  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. Risk factors and possibilities of preventing gastroesophageal reflux disease in school-age children

    Directory of Open Access Journals (Sweden)

    O.Yu. Belousova

    2018-04-01

    Full Text Available Background. The article presents the main problems of early diagnosis of gastroesophageal reflux disease (GERD in school-age children, which leads to late detection and initiation of treatment. The purpose of the study was to identify the main risk factors that may predispose the development of this disease, as well as triggers that provoke GERD in school-age children. Knowledge of risk factors can help prevent the formation of GERD in children, and, with timely diagnosis of therapy, reduce the severity of the disease and improve quality of life. Materials and methods. Open comparative study included 98 school-age children (31 girls, 67 boys aged 6 to 18 years (mean age 14.2 years. Diagnosis of gastroesophageal reflux disease was conducted in accordance with the Order of the Ministry of Health of Ukraine dated January 29, 2013, No. 59 “On Approval of Unified Clinical Protocols for Medical Care of Children with Digestive Disorders”. During the comprehensive examination, the identification of possible risk factors was made, for which a detailed history collection was performed: the nature of the child’s nutrition and the regularity of the meal were evaluated, as well as the mode of the day, the presence and intensity of physical activity, the presence of chronic stress (psycho-traumatic situations, sleep duration, bad habits, false eating habits. Past medical history also revealed the duration of breastfeeding and the time of supplementary food introduction. Physical examination was also aimed at the detection of so-called symptoms of anxiety — “red flags” that may indicate the presence of complications or organic pathology. Results. In both age groups, boys were dominant; besides, there were significantly more children aged 13–17 years in the group with GERD. Early administration of supplements was revealed in both groups, as well as early artificial/mixed feeding. More than 85 % of children had signs of autonomic dysregulation and

  11. Geomechanical analyses to investigate wellbore/mine interactions in the Potash Enclave of Southeastern New Mexico.

    Energy Technology Data Exchange (ETDEWEB)

    Ehgartner, Brian L.; Bean, James E. (Sandia Staffing Alliance, LLC, Albuquerque, NM); Arguello, Jose Guadalupe, Jr.; Stone, Charles Michael

    2010-04-01

    Geomechanical analyses have been performed to investigate potential mine interactions with wellbores that could occur in the Potash Enclave of Southeastern New Mexico. Two basic models were used in the study; (1) a global model that simulates the mechanics associated with mining and subsidence and (2) a wellbore model that examines the resulting interaction impacts on the wellbore casing. The first model is a 2D approximation of a potash mine using a plane strain idealization for mine depths of 304.8 m (1000 ft) and 609.6 m (2000 ft). A 3D wellbore model then considers the impact of bedding plane slippage across single and double cased wells cemented through the Salado formation. The wellbore model establishes allowable slippage to prevent casing yield.

  12. 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

  13. [Prevention of gastroesophageal reflux and aspiration in neonates by holding with hands immediately after delivery by cesarean section].

    Science.gov (United States)

    Guo, Hui-Ping; Li, Hui; Guo, Jing; Li, Yan-Wen

    2002-04-01

    To evaluate the clinical effect of preventing gastroesophageal reflux (GER) and aspiration in neonates delivered by elective cesarean section with hand immediately after birth. On the basis of the principles for drowning resuscitation and evaluation of the principal factors causing GER and aspiration, the author adopted immediate manual management to promote emptying of gastroesophageal and airway contents in 496 newborns delivered by elective cesarean section. No GER and aspiration occurred in the babies receiving the management, and no complication was recorded. As an early preventive measure, manual management is effective in clearing gastroesophageal and airway contents against GER and aspiration, and Apgar scoring can be readily conducted.

  14. Wellbore Microannulus Characterization and Modeling.

    Energy Technology Data Exchange (ETDEWEB)

    Matteo, Edward N; Sobolik, Steven R.; Stormont, John C.; Taha, Mahmoud Reda; Gomez, Steven Paul

    2016-05-01

    Subsurface geologic formations used for extracting resources such as oil and gas can subsequently be used as a storage reservoir for the common greenhouse gas CO2, a concept known as Carbon Capture and Storage (CCS). Pre-existing wellbores penetrate the reservoirs where supercritical CO2 is to be injected. These wellbores can potentially be a pathway for contamination if CO2 leaks through wellbore flaws to an overlying aquifer or the atmosphere. Characterizing wellbore integrity and providing zonal isolation by repairing these wellbore flaws is of critical importance to the long-term isolation of CO2 and success of CCS. This research aims to characterize the microannulus region of the cement sheath-steel casing interface in terms of its compressibility and permeability. A mock-up of a wellbore system was used for lab-scale testing. Specimens, consisting of a cement sheath cast on a steel casing with microannuli, were subjected to confining pressures and casing pressures in a pressure vessel that allows simultaneous measurement of gas flow along the axis of the specimen. The flow was interpreted as the hydraulic aperture of the microannuli. Numerical models are used to analyze stress and displacement conditions along the casing-cement interface. These numerical results provide good agreement with closed-form elastic solutions. Numerical models incorporating flaws of varying dimensions along the casing-cement interface were then developed to describe the microannulus region. A joint model is used to describe the hydraulic aperture of the microannulus region, whose mechanical stiffness is altered in response to the imposed stress state across the joint interface. The aperture-stress behavior is based upon laboratory measurements of hydraulic aperture as a function of imposed stress conditions. This investigation found that microannulus permeability can satisfactorily be described by a joint model and that the constitutive

  15. Gastroesophageal reflux - slideshow

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/presentations/100181.htm Gastroesophageal reflux - series—Normal anatomy To use the sharing features ... junction of the esophagus and the stomach prevents reflux of food and acid from the stomach into the esophagus. Review Date ...

  16. Heating production fluids in a wellbore

    Science.gov (United States)

    Orrego, Yamila; Jankowski, Todd A.

    2016-07-12

    A method for heating a production fluid in a wellbore. The method can include heating, using a packer fluid, a working fluid flowing through a first medium disposed in a first section of the wellbore, where the first medium transfers heat from the packer fluid to the working fluid. The method can also include circulating the working fluid into a second section of the wellbore through a second medium, where the second medium transfers heat from the working fluid to the production fluid. The method can further include returning the working fluid to the first section of the wellbore through the first medium.

  17. 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.)

  18. Drilling subsurface wellbores with cutting structures

    Science.gov (United States)

    Mansure, Arthur James; Guimerans, Rosalvina Ramona

    2010-11-30

    A system for forming a wellbore includes a drill tubular. A drill bit is coupled to the drill tubular. One or more cutting structures are coupled to the drill tubular above the drill bit. The cutting structures remove at least a portion of formation that extends into the wellbore formed by the drill bit.

  19. Plugging wellbore fractures : limit equilibrium of a Bingham drilling mud cake in a tensile crack

    Energy Technology Data Exchange (ETDEWEB)

    Garagash, D.I. [Dalhousie Univ., Halifax, NS (Canada). Dept. of Civil and Resource Engineering

    2009-07-01

    The proper selection of drilling muds is important in order to successfully drill hydrocarbon wells in which wellbore mud pressure remains low enough to prevent circulation loss and high enough to support the uncased wellbore against the shear failure. This paper presented a mathematical model to study invasion of mud cake into a drilling-induced planar fracture at the edge of a wellbore perpendicular to the minimum in situ principal stress. The model assumed a planar edge-crack geometry loaded by the wellbore hoop stress, variable mud pressure along the invaded region adjacent to the wellbore, and uniform pore-fluid pressure along the rest of the crack. The invading mud was assumed to freely displaces the pore-fluid in the crack without mixing with it. The case corresponding to a sufficiently permeable formation was considered. This solution provides a means to evaluate whether or not the mud cake could effectively plug the fracture, thereby prevent fracture propagation and associated uncontrollable loss of wellbore drilling mud. The toughness or tensile strength is evaluated based on criterion for initiation of crack propagation, which may lead to uncontrollable loss of mud circulation in a well. The study provided information on the breakdown pressure as a function of the rock ambient stress, ambient pore pressure, pre-existing crack length, and mud cake properties. 12 refs., 6 figs.

  20. Bile Reflux

    Science.gov (United States)

    ... the upper part of your small intestine (duodenum). Bile reflux into the stomach Bile and food mix ... properly, and bile washes back into the stomach. Bile reflux into the esophagus Bile and stomach acid ...

  1. Gastroesophageal reflux disease

    Science.gov (United States)

    Peptic esophagitis; Reflux esophagitis; GERD; Heartburn - chronic; Dyspepsia - GERD ... into the esophagus. This is called reflux or gastroesophageal reflux. Reflux may cause symptoms. Harsh stomach acids can ...

  2. The effect of blood injection for the prevention of Ethanol reflux after intrahepatic Ethanol injection in the rat

    International Nuclear Information System (INIS)

    Ahn, Kook Jin; Kim, Choon Yul; Kim, Bum Soo; Hahn, Seong Tai; Lee, Jae Mun; Shinn, Kyung Sub

    1998-01-01

    To reduce ethanol reflux from the needle channel by injecting rat blood immediately after the injection of ethanol into rat liver. The first experiment involved 33 rat livers which were divided into four groups (three livers in group 1;ten in groups 2, 3, and 4). Group 1 animals were used as controls, and 0.1ml saline was injected into the liver; in group 2, ethanol-Tc-99m-O 4 - mixed solution (0.1ml, 0.2mCi) was injected into the liver;in groups 3 and 4, the needle channel was blocked with 0.02ml of fresh blood and old blood, respectively, after the injection of ethanol. After removing the needle, a 3cm round filter paper was laid on each injection site to absorb refluxed ethanol-T c -99m-O 4 - mixed solution from the liver, and each paper was then counted by a gamma camera unit. In the second experiment, 33rats were divided into four groups (three rats in group 1;ten in groups 2, 3, and 4). Group 1 animals were used as controls, and after exposing the left lateral lobe of the liver, 0.05 ml of saline was injected;in group 2, 0.05 ml of ethanol was injected into the livder;in groups 3 and 4 the needle channel was blocked with 0.02 ml of fresh blood and old blood, respectively, after the injection of ethanol. After ten days, peritoneal adhesions were scored macroscopically and microscopically. In the first experiment using ethanol- T c -99m-O 4 - mixed solution, groups blocked with blood after the injection of mixed solution showed lower gamma counts than the group injected with mixed solution only (p-value=3D0.0002). The group blocked with old blood showed the lowest count. Macroscopical and microscopical examination of peritoneal adhesions indicated that the grade of adhesion was lower in groups blocked with blood than in the group injected with ethanol onluy (p-value=3D0.0261 and 0.0163, respectively). The above results suggest that an injection of blood after an injection of ethanol is a very effective way of preventing reflux from the liver.=20

  3. Wellbore Seal Repair Using Nanocomposite Materials

    Energy Technology Data Exchange (ETDEWEB)

    Stormont, John [Univ. of New Mexico, Albuquerque, NM (United States)

    2016-08-31

    Nanocomposite wellbore repair materials have been developed, tested, and modeled through an integrated program of laboratory testing and numerical modeling. Numerous polymer-cement nanocomposites were synthesized as candidate wellbore repair materials using various combinations of base polymers and nanoparticles. Based on tests of bond strength to steel and cement, ductility, stability, flowability, and penetrability in opening of 50 microns and less, we identified Novolac epoxy reinforced with multi-walled carbon nanotubes and/or alumina nanoparticles to be a superior wellbore seal material compared to conventional microfine cements. A system was developed for testing damaged and repaired wellbore specimens comprised of a cement sheath cast on a steel casing. The system allows independent application of confining pressures and casing pressures while gas flow is measured through the specimens along the wellbore axis. Repair with the nanocomposite epoxy base material was successful in dramatically reducing the flow through flaws of various sizes and types, and restoring the specimen comparable to an intact condition. In contrast, repair of damaged specimens with microfine cement was less effective, and the repair degraded with application of stress. Post-test observations confirm the complete penetration and sealing of flaws using the nanocomposite epoxy base material. A number of modeling efforts have supported the material development and testing efforts. We have modeled the steel-repair material interface behavior in detail during slant shear tests, which we used to characterize bond strength of candidate repair materials. A numerical model of the laboratory testing of damaged wellbore specimens was developed. This investigation found that microannulus permeability can satisfactorily be described by a joint model. Finally, a wellbore model has been developed that can be used to evaluate the response of the wellbore system (casing, cement, and microannulus

  4. Gastroesophageal reflux

    International Nuclear Information System (INIS)

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

    1986-01-01

    This paper deals with detection and quantification of gastroesophageal reflux. Gastroesophageal reflux (GER) generally refers to a symptom complex consisting of heartburn, regurgitation, and chest pain, the latter of which is often confused with pain of cardiac origin. Gastroesophageal reflux occurs when gastric or duodenal contents enter the esophagus. This phenomenon of symptomatic gastroesophageal reflux has been attributed to a variety of anatomic abnormalities, including loss of the acute cardioesophageal Angle of Hiss, widening of the diaphragmatic hiatus, loss of a normal gastric rosette formed by apposition of the gastric mucosal folds, disruption of the phrenoesophageal ligament, and conversion of the distal paraesophageal pressure from an intra-abdominal to an intrathoracic level. Lower esophageal sphincter (LES) dysfunction has been suggested as a major determinant of gastroesophageal competence. Quantitative scintigraphic studies of gastroesophageal reflux suggest that the LES pressure is the important determinant of gastroesophageal reflux, although some investigators have failed to confirm this role of the LES in gastroesophageal competence

  5. Wellbore stability analysis and its application in the Fergana basin, central Asia

    Science.gov (United States)

    Chuanliang, Yan; Jingen, Deng; Baohua, Yu; Hailong, Liu; Fucheng, Deng; Zijian, Chen; Lianbo, Hu; Haiyan, Zhu; Qin, Han

    2014-02-01

    Wellbore instability is one of the major problems hampering the drilling speed in the Fergana basin. Comprehensive analysis of the geological and engineering data in this area indicates that the Fergana basin is characterized by high in situ stress and plenty of natural fractures, especially in the formations which are rich in bedding structure and have several high-pressure systems. Complex accidents such as wellbore collapse, sticking, well kick and lost circulation happen frequently. Tests and theoretical analysis reveals that the wellbore instability in the Fergana basin was influenced by multiple interactive mechanisms dominated by the instability of the bedding shale. Selecting a proper drilling fluid density and improving the sealing characteristic of the applied drilling fluid is the key to preventing wellbore instability in the Fergana basin. The mechanical mechanism of wellbore instability in the Fergana basin was analysed and a method to determine the proper drilling fluid density was proposed. The research results were successfully used to guide the drilling work of the Jida-4 well; compared with the Jida-3 well, the drilling cycle of the Jida-4 well was reduced by 32%.

  6. Cementing a wellbore using cementing material encapsulated in a shell

    Energy Technology Data Exchange (ETDEWEB)

    Aines, Roger D.; Bourcier, William L.; Duoss, Eric B.; Spadaccini, Christopher M.; Cowan, Kenneth Michael

    2016-08-16

    A system for cementing a wellbore penetrating an earth formation into which a pipe extends. A cement material is positioned in the space between the wellbore and the pipe by circulated capsules containing the cement material through the pipe into the space between the wellbore and the pipe. The capsules contain the cementing material encapsulated in a shell. The capsules are added to a fluid and the fluid with capsules is circulated through the pipe into the space between the wellbore and the pipe. The shell is breached once the capsules contain the cementing material are in position in the space between the wellbore and the pipe.

  7. Cementing a wellbore using cementing material encapsulated in a shell

    Energy Technology Data Exchange (ETDEWEB)

    Aines, Roger D.; Bourcier, William L.; Duoss, Eric B.; Floyd, III, William C.; Spadaccini, Christopher M.; Vericella, John J.; Cowan, Kenneth Michael

    2017-03-14

    A system for cementing a wellbore penetrating an earth formation into which a pipe extends. A cement material is positioned in the space between the wellbore and the pipe by circulated capsules containing the cement material through the pipe into the space between the wellbore and the pipe. The capsules contain the cementing material encapsulated in a shell. The capsules are added to a fluid and the fluid with capsules is circulated through the pipe into the space between the wellbore and the pipe. The shell is breached once the capsules contain the cementing material are in position in the space between the wellbore and the pipe.

  8. Geomechanics of fracture caging in wellbores

    NARCIS (Netherlands)

    Weijermars, R.; Zhang, X.; Schultz-Ela, D.

    2013-01-01

    This study highlights the occurrence of so-called ‘fracture cages’ around underbalanced wellbores, where fractures cannot propagate outwards due to unfavourable principal stress orientations. The existence of such cages is demonstrated here by independent analytical and numerical methods. We explain

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

    NARCIS (Netherlands)

    Weijenborg, Pim W.; Bredenoord, Albert J.

    2013-01-01

    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

  10. Vesicoureteral Reflux

    Science.gov (United States)

    ... the ureter if a child’s valve doesn’t work properly. The doctor provides the treatment using general anesthesia and a child can usually go home the same day. Secondary vesicoureteral reflux Doctors treat secondary VUR after finding the exact cause of the condition . Treatment may include surgery to ...

  11. Reflux in Children

    Science.gov (United States)

    What are reflux (GER) and GERD? The esophagus is the tube that carries food from your mouth to your stomach. If your child has reflux, his or ... into the esophagus. Another name for reflux is gastroesophageal reflux (GER). GERD stands for gastroesophageal reflux disease. It ...

  12. Reflux in Infants

    Science.gov (United States)

    What are reflux (GER) and GERD? The esophagus is the tube that carries food from your mouth to your stomach. If your baby has reflux, his or ... into the esophagus. Another name for reflux is gastroesophageal reflux (GER). GERD stands for gastroesophageal reflux disease. It ...

  13. 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.

  14. Gastroesophageal reflux and lung disease.

    Science.gov (United States)

    Meyer, Keith C

    2015-08-01

    Gastroesophageal reflux (GER) can cause respiratory symptoms and may trigger, drive and/or worsen airway disorders, interstitial lung diseases and lung allograft dysfunction. Whether lifestyle changes and acid suppression alone can counter and prevent the adverse effects of GER on the respiratory tract remains unclear. Recent data suggest that antireflux surgery may be more effective in preventing lung disease progression in patients with idiopathic pulmonary fibrosis or lung transplant recipients who have evidence of allograft dysfunction associated with the presence of excessive GER. Additional research and clinical trials are needed to determine the role of GER in various lung disorders and identify which interventions are most efficacious in preventing the respiratory consequences of gastroesophageal reflux disease. In addition, measuring biomarkers that indicate that gastric refluxate has been aspirated into the lower respiratory tract (e.g., pepsin and bile acid concentrations in bronchoalveolar lavage fluid) may prove helpful in both diagnosis and therapeutic decision making.

  15. Gas and Oil Flow through Wellbore Flaws

    Science.gov (United States)

    Hatambeigi, M.; Anwar, I.; Reda Taha, M.; Bettin, G.; Chojnicki, K. N.; Stormont, J.

    2017-12-01

    We have measured gas and oil flow through laboratory samples that represent two important potential flow paths in wellbores associated with the Strategic Petroleum Reserve (SPR): cement-steel interfaces (microannuli) and cement fractures. Cement fractures were created by tensile splitting of cement cores. Samples to represent microannuli were created by placing thin steel sheets within split cement cores so flow is channeled along the cement-steel interface. The test sequence included alternating gas and oil flow measurements. The test fluids were nitrogen and silicone oil with properties similar to a typical crude oil stored in the SPR. After correcting for non-linear (inertial) flow when necessary, flows were interpreted as effective permeability and hydraulic aperture using the cubic law. For both samples with cement fractures and those with cement-steel interfaces, initial gas and oil permeabilities were comparable. Once saturated with oil, a displacement pressure had to be overcome to establish gas flow through a sample, and the subsequent gas permeability were reduced by more than 50% compared to its initial value. Keywords: wellbore integrity, leakage, fracture, microannulus, SPR. Sandia National Laboratories is a multi-mission laboratory managed and operated by Sandia Corporation, a wholly owned subsidiary of NTESS/Honeywell, for the U.S. Department of Energy's National Nuclear Security Administration under contract DE-AC04-94AL85000. SAND2017-8168 A

  16. A novel once daily microparticulate dosage form comprising lansoprazole to prevent nocturnal acid breakthrough in the case of gastro-esophageal reflux disease: preparation, pharmacokinetic and pharmacodynamic evaluation.

    Science.gov (United States)

    Alai, Milind; Lin, Wen Jen

    2013-01-01

    The objective of this study was to formulate and evaluate the lansoprazole (LPZ)-loaded microparticles to prevent nocturnal acid breakthrough in the case of gastro-esophageal reflux disease (GERD). The microparticulate delivery system was prepared by solvent evaporation method using Eudragit RS100 as a matrix polymer followed by enteric coated with Eudragit S100 and hydroxypropyl methylcellulose phthalate HP55 using spray drying method. The enteric coated microparticles were stable in gastric pH condition. In vivo pharmacokinetic and pharmacodynamic studies in male Wistar rats demonstrated that enteric coated microparticles sustained release of LPZ and promoted ulcer healing activity. In other words, the microparticulate dosage form provided effective drug concentration for a longer period as compared to conventional extended release dosage form, and showed sufficient anti-acid secretion activity to treat acid related disorders including the enrichment of nocturnal acid breakthrough event based on a once daily administration.

  17. Wellbore stability in shales considering chemo-poroelastic effects

    Energy Technology Data Exchange (ETDEWEB)

    Araujo, Ewerton M.P.; Pastor, Jorge A.S.C.; Fontoura, Sergio A.B.; Rabe, Claudio [Pontificia Univ. Catolica do Rio de Janeiro (PUC-Rio), RJ (Brazil). Dept. de Engenharia Civil. Grupo de Tecnologia e Engenharia de Petroleo

    2004-07-01

    Under compaction and low geothermal gradients are deep water characteristics. Both under compaction and low geothermal gradients generate considerable thickness of smectite-rich shales. These rocks are the major source of wellbore stability problems, because they are susceptible to adverse physico-chemical reactions when in contact with inadequate drilling fluids. Due shales are low permeability rocks diffusion processes dominate the changes of pore pressure around wellbore. Diffusion of fluids, ions and temperature occurs in shales during drilling and demand a fully coupled modelling taking account these factors. Despite temperature importance, in this paper wellbore stability in shales is analyzed through a model that considers only the coupling between poroelastic and physico-chemical effects. The coupled equations are solved analytically and have been implemented in a computational simulator with user-friendly interface. Time-dependent simulations of wellbore stability in shales are presented for a typical deep water scenario. The results show that physico-chemical effects change pore pressure around wellbore and have high impact on the wellbore stability. (author)

  18. Reflux and GERD (in Children)

    Science.gov (United States)

    ... Pediatric Gastroenterology and Nutrition Nurses Print Share Reflux GERD Reflux occurs during or after a meal when ... tube connecting the mouth to the stomach). Reflux & GERD The Difference Between Reflux and GERD in Kids ...

  19. The successful use of transverse hydraulic fractures from horizontal wellbores

    Energy Technology Data Exchange (ETDEWEB)

    Crosby, D. G.; Yang, Z.; Rahman, S. S. [New South Wales Univ., NSW (Australia)

    1998-12-31

    Since a significant proportion of the world`s recoverable hydrocarbon resources exist in reservoirs possessing permeabilities of less than one milli-Darcy (mD), some form of permeability enhancement or stimulation is necessary if the hydrocarbons are to be exploited economically. Multi-stage, transversely fractured horizontal wellbores are shown to have the potential to greatly increase production from low permeability formations. To overcome the problems caused by near-wellbore tortuosity, common to wells with multiple fracturing from the same perforated interval, a criterion was devised which predicts the wellbore pressures to initiate secondary multiple transverse hydraulic fractures in close proximity to primary fractures. The criterion, confirmed by laboratory experiments, demonstrates that transversely fractured horizontal wellbores have limited capacities to resist the initiation of multiple fractures from adjacent perforations. This characteristic can be used in designing hydraulic fracture treatments to establish injection pressure limits or threshold pressures, above which additional multiple fractures will initiate and propagate from the wellbore. 23 refs., 1 tab., 10 figs.

  20. Time-Lapse Measurement of Wellbore Integrity

    Science.gov (United States)

    Duguid, A.

    2017-12-01

    estimate of the cement isolating capacity. Cased-hole sidewall cores in the steel and fiberglass casing sections allowed analysis of bulk cement and the cement at the casing- and formation-interface. This presentation will cover how time-lapse logging was conducted, how the results may be applicable to other wells, and how monitoring well design may affect wellbore integrity.

  1. Reaction-driven casing expansion : potential for wellbore leakage mitigation

    NARCIS (Netherlands)

    Wolterbeek, Timotheus K. T.; van Noort, Reinier; Spiers, Christopher J.

    It is generally challenging to predict the post-abandonment behaviour and integrity of wellbores. Leakage is, moreover, difficult to mitigate, particularly between the steel casing and outer cement sheath. Radially expanding the casing with some form of internal plug, thereby closing annular voids

  2. Optimization of SAGD wellbore completions : short production tubing string sensitivities

    Energy Technology Data Exchange (ETDEWEB)

    Cokar, M.; Graham, J. [Society of Petroleum Engineers, Canadian Section, Calgary, AB (Canada)]|[Petro-Canada, Calgary, AB (Canada)

    2008-10-15

    This study investigated the effects of changing the landing position of short production tubing strings near the heel of steam assisted gravity drainage (SAGD) production wells. A homogenous discretized wellbore model was used to model the reservoir and wellbore simultaneously in order to study wellbore and reservoir interactions. The aim of the study was to develop a method of optimizing bitumen production and determining the most economical position for wellbore strings. Simulations were conducted to examine the effect of shortening the production tubing string and examine the impact of extending the tubing string beyond the heel of the well on bitumen bitumen production rates and the steam oil ratio (SOR). Results of the study showed that a shortened string decreased bitumen production rates, while the amounts of steam produced through the tubing string increased. When the tubing string was extended past the heel of the well, bitumen production rates remained the same, but steam injection rates and SOR decreased. A lower pressure differential between the injector and producer wells was also observed. The study showed that SAGD producers can re-position production tubing strings in order to determine ratios of liquid production. It was concluded that although placing the short production tubing string close to the heel increased oil production, a longer tubing string improved production rates while lowering operating costs. 3 refs., 3 tabs., 35 figs.

  3. Wellbore integrity analysis of a natural CO2 producer

    KAUST Repository

    Crow, Walter

    2010-03-01

    Long-term integrity of existing wells in a CO2-rich environment is essential for ensuring that geological sequestration of CO2 will be an effective technology for mitigating greenhouse gas-induced climate change. The potential for wellbore leakage depends in part on the quality of the original construction as well as geochemical and geomechanical stresses that occur over its life-cycle. Field data are essential for assessing the integrated effect of these factors and their impact on wellbore integrity, defined as the maintenance of isolation between subsurface intervals. In this report, we investigate a 30-year-old well from a natural CO2 production reservoir using a suite of downhole and laboratory tests to characterize isolation performance. These tests included mineralogical and hydrological characterization of 10 core samples of casing/cement/formation, wireline surveys to evaluate well conditions, fluid samples and an in situ permeability test. We find evidence for CO2 migration in the occurrence of carbonated cement and calculate that the effective permeability of an 11′-region of the wellbore barrier system was between 0.5 and 1 milliDarcy. Despite these observations, we find that the amount of fluid migration along the wellbore was probably small because of several factors: the amount of carbonation decreased with distance from the reservoir, cement permeability was low (0.3-30 microDarcy), the cement-casing and cement-formation interfaces were tight, the casing was not corroded, fluid samples lacked CO2, and the pressure gradient between reservoir and caprock was maintained. We conclude that the barrier system has ultimately performed well over the last 3 decades. These results will be used as part of a broader effort to develop a long-term predictive simulation tool to assess wellbore integrity performance in CO2 storage sites. © 2009 Elsevier Ltd. All rights reserved.

  4. Self-healing polymer cement composites for geothermal wellbore applications

    Science.gov (United States)

    Rod, K. A.; Fernandez, C.; Childers, I.; Koech, P.; Um, W.; Roosendaal, T.; Nguyen, M.; Huerta, N. J.; Chun, J.; Glezakou, V. A.

    2017-12-01

    Cement is vital for controlling leaks from wellbores employed in oil, gas, and geothermal operations by sealing the annulus between the wellbore casing and geologic formation. Wellbore cement failure due to physical and chemical stresses is common and can result in significant environmental consequences and ultimately significant financial costs due to remediation efforts. To date numerous alternative cement blends have been proposed for the oil and gas industry. Most of these possess poor mechanical properties, or are not designed to work in high temperature environments. This research investigates novel polymer-cement composites which could function at most geothermal temperatures. Thermal stability and mechanical strength of the polymer is attributed to the formation of a number of chemical interactions between the polymer and cement matrix including covalent bonds, hydrogen bonding, and van der Waals interactions. It has been demonstrated that the bonding between cement and casing is more predictable when polymer is added to cement and can even improve healing of adhesion break when subjected to stresses such as thermal shock. Fractures have also been healed, effectively reducing permeability with fractures up to 0.3-0.5mm apertures, which is two orders of magnitude larger than typical wellbore fractures. Additionally, tomography analysis was used to determine internal structure of the cement polymer composite and imaging reveals that polymers fill fractures in the cement and between the cement and casing. By plugging fractures that occur in wellbore cement, reducing permeability of fractures, both environmental safety and economics of subsurface operations will be improved for geothermal energy and oil and gas production.

  5. Sucralfate maintenance therapy in reflux esophagitis. Sucralfate Investigational Working Team

    NARCIS (Netherlands)

    Tytgat, G. N.; Koelz, H. R.; Vosmaer, G. D.

    1995-01-01

    to prove in a double-blind placebo-controlled multinational trial the effects of sucralfate suspension 2 g BID and placebo in the prevention of recurrent reflux esophagitis. One hundred and eighty-four patients from 16 centers with reflux esophagitis Savary grade 1 and 2 were initially healed with

  6. Transient lower oesophageal sphincter relaxations--a pharmacological target for gastro-oesophageal reflux disease?

    NARCIS (Netherlands)

    Hirsch, D. P.; Tytgat, G. N. J.; Boeckxstaens, G. E. E.

    2002-01-01

    The oesophago-gastric junction functions as an anti-reflux barrier preventing increased exposure of the oesophageal mucosa to gastric contents. Failure of this anti-reflux barrier results in gastro-oesophageal reflux disease, and may lead to complications such as oesophagitis, Barrett's oesophagus

  7. Mechanisms of Reflux Perception in Gastroesophageal Reflux Disease: A Review

    NARCIS (Netherlands)

    Bredenoord, Albert J.

    2012-01-01

    Patients with reflux symptoms often do not have excessive esophageal acid exposure, and patients with severe gastroesophageal reflux often do not have reflux symptoms. Understanding why different types of reflux induce symptoms in different patients is vital for addressing therapeutic gaps in the

  8. Stick-slip and Torsional Friction Factors in Inclined Wellbores

    Directory of Open Access Journals (Sweden)

    Aarsnes Ulf Jakob F.

    2018-01-01

    The model is shown to have a good match with the surface and downhole behavior of two deviated wellbores for depths ranging from 1500 to 3000 meters. In particular, the model replicates the amplitude and period of the oscillations, in both the topside torque and the downhole RPM, as caused by the along-string stick slip. It is further shown that by using the surface behavior of the drill-string during rotational startup, an estimate of the static and dynamic friction factors along the wellbore can be obtained, even during stick-slip oscillations, if axial tension in the drillstring is considered. This presents a possible method to estimate friction factors in the field when off-bottom stick slip is encountered, and points in the direction of avoiding stick slip through the design of an appropriate torsional start-up procedure without the need of an explicit friction test.

  9. Reflux and GERD in Infants

    Science.gov (United States)

    ... Gastroenterology and Nutrition Nurses Print Share Reflux and GERD : Reflux and GERD in Infants Reflux and GERD in Infants It’s not uncommon for a baby ... happy, healthy childhood. Quick Facts about Reflux and GERD in Infants The majority of infants do not ...

  10. Quantifying drag on wellbore casings in moving salt sheets

    Science.gov (United States)

    Weijermars, R.; Jackson, M. P. A.; Dooley, T. P.

    2014-08-01

    Frontier hydrocarbon development projects in the deepwater slopes of the Gulf of Mexico Basin, Santos Basin and Lower Congo Basin all require wells to cross ductile layers of autochthonous or allochthonous salt moving at peak rates of 100 mm yr-1. The Couette-Poiseuille number is introduced here to help pinpoint the depth of shear stress reversal in such salt layers. For any well-planned through salt, the probable range of creep forces of moving salt needs to be taken into account when designing safety margins and load-factor tolerance of the well casing. Drag forces increase with wellbore diameter, but more significantly with effective viscosity and speed of the creeping salt layer. The potential drag forces on cased wellbores in moving salt sheets are estimated analytically using a range of salt viscosities (1015-1019 Pa s) and creep rates (0-10 mm yr-1). Drag on perfectly rigid casing of infinite strength may reach up to 13 Giga Newton per meter wellbore length in salt having a viscosity of 1019 Pa s. Well designers may delay stress accumulations due to salt drag when flexible casing accommodates some of the early displacement and strain. However, all creeping salt could displace, fracture and disconnect well casing, eventually. The shear strength of typical heavy duty well casing (about 1000 MPa) can be reached due to drag by moving salt. Internal flow of salt will then fracture the casing near salt entry and exit points, but the structural damage is likely to remain unnoticed early in the well-life when the horizontal shift of the wellbore is still negligibly small (at less than 1 cm yr-1). Disruption of casing and production flow lines within the anticipated service lifetime of a well remains a significant risk factor within distinct zones of low-viscosity salt which may reach ultrafast creep rates of 100 mm yr-1.

  11. 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

  12. Polymer-cement interactions towards improved wellbore cement fracture sealants

    Science.gov (United States)

    Beckingham, B. S.; Iloejesi, C.; Minkler, M. J.; Schindler, A. K.; Beckingham, L. E.

    2017-12-01

    Carbon capture, utilization, and storage (CCUS) in deep geologic formations is a promising means of reducing point source emissions of CO2. In these systems, CO2 is captured at the source and then injected to be utilized (eg. in enhanced oil recovery or as a working fluid in enhanced geothermal energy plants) or stored in geologic formations such as depleted oil and gas reservoirs or saline aquifers. While CCUS in subsurface systems could aid in reducing atmospheric CO2 emissions, the potential for CO2 leakage from these systems to overlying formations remains a major limitation and poses a significant risk to the security of injected CO2. Thus, improved materials for both initial wellbore isolation and repairing leakage pathways that develop over time are sought. One approach for the repair of cement fractures in wellbore (and other) systems is the injection of polymer materials into the fracture with a subsequent environmentally dependent (temperature, pressure, pH, etc.) densification or solidification. Here, we aim to investigate novel polymer materials for use to repair leaking wellbores in the context of CCUS. We synthesize and fully characterize a series of novel polymer materials and utilize a suite of analysis techniques to examine polymer-cement interactions at a range of conditions (namely temperature, pressure and pH). Initial findings will be leveraged to design novel polymer materials for further evaluation in polymer-cement composite cores, cement fracture healing, and the aging behavior of healed cements.

  13. Optimum position for wells producing at constant wellbore pressure

    Energy Technology Data Exchange (ETDEWEB)

    Camacho-Velazquez, R.; Rodriguez de la Garza, F. [Univ. Nacional Autonoma de Mexico, Mexico City (Mexico); Galindo-Nava, A. [Inst. Mexicanos del Petroleo, Mexico City (Mexico)]|[Univ. Nacional de Mexico, Mexico City (Mexico); Prats, M.

    1994-12-31

    This paper deals with the determination of the optimum position of several wells, producing at constant different wellbore pressures from a two-dimensional closed-boundary reservoirs, to maximize the cumulative production or the total flow rate. To achieve this objective they authors use an improved version of the analytical solution recently proposed by Rodriguez and Cinco-Ley and an optimization algorithm based on a quasi-Newton procedure with line search. At each iteration the algorithm approximates the negative of the objective function by a cuadratic relation derived from a Taylor series. The improvement of rodriguez and Cinco`s solution is attained in four ways. First, an approximation is obtained, which works better at earlier times (before the boundary dominated period starts) than the previous solution. Second, the infinite sums that are present in the solution are expressed in a condensed form, which is relevant for reducing the computer time when the optimization algorithm is used. Third, the solution is modified to take into account the possibility of having wells starting to produce at different times. This point allows them to deal with the problem of getting the optimum position for an infill drilling program. Last, the solution is extended to include the possibility of changing the value of wellbore pressure or being able to stimulate any of the wells at any time. When the wells are producing at different wellbore pressures it is found that the optimum position is a function of time, otherwise the optimum position is fixed.

  14. The model coupling fluid flow in reservoir with flow in horizontal wellbore

    Energy Technology Data Exchange (ETDEWEB)

    Liu, Xiangping; Jiang, Zhixiang [RIPED-TEXACO Horizontal Well Technology Laboratory (United States)

    1998-12-31

    Three-dimensional pressure distributions of oil flow in a reservoir with horizontal well were derived, and a new formula to calculate pressure drop along the horizontal wellbore was developed based on the principle of conservation of matter and momentum. The formula considers the effect of influx into the horizontal wellbore from the reservoir on pressure drop in the wellbore. A mathematical model to couple fluid flow in the reservoir with flow in the horizontal wellbore is presented. Model results and experimental data showed good correspondence. Results showed the influence of pressure drop on well performance. 13 refs., 2 tabs., 7 figs.

  15. Anti-reflux surgery

    Science.gov (United States)

    ... surgery. You may need another surgery in the future if you develop new reflux symptoms or swallowing ... Diseases of the esophagus. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine . 25th ed. Philadelphia, PA: ...

  16. 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 ...

  17. Gastro-oesophageal Reflux Disease: An Update

    Directory of Open Access Journals (Sweden)

    T Murphy

    2015-09-01

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

  18. Pathophysiology and management of gastroesophageal reflux disease

    NARCIS (Netherlands)

    Rohof, W. O. A.; Hirsch, D. P.; Boeckxstaens, G. E. E.

    2009-01-01

    Gastroesophageal reflux is a physiological phenomenon but becomes pathological if troublesome symptoms and/or complications occur. Gastroesophageal reflux disease (GERD) has different phenotypes ranging from non-erosive reflux disease (NERD), through reflux esophagitis and Barrett's esophagus, and

  19. Novel Experimental Techniques to Investigate Wellbore Damage Mechanisms

    Science.gov (United States)

    Choens, R. C., II; Ingraham, M. D.; Lee, M.; Dewers, T. A.

    2017-12-01

    A new experimental technique with unique geometry is presented investigating deformation of simulated boreholes using standard axisymmetric triaxial deformation equipment. The Sandia WEllbore SImulation, SWESI, geometry, uses right cylinders of rock 50mm in diameter and 75mm in length. A 11.3mm hole is drilled perpendicular to the axis of the cylinder in the center of the sample to simulate a borehole. The hole is covered with a solid metal cover, and sealed with polyurethane. The metal cover can be machined with a high-pressure port to introduce different fluid chemistries into the borehole at controlled pressures. Samples are deformed in a standard load frame under confinement, allowing for a broad range of possible stresses, load paths, and temperatures. Experiments in this study are loaded to the desired confining pressure, then deformed at a constant axial strain rate or 10-5 sec-1. Two different suites of experiments are conducted in this study on sedimentary and crystalline rock types. The first series of experiments are conducted on Mancos Shale, a finely laminated transversely isotropic rock. Samples are cored at three different orientations to the laminations. A second series of experiments is conducted on Sierra White granite with different fluid chemistries inside the borehole. Numerical modelling and experimental observations including CT-microtomography demonstrate that stresses are concentrated around the simulated wellbore and recreate wellbore deformation mechanisms. Borehole strength and damage development is dependent on anisotropy orientation and fluid chemistry. Observed failure geometries, particularly for Mancos shale, can be highly asymmetric. These results demonstrate uncertainties in in situ stresses measurements using commonly-applied borehole breakout techniques in complicated borehole physico-chemical environments. Sandia National Laboratories is a multimission laboratory managed and operated by National Technology and Engineering

  20. Food and Gastroesophageal Reflux Disease.

    Science.gov (United States)

    Surdea-Blaga, Teodora; Negrutiu, Dana E; Palage, Mariana; Dumitrascu, Dan L

    2017-05-15

    Gastroesophageal reflux disease is a chronic condition with a high prevalence in western countries. Transient lower esophageal sphincter relaxation episodes and a decreased lower esophageal sphincter pressure are the main mechanisms involved. Currently used drugs are efficient on reflux symptoms, but only as long as they are administered, because they do not modify the reflux barrier. Certain nutrients or foods are generally considered to increase the frequency of gastroesophageal reflux symptoms, therefore physicians recommend changes in diet and some patients avoid bothering foods. This review summarizes current knowledge regarding food and gastroesophageal reflux. For example, fat intake increases the perception of reflux symptoms. Regular coffee and chocolate induce gastroesophageal reflux and increase the lower esophageal exposure to acid. Spicy foods might induce heartburn, but the exact mechanism is not known. Beer and wine induce gastroesophageal reflux, mainly in the first hour after intake. For other foods, like fried food or carbonated beverages data on gastroesophageal reflux is scarce. Similarly, there is few data about the type of diet and gastroesophageal reflux. Mediterranean diet and a very low carbohydrate diet protect against reflux. Regarding diet-related practices, consistent data showed that a "short-meal-to-sleep interval" favors reflux episodes, therefore some authors recommend that dinner should be at least four hours before bedtime. All these recommendations should consider patient's weight, because several meta-analysis showed a positive association between increased body mass index and gastroesophageal reflux disease. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  1. Wellbore inertial navigation system (WINS) software development and test results

    Energy Technology Data Exchange (ETDEWEB)

    Wardlaw, R. Jr.

    1982-09-01

    The structure and operation of the real-time software developed for the Wellbore Inertial Navigation System (WINS) application are described. The procedure and results of a field test held in a 7000-ft well in the Nevada Test Site are discussed. Calibration and instrumentation error compensation are outlined, as are design improvement areas requiring further test and development. Notes on Kalman filtering and complete program listings of the real-time software are included in the Appendices. Reference is made to a companion document which describes the downhole instrumentation package.

  2. Measurement of flowing water salinity within or behind wellbore casing

    International Nuclear Information System (INIS)

    Arnold, D.M.

    1981-01-01

    Water flowing within or behind a wellbore casing is irradiated with 14 MeV neutrons from a source in a downhole sonde. Gamma radiation from the isotope nitrogen-16 induced from the O 16 (n,p)N 16 reaction and the products of either the Na 23 (n,α)F 20 or the Cl 37 (n,α)P 34 reactions is measured in intensity and energy with detectors in the sonde. From the gamma radiation measurements, the relative presence of oxygen to at least one of sodium or chlorine in the water is measured, and from the measurement the salinity of the water is to be determined. (author)

  3. Anti-reflux surgery - children

    Science.gov (United States)

    ... stomach). Problems with these muscles can lead to gastroesophageal reflux disease (GERD). This surgery can also be done during a ... Anti-reflux surgery is usually done to treat GERD in children only after medicines have not worked ...

  4. Infant Reflux: Diagnosis and Treatment

    Science.gov (United States)

    ... and children, endoscopy is usually done under general anesthesia. Treatment Infant reflux usually clears up by itself. ... Has evidence of an inflamed esophagus Has chronic asthma and reflux Surgery Rarely, the lower esophageal sphincter ...

  5. Vesicoureteral reflux: A historical perspective

    African Journals Online (AJOL)

    K.N. DeCotiis

    2016-12-28

    Dec 28, 2016 ... Abstract. The management of vesicoureteral reflux is a mainstay of pediatric urology. ... exponential relationship between number of urinary tract infections, .... dysfunction as an independent predictor of low reflux resolution.

  6. Radiologic studies on gastroesophageal reflux

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Seung Gi; Kim, Kun Sang; Park, Soo Soung [College of Medicine, Chung Ang University, Seoul (Korea, Republic of)

    1980-12-15

    Gastroesophageal reflux is generally recognized as the preponderant factor in the causation of the most cases of esophagitis and the accompanying symptom of pyrosis. In has been known that free gastroesophageal reflux is infrequent phenomenon but we observed gastroesophageal reflux during U. G. I. examination in 111 cases among 152 patients (73.3%) who had various gastrointestinal symptoms. Gastroesophageal reflux was most frequently induced in supine LAO position. The next frequent positions are erect position, RAO and supine position.

  7. Malacoplakia associated with vesicoureteral reflux and selective immunoglobulin A deficiency.

    Science.gov (United States)

    Witherington, R; Branan, W J; Wray, B B; Best, G K

    1984-11-01

    A case of malacoplakia involving the lower urinary tract of a young black boy, with associated bilateral vesicoureteral reflux, hydronephrosis and selective immunoglobulin A deficiency is reported. Reflux was caused by the malacoplakia. Reflux and hydronephrosis persisted despite elimination of bacterial infection and malacoplakia by drug therapy. These abnormalities were corrected by a conventional antireflux operation. Malacoplakia appears to be related to immunologic incompetence and diminished levels of intracellular cyclic 3',5' guanine monophosphate. Cholinergic agonists reverse or prevent the pathological changes of malacoplakia.

  8. [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.

  9. Gastroesophageal reflux disease

    International Nuclear Information System (INIS)

    Kault, B.; Halvorsen, T.; Petersen, H.; Grette, K.; Myrvold, H.E.

    1986-01-01

    Radionucleotide scintigraphy and esophagoscopy with biopsy were carried out in 101 patients with symptoms strongly suggestive of gastroesophageal reflux (GER) disease. GER was visualized by scintigraphy in 86.1% of the patients. Endoscopic and histologic esophagitis were found in 68.1% and 58.4% of the patients, respectively, whereas both examinations taken together showed evidence of esophagitis in 82%. Histologic evidence of esophagitis was found in nearly all patients with severe endoscopic changes, and in 43.7% of the patients with no endoscopic abnormality. Scintigraphic reflux was demonstrated more frequently (p<0.05) in the patients with severe endoscopic esophagitis (97.5%) than in those with no or only mild endoscopic changes (78.6%). Scintigraphic reflux was found in 91.5% and 78.5% of the patients with and without histologic evidence of esophagitis (p=0.07). 15 of the 18 patients (83.3%) without endoscopic and histologic abnormalities in the esophagus had scintigraphic evidence of reflux. The present study strongly supports the clinical significance of scintigraphy in GER disease and confirms that esophageal biopsy specimens increase the sensitivity of endoscopic evaluation

  10. AnalyzeHOLE: An Integrated Wellbore Flow Analysis Tool

    Energy Technology Data Exchange (ETDEWEB)

    Keith J. Halford

    2009-10-01

    Conventional interpretation of flow logs assumes that hydraulic conductivity is directly proportional to flow change with depth. However, well construction can significantly alter the expected relation between changes in fluid velocity and hydraulic conductivity. Strong hydraulic conductivity contrasts between lithologic intervals can be masked in continuously screened wells. Alternating intervals of screen and blank casing also can greatly complicate the relation between flow and hydraulic properties. More permeable units are not necessarily associated with rapid fluid-velocity increases. Thin, highly permeable units can be misinterpreted as thick and less permeable intervals or not identified at all. These conditions compromise standard flow-log interpretation because vertical flow fields are induced near the wellbore. AnalyzeHOLE, an integrated wellbore analysis tool for simulating flow and transport in wells and aquifer systems, provides a better alternative for simulating and evaluating complex well-aquifer system interaction. A pumping well and adjacent aquifer system are simulated with an axisymmetric, radial geometry in a two-dimensional MODFLOW model. Hydraulic conductivities are distributed by depth and estimated with PEST by minimizing squared differences between simulated and measured flows and drawdowns. Hydraulic conductivity can vary within a lithology but variance is limited with regularization. Transmissivity of the simulated system also can be constrained to estimates from single-well, pumping tests. Water-quality changes in the pumping well are simulated with simple mixing models between zones of differing water quality. These zones are differentiated by backtracking thousands of particles from the well screens with MODPATH. An Excel spreadsheet is used to interface the various components of AnalyzeHOLE by (1) creating model input files, (2) executing MODFLOW, MODPATH, PEST, and supporting FORTRAN routines, and (3) importing and graphically

  11. THE EFFECT OF WELL-BORE REVERSE FLOW OF FLUID ON ...

    African Journals Online (AJOL)

    ES Obe

    1980-03-01

    Mar 1, 1980 ... ABSTRACT. Well-bore storage may dominate the bottom-hole pressure profile of ... Type- curve matching is however only accurate when the storage factor .... numerical integration technique ... existence of a measure of well-.

  12. Numerical Simulation on Open Wellbore Shrinkage and Casing Equivalent Stress in Bedded Salt Rock Stratum

    Directory of Open Access Journals (Sweden)

    Jianjun Liu

    2013-01-01

    Full Text Available Most salt rock has interbed of mudstone in China. Owing to the enormous difference of mechanical properties between the mudstone interbed and salt rock, the stress-strain and creep behaviors of salt rock are significantly influenced by neighboring mudstone interbed. In order to identify the rules of wellbore shrinkage and casings equivalent stress in bedded salt rock stratum, three-dimensional finite difference models were established. The effects of thickness and elasticity modulus of mudstone interbed on the open wellbore shrinkage and equivalent stress of casing after cementing operation were studied, respectively. The results indicate that the shrinkage of open wellbore and equivalent stress of casings decreases with the increase of mudstone interbed thickness. The increasing of elasticity modulus will reduce the shrinkage of open wellbore and casing equivalent stress. Research results can provide the scientific basis for the design of mud density and casing strength.

  13. Refractory gastroesophageal reflux disease

    Science.gov (United States)

    Subramanian, Charumathi Raghu; Triadafilopoulos, George

    2015-01-01

    Gastroesophageal reflux disease (GERD) is a condition that develops when the reflux of stomach contents into the esophagus causes troublesome symptoms, esophageal injury, and/or complications. Use of proton pump inhibitors (PPI) remains the standard therapy for GERD and is effective in most patients. Those whose symptoms are refractory to PPIs should be evaluated further and other treatment options should be considered, according to individual patient characteristics. Response to PPIs could be total (no symptoms), partial (residual breakthrough symptoms), or absent (no change in symptoms). Patients experiencing complete response do not usually need further management. Patients with partial response can be treated surgically or by using emerging endoscopic therapies. Patients who exhibit no response to PPI need further evaluation to rule out other causes. PMID:25274499

  14. Pulse testing in the presence of wellbore storage and skin effects

    Energy Technology Data Exchange (ETDEWEB)

    Ogbe, D.O.; Brigham, W.E.

    1984-08-01

    A pulse test is conducted by creating a series of short-time pressure transients in an active (pulsing) well and recording the observed pressure response at an observation (responding) well. Using the pressure response and flow rate data, the transmissivity and storativity of the tested formation can be determined. Like any other pressure transient data, the pulse-test response is significantly influenced by wellbore storage and skin effects. The purpose of this research is to examine the influence of wellbore storage and skin effects on interference testing in general and on pulse-testing in particular, and to present the type curves and procedures for designing and analyzing pulse-test data when wellbore storage and skin effects are active at either the responding well or the pulsing well. A mathematical model for interference testing was developed by solving the diffusivity equation for radial flow of a single-phase, slightly compressible fluid in an infinitely large, homogeneous reservoir. When wellbore storage and skin effects are present in a pulse test, the observed response amplitude is attenuated and the time lag is inflated. Consequently, neglecting wellbore storage and skin effects in a pulse test causes the calculated storativity to be over-estimated and the transmissivity to be under-estimated. The error can be as high as 30%. New correlations and procedures are developed for correcting the pulse response amplitude and time lag for wellbore storage effects. Using these correlations, it is possible to correct the wellbore storage-dominated response amplitude and time lag to within 3% of their expected values without wellbore storage, and in turn to calculate the corresponding transmissivity and storativity. Worked examples are presented to illustrate how to use the new correction techniques. 45 references.

  15. Radioisotope monitoring of gastro-esophageal reflux in patients with achalasia cardiae after surgical treatment

    International Nuclear Information System (INIS)

    Tran Dinh Ha; Szilvasi, J.

    1994-01-01

    Results of a radioisotope method of the gastro-esophageal reflux are presented in patients with achalasia cardiae after different types of surgical treatment. Both Belsey-Mark and modified Nissen techniques are effective in preventing spontaneous gastroesophageal reflux, however 2 patients after Nissen fundoplication demonstrated gastro-esophageal reflux provoked by abdominal compression. This simple, noninvasive and physiologic method is an appropriate diagnostic tool for evaluating the efficiency of different anti reflux surgical techniques and is recommended for follow-up studies of patients after gastro-esophageal surgical intervention. (N.T.). 8 refs., 1 fig

  16. Gastroesophageal reflux and pharyngeal function

    International Nuclear Information System (INIS)

    Ekberg, O.; Lindgren, S.; Malmoe Allmaenna Sjukhus

    1986-01-01

    Pharyngeal function and gastroesophageal reflux were compared in 84 dysphagic patients examined clinically and radiologically. Cricopharyngeal muscle incoordination, assessed cineradiographically, was revealed in 5 of 41 patients (12%) without and 17 of 43 patients (40%) with gastroesophageal reflux assessed clinically (p<0.05). Thus, there was a postive correlation between dysfunction of the cricopharyngeal muscle and gastroesophageal reflux. There was no correlation with other types of pharyngeal dysfunction. Our results support the assumption of a positive relationship between gastroesophageal reflux and pharyngeal function in terms of cricopharyngeal dysfunction. The pathogenesis of this relation was, however, not revealed. (orig.)

  17. Gastroesophageal reflux and pharyngeal function

    Energy Technology Data Exchange (ETDEWEB)

    Ekberg, O.; Lindgren, S.

    Pharyngeal function and gastroesophageal reflux were compared in 84 dysphagic patients examined clinically and radiologically. Cricopharyngeal muscle incoordination, assessed cineradiographically, was revealed in 5 of 41 patients (12%) without and 17 of 43 patients (40%) with gastroesophageal reflux assessed clinically (p<0.05). Thus, there was a postive correlation between dysfunction of the cricopharyngeal muscle and gastroesophageal reflux. There was no correlation with other types of pharyngeal dysfunction. Our results support the assumption of a positive relationship between gastroesophageal reflux and pharyngeal function in terms of cricopharyngeal dysfunction. The pathogenesis of this relation was, however, not revealed.

  18. Geomechanical analysis to predict the oil leak at the wellbores in Big Hill Strategic Petroleum Reserve

    Energy Technology Data Exchange (ETDEWEB)

    Park, Byoung Yoon

    2014-02-01

    Oil leaks were found in wellbores of Caverns 105 and 109 at the Big Hill Strategic Petroleum Reserve site. According to the field observations, two instances of casing damage occurred at the depth of the interbed between the caprock bottom and salt top. A three dimensional finite element model, which contains wellbore element blocks and allows each cavern to be configured individually, is constructed to investigate the wellbore damage mechanism. The model also contains element blocks to represent interface between each lithology and a shear zone to examine the interbed behavior in a realistic manner. The causes of the damaged casing segments are a result of vertical and horizontal movements of the interbed between the caprock and salt dome. The salt top subsides because the volume of caverns below the salt top decrease with time due to salt creep closure, while the caprock subsides at a slower rate because the caprock is thick and stiffer. This discrepancy yields a deformation of the well. The deformed wellbore may fail at some time. An oil leak occurs when the wellbore fails. A possible oil leak date of each well is determined using the equivalent plastic strain failure criterion. A well grading system for a remediation plan is developed based on the predicted leak dates of each wellbore.

  19. Role of non-acid reflux in patients with non-erosive reflux disease

    OpenAIRE

    Karamanolis, Georgios P.; Tutuian, Radu

    2013-01-01

    Non-erosive reflux disease (NERD) is the most common presentation of gastroesophageal reflux disease. Although acid reflux is the most important cause of symptom generation in NERD patients, non-acid reflux is also associated with reflux symptoms. The temporal relation between symptoms and reflux episodes is of importance in evaluating the results of combined pH-impedance monitoring in NERD patients. Mucosal hypersensitivity and mechanical stimulation due to great volume of non-acid reflux ar...

  20. Steam injection for heavy oil recovery: Modeling of wellbore heat efficiency and analysis of steam injection performance

    International Nuclear Information System (INIS)

    Gu, Hao; Cheng, Linsong; Huang, Shijun; Li, Bokai; Shen, Fei; Fang, Wenchao; Hu, Changhao

    2015-01-01

    Highlights: • A comprehensive mathematical model was established to estimate wellbore heat efficiency of steam injection wells. • A simplified approach of predicting steam pressure in wellbores was proposed. • High wellhead injection rate and wellhead steam quality can improve wellbore heat efficiency. • High wellbore heat efficiency does not necessarily mean good performance of heavy oil recovery. • Using excellent insulation materials is a good way to save water and fuels. - Abstract: The aims of this work are to present a comprehensive mathematical model for estimating wellbore heat efficiency and to analyze performance of steam injection for heavy oil recovery. In this paper, we firstly introduce steam injection process briefly. Secondly, a simplified approach of predicting steam pressure in wellbores is presented and a complete expression for steam quality is derived. More importantly, both direct and indirect methods are adopted to determine the wellbore heat efficiency. Then, the mathematical model is solved using an iterative technique. After the model is validated with measured field data, we study the effects of wellhead injection rate and wellhead steam quality on steam injection performance reflected in wellbores. Next, taking cyclic steam stimulation as an example, we analyze steam injection performance reflected in reservoirs with numerical reservoir simulation method. Finally, the significant role of improving wellbore heat efficiency in saving water and fuels is discussed in detail. The results indicate that we can improve the wellbore heat efficiency by enhancing wellhead injection rate or steam quality. However, high wellbore heat efficiency does not necessarily mean satisfactory steam injection performance reflected in reservoirs or good performance of heavy oil recovery. Moreover, the paper shows that using excellent insulation materials is a good way to save water and fuels due to enhancement of wellbore heat efficiency

  1. Gastro-oesophageal reflux disease

    NARCIS (Netherlands)

    Bredenoord, Albert J.; Pandolfino, John E.; Smout, André J. P. M.

    2013-01-01

    Gastro-oesophageal reflux disease is one of the most common disorders of the gastrointestinal tract. Over past decades, considerable shifts in thinking about the disease have taken place. At a time when radiology was the only diagnostic test available, reflux disease was regarded as synonymous with

  2. Gastroesophageal and biliary reflux. 10

    International Nuclear Information System (INIS)

    Bares, Roland; Buell, Udalrich

    1991-01-01

    After a brief recapitulation of reflux pathogenesis, this review presents the state of the art of nuclear medicine techniques to diagnose gastroesophageal or duodenogastric reflux, as well as a summary of clinical results and considerations about indication. (author).53 refs.; 5 figs.; 8 tabs

  3. Infant apnea and gastroesophageal reflux

    International Nuclear Information System (INIS)

    Gomes, H.; Lallemand, P.

    1992-01-01

    The value of a combination of ultrasound studies and barium swallow examination in the analysis of temporal relationships between apnea and reflux is demonstrated. The two techniques allow acute apneic spells induced by gastrosophageal reflux to be documented and underlying specific digestive tract disorders demonstrated. The high incidence of digestive tract disorders in this area has been identified. (orig.)

  4. Infant apnea and gastroesophageal reflux

    Energy Technology Data Exchange (ETDEWEB)

    Gomes, H.; Lallemand, P. (AMH, 51 - Reims (France). Service d' Imagerie Pediatrique)

    1992-04-01

    The value of a combination of ultrasound studies and barium swallow examination in the analysis of temporal relationships between apnea and reflux is demonstrated. The two techniques allow acute apneic spells induced by gastrosophageal reflux to be documented and underlying specific digestive tract disorders demonstrated. The high incidence of digestive tract disorders in this area has been identified. (orig.).

  5. 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.

  6. Numerical analysis of wellbore instability in gas hydrate formation during deep-water drilling

    Science.gov (United States)

    Zhang, Huaiwen; Cheng, Yuanfang; Li, Qingchao; Yan, Chuanliang; Han, Xiuting

    2018-02-01

    Gas hydrate formation may be encountered during deep-water drilling because of the large amount and wide distribution of gas hydrates under the shallow seabed of the South China Sea. Hydrates are extremely sensitive to temperature and pressure changes, and drilling through gas hydrate formation may cause dissociation of hydrates, accompanied by changes in wellbore temperatures, pore pressures, and stress states, thereby leading to wellbore plastic yield and wellbore instability. Considering the coupling effect of seepage of drilling fluid into gas hydrate formation, heat conduction between drilling fluid and formation, hydrate dissociation, and transformation of the formation framework, this study established a multi-field coupling mathematical model of the wellbore in the hydrate formation. Furthermore, the influences of drilling fluid temperatures, densities, and soaking time on the instability of hydrate formation were calculated and analyzed. Results show that the greater the temperature difference between the drilling fluid and hydrate formation is, the faster the hydrate dissociates, the wider the plastic dissociation range is, and the greater the failure width becomes. When the temperature difference is greater than 7°C, the maximum rate of plastic deformation around the wellbore is more than 10%, which is along the direction of the minimum horizontal in-situ stress and associated with instability and damage on the surrounding rock. The hydrate dissociation is insensitive to the variation of drilling fluid density, thereby implying that the change of the density of drilling fluids has a minimal effect on the hydrate dissociation. Drilling fluids that are absorbed into the hydrate formation result in fast dissociation at the initial stage. As time elapses, the hydrate dissociation slows down, but the risk of wellbore instability is aggravated due to the prolonged submersion in drilling fluids. For the sake of the stability of the wellbore in deep

  7. Geomechanical Modeling of CO2 Injection Site to Predict Wellbore Stresses and Strains for the Design of Wellbore Seal Repair Materials

    Science.gov (United States)

    Sobolik, S. R.; Gomez, S. P.; Matteo, E. N.; Stormont, J.

    2015-12-01

    This paper will present the results of large-scale three-dimensional calculations simulating the hydrological-mechanical behavior of a CO2injection reservoir and the resulting effects on wellbore casings and sealant repair materials. A critical aspect of designing effective wellbore seal repair materials is predicting thermo-mechanical perturbations in local stress that can compromise seal integrity. The DOE-NETL project "Wellbore Seal Repair Using Nanocomposite Materials," is interested in the stress-strain history of abandoned wells, as well as changes in local pressure, stress, and temperature conditions that accompany carbon dioxide injection or brine extraction. Two distinct computational models comprise the current modeling effort. The first is a field scale model that uses the stratigraphy, material properties, and injection history from a pilot CO2injection operation in Cranfield, MS to develop a stress-strain history for wellbore locations from 100 to 400 meters from an injection well. The results from the field scale model are used as input to a more detailed model of a wellbore casing. The 3D wellbore model examines the impacts of various loading scenarios on a casing structure. This model has been developed in conjunction with bench-top experiments of an integrated seal system in an idealized scaled wellbore mock-up being used to test candidate seal repair materials. The results from these models will be used to estimate the necessary mechanical properties needed for a successful repair material. This material is based upon work supported by the US Department of Energy (DOE) National Energy Technology Laboratory (NETL) under Grant Number DE-FE0009562. This project is managed and administered by the Storage Division of the NETL and funded by DOE/NETL and cost-sharing partners. This work was funded in part by the Center for Frontiers of Subsurface Energy Security, an Energy Frontier Research Center funded by the US Department of Energy, Office of Science

  8. Simulation of a SAGD well blowout using a reservoir-wellbore coupled simulator

    Energy Technology Data Exchange (ETDEWEB)

    Walter, J.; Vanegas, P.; Cunha, L.B. [Alberta Univ., Edmonton, AB (Canada); Worth, D.J. [C-FER Technologies, Edmonton, AB (Canada); Crepin, S. [Petrocedeno, Caracas (Venezuela)

    2008-10-15

    Single barrier completion systems are typically used in SAGD projects due to the lack of equipment suitable for high temperature SAGD downhole environments. This study used a wellbore and reservoir coupled thermal simulator tool to investigate the blowout behaviour of a steam assisted gravity drainage (SAGD) well pair when the safety barrier has failed. Fluid flow pressure drop through the wellbore and heat losses between the wellbore and the reservoir were modelled using a discretized wellbore option and a semi-analytical model. The fully coupled mechanistic model accounted for the simultaneous transient pressure and temperature variations along the wellbore and the reservoir. The simulations were used to predict flowing potential and fluid compositions of both wells in a SAGD well pair under various flowing conditions. Blowout scenarios were created for 3 different points in the well pair's life. Three flow paths during the blowout were evaluated for both the production and injection wells. Results of the study were used to conduct a comparative risk assessment between a double barrier and a single barrier completion. The modelling study confirmed that both the injection and production wells had the potential for blowouts lasting significant periods of time, with liquid rates over 50 times the normal production liquid rates. The model successfully predicted the blowout flow potential of the SAGD well pairs. 8 refs., 3 tabs., 18 figs.

  9. Determination of transient temperature distribution inside a wellbore considering drill string assembly and casing program

    International Nuclear Information System (INIS)

    Yang, Mou; Zhao, Xiangyang; Meng, Yingfeng; Li, Gao; Zhang, Lin; Xu, Haiming; Tang, Daqian

    2017-01-01

    Highlights: • The different wellbore conditions of heat transfer models were developed. • Drill string assembly and casing programs impact on down-hole temperatures. • The thermal performance in circulation and shut-in stages were deeply investigated. • Full-scale model coincided with the measured field data preferably. - Abstract: Heat exchange efficiency between each region of the wellbore and formation systems is influenced by the high thermal conductivity of the drill string and casing, which further affects temperature distribution of the wellbore. Based on the energy conservation principle, the Modified Raymond, Simplified and Full-scale models were developed, which were solved by the fully implicit finite difference method. The results indicated that wellbore and formation temperatures were significantly influenced at the connection points between the drill collar and drill pipe, as well as the casing shoe. Apart from the near surface, little change was observed in temperature distribution in the cement section. In the open-hole section, the temperature rapidly decreased in the circulation stage and gradually increased in the shut-in stage. Most important, the simulated result from the full-scale model coincided with the measured field data better than the other numerical models. These findings not only confirm the effect of the drill string assembly and casing programs on the wellbore and formation temperature distribution, but also contribute to resource exploration, drilling safety and reduced drilling costs.

  10. Subsurface fracture mapping from geothermal wellbores. Final report

    Energy Technology Data Exchange (ETDEWEB)

    Hartenbaum, B.A.; Rawson, G.

    1983-08-01

    To advance the state-of-the-art in Hot Dry Rock technology, and evaluation is made of (1) the use of both electromagnetic and acoustic radar to map far-field fractures, (2) the use of more than twenty different conventional well logging tools to map borehole-fracture intercepts, (3) the use of magnetic dipole ranging to determine the relative positions of the injection well and the production well within the fractured zone, (4) the use of passive microseismic methods to determine the orientation and extent of hydraulic fractures, and (5) the application of signal processing techniques to fracture mapping including tomography, holography, synthetic aperture, image reconstruction, and the relative importance of phase and amplitude information. It is found that according to calculations, VHF backscatter radar has the potential for mapping fractures within a distance of 50 +- 20 meters from the wellbore. A new technique for improving fracture identification is presented. The range of acoustic radar is five to seven times greater than that of VHF radar when compared on the basis of equal resolution, i.e., equal wavelengths. Analyses of extant data indicate that when used synergistically the (1) caliper, (2) resistivity dipmeter, (3) televiewer, (4) television, (5) impression packer, and (6) acoustic transmission are useful for mapping borehole-fracture intercepts. A new model of hydraulic fracturing is presented which indicates that a hydraulic fracture is dynamically unstable; consequently, improvements in locating the crack tip may be possible. The importance of phase in signal processing is stressed and those techniques which employ phase data are emphasized for field use.

  11. [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.

  12. Symptom perception in gastroesophageal reflux disease is dependent on spatiotemporal reflux characteristics

    NARCIS (Netherlands)

    Weusten, B. L.; Akkermans, L. M.; vanBerge-Henegouwen, G. P.; Smout, A. J.

    1995-01-01

    BACKGROUND/AIMS: The mechanisms responsible for the development of symptoms in gastroesophageal reflux disease (GERD) are poorly understood. The aims of this study were to identify differences in spatiotemporal reflux characteristics (proximal extent and duration of reflux episodes, ascending

  13. 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

  14. Effect of fluid penetration on tensile failure during fracturing of an open-hole wellbore

    Science.gov (United States)

    Zeng, Fanhui; Cheng, Xiaozhao; Guo, Jianchun; Chen, Zhangxin; Tao, Liang; Liu, Xiaohua; Jiang, Qifeng; Xiang, Jianhua

    2018-06-01

    It is widely accepted that a fracture can be induced at a wellbore surface when the fluid pressure overcomes the rock tensile strength. However, few models of this phenomenon account for the fluid penetration effect. A rock is a typical permeable, porous medium, and the transmission of pressure from a wellbore to the surrounding rock temporally and spatially perturbs the effective stresses. In addition, these induced stresses influence the fracture initiation pressure. To gain a better understanding of the penetration effect on the initiation pressure of a permeable formation, a comprehensive formula is presented to study the effects of the in situ stresses, rock mechanical properties, injection rate, rock permeability, fluid viscosity, fluid compressibility and wellbore size on the magnitude of the initiation pressure during fracturing of an open-hole wellbore. In this context, the penetration effect is treated as a consequence of the interaction among these parameters by using Darcy’s law of radial flow. A fully coupled analytical procedure is developed to show how the fracturing fluid infiltrates the rock around the wellbore and considerably reduces the magnitude of the initiation pressure. Moreover, the calculation results are validated by hydraulic fracturing experiments in hydrostone. An exhaustive sensitivity study is performed, indicating that the local fluid pressure induced from a seepage effect strongly influences the fracture evolution. For permeable reservoirs, a low injection rate and a low viscosity of the injected fluid have a significant impact on the fracture initiation pressure. In this case, the Hubbert and Haimson equations to predict the fracture initiation pressure are not valid. The open-hole fracture initiation pressure increases with the fracturing fluid viscosity and fluid compressibility, while it decreases as the rock permeability, injection rate and wellbore size increase.

  15. Scintigraphic evaluation of gastroesophageal reflux

    International Nuclear Information System (INIS)

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

    1983-01-01

    When patients have symptomatic gastroesophageal reflux disease, their symptoms usually respond to conventional therapeutic measures. In some patients, however, the symptoms may persist despite the application of standard treatment regimens. It is in these instances that the clinician may employ extensive diagnostic tests to determine the cause of the patient's complaints. Because the introduction of gastroesophageal scintigraphy, a number of other techniques were employed to evaluate gastroesophageal reflux. These include barium esophagography, barium cineesophagography; endoscopy; esophageal mucosal biopsy; esophageal manometry; the acid-clearance test; and acid-reflux testing. Each of the nonscintigraphic techniques has a limitation either in its sensitivity or in the requirement for endogastric intubation. In addition, with the exception of the scintigraphic method, none of the tests permits quantitation of reflux

  16. In-situ Mechanical Manipulation of Wellbore Cements as a Solution to Leaky Wells

    Science.gov (United States)

    Kupresan, D.; Radonjic, M.; Heathman, J.

    2013-12-01

    Wellbore cement provides casing support, zonal isolation, and casing protection from corrosive fluids, which are essential for wellbore integrity. Cements can undergo one or more forms of failure such as debonding at cement/formation and cement/casing interface, fracturing and defects within cement matrix. Failures and defects within cement will ultimately lead to fluids migration, resulting in inter-zonal fluid migration and premature well abandonment. There are over 27,000 abandoned oil and gas wells only in The Gulf of Mexico (some of them dating from the late 1940s) with no gas leakage monitoring. Cement degradation linked with carbon sequestration can potentially lead to contamination of fresh water aquifers with CO2. Gas leaks can particularly be observed in deviated wells used for hydraulic fracking (60% leakage rate as they age) as high pressure fracturing increases the potential for migration pathways. Experimental method utilized in this study enables formation of impermeable seals at interfaces present in a wellbore by mechanically manipulating wellbore cement. Preliminary measurements obtained in bench scale experiments demonstrate that an impermeable cement/formation and cement/casing interface can be obtained. In post-modified cement, nitrogen gas flow-through experiments showed complete zonal isolation and no permeability in samples with pre-engineered microannulus. Material characterization experiments of modified cement revealed altered microstructural properties of cement as well as changes in mineralogical composition. Calcium-silicate-hydrate (CSH), the dominant mineral in hydrated cement which provides low permeability of cement, was modified as a result of cement pore water displacement, resulting in more dense structures. Calcium hydroxide (CH), which is associated with low resistance of cement to acidic fluids and therefore detrimental in most wellbore cements, was almost completely displaced and/or integrated in CSH as a result of

  17. 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)

  18. Vesicoureteral Reflux and Duplex Systems

    OpenAIRE

    Thomas, John C.

    2008-01-01

    Vesicoureteral reflux (VUR) is the most common anomaly associated with duplex systems. In addition to an uncomplicated duplex system, reflux can also be secondary in the presence of an ectopic ureterocele with duplex systems. Controversy exists in regard to the initial and most definitive management of these anomalies when they coexist. This paper will highlight what is currently known about duplex systems and VUR, and will attempt to provide evidence supporting the various surgical approa...

  19. 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

  20. Gastroesophageal reflux disease in children.

    Science.gov (United States)

    Barnhart, Douglas C

    2016-08-01

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

  1. Experimental determination of wellbore diameter and shape (4D imaging of wellbore) by using ultrasonic caliper within different fluids for real-time drilling application

    Energy Technology Data Exchange (ETDEWEB)

    Elahifar, Behzad; Esmaeili, Abdolali; Thonhauser, Gerhard [Montanuniversitaet Leoben (Austria); Fruhwirth, Rudolf K. [TDE Thonhauser Data Engineering GmbH, Leoben (Austria)

    2013-03-15

    Drilling programs continue to push into new and more complicated environments. As a result, accurate measurement, interpretation and analysis of drilling data in real time are becoming more critical. One of the key measurement devices for drilling, cementing and formation evaluation is the borehole caliper. An ultrasonic sensor caliper tool is thereby a key measurement device for determining the borehole diameter in MWD or LWD tools. Another use of ultrasonic caliper tools is to offer a method for calculating borehole volumes. Real-time application of ultrasonic caliper tools can also support the early detection of borehole instability. This paper describes the experiments related to the accuracy of the ultrasonic sensor for measuring wellbore diameter by performing the tests in different fluids, comparing the results and determining the weak points of the sensor for detecting echoes. In addition the wellbore profiles were simulated and the simulated results were compared with the recorded data. Different tests related to the position of the caliper tool inside the wellbore were performed as well as the evaluation of the accuracy of the ultrasonic sensor by simulating dog-legs and latches. (orig.)

  2. Impaired Upper Esophageal Sphincter Reflexes in Patients with Supra-Esophageal Reflux Disease

    Science.gov (United States)

    Babaei, Arash; Venu, Mukund; Naini, Sohrab Rahimi; Gonzaga, Jason; Lang, Ivan; Massey, Benson; Jadcherla, Sudarshan; Shaker, Reza

    2015-01-01

    Background & Aims Normal responses of the upper esophageal sphincter (UES) and esophageal body to liquid reflux events prevent esophagopharyngeal reflux and its complications, but abnormal responses have not been characterized. We investigated whether patients with supra-esophageal reflux disease (SERD) have impaired UES and esophageal body responses to simulated reflux events. Methods We performed a prospective study of 25 patients with SERD (19–82 y old, 13 female) and complaints of regurgitation and supra-esophageal manifestations of reflux. We also included 10 patients with gastroesophageal reflux disease (GERD; 32–60 y old, 7 female) without troublesome regurgitation and supra-esophageal symptoms and 24 healthy asymptomatic individuals (controls; 19–49 y old, 13 female). UES and esophageal body pressure responses, along with luminal distribution of infusate during esophageal rapid and slow infusion of air or liquid, were monitored by concurrent high-resolution manometry and intraluminal impedance. Results A significantly smaller proportion of patients with SERD had UES contractile reflexes in response to slow esophageal infusion of acid than controls or patients with GERD. Only patients with SERD had abnormal UES relaxation responses to rapid distension with saline. Diminished esophageal peristaltic contractions resulted in esophageal stasis in patients with GERD or SERD. Conclusions Patients with SERD and complaints of regurgitation have impaired UES and esophageal responses to simulated liquid reflux events. These patterns could predispose them to esophagopharyngeal reflux. PMID:26188682

  3. Numerical Investigation of the Influences of Wellbore Flow on Compressed Air Energy Storage in Aquifers

    Directory of Open Access Journals (Sweden)

    Yi Li

    2017-01-01

    Full Text Available With the blossoming of intermittent energy, compressed air energy storage (CAES has attracted much attention as a potential large-scale energy storage technology. Compared with caverns as storage vessels, compressed air energy storage in aquifers (CAESA has the advantages of wide availability and lower costs. The wellbore can play an important role as the energy transfer mechanism between the surroundings and the air in CAESA system. In this paper, we investigated the influences of the well screen length on CAESA system performance using an integrated wellbore-reservoir simulator (T2WELL/EOS3. The results showed that the well screen length can affect the distribution of the initial gas bubble and that a system with a fully penetrating wellbore can obtain acceptably stable pressurized air and better energy efficiencies. Subsequently, we investigated the impact of the energy storage scale and the target aquifer depth on the performance of a CAESA system using a fully penetrating wellbore. The simulation results demonstrated that larger energy storage scales exhibit better performances of CAESA systems. In addition, deeper target aquifer systems, which could decrease the energy loss by larger storage density and higher temperature in surrounding formation, can obtain better energy efficiencies.

  4. Parametric Sensitivity Study of Operating and Design Variables in Wellbore Heat Exchangers

    International Nuclear Information System (INIS)

    Nalla, G.; Shook, G.M.; Mines, G.L.; Bloomfield, K.K.

    2004-01-01

    This report documents the results of an extensive sensitivity study conducted by the Idaho National Engineering and Environmental Laboratory. This study investigated the effects of various operating and design parameters on wellbore heat exchanger performance to determine conditions for optimal thermal energy extraction and evaluate the potential for using a wellbore heat exchanger model for power generation. Variables studied included operational parameters such as circulation rates, wellbore geometries and working fluid properties, and regional properties including basal heat flux and formation rock type. Energy extraction is strongly affected by fluid residence time, heat transfer contact area, and formation thermal properties. Water appears to be the most appropriate working fluid. Aside from minimal tubing insulation, tubing properties are second order effects. On the basis of the sensitivity study, a best case model was simulated and the results compared against existing low-temperature power generation plants. Even assuming ideal work conversion to electric power, a wellbore heat exchange model cannot generate 200 kW (682.4e+3 BTU/h) at the onset of pseudosteady state. Using realistic conversion efficiency, the method is unlikely to generate 50 kW (170.6e+3 BTU/h)

  5. A coupled conductive-convective thermo-poroelastic solution and implications for wellbore stability

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Yarlong [Petro-Geotech Inc., Suite no.300, 840-6th Avenue, S.W., Calgary, AB (Canada) T2P 3E5; Dusseault, Maurice B. [Porous Media Research Institute, Department of Earth Sciences, University of Waterloo, Waterloo, ON (Canada) N2L 361

    2003-06-01

    Steam injection is widely used in heavy oil reservoirs to enhance oil recovery; elevated temperatures increase fluid mobility in several ways, but can also generate damage through shearing, crushing of weak grains, and casing impairment by shear, collapse, or buckling. Disposal of cold produced water by injection can generate thermally induced extensional fracturing, increasing the effective wellbore radius. Drilling with long open-hole sections can lead to rock temperature changes as large as 30-40 C at the casing shoe through mud heating at depth and upward mud circulation, dramatically impacting wellbore stability. Clearly, thermal stress analysis of open and cased boreholes is of primary interest for drilling and completion planning, as bottom-hole temperature changes can have as large an impact as bottom-hole pressure changes. Local wellbore stresses are the sum of far-field, pore pressure and thermally induced stresses; they may be highly inhomogeneous because of different rock properties and heat transport processes. These stresses, combined with thermal weakening and pore pressure changes, may lead to phenomena such as formation damage, sand production, shale shrinkage, and various modes of instability (shearing, spalling, fracturing, etc.). Previous studies of thermally induced stresses were primarily based on assumptions of low permeability and heat conduction only; this is inadequate when high-permeability formations are encountered. To analyze induced stresses and formation damage, a geomechanics model that is fully coupled to diffusive transport processes is employed. By assuming a constant wellbore pressure and temperature boundary condition, a closed-form solution including heat conduction and convection is obtained for the stresses near a cylindrical wellbore. The stability of an open-hole subject to non-isothermal, non-hydrostatic in situ loading and various conditions is then investigated. Our studies indicate that maximum tangential stresses are

  6. Gastroesophageal Reflux Disease and Aerodigestive Disorders.

    Science.gov (United States)

    Maqbool, Asim; Ryan, Matthew J

    2018-03-01

    This relationship between gastroesophageal reflux and airway disorders is complex, possibly bidirectional, and not clearly defined. The tools used to investigate gastroesophageal reflux are mostly informative about involvement of gastroesophageal reflux within the gastrointestinal tract, although they are often utilized to study the relationship between gastroesophageal reflux and airway issues with are suspected to occur in relation to reflux. These modalities often lack specificity for reflux-related airway disorders. Co-incidence of gastroesophageal reflux and airway disorders does not necessarily infer causality. While much of our focus has been on managing acidity, controlling refluxate is an area that has not been traditionally aggressively pursued. Our management approach is based on some of the evidence presented, but also often from a lack of adequate study to provide further guidance. Copyright © 2018 Mosby, Inc. All rights reserved.

  7. Acid Reflux (GER & GERD) in Infants

    Science.gov (United States)

    ... Definition & Facts Symptoms & Causes Diagnosis Treatment Eating, Diet, & Nutrition Clinical Trials Acid Reflux (GER & GERD) in Children & Teens Definition & Facts Symptoms & Causes Diagnosis Treatment Eating, Diet, & Nutrition Clinical Trials Acid Reflux (GER & GERD) in Infants Definition & ...

  8. Role of endoscopy in gastroesophageal reflux disease

    Directory of Open Access Journals (Sweden)

    Tarun Rai

    2015-01-01

    Full Text Available Gastroesophageal reflux disease is a condition due to reflux of stomach content in the esophagus causing trouble symptoms or complications or both. GERD is a clinical diagnosis and typically presents with a heartburn and/or regurgitation and a positive response to antacid secretory medications. GERD is the leading outpatient diagnosis among all gastrointestinal disorders in the United States. Approximately 40% of population report occasional symptoms of GERD whereas 10-20% of patients will have symptoms at least once in a week. Recent guidelines from gastrointestinal societies such as American College of Gastroenterology, American Society for Gastrointestinal Endoscopy and American College of Physicians have laid out specific indications regarding role of esophagogastroduodenoscopy in GERD. Despite these recommendations, studies have revealed that one-fifth to two-fifth EGDs may not be clinically indicated, especially where open access endoscopy referral system is used. Traditionally, GERD has been thought to be a disease of the western world. Prevalence rates had been estimated to be lower in Asia when compared to that of the Western Countries. Few recent epidemiological studies in India showed the prevalence of reflux disease in India to be between 8-24%, which is comparable to the western world. The use of EGDs becomes more critical for developing countries such as India where prevalence of GERD and BE is comparable to the western countries but have limited resources. In addition to direct cost for an EGD, it burdens economy with indirect costs such as time off from the work, transportation and any procedural complications. Risk stratifying patients with GERD may therefore prevent unnecessary procedures, harms and costs. The aim of this paper is to review the existing evidence on the role of endoscopy in GERD.

  9. [Esophageal complications of gastroesophageal reflux disease: consequences or defensive reactions?

    Science.gov (United States)

    Horváth, Örs Péter; Bognár, Laura; Papp, András; Vereczkei, András

    2017-05-01

    Gastroesophageal reflux disease affects more than 10% of the adult population. Most patients can be effectively treated with lifestyle changes and adequate acid-reducing therapy. However, about 10% of the patients remain symptomatic despite treatment and severe complications may develop. Interestingly, some of these complications seem to be a sort of defensive mechanism that may either alleviate the patient's symptoms or prevent developing further complications. In Barrett's esophagus, which can be unambigously considered as a complication of gastroesophageal reflux disease, reflux symptoms ruining the quality of life may significantly improve, since the metaplastic Barrett epithelium is much more resistent to gastric acid, than the normal epithelial lining of the esophagus. Furthermore, the motility disorders (hypertensive lower esophageal sphincter, achalasia, cricopharyngeal achalasia) and structural changes (Schatzki's ring, esophageal stricture, subglottic trachea stenosis), which develop as a complication of reflux may help to prevent aspiration that can cause new complaints and may lead to further complications. Orv Hetil. 2017; 158(20): 763-769.

  10. Gastro-oesophageal reflux and cough.

    Science.gov (United States)

    Abdulqawi, Rayid; Houghton, Lesley A; Smith, Jaclyn A

    2013-05-01

    Gastro-oesophageal reflux, either singly or in association with postnasal drip and/or asthma is considered to be a cause of chronic cough. The amount and nature of gastro-oesophageal reflux however is often normal with acid suppression having very little, if any therapeutic effect in these patients. This review examines the challenges posed when exploring the reflux-cough link, and discusses the merits and limitations of the proposed mechanisms of reflux leading to cough.

  11. Influence of bromoprid on pathological gastroesophageal reflux

    International Nuclear Information System (INIS)

    Leisner, B.; Brueckner, W.L.; Luderschmidt, C.

    1982-01-01

    In 20 out of 28 patients with pathological reflux, decreased reflux intensity was found in the functional scintiscan after i.v. injection of 10 mg Bromoprid. This way, reflux cases in which successful therapy with so-called motility-influencing substances is highly probable can be identified already during primary diagnosis. In two thirds of all patients with affected oesophagus and pathological reflux accompanying sclerodermatitis, the lower oesophagal sphincter still responded to Bromoprid. (orig.) [de

  12. 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.

  13. Qualitative evaluation of the enterogastric reflux

    International Nuclear Information System (INIS)

    Jimenez Garcia, A.; Ortega Bevia, J.M.; Garcia Fernandez, S.; Bonet Padilla, R.; Jimenez Garcia, E.; Rodrigues de Quesada, B.; Szego, T.

    1982-01-01

    Using Tc 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 morbility in these series, with a clear picture of the enterogastric reflux. (Author) [pt

  14. Influence of bromoprid on pathological gastroesophageal reflux

    Energy Technology Data Exchange (ETDEWEB)

    Leisner, B.; Brueckner, W.L.; Luderschmidt, C.

    1982-10-28

    In 20 out of 28 patients with pathological reflux, decreased reflux intensity was found in the functional scintiscan after i.v. injection of 10 mg Bromoprid. This way, reflux cases in which successful therapy with so-called motility-influencing substances is highly probable can be identified already during primary diagnosis. In two thirds of all patients with affected oesophagus and pathological reflux accompanying sclerodermatitis, the lower oesophagal sphincter still responded to Bromoprid.

  15. Role of Acid and Weakly Acidic Reflux in Gastroesophageal Reflux Disease Off Proton Pump Inhibitor Therapy

    Science.gov (United States)

    Sung, Hea Jung; Moon, Sung Jin; Kim, Jin Su; Lim, Chul Hyun; Park, Jae Myung; Lee, In Seok; Kim, Sang Woo; Choi, Myung-Gye

    2012-01-01

    Background/Aims Available data about reflux patterns and symptom determinants in the gastroesophageal reflux disease (GERD) subtypes off proton pump inhibitor (PPI) therapy are lacking. We aimed to evaluate reflux patterns and determinants of symptom perception in patients with GERD off PPI therapy by impedance-pH monitoring. Methods We retrospectively reviewed the impedance-pH data in patients diagnosed as GERD based on results of impedance-pH monitoring, endoscopy and/or typical symptoms. The characteristics of acid and weakly acidic reflux were evaluated. Symptomatic and asymptomatic reflux were compared according to GERD subtypes and individual symptoms. Results Forty-two patients (22 males, mean age 46 years) were diagnosed as GERD (17 erosive reflux disease, 9 pH(+) non-erosive reflux disease [NERD], 9 hypersensitive esophagus and 7 symptomatic NERD). A total of 1,725 reflux episodes were detected (855 acid [50%], 857 weakly acidic [50%] and 13 weakly alkaline reflux [reflux was more frequently symptomatic and bolus clearance was longer compared with weakly acidic reflux. In terms of globus, weakly acidic reflux was more symptomatic. Symptomatic reflux was more frequently acid and mixed reflux; these associations were more pronounced in erosive reflux disease and symptomatic NERD. The perception of regurgitation was related to acid reflux, while that of globus was more related to weakly acidic reflux. Conclusions In patients not taking PPI, acid reflux was more frequently symptomatic and had longer bolus clearance. Symptomatic reflux was more frequently acid and mixed type; however, weakly acidic reflux was associated more with globus. These data suggest a role for impedance-pH data in the evaluation of globus. PMID:22837877

  16. Role of Acid and weakly acidic reflux in gastroesophageal reflux disease off proton pump inhibitor therapy.

    Science.gov (United States)

    Sung, Hea Jung; Cho, Yu Kyung; Moon, Sung Jin; Kim, Jin Su; Lim, Chul Hyun; Park, Jae Myung; Lee, In Seok; Kim, Sang Woo; Choi, Myung-Gye

    2012-07-01

    Available data about reflux patterns and symptom determinants in the gastroesophageal reflux disease (GERD) subtypes off proton pump inhibitor (PPI) therapy are lacking. We aimed to evaluate reflux patterns and determinants of symptom perception in patients with GERD off PPI therapy by impedance-pH monitoring. We retrospectively reviewed the impedance-pH data in patients diagnosed as GERD based on results of impedance-pH monitoring, endoscopy and/or typical symptoms. The characteristics of acid and weakly acidic reflux were evaluated. Symptomatic and asymptomatic reflux were compared according to GERD subtypes and individual symptoms. Forty-two patients (22 males, mean age 46 years) were diagnosed as GERD (17 erosive reflux disease, 9 pH(+) non-erosive reflux disease [NERD], 9 hypersensitive esophagus and 7 symptomatic NERD). A total of 1,725 reflux episodes were detected (855 acid [50%], 857 weakly acidic [50%] and 13 weakly alkaline reflux [Acid reflux was more frequently symptomatic and bolus clearance was longer compared with weakly acidic reflux. In terms of globus, weakly acidic reflux was more symptomatic. Symptomatic reflux was more frequently acid and mixed reflux; these associations were more pronounced in erosive reflux disease and symptomatic NERD. The perception of regurgitation was related to acid reflux, while that of globus was more related to weakly acidic reflux. In patients not taking PPI, acid reflux was more frequently symptomatic and had longer bolus clearance. Symptomatic reflux was more frequently acid and mixed type; however, weakly acidic reflux was associated more with globus. These data suggest a role for impedance-pH data in the evaluation of globus.

  17. [Congenital bladder diverticula and vesicoureteral reflux].

    Science.gov (United States)

    Garat, José María; Angerri, Oriol; Caffaratti, Jorge; Moscatiello, Pietro

    2008-03-01

    To analyze our series of primary congenital diverticula (PCD) and their association with vesicoureteral reflux. We have taken care of 23 children with PCD. Eleven of them had big diverticula (> 2 cm) and twelve small. In the first group, 4 children had vesicoureteral reflux and 5 in the second group. In group A, ureteral reimplantation was performed at the time of diverticulum excision. Nor diverticula neither refluxes were operated in group B. We analyze separately results in both groups. Group A: Patients were operated including diverticulum excision. There were not recurrences except in one case with Ehler-Danlos Syndrome. No reimplanted ureter showed postoperative reflux. Nevertheless, one case with multiple bladder diverticula without reflux presented reflux after the excision of several diverticula without reimplantation. Group B: Small diverticula did not undergo surgery Spontaneous outcome of reflux was similar to that of the general population without diverticula. Bladder diverticula are frequently associated with vesicoureteral reflux. The presence of reflux is not an absolute condition for surgical or endoscopic treatment. When diverticula are big in size (Group A) the indication for surgery comes from recurrent infection or voiding disorders, not from reflux. If they undergo surgery, ureteral reimplantation is performed in the case they had reflux or for technical reasons like bladder wall weakness. When diverticula are small (Group B) the presence of reflux does not condition treatment, being the rate of spontaneous resolution similar to the general population.

  18. Pathophysiology of gastro-oesophageal reflux disease

    NARCIS (Netherlands)

    Smout, A. J. P. M.

    2003-01-01

    Gastro-oesophageal reflux disease (GERD), defined as symptoms or mucosal damage caused by reflux of gastric contents into the esophageal body, is a multifactorial disorder. Malfunctioning of the anti-reflux barrier at the esophagogastric junction, consisting of the right diaphragmatic crus and the

  19. Complications of gastro-oesophageal reflux disease.

    Science.gov (United States)

    Parasa, S; Sharma, P

    2013-06-01

    Gastro-oesophageal reflux disease (GORD) is on the rise with more than 20% of the western population reporting symptoms and is the most common gastrointestinal disorder in the United States. This increase in GORD is not exactly clear but has been attributed to the increasing prevalence of obesity, changing diet, and perhaps the decreasing prevalence of H. pylori infection. Complications of GORD could be either benign or malignant. Benign complications include erosive oesophagitis, bleeding and peptic strictures. Premalignant and malignant lesions include Barrett's metaplasia, and oesophageal cancer. Management of both the benign and malignant complications can be challenging. With the use of proton-pump inhibitors, peptic strictures (i.e., strictures related to reflux) have significantly declined. Several aspects of Barrett's management remain controversial including the stage in the disease process which needs to be intervened, type of the intervention and surveillance of these lesions to prevent development of high grade dysplasia and oesophageal adenocarcinoma. Copyright © 2013 Elsevier Ltd. All rights reserved.

  20. Gastroesophageal Reflux Disease and Tooth Erosion

    Directory of Open Access Journals (Sweden)

    Sarbin Ranjitkar

    2012-01-01

    Full Text Available The increasing prevalence of gastroesophageal reflux disease (GERD in children and adults, and of “silent refluxers” in particular, increases the responsibility of dentists to be alert to this potentially severe condition when observing unexplained instances of tooth erosion. Although gastroesophageal reflux is a normal physiologic occurrence, excessive gastric and duodenal regurgitation combined with a decrease in normal protective mechanisms, including an adequate production of saliva, may result in many esophageal and extraesophageal adverse conditions. Sleep-related GERD is particularly insidious as the supine position enhances the proximal migration of gastric contents, and normal saliva production is much reduced. Gastric acid will displace saliva easily from tooth surfaces, and proteolytic pepsin will remove protective dental pellicle. Though increasing evidence of associations between GERD and tooth erosion has been shown in both animal and human studies, relatively few clinical studies have been carried out under controlled trial conditions. Suspicion of an endogenous source of acid being associated with observed tooth erosion requires medical referral and management of the patient as the primary method for its prevention and control.

  1. The gastric accommodation response to meal intake determines the occurrence of transient lower esophageal sphincter relaxations and reflux events in patients with gastro-esophageal reflux disease.

    Science.gov (United States)

    Pauwels, A; Altan, E; Tack, J

    2014-04-01

    Gastro-esophageal reflux (GER), the retrograde flow of gastric contents into the esophagus is a physiologic phenomenon, which can evoke symptoms and/or lesions in the esophagus (=gastro-esophageal reflux disease or GERD). Proton pump inhibitors (PPIs) reduce gastric acidity; however, as they are unable to control transient lower esophageal sphincter relaxations (TLESRs), the main mechanism for reflux in GERD, they do not abolish reflux. TLESRs occur predominantly in the postprandial period, and they are believed to be triggered by gastric distention. Gastric accommodation (GA) is the physiologic response to gastric distention and serves to prevent a rise in gastric wall tension during food intake. We aimed to study the relationship between GA and TLESRs, as they both are triggered by gastric distention. We studied 12 GERD patients (average age 37 years [range 18-62], 7m/5f) and nine healthy volunteers (average age 27 years [range 22-36], 2m/7f) using high resolution manometry-impedance measurement before and after a mixed meal challenge. We determined the number of TLESRs (with or without reflux) and measured pre- and postprandial IGP. The change in IGP between the pre- and postprandial period (ΔIGP) is used as surrogate for GA. We also measured LES pressure before and after the meal and calculated the change (ΔLESp). There were no statistical differences between pre- and postprandial IGP in GERD and healthy volunteers and similarly, there was no significant difference between pre- and postprandial LES pressures in GERD patients and healthy volunteers. The number of TLESRs (with or without reflux) was similar in GERD and healthy volunteers. More importantly, we did observe a negative correlation between ΔIGP and the number of TLESRs, irrespective of whether they were associated with reflux or not, in the GERD patients (without reflux r = -0.67, p = 0.017; with reflux r = -0.81, p = 0.0014). The same observations were found in healthy volunteers, where ΔIGP and

  2. Micro Mechanics and Microstructures of Major Subsurface Hydraulic Barriers: Shale Caprock vs Wellbore Cement

    Science.gov (United States)

    Radonjic, M.; Du, H.

    2015-12-01

    Shale caprocks and wellbore cements are two of the most common subsurface impermeable barriers in the oil and gas industry. More than 60% of effective seals for geologic hydrocarbon bearing formations as natural hydraulic barriers constitute of shale rocks. Wellbore cements provide zonal isolation as an engineered hydraulic barrier to ensure controlled fluid flow from the reservoir to the production facilities. Shale caprocks were deposited and formed by squeezing excess formation water and mineralogical transformations at different temperatures and pressures. In a similar process, wellbore cements are subjected to compression during expandable tubular operations, which lead to a rapid pore water propagation and secondary mineral precipitation within the cement. The focus of this research was to investigate the effect of wellbore cement compression on its microstructure and mechanical properties, as well as a preliminary comparison of shale caprocks and hydrated cement. The purpose of comparative evaluation of engineered vs natural hydraulic barrier materials is to further improve wellbore cement durability when in contact with geofluids. The micro-indentation was utilized to evaluate the change in cement mechanical properties caused by compression. Indentation experiments showed an overall increase in hardness and Young's modulus of compressed cement. Furthermore, SEM imaging and Electron Probe Microanalysis showed mineralogical alterations and decrease in porosity. These can be correlated with the cement rehydration caused by microstructure changes as a result of compression. The mechanical properties were also quantitatively compared to shale caprock samples in order to investigate the similarities of hydraulic barrier features that could help to improve the subsurface application of cement in zonal isolation. The comparison results showed that the poro-mechanical characteristics of wellbore cement appear to be improved when inherent pore sizes are shifted to

  3. Risks to Drinking Water from Oil and Gas Wellbore Construction and Integrity: Case Studies and Lessons Learned

    Science.gov (United States)

    This presentation examines various published reports from two drinking water contamination cases, and discuss the potential roles of wellbore construction and integrity and hydraulic fracturing in the resultant drinking water contamination.

  4. Radiologic diagnosis of gastro-oesophageal reflux

    Energy Technology Data Exchange (ETDEWEB)

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

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

  5. Radiologic quantitation of gastro-oesophageal reflux

    International Nuclear Information System (INIS)

    Christiansen, T.; Funch-Jensen, P.; Jacobsen, N.O.; Thommesen, P.; Kommunehospitalet, Aarhus; Kommunehospitalet, Aarhus

    1987-01-01

    In a prospective study, 26 patients with symptoms of reflux oesophagitis underwent a barium examination for gastro-oesophageal reflux after food stimulation, and endoscopy with biopsy from different levels of the oesophagus. Radiologic grading of the gastro-oesophageal reflux depending on the height of the reflux into the oesophagus was performed, and this was correlated to the microscopic appearance at different levels in the oesophagus. Complete agreement between the radiologic grading and the histology was found in 69 per cent of the cases, and when gastro-oesophageal reflux was demonstrated the agreement was 75 per cent. Accordingly, the results showed a good accordance between the two variants, indicating that the height of the reflux during the food stimulated test may be truly indicative of the reflux height under non-test conditions. (orig.)

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1984-05-01

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

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

    International Nuclear Information System (INIS)

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

    1984-01-01

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

  8. Pathophysiology of gastroesophageal reflux disease

    NARCIS (Netherlands)

    Boeckxstaens, Guy E.; Rohof, Wout O.

    2014-01-01

    Gastroesophageal reflux disease (GERD) is one of the most common digestive diseases in the Western world, with typical symptoms, such as heartburn, regurgitation, or retrosternal pain, reported by 15% to 20% of the general population. The pathophysiology of GERD is multifactorial. Our understanding

  9. Nuclear imaging in reflux diagnosis

    Energy Technology Data Exchange (ETDEWEB)

    Bares, R.

    1988-12-01

    Duodenogastric and gastroesophageal refluxes can be accurately detected by hepatobiliary and gastroesophageal scintigraphy. These procedures are non-invasive and easy to perform. Practical details and evaluation are described. Subsequent to a review of diagnostic results, indications are discussed. Both techniques should be applied in cases where morphological examinations did not yield any pathologic result and clinical symptoms are suggestive for functional disturbances.

  10. A Transient Analytical Model for Predicting Wellbore/Reservoir Temperature and Stresses during Drilling with Fluid Circulation

    Directory of Open Access Journals (Sweden)

    Bisheng Wu

    2017-12-01

    Full Text Available Accurate characterization of heat transfer in a wellbore during drilling, which includes fluid circulation, is important for wellbore stability analysis. In this work, a pseudo-3D model is developed to simultaneously calculate the heat exchange between the flowing fluid and the surrounding media (drill pipe and rock formation and the in-plane thermoelastic stresses. The cold drilling fluid descends through the drill pipe at constant injection rates and returns to the ground surface via the annulus. The fluid circulation will decrease the wellbore bottom temperature and reduce the near-wellbore high compressive stress, potentially leading to tensile fracturing of the well. The governing equations for the coupled heat transfer stress problem are formulated to ensure that the most important parameters are taken into account. The wellbore is subject to a non-hydrostatic in situ far-field stress field. In modeling heat exchange between fluid and surrounding media, the heat transfer coefficients are dependent on fluid properties and flow behavior. Analytical solutions in the Laplace space are obtained for the temperatures of the fluid in both the drill pipe and annulus and for the temperature and stress changes in the formation. The numerical results in the time domain are obtained by using an efficient inversion approach. In particular, the near-well stresses are compared for the cases with fixed and time-dependent cooling wellbore conditions. This comparison indicates that the using a fixed temperature wellbore conditions may over-estimate or under-estimate the bottom-hole stress change, potentially leading to wellbore stability problems.

  11. Clinical characteristics and psychosocial impact of different reflux time in gastroesophageal reflux disease patients.

    Science.gov (United States)

    Chen, Jiann-Hwa; Wen, Shu-Hui; Hsu, Ching-Sheng; Yi, Chih-Hsun; Liu, Tso-Tsai; Chen, Chien-Lin; Wang, Chia-Chi

    2017-02-01

    Gastroesophageal reflux disease (GERD) is an emerging disease, and can impair quality of life and sleep. This study aimed to investigate whether GERD patients with different timings of reflux symptoms have different clinical characteristics. This study prospectively enrolled individuals who underwent upper gastrointestinal endoscopy during a health checkup. Each participant completed all questionnaires including Reflux Disease Questionnaire, Nighttime GERD questionnaire, Pittsburg Sleep Quality Index, Taiwanese Depression Questionnaire, and State-Trait Anxiety Inventory. Combined reflux was defined as the timing of reflux symptoms occurring at both daytime and nighttime. A total of 2604 participants were enrolled. Of them, 651 symptomatic GERD patients, according to the Reflux Disease Questionnaire score, were recruited for final analysis. Of them, 224 (34.4%) had erosive esophagitis on endoscopy. According to the timing of reflux symptoms, 184 (28.3%) were assigned to the daytime reflux group, 71 (10.9%) to the nighttime reflux group, and 396 (60.8%) to the combined reflux group. In post hoc analysis, the combined reflux group had a significantly higher Reflux Disease Questionnaire score than the daytime reflux group (p reflux groups had higher body mass index and longer duration (> 12 years) of education than the daytime reflux group (p reflux of have more troublesome symptoms than those with daytime reflux. GERD patients with different timings of reflux symptoms have different clinical characteristics in terms of body mass index and duration of education, but not in terms of esophageal inflammation, quality of sleep, and psychosocial status. Copyright © 2016. Published by Elsevier B.V.

  12. Wellbore enlargement investigation: Potential analogs to the Waste Isolation Pilot Plant during inadvertent intrusion of the repository

    International Nuclear Information System (INIS)

    Boak, D.M.; Dotson, L.; Aguilar, R.

    1997-01-01

    This study involved the evaluation and documentation of cases in which petroleum wellbores were enlarged beyond the nominal hole diameter as a consequence of erosion during exploratory drilling, particularly as a function of gas flow into the wellbore during blowout conditions. A primary objective was to identify analogs to potential wellbore enlargement at the Waste Isolation Pilot Plant (WIPP) during inadvertent human intrusion. Secondary objectives were to identify drilling scenarios associated with enlargement, determine the physical extent of enlargement, and establish the physical properties of the formation in which the enlargement occurred. No analogs of sufficient quality to establish quantitative limits on wellbore enlargement at the WIPP disposal system were identified. However, some information was obtained regarding the frequency of petroleum well blowouts and the likelihood that such blowouts would bridge downhole, self-limiting the surface release of disposal-system material. Further work would be necessary, however, to determine the conditions under which bridging could occur and the extent to which the bridging might be applicable to WIPP. In addition, data on casing sizes of petroleum boreholes in the WIPP vicinity support the use of a 12-1/4 inch borehole size in WIPP performance assessment calculations. Finally, although data are limited, there was no evidence of significant wellbore enlargement in any of three blowouts that occur-red in wellbores in the Delaware Basin (South Culebra Bluff Unit No. 1, Energy Research and Development Administration (ERDA) 6, and WIPP 12)

  13. Coupling of the reservoir simulator TOUGH and the wellbore simulator WFSA

    Energy Technology Data Exchange (ETDEWEB)

    Hadgu, T.; Zimmerman, R.W.; Bodvarsson [Lawrence Berkeley Laboratory, Berkeley, CA (United States)

    1995-03-01

    The reservoir simulator TOUGH and the wellbore simulator WFSA have been coupled, so as to allow simultaneous modeling of the flow of geothermal brine in the reservoir as well as in the wellbore. A new module, COUPLE, allows WFSA to be called as a subroutine by TOUGH. The mass flowrate computed by WFSA now serves as a source/sink term for the TOUGH wellblocks. Sample problems are given to illustrate the use of the coupled codes. One of these problems compares the results of the new simulation method to those obtained using the deliverability option in TOUGH. The coupled computing procedure is shown to simulate more accurately the behavior of a geothermal reservoir under exploitation.

  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. Numerical studies of CO2 and brine leakage into a shallow aquifer through an open wellbore

    Science.gov (United States)

    Wang, Jingrui; Hu, Litang; Pan, Lehua; Zhang, Keni

    2018-03-01

    Industrial-scale geological storage of CO2 in saline aquifers may cause CO2 and brine leakage from abandoned wells into shallow fresh aquifers. This leakage problem involves the flow dynamics in both the wellbore and the storage reservoir. T2Well/ECO2N, a coupled wellbore-reservoir flow simulator, was used to analyze CO2 and brine leakage under different conditions with a hypothetical simulation model in water-CO2-brine systems. Parametric studies on CO2 and brine leakage, including the salinity, excess pore pressure (EPP) and initially dissolved CO2 mass fraction, are conducted to understand the mechanism of CO2 migration. The results show that brine leakage rates increase proportionally with EPP and inversely with the salinity when EPP varies from 0.5 to 1.5 MPa; however, there is no CO2 leakage into the shallow freshwater aquifer if EPP is less than 0.5 MPa. The dissolved CO2 mass fraction shows an important influence on the CO2 plume, as part of the dissolved CO2 becomes a free phase. Scenario simulation shows that the gas lifting effect will significantly increase the brine leakage rate into the shallow freshwater aquifer under the scenario of 3.89% dissolved CO2 mass fraction. The equivalent porous media (EPM) approach used to model the wellbore flow has been evaluated and results show that the EPM approach could either under- or over-estimate brine leakage rates under most scenarios. The discrepancies become more significant if a free CO2 phase evolves. Therefore, a model that can correctly describe the complex flow dynamics in the wellbore is necessary for investigating the leakage problems.

  16. Problems in the wellbore integrity of a shale gas horizontal well and corresponding countermeasures

    Directory of Open Access Journals (Sweden)

    Zhonglan Tian

    2015-12-01

    Full Text Available In the Changning–Weiyuan national shale gas demonstration area, SW Sichuan Basin, the wellbore integrity damage occurs in some shale gas wells and has direct effect on the gas production rate of single shale gas horizontal well. After statistics analysis was performed on the problems related with wellbore integrity, such as casing damage, casing running difficulty and cement sheath blow-by, the multi-factor coupling casing stress calculation and evaluation mode laws established. Then study was conducted on the influential mechanism of multi-factor coupling (temperature effect, casing bending and axial pressure on casing damage. The shale slip mechanism and its relationship with casing sheared formation were analyzed by using the Mohr–Coulomb criterion. Inversion analysis was performed on the main controlling factors of casing friction by using the developed casing hook load prediction and friction analysis software. And finally, based on the characteristics of shale gas horizontal wells, wellbore integrity control measures were proposed in terms of design and construction process, so as to improve the drilling quality (DQ. More specifically, shale gas well casing design calculation method and check standard were modified, well structure and full bore hole trajectory design were optimized, drilling quality was improved, cement properties were optimized and cement sealing integrity during fracturing process was checked. These research findings are significant in the design and management of future shale gas borehole integrity.

  17. Hydrophysical logging: A new wellbore technology for hydrogeologic and contaminant characterization of aquifers

    International Nuclear Information System (INIS)

    Pedler, W.H.; Williams, L.L.; Head, C.L.

    1992-01-01

    In the continuing search for improved groundwater characterization technologies, a new wellbore fluid logging method has recently been developed to provide accurate and cost effective hydrogeologic and contaminant characterization of bedrock aquifers. This new technique, termed hydrophysical logging, provides critical information for contaminated site characterization and water supply studies and, in addition, offers advantages compared to existing industry standards for aquifer characterization. Hydrophysical logging is based on measuring induced electrical conductivity changes in the fluid column of a wellbore by employing advanced downhole water quality instrumentation specifically developed for the dynamic borehole environment. Hydrophysical logging contemporaneously identifies the locations of water bearing intervals, the interval-specific inflow rate during pumping, and in-situ hydrochemistry of the formation waters associated with each producing interval. In addition, by employing a discrete point downhole fluid sampler during hydrophysical logging, this technique provides evaluation of contaminant concentrations and migration of contaminants vertically within the borehole. Recently, hydrophysical logging was applied in a deep bedrock wellbore at an industrial site in New Hampshire contaminated with dense nonaqueous phase liquids (DNAPLs). The results of the hydrophysical logging, conducted as part of a hydrogeologic site investigation and feasibility study, facilitated investigation of the site by providing information which indicated that the contamination had not penetrated into deeper bedrock fractures at concentrations of concern. This information was used to focus the pending Remedial Action Plan and to provide a more cost-effective remedial design

  18. Sleeve gastrectomy and gastro-oesophageal reflux disease: a complex relationship.

    Science.gov (United States)

    Mahawar, Kamal K; Jennings, Neil; Balupuri, Shlok; Small, Peter K

    2013-07-01

    Sleeve gastrectomy is rapidly becoming popular as a standalone bariatric operation. At the same time, there are valid concerns regarding its long-term durability and postoperative gastro-oesophageal reflux disease. Though gastric bypass remains the gold standard bariatric operation, it is not suitable for all patients. Sleeve gastrectomy is sometimes the only viable option. Patients with inflammatory bowel disease, liver cirrhosis, significant intra-abdominal adhesions involving small bowel and those reluctant to undergo gastric bypass could fall in this category. It is widely recognised that some patients report worsening of their gastro-oesophageal reflux disease after sleeve gastrectomy. Still, others develop de novo reflux. This review examines if it is possible to identify these patients prior to surgery and thus prevent postoperative gastro-oesophageal reflux disease after sleeve gastrectomy.

  19. Evolution of Cement-Casing Interface in Wellbore Microannuli under Stress

    Science.gov (United States)

    Matteo, E. N.; Gomez, S. P.; Sobolik, S. R.; Taha, M. R.; Stormont, J.

    2017-12-01

    Laboratory tests measured the compressibility and flow characteristics of wellbore microannuli. Specimens, consisting of a cement sheath cast on a steel casing with microannuli, were subjected to confining pressures and casing pressures in a pressure vessel that allows simultaneous measurement of gas flow along the axis of the specimen. The flow was interpreted as the hydraulic aperture of the microannuli. We found the hydraulic aperture decreases as confining stress is increased. The larger the initial hydraulic aperture, the more it decreases as confining stress increases. The changes in measured hydraulic aperture correspond to changes of many orders of magnitude in permeability of the wellbore system, suggesting that microannulus response to stress changes may have a significant impact on estimates of wellbore leakage. A finite element model of a wellbore system was developed that included elements representing the microannulus that incorporated the hyperbolic joint model. The thickness of the microannulus elements is equivalent to the hydraulic aperture. The calculated normal stress across the microannulus used in the numerical implementation was found to be similar to the applied confining pressure in the laboratory tests. The microannulus elements were found to reasonably reproduce laboratory behavior during loading from confining pressure increases. The calculated microannulus response to internal casing pressure changes was less stiff than measured, which may be due to hardening of the microannulus during testing. In particular, the microannulus model could be used to estimate CO2 leakage as a function of formation stress changes and/or displacements, or loading from casing expansion or contraction during wellbore operations. Recommendations for future work include an application of the joint model with a thermally active large-scale reservoir coupled with pore pressure caused by dynamic CO2 injection and subsequent microannulus region affects. Sandia

  20. Detection of gastro-oesophageal reflux disease

    International Nuclear Information System (INIS)

    Christiansen, T.; Ravnsbaek, J.; Toettrup, A.; Funch-Jensen, P.; Thommesen, P.; Aarhus Kommunehospital

    1986-01-01

    In a prospective study a barium examination combined with food stimulation was compared with the acid reflux test in 30 consecutive patients with symptoms of gastro-oesophageal reflux. Both methods were further compared with endoscopy and histology. Gastro-oesophageal reflux could be demonstrated by the radiologic examination in 22 patients and by the acid reflux test in 23 patients. By combining the two methods gastro-oesophageal reflux could be demonstrated in 27 patients. Comparing the two methods with symptoms, endoscopy, and histology they seemed to be of equal value. Accordingly, a food-stimulated barium examination is recommended as the first method for demonstrating gastro-oesophageal reflux because it is simple and well-tolerated by the patient. (orig.)

  1. A 3-D wellbore simulator (WELLTHER-SIM) to determine the thermal diffusivity of rock-formations

    Science.gov (United States)

    Wong-Loya, J. A.; Santoyo, E.; Andaverde, J.

    2017-06-01

    Acquiring thermophysical properties of rock-formations in geothermal systems is an essential task required for the well drilling and completion. Wellbore thermal simulators require such properties for predicting the thermal behavior of a wellbore and the formation under drilling and shut-in conditions. The estimation of static formation temperatures also needs the use of these properties for the wellbore and formation materials (drilling fluids and pipes, cements, casings, and rocks). A numerical simulator (WELLTHER-SIM) has been developed for modeling the drilling fluid circulation and shut-in processes of geothermal wellbores, and for the in-situ determination of thermal diffusivities of rocks. Bottomhole temperatures logged under shut-in conditions (BHTm), and thermophysical and transport properties of drilling fluids were used as main input data. To model the thermal disturbance and recovery processes in the wellbore and rock-formation, initial drilling fluid and static formation temperatures were used as initial and boundary conditions. WELLTHER-SIM uses these temperatures together with an initial thermal diffusivity for the rock-formation to solve the governing equations of the heat transfer model. WELLTHER-SIM was programmed using the finite volume technique to solve the heat conduction equations under 3-D and transient conditions. Thermal diffusivities of rock-formations were inversely computed by using an iterative and efficient numerical simulation, where simulated thermal recovery data sets (BHTs) were statistically compared with those temperature measurements (BHTm) logged in some geothermal wellbores. The simulator was validated using a well-documented case reported in the literature, where the thermophysical properties of the rock-formation are known with accuracy. The new numerical simulator has been successfully applied to two wellbores drilled in geothermal fields of Japan and Mexico. Details of the physical conceptual model, the numerical

  2. Reduced-Order Model for Leakage Through an Open Wellbore from the Reservoir due to Carbon Dioxide Injection

    Energy Technology Data Exchange (ETDEWEB)

    Pan, Lehua [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Oldenburg, Curtis M. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)

    2017-07-26

    Potential CO2 leakage through existing open wellbores is one of the most significant hazards that need to be addressed in geologic carbon sequestration (GCS) projects. In the framework of the National Risk Assessment Partnership (NRAP) which requires fast computations for uncertainty analysis, rigorous simulation of the coupled wellbore-reservoir system is not practical. We have developed a 7,200-point look-up table reduced-order model (ROM) for estimating the potential leakage rate up open wellbores in response to CO2 injection nearby. The ROM is based on coupled simulations using T2Well/ECO2H which was run repeatedly for representative conditions relevant to NRAP to create a look-up table response-surface ROM. The ROM applies to a wellbore that fully penetrates a 20-m thick reservoir that is used for CO2 storage. The radially symmetric reservoir is assumed to have initially uniform pressure, temperature, gas saturation, and brine salinity, and it is assumed these conditions are held constant at the far-field boundary (100 m away from the wellbore). In such a system, the leakage can quickly reach quasi-steady state. The ROM table can be used to estimate both the free-phase CO2 and brine leakage rates through an open well as a function of wellbore and reservoir conditions. Results show that injection-induced pressure and reservoir gas saturation play important roles in controlling leakage. Caution must be used in the application of this ROM because well leakage is formally transient and the ROM lookup table was populated using quasi-steady simulation output after 1000 time steps which may correspond to different physical times for the various parameter combinations of the coupled wellbore-reservoir system.

  3. Gastroesophageal Reflux Disease and Metabolic Syndrome

    OpenAIRE

    Olinichenko, A. V.

    2014-01-01

    Purpose of the research is to study the features of gastroesophageal reflux disease, combined with the metabolic syndrome. Materials and methods. The study involved 490 patients (250 have got gastroesophageal reflux disease, combined with the metabolic syndrome and 240 have got gastroesophageal reflux disease without the metabolic syndrome). The patients besides general clinical examination were carried out video-fibro-gastro-duodeno-skopy, pH-monitoring in the esophagus, anthropometry, deter...

  4. Gastroesophageal scintigraphy in patients with gastroesophageal reflux: comparison with manometry and with acid reflux test

    International Nuclear Information System (INIS)

    Bouvard, G.; Baptiste, J.C.; Peres, J.C.; Segol, P.; Fernandez, Y.

    1985-01-01

    Gastroesophageal scintiscanning offers several advantages: it is more physiological and more convenient than acid reflux test, does not require nasogastric intubation or installation of hydrochloric acid into the stomach; its diagnostic value is satisfactory (very good specificity and sensitivity); it can be easily repeated and permits a semi-quantitative evaluation of the reflux and a discrimination between physiological and pathological gastroesophageal reflux [fr

  5. Mechanisms of acid, weakly acidic and gas reflux after anti-reflux surgery

    NARCIS (Netherlands)

    Bredenoord, A. J.; Draaisma, W. A.; Weusten, B. L. A. M.; Gooszen, H. G.; Smout, A. J. P. M.

    2008-01-01

    BACKGROUND: Whereas it is well documented that fundoplication reduces acid reflux, the effects of the procedure on non-acid and gas reflux and the mechanisms through which this is achieved have not been fully elucidated. METHODS: In 14 patients, reflux was measured with impedance-pH monitoring

  6. Gastroesophageal scintigraphy in patients with gastroesophageal reflux: comparison with manometry and with acid reflux test

    Energy Technology Data Exchange (ETDEWEB)

    Bouvard, G.; Baptiste, J.C.; Peres, J.C.; Segol, P.; Fernandez, Y.

    1985-01-01

    Gastroesophageal scintiscanning offers several advantages: it is more physiological and more convenient than acid reflux test, does not require nasogastric intubation or installation of hydrochloric acid into the stomach; its diagnostic value is satisfactory (very good specificity and sensitivity); it can be easily repeated and permits a semi-quantitative evaluation of the reflux and a discrimination between physiological and pathological gastroesophageal reflux.

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

    NARCIS (Netherlands)

    Weijenborg, P.W.

    2016-01-01

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

  8. Characteristics of symptomatic reflux episodes in Japanese proton pump inhibitor-refractory non-erosive reflux disease patients

    Science.gov (United States)

    Nakagawa, Kenichiro; Koike, Tomoyuki; Iijima, Katsunori; Saito, Masahiro; Kikuchi, Hiroki; Hatta, Waku; Ara, Nobuyuki; Uno, Kaname; Asano, Naoki; Shimosegawa, Tooru

    2015-01-01

    AIM: To clarify the pathogenesis of gastroesophageal reflux disease symptoms in non-erosive reflux disease (NERD) patients. METHODS: Thirty-five NERD patients with persistent symptoms, despite taking rabeprazole 10 mg twice daily for at least 8 wk, were included in this study. All patients underwent 24 h combined impedance - pH on rabeprazole. The symptom index (SI) was considered to be positive if ≥ 50%, and proximal reflux episodes were determined when reflux reached 15 cm above the proximal margin of the lower esophageal sphincter. RESULTS: In 14 (40%) SI-positive patients, with liquid weakly acid reflux, the occurrence rate of reflux symptoms was significantly more frequent in proximal reflux episodes (46.7%) than in distal ones (5.7%) (P acid reflux, there were no significant differences in the occurrence rate of reflux symptoms between proximal reflux episodes (38.5%) and distal ones (20.5%) (NS). With mixed liquid-gas weakly acid reflux, the occurrence rate of reflux symptoms in proximal reflux episodes was significantly more frequent (31.0%) than in distal reflux ones (3.3%) (P acid reflux, there were no significant differences in the occurrence rate of reflux symptoms between proximal reflux episodes (29.4%) and distal ones (14.3%) (NS). CONCLUSION: The proximal extent of weakly acidic liquid and mixed liquid-gas reflux is a major factor associated with reflux perception in SI-positive patients on proton pump inhibitor therapy. PMID:26715820

  9. Gastroesophageal reflux in children: radionuclide gastroesophagography

    International Nuclear Information System (INIS)

    Blumhagen, J.D.; Rudd, T.G.; Christie, D.L.

    1980-01-01

    Sixty-five symptomatic infants and children underwent radionuclide gastroesophagography, acid reflux testing, and barium esophagography with water-siphon testing to evaluate the clinical efficacy of the scintigraphic technique in detecting gastroesophageal reflux. After ingesting /sup 99m/Tc sulfur colloid in fruit juice, patients rested beneath the gamma camera for 30 to 60 min while esophageal activity was monitored continuously. By using the acid reflux test as a standard of comparison, the senstivity of radionuclide gastroesophagography was 75%. Because of its physiologic nature, low radiation exposure, and convenience, radionuclide gastroesophagography warrants further evaluation as a screening test for gastroesophageal reflux

  10. Gastroesophageal reflux disease in pediatric practice: current topical issues

    Directory of Open Access Journals (Sweden)

    O.Yu. Bielousova

    2017-03-01

    Full Text Available In recent years, much attention has been paid to the upper digestive tract diseases in children, particularly gastroesophageal reflux disease, as a cause that has an impact on the quality of life, even in children of school age, and thereafter in young adults. Consequently, there are searches for optimization of early detection, new me-thods of non-invasive diagnosis, screening of this pathology in children’s population in order to determine persons with risk factors and to control disease development and complicated course, as well as searches for the formation of preventive activities algorithm. Scientists came to a consensus that all examinations, which are used in pediatric practice, must be maximally available, simple and non-invasive to the extent of child’s condition. The question about advisability of performing esophagogastroduodenoscopy for all patients with complaints of heartburn and with other symptoms of gastroesophageal reflux disease, the question relative to performing ultrasonography of the esophagus in children as an additional method of examination, usage of questionnaire in pediatric practice, formation of disease course prediction algorithm, and identification of preventive measures specific to every patient remain open. In order to explain their application, the developmental mechanisms of this pathology must be well-understood, and individual risk factors that may influence disease severity and disease course prediction, which occur in children in different periods of life, must be taken into account. Therefore, the goal of this research is to provide an overview of modern literature with reference to topical issues of clinical evidence, risk factors, diagnosis, prediction of gastroesophageal reflux disease course in children of different ages (regarding main causative and pathogenic factors, clinical evidence (esophageal and extra-esophageal, diagnostic methods and modern approaches to gastroesophageal reflux disease

  11. Mechanisms of acid reflux and how refluxed Acid extends proximally in patients with non-erosive reflux disease.

    Science.gov (United States)

    Sano, Hirohito; Iwakiri, Katsuhiko; Kawami, Noriyuki; Tanaka, Yuriko; Sakamoto, Choitsu

    2014-01-01

    The mechanisms that cause acid reflux in patients with non-erosive reflux disease (NERD), including those that determine how acid extends proximally, are not yet clear. Concurrent esophageal manometry and pH monitoring were performed for 3 h after a meal in 13 patients with NERD, 12 with mild reflux esophagitis (RE), and 13 healthy subjects (HS). Transient lower esophageal sphincter (LES) relaxation (TLESR) was the major mechanism of acid reflux in all three groups. LES pressure did not differ between the groups. At 2 cm above the LES, there were no differences between the three groups in the number of TLESR-related acid reflux episodes, rate of TLESRs and rate of acid reflux during TLESR. However, at 7 cm above the LES, the rate of acid reflux during TLESRs was significantly higher in patients with NERD (mean ± SEM 42.3 ± 4.8) than in those with mild RE (28.0 ± 3.8) and HS (10.8 ± 2.5). TLESRs are the sole motor events underlying acid reflux episodes in patients with NERD. Acid extends proximally more readily in patients with NERD than in HS and those with mild RE.

  12. [Association between acid reflux and esophageal dysmotility in patients with gastroesophageal reflux disease].

    Science.gov (United States)

    Yi, Zhi-hui; Feng, Li; Wen, Mao-yao; Liu, Jian-rong; Yang, Li

    2014-05-01

    To investigate the association between esophageal motility and acid reflux in patients with gastroesophageal reflux disease (GERD). A total of 94 patients with typical reflux symptoms such as heartburn, regurgitation and chest pain, whose score (Sc) of reflux diagnostic questionnaire (RDQ) was greater than or equal to 12 were enrolled in the study. Each participant was evaluated by upper gastrointestinal endoscopy, high resolution manometry (HRM) of esophagus and 24 h esophageal pH monitoring. The participants were divided into groups of reflux esophagitis (RE) and non-erosive reflux disease (NERD) on the basis of endoscopy findings. The 24 h esophageal pH monitoring categorized participants into physiologic reflux (pH) and pathologic reflux (pH+). The characteristics of esophageal motility and acid reflux were compared between the two groups of participants. Lower but non-significant differences (P > 0.05) were found in pressure of lower esophageal sphincter (LESP), length of lower esophageal sphincter (LESL), esophageal contraction amplitude (CA), distal contractile integral (DCI) and effective peristalsis proportion (EPP) in the participants in the RE group compared with those in the NERD group. Participants in the RE group had significantly higher prevalence of reduced LESP (63.0% vs. 31.7%, P 0.05). RE is closely associated with acid reflux and hiatus hernia. Esophageal dysmotility is more likely to appear in patients with pH+. The interaction of acid reflux and esophageal dysmotility may play a role in GERD.

  13. Nocturnal Gastroesophageal Reflux Revisited by Impedance-pH Monitoring

    Science.gov (United States)

    Blondeau, Kathleen; Mertens, Veerle; Tack, Jan; Sifrim, Daniel

    2011-01-01

    Background/Aims Impedance-pH monitoring allows detailed characterization of gastroesophageal reflux and esophageal activity associated with reflux. We assessed the characteristics of nocturnal reflux and esophageal activity preceding and following reflux. Methods Impedance-pH tracings from 11 healthy subjects and 76 patients with gastroesophageal reflux disease off acid-suppressive therapy were analyzed. Characteristics of nocturnal supine reflux, time distribution and esophageal activity seen on impedance at 2 minute intervals preceding and following reflux were described. Results Patients had more nocturnal reflux events than healthy subjects (8 [4-12] vs 2 [1-5], P = 0.002), with lower proportion of weakly acidic reflux (57% [35-78] vs 80% [60-100], P = 0.044). Nocturnal reflux was mainly liquid (80%) and reached the proximal esophagus more often in patients (6% vs 0%, P = 0.047). Acid reflux predominated in the first 2 hours (66%) and weakly acidic reflux in the last 3 hours (70%) of the night. Most nocturnal reflux was preceded by aboral flows and cleared by short lasting volume clearance. In patients, prolonged chemical clearance was associated with less esophageal activity. Conclusions Nocturnal weakly acidic reflux is as common as acid reflux in patients with gastroesophageal reflux disease, and predominates later in the night. Impedance-pH can predict prolonged chemical clearance after nocturnal acid reflux. PMID:21602991

  14. Vomiting and gastro-oesophageal reflux.

    Science.gov (United States)

    Paton, J Y; Nanayakkhara, C S; Simpson, H

    1988-01-01

    During radionuclide scans in 82 infants and children gastro-oesophageal reflux extending to the upper oesophageal/laryngeal level was detected in 636 one minute frames. Only 61 (9.6%) of these frames were associated with vomiting, defined as the appearance of milk at the mouth. Thus the absence of vomiting does not preclude appreciable gastro-oesophageal reflux. PMID:3415303

  15. Gastro-oesophageal reflux and belching revisited

    NARCIS (Netherlands)

    Bredenoord, Albert Jan

    2006-01-01

    In this thesis recent studies into the pathophysiology of gastro-oesophageal reflux disease and belching are described. The thesis is divided into four parts. Part I describes studies in which the technique of impedance monitoring is validated. With impedance monitoring reflux of liquid and gas can

  16. Final Scientific/Technical Report for "Nanite" for Better Well-Bore Integrity and Zonal Isolation

    Energy Technology Data Exchange (ETDEWEB)

    Veedu, Vinod [Oceanit Laboratories, Inc., Honolulu, HI (United States); Hadmack, Michael [Oceanit Laboratories, Inc., Honolulu, HI (United States); Pollock, Jacob [Oceanit Laboratories, Inc., Honolulu, HI (United States); Pernambuco-Wise, Paul [Oceanit Laboratories, Inc., Honolulu, HI (United States); Ah Yo, Derek [Oceanit Laboratories, Inc., Honolulu, HI (United States)

    2017-05-30

    Nanite™ is a cementitious material that contains a proprietary formulation of functionalized nanomaterial additive to transform conventional cement into a smart material responsive to pressure (or stress), temperature, and any intrinsic changes in composition. This project has identified optimal sensing modalities of smart well cement and demonstrated how real-time sensing of Nanite™ can improve long-term wellbore integrity and zonal isolation in shale gas and applicable oil and gas operations. Oceanit has explored Nanite’s electrical sensing properties in depth and has advanced the technology from laboratory proof-of-concept to sub-scale testing in preparation for field trials.

  17. Shale-Gas Experience as an Analog for Potential Wellbore Integrity Issues in CO2 Sequestration

    Energy Technology Data Exchange (ETDEWEB)

    Carey, James W. [Los Alamos National Laboratory; Simpson, Wendy S. [Los Alamos National Laboratory; Ziock, Hans-Joachim [Los Alamos National Laboratory

    2011-01-01

    Shale-gas development in Pennsylvania since 2003 has resulted in about 19 documented cases of methane migration from the deep subsurface (7,0000) to drinking water aquifers, soils, domestic water wells, and buildings, including one explosion. In all documented cases, the methane leakage was due to inadequate wellbore integrity, possibly aggravated by hydrofracking. The leakage of methane is instructive on the potential for CO{sub 2} leakage from sequestration operations. Although there are important differences between the two systems, both involve migrating, buoyant gas with wells being a primary leakage pathway. The shale-gas experience demonstrates that gas migration from faulty wells can be rapid and can have significant impacts on water quality and human health and safety. Approximately 1.4% of the 2,200 wells drilled into Pennsylvania's Marcellus Formation for shale gas have been implicated in methane leakage. These have resulted in damage to over 30 domestic water supplies and have required significant remediation via well repair and homeowner compensation. The majority of the wellbore integrity problems are a result of over-pressurization of the wells, meaning that high-pressure gas has migrated into an improperly protected wellbore annulus. The pressurized gas leaks from the wellbore into the shallow subsurface, contaminating drinking water or entering structures. The effects are localized to a few thousands of feet to perhaps two-three miles. The degree of mixing between the drinking water and methane is sufficient that significant chemical impacts are created in terms of elevated Fe and Mn and the formation of black precipitates (metal sulfides) as well as effervescing in tap water. Thus it appears likely that leaking CO{sub 2} could also result in deteriorated water quality by a similar mixing process. The problems in Pennsylvania highlight the critical importance of obtaining background data on water quality as well as on problems associated with

  18. Methodology to predict the initiation of multiple transverse fractures from horizontal wellbores

    Energy Technology Data Exchange (ETDEWEB)

    Crosby, D. G.; Yang, Z.; Rahman, S. S. [Univ. of New South Wales (Australia)

    2001-10-01

    The criterion based on Drucker and Prager which is designed to predict the pressure required to initiate secondary multiple transverse fractures in close proximity to primary fractures is discussed. Results based on this criterion compare favorably with those measured during a series of laboratory-scale hydraulic fracture interaction tests. It is concluded that the multiple fracture criterion and laboratory results demonstrate that transversely fractured horizontal wellbores have a limited capacity to resist the initiation of multiple fractures from adjacent perforations, or intersecting induced and natural fractures. 23 refs., 1 tab., 9 figs.

  19. Method for measurement of flowing water salinity within or behind wellbore casing

    International Nuclear Information System (INIS)

    Arnold, D.M.

    1986-01-01

    Water flowing within or behind a wellbore casing is irradiated with 14 MeV neutrons from a source in a downhole sonde. Gamma radiation from the isotope nitrogen-16 induced from the O 16 (n,p)N 16 reaction and the products of either the Na 23 (n,α)F 20 or the Cl 37 (n,α)p 34 reactions is measured in intensity and energy with detectors in the sonde. From the gamma radiation measurements, the relative presence of oxygen to at least one of sodium or chlorine in the water is measured, and from the measurement the salinity of the water is determined

  20. Final Research Performance Progress Report: Geothermal Resource Development with Zero Mass Withdrawal, Engineered Convection, and Wellbore Energy Conversion

    Energy Technology Data Exchange (ETDEWEB)

    Hughes, Richard [Louisiana State Univ., Baton Rouge, LA (United States); Tyagi, Mayank [Louisiana State Univ., Baton Rouge, LA (United States); Radonjic, Mileva [Louisiana State Univ., Baton Rouge, LA (United States); Dahi, Arash [Louisiana State Univ., Baton Rouge, LA (United States); Wang, Fahui [Louisiana State Univ., Baton Rouge, LA (United States); John, Chacko [Louisiana State Univ., Baton Rouge, LA (United States); Kaiser, Mark [Louisiana State Univ., Baton Rouge, LA (United States); Snyder, Brian [Louisiana State Univ., Baton Rouge, LA (United States); Sears, Stephen [Louisiana State Univ., Baton Rouge, LA (United States)

    2017-07-07

    This project is intended to demonstrate the technical and economic feasibility, and environmental and social attractiveness of a novel method of heat extraction from geothermal reservoirs. The emphasis is on assessing the potential for a heat extraction method that couples forced and free convection to maximize extraction efficiency. The heat extraction concept is enhanced by considering wellbore energy conversion, which may include only a boiler for a working fluid, or perhaps a complete boiler, turbine, and condenser cycle within the wellbore. The feasibility of this system depends on maintaining mechanical and hydraulic integrity of the wellbore, so the material properties of the casing-cement system are examined both experimentally and with well design calculations. The attractiveness depends on mitigation of seismic and subsidence risks, economic performance, environmental impact, and social impact – all of which are assessed as components of this study.

  1. Achalasia following gastro-oesophageal reflux.

    Science.gov (United States)

    Smart, H L; Mayberry, J F; Atkinson, M

    1986-01-01

    Five patients initially presenting with symptomatic gastro-oesophageal reflux, proven by radiology or pH monitoring, subsequently developed achalasia, confirmed by radiology and manometry, after an interval of 2-10 years. During this period dysphagia, present as a mild and intermittent symptom accompanying the initial reflux in 3 of the 5, became severe and resulted in oesophageal stasis of food in all. Three of the 5 had a demonstrable hiatal hernia. In none was reflux a troublesome symptom after Rider-Moeller dilatation or cardiomyotomy undertaken for the achalasia. Gastro-oesophageal reflux does not protect against the subsequent development of achalasia. It is suggested that the autonomic damage eventually leading to achalasia may in its initial phases cause gastro-oesophageal reflux. Images Figure 1. A Figure 1. B Figure 2. PMID:3950898

  2. Esophageal abnormalities in gastroesophageal reflux disease.

    Science.gov (United States)

    Levine, Marc S; Carucci, Laura R

    2018-06-01

    Fluoroscopic esophagography is a widely available, safe, and inexpensive test for detecting gastroesophageal reflux disease. In this article, we review the technique for performing a high-quality esophagram, including upright, double-contrast views of the esophagus and cardia with high-density barium; prone, single-contrast views of the esophagus with low-density barium; and evaluation of gastroesophageal reflux. We then discuss the radiographic findings associated with gastroesophageal reflux disease, including esophageal dysmotility, reflux esophagitis, peptic strictures, and Barrett's esophagus. Finally, we consider the differential diagnosis for the various radiographic findings associated with this condition. When carefully performed and interpreted, the esophagram is a useful test for evaluating gastroesophageal reflux disease and its complications.

  3. 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.

  4. Acid reflux management: ENT perspective.

    Science.gov (United States)

    Ahmad, Ijaz; Batch, A J G

    2004-01-01

    Otolaryngological manifestations of acid reflux include a wide range of pharyngeal and laryngeal symptoms; and the constellation of symptoms has been called laryngopharyngeal reflux. This is a prospective study in a cohort of patients with various throat symptoms suggestive of laryngopharyngeal reflux (LPR) who underwent flexible oesophago-gastroscopy, as a principal investigation. The aims were to look at the most reliable symptom(s) and sign(s), the diagnostic role of flexible oesophago-gastroscopy and the treatment response in these patients. The endoscopy score of 0 to 3 was based on endoscopic findings and the treatment response was measured from 0 to 100 per cent improvement of symptoms, as described by the patients. There were a total of 303 patients, 174 females and 129 males with ages ranging from 19 to 88 years. Seventy-five per cent had had symptoms for more than a year. Fifteen per cent were smokers. Globus, voice change, sore throat, dysphagia and cough were the predominant symptoms. Most patients, however, presented with a complex of various other secondary symptoms. The endoscopic findings were abnormal in 98 per cent of patients. Apart from the finding of non-specific hyperaemia, usually of the posterior larynx (13 per cent), lesions of the larynx and vocal folds were surprisingly uncommon. Proton pump inhibitors (PPI) were prescribed in 90 per cent of patients. A total of 233 (76.8 per cent) responded to treatment. The improvement of symptoms ranged from 25 per cent in 36 (23 per cent), 50 per cent in 60 (20 per cent), 75 per cent in 59 (19 per cent) and 100 per cent in 78 (26 per cent) patients. Accumulative analysis of variance showed a significant difference between treatment responders and non-responders (p <0.04). In a logistic regression model patients with globus, voice change and gastric prolapse were more likely to respond to treatment (p <0.04). It can be concluded that voice change, sore throat, globus and cough choking are the most

  5. Gastrointestinal transit and reflux studies

    International Nuclear Information System (INIS)

    Greenspan, R.L.; Kochan, J.

    1988-01-01

    Current imaging modalities such as magnetic resonance imaging and computed tomography provide anatomic resolution far beyond that achievable with the current methods of scintigraphic imaging. Consequently, the strength of nuclear medicine has shifted and now lies in its ability to provide physiologic data noninvasively and simply. This ability is well illustrated by the scintigraphic techniques developed for evaluation of the alimentary tract. Studies of esophageal transit, gastroesophageal reflux, and gastric emptying are now widely available. Evaluation of small and large intestinal transit have also been investigated. These techniques are discussed in the present chapter

  6. 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

  7. A review of pharmacotherapy for treating gastroesophageal reflux disease (GERD).

    Science.gov (United States)

    Savarino, Edoardo; Zentilin, Patrizia; Marabotto, Elisa; Bodini, Giorgia; Della Coletta, Marco; Frazzoni, Marzio; de Bortoli, Nicola; Martinucci, Irene; Tolone, Salvatore; Pellegatta, Gaia; Savarino, Vincenzo

    2017-09-01

    Medical therapy of gastroesophageal reflux disease (GERD) is based on the use of proton pump inhibitors (PPIs) as first choice treatment. Despite their effectiveness, about 20-30% of patients report an inadequate response and alternative drugs are required. Areas covered: This review provides an overview of current pharmacotherapy for treating GERD by showing the results of PPIs, reflux inhibitors, antidepressants and mucosa protective medications. Expert opinion: Medical therapy of GERD does not definitely cure the disease, because even PPIs are not able to change the key factors responsible for it. However, they remain the mainstay of medical treatment, allowing us to alleviate symptoms, heal esophagitis and prevent complications in the majority of cases. Nevertheless, many patients do not respond, because acid does not play any pathogenetic role. Prokinetics and reflux inhibitors have the potential to control motor abnormalities, but the results of clinical trials are inconsistent. Antidepressant drugs are effective in specific subgroups of NERD patients with visceral hypersensitivity, but larger, controlled clinical studies are necessary. Protective drugs or medical devices have been recently adopted to reinforce mucosal resistance and preliminary trials have confirmed their efficacy either combined with or as add-on medication to PPIs in refractory patients.

  8. 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 ...

  9. Management of Gastroesophageal Reflux Disease.

    Science.gov (United States)

    Gyawali, C Prakash; Fass, Ronnie

    2018-01-01

    Management of gastroesophageal reflux disease (GERD) commonly starts with an empiric trial of proton pump inhibitor (PPI) therapy and complementary lifestyle measures, for patients without alarm symptoms. Optimization of therapy (improving compliance and timing of PPI doses), or increasing PPI dosage to twice daily in select circumstances, can reduce persistent symptoms. Patients with continued symptoms can be evaluated with endoscopy and tests of esophageal physiology, to better determine their disease phenotype and optimize treatment. Laparoscopic fundoplication, magnetic sphincter augmentation, and endoscopic therapies can benefit patients with well-characterized GERD. Patients with functional diseases that overlap with or mimic GERD can also be treated with neuromodulators (primarily antidepressants), or psychological interventions (psychotherapy, hypnotherapy, cognitive and behavioral therapy). Future approaches to treatment of GERD include potassium-competitive acid blockers, reflux-reducing agents, bile acid binders, injection of inert substances into the esophagogastric junction, and electrical stimulation of the lower esophageal sphincter. Copyright © 2018 AGA Institute. Published by Elsevier Inc. All rights reserved.

  10. Vesicoureteral Reflux in Kidney Transplantation.

    Science.gov (United States)

    Molenaar, Nina M; Minnee, Robert C; Bemelman, Frederike J; Idu, Mirza M

    2017-06-01

    Vesicoureteral reflux (VUR) is frequently found after transplantation, but its impact on graft function, urine tract infection, and graft loss remains uncertain. Therefore our objective was to evaluate the effects of VUR on the outcome of renal transplantation. We included 1008 adult renal transplant recipients of whom a 1-week posttransplant voiding cystourethrogram was available. Study end points included occurrence of bacteriuria, renal function, and graft survival. In total, 106 (10.5%) of 1008 graft recipients had a diagnosis of VUR on voiding cystography. The incidence of bacteriuria was comparable in the reflux and nonreflux group (17% vs 17.4%, P = .91). There was no significant difference in renal function at 3 months and 1 year in patients with and without VUR. One- and 5-year graft survival in patients with VUR was 85.8% and 82.1% compared to 87.3% and 83.0% in patients without VUR ( P = .68 and P = .80). Posttransplant VUR has no correlations with early bacteriuria, renal function, and graft survival.

  11. Exploring the hole cleaning parameters of horizontal wellbore using two-phase Eulerian CFD approach

    Directory of Open Access Journals (Sweden)

    Satish K Dewangan

    2016-03-01

    Full Text Available The present investigation deals with the flow through concentric annulus with the inner cylinder in rotation. This work has got its importance in the petroleum industries in relation to the wellbore drilling. In wellbore drilling, the issue of the hole-cleaning is very serious problem especially in case of the horizontal drilling process. The effect of the various parameters like slurry flow velocity, inner cylinder rotational speed, inlet solid concentration which affect hole cleaning was discussed. Their effect on the pressure drop, wall shear stress, mixture turbulence kinetic energy, and solid-phase velocity and slip velocity were analyzed, which are responsible for solid-phase distribution. Flow was considered to be steady, incompressible and two-phase slurry flow with water as carrier fluid and silica sand as the secondary phase. Eulerian approach was used for modeling the slurry flow. Silica sand was considered of spherical shape with particle size of 180 µm. ANSYS FLUENT software was used for modeling and solution. Plotting was done using Tecplot software and Microsoft Office.

  12. A mechanistic model of heat transfer for gas-liquid flow in vertical wellbore annuli.

    Science.gov (United States)

    Yin, Bang-Tang; Li, Xiang-Fang; Liu, Gang

    2018-01-01

    The most prominent aspect of multiphase flow is the variation in the physical distribution of the phases in the flow conduit known as the flow pattern. Several different flow patterns can exist under different flow conditions which have significant effects on liquid holdup, pressure gradient and heat transfer. Gas-liquid two-phase flow in an annulus can be found in a variety of practical situations. In high rate oil and gas production, it may be beneficial to flow fluids vertically through the annulus configuration between well tubing and casing. The flow patterns in annuli are different from pipe flow. There are both casing and tubing liquid films in slug flow and annular flow in the annulus. Multiphase heat transfer depends on the hydrodynamic behavior of the flow. There are very limited research results that can be found in the open literature for multiphase heat transfer in wellbore annuli. A mechanistic model of multiphase heat transfer is developed for different flow patterns of upward gas-liquid flow in vertical annuli. The required local flow parameters are predicted by use of the hydraulic model of steady-state multiphase flow in wellbore annuli recently developed by Yin et al. The modified heat-transfer model for single gas or liquid flow is verified by comparison with Manabe's experimental results. For different flow patterns, it is compared with modified unified Zhang et al. model based on representative diameters.

  13. The Effects of Boundary Conditions and Friction on the Helical Buckling of Coiled Tubing in an Inclined Wellbore.

    Science.gov (United States)

    Gong, Yinchun; Ai, Zhijiu; Sun, Xu; Fu, Biwei

    2016-01-01

    Analytical buckling models are important for down-hole operations to ensure the structural integrity of the drill string. A literature survey shows that most published analytical buckling models do not address the effects of inclination angle, boundary conditions or friction. The objective of this paper is to study the effects of boundary conditions, friction and angular inclination on the helical buckling of coiled tubing in an inclined wellbore. In this paper, a new theoretical model is established to describe the buckling behavior of coiled tubing. The buckling equations are derived by applying the principles of virtual work and minimum potential energy. The proper solution for the post-buckling configuration is determined based on geometric and natural boundary conditions. The effects of angular inclination and boundary conditions on the helical buckling of coiled tubing are considered. Many significant conclusions are obtained from this study. When the dimensionless length of the coiled tubing is greater than 40, the effects of the boundary conditions can be ignored. The critical load required for helical buckling increases as the angle of inclination and the friction coefficient increase. The post-buckling behavior of coiled tubing in different configurations and for different axial loads is determined using the proposed analytical method. Practical examples are provided that illustrate the influence of the angular inclination on the axial force. The rate of change of the axial force decreases with increasing angular inclination. Moreover, the total axial friction also decreases with an increasing inclination angle. These results will help researchers to better understand helical buckling in coiled tubing. Using this knowledge, measures can be taken to prevent buckling in coiled tubing during down-hole operations.

  14. Endoscopic and laparoscopic treatment of gastroesophageal reflux.

    Science.gov (United States)

    Watson, David I; Immanuel, Arul

    2010-04-01

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

  15. Motor disorders of the oesophagus in gastro-oesophageal reflux.

    OpenAIRE

    Mahony, M J; Migliavacca, M; Spitz, L; Milla, P J

    1988-01-01

    Mechanisms of gastro-oesophageal reflux were studied by oesophageal manometry and pH monitoring in 33 children: nine controls, 15 with gastro-oesophageal reflux alone, and nine with reflux oesophagitis. A total of 122 episodes of reflux were analysed in detail: 82 (67%) were synchronous with swallowing and 40 (33%) asynchronous. Infants with trivial symptoms had gastro-oesophageal reflux synchronous with swallowing, whereas those with serious symptoms had slower acid clearance and asynchronou...

  16. Esophageal motility abnormalities in gastroesophageal reflux disease

    Science.gov (United States)

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

    2014-01-01

    Esophageal motility abnormalities are among the main factors implicated in the pathogenesis of gastroesophageal reflux disease. The recent introduction in clinical and research practice of novel esophageal testing has markedly improved our understanding of the mechanisms contributing to the development of gastroesophageal reflux disease, allowing a better management of patients with this disorder. In this context, the present article intends to provide an overview of the current literature about esophageal motility dysfunctions in patients with gastroesophageal reflux disease. Esophageal manometry, by recording intraluminal pressure, represents the gold standard to diagnose esophageal motility abnormalities. In particular, using novel techniques, such as high resolution manometry with or without concurrent intraluminal impedance monitoring, transient lower esophageal sphincter (LES) relaxations, hypotensive LES, ineffective esophageal peristalsis and bolus transit abnormalities have been better defined and strongly implicated in gastroesophageal reflux disease development. Overall, recent findings suggest that esophageal motility abnormalities are increasingly prevalent with increasing severity of reflux disease, from non-erosive reflux disease to erosive reflux disease and Barrett’s esophagus. Characterizing esophageal dysmotility among different subgroups of patients with reflux disease may represent a fundamental approach to properly diagnose these patients and, thus, to set up the best therapeutic management. Currently, surgery represents the only reliable way to restore the esophagogastric junction integrity and to reduce transient LES relaxations that are considered to be the predominant mechanism by which gastric contents can enter the esophagus. On that ground, more in depth future studies assessing the pathogenetic role of dysmotility in patients with reflux disease are warranted. PMID:24868489

  17. Role of Acid and Weakly Acidic Reflux in Gastroesophageal Reflux Disease Off Proton Pump Inhibitor Therapy

    OpenAIRE

    Sung, Hea Jung; Cho, Yu Kyung; Moon, Sung Jin; Kim, Jin Su; Lim, Chul Hyun; Park, Jae Myung; Lee, In Seok; Kim, Sang Woo; Choi, Myung-Gye

    2012-01-01

    Background/Aims Available data about reflux patterns and symptom determinants in the gastroesophageal reflux disease (GERD) subtypes off proton pump inhibitor (PPI) therapy are lacking. We aimed to evaluate reflux patterns and determinants of symptom perception in patients with GERD off PPI therapy by impedance-pH monitoring. Methods We retrospectively reviewed the impedance-pH data in patients diagnosed as GERD based on results of impedance-pH monitoring, endoscopy and/or typical symptoms. T...

  18. Rotating preventers

    International Nuclear Information System (INIS)

    Tangedahl, M.J.; Stone, C.R.

    1992-01-01

    This paper reports that recent changes in the oil and gas industry and ongoing developments in horizontal and underbalanced drilling necessitated development of a better rotating head. A new device called the rotating blowout preventer (RBOP) was developed by Seal-Tech. It is designed to replace the conventional rotating control head on top of BOP stacks and allows drilling operations to continue even on live (underbalanced) wells. Its low wear characteristics and high working pressure (1,500 psi) allow drilling rig crews to drill safely in slightly underbalanced conditions or handle severe well control problems during the time required to actuate other BOPs in the stack. Drilling with a RBOP allows wellbores to be completely closed in tat the drill floor rather than open as with conventional BOPs

  19. Acid reflux episodes sensitize the esophagus to perception of weakly acidic and mixed reflux in non-erosive reflux disease patients.

    Science.gov (United States)

    Emerenziani, S; Ribolsi, M; Guarino, M P L; Balestrieri, P; Altomare, A; Rescio, M P; Cicala, M

    2014-01-01

    Non-erosive reflux disease (NERD) patients are more sensitive than erosive esophagitis patients to weakly acidic reflux and to the presence of gas in the refluxate. Intra-esophageal acid perfusion sensitizes esophageal receptors to mechanical and chemical stimuli. To establish whether acid sensitization plays a role in the perception of weakly acidic and mixed reflux episodes, 29 NERD patients, responders and 14 non-responders to proton pump inhibitors (PPIs), underwent pH-impedance monitoring. Non-responders repeated the study while on PPIs. To assess the effect of acid exposure on symptom perception, the time period with pH below 4 was measured in 15- and 30-minute time-windows preceding the onset of each reflux episode. Considering weakly acidic and mixed refluxes, both in responder and non-responder patients (off PPIs), the symptomatic refluxes were preceded by a significantly higher cumulative acid exposure than the asymptomatic refluxes. In all patients, following acid reflux, the percentage of symptomatic weakly acidic reflux episodes was significantly higher than that of asymptomatic refluxes. Non-responder patients, off-treatment, were characterized by a lower proportion of weakly acidic reflux and mixed reflux episodes. In the non-responder patients on PPI, only mixed and weakly symptomatic reflux episodes were preceded by a higher cumulative acid exposure. In NERD patients, spontaneous acid reflux enhances subsequent reflux perception, regardless of acidity or liquid/mixed composition of episodes; in non-responder patients on PPIs, only the perception of mixed and weakly acidic reflux episodes seems to be mediated by a preceding acid exposure. © 2013 John Wiley & Sons Ltd.

  20. Human radicular veins : regulation of venous reflux in the absence of valves

    NARCIS (Netherlands)

    van der Kuip, M; Hoogland, P V; Groen, R J

    1999-01-01

    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

  1. Numerical simulation on streaming potentials in a wellbore; Koseinai no ryudo den`i ni kansuru suchi simulation

    Energy Technology Data Exchange (ETDEWEB)

    Ikeda, N [Kyushu University, Fukuoka (Japan)

    1996-05-01

    This paper reports numerical computation of streaming potentials which are generated by transient pressure waves propagating the vicinity of wellbore wall immediately after a mud cake formed on the wellbore wall has been removed. One existing analysis solution on heat conduction was utilized upon changing the parameters in order to derive fluid pressure inside the ground bed. Calculations were carried out by using the existing three-dimensional finite difference method (partly re-written) based on the relationship constituted between the fluid pressure and the streaming potential. This paper presents results of calculating the streaming potentials in wellbores on models having wellbores filled with mud water in a cubic ground bed existing with ground bed water at saturation of 100%. The calculations have been conducted on the following cases: a case where permeability of the ground bed is small with the fluid under two conditions of low electric resistivity and high electric resistivity, a case where the permeability is large with the fluid under the above conditions, and a case where a small area of bore wall is covered with a rubber pad having high electric resistivity under a low electric resistivity condition. 8 refs., 5 figs.

  2. Near Wellbore Hydraulic Fracture Propagation from Perforations in Tight Rocks: The Roles of Fracturing Fluid Viscosity and Injection Rate

    Directory of Open Access Journals (Sweden)

    Seyed Hassan Fallahzadeh

    2017-03-01

    Full Text Available Hydraulic fracture initiation and near wellbore propagation is governed by complex failure mechanisms, especially in cased perforated wellbores. Various parameters affect such mechanisms, including fracturing fluid viscosity and injection rate. In this study, three different fracturing fluids with viscosities ranging from 20 to 600 Pa.s were used to investigate the effects of varying fracturing fluid viscosities and fluid injection rates on the fracturing mechanisms. Hydraulic fracturing tests were conducted in cased perforated boreholes made in tight 150 mm synthetic cubic samples. A true tri-axial stress cell was used to simulate real far field stress conditions. In addition, dimensional analyses were performed to correspond the results of lab experiments to field-scale operations. The results indicated that by increasing the fracturing fluid viscosity and injection rate, the fracturing energy increased, and consequently, higher fracturing pressures were observed. However, when the fracturing energy was transferred to a borehole at a faster rate, the fracture initiation angle also increased. This resulted in more curved fracture planes. Accordingly, a new parameter, called fracturing power, was introduced to relate fracture geometry to fluid viscosity and injection rate. Furthermore, it was observed that the presence of casing in the wellbore impacted the stress distribution around the casing in such a way that the fracture propagation deviated from the wellbore vicinity.

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

    Directory of Open Access Journals (Sweden)

    Flora Filho Rowilson

    1999-01-01

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

  4. Optimization of the Treatment Protocol in Children with Gastroesophageal Reflux Disease

    Directory of Open Access Journals (Sweden)

    T.O. Kriuchko

    2016-03-01

    Full Text Available The article deals with the substantiation and assessment of the effectiveness of the inclusion of ursodeoxycholic acid preparation Ukrliv suspension in the treatment protocol of children with gastroesophageal reflux disease. Taking into account the results of the studies, the use of ursodeoxycholic acid drug can be recommended as a pathogenetic therapy in the combination treatment of children with gastroesophageal reflux disease. The findings suggest both the efficiency and the high level of safety and tolerability of ursodeoxycholic acid, in particular Ukrliv suspension, during long-term use to prevent recurrences.

  5. Adaptive forward-inverse modeling of reservoir fluids away from wellbores; TOPICAL

    International Nuclear Information System (INIS)

    Ziagos, J P; Gelinas, R J; Doss, S K; Nelson, R G

    1999-01-01

    This Final Report contains the deliverables of the DeepLook Phase I project entitled, ''Adaptive Forward-Inverse Modeling of Reservoir Fluids Away from Wellbores''. The deliverables are: (i) a description of 2-D test problem results, analyses, and technical descriptions of the techniques used, (ii) a listing of program setup commands that construct and execute the codes for selected test problems (these commands are in mathematical terminology, which reinforces technical descriptions in the text), and (iii) an evaluation and recommendation regarding continuance of this project, including considerations of possible extensions to 3-D codes, additional technical scope, and budget for the out-years. The far-market objective in this project is to develop advanced technologies that can help locate and enhance the recovery of oil from heterogeneous rock formations. The specific technical objective in Phase I was to develop proof-of-concept of new forward and inverse (F-I) modeling techniques[Gelinas et al, 1998] that seek to enhance estimates (images) of formation permeability distributions and fluid motion away from wellbore volumes. This goes to the heart of improving industry's ability to jointly image reservoir permeability and flow predictions of trapped and recovered oil versus time. The estimation of formation permeability away from borehole measurements is an ''inverse'' problem. It is an inseparable part of modeling fluid flows throughout the reservoir in efforts to increase the efficiency of oil recovery at minimum cost. Classic issues of non-uniqueness, mathematical instability, noise effects, and inadequate numerical solution techniques have historically impeded progress in reservoir parameter estimations. Because information pertaining to fluid and rock properties is always sampled sparsely by wellbore measurements, a successful method for interpolating permeability and fluid data between the measurements must be: (i) physics-based, (ii) conditioned by signal

  6. Laparoscopic Anti-Reflux (GERD) Surgery

    Science.gov (United States)

    ... and Humanitarian Efforts Login Laparoscopic Anti-Reflux (GERD) Surgery Patient Information from SAGES Download PDF Find a SAGES Surgeon Surgery for “Heartburn” If you suffer from moderate to ...

  7. [Gastro-oesophageal reflux in infants].

    Science.gov (United States)

    de Jong, Trudy; Kamphuis, Mascha; Kivit-Schwengle, Lilly

    2014-01-01

    A more prominent role for the youth healthcare physician: Youth Healthcare physicians reflect on the Dutch Paediatric Association (NVK) guideline entitled 'Gastro-oesophageal reflux (disease) in children aged 0-18 years'. This guideline states that medicinal treatment is given to these children too often. Dutch Youth Healthcare physicians see a large number of children with gastro-oesophageal reflux, with or without additional symptoms. The most common symptoms (crying and diminished weight gain) might be present even in the absence of reflux. Parents should be given advice and support when they are worried about reflux, crying or low weight gain. A lower weight gain curve on the growth chart is normal in breastfed children, and crying might be due to factors such as lack of routine or stimulus reduction. Overfeeding might also be the cause. Parents should be supported and followed up, with or without treatment, as necessary. Youth Healthcare professionals could perform this task.

  8. EAU Guidelines on Vesicoureteral Reflux in Children

    NARCIS (Netherlands)

    Tekgul, Serdar; Riedmiller, Hubertus; Hoebeke, Piet; Kocvara, Radim; Nijman, Rien J. M.; Radmayr, Christian; Stein, Raimund; Dogan, Hasan Serkan

    Context: Primary vesicoureteral reflux (VUR) is a common congenital urinary tract abnormality in children. There is considerable controversy regarding its management. Preservation of kidney function is the main goal of treatment, which necessitates identification of patients requiring early

  9. Pediatric GERD (Gastro-Esophageal Reflux Disease)

    Science.gov (United States)

    ... Marketplace Find an ENT Doctor Near You Pediatric GERD (Gastro-Esophageal Reflux Disease) Pediatric GERD (Gastro-Esophageal ... What symptoms are displayed by a child with GERD? While GER and EER in children often cause ...

  10. Quantitation of esophageal transit and gastroesophageal reflux

    International Nuclear Information System (INIS)

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

    1986-01-01

    Scintigraphic techniques are the only quantitative methods for the evaluation of esophageal transit and gastroesophageal reflux. By comparison, other techniques are not quantitative and are either indirect, inconvenient, or less sensitive. Methods, such as perfusion techniques, which measure flow, require the introduction of a tube assembly into the gastrointestinal tract with the possible introduction of artifacts into the measurements due to the indwelling tubes. Earlier authors using radionuclide markers, introduced a method for measuring gastric emptying which was both tubeless and quantitative in comparison to other techniques. More recently, a number of scintigraphic methods have been introduced for the quantitation of esophageal transit and clearance, the detection and quantitation of gastroesophageal reflux, the measurement of gastric emptying using a mixed solid-liquid meal, and the quantitation of enterogastric reflux. This chapter reviews current techniques for the evaluation of esophageal transit and gastroesophageal reflux

  11. Grading of vesicoureteral reflux by radionuclide cystography

    International Nuclear Information System (INIS)

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

    1984-01-01

    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 found 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. (orig.)

  12. 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.

  13. Gastroesophageal Reflux Disease: A Population Based Study

    OpenAIRE

    Nwokediuko, Sylvester

    2009-01-01

    Background The prevalence of gastroesophageal reflux disease varies in different parts of the world. There are no population based studies in Nigeria. The main objectives of this study were to determine the prevalence and risk factors for gastroesophageal reflux disease in a population of Nigerian medical students. Methods The Carlsson-Dent questionnaire was administered to medical students in the clinical phase of their training at the University of Nigeria, Enugu Campus. Some putative risk ...

  14. Papel da esofagogastroplastia (Thal-Hatafuku e da gastrectomia parcial com anastomose gastrojejunal em Y (Holt -Large na prevenção do refluxo gastroesofágico. estudo experimental em cães Role of the esofagogastroplasty (Thal-Hatafuku and of the partial gastrectomy and gastrojejunoanastomosis with excluded loop on Y (Holt & Large in the gastroesophageal reflux prevention

    Directory of Open Access Journals (Sweden)

    Joaquim Mendes Castilho Netto

    2000-03-01

    refluxo gastroesofágico; a esofagocardioplastia mostrou ter importante eficácia anti-refluxo e menor morbidade; a cirurgia realizada no grupo III teve morbidade elevada e mortalidade precoce com o estímulo histamínico. Acredita-se que a esofagogastroplastia tenha lugar reservado entre os procedimentos destinados ao tratamento de casos selecionados de acalásia e de estenose péptica do esôfago.The aim of this study was to evaluate in dogs the effects of two kinds of procedures in the gastroesophageal reflux prevention. Thirty animals divided in three randomized groups of ten were analysed as follow: group I (control - esophagastrostomy side-to-side ; group II - esophagogastroplasty; group III -esophagogastrostomy side-to-side, partial gastrectomy and gastrojejunoanastomosis with excluded loop on y, The following parameters were used: body weight, endoscopy, radiological study and macro and microscopy data of the inner surface of the esophagus. The animals received daily histamine-in-beeswax parenterally for the posoperative stimulation of the gastric acid output until death or sacrifice. The research was carried out in three phases: préoperative phase, between the 35° and the 40° postoperative day and after histamine application. Group I showed sgnificant weight loss between the 1st and 2nd phase, which was intense on the 3rd phase. Group II showed no significative weight changes in any phase. Group III revealed significant weight changes even without histaminic stimulus. Endoscopy brought out significant more intensive esophagitis in group I than in II, after histaminic stimulus. In III, it was not possible to obtain these results, because of the precocious death of the animals. Fluoroscopic examination showed that 70% of the animals from group I, exhibited significative reflux, while in 30% this complication was not present. In group II, the reflux ocurred in few dogs and was not seen in 70% of the dogs.. Group III, revealed reflux in all animals and of

  15. Motor disorders of the oesophagus in gastro-oesophageal reflux.

    Science.gov (United States)

    Mahony, M J; Migliavacca, M; Spitz, L; Milla, P J

    1988-01-01

    Mechanisms of gastro-oesophageal reflux were studied by oesophageal manometry and pH monitoring in 33 children: nine controls, 15 with gastro-oesophageal reflux alone, and nine with reflux oesophagitis. A total of 122 episodes of reflux were analysed in detail: 82 (67%) were synchronous with swallowing and 40 (33%) asynchronous. Infants with trivial symptoms had gastro-oesophageal reflux synchronous with swallowing, whereas those with serious symptoms had slower acid clearance and asynchronous reflux. There were significant differences in lower oesophageal sphincter pressure and amplitude of oesophageal contractions between controls and patients with both gastro-oesophageal reflux and reflux oesophagitis. In reflux oesophagitis there was a decrease in lower oesophageal sphincter pressure and the contractions had a bizarre waveform suggesting a neuropathic process. PMID:3202640

  16. Influence of exercise testing in gastroesophageal reflux in patients with gastroesophageal reflux disease.

    Science.gov (United States)

    Mendes-Filho, Antonio Moreira; Moraes-Filho, Joaquim Prado Pinto; Nasi, Ary; Eisig, Jaime Natan; Rodrigues, Tomas Navarro; Barbutti, Ricardo Correa; Campos, Josemberg Marins; Chinzon, Decio

    2014-01-01

    Gastroesophageal reflux disease is a worldwide prevalent condition that exhibits a large variety of signs and symptoms of esophageal or extra-esophageal nature and can be related to the esophagic adenocarcinoma. In the last few years, greater importance has been given to the influence of physical exercises on it. Some recent investigations, though showing conflicting results, point to an exacerbation of gastroesophageal reflux during physical exercises. To evaluate the influence of physical activities in patients presenting with erosive and non erosive disease by ergometric stress testing and influence of the lower esophageal sphincter tonus and body mass index during this situation. Twenty-nine patients with erosive disease (group I) and 10 patients with non-erosive disease (group II) were prospectively evaluated. All the patients were submitted to clinical evaluation, followed by upper digestive endoscopy, manometry and 24 h esophageal pH monitoring. An ergometric testing was performed 1 h before removing the esophageal pH probe. During the ergometric stress testing, the following variables were analyzed: test efficacy, maximum oxygen uptake, acid reflux duration, gastroesophageal reflux symptoms, influence of the lower esophageal sphincter tonus and influence of body mass index in the occurrence of gastroesophageal reflux during these physical stress. Maximum oxigen consumption or VO 2 max, showed significant correlation when it was 70% or higher only in the erosive disease group, evaluating the patients with or without acid reflux during the ergometric testing (p=0,032). The other considered variables didn't show significant correlations between gastroesophageal reflux and physical activity (p>0,05). 1) Highly intensive physical activity can predispose the occurrence of gastroesophageal reflux episodes in gastroesophageal reflux disease patients with erosive disease; 2) light or short sessions of physical activity have no influence on reflux, regardless of body

  17. The effect of dietary carbohydrate on gastroesophageal reflux disease.

    Science.gov (United States)

    Wu, Keng-Liang; Kuo, Chung-Mou; Yao, Chih-Chien; Tai, Wei-Chen; Chuah, Seng-Kee; Lim, Chee-Sang; Chiu, Yi-Chun

    2018-01-12

    Acid changes in gastroesophageal reflux with vary component in the food have less been studied, especially carbohydrate. We plan to clarify the effect of different carbohydrate density on low esophageal acid and reflux symptoms of patients with gastroesophgeal reflux disease. Twelve patients (52 ± 12 years old; five female) with gastroesophageal reflux disease were recruited for the prospective crossover study. Each patient was invited for panendoscope, manometry and 24 h pH monitor. The two formulated liquid meal, test meal A: 500 ml liquid meal (containing 84.8 g carbohydrate) and B: same volume liquid meal (but 178.8 g carbohydrate) were randomized supplied as lunch or dinner. Reflux symptoms were recorded. There are significant statistic differences in more Johnson-DeMeester score (p = 0.019), total reflux time (%) (p = 0.028), number of reflux periods (p = 0.026) and longest reflux (p = 0.015) after high carbohydrate diet than low carbohydrate. Total reflux time and number of long reflux periods more than 5 min are significant more after high carbohydrate diet. More acid reflux symptoms are found after high carbohydrate diet. High carbohydrate diet could induce more acid reflux in low esophagus and more reflux symptoms in patients with gastroesophageal reflux disease. Copyright © 2018. Published by Elsevier B.V.

  18. Idiopathic pulmonary fibrosis is associated with increased impedance measures of reflux compared to non-fibrotic disease among pre-lung transplant patients.

    Science.gov (United States)

    Gavini, S; Finn, R T; Lo, W-K; Goldberg, H J; Burakoff, R; Feldman, N; Chan, W W

    2015-09-01

    Gastroesophageal reflux (GER) has been associated with idiopathic pulmonary fibrosis (IPF), although the mechanism remains unclear. Gastroesophageal reflux/microaspiration may lead to lung fibrosis, while increased pulmonary workload may also worsen GER. Comparing the GER profile of IPF patients to chronic obstructive pulmonary disease (COPD) patients with similar lung function may help delineate the role of GER in IPF pathogenesis. This was a retrospective cohort study of IPF and COPD patients undergoing pre-lung transplant multichannel intraluminal impedance and pH study (MII-pH) off acid suppression at a tertiary center in 2008-2014. Patients with prior fundoplication were excluded. Baseline demographics, pulmonary function test, and MII-pH results were recorded. Univariate analyses were performed using Fisher's exact (binary variables) and Student's t (continuous variables) tests. Logistic regression was performed to adjust for potential confounders. A total of 90 subjects (54 IPF, 36 COPD) met inclusion criteria. Compared to COPD, IPF patients had increased total reflux episodes (65.9 vs 46.1, p = 0.02), proximal reflux episodes (30.3 vs 20.3, p = 0.04), and prevalence of abnormal total reflux episodes (38.9% vs 16.7%, p = 0.02). On multivariate analyses, abnormal total reflux episodes (OR: 4.9, p = 0.05) and bolus reflux exposure time (OR: 4, p = 0.04) remained significantly associated with IPF. Abnormal reflux was significantly more prevalent among IPF patients after controlling for lung disease severity. Gastroesophageal reflux/microaspiration likely plays a role in fibrosis in IPF. A significant portion of IPF patients had increased non-acid reflux. Therapies aiming to prevent reflux of gastric contents may be more beneficial than antisecretory medications alone in these patients. © 2015 John Wiley & Sons Ltd.

  19. Near-wellbore modeling of a horizontal well with Computational Fluid Dynamics

    DEFF Research Database (Denmark)

    Szanyi, Márton L.; Hemmingsen, Casper Schytte; Yan, Wei

    2018-01-01

    Dynamics (CFD) is capable of modeling the complex interaction between the creeping reservoir flow and turbulent well flow for single phases, while capturing both the completion geometry and formation damage. A series of single phase steady-state simulations are undertaken, using such fully coupled three...... dimensional numerical models, to predict the inflow to the well. The present study considers the applicability of CFD for near-wellbore modeling through benchmark cases with available analytical solutions. Moreover, single phase steady-state numerical investigations are performed on a specific perforated...... horizontal well producing from the Siri field, offshore Denmark. The performance of the well is investigated with an emphasis on the inflow profile and the productivity index for different formation damage scenarios. A considerable redistribution of the inflow profile were found when the filtrate invasion...

  20. Improving the accuracy and reliability of MWD/magnetic-Wellbore-Directional surveying in the barents sea

    DEFF Research Database (Denmark)

    Edvardsen, I.; Nyrnes, E.; Johnsen, M. G.

    2014-01-01

    of nonmagnetic steel in the bottomhole assembly (BHA). To maintain azimuth uncertaintyat an acceptable level in northern areas, it is crucial that wellbore-directional-surveying requirements are given high priority and considered early during well planning. During the development phase of an oil and gas field...... magnetic-reference stations. The different land and sea configuration, distant offshore oil and gas fields, higher geomagnetic latitude, and different behavior of the magnetic field require the procedures to be reassessed before being applied to the Barents Sea. To reduce drilling delays, procedures must...... be implemented to enable efficient management of magnetic disturbances.In some areas of the Barents Sea, the management requires new equipment to be developed and tested before drilling, such as seabed magnetometer stations. One simple way to reduce drillstring interference is increasing the amount...

  1. Systematic assessment of wellbore integrity for geologic carbon storage projects using regulatory and industry information

    Energy Technology Data Exchange (ETDEWEB)

    Moody, Mark [Battelle Memorial Institute, Columbus, OH (United States); Sminchak, J.R. [Battelle Memorial Institute, Columbus, OH (United States)

    2015-11-01

    Under this three year project, the condition of legacy oil and gas wells in the Midwest United States was evaluated through analysis of well records, well plugging information, CBL evaluation, sustained casing pressure (SCP) field testing, and analysis of hypothetical CO2 test areas to provide a realistic description of wellbore integrity factors. The research included a state-wide review of oil and gas well records for Ohio and Michigan, along with more detailed testing of wells in Ohio. Results concluded that oil and gas wells are clustered along fields in areas. Well records vary in quality, and there may be wells that have not been identified in records, but there are options for surveying unknown wells. Many of the deep saline formations being considered for CO2 storage have few wells that penetrate the storage zone or confining layers. Research suggests that a variety of well construction and plugging approaches have been used over time in the region. The project concluded that wellbore integrity is an important issue for CO2 storage applications in the Midwest United States. Realistic CO2 storage projects may cover an area in the subsurface with several hundred legacy oil and gas wells. However, closer inspection may often establish that most of the wells do not penetrate the confining layers or storage zone. Therefore, addressing well integrity may be manageable. Field monitoring of SCP also indicated that tested wells provided zonal isolation of the reservoirs they were designed to isolate. Most of these wells appeared to exhibit gas pressure originating from intermediate zones. Based on these results, more flexibility in terms of cementing wells to surface, allowing well testing, and monitoring wells may aid operators in completing CO2 storage project. Several useful products were developed under this project for examining wellbore integrity for CO2 storage applications including, a

  2. Understanding acoustic physics in oil and gas wellbores with the presence of ubiquitous geometric eccentricity

    Science.gov (United States)

    Liu, Yang; D'Angelo, Ralph M.; Choi, Gloria; Zhu, Lingchen; Bose, Sandip; Zeroug, Smaine

    2018-04-01

    Once an oil and gas wellbore has been drilled, steel casings and cement slurry are placed to ensure structural support, protection from fluid invasion, and most importantly to provide zonal isolation. The actual wellbore and string structure is rarely concentric but rather is often an eccentric one, especially in deviated boreholes. The term "eccentricity" is used to describe how off-center a casing string is within another pipe or the open-hole. In a typical double-string configuration, the inner casing is eccentered with respect to the outer string which itself is also eccentered within the cylindrical hole. The annuli may or may not be filled with solid cement, and the cement may have liquid-filled channels or be disbonded over localized azimuthal ranges. The complexity of wave propagation along axial intervals is significant in that multiple modes can be excited and detected with characteristics that are affected by the various parameters, including eccentering, in a non-linear fashion. A successful diagnosis of cement flaws largely relies on a thorough understanding of the complex acoustic modal information. The present study employs both modeling and experiments to fully understand the acoustic wave propagation in the complex, fluid-solid nested, cylindrically layered structures, with geometric eccentricities. The experimental results show excellent agreement with the theoretical predictions from newly developed, borehole acoustic modeling approaches. As such, it provides the basis for better understanding the operative wave physics and providing the means for effective inspection methodologies to assess well integrity and zonal isolation of oil wells.

  3. Impact of Casing Expansion on the Mechanical and Petro-Physical Properties of Wellbore Cements

    Science.gov (United States)

    Oyibo, A. E.

    2014-12-01

    The main objective of this research is to investigate the applicability of expandable casing technology as a remediation technique for leaky wells resulting in gas migration problems. Micro annulus is usually created at the cement-formation/cement-casing interface or within the cement matrix either due to poor primary cementing or as a result of activities such as temperature and pressure variation or fracturing operations. Recent reports on gas migration in hydraulically fractured wellbores, has raised concerns on the contamination of fresh water aquifers resulting from fluid migration though this flow path. A unique bench-scale physical model which utilizes expandable tubulars in the remediation of micro annular gas flow has been used to simulate expansion of a previously-cemented casing under field-like conditions. Three different designs of cement slurry: regular 16.4 lb. /gal, 16.4 lb. /gal base slurry foamed to 13 lb. /gal and 16.4 lb. /gal cement slurry with 10% salt concentration. Gas flow path (microannulus) was artificially created at the pipe-cement interface by rotating the inner pipe in a pipe inside pipe assembly with cement in the annulus within the first few hours of hydration to create debonding at the cement-casing interface. Nitrogen gas flow-through experiments were performed before and after the expansion to confirm the sealing of the microannulus. The results obtained confirmed the effectiveness of this technique in the complete closure of gas leakage path, providing seal-tight cement-formation interface free of microannulus. The manipulation of the cement sheath during the casing expansion resulted in improved porosity, permeability and the strength of the cement sheath. SEM micrographs revealed decrease in pore size and fracturing of unhydrated cement grains within the cement matrix. This technology has great potential to become one of the leading cement remediation techniques for leaks behind the casing if implemented. Keywords: Wellbore

  4. Regional oesophageal sensitivity to acid and weakly acidic reflux in patients with non-erosive reflux disease.

    Science.gov (United States)

    Emerenziani, S; Ribolsi, M; Sifrim, D; Blondeau, K; Cicala, M

    2009-03-01

    The mechanisms underlying symptoms in non-erosive reflux disease (NERD) remain to be elucidated. Non-erosive reflux disease patients appear to be more sensitive to intraluminal stimula than erosive patients, the proximal oesophagus being the most sensitive. In order to assess regional oesophageal changes in reflux acidity and sensitivity to reflux, according either to the acidity or the composition of the refluxate, combined multiple pH and multiple pH-impedance (pH-MII) was performed in 16 NERD patients. According to multiple pH-metry, 29% and 12% of reflux events reached the middle and proximal oesophagus respectively, and 35% and 19% according to conventional pH-MII (P acid reflux became weakly acidic at the proximal oesophagus. In all patients, the frequency of symptomatic refluxes, both acid and weakly acidic, was significantly higher at the proximal, compared with distal oesophagus (25 +/- 8%vs 11 +/- 2% for acid reflux and 27 +/- 8%vs 8 +/- 2% for weakly acidic reflux; P reflux. As approximately 30% of acid reflux becomes weakly acidic along the oesophageal body, to better characterize proximal reflux, in clinical practice, combined proximal pH-impedance monitoring should be used. In NERD patients, the proximal oesophagus seems to be more sensitive to both acid and weakly acidic reflux.

  5. 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.).

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

    NARCIS (Netherlands)

    Boekema, P. J.; Samsom, M.; Smout, A. J.

    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-oesophageal acid reflux. DESIGN: A randomized, controlled, crossover

  7. Patterns of reflux in gastroesophageal reflux disease in pediatric population of New South Wales.

    Science.gov (United States)

    Narayanan, Sarath Kumar; Cohen, Ralph Clinton; Karpelowsky, Jonathan Saul

    2017-02-01

    This study is to determine the association of ambulatory pH monitoring (24hr pH) with symptoms of gastroesophageal reflux and its other investigations. The clinical and epidemiological profiles of subjects referred for reflux disorders are also studied. Symptoms or group of symptoms, profiles and prior investigations of 1259 consecutive pediatric subjects (with 1332 24hr pH studies performed) referred for evaluation of reflux disorders between 1988 and 2012 were retrospectively studied. Chi-square or fisher exact test was used for hypothesis testing, student t-test for the comparison of means and the Wilcoxon rank-sum test for comparing medians of continuous variables. Gastroesophageal reflux disease (GERD), defined as reflux causing major symptoms and complications, was diagnosed in 57.5% subjects of the total sample. Forty-three percent were girls and 56.7% were boys. The most common age group was between 4 months and 2 years (51.2%). Vomiting (64.4%) and irritability (74%) were the most common symptoms with the neurological conditions (23.2%) being the most frequent underlying condition. The parameters used in 24hr pH were significantly higher in those diagnosed with GERD (P reflux disorders. 24hr pH is reliable and should be considered routine in reflux disorders, as it identifies patients with pathologic reflux and avoids a needless surgery. © 2016 International Society for Diseases of the Esophagus.

  8. Air swallowing, belching, and reflux in patients with gastroesophageal reflux disease

    NARCIS (Netherlands)

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

    2006-01-01

    OBJECTIVES: Belching and gastroesophageal reflux share a common physiological mechanism. The aim of this study was to investigate whether air swallowing leads to both belching and reflux. METHODS: Esophageal impedance, pH, and pressure were measured during two 20-min recording periods in 12 controls

  9. Effects of lesogaberan on reflux and lower esophageal sphincter function in patients with gastroesophageal reflux disease

    NARCIS (Netherlands)

    Boeckxstaens, Guy E.; Beaumont, Hanneke; Mertens, Veerle; Denison, Hans; Ruth, Magnus; Adler, John; Silberg, Debra G.; Sifrim, Daniel

    2010-01-01

    BACKGROUND & AIMS: Transient lower esophageal sphincter relaxations (TLESRs) are a major mechanism behind reflux. This study assessed the effects of lesogaberan (AZD3355), a novel gamma-aminobutyric acid type B receptor agonist, on reflux and lower esophageal sphincter (LES) function when used as

  10. Do laryngoscopic findings reflect the characteristics of reflux in patients with laryngopharyngeal reflux?

    Science.gov (United States)

    Lee, Y C; Kwon, O E; Park, J M; Eun, Y G

    2018-02-01

    To analyse the association between 24-hour multichannel intraluminal impedance-pH (24-h MII-pH) parameters and each item of the reflux finding score (RFS) to determine whether the laryngoscopic findings of the RFS could reflect the characteristics of reflux in patients with laryngopharyngeal reflux (LPR). Prospective cohort study. Tertiary care referral medical centre. Patients complaining of LPR symptoms were evaluated via a 24-hour MII-pH. Among them, 99 patients whose LPR was confirmed via 24-hour MII-pH were enrolled in this study. Correlations between RFS ratings and 24-hour MII-pH parameters were evaluated and compared between patients with or without each laryngoscopic finding used in the RFS. Subglottic oedema had a statistically significant positive correlation with number of non-acid LPR and non-acid full column reflux events. Ventricular obliteration and posterior commissure hypertrophy showed a significant correlation with non-acid exposure time and total reflux exposure time. We also found a significant correlation between granuloma/granulation score and number of acid LPR events. The numbers of non-acid LPR and full column reflux events in patients with subglottic oedema were significantly higher than those without subglottic oedema. Among the laryngoscopic findings used in the RFS, subglottic oedema is specific for non-acid reflux episodes, and granuloma/granulation is specific for acid reflux episodes. © 2017 John Wiley & Sons Ltd.

  11. Gastroesophageal reflux disease and vocal disturbances

    Directory of Open Access Journals (Sweden)

    Maria Aparecida Coelho de Arruda Henry

    2011-06-01

    Full Text Available CONTEXT: Gastroesophageal reflux disease is a chronic disease in which gastroduodenal contents reflux into the esophagus. The clinical picture of gastroesophageal reflux disease is usually composed by heartburn and regurgitation (typical manifestations. Atypical manifestations (vocal disturbances and asthma may also be complaint. OBJECTIVE: To analyse the clinical, endoscopic, manometric and pHmetric aspects of patients suffering from gastroesophageal reflux disease associated with vocal disturbances. METHODS: Fifty patients with gastroesophageal reflux disease were studied, including 25 with vocal disturbances (group 1 - G1 and 25 without these symptoms (group 2 - G2. All patients were submitted to endoscopy, manometry and esophageal pHmetry (2 probes. The group 1 patients were submitted to videolaryngoscopy. RESULTS: Endoscopic findings: non-erosive reflux disease was observed in 95% of G1 patients and 88% of G2. Videolaryngoscopy: vocal fold congestion, asymmetry, nodules and polyps were observed in G1 patients. Manometric findings: pressure in the lower esophageal sphincter (mm Hg: 11.6 ± 5.2 in G1 and 14.0 ± 6.2 in G2 (P = 0.14; pressure in the upper esophageal sphincter (mm Hg: 58.4 ± 15.9 in G1 and 69.5 ± 30.7 in the controls. pHmetric findings: De Meester index: 34.0 ± 20.9 in G1 and 15.4 ± 9.4 in G2 (P<0.001; number of reflux episodes in distal probe: 43.0 ± 20.4 in G1 and 26.4 ± 17.2 in G2 (P = 0.003; percentage of time with esophageal pH value lower than 4 units (distal sensor: 9.0% ± 6.4% in G1 and 3.4% ± 2.1% in G2 (P<0.001; number of reflux episodes in proximal probe: 7.5 ± 10.9 in G1 and 5.3 ± 5.7 in G2 (P = 0.38; percentage of time with esophageal pH values lower than 4 units (Proximal probe: 1.2 ± 2.7 in G1 and 0.5 ± 0.7 in G2 (P = 0.21. CONCLUSIONS: 1 The clinical, endoscopic, and manometric findings observed in patients with vocal disturbance do not differ from those without these symptoms; 2 gastroesophageal

  12. Reproducibility of gastroesophageal reflux scintigraphy and the standard acid reflux test

    International Nuclear Information System (INIS)

    Kaul, B.; Petersen, H.; Grette, K.; Myrvold, H.E.

    1986-01-01

    Patients with symptoms compatible with gastroesophageal reflux (GER) disease and asymptomatic controls were evaluated three times for GER by gastroesophageal reflux scintigraphy (GES) at intervals ranging from 6 h to 15 days and after various periods of fasting. Similarly, in patients and controls, pH monitoring at the distal esophagus was conducted three times by applying the standard reflux test (SART) at intervals ranging from 4 h to 3 days after different fasting periods. In 18 of 19 patients and 14 of 15 controls the results of SART were indentical on all three occations. A similar agreement was found for GES in 23 of 25 patients and 20 of 21 controls. The reproducibility of the induced type of reflux after ingestion of acidified organic juce was significantly better than that of the spontaneous types or the induced type of reflux after ingestion of saline. It is concluded that the reproducibility of GES and SART is similatly good

  13. Reproducibility of gastroesophageal reflux scintigraphy and the standard acid reflux test

    Energy Technology Data Exchange (ETDEWEB)

    Kaul, B.; Petersen, H.; Grette, K.; Myrvold, H.E.

    1986-01-01

    Patients with symptoms compatible with gastroesophageal reflux (GER) disease and asymptomatic controls were evaluated three times for GER by gastroesophageal reflux scintigraphy (GES) at intervals ranging from 6 h to 15 days and after various periods of fasting. Similarly, in patients and controls, pH monitoring at the distal esophagus was conducted three times by applying the standard reflux test (SART) at intervals ranging from 4 h to 3 days after different fasting periods. In 18 of 19 patients and 14 of 15 controls the results of SART were indentical on all three occations. A similar agreement was found for GES in 23 of 25 patients and 20 of 21 controls. The reproducibility of the induced type of reflux after ingestion of acidified organic juce was significantly better than that of the spontaneous types or the induced type of reflux after ingestion of saline. It is concluded that the reproducibility of GES and SART is similatly good.

  14. [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.

  15. Bladder Dysfunction and Vesicoureteral Reflux

    Directory of Open Access Journals (Sweden)

    Ulla Sillén

    2008-01-01

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

  16. Radiologic quantitation of gastro-oesophageal reflux. Correlation between height of food stimulated gastro-oesophageal reflux and level of histologic changes in reflux oesophagitis

    Energy Technology Data Exchange (ETDEWEB)

    Christiansen, T.; Funch-Jensen, P.; Jacobsen, N.O.; Thommesen, P.

    In a prospective study, 26 patients with symptoms of reflux oesophagitis underwent a barium examination for gastro-oesophageal reflux after food stimulation, and endoscopy with biopsy from different levels of the oesophagus. Radiologic grading of the gastro-oesophageal reflux depending on the height of the reflux into the oesophagus was performed, and this was correlated to the microscopic appearance at different levels in the oesophagus. Complete agreement between the radiologic grading and the histology was found in 69 per cent of the cases, and when gastro-oesophageal reflux was demonstrated the agreement was 75 per cent. Accordingly, the results showed a good accordance between the two variants, indicating that the height of the reflux during the food stimulated test may be truly indicative of the reflux height under non-test conditions.

  17. Parent's Take Home Guide to GERD (Gastroesophogeal Reflux Disease)

    Science.gov (United States)

    ... or recurrent pneumonia •Hoarseness •Asthma If you have concerns, speak to your healthcare provider. SICK AND TIRED OF BEING SICK (13+ years) Reflux and your Teen Gastroesophageal Reflux (GER) occurs during or after a ...

  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. if, when and how to treat gastro-oesophageal reflux

    African Journals Online (AJOL)

    persistent occult gastro-oesophageal reflux; (iiz) persistence ... deterioration of bronchopulmonary disease. From this the reader ... problem by means of simple barium studies, to management ... Gastroesophageal reflux in the preterm infant.

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

    African Journals Online (AJOL)

    2010-01-31

    Jan 31, 2010 ... hypersensitivity.7,8. Management of GORD. Depending on how ... reflux include lifestyle changes, dietary modification and using non-prescription ... acid clearance, minimising the incidence of reflux events, or both.8 Lifestyle ...

  1. Gastropharyngeal and gastroesophageal reflux in globus and hoarseness

    NARCIS (Netherlands)

    Smit, C. F.; van Leeuwen, J. A.; Mathus-Vliegen, L. M.; Devriese, P. P.; Semin, A.; Tan, J.; Schouwenburg, P. F.

    2000-01-01

    The role of gastropharyngeal reflux in patients with globus pharyngeus and hoarseness remains unclear. To evaluate patients with complaints of globus, hoarseness, or globus and hoarseness combined for the presence of gastropharyngeal and gastroesophageal reflux. Prospective clinical cohort study of

  2. Scintigraphic diagnosis of the gastro-esophageal reflux

    Energy Technology Data Exchange (ETDEWEB)

    Pfluecke, F.; Krueger, M.; Reinke, R.; Groth, P. (Rostock Univ. (German Democratic Republic). Radiologische Klinik)

    1982-09-01

    Patients with peptic esophagitis or typical complaints with respect to reflux without esophagitis and control persons (n = 68) were comparatively examined for gastroesophageal reflux by means of scintigraphy (after administration of test solutions labelled with /sup 99m/Tc-DTPA or after intravenous application of /sup 99m/Tc-pertechnetate) and by means of continuous intraesophageal p/sub H/ measurement. The scintigraphic test of the reflux was successful for very few patients only with reflux disease and a reflux detectable by measuring the p/sub H/. The application of pentagastrin failed in improving the scintigraphic detection of the reflux. The cause of the unsuccessful scintigraphic evidence for the majority of the reflux patients seems to be the relatively small reflux volume.

  3. Scintigraphic diagnosis of the gastro-esophageal reflux

    International Nuclear Information System (INIS)

    Pfluecke, F.; Krueger, M.; Reinke, R.; Groth, P.

    1982-01-01

    Patients with peptic esophagitis or typical complaints with respect to reflux without esophagitis and control persons (n = 68) were comparatively examined for gastroesophageal reflux by means of scintigraphy (after administration of test solutions labelled with /sup 99m/Tc-DTPA or after intravenous application of /sup 99m/Tc-pertechnetate) and by means of continuous intraesophageal p/sub H/ measurement. The scintigraphic test of the reflux was successful for very few patients only with reflux disease and a reflux detectable by measuring the p/sub H/. The application of pentagastrin failed in improving the scintigraphic detection of the reflux. The cause of the unsuccessful scintigraphic evidence for the majority of the reflux patients seems to be the relatively small reflux volume

  4. Gastroesophageal reflux disease burden in Iran.

    Science.gov (United States)

    Delavari, Alireza; Moradi, Ghobad; Elahi, Elham; Moradi-Lakeh, Maziar

    2015-02-01

    Gastroesophageal reflux disease is one of the most common disorders of the gastrointestinal tract. The prevalence of this disease ranges from 5% to 20% in Asia, Europe, and North America. The aim of this study was to estimate the burden of gastroesophageal reflux disease in Iran. Burden of gastroesophageal reflux disease in Iran was estimated for one year from 21 March 2006 to 20 March 2007. The definition was adjusted with ICD-code of K21. Incident-based disability-adjusted life year (DALY) was used as the unit of analysis to quantify disease burden. A simplified disease model and DisMod II software were used for modeling. The annual incidence for total population of males and females in Iran was estimated 17.72 and 28.06 per 1000, respectively. The average duration of gastroesophageal reflux disease as a chronic condition was estimated around 10 years in both sexes. Total DALYs for an average of 59 symptomatic days per year was estimated 153,554.3 (60,330.8 for males and 93,223.5 for females).   The results of this study showed that reflux imposes high burden and high financial costs on the Iranian population. The burden of this disease in Iran is more similar to that of European countries rather than Asian countries. It is recommended to consider the disease as a public health problem and make decisions and public health plans to reduce the burden and financial costs of the disease in Iran.

  5. Association between follicular tracheitis and gastroesophageal reflux.

    Science.gov (United States)

    Duval, Melanie; Meier, Jeremy; Asfour, Fadi; Jackson, Daniel; Grimmer, J Fredrik; Muntz, Harlan R; Park, Albert H

    2016-03-01

    Follicular tracheitis (also known as tracheal cobblestoning) is an entity that is poorly described and of unclear significance. The objective of this study was to better define follicular tracheitis and determine the association between the clinical finding of follicular tracheitis on bronchoscopy and objective evidence of gastroesophageal reflux disease. Retrospective chart review of children with recurrent croup having undergone a rigid bronchoscopy and an investigation for gastroesophageal reflux between 2001 and 2013. 117 children with recurrent croup children age 6-144 months were included in the study. Follicular tracheitis was noted on 41% of all bronchoscopies. Fifty-nine percent of all children who underwent bronchoscopy were diagnosed with gastroesophageal reflux on at least one investigation. Forty-nine of 117 children underwent a pH probe study, and 51% were found to have evidence of reflux on this study. Nine children were diagnosed with eosinophilic esophagitis. Three patients underwent a biopsy of the follicular tracheitis lesions, which revealed chronic inflammation. There was no evidence of an association between findings of follicular tracheitis and a positive test for gastroesophageal reflux (p=0.52) or a positive pH probe study (p=0.64). There was no association between follicular tracheitis and subglottic stenosis (p=0.33) or an history of asthma and/or atopy (p=0.19). In children with recurrent croup, follicular tracheitis remains an unspecific finding associated with an inflammatory disorder of unknown etiology. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  6. Reflux revisited: advancing the role of pepsin.

    Science.gov (United States)

    Bardhan, Karna Dev; Strugala, Vicki; Dettmar, Peter W

    2012-01-01

    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."For now we see through a glass, darkly."-First epistle, Chapter 13, Corinthians.

  7. 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.

  8. Improving wellbore position accuracy of horizontal wells by using a continuous inclination measurement from a near bit inclination MWD sensor

    Energy Technology Data Exchange (ETDEWEB)

    Berger, P. E.; Sele, R. [Baker Hughes INTEQ (United States)

    1998-12-31

    Wellbore position calculations are typically performed by measuring azimuth and inclination at 10 to 30 meter intervals and using interpolation techniques to determine the borehole position between survey stations. The input parameters are measured depth (MD), azimuth and inclination, where the two parameters are measured with an MWD tool. Output parameters are the geometric coordinates; true value depth (TVD), north and east. By improving the accuracy of the inclination measurement reduces the uncertainty of the calculated TVD value, resulting in increased confidence in wellbore position. Significant improvements in quality control can be achieved by using multiple sensors. This paper describes a set of quality control parameters that can be used to verify individual sensor performance and a method for calculating TVD uncertainty in horizontal wells, using a single sensor or a combination of sensors. 6 refs., 5 figs.

  9. Thermal effects on fluid flow and hydraulic fracturing from wellbores and cavities in low-permeability formations

    Energy Technology Data Exchange (ETDEWEB)

    Yarlong Wang [Petro-Geotech Inc., Calgary, AB (Canada); Papamichos, Euripides [IKU Petroleum Research, Trondheim (Norway)

    1999-07-01

    The coupled heat-fluid-stress problem of circular wellbore or spherical cavity subjected to a constant temperature change and a constant fluid flow rate is considered. Transient analytical solutions for temperature, pore pressure and stress are developed by coupling conductive heat transfer with Darcy fluid flow in a poroelastic medium. They are applicable to lower permeability porous media suitable for liquid-waste disposal and also simulating reservoir for enhanced oil recovery, where conduction dominates the heat transfer process. A full range of solutions is presented showing separately the effects of temperature and fluid flow on pore pressure and stress development. It is shown that injection of warm fluid can be used to restrict fracture development around wellbores and cavities and generally to optimise a fluid injection operation. Both the limitations of the solutions and the convective flow effect are addressed. (Author)

  10. Association Between Nocturnal Acid Reflux and Sleep Disturbance in Patients With Gastroesophageal Reflux Disease.

    Science.gov (United States)

    Hung, Jui-Sheng; Lei, Wei-Yi; Yi, Chih-Hsun; Liu, Tso-Tsai; Chen, Chien-Lin

    2016-08-01

    This study was conducted to investigate whether there is a direct association between subjective sleep quality and esophageal acid reflux in patients with gastroesophageal reflux disease. We enrolled patients with classic reflux symptoms for endoscopy and ambulatory pH monitoring. The severity of esophageal mucosal injury was assessed by upper endoscopy. Distal esophageal acid exposure was determined by ambulatory 24-hour pH monitoring. Sleep disturbance was assessed by using the Pittsburgh Sleep Quality Index. In total, 103 patients (53 patients without sleep dysfunction and 50 patients with sleep dysfunction) were studied. Erosive esophagitis was found more in patients with sleep disturbance than in those without sleep disturbance (45% versus 31%, P = 0.04). Abnormal esophageal pH was found more in patients with dysfunction (22%) than in patients without sleep dysfunction (5.7%, P = 0.03). Recumbent acid contact time (%) was greater in patients with sleep disturbance than in those without sleep disturbance (3.7 ± 2.4 versus 1.9 ± 0.9, P = 0.04). Sleep quality score positively correlated with acid contact time (r = 0.32, P = 0.02), prolonged reflux events (r = 0.45, P = 0.008) and longer reflux event (r = 0.28, P = 0.03) during recumbent period. Patients with gastroesophageal reflux disease along with sleep dysfunction are characterized with greater nocturnal acid reflux and more erosive esophagitis. Our study suggests that increased nocturnal acid reflux may play a role in inducing sleep disturbance in patients with gastroesophageal reflux disease. Copyright © 2016 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.

  11. Enterogastric reflux detection with technetium-99m IDA

    International Nuclear Information System (INIS)

    Garcia, A.; Pavia, J.; Loomena, F.; Abello, R.; Herranz, R.; Setoain, J.

    1985-01-01

    A Tc-99m IDA scan was performed in a patient with severe alkaline esophagitis subsequent to a Billroth I gastroenterostomy. The scan showed enterogastric reflux simultaneously with gastroesophageal reflux of bile. The study was recorded in a computer and the reflux quantitated

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

    International Nuclear Information System (INIS)

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

    1987-01-01

    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. (orig.)

  13. The Mystery and Misery of Acid Reflux in Children

    Science.gov (United States)

    Davenport, Mike; Davenport, Tracy

    2006-01-01

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

  14. Extravesical detrusorrhaphy for vesicoureteral reflux in children.

    Science.gov (United States)

    Chung, H M; Yu, T J

    1998-03-01

    Extravesical detrusorrhaphy is a simple and safe approach to antireflux surgery; however, its use in Taiwan has seldom been reported. We report the outcomes of 15 patients (23 ureters) with primary vesicoureteral reflux who underwent extravesical detrusorrhaphy between January 1995 and April 1996, and describe the surgical technique. Overall, vesicoureteral reflux was cured in 22 of 23 ureters. Postoperative morbidity and complications were minimal. None of the patients had obstruction or significant hematuria. The discomfort related to bladder spasms during the postoperative period was subjectively decreased compared to the conventional transvesical technique. There was transient voiding inefficiency in three patients, as well as urinary retention in one, which resolved spontaneously after 4 weeks of Foley catheter drainage. Our experience showed that detrusorrhaphy is an effective way to correct vesicoureteral reflux with minimal morbidity and discomfort. Proper patient selection and strict adherence to the surgical principle are important for high success rates.

  15. Vesicoureteral reflux and continuous prophylactic antibiotics

    Directory of Open Access Journals (Sweden)

    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.

  16. 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

  17. Airway Reflux, Cough and Respiratory Disease

    Science.gov (United States)

    Molyneux, Ian D.; Morice, Alyn H.

    2011-01-01

    It is increasingly accepted that the effects of gastro-oesophageal reflux are not limited to the gastrointestinal tract. The adjacent respiratory structures are also at risk from material ejected from the proximal oesophagus as a result of the failure of anatomical and physiological barriers. There is evidence of the influence of reflux on several respiratory and otorhinological conditions and although in many cases the precise mechanism has yet to be elucidated, the association alone opens potential novel avenues of therapy to clinicians struggling to treat patients with apparently intractable respiratory complaints. This review provides a description of the airway reflux syndrome, its effects on the lung and current and future therapeutic options. PMID:23251752

  18. Gastroesophageal reflux - correlation between diagnostic methods

    International Nuclear Information System (INIS)

    Cruz, Maria das Gracas de Almeida; Penas, Maria Exposito; Fonseca, Lea Mirian Barbosa; Lemme, Eponina Maria O.; Martinho, Maria Jose Ribeiro

    1999-01-01

    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 int he 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)

  19. Hiatial hernia in gastroesophageal reflux disease

    Energy Technology Data Exchange (ETDEWEB)

    Kaul, B.; Petersen, H.; Myrvold, H.E.; Grette, K.; Roeysland, P.; Halvorsen, T.

    1986-01-01

    Upper gastrointestinal endoscopy and radiologic examination were performed in 101 patients with symptoms strongly suggestive of gastroesophageal reflux (GER) disease. Hiatus hernia (HH) was found in 50 patients diagnosed by radiography or endoscopy, or both, in 22, 19, and 9 patients respectively. Severe endoscopic esophagitis (grades III and IV) was found more often in the patients with HH than in those without. The same was true for the early positive timed acid perfusion tests. Furthermore, the patients with HH more often had reflux by the standard acid reflux test (42 og 50 versus 28 of 51, gastroesophageal scintigraphy (47 of 50 versus 40 of 51; and radiography (20 of 50 versus 2 of 51; than the patients without HH. The results show that severe GER disease can occur without an associated HH and indicate that patients with symptoms of GER disease and associated HH are likely to have a more severe GER disease than those without HH.

  20. Treatment of Post-Stent Gastroesophageal Reflux by Anti-Reflux Z-Stent

    International Nuclear Information System (INIS)

    Davies, Roger Philip; Kew, Jacqueline; Byrne, Peter D.

    2000-01-01

    Severe symptoms of heartburn and retrosternal pain consistent with gastro-esophageal reflux (GER) developed in a patient following placement of a conventional self-expanding 16-24-mm-diameter x 12-cm-long esophageal stent across the gastroesophageal junction to treat an obstructing esophageal carcinoma. A second 18-mm-diameter x 10-cm-long esophageal stent with anti-reflux valve was deployed coaxially and reduced symptomatic GER immediately. Improvement was sustained at 4-month follow-up. An anti-reflux stent can be successfully used to treat significant symptomatic GER after conventional stenting

  1. Relative permeability of fractured wellbore cement: an experimental investigation using electrical resistivity monitoring for moisture content

    Science.gov (United States)

    Um, W.; Rod, K. A.; Strickland, C. E.

    2016-12-01

    Permeability is a critical parameter needed to understand flow in subsurface environments; it is particularly important in deep subsurface reservoirs where multiphase fluid flow is common, such as carbon sequestration and geothermal reservoirs. Cement is used in the annulus of wellbores due to its low permeable properties to seal aquifers, reducing leaks to adjacent strata. Extreme subsurface environments of CO2 storage and geothermal production conditions will eventually reduce the cement integrity, propagating fracture networks and increasing the permeability for air and/or water. To date, there have been no reproducible experimental investigations of relative permeability in fractured wellbore cement published. To address this gap, we conducted a series of experiments using fractured Portland cement monoliths with increasing fracture networks. The monolith cylinder sides were jacketed with heavy-duty moisture-seal heat-shrink tubing, then fractured using shear force applied via a hydraulic press. Fractures were generated with different severity for each of three monoliths. Stainless steel endcaps were fixed to the monoliths using the same shrink-wrapped jacket. Fracture characteristics were determined using X-ray microtomography and image analysis. Flow controllers were used to control flow of water and air to supply continuous water or water plus air, both of which were delivered through the influent end cap. Effluent air flow was monitored using a flow meter, and water flow was measured gravimetrically. To monitor the effective saturation of the fractures, a RCON2 concrete bulk electrical resistivity test device was attached across both endcaps and a 0.1M NaNO3 brine was used as the transport fluid to improve resistivity measurements. Water content correlated to resistivity measurements with a r2 > 0.96. Data from the experiments was evaluated using two relative permeability models, the Corey-curve, often used for modeling relative permeability in porous media

  2. The Development of a Gas-Liquid Two-Phase Flow Sensor Applicable to CBM Wellbore Annulus.

    Science.gov (United States)

    Wu, Chuan; Wen, Guojun; Han, Lei; Wu, Xiaoming

    2016-11-18

    The measurement of wellbore annulus gas-liquid two-phase flow in CBM (coalbed methane) wells is of great significance for reasonably developing gas drainage and extraction processes, estimating CBM output, judging the operating conditions of CBM wells and analyzing stratum conditions. Hence, a specially designed sensor is urgently needed for real-time measurement of gas-liquid two-phase flow in CBM wellbore annulus. Existing flow sensors fail to meet the requirements of the operating conditions of CBM wellbore annulus due to such factors as an inapplicable measurement principle, larger size, poor sealability, high installation accuracy, and higher requirements for fluid media. Therefore, based on the principle of a target flowmeter, this paper designs a new two-phase flow sensor that can identify and automatically calibrate different flow patterns of two-phase flows. Upon the successful development of the new flow sensor, lab and field tests were carried out, and the results show that the newly designed sensor, with a measurement accuracy of ±2.5%, can adapt to the operating conditions of CBM wells and is reliable for long-term work.

  3. The Development of a Gas–Liquid Two-Phase Flow Sensor Applicable to CBM Wellbore Annulus

    Directory of Open Access Journals (Sweden)

    Chuan Wu

    2016-11-01

    Full Text Available The measurement of wellbore annulus gas–liquid two-phase flow in CBM (coalbed methane wells is of great significance for reasonably developing gas drainage and extraction processes, estimating CBM output, judging the operating conditions of CBM wells and analyzing stratum conditions. Hence, a specially designed sensor is urgently needed for real-time measurement of gas–liquid two-phase flow in CBM wellbore annulus. Existing flow sensors fail to meet the requirements of the operating conditions of CBM wellbore annulus due to such factors as an inapplicable measurement principle, larger size, poor sealability, high installation accuracy, and higher requirements for fluid media. Therefore, based on the principle of a target flowmeter, this paper designs a new two-phase flow sensor that can identify and automatically calibrate different flow patterns of two-phase flows. Upon the successful development of the new flow sensor, lab and field tests were carried out, and the results show that the newly designed sensor, with a measurement accuracy of ±2.5%, can adapt to the operating conditions of CBM wells and is reliable for long-term work.

  4. The Development of a Gas–Liquid Two-Phase Flow Sensor Applicable to CBM Wellbore Annulus

    Science.gov (United States)

    Wu, Chuan; Wen, Guojun; Han, Lei; Wu, Xiaoming

    2016-01-01

    The measurement of wellbore annulus gas–liquid two-phase flow in CBM (coalbed methane) wells is of great significance for reasonably developing gas drainage and extraction processes, estimating CBM output, judging the operating conditions of CBM wells and analyzing stratum conditions. Hence, a specially designed sensor is urgently needed for real-time measurement of gas–liquid two-phase flow in CBM wellbore annulus. Existing flow sensors fail to meet the requirements of the operating conditions of CBM wellbore annulus due to such factors as an inapplicable measurement principle, larger size, poor sealability, high installation accuracy, and higher requirements for fluid media. Therefore, based on the principle of a target flowmeter, this paper designs a new two-phase flow sensor that can identify and automatically calibrate different flow patterns of two-phase flows. Upon the successful development of the new flow sensor, lab and field tests were carried out, and the results show that the newly designed sensor, with a measurement accuracy of ±2.5%, can adapt to the operating conditions of CBM wells and is reliable for long-term work. PMID:27869708

  5. Application of Neutron imaging in pore structure of hydrated wellbore cement: comparison of hydration of H20 with D2O based Portland cements

    Science.gov (United States)

    Dussenova, D.; Bilheux, H.; Radonjic, M.

    2012-12-01

    Wellbore Cement studies have been ongoing for decades. The studies vary from efforts to reduce permeability and resistance to corrosive environment to issues with gas migration also known as Sustained Casing Pressure (SCP). These practical issues often lead to health and safety problems as well as huge economic loss in oil and gas industry. Several techniques have been employed to reduce the impact of gas leakage. In this study we purely focus on expandable liners, which are introduced as part of oil well reconstruction and work-overs and as well abandonment procedures that help in prevention of SCP. Expandable liner is a tube that after application of a certain tool can increase its diameter. The increase in diameter creates extra force on hydrated cement that results in reducing width of interface fractures and cement-tube de-bonding. Moreover, this also causes cement to change its microstructure and other porous medium properties, primarily hydraulic conductivity. In order to examine changes before and after operations, cement pore structure must be well characterized and correlated to cement slurry design as well as chemical and physical environmental conditions. As modern oil well pipes and tubes contain iron, it is difficult to perform X-ray tomography of a bulk measurement of the cement in its wellbore conditions, which are tube wall-cement-tube wall. Neutron imaging is a complementary technique to x-ray imaging and is well suited for detection of light elements imbedded in metallic containers. Thus, Neutron Imaging (NI) is investigated as a tool for the detection of pore structure of hydrated wellbore cement. Recent measurements were conducted at the Oak Ridge National Laboratory (ORNL) High Flux Isotope Reactor (HFIR) neutron imaging facility. NI is is highly sensitive to light elements such as Hydrogen (H). Oil well cements that have undergone a full hydration contain on average 30%-40% of free water in its pore structure. The unreacted water is the main

  6. Association between nocturnal bruxism and gastroesophageal reflux.

    Science.gov (United States)

    Miyawaki, Shouichi; Tanimoto, Yuko; Araki, Yoshiko; Katayama, Akira; Fujii, Akihito; Takano-Yamamoto, Teruko

    2003-11-01

    To examine the relationship between nocturnal bruxism and gastroesophageal reflux. Controlled descriptive study and double-blind, placebo-controlled, clinical study. Portable pH monitoring, electromyography, and audio-video recordings were conducted during the night in the subjects' home. Ten patients with bruxism and 10 normal subjects were matched for height, weight, age, and sex. They did not have symptoms of gastroesophageal reflux disease. Medication with a proton pump inhibitor (ie, a gastric-acid-inhibiting drug). The bruxism group showed a significantly higher frequency of nocturnal rhythmic masticatory muscle activity (RMMA) episodes (mean +/- SD: 6.7 +/- 2.2 times per hour) and a higher frequency and percentage of time of gastroesophageal reflux episodes with a pH less than 4.0 and 5.0 (0.5 +/- 0.9 and 3.6 +/- 1.6 times per hour and 1.3% +/- 2.5% and 7.4% +/- 12.6%, respectively) than the control group (RMMA episodes: 2.4 +/- 0.9 times per hour; gastroesophageal reflux episodes: 0.0 +/- 0.0 and 0.1 +/- 0.3 times per hour and 0.0% +/- 0.0% and 0.0% +/- 0.0%, respectively). In the bruxism group, 100% of the gastroesophageal reflux episodes with a pH less than 3.0 and 4.0 included both an RMMA episode and an electromyographic burst, the duration of which was approximately 0.5 to 1.0 seconds, probably representing swallowing of saliva. The majority of gastroesophageal reflux episodes with a pH of 4.0 to 5.0 also included both an RMMA episode and an electromyographic burst in the control and bruxism groups (100% +/- 0.0% vs 70.7% +/- 16.5%), again probably due to swallowing of saliva. The remaining minority of gastroesophageal reflux episodes with a pH of 4.0 to 5.0 contained only an electromyographic burst (swallowing of saliva). The frequency of RMMA episodes after the release of the medication from the proton pump inhibitor, which increased the gastric and esophageal pH, was significantly lower than that after administration of the placebo in the control

  7. Physiology and pathogenesis of gastroesophageal reflux disease.

    Science.gov (United States)

    Mikami, Dean J; Murayama, Kenric M

    2015-06-01

    Gastroesophageal reflux disease (GERD) is one of the most common problems treated by primary care physicians. Almost 20% of the population in the United States experiences occasional regurgitation, heartburn, or retrosternal pain because of GERD. Reflux disease is complex, and the physiology and pathogenesis are still incompletely understood. However, abnormalities of any one or a combination of the three physiologic processes, namely, esophageal motility, lower esophageal sphincter function, and gastric motility or emptying, can lead to GERD. There are many diagnostic and therapeutic approaches to GERD today, but more studies are needed to better understand this complex disease process. Copyright © 2015 Elsevier Inc. All rights reserved.

  8. Gastroesophageal Reflux: Regurgitation in the Infant Population.

    Science.gov (United States)

    Ferguson, Teresa D

    2018-03-01

    Gastroesophageal reflux (GER) is common in infancy and mainly treated through nonpharmacological interventions. Knowing the early warning signs of GER is important for nursing assessment. Untreated GER can become acute when an infant fails to gain weight and has recurrent, forceful vomiting. Further investigation of gastroesophageal reflux disease (GERD) is indicated when failure to gain weight, irritability, swallowing difficulties, regurgitation, and respiratory complications occur and should trigger referral to pediatric specialists. This article will share information about uncomplicated GER, GERD, and symptoms of these diagnoses, common screening tests, and treatment options. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Gastroesophageal reflux and respiratory diseases in children

    International Nuclear Information System (INIS)

    Fatima, S.; Saeed, M.A.; Jafri, S.R.A.; Raza, M.; Kundi, Z.U.; Hyder, S.W.

    2002-01-01

    The association of gastroesophageal reflux disease and its pulmonary manifestation is well known however the exact underlying mechanism is unclear. The medical literature is deluged with studies on relationship between Gear and its pulmonary manifestations. The aim of this study was to 1) determine prevalence of GER in children with rLRTI, wheezing and asthma. 2) determine prevalence of asymptomatic respiratory anomalies in children with clinical reflux 3) determine effectiveness of anti-reflux therapy in clinical control of asthma, wheezing and rLRTI. Children were included in the study if they presented either with rLRTI, wheezing, Bronchial asthma or Clinical suspicion of GER without any respiratory symptoms. The GER study comprised esophageal transit, gastroesophageal reflux and lung aspiration studies. Acquisition and processing were according to predetermined protocol. Segmental and global esophageal transit times, GER according to duration of episode and volume of refluxed liquid, Reflux severity, Gastric retention at 30 minutes, Gastric emptying time, Presence of lung aspiration were calculated for each study. All children underwent Barium studies on a separate day. Clinical follow-up was done every 3 months and GER study was repeated every 6 months up to one year. The patient's therapy was determined by local protocols at discretion of clinicians. GER scintigraphy was performed in 43 patients (age range 5 months -12 years). Gastroesophageal reflux of varying degrees was observed in 10 children (23.25%) in all groups. The severity of clinical symptoms was directly related to severity of GER. The direct correlation was found between GER and reflux index. The results of GER scintigraphy were compared with Barium studies and results were found to be superior in terms of sensitivity, specificity and accuracy in detecting disease. It was possible to objectively evaluate and monitor response to therapy after medical treatment in few cases with help of follow

  10. Gastroesophageal scintigraphy for diagnosis of gastroesophageal reflux

    Energy Technology Data Exchange (ETDEWEB)

    Ishihara, Michiomi; Aoki, Nobuhiko; Imura, Souichi; Eguchi, Hiroyuki; Tamamoto, Humihiko [Tokyo Metropolitan Otsuka Hospital (Japan)

    1995-06-01

    {sup 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).

  11. 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)

  12. Prevention

    DEFF Research Database (Denmark)

    Halken, S; Høst, A

    2001-01-01

    , breastfeeding should be encouraged for 4-6 months. In high-risk infants a documented extensively hydrolysed formula is recommended if exclusive breastfeeding is not possible for the first 4 months of life. There is no evidence for preventive dietary intervention neither during pregnancy nor lactation...... populations. These theories remain to be documented in proper, controlled and prospective studies. Breastfeeding and the late introduction of solid foods (>4 months) is associated with a reduced risk of food allergy, atopic dermatitis, and recurrent wheezing and asthma in early childhood. In all infants....... Preventive dietary restrictions after the age of 4-6 months are not scientifically documented....

  13. 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

  14. 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

  15. Nanostructural control of methane release in kerogen and its implications to wellbore production decline

    Science.gov (United States)

    Ho, Tuan Anh; Criscenti, Louise J.; Wang, Yifeng

    2016-06-01

    Despite massive success of shale gas production in the US in the last few decades there are still major concerns with the steep decline in wellbore production and the large uncertainty in a long-term projection of decline curves. A reliable projection must rely on a mechanistic understanding of methane release in shale matrix-a limiting step in shale gas extraction. Using molecular simulations, we here show that methane release in nanoporous kerogen matrix is characterized by fast release of pressurized free gas (accounting for ~30-47% recovery) followed by slow release of adsorbed gas as the gas pressure decreases. The first stage is driven by the gas pressure gradient while the second stage is controlled by gas desorption and diffusion. We further show that diffusion of all methane in nanoporous kerogen behaves differently from the bulk phase, with much smaller diffusion coefficients. The MD simulations also indicate that a significant fraction (3-35%) of methane deposited in kerogen can potentially become trapped in isolated nanopores and thus not recoverable. Our results shed a new light on mechanistic understanding gas release and production decline in unconventional reservoirs. The long-term production decline appears controlled by the second stage of gas release.

  16. Polymer nanocomposites for sealing microannulus cracks in wellbores cement-steel interface

    Science.gov (United States)

    Genedy, M.; Fernandez, S. G.; Stormont, J.; Matteo, E. N.; Dewers, T. A.; Reda Taha, M.

    2017-12-01

    Seal integrity of production and storage wellbores has become a critical challenge with the increasing oil and gas leakage incidents. The general consensus is that one of the potential leakage pathways is micro-annuli at the cement-steel interface. In this paper, we examine the efficiency of proposed polymer nanocomposite to seal microannulus cracks at the cement-steel interface. The repair material efficiency is defined as the ability of the repair material to reduce or eliminate the gas permeability of the cement-steel interface. The flow rate of an inert gas (Nitrogen) at the cement-steel interface was investigated for three cases: 1) repaired test samples with traditional repair material (microfine cement), 2) polymer nanocomposites, and 3) unrepaired test samples. Flow rates were measured and compared for all three cases. The experimental results show up to 99.5% seal efficiency achieved by using polymer nanocomposites compared to 20% efficiency achieved in the case of microfine cement. Sandia National Laboratories is a multimission laboratory managed and operated by National Technology and Engineering Solutions of Sandia, LLC., a wholly owned subsidiary of Honeywell International, Inc., for the U.S. Department of Energy's National Nuclear Security Administration under contract DE-NA-0003525. SAND2017-8094 A.

  17. Defining the Brittle Failure Envelopes of Individual Reaction Zones Observed in CO2-Exposed Wellbore Cement.

    Science.gov (United States)

    Hangx, Suzanne J T; van der Linden, Arjan; Marcelis, Fons; Liteanu, Emilia

    2016-01-19

    To predict the behavior of the cement sheath after CO2 injection and the potential for leakage pathways, it is key to understand how the mechanical properties of the cement evolves with CO2 exposure time. We performed scratch-hardness tests on hardened samples of class G cement before and after CO2 exposure. The cement was exposed to CO2-rich fluid for one to six months at 65 °C and 8 MPa Ptotal. Detailed SEM-EDX analyses showed reaction zones similar to those previously reported in the literature: (1) an outer-reacted, porous silica-rich zone; (2) a dense, carbonated zone; and (3) a more porous, Ca-depleted inner zone. The quantitative mechanical data (brittle compressive strength and friction coefficient) obtained for each of the zones suggest that the heterogeneity of reacted cement leads to a wide range of brittle strength values in any of the reaction zones, with only a rough dependence on exposure time. However, the data can be used to guide numerical modeling efforts needed to assess the impact of reaction-induced mechanical failure of wellbore cement by coupling sensitivity analysis and mechanical predictions.

  18. Flexible cement improves wellbore integrity for steam assisted gravity drainage SAGD wells

    Energy Technology Data Exchange (ETDEWEB)

    DeBruijn, G.; Whitton, S.; Redekopp, D. [Society of Petroleum Engineers, Canadian Section, Calgary, AB (Canada)]|[Schlumberger Canada Ltd., Calgary, AB (Canada); Siso, C. [ConocoPhillips Canada Resources Corp., Calgary, AB (Canada); Reinheimer, D. [Schlumberger Canada Ltd., Calgary, AB (Canada)

    2008-10-15

    Cement sheath integrity is an important factor in ensuring the zonal isolation of wells. Significant stresses are placed on the cement sheaths of wells during steam assisted gravity drainage (SAGD) processes, as the expanded forces from the heating of the well are transferred to the cement sheath, which places a tensile load on the cement at the sheath's outer edge. In this study, a computerized simulation was conducted to examine stresses in a novel flexible cement sheath system during an SAGD heat-up cycle. Wellbore temperature was increased from 10 degrees C to 250 degrees C over a period of 720 minutes. Pressure was increased from 0 MPa to 5 MPa. The finite element model was used to predict microannulus, cement failure in compression, and cement failure in tension. A sensitivity analysis was used to estimate the effect of different parameters as well as to estimate the value of the Young's modulus of the shale. Results of the study showed that temperature and pressure dynamics have a significant impact on stresses in the cement sheath. An extended heat-up period resulted in reduced stresses to the sheath. Lower operating pressures also reduced stresses. It was concluded that pressure and temperature increases should be extended over a long a period as possible in order to reduce stresses. Results suggested that a flexible cement system with a low Young's modulus is suitable for SAGD wells. 8 refs., 2 tabs., 6 figs.

  19. Sexual activity does not predispose to reflux episodes in patients with gastroesophageal reflux disease

    Science.gov (United States)

    Bor, Serhat; Valytova, Elen; Yildirim, Esra; Vardar, Rukiye

    2014-01-01

    Background The role of sexual activity on gastroesophageal reflux disease (GERD) is an under-recognized concern of patients, and one rarely assessed by physicians. Objective The objective of this article is to determine the influence of sexual activity on the intraesophageal acid exposure and acid reflux events in GERD patients. Methods Twenty-one patients with the diagnosis of GERD were prospectively enrolled. Intraesophageal pH monitoring was recorded for 48 hours with a Bravo capsule. All patients were instructed to have sexual intercourse or abstain in a random order two hours after the same refluxogenic dinner within two consecutive nights. Patients were requested to have sex in the standard “missionary position” and women were warned to avoid abdominal compression. The patients completed a diary reporting the time of the sexual intercourse and GERD symptoms. The percentage of reflux time and acid reflux events were compared in two ways: within 30 and 60 minutes prior to and after sexual intercourse on the day of sexual intercourse and in the same time frame of the day without sexual intercourse. Results Fifteen of 21 GERD patients were analyzed. The percentage of reflux time and number of acid reflux events did not show a significant difference within the 30- and 60-minute periods prior to and after sexual intercourse on the day of sexual intercourse and on the day without sexual intercourse, as well. Conclusion Sexual activity does not predispose to increased intraesophageal acid exposure and acid reflux events. Larger studies are needed to confirm our findings in patients who define reflux symptoms during sexual intercourse. PMID:25452843

  20. Gastroesophageal Reflux Management with the LINX® System for Gastroesophageal Reflux Disease Following Laparoscopic Sleeve Gastrectomy.

    Science.gov (United States)

    Desart, Kenneth; Rossidis, Georgios; Michel, Michael; Lux, Tamara; Ben-David, Kfir

    2015-10-01

    Laparoscopic sleeve gastrectomy (LSG) has gained significant popularity in the USA, and consequently resulted in patients experiencing new-onset gastroesophageal reflux disease (GERD) following this bariatric procedure. Patients with GERD refractory to medical therapy present a more challenging situation limiting the surgical options to further treat the de novo GERD symptoms since the gastric fundus to perform a fundoplication is no longer an option. The aim of this study is to determine if the LINX® magnetic sphincter augmentation system is a safe and effective option for patients with new gastroesophageal reflux disease following laparoscopic sleeve gastrectomy. This study was conducted at the University Medical Center. This is a retrospective review of seven consecutive patients who had a laparoscopic LINX® magnetic sphincter device placement for patients with refractory gastroesophageal reflux disease after laparoscopic sleeve gastrectomy between July 2014 and April 2015. All patients were noted to have self-reported greatly improved gastroesophageal reflux symptoms 2-4 weeks after their procedure. They were all noted to have statistically significant improved severity and frequency of their reflux, regurgitation, epigastric pain, sensation of fullness, dysphagia, and cough symptoms in their postoperative GERD symptoms compared with their preoperative evaluation. This is the first reported pilot case series, illustrating that the LINX® device is a safe and effective option in patients with de novo refractory gastroesophageal reflux disease after a laparoscopic sleeve gastrectomy despite appropriate weight loss.

  1. 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

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

    OpenAIRE

    Siregar, Gontar Alamsyah; Halim, Sahat; Sitepu, Ricky Rivalino

    2015-01-01

    ABSTRACT Background: There are many questionnaires that have been developed to diagnose gastroesophageal reflux disease (GERD), i.e. reflux disease questionnaire (RDQ), and the recently developed, gastroesophageal reflux disease questionnaires (GerdQ). In this study, we tried to compare GerdQ and RDQ in terms of sensitivity and specificity to diagnose GERD and its relationship with endoscopic findings. Method: This study was a cross sectional analytical study. Subsequently, all the subj...

  3. Esophageal Sphincter Device for Gastroesophageal Reflux Disease

    NARCIS (Netherlands)

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

    2013-01-01

    BACKGROUND Patients with gastroesophageal reflux disease who have a partial response to proton-pump inhibitors often seek alternative therapy. We evaluated the safety and effectiveness of a new magnetic device to augment the lower esophageal sphincter. METHODS We prospectively assessed 100 patients

  4. 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

  5. Gastroesophageal reflux disease and Barrett's Esophagus

    NARCIS (Netherlands)

    Bergman, J. J. G. H. M.

    2005-01-01

    Several articles have been published during the last year that may affect the management of patients with gastroesophageal reflux disease (GERD) and/or Barrett's esophagus in the near future. A new method of measuring esophageal pH has been introduced that does not require an indwelling transnasal

  6. Spatiotemporal characteristics of physiological gastroesophageal reflux

    NARCIS (Netherlands)

    Weusten, B. L.; Akkermans, L. M.; vanBerge-Henegouwen, G. P.; Smout, A. J.

    1994-01-01

    Recent technological developments have made it possible to measure intraluminal pH simultaneously at multiple sites using one single small-caliber catheter. The aim of this study was to investigate the dynamics of physiological gastroesophageal reflux in eight ambulatory healthy volunteers (age

  7. 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.

  8. 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.

  9. Experimental and theoretical study of reflux condensation

    Energy Technology Data Exchange (ETDEWEB)

    Bakke, Knut

    1997-12-31

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

  10. Experimental pancreatitis in the rat: role of bile reflux in sodium taurocholate-induced acute haemorrhagic pancreatitis

    NARCIS (Netherlands)

    Lange, J. F.; van Gool, J.; Tytgat, G. N.

    1986-01-01

    Mortality of sodium taurocholate-induced acute haemorrhagic pancreatitis in the rat was prevented by biliary diversion. Bile reflux into the pancreas after the induction of pancreatitis is postulated to be a major factor affecting mortality of this popular model of acute pancreatitis. The reduction

  11. AREA 2: Novel Materials for Robust Repair of Leaky Wellbores in CO2 Storage Formations

    Energy Technology Data Exchange (ETDEWEB)

    Balhoff, Matthew [Univ. of Texas, Austin, TX (United States); Tavassoli, Shayan [Univ. of Texas, Austin, TX (United States); Fei Ho, Jostine [Univ. of Texas, Austin, TX (United States)

    2016-01-31

    cement cores to remove calcium and prevent syneresis during polymer placement. A chelating agent, sodium triphosphate (Na5P3O10), was found to successfully eliminate syneresis without compromising the injectivity of polymer solution during placement. Polymer gel strength is determined by recording the maximum holdback pressure gradients during liquid breakthrough tests after various periods of pretreatment and polymer shut-in time. Cores pretreated with Na5P3O10 successfully held up to an average of 80 psi/ft, which is significantly greater than the expected threshold value of about 0.1-5 psi/ft required to prevent flow in a typical CO2 leakage scenario. The use of such inexpensive, pH-triggered poly-acrylic acid polymer allows long-term robust seal of leaky wellbores under high pH conditions.

  12. Numerical simulation in steam injection wellbores by mechanistic approach; Simulacao numerica do escoamento de vapor em pocos por uma abordagem mecanicista

    Energy Technology Data Exchange (ETDEWEB)

    Souza Junior, J.C. de; Campos, W.; Lopes, D.; Moura, L.S.S. [PETROBRAS, Rio de Janeiro, RJ (Brazil); Thomas, A. Clecio F. [Universidade Estadual do Ceara (UECE), CE (Brazil)

    2008-07-01

    This work addresses to the development of a hydrodynamic and heat transfer mechanistic model for steam flow in injection wellbores. The problem of two-phase steam flow in wellbores has been solved recently by using available empirical correlations from petroleum industry (Lopes, 1986) and nuclear industry (Moura, 1991).The good performance achieved by mechanistic models developed by Ansari (1994), Hasan (1995), Gomez (2000) and Kaya (2001) supports the importance of the mechanistic approach for the steam flow problem in injection wellbores. In this study, the methodology to solve the problem consists in the application of a numerical method to the governing equations of steam flow and a marching algorithm to determine the distribution of the pressure and temperature along the wellbore. So, a computer code has been formulated to get numerical results, which provides a comparative study to the main models found in the literature. Finally, when compared to available field data, the mechanistic model for downward vertical steam flow in wellbores gave better results than the empirical correlations. (author)

  13. Incorporating electrokinetic effects in the porochemoelastic inclined wellbore formulation and solution

    Directory of Open Access Journals (Sweden)

    Vinh X. Nguyen

    2010-03-01

    Full Text Available The porochemoelectroelastic analytical models and solutions have been used to describe the response of chemically active and electrically charged saturated porous media such as clays, shales, and biological tissues. However, these attempts have been restricted to one-dimensional consolidation problems, which are very limited in practice and not general enough to serve as benchmark solutions for numerical validation. This work summarizes the general linear porochemoelectroelastic formulation and presents the solution of an inclined wellbore drilled in a fluid-saturated chemically active and ionized formation, such as shale, and subjected to a three-dimensional in-situ state of stress. The analytical solution to this geometry incorporates the coupled solid deformation and simultaneous fluid/ion flows induced by the combined influences of pore pressure, chemical potential, and electrical potential gradients under isothermal conditions. The formation pore fluid is modeled as an electrolyte solution comprised of a solvent and one type of dissolved cation and anion. The analytical approach also integrates into the solution the quantitative use of the cation exchange capacity (CEC commonly obtained from laboratory measurements on shale samples. The results for stresses and pore pressure distributions due to the coupled electrochemical effects are illustrated and plotted in the vicinity of the inclined wellbore and compared with the classical porochemoelastic and poroelastic solutions.Modelos analíticos poroelásticos incluindo acoplamento químico e elétrico e soluções têm sido utilizados paradescrever a resposta de meios porosos saturados ativos química e eletricamente tais como argilas, folhelhos e tecidos biológicos. Entretanto tais tentativas têm sido restritas a problemas de consolidação unidimensional os quais exibem limitações na prática não constituindo exemplos realistas para validação de soluções numéricas. Este trabalho

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

    Science.gov (United States)

    Li, Chung-Hsien; Hsieh, Tsung-Cheng; Hsiao, Tsung-Hsien; Wang, Pin-Chao; Tseng, Tai-Chung; Lin, Hans Hsienhong; Wang, Chia-Chi

    2015-06-01

    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 2(nd) 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. Copyright © 2015. Published by Elsevier Taiwan.

  15. 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.

  16. Systematic review: relationships between sleep and gastro-oesophageal reflux.

    Science.gov (United States)

    Dent, J; Holloway, R H; Eastwood, P R

    2013-10-01

    Gastro-oesophageal reflux disease (GERD) adversely impacts on sleep, but the mechanism remains unclear. To review the literature concerning gastro-oesophageal reflux during the sleep period, with particular reference to the sleep/awake state at reflux onset. Studies identified by systematic literature searches were assessed. Overall patterns of reflux during the sleep period show consistently that oesophageal acid clearance is slower, and reflux frequency and oesophageal acid exposure are higher in patients with GERD than in healthy individuals. Of the 17 mechanistic studies identified by the searches, 15 reported that a minority of reflux episodes occurred during stable sleep, but the prevailing sleep state at the onset of reflux in these studies remains unclear owing to insufficient temporal resolution of recording or analysis methods. Two studies, in healthy individuals and patients with GERD, analysed sleep and pH with adequate resolution for temporal alignment of sleep state and the onset of reflux: all 232 sleep period reflux episodes evaluated occurred during arousals from sleep lasting less than 15 s or during longer duration awakenings. Six mechanistic studies found that transient lower oesophageal sphincter relaxations were the most common mechanism of sleep period reflux. Contrary to the prevailing view, subjective impairment of sleep in GERD is unlikely to be due to the occurrence of reflux during stable sleep, but could result from slow clearance of acid reflux that occurs during arousals or awakenings from sleep. Definitive studies are needed on the sleep/awake state at reflux onset across the full GERD spectrum. © 2013 John Wiley & Sons Ltd.

  17. Wellbore cement fracture evolution at the cement–basalt caprock interface during geologic carbon sequestration

    Energy Technology Data Exchange (ETDEWEB)

    Jung, Hun Bok; Kabilan, Senthil; Carson, James P.; Kuprat, Andrew P.; Um, Wooyong; Martin, Paul F.; Dahl, Michael E.; Kafentzis, Tyler A.; Varga, Tamas; Stephens, Sean A.; Arey, Bruce W.; Carroll, KC; Bonneville, Alain; Fernandez, Carlos A.

    2014-08-07

    Composite Portland cement-basalt caprock cores with fractures, as well as neat Portland cement columns, were prepared to understand the geochemical and geomechanical effects on the integrity of wellbores with defects during geologic carbon sequestration. The samples were reacted with CO2-saturated groundwater at 50 ºC and 10 MPa for 3 months under static conditions, while one cement-basalt core was subjected to mechanical stress at 2.7 MPa before the CO2 reaction. Micro-XRD and SEM-EDS data collected along the cement-basalt interface after 3-month reaction with CO2-saturated groundwater indicate that carbonation of cement matrix was extensive with the precipitation of calcite, aragonite, and vaterite, whereas the alteration of basalt caprock was minor. X-ray microtomography (XMT) provided three-dimensional (3-D) visualization of the opening and interconnection of cement fractures due to mechanical stress. Computational fluid dynamics (CFD) modeling further revealed that this stress led to the increase in fluid flow and hence permeability. After the CO2-reaction, XMT images displayed that calcium carbonate precipitation occurred extensively within the fractures in the cement matrix, but only partially along the fracture located at the cement-basalt interface. The 3-D visualization and CFD modeling also showed that the precipitation of calcium carbonate within the cement fractures after the CO2-reaction resulted in the disconnection of cement fractures and permeability decrease. The permeability calculated based on CFD modeling was in agreement with the experimentally determined permeability. This study demonstrates that XMT imaging coupled with CFD modeling represent a powerful tool to visualize and quantify fracture evolution and permeability change in geologic materials and to predict their behavior during geologic carbon sequestration or hydraulic fracturing for shale gas production and enhanced geothermal systems.

  18. 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

  19. 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

  20. The effect of baclofen on gastro-oesophageal reflux, lower oesophageal sphincter function and reflux symptoms in patients with reflux disease

    NARCIS (Netherlands)

    van Herwaarden, M. A.; Samsom, M.; Rydholm, H.; Smout, A. J. P. M.

    2002-01-01

    BACKGROUND: Baclofen decreases gastro-oesophageal reflux episodes in healthy subjects by reducing the incidence of transient lower oesophageal sphincter relaxations. AIM: To investigate the effect of baclofen on reflux symptoms, oesophageal pH and lower oesophageal sphincter manometry in patients

  1. Respiratory and laryngeal symptoms secondary to gastro-oesophageal reflux

    Science.gov (United States)

    Rafferty, G; Mainie, I; McGarvey, L P A

    2011-01-01

    Gastro-oesophageal reflux may cause a range of laryngeal and respiratory symptoms. Mechanisms responsible include the proximal migration of gastric refluxate beyond the upper oesophageal sphincter causing direct irritation of the larynx and lower airway. Alternatively, refluxate entering the distal oesophagus alone may stimulate oesophageal sensory nerves and indirectly activate airway reflexes such as cough and bronchospasm. Recognising reflux as a cause for these extraoesophageal symptoms can be difficult as many patients do not have typical oesophageal symptoms (eg, heartburn) and clinical findings on laryngoscopy are not very specific. Acid suppression remains an effective treatment in the majority of patients but there is growing appreciation of the need to consider and treat non-acid and volume reflux. New opinions about the role of existing medical and surgical (laparoscopic techniques) treatment are emerging and a number of novel anti-reflux treatments are under development. PMID:28839612

  2. 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.

  3. Gastroesophageal Reflux Disease and Sleeve Gastrectomy.

    Science.gov (United States)

    Melissas, John; Braghetto, Italo; Molina, Juan Carlos; Silecchia, Gianfranco; Iossa, Angelo; Iannelli, Antonio; Foletto, Mirto

    2015-12-01

    Gastroesophageal reflux disease (GERD) and/or hiatus hernia (HH) are one of the most common disorders of the upper gastrointestinal tract. Despite the positive effect of sleeve gastrectomy (SG) regarding weight loss and improvement in obesity co-morbidities, there are concerns about the development of de novo gastroesophageal reflux disease or worsening the existing GERD after this bariatric operation. Furthermore, controversy exists on the consequences of SG in lower esophageal sphincter function and about the ideal procedure when a hiatus hernia is preoperatively diagnosed or discovered during the laparoscopic SG. This review systematically investigates the incidence, the pathophysiology of GERD and/or HH in morbidly obese individuals before and after SG, and the treatment options for concomitant HH repair during laparoscopic sleeve gastrectomy.

  4. Gastro-Esophageal Reflux in Children

    Directory of Open Access Journals (Sweden)

    Anna Rybak

    2017-08-01

    Full Text Available Gastro-esophageal reflux (GER is common in infants and children and has a varied clinical presentation: from infants with innocent regurgitation to infants and children with severe esophageal and extra-esophageal complications that define pathological gastro-esophageal reflux disease (GERD. Although the pathophysiology is similar to that of adults, symptoms of GERD in infants and children are often distinct from classic ones such as heartburn. The passage of gastric contents into the esophagus is a normal phenomenon occurring many times a day both in adults and children, but, in infants, several factors contribute to exacerbate this phenomenon, including a liquid milk-based diet, recumbent position and both structural and functional immaturity of the gastro-esophageal junction. This article focuses on the presentation, diagnosis and treatment of GERD that occurs in infants and children, based on available and current guidelines.

  5. Gastro-Esophageal Reflux in Children.

    Science.gov (United States)

    Rybak, Anna; Pesce, Marcella; Thapar, Nikhil; Borrelli, Osvaldo

    2017-08-01

    Gastro-esophageal reflux (GER) is common in infants and children and has a varied clinical presentation: from infants with innocent regurgitation to infants and children with severe esophageal and extra-esophageal complications that define pathological gastro-esophageal reflux disease (GERD). Although the pathophysiology is similar to that of adults, symptoms of GERD in infants and children are often distinct from classic ones such as heartburn. The passage of gastric contents into the esophagus is a normal phenomenon occurring many times a day both in adults and children, but, in infants, several factors contribute to exacerbate this phenomenon, including a liquid milk-based diet, recumbent position and both structural and functional immaturity of the gastro-esophageal junction. This article focuses on the presentation, diagnosis and treatment of GERD that occurs in infants and children, based on available and current guidelines.

  6. Demonstration of gastroesophageal reflux in children by radionuclide gastroesophagography

    International Nuclear Information System (INIS)

    Rudd, T.G.; Christie, D.L.

    1979-01-01

    Twenty-five infants and children with proved gastroesophageal reflux were studied by radionuclide gastroesophagography to determine its sensitivity in detecting reflux. Patients swallowed an inert radiotracer (Tc-99m sulfur colloid) and gamma camera images of the stomach and esophagus were made with and without abdominal pressure. The test was easy to perform and was well tolerated. Reflux was demonstrated in 20 patients (80%); this compared favorably with barium gastroesophagography

  7. [Gastritis associated with duodeno-gastric reflux].

    Science.gov (United States)

    Diarra, M; Konate, A; Traore, C B; Drabo, M; Soukho, A espouse Diarra; Kalle, A; Dembele, M; Traore, H A; Maiga, M Y

    2007-01-01

    Our main objective was to study gastritis associated to duodeno-gastric reflux. It is about a longitudinal study case/witness, paired according to the sex and the age. It was unrolled from February 2005 to January 2006 in the digestive diseases department of the hospital Gabriél Touré, and endoscopic centers of Promenade des Angevins, and clinique Farako. The patients profited from an upper digestive endoscopy to appreciate endoscopic aspect of gastritis associated to bile in the stomach mucus lake. The gastric biopsies were systematic. This study included 50 patients having gastritis associated to bile in gastric mucus lake compared to 50 patients having gastritis associated to clearly gastric mucus lake. The sex-ratio was 1.26 in favour of men. The average age of the patients was of 41.30 +/- 15.43 years. On the symptomatic hand, fetid breath was significantly met in duodeno-gastric reflux (p = 0.013). Potash consumption in the "tô" (millet cake) was significantly reported in gastritis associated to bile in gastric mucus lake (p = 0.042). The endoscopic aspects were comparable. Histological aspects of nonatrophic chronic gastritis were significantly mint in witnesses as well into the antrum as into the fundus (p = 0.0001 and p = 0.00023). The reactional gastritis aspect was the prerogative of duodenogastric reflux (p ranging between 10(-6) and 3.10 (-6). Helicobacter pylori infection was found comparable in the two groups (p = 0.297). Dysplasia although rare was found only in gastritis associated to duodeno-gastric reflux. Gastritis associated to bile in gastric mucus does not se,nm to have specific clinical, endoscopic and histological presentation. However the presence of dysplasia must have an attentive monitoring.

  8. Mitochondrial dysfunction in children with reflux esophagitis

    Directory of Open Access Journals (Sweden)

    A. A. Ziganshina

    2017-01-01

    Full Text Available Objective: to evaluate cellular energy metabolism in children with pathological gastroesophageal reflux, by determining the levels of free and bound carnitine in dry blood spot specimens and lactate and pyruvate in plasma.Characterization of children and methods. A total of 49 patients from the Diagnostic Department, Republican Children’s Clinical Hospital, Ministry of Health of the Republic of Tatarstan, were examined. A study group included 29 patients diagnosed as having reflux esophagitis. A control group consisted of 20 somatically healthy children without signs of gastrointestinal tract diseases. The investigators determined the levels of lactate and pyruvate in plasma by the Umbreit method and those of free and bound carnitine in the dried blood spot specimens by liquid chromatography-tandem mass spectrometry.Results. There were significant changes in the lactate-to-pyruvate ratio in children with reflux esophagitis accompanied by motility disorders. The values of free carnitine were higher than normal in 41% of the study group representatives. The mean values of lactate, pyruvate, and carnitines were within the acceptable range in the examined groups with significantly high values in the children with pathological gastroesophageal reflux.Conclusion. Gastrointestinal tract motility disorders are an indication for the detection of  energy-deficient diathesis in children and the early correction with energy-rich medications that will potentially affect the rate of recurrences and the severity of clinical manifestations of the disease. 

  9. 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

  10. Diagnosis and treatment of gastroesophageal reflux disease

    Science.gov (United States)

    Badillo, Raul; Francis, Dawn

    2014-01-01

    Gastroesophageal reflux disease (GERD) is a common disease with a prevalence as high as 10%-20% in the western world. The disease can manifest in various symptoms which can be grouped into typical, atypical and extra-esophageal symptoms. Those with the highest specificity for GERD are acid regurgitation and heartburn. In the absence of alarm symptoms, these symptoms can allow one to make a presumptive diagnosis and initiate empiric therapy. In certain situations, further diagnostic testing is needed to confirm the diagnosis as well as to assess for complications or alternate causes for the symptoms. GERD complications include erosive esophagitis, peptic stricture, Barrett’s esophagus, esophageal adenocarcinoma and pulmonary disease. Management of GERD may involve lifestyle modification, medical therapy and surgical therapy. Lifestyle modifications including weight loss and/or head of bed elevation have been shown to improve esophageal pH and/or GERD symptoms. Medical therapy involves acid suppression which can be achieved with antacids, histamine-receptor antagonists or proton-pump inhibitors. Whereas most patients can be effectively managed with medical therapy, others may go on to require anti-reflux surgery after undergoing a proper pre-operative evaluation. The purpose of this review is to discuss the current approach to the diagnosis and treatment of gastroesophageal reflux disease. PMID:25133039

  11. Hiatus hernia in gastroesophageal reflux disease

    International Nuclear Information System (INIS)

    Kaul, B.; Petersen, H.; Myrvold, H.E.; Grette, K.; Roeysland, P.; Halvorsen, T.

    1986-01-01

    Upper gastrointestinal endoscopy and radiologic examination were performed in 101 patients with symptoms strongly suggestive of gastroesophageal reflux (GER) disease. Hiatus hernia (HH) was found in 50 patients diagnosed by radiography or endoscopy, or both, in 22, 19, and 9 patients respectively. Severe endoscopic esophagitis (grades III and IV) was found more often (p<0.05) in the patients with HH than in those without. The same was true for the early positive timed acid perfusion tests (p<0.02). Furthermore, the patients with HH more often had reflux by the standard acid reflux test (42 og 50 versus 28 of 51; p<0.01), gastroesophageal scintigraphy (47 of 50 versus 40 of 51; p<0.05), and radiography (20 of 50 versus 2 of 51; p<0.001) than the patients without HH. The results show that severe GER disease can occur without an associated HH and indicate that patients with symptoms of GER disease and associated HH are likely to have a more severe GER disease than those without HH

  12. 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.

  13. Radionuclide voiding cystography in intrarenal reflux detection

    International Nuclear Information System (INIS)

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

    1986-01-01

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

  14. Surgery for Gastroesophageal Reflux Disease in the Morbidly Obese Patient.

    Science.gov (United States)

    Duke, Meredith C; Farrell, Timothy M

    2017-01-01

    The prevalence of gastroesophageal reflux disease (GERD) has mirrored the increase in obesity, and GERD is now recognized as an obesity-related comorbidity. There is growing evidence that obesity, specifically central obesity, is associated with the complications of chronic reflux, including erosive esophagitis, Barrett's esophagus, and esophageal adenocarcinoma. While fundoplication is effective in creating a competent gastroesophageal junction and controlling reflux in most patients, it is less effective in morbidly obese patients. In these patients a bariatric operation has the ability to correct both the obesity and the abnormal reflux. The Roux-en-Y gastric bypass is the preferred procedure.

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

    Science.gov (United States)

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

    2016-07-01

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

  16. 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.)

  17. 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.

  18. Gastro-oesophageal reflux. Part 1: smoking and alcohol reduction.

    Science.gov (United States)

    Al Talalwah, Narmeen; Woodward, Sue

    Gastro-oesophageal reflux disease (GORD) is defined as an abnormal reflux of the stomach contents into the oesophagus, which provokes symptoms and impairs the quality of life. GORD has a high prevalence and incurs costs to the healthcare system. This is the first paper in a series of three exploring the conservative, medical and surgical treatment of GORD. This first paper presents a review of the effect of smoking and alcohol on reflux symptoms and the impact of smoking and alcohol reduction on symptoms of GORD. A search for English language studies on adults was conducted using three databases, MEDLINE, Embase and the Cochrane Central Register of Controlled Trials (CENTRAL). Eleven relevant studies were included in the review. The effect of alcohol on the stimulation of reflux has been debated over the years in different studies. Some studies state that alcohol consumption induces reflux and moderate amounts exacerbate nocturnal gastro-oesophageal heartburn reflux. However, other studies have found no association between alcohol consumption and reflux. Most reflux occurs during smoking because nicotine causes the lower oesophageal sphincter to relax, which increases the risk of reflux. Similarly, the number of cigarettes smoked is associated with the risk of reflux. Nurses need to be aware of the effect of smoking and alcohol on reflux to provide evidence-based advice to empower patients to change their lifestyle, which results in increased therapeutic compliance and a better clinical status. There is no evidence that reducing alcohol consumption decreases symptoms and only limited evidence on the effectiveness of smoking cessation. Further research into the effectiveness of these lifestyle modifications is therefore required.

  19. Gastro-esophageal reflux time parameters and esophagitis in children

    International Nuclear Information System (INIS)

    Baulieu, F.; Baulieu, J.; Maurage, C.; Casset, D.; Itti, R.

    1985-01-01

    The aim of this work was to study the correlation between the reflux timing and the presence of esophagitis, an inconstant but serious complication of gastro-esophageal reflux (GER). The hypothesis was that reflux occurring late after meal can be incriminated more than early reflux in esophagitis genesis. 32 children with GER (mean age = 10.5 months, 2 to 30 months) had esophagoscopy and scintigraphy in the same week. The children were classified in two groups according to esophagoscopy: group 1 (n = 18) no esophagitis, group 2 (n = 14) esophaqgitis. The scintigraphy involved the ingestion of 0.5 mCi Tc-99m sulfur colloid milk mixture, followed by esophageal and gastric activity recording (one image per minute for 1 hour). The reflux was assessed from contrast enhanced images and esophageal time activity curves. Reflux intensity was quantitated by reflux index (Re). Mean reflux time was calculated as the mean esophageal activity peaks time (t-bar). Finally a composite parameter was calculated as the mean reflux time weighted by the relative intensity of each reflux peak (t-barw). Re was not found to be different between the two groups. t-bar was significantly higher in group 2: t-bar = 29.6 +- 3.0 mn (mean +- SD) than in group 1: t-bar = 24.5 +- 6.8 mn; rho <0.02. The difference between the two groups was enhanced by intensity weighting: group 1: t-barw = 16.6 +- 6.3 mn, group 2: t-barw = 33.5 +- 7.1 mn rho <0.001. t-barw value was not correlated to esophagitis grade. These results suggest that late reflux is more likely responsible of esophagitis

  20. The wellbore simulator SIMU1999; El simulador de pozos SIMU1999

    Energy Technology Data Exchange (ETDEWEB)

    Sanchez Upton, Pedro [Comision Federal de Electricidad, Morelia, Michoacan (Mexico)

    1999-08-01

    This work presents a brief description of the architecture and scope of the wellbore simulator SIMU1999. Its prime application involves the representation of the different flow types and thermodynamic conditions found in geothermal wells. The simulator utilizes a homogeneous flow model which incorporates the fundamental theories of fluid mechanics and allows the handling of two-phase three component mixtures (H{sub 2}O-NaCl-CO{sub 2}), which represent the main constituents appearing in the production of geothermal fluids. SIMU1999 uses a two-phase friction factor developed on the basis of 64 production test carried out on 45 different wells. There were recovered more than 324 pressure drop data and 628 temperature measurements from the inner of the wells. Mechanical log recorders (Kuster) were mainly used but some electronic logs (Hot Hole and Pruett) were carried out, too. The friction factor is calculated using the Reynolds number, steam quality, and fluid pressure, therefore, it is independent of any previous flow pattern identification. Production data included specific enthalpies from 650 to 2 780 kj/kg, fluid pressures between 0.4 and 14 MPa, and fluid temperatures from 110 to 340 Celsius degrees. The computer code of SIMU 1999 is written in Fortran 90 and generates and executable file a little bit greater than 1 Mb. The program is divided in four parts, these are: the wellbore simulator; a graphical output to analyze the results on the screen; a separated subroutine to evaluate the mass flow rate of three component flows discharging to the atmosphere at the speed of sound; and an independent thermodynamic module which could be utilized to make estimations to be used in manual analysis. The code incorporates an efficient algorithm to solve the fluid transport phenomena problem, based on a numerical method of successive approaches. The simulator uses the International System of Units, for data input and for results (outcomes) generation. Everything is realized

  1. Supraesophageal Reflux: Correlation of Position and Occurrence of Acid Reflux-Effect of Head-of-Bed Elevation on Supine Reflux.

    Science.gov (United States)

    Scott, David R; Simon, Ronald A

    2015-01-01

    Supraesophageal reflux of gastric contents can contribute to perennial nasopharyngitis, cough, and asthma. However, effective treatment strategies for supraesophageal reflux disease (SERD) remain inadequately defined. The purpose of this study is to assess the prevalence and timing of SERD and to investigate the efficacy of head-of-bed elevation in its treatment. A retrospective chart review of patients seen at Scripps Clinic Division of Allergy, Asthma and Immunology was performed who had undergone overnight nasopharyngeal pH monitoring with a commercially available nasopharyngeal pH-monitoring device, Dx-pH Measurement System from Restech, San Diego, Calif. Subjects with reflux were classified based on the position of reflux as either supine only, upright only, or both supine and upright. In a subset of subjects with supine-only reflux, pH monitoring was compared before and after elevating the head of bed 6 inches. Adequate nasopharyngeal pH-monitoring data were obtained for 235 patients. Reflux was detected in 113 (48%) patients. The pattern of reflux observed was 62 (55%) supine only, 4 (4%) upright only, and 47 (42%) upright and supine. Sequential overnight nasopharyngeal pH monitoring before and after head-of-bed elevation was obtained in 13 individuals with supine-only reflux. Ten subjects demonstrated significant improvement, 8 of whom demonstrated complete resolution of supine reflux with 6 inches of head-of-bed elevation. This study provides new evidence that SERD frequently occurs in the supine position and that 6 inches of head-of-bed elevation is effective in reducing supine SERD. Copyright © 2015 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  2. LINX®, a novel treatment for patients with refractory asthma complicated by gastroesophageal reflux disease: a case report.

    Science.gov (United States)

    Sriratanaviriyakul, Narin; Kivler, Celeste; Vidovszky, Tamas J; Yoneda, Ken Y; Kenyon, Nicholas J; Murin, Susan; Louie, Samuel

    2016-05-24

    Gastroesophageal reflux disease is one of the most common comorbidities in patients with asthma. Gastroesophageal reflux disease can be linked to difficult-to-control asthma. Current management includes gastric acid suppression therapy and surgical antireflux procedures. The LINX® procedure is a novel surgical treatment for patients with gastroesophageal reflux disease refractory to medical therapy. To the best of our knowledge, we report the first case of successful treatment of refractory asthma secondary to gastroesophageal reflux disease using the LINX® procedure. Our patient was a 22-year-old white woman who met the American Thoracic Society criteria for refractory asthma that had remained poorly controlled for 5 years despite progressive escalation to step 6 treatment as recommended by National Institutes of Health-National Asthma Education and Prevention Program guidelines, including high-dose oral corticosteroids, high-dose inhaled corticosteroid plus long-acting β2-agonist, leukotriene receptor antagonist, and monthly omalizumab. Separate trials with azithromycin therapy and roflumilast did not improve her asthma control, nor did bronchial thermoplasty help. Additional consultations with two other university health systems left the patient with few treatment options for asthma, which included cyclophosphamide. Instead, the patient underwent a LINX® procedure after failure of maximal medical therapy for gastroesophageal reflux disease with the additional aim of improving asthma control. After she underwent LINX® treatment, her asthma improved dramatically and was no longer refractory. She had normal exhaled nitric oxide levels and loss of peripheral eosinophilia after LINX® treatment. Prednisone was discontinued without loss of asthma control. The only immediate adverse effects due to the LINX® procedure were bloating, nausea, and vomiting. LINX® is a viable alternative to the Nissen fundoplication procedure for the treatment of patients with

  3. Mosapride for gastroesophageal reflux disease in neurologically impaired patients.

    Science.gov (United States)

    Komura, Makoto; Kanamori, Yutaka; Tanaka, Yujiro; Kodaka, Tetsuro; Sugiyama, Masahiko; Terawaki, Kan; Suzuki, Kan; Iwanaka, Tadashi

    2017-03-01

    The prokinetic agent cisapride is effective for the treatment of gastroesophageal reflux disease (GERD) in infants and children, but is no longer used for this purpose because of safety concerns. Therefore, other pharmacological agents need to be investigated for efficacy in GERD treatment. In this study, we examined the effectiveness and safety of mosapride for the treatment of neurologically impaired children and adolescents with GERD. Mosapride (0.3 mg/kg/day) was administered to 11 neurologically impaired patients with GERD (five male; median age, 12.3 years). Esophageal acid exposure was measured using esophageal pH monitoring before and at >5 days after the start of mosapride treatment. The pressure and length of the lower esophageal sphincter were compared before and after mosapride treatment. In the 11 patients, median reflux index (percentage of the total monitoring period during which recorded pH was reflux (range, 0.5-2.1 min/reflux) before and 0.7 min/reflux (range, 0.4-1.2 min/reflux) after treatment with mosapride (P = 0.02). The median number of reflux episodes before (219) and after (122) drug treatment did not differ significantly. The decreased reflux index in neurologically impaired patients with GERD is due to mosapride, therefore mosapride may be a candidate for GERD treatment. © 2016 Japan Pediatric Society.

  4. [Underlying Mechanisms and Management of Refractory Gastroesophageal Reflux Disease].

    Science.gov (United States)

    Lee, Kwang Jae

    2015-08-01

    The prevalence of gastroesophageal reflux disease (GERD) in South Korea has increased over the past 10 years. Patients with erosive reflux disease (ERD) shows better response to proton pump inhibitors (PPIs) than those with non-erosive reflux disease (NERD). NERD is a heterogeneous condition, showing pathological gastroesophageal reflux or esophageal hypersensitivity to reflux contents. NERD patients with pathological gastroesophageal reflux or hypersensitivity to acid may respond to PPIs. However, many patients with esophageal hypersensitivity to nonacid or functional heartburn do not respond to PPIs. Therefore, careful history and investigations are required when managing patients with refractory GERD who show poor response to conventional dose PPIs. Combined pH-impedance studies and a PPI diagnostic trial are recommended to reveal underlying mechanisms of refractory symptoms. For those with ongoing reflux-related symptoms, split dose administration, change to long-acting PPIs or PPIs less influenced by CYP2C19 genotypes, increasing dose of PPIs, and the addition of alginate preparations, prokinetics, selective serotonin reuptake inhibitors, or tricyclic antidepressants can be considered. Pain modulators, selective serotonin reuptake inhibitors, or tricyclic antidepressants are more likely to be effective for those with reflux-unrelated symptoms. Surgery or endoscopic per oral fundoplication may be effective in selected patients.

  5. Pediatric gastroesophageal reflux disease: Current diagnosis and management

    NARCIS (Netherlands)

    van der Pol, R.J.

    2014-01-01

    Pediatric gastroesophageal reflux disease (GERD) is a disorder difficult to diagnose and to treat. Due to the current definition of GERD, i.e. gastroesophageal reflux (GER) causing bothersome symptoms and/or complications, diagnosis is subject to broad interpretation. This thesis consists of studies

  6. Laparoscopic anti-reflux surgery : indications, techniques and physiological effects

    NARCIS (Netherlands)

    Broeders, J.A.J.L.

    2011-01-01

    Gastro-oesophageal reflux disease (GORD) is a highly prevalent chronic disorder in which retrograde flow of gastric contents into the oesophagus causes troublesome symptoms or lesions. Proton pump inhibitor (PPI) therapy controls reflux disease in 95% of the patients and the remaining 5% have

  7. Reflux oesophagitis and Helicobacter pylori infection in elderly patients.

    Science.gov (United States)

    Liston, R.; Pitt, M. A.; Banerjee, A. K.

    1996-01-01

    Helicobacter pylori is associated with gastritis, peptic ulcers and gastric malignancies. Little attention has been paid to the possibility that it may also have a role in the pathogenesis of reflux oesophagitis. This is especially true in elderly patients who have life-long infection and provide an ideal group to study the mucosal changes associated with the organism. The aim of this study was to determine if H pylori is associated with reflux oesophagitis in elderly patients. Consecutive gastroscopy patients were recruited. Multiple biopsies were taken from oesophagus, stomach, antrum and duodenum for histology and rapid urease tests. Patients also had IgG ELISA antibodies and 13C-urea breath tests performed. Patients with macroscopic or microscopic evidence of reflux oesophagitis were compared to patients with macroscopically normal upper gastrointestinal tracts and no microscopic evidence of reflux. A total of 114 patients were recruited, average age 78.9 years (+/- 5.4). There were 37 refluxers and 33 non-refluxers. We found no evidence for an association between the presence of H pylori and reflux oesophagitis in elderly patients. The high prevalence of H pylori in patients with reflux oesophagitis can be explained by the presence of incidental gastritis. PMID:8733530

  8. 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

  9. Detection of gastro-oesophageal reflux in the neonatal unit.

    Science.gov (United States)

    Rossor, Thomas; Lingam, Ingran; Douiri, Abdel; Bhat, Ravindra; Greenough, Anne

    2018-03-13

    To determine whether a pH probe or multichannel intraluminal impedance (MII) more frequently detected gastro-oesophageal reflux and test the hypothesis that acid reflux was associated with lower baseline impedance. A prospective study of infants in whom reflux was suspected and evaluated using combined pH and multichannel impedance. Studies were considered abnormal if the acid index was >10% or there were >79MII reflux events in 24 hours. The acid index was the percentage of total study time with a pHacid clearance time (ACT) the time from the pH falling below four to rising above four. Forty-two infants [median gestational age 31 (range 23-42) weeks] were assessed. Only nine infants (21%) had abnormal studies, seven detected by pH monitoring, one by MII monitoring and one by both techniques (p = 0.04). After correcting for gestational age and post-natal age, baseline impedance remained negatively correlated with the acid index (r = -0.34, p = 0.038) and the maximum ACT (r = -0.44, p = 0.006). Clinical suspicion of reflux was frequently incorrect, and reflux was more frequently detected by a pH probe. The inverse relationship of acid reflux to baseline impedance suggests that mucosal disruption may result from acid reflux in this population. ©2018 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

  10. Respiratory repercussions of gastroesophageal reflux and Cine-esophagogastroscintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Guillemeteau, C.; Saudubray, F. (Hopital des Enfants, 33 - Bordeaux (France)); Guillet, J. (Hopital Pellegrin, 33 - Bordeaux (France))

    1985-04-01

    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.

  11. Respiratory repercussions of gastroesophageal reflux and cine-esophagogastroscintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Guillemeteau, C.; Saudubray, F. (Hopital des Enfants, 33 - Bordeaux (France)); Guillet, J. (Hopital Pellegrin, 33 - Bordeaux (France))

    1984-10-01

    Asthma and recurrent bronchopneumopathies in children are often associated with gastroesophageal reflux. Cine-esophagogastroscintigraphy 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.

  12. 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 ...

  13. 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

  14. Out-patient radiology in gastro-esophageal reflux

    International Nuclear Information System (INIS)

    Alessi, G.; Risi, D.; Accordino, M.E.; Meli, C.; Iascone, C.

    1987-01-01

    A retrospective analysis is reported of 131 symptomatic patients for gastro-esophageal reflux, comparing the radiological diagnosis to endoscopic, manometric and pH-metric results. A low incidence of x-ray examination is found. The role of radiology in gastro-esophageal reflux is considered and discussed

  15. 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

  16. Hydrated Ordinary Portland Cement as a Carbonic Cement: The Mechanisms, Dynamics, and Implications of Self-Sealing and CO2 Resistance in Wellbore Cements

    Energy Technology Data Exchange (ETDEWEB)

    Guthrie, George Drake Jr. [Los Alamos National Laboratory; Pawar, Rajesh J. [Los Alamos National Laboratory; Carey, James William [Los Alamos National Laboratory; Karra, Satish [Los Alamos National Laboratory; Harp, Dylan Robert [Los Alamos National Laboratory; Viswanathan, Hari S. [Los Alamos National Laboratory

    2017-07-28

    This report analyzes the dynamics and mechanisms of the interactions of carbonated brine with hydrated Portland cement. The analysis is based on a recent set of comprehensive reactive-transport simulations, and it relies heavily on the synthesis of the body of work on wellbore integrity that we have conducted for the Carbon Storage Program over the past decade.

  17. Esophageal Mucosal Impedance Pattern is Distinct in Patients With Extraesophageal Reflux Symptoms and Pathologic Acid Reflux.

    Science.gov (United States)

    Kavitt, Robert T; Lal, Pooja; Yuksel, Elif Saritas; Ates, Fehmi; Slaughter, James C; Garrett, C Gaelyn; Higginbotham, Tina; Vaezi, Michael F

    2017-05-01

    Current diagnostic tests for gastroesophageal reflux disease (GERD) do not consistently measure chronicity of reflux. Mucosal impedance (MI) is a minimally invasive measurement to assess esophageal conductivity changes due to GERD. We aimed to investigate MI pattern in patients with symptoms of extraesophageal reflux (EER) in a prospective longitudinal cohort study. Patients with potential symptoms of EER undergoing esophagogastroduodenoscopy (EGD) with wireless pH monitoring were studied. Participants included those with erosive esophagitis (E+), normal EGD/abnormal pH (E-/pH+), and normal EGD/normal pH (E-/pH-). MI was measured from the site of injury in patients with E+, as well as at 2, 5, and 10 cm above the squamocolumnar junction (SCJ) in all participants. Forty-one patients with symptoms of EER were studied. MI measurements at 2 cm above the SCJ were significantly (P = 0.04) different among the three groups, with MI lowest for E+ and greatest for E-/pH- patients. Although not statistically significant, there is a graded increase in median (interquartile range) MI axially along the esophagus at 5 cm (P = 0.20) and at 10 cm (P = 0.27) above the SCJ, with those with reflux (E+ and E-/pH+) having a lower MI than those without. Patients with symptoms of EER and evidence of acid reflux have an MI lower than those without at 2 cm above the SCJ, with a trend at 5 cm and 10 cm as well. MI may be a tool to assess presence of GERD in patients presenting with EER symptoms. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

  18. Diagnostic tests in gastroesophageal reflux disease (GERD)

    International Nuclear Information System (INIS)

    Hani de Ardila, Albis

    2009-01-01

    The true prevalence of gastroesophageal reflux disease (GERD) is difficult to establish despite that an estimated 11% of the U.S. population experiencing heartburn daily or 30% every three days (1), perhaps due to that the disease can cause many symptoms, both typical and atypical as heartburn or chest pain, among others. Multiple techniques for measuring reflux have been used, and many authors (1-3) have asked why this situation, possibly because the techniques measure and quantify the basic pathophysiologic problem disease, the time of exposure of the esophagus distal to the gastric juice, because the measures are quantitatively related to the degree of esophageal mucosal injury, or because the episodes of exposure to gastric juice correlated with the patient's symptoms. As said Richter (4) m any times these studies are unnecessary because the history is sufficiently revealing to identify the presence of GERD. But the clinician must decide which test you choose to carry a diagnosis of a reliable, timely and cost-effective . But we cannot rely on the presence of symptoms to diagnosis, because we incur the overdiagnosis in a considerable number of individuals, the sensitivity set for the typical symptoms as heartburn is 68% and specificity was 63% (2), which leads us to conclude that atypical symptoms should be investigated as they may relate to functional dyspepsia rather than GERD. It is also clear that the severity and frequency of symptoms in any way correlates with the presence or absence of esophagitis, patients with erosive esophagitis are more severe disease and increased risk of developing complications. The persistent exposure of the esophagus to gastric juice does not cause mucosal injury in all individuals, therefore, it is possible to define the disease by the presence of mucosal injury, while endoscopy is able to define the mucosal injury caused by the reflux can also lead to false conclusions, such as those patients with symptoms of GERD who have no

  19. 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)

  20. Scintigraphic demonstration of bile reflux after gastro-intestinal surgery

    Energy Technology Data Exchange (ETDEWEB)

    Gratz, K.F.; Creutzig, H.; Lieth, U. von der; Hundeshagen, H.

    1983-04-01

    Bile reflux may occur after a variety of reconstructive procedures in the gastro-intestinal tract and biliary system. The present paper deals with reflux into the duodenum, jejunum, stomach, oesophagus and into blind loops. The demonstration of reflux by sup(99m)Tc labelled IDA acid derivatives, and a possible quantitative approach, are discussed. The advantages of isotope methods are: 1. Direct demonstration of bile reflux without any intervention in the physiological process and with little trouble to the patient. 2. The ability to use the method for various reconstructive procedures and 3. the additional information obtained which may help in the differential diagnosis of blind loops, biliary obstruction, cholecystitis or liver metastases if there has been a gastrectomy for a malignant tumour. In combination with a second administration of a radio-isotope tracer, one may be able to demonstrate abnormalities in the motility of the stomach or gut, or pyloric stenosis or gastro-oesophageal reflux.

  1. Tobacco smoking, alcohol consumption and gastro-oesophageal reflux disease.

    Science.gov (United States)

    Ness-Jensen, Eivind; Lagergren, Jesper

    2017-10-01

    Gastro-oesophageal reflux disease (GORD) develops when reflux of gastric content causes troublesome symptoms or complications. The main symptoms are heartburn and acid regurgitation and complications include oesophagitis, strictures, Barrett's oesophagus and oesophageal adenocarcinoma. In addition to hereditary influence, GORD is associated with lifestyle factors, mainly obesity. Tobacco smoking is regarded as an aetiological factor of GORD, while alcohol consumption is considered a triggering factor of reflux episodes and not a causal factor. Yet, both tobacco smoking and alcohol consumption can reduce the lower oesophageal sphincter pressure, facilitating reflux. In addition, tobacco smoking reduces the production of saliva rich in bicarbonate, which is important for buffering and clearance of acid in the oesophagus. Alcohol also has a direct noxious effect on the oesophageal mucosa, which predisposes to acidic injury. Tobacco smoking cessation reduces the risk of GORD symptoms and avoidance of alcohol is encouraged in individuals where alcohol consumption triggers reflux. Copyright © 2017 Elsevier Ltd. All rights reserved.

  2. 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.

  3. Gastroesophageal scintigraphy to assess the severity of gastroesophageal reflux disease

    International Nuclear Information System (INIS)

    Menin, R.A.; Malmud, L.S.; Petersen, R.P.; Maier, W.P.; Fisher, R.S.

    1980-01-01

    Thirty-six (36) patients with symptomatic gastroesophageal reflux were studied. Symptoms of heartburn, regurgitation, and dysphagia were scored as to their severity and compared to quantitative tests of gastroesophageal reflux. Patients were studied with the acid reflux test, fiberoptic endoscopy, exophageal mucosal biopsy with a pinch forceps, esophageal manometry, and radioisotopic gastroesophgeal scintigraphy. Symptoms were scored according to an arbitrary grading system as mild, moderate, or severe. There were significant correlations between symptoms scores and both the degree of endoscopic esophagitis and the gastroesophageal reflux indices as measured by the radioisotopic scintiscan, but not with the degree of histologic esophagitis or lower esophageal sphincter pressure. Review of the findings suggest the following profile for patients who might require antireflux surgery: severe symptoms; presence of endoscopic esophagitis; resting lower esophageal sphincter pressure below 10 mmHg; and gastroesophageal reflux index above 10%

  4. Correlation of obstructive sleep apnoea and laryngopharyngeal reflux: phmetry study.

    Science.gov (United States)

    Elhennawi, D M; Ahmed, M R; Abou-Halawa, A S

    2016-12-01

    To study the correlation of obstructive sleep apnoea (OSA) and laryngopharyngeal reflux (LPR). A descriptive study. Suez Canal University Hospital, Ismailia, Egypt. 62 patients with polysomnography confirmed OSA. Patients were evaluated with ambulatory 24-h double channel pH monitoring. Mean reflux symptom index in the study group was 9 ± 5.5, and it was > 13 in all patients with severe OSA. Signs of LPR reflux were present in 34 (55%) patients. Abnormal reflux was detected in the distal oesophagus in 41 patients (66%) and in the proximal oesophagus in 21 patients (34%). Patients with severe OSA had significantly higher nocturnal LPR reflux episodes compared to patients with mild disease (P .05). LPR is common in patients with OSA. Patients with severe OSA have significantly higher nocturnal LPR. This should be considered when treating this group of patients. © 2016 John Wiley & Sons Ltd.

  5. Investigation of extraesophageal gastroesophageal reflux disease

    Science.gov (United States)

    Tsoukali, Emmanouela; Sifrim, Daniel

    2013-01-01

    The most common extraesophageal manifestations of gastroesophageal reflux disease (GERD) include chronic cough, asthma and laryngitis. There are two mechanisms proposed to explain extraesophageal syndromes caused by GERD. The first one is a direct way via irritation and/or microaspiration and the second one is an indirect, vagally mediated way. The investigation of extraesophageal manifestations of GERD is difficult and the empirical therapy with proton pump inhibitors usually double dose for at least three months is still the most common approach. PMID:24714277

  6. 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.

  7. Dynamic characteristic of gastro-oesophageal reflux in ambulatory patients with gastro-oesophageal reflux disease and normal control subjects

    NARCIS (Netherlands)

    Weusten, B. L.; Akkermans, L. M.; vanBerge-Henegouwen, G. P.; Smout, A. J.

    1995-01-01

    BACKGROUND: The aim of the study was to investigate the dynamic characteristics of pathologic gastro-oesophageal reflux. METHODS: Five-channel ambulatory 24-h oesophageal pH monitoring was performed in 19 gastro-oesophageal reflux disease patients (age, 21-74 years) and in 19 healthy volunteers

  8. 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 reflux and GORD and their management including prescribing of acid-suppressant medicines (proton pump inhibitors (PPIs) and histamine receptor antagonists (H2RAs)) and counselling, advice or education. Of all infants' visits, 512 (2.7%) included a diagnosis of reflux (n=413, 2.2%) or GORD (n=99, 0.5%). From 2006 to 2016, diagnostic rates decreased for reflux and increased for GORD. Prescribing of acid suppressants occurred in 43.6% visits for reflux and 48.5% visits for GORD, similar to rates of counselling, advice or education (reflux: 38.5%, GORD: 43.4% of visits). Prescribing of PPIs increased (statistically significant only for visits for reflux), while prescribing of H2RAs decreased. 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.

  9. Risk factors for renal scarring in children with primary vesicoureteral reflux disease

    Directory of Open Access Journals (Sweden)

    Sevgi Mir

    2013-01-01

    Full Text Available To determine the incidence of renal scarring among patients with primary vesicoureteral reflux (VUR and the possible risk factor(s, we studied 90 children (60 girls and 30 boys with VUR followed in the Pediatric Nephrology Unit at the Ege University Hospital from 1998 to 2003. All the patients were assessed for VUR grade by voiding cystoureterography and for presence of renal scarring by (99 m technetium dimercapto-succinic acid scintigraphy. All infants with VUR were given low-dose prophylactic antibiotics and followed-up until resolution of the reflux. Grade of reflux and number of urinary tract infection (UTI episodes (≥3 were found to be statistically significant risk factors for renal scarring (P 0.05. Similarly, there was no statistically significant difference of frequency of renal scarring among the different age groups (P >0.05. We conclude that recurrences of UTI and VUR severity are significant risk factors for renal scarring in children with VUR. Therefore, identification of VUR at an early age may offer the opportunity to prevent episodes of UTI and possible formation of renal scars that may result in end-stage renal failure.

  10. Causes of, and Therapeutic Approaches for, Proton Pump Inhibitor-Resistant Gastroesophageal Reflux Disease in Asia

    OpenAIRE

    Kinoshita, Yoshikazu; Ishihara, Shunji

    2008-01-01

    Proton pump inhibitors (PPIs) are the most widely used drugs for treatment of gastroesophageal reflux disease. However, approximately 20% of patients with reflux esophagitis and 40% of those with nonerosive reflux diseases complain of troublesome symptoms, even during treatment with PPIs. In patients with reflux esophagitis, dose escalation and co-administration with a histamine ...

  11. Achalasia following reflux disease: coincidence, consequence, or accommodation? An experience-based literature review

    Directory of Open Access Journals (Sweden)

    Vereczkei A

    2017-12-01

    Full Text Available András Vereczkei, Laura Bognár, András Papp, Örs Péter Horváth Department of Surgery, University of Pécs, Pécs, Hungary Abstract: Achalasia is a motility disorder of the esophagus characterized by the defective peristaltic activity of the esophageal body and impaired relaxation of the lower esophageal sphincter due to the degeneration of the inhibitory neurons in the myenteric plexus of the esophageal wall. The histopathological and pathophysiological changes in achalasia have been well described. However, the exact etiological factors leading to the disease still remain unclear. Currently, achalasia is believed to be a multifactorial disease, involving both extrinsic and intrinsic factors. Based on our experience and the review of literature, we believe that gastroesophageal reflux disease (GERD might be one of the triggering factors leading to the development of achalasia. However, it is also stated that the two diseases can simultaneously appear independently from each other. Considering the large number and routine treatment of patients with GERD and achalasia, the rare combination of the two may even remain unnoticed; thus, the analysis of larger patient groups with this entity is not feasible. In this context, we report four cases where long-standing reflux symptoms preceded the development of achalasia. A literature review of the available data is also given. We hypothesize that achalasia following the chronic acid exposure of the esophagus is not accidental but either a consequence of a chronic inflammation or a protective reaction of the organism in order to prevent aspiration and lessen reflux-related symptoms. This hypothesis awaits further clinical confirmation. Keywords: achalasia, gastroesophageal reflux disease, Barrett’s esophagus, Nissen fundoplication

  12. Orally administered L-arginine and glycine are highly effective against acid reflux esophagitis in rats

    Science.gov (United States)

    Nagahama, Kenji; Nishio, Hikaru; Yamato, Masanori; Takeuchi, Koji

    2012-01-01

    Summary Background Reflux esophagitis is caused mainly by excessive exposure of the mucosa to gastric contents. In the present study, we examined the effect of several amino acids on acid reflux esophagitis in rats. Material/Methods After 18 h of fasting, acid reflux esophagitis was induced by ligating both the pylorus and the transitional region between the forestomach and the corpus under ether anesthesia, and the animals were killed 4 h later. The severity of esophagitis was reduced by the oral administration of omeprazole, a proton pump inhibitor, or pepstatin, a specific pepsin inhibitor. Results The development of esophageal lesions was dose-dependently prevented by L-arginine and glycine, given intragastrically (i.g.) after the ligation, with complete inhibition obtained at 250 mg/kg and 750 mg/kg, respectively, and these effects were not influenced by the prior s.c. administration of indomethacin or L-NAME. By contrast, both L-alanine and L-glutamine given i.g. after the ligation aggravated these lesions in a dose-dependent manner. These amino acids had no effect on acid secretion but increased the pH of the gastric contents to 1.8~2.3 due to their buffering action. Conclusions The results confirmed an essential role for acid and pepsin in the pathogenesis of acid reflux esophagitis in the rat model and further suggested that various amino acids affect the severity of esophagitis in different ways, due to yet unidentified mechanisms; L-alanine and L-glutamine exert a deleterious effect on the esophagitis, while L-arginine and glycine are highly protective, independent of endogenous prostaglandins and nitric oxide. PMID:22207112

  13. [Esophageal motor function of gastroesophageal reflux disease].

    Science.gov (United States)

    Wang, Hong; Tian, Yuan; Ding, Yan

    2010-08-01

    To study the relationship between esophageal motor functional disorder [decreased lower esophageal sphincter pressure (LESP)and ineffective motility (IEM)] and gastroesophageal reflux disease (GERD). Totally 89 patients with GERD were enrolled in this study. All of them underwent 24-hour pH monitoring with dual-channel probe and stationary esophageal manometry. In addition, 77 of these patients underwent upper endoscopy. IEM and LES, 10 mmHg were common disturbances in patients with GERD (54% and 48%, respectively). The number of the acid reflux events of distal esophagus and prevalence of moderate or severe erosive esophagitis (EE) were significantly higher in patients with low LESP and IEM than patients without low LESP ( Pesophagus was significantly correlated with the severity of esophagitis, distal esophagus amplitude, and LESP, while no such correlation was found between IEM and degree of esophageal acid exposure or esophagitis. The pathophysiology of GERD is probably multifactorial. Lower LESP or IEM is not a independent pathophysiological factor for GERD. However,one single factor is insufficient to explain all the pathogenic mechanism of GERD.

  14. Lipid aspiration pneumonia due to gastroesophageal reflux

    International Nuclear Information System (INIS)

    Wolfson, B.J.; Temple Univ., Philadelphia, PA; Allen, J.L.; Panitch, H.B.; Temple Univ., Philadelphia, PA; Karmazin, N.; Temple Univ., Philadelphia, PA

    1989-01-01

    The development of lipid aspiration pneumonia after chronic nasopharyngeal installation of mineral oil was first described in 1925 by Laughlin. Since that time this entity has been well recognized and numerous substances have been identified or implicated as the aspirated material. The classic radiographic appearance of severe chronic lipid aspiration pneumonia has been described as consisting of intense perihilar infiltrates. However, the radiographic findings are more often non-specific and usually consist of varying degrees of diffuse interstitial infiltrates that tend to be more prominent in the perihilar regions and the right lung. We are reporting a case of biopsy-proven lipid aspiration pneumonia in an infant with known gastro-esophageal reflux (GER) who had medium-chain triglyceride oil administered via nasogastric tube. Serial roentgenograms demonstrated a changing pulmonary pattern from diffuse bilateral interstitial infiltrates initially to a diffuse alveolar pattern at the time of the lung biopsy. Modern medicine has developed new methods for providing nourishment to sick newborns and infants to improve their nutritional status and help them to grow. One such method involves the administration of medium-chain triglycerides (MCT oil) into the GI tract via a nasogastric or nasoenteral tube. The purpose of this report is to describe a significant complication of this method of providing nutrition to an infant with gastroesophageal reflux (GER) and the diagnostic dilemma it presented. (orig.)

  15. How useful is gastroesophageal reflux scintigraphy in suspected childhood aspiration

    Energy Technology Data Exchange (ETDEWEB)

    Fawcett, H.D.; Adams, J.C.; Hayden, C.K.; Swischuk, L.E.

    1988-05-01

    It has been suggested that gastroesophageal reflux scintigraphy might be useful in assisting one in determining therapy for patients suspected of aspirating or becoming apneic secondary to gastroesophageal reflux. This, however, has not been our experience and in reviewing 23 patients with recurrent pneumonia and/or apnea who had gastroesophageal reflux scintigraphy, we were able to detect aspiration in only one. This was especially significant since 13 (59%) of these patients had demonstrable reflux, and of these, eight were treated successfully for suspected aspiration even though none was demonstrated isotopically. To be sure, the demonstration of pulmonary aspiration with gastroesophageal reflux scintigraphy had little influence on patient selection and response to therapy. For this reason we feel there is little justification in depending on the GRS for the specific purpose of trying to document pulmonary aspiration in infants and children who are refluxing. One of the more serious complications of gastroesophageal (GE) reflux is aspiration leading to recurrent pulmonary infections and/or apnea. However, it always has been difficult to demonstrate actual aspiration into the lungs, and to be sure, barium studies of the upper GI tract seldom reveal this complication. Recently, however, considerable interest has been generated in gastroesophageal scintigraphy (GRS) as a possible means of documenting such aspiration. Rationale for this stems from the fact that suspected patients can be studied over a longer period of time and in addition, delayed and overnight images can be obtained. However, our experience does not support GRS as being an adequate method for demonstrating aspiration.

  16. Technique of Antireflux Procedure without Creating Submucosal Tunnel for Surgical Correction of Vesicoureteric Reflux during Bladder Closure in Exstrophy.

    Science.gov (United States)

    Sunil, Kanoujia; Gupta, Archika; Chaubey, Digamber; Pandey, Anand; Kureel, Shiv Narain; Verma, Ajay Kumar

    2018-01-01

    To report the clinical application of the new surgical technique of antireflux procedure without creating submucosal tunnel for surgical correction of vesicoureteric reflux during bladder closure in exstrophy. Based on the report of published experimental technique, the procedure was clinically executed in seven patients of classic exstrophy bladder with small bladder plate with polyps, where the creation of submucosal tunnel was not possible, in last 18 months. Ureters were mobilized. A rectangular patch of bladder mucosa at trigone was removed exposing the detrusor. Mobilized urteres were advanced, crossed and anchored to exposed detrusor parallel to each other. Reconstruction included bladder and epispadias repair with abdominal wall closure. The outcome was measured with the assessment of complications, abolition of reflux on cystogram and upper tract status. At 3-month follow-up cystogram, reflux was absent in all. Follow-up ultrasound revealed mild dilatation of pelvis and ureter in one. The technique of extra-mucosal ureteric reimplantation without the creation of submucosal tunnel is simple to execute without risk and complications and effectively provides an antireflux mechanism for the preservation of upper tract in bladder exstrophy. With the use of this technique, reflux can be prevented since the very beginning of exstrophy reconstruction.

  17. Treatment of supragastric belching with cognitive behavioral therapy improves quality of life and reduces acid gastroesophageal reflux.

    Science.gov (United States)

    Glasinovic, E; Wynter, E; Arguero, J; Ooi, J; Nakagawa, K; Yazaki, E; Hajek, P; Psych, C Clin; Woodland, P; Sifrim, D

    2018-04-01

    Excessive supragastric belching (SGB) manifests as troublesome belching, and can be associated with reflux and significant impact on quality of life (QOL). In some GERD patients, SGB-associated reflux contributes to up to 1/3 of the total esophageal acid exposure. We hypothesized that a cognitive-behavioral intervention (CBT) might reduce SGB, improve QOL, and reduce acid gastroesophageal reflux (GOR). We aimed to assess the effectiveness of CBT in patients with pathological SGB. Patients with SGB were recruited at the Royal London Hospital. Patients attended CBT sessions focused on recognition of warning signals and preventative exercises. Objective outcomes were the number of SGBs, esophageal acid exposure time (AET), and proportion of AET related to SGBs. Subjective evaluation was by patient-reported questionnaires. Of 51 patients who started treatment, 39 completed the protocol, of whom 31 had a follow-up MII-pH study. The mean number of SGBs decreased significantly after CBT (before: 116 (47-323) vs. after 45 (22-139), P50%. In patients with increased AET at baseline, AET after CBT was decreased: 9.0-6.1% (P=0.005). Mean visual analog scale severity scores decreased after CBT (before: 260 (210-320) mm vs. after: 140 (80-210) mm, Pacid reflux predominantly driven by SGB. In these patients, CBT can reduce esophageal acid exposure.

  18. Correlation of Gastroesophageal reflux disease Assessment Symptom Questionnaire to impedance-pH measurements in children

    OpenAIRE

    Prachuapthunyachart, Sittichoke; Jarasvaraparn, Chaowapong; Gremse, David A

    2017-01-01

    Background: Esophageal multichannel intraluminal impedance-pH monitoring has become one of the preferred tests to correlate observed reflux-like behaviors with esophageal reflux events. The Gastroesophageal reflux disease Assessment Symptom Questionnaire is a validated tool used to distinguish infants with gastroesophageal reflux disease from healthy children. The aim of this study was to determine whether the Gastroesophageal reflux disease Assessment Symptom Questionnaire composite symptom ...

  19. The Role of Esophageal PH-metri Test on Gastro-Esophageal Reflux Disease Diagnosis

    OpenAIRE

    Setyawati, Katharina; Abdullah, Murdani; Syam, Ari Fahrial; Fauzi, Achmad; Makmun, Dadang; Simadibrata, Marcellus; Manan, Chudahman; Rani, Abdul Aziz

    2008-01-01

    Gastro-esophageal reflux disease is a pathological condition of esophagus which is caused by gastric content reflux into esophagus. There is an increased prevalence of gastro-esophageal reflux disease. The roles of esophageal pH-metry in clinical application include looking for abnormal acid exposure on esophagus with no abnormality found in endoscopy; evaluating patients following the anti-reflux surgery who are being suspected for abnormal esophageal reflux; evaluating patients with normal ...

  20. Radiological evaluation of esophageal motility and gastroesophageal reflux disease

    International Nuclear Information System (INIS)

    Schima, W.; Pokieser, P.; Schober, E.

    1995-01-01

    Radiological evaluation of esophageal motility and the lower esophageal sphincter has gained increased attention in recent years. Videofluoroscopic investigation of esophageal motor function is superior to static film radiography, as repeated analysis of the videotaped recordings is possible. With emphasis on radiological techniques, normal esophagel physiology and motility and a variety of esophageal motor disorders are discussed in this review paper. Radiological evaluation of gastroesophageal reflux and reflux esophagitis is described. Clinical and radiological findings in esophageal motility disorders and gastroesophageal reflux disease and the radiological efficacy compared to that of manometry and pH-metry are discussed. (orig.) [de

  1. [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.

  2. Persistent reflux symptoms cause anxiety, depression, and mental health and sleep disorders in gastroesophageal reflux disease patients.

    Science.gov (United States)

    Kimura, Yoshihide; Kamiya, Takeshi; Senoo, Kyouji; Tsuchida, Kenji; Hirano, Atsuyuki; Kojima, Hisayo; Yamashita, Hiroaki; Yamakawa, Yoshihiro; Nishigaki, Nobuhiro; Ozeki, Tomonori; Endo, Masatsugu; Nakanishi, Kazuhisa; Sando, Motoki; Inagaki, Yusuke; Shikano, Michiko; Mizoshita, Tsutomu; Kubota, Eiji; Tanida, Satoshi; Kataoka, Hiromi; Katsumi, Kohei; Joh, Takashi

    2016-07-01

    Some patients with gastroesophageal reflux disease experience persistent reflux symptoms despite proton pump inhibitor therapy. These symptoms reduce their health-related quality of life. Our aims were to evaluate the relationship between proton pump inhibitor efficacy and health-related quality of life and to evaluate predictive factors affecting treatment response in Japanese patients. Using the gastroesophageal reflux disease questionnaire, 145 gastroesophageal reflux disease patients undergoing proton pump inhibitor therapy were evaluated and classified as responders or partial-responders. Their health-related quality of life was then evaluated using the 8-item Short Form Health Survey, the Pittsburgh Sleep Quality Index, and the Hospital Anxiety and Depression Scale questionnaires. Sixty-nine patients (47.6%) were partial responders. These patients had significantly lower scores than responders in 5/8 subscales and in the mental health component summary of the 8-item Short Form Health Survey. Partial responders had significantly higher Pittsburgh Sleep Quality Index and Hospital Anxiety and Depression Scale scores, including anxiety and depression scores, than those of responders. Non-erosive reflux disease and double proton pump inhibitor doses were predictive factors of partial responders. Persistent reflux symptoms, despite proton pump inhibitor therapy, caused mental health disorders, sleep disorders, and psychological distress in Japanese gastroesophageal reflux disease patients.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2000-06-01

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

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

    International Nuclear Information System (INIS)

    Fujimatsu, Akiko

    2000-01-01

    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)

  5. Endoscopic augmentation of the lower esophageal sphincter for the treatment of gastroesophageal reflux disease: Multicenter study of the gatekeeper reflux repair system

    NARCIS (Netherlands)

    Fockens, P.; Bruno, M. J.; Gabbrielli, A.; Odegaard, S.; Hatlebakk, J.; Allescher, H. D.; Rösch, T.; Rhodes, M.; Bastid, C.; Rey, J.; Boyer, J.; Muehldorffer, S.; van den Hombergh, U.; Costamagna, G.

    2004-01-01

    Background and Study Aims: The safety and effectiveness of the Gatekeeper Reflux Repair System (Medtronic Europe, Tolochenaz, Switzerland) in the treatment of gastroesophageal reflux disease (GERD) was evaluated. This new, reversible treatment modality involves the endoscopic introduction of

  6. 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.

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

    International Nuclear Information System (INIS)

    Koehler, J.; Thysell, H.; Tencer, J.; Forsberg, L.; Hellstroem, M.

    2001-01-01

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

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

    Science.gov (United States)

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

    2013-12-01

    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 alginate formulation in relation to the acid pocket and the corresponding effects on reflux parameters and acid pocket positioning in patients with gastroesophageal reflux disease (GERD). We randomly assigned patients with symptomatic GERD and large hiatal hernias to groups who were given either (111)In-labeled alginate-antacid (n = 8, Gaviscon Double Action Liquid) or antacid (n = 8, Antagel) after a standard meal. The relative positions of labeled alginate and acid pocket were analyzed for 2 hours by using scintigraphy; reflux episodes were detected by using high-resolution manometry and pH-impedance monitoring. The alginate-antacid label localized to the acid pocket. The number of acid reflux episodes was significantly reduced in patients receiving alginate-antacid (3.5; range, 0-6.5; P = .03) compared with those receiving antacid (15; range, 5-20), whereas time to acid reflux was significantly increased in patients receiving alginate-antacid (63 minutes; range, 23-92) vs those receiving antacid (14 minutes; range, 9-23; P = .01). The acid pocket was located below the diaphragm in 71% of patients given alginate-antacid vs 21% of those given antacid (P = .08). There was an inverse correlation between a subdiaphragm position of the acid pocket and acid reflux (r = -0.76, P acid pocket and displaces it below the diaphragm to reduce postprandial acid reflux. These findings indicate the importance of the acid pocket in GERD pathogenesis and establish alginate-antacid as an appropriate therapy for postprandial acid reflux. Copyright © 2013 AGA Institute. Published by Elsevier Inc. All rights reserved.

  9. Idiopathic gastroesophageal reflux disease in an adult horse.

    Science.gov (United States)

    Baker, Shannon J; Johnson, Philip J; David, Andrew; Cook, Cristi Reeves

    2004-06-15

    Chronic gastroesophageal reflux disease was diagnosed in a 22-year-old female Tennessee Walking Horse that had signs of bruxism and ptyalism. Esophageal ulceration was detected via endoscopy. Compared with the damage to the proximal portions of the esophagus, the severity of the ulceration increased toward the gastroesophageal junction. Esophageal ulceration attributable to chronic gastric acid reflux is usually secondary to pyloric outflow obstruction in horses. In the horse of this report, there was no evidence of either a chronic pyloric or duodenal obstruction that could have resulted in esophageal ulceration. Esophageal ulceration in this horse was attributed to gastroesophageal reflux disease, a common condition in humans in which the underlying abnormality is functional incompetence of the gastroesophageal junction. Treatment is directed at decreasing gastric acidity and protecting the ulcerated mucosa. In the horse of this report, treatment was unsuccessful and the horse was euthanatized; a physical cause of gastroesophageal reflux disease was not identified during an extensive postmortem examination.

  10. Upper aerodigestive tract disorders and gastro-oesophageal reflux disease.

    Science.gov (United States)

    Ciorba, Andrea; Bianchini, Chiara; Zuolo, Michele; Feo, Carlo Vittorio

    2015-02-16

    A wide variety of symptoms and diseases of the upper aerodigestive tract are associated to gastro-oesophageal reflux disease (GORD). These disorders comprise a large variety of conditions such as asthma, chronic otitis media and sinusitis, chronic cough, and laryngeal disorders including paroxysmal laryngospasm. Laryngo-pharyngeal reflux disease is an extraoesophageal variant of GORD that can affect the larynx and pharynx. Despite numerous research efforts, the diagnosis of laryngopharyngeal reflux often remains elusive, unproven and controversial, and its treatment is then still empiric. Aim of this paper is to review the current literature on upper aerodigestive tract disorders in relation to pathologic gastro-oesophageal reflux, focusing in particular on the pathophysiology base and results of the surgical treatment of GORD.

  11. Cineoesophagogastroscintigraphy and positioning therapy of infant gastroesophageal reflux

    Energy Technology Data Exchange (ETDEWEB)

    Peyraud, J.; Guillet, J.; Bouix, G.; Brendel, A.J.

    1985-01-01

    During this prospective study, using cineoesophagogastroscintigraphy carried out in 27 infants under seven months of age, the positioning of the infants in the infant seat for the treatment of the gastroesophageal reflux was not detrimental in comparison to prone positioning.

  12. Novel therapeutics for gastro-esophageal reflux symptoms.

    Science.gov (United States)

    Zerbib, Frank; Simon, Mireille

    2012-09-01

    Approximately 20-30% of patients with gastro-esophageal reflux symptoms report inadequate symptom relief while on proton-pump inhibitor therapy. The mechanisms involved are failure of the antireflux barrier (transient lower esophageal sphincter relaxations), high proximal extent of the refluxate, esophageal hypersensitivity and impaired mucosal integrity. Persisting acid or nonacid reflux can be demonstrated in 40-50% of cases, suggesting that there is room for antireflux therapy in these patients. New antireflux compounds have been shown to decrease the occurrence of transient lower esophageal sphincter relaxations. The most promising classes of compounds are GABA type B agonists and metabotropic glutamate receptor 5 antagonists, which can reduce both reflux episodes and symptoms, but the development of these compounds has been abandoned for either safety issues or lack of efficacy. Esophageal hypersensitivity and impaired mucosal integrity may prove to be relevant therapeutic targets in the future.

  13. Acid and non-acid reflux patterns in patients with erosive esophagitis and non-erosive reflux disease (NERD): a study using intraluminal impedance monitoring

    NARCIS (Netherlands)

    Conchillo, José M.; Schwartz, Matthijs P.; Selimah, Mohamed; Samsom, Melvin; Sifrim, Daniel; Smout, André J.

    2008-01-01

    BACKGROUND: Non-erosive reflux disease (NERD) and erosive esophagitis (EE) are the most common phenotypic presentations of gastroesophageal reflux disease (GERD). AIM: To assess acid and non-acid reflux patterns in patients with EE and NERD using combined esophageal pH-impedance monitoring. METHODS:

  14. Acid and non-acid reflux patterns in patients with erosive esophagitis and non-erosive reflux disease (NERD) : A study using intraluminal impedance monitoring

    NARCIS (Netherlands)

    Conchillo, Jose M.; Schwartz, Matthijs P.; Selimah, Mohamed; Samsom, Melvin; Sifrim, Daniel; Smout, Andre J.

    Background Non-erosive reflux disease (NERD) and erosive esophagitis (EE) are the most common phenotypic presentations of gastroesophageal reflux disease (GERD). Aim To assess acid and non-acid reflux patterns in patients with EE and NERD using combined esophageal pH-impedance monitoring. Methods A

  15. 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

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

    Science.gov (United States)

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

    2016-01-01

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

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

    OpenAIRE

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

    2009-01-01

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

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

    International Nuclear Information System (INIS)

    Smith, Edwin A.

    2008-01-01

    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.)

  19. Gastro-oesophageal reflux in children--what's the worry?

    Science.gov (United States)

    Allen, Katie; Ho, Shaun S C

    2012-05-01

    Gastro-oesophageal reflux is common and benign in children, especially during infancy. Distinguishing between gastrooesophageal reflux, gastro-oesophageal reflux disease and other illnesses presenting as chronic vomiting can be difficult. The general practitioner has a key role to play in identifying if a child requires referral for further investigation. This article outlines the main differential diagnoses to be considered in children presenting with chronic vomiting and/ or regurgitation. We also discuss key management decisions regarding gastro-oesophageal reflux disease in children and when to refer to a specialist for further investigation. Chronic vomiting and regurgitation frequently occurs in infancy and is most commonly due to simple, benign gastrooesophageal reflux, which is usually self limiting without requirement for further investigation. In contrast, gastrooesophageal reflux disease requires considered management and may be a presenting symptom of food allergy requiring more intensive therapy than simple acid suppression. Regular review by the general practitioner to ascertain warning signs will ensure that other serious illnesses are not overlooked and that appropriate investigation and specialist referral are made.

  20. The Changing Impact of Gastroesophageal Reflux Disease in Clinical Practice.

    Science.gov (United States)

    Akst, Lee M; Haque, Omar J; Clarke, John O; Hillel, Alexander T; Best, Simon R A; Altman, Kenneth W

    2017-03-01

    The National Ambulatory Medical Care Survey (NAMCS) database was utilized to understand evolving national trends in diagnosis and management of reflux. The NAMCS database was queried for visits related to gastroesophageal reflux diagnosis and management. Analysis performed for time periods 1998-2001, 2002-2005, and 2006-2009 was weighted to provide national estimates of care. Results were compared to previously reported time periods from 1990 to 2001 to evaluate patterns in overall visits, age and ethnicity of patients, provider type, and prescriptions provided. The number of ambulatory visits for reflux increased from 8 684 000 in 1998-2001 to 15 750 000 in 2006-2009. Visits increased across each time period for internal medicine, family, and gastroenterology physicians. Among otolaryngologists, absolute visits increased from 1998-2001 to 2002-2005 but decreased in 2006-2009; difference between these time periods did not reach statistical significance. From 1998-2001 to 2006-2009, reflux medication use increased 233%, with continuing trends toward increased proton pump inhibitor use. Reflux visits have increased across all demographic subgroups studied. Knowledge of these trends may inform further paradigm shifts in diagnosis and management of reflux.

  1. 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.

  2. Reflux episodes and esophageal impedance levels in patients with typical and atypical symptoms of gastroesophageal reflux disease

    Science.gov (United States)

    Ye, Bi Xing; Jiang, Liu Qin; Lin, Lin; Wang, Ying; Wang, Meifeng

    2017-01-01

    Abstract To determine the relationship between baseline impedance levels and gastroesophageal reflux, we retrospectively enrolled 110 patients (54 men and 56 female; mean age, 51 ± 14 years) with suspected gastroesophageal reflux disease (GERD) who underwent 24-h multichannel intraluminal impedance and pH monitoring. Patients were stratified according to symptom (typical or atypical) and reflux types (acid reflux, nonacid reflux [NAR], or no abnormal reflux). Mean nocturnal baseline impedance (MNBI) were measured 3 cm (distal esophagus) and 17 cm (proximal esophagus) above the lower esophageal sphincter. Median distal esophageal MNBI was lower in the acid reflux group (1244 Ω; 647–1969 Ω) than in the NAR (2586 Ω; 1368–3666 Ω) or no abnormal reflux groups (3082 Ω; 2495–4472 Ω; all P < .05). Distal MNBI were negatively correlated with DeMeester score and acid exposure time. Atypical symptoms were more frequently associated with NAR than typical symptoms (P < .01). Among patients with positive symptom-association probability (SAP) for NAR, median proximal MNBI tended to be lower in patients with typical symptoms (median, 3013 Ω; IQR, 2535–3410 Ω) than in those with atypical symptoms (median, 3386 Ω; IQR, 3044–3730 Ω, P = .05). Thus, atypical GERD symptoms were more likely to be associated with NAR. The mucosal integrity of the proximal esophagus might be relatively impaired in GERD patients with typical symptoms for NAR. PMID:28906377

  3. 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)

  4. Association between respiratory events and nocturnal gastroesophageal reflux events in patients with coexisting obstructive sleep apnea and gastroesophageal reflux disease.

    Science.gov (United States)

    Jaimchariyatam, Nattapong; Tantipornsinchai, Warangkana; Desudchit, Tayard; Gonlachanvit, Sutep

    2016-06-01

    Literature has addressed the increased prevalence of gastroesophageal reflux disease (GERD) in obstructive sleep apnea (OSA). Significant improvement of GERD has been found after OSA treatment. However, precise mechanisms underlying this correlation remain unclear. We examined the association between nocturnal gastroesophageal reflux (GER) and sleep events in patients with coexisting OSA and GERD. A case-crossover study among 12 patients with coexisting moderate-severe OSA and GERD was conducted. Participants underwent simultaneous polysomnography and esophageal impedance and pH monitoring. GER subtypes (ie, acid reflux, non-acid reflux) were defined as outcomes. Respective control time points were selected in all eligible control periods. Each sleep event was assessed individually. Estimated odds ratios (ORs) and 95% confidence intervals (CIs) were analyzed. A p-value of reflux and 28 non-acid reflux. Arousals and awakenings were significantly associated with subsequent GER events. The OR for GER following an arousal was 2.31 (95% CI 1.39-3.68; p  0.05). Both awakening and arousal appear to precipitate any subtype of GER events in patients with coexisting GERD and moderate to severe OSA. However, GER events were significantly less likely to occur after other respiratory events and did not appear to cause sleep-related events. Copyright © 2016 Elsevier B.V. All rights reserved.

  5. 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

  6. Clinical study of anti-reflux surgery for pediatric patients with primary vesico-ureteral reflux

    International Nuclear Information System (INIS)

    Miyamae, Koichi; Kitani, Kosuke; Miyamoto, Kenji; Nakakuma, Kensuke; Hamada, Yasuyuki; Nagano, Koji; Kawano, Tomoyasu; Nakamura, Toshiro

    2012-01-01

    We reviewed the characteristics of 25 pediatric patients (41 ureters) with primary vesico-ureteral reflux (VUR) who underwent anti-reflux surgery. The patients comprised 14 males and 11 females. The median age at diagnosis and at operation was 5 years 3 months and 6 years 5 months, respectively. VUR grade comprised grade I, 4 cases, grade II, 3 cases, grade III, 11 cases, grade IV, 11 cases and grade V, 12 cases. We utilized the Cohen method as the anti-reflux surgery technique. VUR recurrence was detected in 1 case (2.9%) during follow-up. Moreover, there were no cases with progressive renal dysfunction or breakthrough infection. The rate of kidney with renal scar on scintigraphy before the operation was 48.9%, and the rate of kidney with renal dysfunction before the operation was 60.0%. As a result of Fisher's exact probability test, the risk factors of breakthrough infection (BTI) were high grade VUR and renal scar on scintigraphy. Based on our clinical results, our future strategy for the management of pediatric patients with primary VUR is proposed as follows. In all patients younger than 1 year old, antibacterial prophylaxis should be applied. For patients younger than 6 years old, the initial treatment should be antibacterial prophylaxis, but for patients with VUR of grade III or more, in cases of breakthrough infection or in cases with progressive renal dysfunction, surgical treatment should be considered. For patients older than 6 years with VUR of grade III or more, surgical treatment is strongly recommended. (author)

  7. 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

  8. Impact of concomitant laparoscopic sleeve gastrectomy and hiatal hernia repair on gastro-oesophageal reflux disease in morbidly obese patients.

    Science.gov (United States)

    Garg, Harshit; Vigneshwaran, Balasubiramaniyan; Aggarwal, Sandeep; Ahuja, Vineet

    2017-01-01

    The aim of this study was to analyse the impact of hiatal hernia repair (HHR) on gastro-oesophageal reflux disease (GERD) in morbidly obese patients with hiatus hernia undergoing laparoscopic sleeve gastrectomy (LSG). It is a retrospective study involving ten morbidly obese patients with large hiatus hernia diagnosed on pre-operative endoscopy who underwent LSG and simultaneous HHR. The patients were assessed for symptoms of GERD using a Severity symptom score (SS) questionnaire and anti-reflux medications. Of the ten patients, five patients had GERD preoperatively. At the mean follow-up of 11.70 ± 6.07 months after surgery, four patients (80%) showed complete resolution while one patient complained of persistence of symptoms. Endoscopy in this patient revealed resolution of esophagitis indicating that the persistent symptoms were not attributable to reflux. The other five patients without GERD remained free of any symptom attributable to GERD. Thus, in all ten patients, repair of hiatal hernia (HH) during LSG led to either resolution of GERD or prevented any new onset symptom related to GER. In morbidly obese patients with HH with or without GERD undergoing LSG, repair of the hiatus hernia helps in amelioration of GERD and prevents any new onset GER. Thus, the presence of HH should not be considered as a contraindication for LSG.

  9. Impact of concomitant laparoscopic sleeve gastrectomy and hiatal hernia repair on gastro-oesophageal reflux disease in morbidly obese patients

    Directory of Open Access Journals (Sweden)

    Harshit Garg

    2017-01-01

    Full Text Available Background: The aim of this study was to analyse the impact of hiatal hernia repair (HHR on gastro-oesophageal reflux disease (GERD in morbidly obese patients with hiatus hernia undergoing laparoscopic sleeve gastrectomy (LSG. Materials and Methods: It is a retrospective study involving ten morbidly obese patients with large hiatus hernia diagnosed on pre-operative endoscopy who underwent LSG and simultaneous HHR. The patients were assessed for symptoms of GERD using a Severity symptom score (SS questionnaire and anti-reflux medications. Results: Of the ten patients, five patients had GERD preoperatively. At the mean follow-up of 11.70 ± 6.07 months after surgery, four patients (80% showed complete resolution while one patient complained of persistence of symptoms. Endoscopy in this patient revealed resolution of esophagitis indicating that the persistent symptoms were not attributable to reflux. The other five patients without GERD remained free of any symptom attributable to GERD. Thus, in all ten patients, repair of hiatal hernia (HH during LSG led to either resolution of GERD or prevented any new onset symptom related to GER. Conclusion: In morbidly obese patients with HH with or without GERD undergoing LSG, repair of the hiatus hernia helps in amelioration of GERD and prevents any new onset GER. Thus, the presence of HH should not be considered as a contraindication for LSG.

  10. Dynamic measurements of reflux for quantifying gastroesophageal reflux in patients with prolonged esophageal transit time

    International Nuclear Information System (INIS)

    Gratz, K.F.; Creutzig, H.; Schmiedt, W.; Oelert, H.; Hundeshagen, H.; Medizinische Hochschule Hannover

    1985-01-01

    A combination of a radionuclide transit test and a dynamic gastroesophageal scan was evaluated in normal volunteers, in patients with achalasia treated by pneumatic dilatation (n=34) or Heller myotomy (n=21). Interpretation of 31 of 57 examinations done with usual scintiscan was not possible because of too high esophageal tracer retention. Only one case could not be interpreted with the modified technique. Gastroesophageal reflux was detected and quantified in this manner in 8 patients, 6 more than with the usual scintiscan. 7 of these 8 patients have had Heller procedure, 1 patient even combined with fundoplasty. (orig.) [de

  11. Dynamic measurements of reflux for quantifying gastroesophageal reflux in patients with prolonged esophageal transit time

    Energy Technology Data Exchange (ETDEWEB)

    Gratz, K.F.; Creutzig, H.; Schmiedt, W.; Oelert, H.; Hundeshagen, H.

    1985-05-01

    A combination of a radionuclide transit test and a dynamic gastroesophageal scan was evaluated in normal volunteers, in patients with achalasia treated by pneumatic dilatation (n=34) or Heller myotomy (n=21). Interpretation of 31 of 57 examinations done with usual scintiscan was not possible because of too high esophageal tracer retention. Only one case could not be interpreted with the modified technique. Gastroesophageal reflux was detected and quantified in this manner in 8 patients, 6 more than with the usual scintiscan. 7 of these 8 patients have had Heller procedure, 1 patient even combined with fundoplasty.

  12. How useful is gastroesophageal reflux scintigraphy in suspected childhood aspiration?

    International Nuclear Information System (INIS)

    Fawcett, H.D.; Adams, J.C.; Hayden, C.K.; Swischuk, L.E.

    1988-01-01

    It has been suggested that gastroesophageal reflux scintigraphy might be useful in assisting one in determining therapy for patients suspected of aspirating or becoming apneic secondary to gastroesophageal reflux. This, however, has not been our experience and in reviewing 23 patients with recurrent pneumonia and/or apnea who had gastroesophageal reflux scintigraphy, we were able to detect aspiration in only one. This was especially significant since 13 (59%) of these patients had demonstrable reflux, and of these, eight were treated successfully for suspected aspiration even though none was demonstrated isotopically. To be sure, the demonstration of pulmonary aspiration with gastroesophageal reflux scintigraphy had little influence on patient selection and response to therapy. For this reason we feel there is little justification in depending on the GRS for the specific purpose of trying to document pulmonary aspiration in infants and children who are refluxing. One of the more serious complications of gastroesophageal (GE) reflux is aspiration leading to recurrent pulmonary infections and/or apnea. However, it always has been difficult to demonstrate actual aspiration into the lungs, and to be sure, barium studies of the upper GI tract seldom reveal this complication. Recently, however, considerable interest has been generated in gastroesophageal scintigraphy (GRS) as a possible means of documenting such aspiration. Rationale for this stems from the fact that suspected patients can be studied over a longer period of time and in addition, delayed and overnight images can be obtained. However, our experience does not support GRS as being an adequate method for demonstrating aspiration. (orig.)

  13. Regional-scale advective, diffusive, and eruptive dynamics of CO2 and brine leakage through faults and wellbores

    Science.gov (United States)

    Jung, Na-Hyun; Han, Weon Shik; Han, Kyungdoe; Park, Eungyu

    2015-05-01

    Regional-scale advective, diffusive, and eruptive transport dynamics of CO2 and brine within a natural analogue in the northern Paradox Basin, Utah, were explored by integrating numerical simulations with soil CO2 flux measurements. Deeply sourced CO2 migrates through steeply dipping fault zones to the shallow aquifers predominantly as an aqueous phase. Dense CO2-rich brine mixes with regional groundwater, enhancing CO2 dissolution. Linear stability analysis reveals that CO2 could be dissolved completely within only 500 years. Assigning lower permeability to the fault zones induces fault-parallel movement, feeds up-gradient aquifers with more CO2, and impedes down-gradient fluid flow, developing anticlinal CO2 traps at shallow depths (<300 m). The regional fault permeability that best reproduces field spatial CO2 flux variation is estimated 1 × 10-17 ≤ kh < 1 × 10-16 m2 and 5 × 10-16 ≤ kv < 1 × 10-15 m2. The anticlinal trap serves as an essential fluid source for eruption at Crystal Geyser. Geyser-like discharge sensitively responds to varying well permeability, radius, and CO2 recharge rate. The cyclic behavior of wellbore CO2 leakage decreases with time.

  14. The efficacy of the upright position on gastro-esophageal reflux and reflux-related respiratory symptoms in infants with chronic respiratory symptoms.

    Science.gov (United States)

    Jung, Woo Jin; Yang, Hyeon Jong; Min, Taek Ki; Jeon, You Hoon; Lee, Hae Won; Lee, Jun Sung; Pyun, Bok Yang

    2012-01-01

    Gastro-esophageal reflux (GER), particularly non-acid reflux, is common in infants and is a known cause of chronic respiratory symptoms in infancy. Recent guidelines recommended empirical acid suppression therapy and the head-up position in patients with suspected GER. However, the efficacy of the upright position in relieving GER and reflux-related respiratory symptoms in infants is unclear. We conducted this study to investigate the efficacy of the upright position on GER and reflux-related respiratory symptoms in infants with chronic respiratory symptoms. Thirty-two infants (21 male; median age, 5 months; range, 0 to 19 months) with unexplained chronic respiratory symptoms underwent multi-channel intraluminal esophageal impedance and pH monitoring. We retrospectively compared the frequencies of GER and reflux-related symptoms according to body position. A mean of 3.30 episodes of reflux per hour was detected. Overall, refluxes were more frequent during the postprandial period than the emptying period (3.77 vs. 2.79 episodes/hour, respectively; P=0.01). Although there was no significant difference in the total refluxes per hour between the upright and recumbent positions (6.12 vs. 3.77 episodes, P=0.10), reflux-related respiratory symptoms per reflux were significantly fewer in infants kept in an upright position than in a recumbent position during the postprandial period (3.07% vs. 14.75%, P=0.016). Non-acid reflux was the predominant type of reflux in infants, regardless of body position or meal time. The upright position may reduce reflux-related respiratory symptoms, rather than reflux frequency. Thus, it may be a useful non-pharmacological treatment for infantile GER disease resistant to acid suppressants.

  15. 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

  16. 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.

  17. Acid perfusion test in gastroesophageal reflux disease

    Energy Technology Data Exchange (ETDEWEB)

    Kaul, B.; Petersen, H.; Grette, K.; Myrvold, H.E.

    1986-01-01

    An acid perfusion test, isotope scanning, endoscopy, and esophageal biopsy were performed in 101 patients with symptoms strongly suggestive of gastroesophageal reflux (GER) disease. A positive acid perfusion test within 30 min (APT) and within 5 min (TAPT) was found in 70.2% and 37.6% of the patients, respectively. A positive APT was found significantly more often in patients with than without endoscopic esophagitis, whereas a positive TAPT was found significantly more often in patients with severe symptoms than in patients with moderate symptoms, and in a significantly higher proportion of patients with than without GER by scintigraphy. Neither the APT nor the TAPT showed any dependency on the presence of histologic esophagitis. Most (97%) patients with a negative acid perfusion test, in addition to typical symptoms, also presented with scintigraphic, endoscopic, or histologic evidence of GER disease. Although it shows that the acid perfusion test, particularly when early positive, may serve as a weak predictor of the severity of GER disease, the present study gives little support to the test's clinical usefulness.

  18. Prevalence of gastro-oesophageal reflux disease symptoms and reflux-associated respiratory symptoms in asthma

    Directory of Open Access Journals (Sweden)

    de Silva H Janaka

    2010-09-01

    Full Text Available Abstract Background Gastro-oesophageal reflux disease (GORD symptoms are common in asthma and have been extensively studied, but less so in the Asian continent. Reflux-associated respiratory symptoms (RARS have, in contrast, been little-studied globally. We report the prevalence of GORD symptoms and RARS in adult asthmatics, and their association with asthma severity and medication use. Methods A cross-sectional analytical study. A validated interviewer-administered GORD scale was used to assess frequency and severity of seven GORD symptoms. Subjects were consecutive asthmatics attending medical clinics. Controls were matched subjects without respiratory symptoms. Results The mean (SD composite GORD symptom score of asthmatics was significantly higher than controls (21.8 (17.2 versus 12.0 (7.6; P P Conclusions GORD symptoms and RARS were more prevalent in a cohort of Sri Lankan adult asthmatics compared to non-asthmatics. Increased prevalence of RARS is associated with both typical and atypical symptoms of GORD. Asthma disease and its severity, but not asthma medication, appear to influence presence of GORD symptoms.

  19. Prevalence of Gastroesophageal Reflux Disease in Saudi Arabia.

    Science.gov (United States)

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

    2018-03-01

    Gastroesophageal reflux disease (GERD) is a common chronic gastrointestinal tract disease. The incidence is higher in Asian and Arab countries. In Saudi Arabia, there are few studies that have assessed the prevalence of GERD among some cities' communities. Hence, this study aims to study the prevalence of GERD among the general population of Saudi Arabia. A cross-sectional study was designed to determine the prevalence of GERD among the community of Saudi Arabia. The sample was randomly gathered through self-administered validated GERD questionnaire (GerdQ) to diagnose GERD, during the period from November to December 2016. The sociodemographic data was assessed for all participants. The data were analysed using Statistical Package for Social Sciences version 21.0 (SPSS); the t -test was used to assess the association of GERD and sociodemographic data. The sample was comprised of 2,043 participants. Female and male were 51.8% and 48.2%, respectively. Mean age was 29.6 years with the standard deviation of 10.5 years. The GERD prevalence was 28.7%. It was found statistically significant among divorced/widow (34.9%, P = 0.003). In contrast, there was no association between GERD's prevalence and gender, age, residence status, education level, occupation, and blood group (P > 0.05). The prevalence of GERD among Saudi population is higher than that in Western countries and East Asia. It affects divorced/widow, obese and those with a sedentary lifestyle. It is advocated that national programs and educational campaigns for prevention of this disease and its complications should be established.

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

    International Nuclear Information System (INIS)

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

    1981-01-01

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

  1. The Role of the Acid Pocket in Gastroesophageal Reflux Disease.

    Science.gov (United States)

    Mitchell, David R; Derakhshan, Mohammad H; Robertson, Elaine V; McColl, Kenneth E L

    2016-02-01

    Gastroesophageal reflux disease is one of the commonest chronic conditions in the western world and its prevalence is increasing worldwide. The discovery of the acid pocket explained the paradox of acid reflux occurring more frequently in the postprandial period despite intragastric acidity being low due to the buffering effect of the meal. The acid pocket was first described in 2001 when it was detected as an area of low pH immediately distal to the cardia using dual pH electrode pull-through studies 15 minutes after a meal. It was hypothesized that there was a local pocket of acid close to the gastroesophageal junction that escapes the buffering effect of the meal, and that this is the source of postprandial acidic reflux. The presence of the acid pocket has been confirmed in other studies using different techniques including high-resolution pHmetry, Bravo capsule, magnetic resonance imaging, and scintigraphy. This review aims to describe what we know about the acid pocket including its length, volume, fluid constituents, and its relationship to the lower esophageal sphincter and squamocolumnar junction. We will discuss the possible mechanisms that lead to the formation of the acid pocket and examine what differences exist in patients who suffer from acid reflux. Treatments for reflux disease that affect the acid pocket will also be discussed.

  2. Role of gastroesophageal reflux disease in lung transplantation

    Science.gov (United States)

    Hathorn, Kelly E; Chan, Walter W; Lo, Wai-Kit

    2017-01-01

    Lung transplantation is one of the highest risk solid organ transplant modalities. Recent studies have demonstrated a relationship between gastroesophageal reflux disease (GERD) and lung transplant outcomes, including acute and chronic rejection. The aim of this review is to discuss the pathophysiology, evaluation, and management of GERD in lung transplantation, as informed by the most recent publications in the field. The pathophysiology of reflux-induced lung injury includes the effects of aspiration and local immunomodulation in the development of pulmonary decline and histologic rejection, as reflective of allograft injury. Modalities of reflux and esophageal assessment, including ambulatory pH testing, impedance, and esophageal manometry, are discussed, as well as timing of these evaluations relative to transplantation. Finally, antireflux treatments are reviewed, including medical acid suppression and surgical fundoplication, as well as the safety, efficacy, and timing of such treatments relative to transplantation. Our review of the data supports an association between GERD and allograft injury, encouraging a strategy of early diagnosis and aggressive reflux management in lung transplant recipients to improve transplant outcomes. Further studies are needed to explore additional objective measures of reflux and aspiration, better compare medical and surgical antireflux treatment options, extend follow-up times to capture longer-term clinical outcomes, and investigate newer interventions including minimally invasive surgery and advanced endoscopic techniques. PMID:28507913

  3. 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)

  4. Gastroesophageal reflux disease: Update on inflammation and symptom perception.

    Science.gov (United States)

    Altomare, Annamaria; Guarino, Michele Pier Luca; Cocca, Silvia; Emerenziani, Sara; Cicala, Michele

    2013-10-21

    Although gastroesophageal reflux disease (GERD) is a common disorder in Western countries, with a significant impact on quality of life and healthcare costs, the mechanisms involved in the pathogenesis of symptoms remain to be fully elucidated. GERD symptoms and complications may result from a multifactorial mechanism, in which acid and acid-pepsin are the important noxious factors involved. Prolonged contact of the esophageal mucosa with the refluxed content, probably caused by a defective anti-reflux barrier and luminal clearance mechanisms, would appear to be responsible for macroscopically detectable injury to the esophageal squamous epithelium. Receptors on acid-sensitive nerve endings may play a role in nociception and esophageal sensitivity, as suggested in animal models of chronic acid exposure. Meanwhile, specific cytokine and chemokine profiles would appear to underlie the various esophageal phenotypes of GERD, explaining, in part, the genesis of esophagitis in a subset of patients. Despite these findings, which show a significant production of inflammatory mediators and neurotransmitters in the pathogenesis of GERD, the relationship between the hypersensitivity and esophageal inflammation is not clear. Moreover, the large majority of GERD patients (up to 70%) do not develop esophageal erosions, a variant of the condition called non-erosive reflux disease. This summary aims to explore the inflammatory pathway involved in GERD pathogenesis, to better understand the possible distinction between erosive and non-erosive reflux disease patients and to provide new therapeutic approaches.

  5. 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

  6. Gastroesophageal reflux disease in 2006. The imperfect diagnosis

    International Nuclear Information System (INIS)

    Boyle, John T.

    2006-01-01

    There continues to be significant controversy related to diagnostic testing for gastroesophageal reflux disease (GERD). Clearly, barium contrast fluoroscopy is superior to any other test in defining the anatomy of the upper gastrointestinal (UGI) tract. Although fluoroscopy can demonstrate gastroesophageal reflux (GER), this observation does not equate to GERD. Fluoroscopy time should not be prolonged to attempt to demonstrate GER during barium contrast radiography. There are no data to justify prolonging fluoroscopy time to perform provocative maneuvers to demonstrate reflux during barium contrast UGI series. Symptoms of GERD may be associated with physiologic esophageal acid exposure measured by intraesophageal pH monitoring, and a significant percentage of patients with abnormal esophageal acid exposure have no or minimal clinical symptoms of reflux. Abnormal acid exposure defined by pH monitoring over a 24-h period does not equate to GERD. In clinical practice presumptive diagnosis of GERD is reasonably assumed by substantial reduction or elimination of suspected reflux symptoms during therapeutic trial of acid reduction therapy. (orig.)

  7. Protective Effect of ECQ on Rat Reflux Esophagitis Model.

    Science.gov (United States)

    Jang, Hyeon-Soon; Han, Jeong Hoon; Jeong, Jun Yeong; Sohn, Uy Dong

    2012-12-01

    This study was designed to determine the protective effect of Rumex Aquaticus Herba extracts containing quercetin-3-β-D-glucuronopyranoside (ECQ) on experimental reflux esophagitis. Reflux esophagitis was induced by surgical procedure. The rats were divided into seven groups, namely normal group, control group, ECQ (1, 3, 10, 30 mg/kg) group and omeprazole (30 mg/kg) group. ECQ and omeprazole groups received intraduodenal administration. The Rats were starved for 24 hours before the experiments, but were freely allowed to drink water. ECQ group attenuated the gross esophagitis significantly compared to that treated with omeprazole in a dose-dependent manner. ECQ decreased the volume of gastric juice and increased the gastric pH, which are similar to those of omeprazole group. In addition, ECQ inhibited the acid output effectively in reflux esophagitis. Significantly increased amounts of malondialdehyde (MDA), myeloperoxidase (MPO) activity and the mucosal depletion of reduced glutathione (GSH) were observed in the reflux esophagitis. ECQ administration attenuated the decrement of the GSH levels and affected the MDA levels and MPO activity. These results suggest that the ECQ has a protective effect which may be attributed to its multiple effects including anti-secretory, anti-oxidative and anti-inflammatory actions on reflux esophagitis in rats.

  8. Gastroesophageal reflux disease in 2006. The imperfect diagnosis

    Energy Technology Data Exchange (ETDEWEB)

    Boyle, John T. [Children' s Hospital of Alabama, Division of Pediatric Gastroenterology, Birmingham, AL (United States); University of Alabama-Birmingham School of Medicine, Division of Pediatric Gastroenterology, Birmingham, AL (United States)

    2006-09-15

    There continues to be significant controversy related to diagnostic testing for gastroesophageal reflux disease (GERD). Clearly, barium contrast fluoroscopy is superior to any other test in defining the anatomy of the upper gastrointestinal (UGI) tract. Although fluoroscopy can demonstrate gastroesophageal reflux (GER), this observation does not equate to GERD. Fluoroscopy time should not be prolonged to attempt to demonstrate GER during barium contrast radiography. There are no data to justify prolonging fluoroscopy time to perform provocative maneuvers to demonstrate reflux during barium contrast UGI series. Symptoms of GERD may be associated with physiologic esophageal acid exposure measured by intraesophageal pH monitoring, and a significant percentage of patients with abnormal esophageal acid exposure have no or minimal clinical symptoms of reflux. Abnormal acid exposure defined by pH monitoring over a 24-h period does not equate to GERD. In clinical practice presumptive diagnosis of GERD is reasonably assumed by substantial reduction or elimination of suspected reflux symptoms during therapeutic trial of acid reduction therapy. (orig.)

  9. MicroRNA-196a & microRNA-101 expression in Barrett's oesophagus in patients with medically and surgically treated gastro-oesophageal reflux

    Directory of Open Access Journals (Sweden)

    Bright Tim

    2011-02-01

    Full Text Available Abstract Background Proton pump inhibitor (PPI medication and surgical fundoplication are used for the control of gastro-oesophageal reflux in patients with Barrett's oesophagus, but differ in their effectiveness for both acid and bile reflux. This might impact on the inflammatory processes that are associated with progression of Barrett's oesophagus to cancer, and this may be evident in the gene expression profile and microRNA expression pattern in Barrett's oesophagus mucosa. We hypothesised that two miRNAs with inflammatory and oncogenic roles, miR-101 and miR-196a, are differentially expressed in Barrett's oesophagus epithelium in patients with reflux treated medically vs. surgically. Findings Mucosal tissue was obtained at endoscopy from patients with Barrett's oesophagus whose reflux was controlled by proton pump inhibitor (PPI therapy (n = 20 or by fundoplication (n = 19. RNA was extracted and the expression of miR-101 and miR-196a was measured using real-time reverse transcription - polymerase chain reaction. There were no significant differences in miR-101 and miR-196a expression in Barrett's oesophagus epithelium in patients treated by PPI vs. fundoplication (p = 0.768 and 0.211 respectively. Secondary analysis showed a correlation between miR-196a expression and Barrett's oesophagus segment length (p = 0.014. Conclusion The method of reflux treatment did not influence the expression of miR-101 and miR-196a in Barrett's oesophagus. This data does not provide support to the hypothesis that surgical treatment of reflux better prevents cancer development in Barrett's oesophagus. The association between miR-196a expression and Barrett's oesophagus length is consistent with a tumour promoting role for miR-196a in Barrett's oesophagus.

  10. MicroRNA-196a & microRNA-101 expression in Barrett's oesophagus in patients with medically and surgically treated gastro-oesophageal reflux

    Science.gov (United States)

    2011-01-01

    Background Proton pump inhibitor (PPI) medication and surgical fundoplication are used for the control of gastro-oesophageal reflux in patients with Barrett's oesophagus, but differ in their effectiveness for both acid and bile reflux. This might impact on the inflammatory processes that are associated with progression of Barrett's oesophagus to cancer, and this may be evident in the gene expression profile and microRNA expression pattern in Barrett's oesophagus mucosa. We hypothesised that two miRNAs with inflammatory and oncogenic roles, miR-101 and miR-196a, are differentially expressed in Barrett's oesophagus epithelium in patients with reflux treated medically vs. surgically. Findings Mucosal tissue was obtained at endoscopy from patients with Barrett's oesophagus whose reflux was controlled by proton pump inhibitor (PPI) therapy (n = 20) or by fundoplication (n = 19). RNA was extracted and the expression of miR-101 and miR-196a was measured using real-time reverse transcription - polymerase chain reaction. There were no significant differences in miR-101 and miR-196a expression in Barrett's oesophagus epithelium in patients treated by PPI vs. fundoplication (p = 0.768 and 0.211 respectively). Secondary analysis showed a correlation between miR-196a expression and Barrett's oesophagus segment length (p = 0.014). Conclusion The method of reflux treatment did not influence the expression of miR-101 and miR-196a in Barrett's oesophagus. This data does not provide support to the hypothesis that surgical treatment of reflux better prevents cancer development in Barrett's oesophagus. The association between miR-196a expression and Barrett's oesophagus length is consistent with a tumour promoting role for miR-196a in Barrett's oesophagus. PMID:21352563

  11. The usefulness of esophagography as a screening test for laryngopharyngeal reflux

    International Nuclear Information System (INIS)

    Kim, Tae Hoon; Chung, Phil Sang

    2006-01-01

    There are many articles about the role of barium esophagography for the diagnosis of gastroesophageal reflux disease. However, there are only rare articles reporting on laryngopharyngeal reflux disease. The purpose of this study is to evaluate the usefulness of performing esophagography with the water-siphon test as an initial screening test for patients with suspected laryngopharyngeal reflux. From October 2002 to December 2004, barium esophagography with the water-siphon test was performed for 707 patients who had the typical symptoms and telescopic findings of laryngopharyngeal reflux. The results of the 707 esophagograms (the group with laryngopharyngeal reflux) were compared with those of 122 patients who were confirmed as having gastroesophageal reflux upon performing pH-metry (the group with gastroesophageal reflux) and the 324 patients without laryngopharyngeal reflux symptoms (the control group). The results of the water-siphon test were classified into normal, mild, moderate and severe degrees of gastroesophageal reflux. On the water-siphon test for the laryngopharyneal reflux group patients, 71 patients had normal (10.0%), 207 had mild (29.2%), 201 had moderate (28.4%) and 228 had severe (32.2%) degrees of reflux. The positive rates of the water-siphon test were 90.0%, 89.3% and 54.6% for the groups with laryngopharyngeal reflux, gastroesophageal reflux and the control group, respectively. A statistically significant difference was observed between the group with laryngopharyngeal reflux and the control group, and between the group with gastroesophageal reflux and the control group, respectively (ρ < 0.05). Esophagography with the water-siphon test is useful as an initial screening test for laryngopharyngeal reflux disease

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

    OpenAIRE

    Batool M Mahdi

    2011-01-01

    Background : Gastro-esophageal reflux disease is a common condition, affecting 25%-40% of the population. Increasing attention has been paid to the relationship between Helicobacter pylori infection and reflux esophagitis. Aim: The aim of this study was to investigate the association between CagA+ H. pylori and endoscopically proven gastro-esophageal reflux disease. Patients and Methods: The study group included 60 hospital patients with gastro-esophageal reflux disease between 2007 and 2009 ...

  13. The usefulness of esophagography as a screening test for laryngopharyngeal reflux

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Tae Hoon; Chung, Phil Sang [Dankook University Hospital, Cheonan (Korea, Republic of)

    2006-04-15

    There are many articles about the role of barium esophagography for the diagnosis of gastroesophageal reflux disease. However, there are only rare articles reporting on laryngopharyngeal reflux disease. The purpose of this study is to evaluate the usefulness of performing esophagography with the water-siphon test as an initial screening test for patients with suspected laryngopharyngeal reflux. From October 2002 to December 2004, barium esophagography with the water-siphon test was performed for 707 patients who had the typical symptoms and telescopic findings of laryngopharyngeal reflux. The results of the 707 esophagograms (the group with laryngopharyngeal reflux) were compared with those of 122 patients who were confirmed as having gastroesophageal reflux upon performing pH-metry (the group with gastroesophageal reflux) and the 324 patients without laryngopharyngeal reflux symptoms (the control group). The results of the water-siphon test were classified into normal, mild, moderate and severe degrees of gastroesophageal reflux. On the water-siphon test for the laryngopharyneal reflux group patients, 71 patients had normal (10.0%), 207 had mild (29.2%), 201 had moderate (28.4%) and 228 had severe (32.2%) degrees of reflux. The positive rates of the water-siphon test were 90.0%, 89.3% and 54.6% for the groups with laryngopharyngeal reflux, gastroesophageal reflux and the control group, respectively. A statistically significant difference was observed between the group with laryngopharyngeal reflux and the control group, and between the group with gastroesophageal reflux and the control group, respectively ({rho} < 0.05). Esophagography with the water-siphon test is useful as an initial screening test for laryngopharyngeal reflux disease.

  14. Acid Secretion and Its Relationship to Esophageal Reflux Symptom in Patients with Subtotal Gastrectomy.

    Science.gov (United States)

    Oh, Hyun Jin; Choi, Myung-Gyu; Park, Jae Myung; Song, Kyo Young; Yoo, Han Mo

    2018-03-01

    Esophageal reflux symptom has been reported as common in patients with subtotal gastrectomy. Management of postoperative esophageal reflux symptom is not satisfactory. The aim of this study is to investigate prevalence of esophageal reflux symptom after subtotal gastrectomy and assess factors affecting esophageal reflux symptom in subtotal gastrectomy patients. We prospectively enrolled 100 consecutive patients with subtotal gastrectomy who were regularly followed up by endoscopic examination. Acid secretory capacity was assessed by measuring messenger RNA (mRNA) expression of H + /K + -adenosine triphosphatase (ATPase) via real-time polymerase chain reaction (PCR) in biopsy specimens. In total, 47 % of patients had typical esophageal reflux symptom, where heartburn or regurgitation was experienced at least weekly. Age, sex, body mass index, and type of reconstruction did not differ between esophageal reflux and non-esophageal-reflux groups. The esophageal reflux group had longer duration from time of operation until study (median 5.0 versus 3.6 years; P = 0.017). Hill grade for gastroesophageal (GE) flap valve was higher in the esophageal reflux group than in the non-esophageal-reflux group (P = 0.027). H + /K + -ATPase mRNA expression was higher in the esophageal reflux group than in the non-esophageal-reflux group [3967.6 (± 7583.7) versus 896.2 (± 1456.0); P = 0.006]. Multivariate analysis revealed that postoperative duration, H + /K + -ATPase mRNA expression level, and GE flap valve disruption were significantly associated with esophageal reflux symptom development. Esophageal reflux symptom is common in patients after subtotal gastrectomy, possibly because of anti-reflux-barrier impairment and preservation of acid secretory capacity following surgery. Optimal acid suppression may be helpful in managing postoperative esophageal reflux symptom.

  15. There is no correlation between signs of reflux laryngitis and reflux oesophagitis in patients with gastro-oesophageal reflux disease symptoms.

    Science.gov (United States)

    Zelenik, K; Kajzrlikova, I M; Vitek, P; Urban, O; Hanousek, M; Kominek, P

    2017-10-01

    The objective of the present study was to determine if there is correlation between signs of reflux laryngitis (RL) and reflux oesophagitis (RE) in patients with gastro-oesophageal reflux disease (GORD) symptoms. Laryngeal photography obtained from patients during oesophagogastroduodenoscopy were examined by two otolaryngologists experienced in the field of extra-oesophageal reflux regarding the presence and severity of RL. The presence of RE was evaluated by gastroenterologist. Smokers, heavy drinkers and patients with bronchial asthma were excluded from the statistical analysis. A total of 681 patients were analysed. RL was diagnosed in 367 (53.9%) cases, of whom 182 patients had mild, 118 moderate and 67 severe (Reflux Finding Score > 7) RL. RE was diagnosed in 103 (28.1%) patients with RL and in 80 (25.7%) patients without RL. Neither the difference between the overall group of patients with RL and those without (OR 1.141, 95% CI 0.811-1.605, p = 0.448), nor the differences between the respective subgroups of patients with mild, moderate and severe RL and those without RL were statistically significant. The OR and 95% CI for mild, moderate and severe RL were 1.042, 95% CI 0.712-1.526, p = 0.834, 1.182, 95% CI 0.764-1.831, p = 0.453 and 1.0, 95% CI 0.566-1.766, p = 0.999 respectively. It can be concluded that there is no correlation between RL and RE in patients with GORD symptoms. © Copyright by Società Italiana di Otorinolaringologia e Chirurgia Cervico-Facciale, Rome, Italy.

  16. 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

  17. Review article: The measurement of non-acid gastro-oesophageal reflux

    NARCIS (Netherlands)

    Smout, A. J. P. M.

    2007-01-01

    BACKGROUND: Oesophageal pH monitoring has been used for three decades to study gastro-oesophageal reflux, but it does not allow detection of non-acid reflux episodes. AIM: To discuss the techniques by which non-acid reflux can be measured and to evaluate the clinical relevance of such measurements.

  18. Esophageal scintigraphy and pH monitoring in adults with gastroesophageal reflux

    Energy Technology Data Exchange (ETDEWEB)

    Jouin, H.; Chamouard, P.; Baumann, R. and others

    1987-10-01

    Thirty-seven adults with gastroesophageal reflux were explored by oesophageal scintigraphy and pH monitoring (three hours postprandial). Scintigraphy was less frequently positive than pH test in gastroesophageal reflux (81% versus 57%) with a significant difference. It is suggested that postprandial pH monitoring is reliable in the initial assessment of symptomatic gastroesophageal reflux.

  19. Esophageal scintigraphy and pH monitoring in adults with gastroesophageal reflux

    International Nuclear Information System (INIS)

    Jouin, H.; Chamouard, P.; Baumann, R.

    1987-01-01

    Thirty-seven adults with gastroesophageal reflux were explored by oesophageal scintigraphy and pH monitoring (three hours postprandial). Scintigraphy was less frequently positive than pH test in gastroesophageal reflux (81% versus 57%) with a significant difference. It is suggested that postprandial pH monitoring is reliable in the initial assessment of symptomatic gastroesophageal reflux [fr

  20. The Effect of Laparoscopic Sleeve Gastrectomy with Concomitant Hiatal Hernia Repair on Gastroesophageal Reflux Disease in the Morbidly Obese.

    Science.gov (United States)

    Samakar, Kamran; McKenzie, Travis J; Tavakkoli, Ali; Vernon, Ashley H; Robinson, Malcolm K; Shikora, Scott A

    2016-01-01

    The effect of laparoscopic sleeve gastrectomy (LSG) on gastroesophageal reflux disease (GERD) is controversial. Although concomitant hiatal hernia repair (HHR) at the time of LSG is common and advocated by many, there are few data on the outcomes of GERD symptoms in these patients. The aim of this study was to evaluate the effect of concomitant HHR on GERD symptoms in morbidly obese patients undergoing LSG. A single institution, multi-surgeon, prospectively maintained database was examined to identify patients who underwent LSG and concomitant HHR from December 2010 to October 2013. Patient characteristics, operative details, and postoperative outcomes were analyzed. Standardized patient questionnaires administered both pre- and postoperatively were utilized. Primary endpoints included subjective reflux symptoms and the need for antisecretory therapy. Weight loss was considered a secondary endpoint. Fifty-eight patients were identified meeting inclusion criteria (LSG + HHR), with a mean follow-up of 97.5 weeks (range 44-172 weeks). The mean age of the cohort was 49.5 ± 11.2 years, with 74.1 % being female. Mean preoperative BMI was 44.2 ± 6.6 kg/m(2). Preoperative upper gastrointestinal contrast series was performed in all patients and demonstrated a hiatal hernia in 34.5 % of patients and reflux in 15.5 % of patients. Preoperatively, 44.8 % (n = 26) of patients reported subjective symptoms of reflux and/or required daily antisecretory therapy [Corrected]. After LSG + HHR, 34.6 % of symptomatic patients had resolution of their symptoms off therapy while the rest remained symptomatic and required daily antisecretory therapy; 84.4 % of patients that were asymptomatic preoperatively remained asymptomatic after surgery. New onset reflux symptoms requiring daily antisecretory therapy was seen in 15.6 % of patients who were previously asymptomatic. Post surgical weight loss did not correlate with the presence or resolution of reflux symptoms. Based

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1986-01-01

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

  2. 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%

  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. Gastro-Oesophageal Reflux in Noncystic Fibrosis Bronchiectasis

    Directory of Open Access Journals (Sweden)

    Annemarie L. Lee

    2011-01-01

    Full Text Available The clinical presentation of noncystic fibrosis bronchiectasis may be complicated by concomitant conditions, including gastro-oesophageal reflux (GOR. Increased acidic GOR is principally caused by gastro-oesophageal junction incompetence and may arise from lower oesophageal sphincter hypotension, including transient relaxations, hiatus hernia, and oesophageal dysmotility. Specific pathophysiological features which are characteristic of respiratory diseases including coughing may further increase the risk of GOR in bronchiectasis. Reflux may impact on lung disease severity by two mechanisms, reflex bronchoconstriction and pulmonary microaspiration. Symptomatic and clinically silent reflux has been detected in bronchiectasis, with the prevalence of 26 to 75%. The cause and effect relationship has not been established, but preliminary reports suggest that GOR may influence the severity of bronchiectasis. Further studies examining the implications of GOR in this condition, including its effect across the disease spectrum using a combination of diagnostic tools, will clarify the clinical significance of this comorbidity.

  6. Assessing Old and New Diagnostic Tests for Gastroesophageal Reflux Disease.

    Science.gov (United States)

    Vaezi, Michael F; Sifrim, Daniel

    2018-01-01

    A detailed critique of objective measurements of gastroesophageal reflux disease (GERD) would improve management of patients suspecting of having reflux, leading to rational selection of treatment and better outcomes. Many diagnostic tests for GERD have been developed over the past decades. We analyze their development, positive- and negative-predictive values, and ability to predict response to treatment. These features are important for development of medical, surgical, and endoscopic therapies for GERD. We discuss the value of available diagnostic tests and review their role in management of patients with persistent reflux symptoms despite adequate medical or surgical treatment. This is becoming a significant health economic problem, due to the widespread use of proton pump inhibitors. GERD is believed to cause nonesophageal symptoms, such as those provoked by ear, nose, throat, or respiratory disorders. We analyze the value of GERD diagnostic tests in evaluation of these troublesome, nonesophageal symptoms. Copyright © 2018 AGA Institute. Published by Elsevier Inc. All rights reserved.

  7. Gastroesophageal reflux disease: recent advances and its association with sleep.

    Science.gov (United States)

    Oh, Jung Hwan

    2016-09-01

    Gastroesophageal reflux disease (GERD) is prevalent in Asia as well as in Western countries. Sleep disturbance and breathing disorders during sleep are becoming increasingly prevalent, and they are commonly associated with GERD. The relationship between GERD and obstructive sleep apnea (OSA) is still questionable, and it has expanded to include Barrett's esophagus. Nocturnal gastroesophageal reflux (nGER) symptoms might be clinically important in the explanation of this association. The therapy for reflux symptoms has resulted in improved subjective sleep parameters and enhanced sleep quality, thus supporting a direct relationship between GERD and sleep disturbance. This review discusses the epidemiology of sleep disturbances in GERD patients; the causative relationship between GERD and OSA, even though it remains an area of controversy; and the possible role of nGER in sleep problems. It also provides an update on the current state of knowledge linking GERD and sleep. © 2016 New York Academy of Sciences.

  8. 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.)

  9. Benzole still reflux system - Dawes Lane Coke Ovens

    Energy Technology Data Exchange (ETDEWEB)

    Hardwick, J.

    2005-07-01

    The paper describes a project carried out at Dawes Lane coking plant (in Scunthorpe, UK) to access current performance of the batch reflux system with respect to the operation of personnel and to recommend a solution to eliminate naphthalene blockage and problems previously caused by the use of hot debenzolised oil (DBO) as make-up. A successful solution was found and implemented. The benzole product now being produced is within specification and regularly achieves the composition produced by the previous hot reflux system (83% benzole, 7% naphthalene) with an addition reduction in wash oil usage of 20%. Problems of naphthalene blockages in reflux pipework have been cured. The expenses on the project were small. The paper was presented at a COMA meeting at Monckton Coke Ovens on 19 May 2005. 6 figs.

  10. Surgical techniques for treatment of gastroesophageal reflux disease

    Directory of Open Access Journals (Sweden)

    Carlos Édder de Mello Cardoso Lima

    2015-12-01

    Full Text Available Gastroesophageal reflux is one of the most frequently gastrointestinal tract diseases currently found, having a great impact on the patient's quality of life. Purpose: to analyze the main surgical techniques used in the treatment of this pathology, their indications, advantages and disadvantages. Methods: this is a literature review. Thirteen articles published between 1998 and 2013 in the Lilacs, Bireme e Scielo databases, addressing different surgical techniques for the treatment of gastroesophageal reflux were selected. Results: Five hundred and thirty-eight total fundoplications and 466 partial fundoplications were performed. Conclusion: The findings of this review show that total fundoplication is the most commonly used technique in the treatment of gastroesophageal reflux disease.

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

    International Nuclear Information System (INIS)

    Lee, Richard S.; Diamond, David A.; Chow, Jeanne S.

    2006-01-01

    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.)

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

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    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.

  13. An updated review on gastro-esophageal reflux in pediatrics.

    Science.gov (United States)

    Vandenplas, Yvan; Hauser, Bruno

    2015-01-01

    Comprehensive guidelines for the diagnosis and management of gastro-esophageal reflux (GER) and GER disease (GERD) were developed by the European and North American Societies for Pediatric Gastroenterology, Hepatology and Nutrition. GERD is reflux associated with troublesome symptoms or complications. The recognition of GER and GERD is relevant to implement best management practices. A conservative management is indicated in infants with uncomplicated physiologic reflux. Children with GERD may benefit from further evaluation and treatment. Since the publications of the European and North American Societies for Pediatric Gastroenterology, Hepatology and Nutrition guidelines in 2009, no important novelties in drug treatment have been reported. Innovations are mainly restricted to the management of regurgitation in infants. During the last 5 years, pros and cons of multichannel intraluminal impedance have been highlighted. However, overall 'not much has changed' in the diagnosis and management of GER and GERD in infants and children.

  14. 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.

  15. Treatment of clinically diagnosed laryngopharyngeal reflux disease.

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    Youssef, Tarek Fouad; Ahmed, Mohamed Rifaat

    2010-11-01

    To determine the incidence of Helicobacter pylori (HP) stool antigen (HPSA) in patients with laryngopharyngeal reflux disease (LPRD), and to make a comparison of 2 treatment regimens that have been used based on the presence or absence of HPSA positivity in patients with LPRD. Randomized controlled study. Suez Canal University Hospital, Ismalia, Egypt. A total of 212 patients with symptoms of LPRD. Patients were evaluated by laryngoscopy, ambulatory pH monitoring for 24 hours, and HPSA testing. Esomeprazole magnesium as a monotherapy was evaluated vs triple therapy in patients with HP infection. To determine the incidence of HPSA in patients with LPRD, and to make a comparison of 2 treatment regimens that have been used based on the presence or absence of HPSA positivity in patients with LPRD. Persistent dry cough and a feeling of a lump in the throat (globus sensation) were the most frequent symptoms of LPRD, while posterior laryngeal inflammation was the main laryngoscopic finding. Results from the HPSA test were positive in 57% of the studied group. Patients with negative HPSA were treated with esomeprazole as single modality with a reported improvement score of 96.6%. Patients with positive HPSA test results were divided into 2 groups: 1 received only esomeprazole, with reported improvement in 40%, whereas the second group was treated with esomeprazole, plus amoxicillin sodium and clarithromycin (triple therapy) and reported a 90% incidence of symptom improvement. The incidence of HP infection in patients with LPRD in our study was 57%. Triple therapy showed a higher cure rate in patients with HPSA-positive test results.

  16. COMBINED 24-HOURS ESOPHAGEAL PH MONITORING AND MULTICHANNEL INTRALUMINAL IMPEDANCE FOR COMPARISON OF GASTROESOPHAGEAL REFLUX IN CHILDREN WITH TYPICAL VERSUS ATYPICAL SYMPTOMS OF GASTROESOPHAGEAL REFLUX DISEASE.

    Science.gov (United States)

    Dehghani, Seyed Mohsen; Taghavi, Seyed Alireza; Javaherizadeh, Hazhir; Nasri, Maryam

    2016-01-01

    - Gastroesophageal reflux disease is the most common esophageal disorder in pediatrics. - The aim of this study was to compare reflux parameters of typical and atypical symptoms of gastroesophageal reflux disease using 24-hour esophageal pH monitoring and multichannel intraluminal impedance in pediatric population. - In this prospective study, 43 patients aged less than 18 year with suspected gastroesophageal reflux disease were enrolled. The patients were divided into two groups based on the main presenting symptoms (typical versus atypical). Twenty four-hour pH monitoring and multichannel intraluminal impedance were performed in all the patients for comparing these two group regarding association of symptoms and reflux. Number of refluxes, pH related reflux, total reflux time, reflux more than 5 minutes, longest time of the reflux, lowest pH at reflux, reflux index were recorded and compared. Data comparison was done using SPSS. - The mean age of the patients was 5.7±3.4 years and 65.1% were male. Out of 43 patients 24 cases had typical symptoms and 19 had atypical symptoms. The mean reflux events detected by multichannel intraluminal impedance was more than mean reflux events detected by pH monitoring (308.4±115.8 vs 69.7±66.6) with P value of 0.037, which is statistically significant. The mean symptom index and symptom association probability were 35.01% ± 20.78% and 86.42% ± 25.79%, respectively in multichannel intraluminal impedance versus 12.73% ± 12.48% and 45.16% ± 42.29% in pH monitoring (P value reflux was 46.26±47.16 and 30.9±22.09 for atypical and typical symptoms respectively. The mean symptom index was 18.12% ± 13.101% and 8.30% ± 10.301% in atypical and typical symptoms respectively (P=0.034). Bolus clearance was longer in atypical symptoms compared typical symptoms(Preflux was found in children with atypical symptoms of reflux. Longer duration of bolus clearance was found in group with atypical symptoms of reflux.

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

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    Mattos, Ângelo Zambam de; Marchese, Gabriela Meirelles; Fonseca, Bárbara Brum; Kupski, Carlos; Machado, Marta Brenner

    2017-12-01

    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. To evaluate the use of proton pump inhibitors and histamine H2 receptor antagonists in pediatric gastroesophageal reflux disease through a systematic review. 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). 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 different combinations of omeprazole, bethanechol and placebo for the

  18. Does gastroesophageal reflux increase chronic obstructive pulmonary disease exacerbations?

    Science.gov (United States)

    Iliaz, Sinem; Iliaz, Raim; Onur, Seda Tural; Arici, Serpil; Akyuz, Umit; Karaca, Cetin; Demir, Kadir; Besisik, Fatih; Kaymakoglu, Sabahattin; Akyuz, Filiz

    2016-06-01

    The relationship between chronic obstructive pulmonary disease (COPD) exacerbations and gastroesophageal reflux (GER) has been investigated less than asthma-GER. We aimed to evaluate the presence of GER in patients with COPD and its impact on exacerbations. We included 24 patients with stable mild-moderate stage COPD and 19 volunteers as the control group. We conducted a gastroesophageal reflux disease (GERD) symptom questionnaire, gastroscopy, manometry, and an ambulatory 24-h pH-impedance study. According to the GERD questionnaire, only 5 (20.8%) patients with COPD had typical GER symptoms. According to the 24-h pH-impedance study, the mean DeMeester score (DMS) was 38.1 ± 34.6 in the COPD group and 13.3 ± 16.8 in the control group (p = 0.01). The acid reflux (DMS > 14.7) rate was higher in patients with COPD than in controls (73.9% vs 26.3%, p = 0.01). The symptom association probability positivity rate was 17.4% (n = 4) in the COPD group, which was similar to the controls (p = 0.11). The mean proximal extension rate of reflux (Z 17 cm) was 26.4 ± 12.9% in the COPD group. The proximal extent of reflux was positively correlated with the number of COPD exacerbations per year (p = 0.03, r = 0.448). In the motility results, only 2 (20%) patients in the control group had a minor motility disorder. Seventeen (70.8%) patients in the COPD group had a minor motility disorder, and 4 (16.7%) had major motility disorders (p gastroesophageal reflux was frequent in patients with COPD, but only a quarter had typical reflux symptoms. The proximal extent of reflux may trigger frequent exacerbations of COPD. Copyright © 2016 Elsevier Ltd. All rights reserved.

  19. Unmet Needs in the Treatment of Gastroesophageal Reflux Disease

    Science.gov (United States)

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

    2015-01-01

    Gastroesophageal reflux disease (GERD) is a highly prevalent gastrointestinal disorder. Proton pump inhibitors have profoundly revolutionized the treatment of GERD. However, several areas of unmet need persist despite marked improvements in the therapeutic management of GERD. These include the advanced grades of erosive esophagitis, nonerosive reflux disease, maintenance treatment of erosive esophagitis, refractory GERD, postprandial heartburn, atypical and extraesophageal manifestations of GERD, Barrett’s esophagus, chronic protein pump inhibitor treatment, and post-bariatric surgery GERD. Consequently, any future development of novel therapeutic modalities for GERD (medical, endoscopic, or surgical), would likely focus on the aforementioned areas of unmet need. PMID:26130628

  20. Simple multicomponent batch distillation procedure with a variable reflux policy

    Directory of Open Access Journals (Sweden)

    A. N. García

    2014-06-01

    Full Text Available This paper describes a shortcut procedure for batch distillation simulation with a variable reflux policy. The procedure starts from a shortcut method developed by Sundaram and Evans in 1993 and uses an iterative cycle to calculate the reflux ratio at each moment. The functional relationship between the concentrations at the bottom and the dome is evaluated using the Fenske equation and is complemented with the equations proposed by Underwood and Gilliland. The results of this procedure are consistent with those obtained using a fast method widely validated in the relevant literature.

  1. Gastroesophageal reflux and idiopathic pulmonary fibrosis: A long term relationship

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    Karthik Gnanapandithan

    2016-01-01

    Full Text Available Idiopathic pulmonary fibrosis (IPF is a dreaded disease of uncertain etiology and no available cure. It is still unclear if a causal relationship exists between gastro-esophageal reflux (GER and IPF, but studies have shown an increased prevalence of acid reflux in patients with IPF. We describe a patient with achalasia and GER who went on to develop IPF. She underwent a rapidly worsening course punctuated by acute exacerbations of IPF, despite best efforts to manage the acid GER. We also reviewed the literature on the role of GER in the etiology and progression of IPF and the impact of antireflux measures on its course.

  2. Seismic monitoring of hydraulic fracturing: techniques for determining fluid flow paths and state of stress away from a wellbore

    Energy Technology Data Exchange (ETDEWEB)

    Fehler, M.; House, L.; Kaieda, H.

    1986-01-01

    Hydraulic fracturing has gained in popularity in recent years as a way to determine the orientations and magnitudes of tectonic stresses. By augmenting conventional hydraulic fracturing measurements with detection and mapping of the microearthquakes induced by fracturing, we can supplement and idependently confirm information obtained from conventional analysis. Important information obtained from seismic monitoring includes: the state of stress of the rock, orientation and spacing of the major joint sets, and measurements of rock elastic parameters at locations distant from the wellbore. While conventional well logging operations can provide information about several of these parameters, the zone of interrogation is usually limited to the immediate proximity of the borehole. The seismic waveforms of the microearthquakes contain a wealth of information about the rock in regions that are otherwise inaccessible for study. By reliably locating the hypocenters of many microearthquakes, we have inferred the joint patterns in the rock. We observed that microearthquake locations do not define a simple, thin, planar distribution, that the fault plane solutions are consistent with shear slippage, and that spectral analysis indicates that the source dimensions and slip along the faults are small. Hence we believe that the microearthquakes result from slip along preexisting joints, and not from tensile extension at the tip of the fracture. Orientations of the principal stresses can be estimated by using fault plane solutions of the larger microearthquakes. By using a joint earthquake location scheme, and/or calibrations with downhole detonators, rock velocities and heterogeneities thereof can be investigated in rock volumes that are far enough from the borehole to be representative of intrincis rock properties.

  3. Treating acid reflux disease in patients with Down syndrome: pharmacological and physiological approaches

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    Francesco Macchini

    2011-01-01

    Full Text Available Francesco Macchini, Ernesto Leva, Maurizio Torricelli, Alberto ValadèPediatric Surgery Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, ItalyAbstract: Down syndrome (DS is often accompanied by gastrointestinal disease, occurring mainly in early infancy and frequently requiring therapy. Among motility disorders, the most frequent is gastroesophageal reflux disease (GERD, which may often be misdiagnosed because of its atypical manifestations. Early diagnosis of esophageal functional disorders is essential to prevent respiratory problems, growth retardation in children, weight loss in adults, and to establish the correct type of surgery if needed. Furthermore, the involvement of the enteric nervous system in the pathophysiology of GERD in DS is not yet completely understood but seems supported by much evidence. In fact DS is often associated with motor disorders and this evidence must be considered in the choice of therapy: in particular all options available to improve motility seem to be effective in these patients. The effectiveness of therapy is strictly related to the rate of mental impairment, so that modulating therapy is essential, especially in view of the severity of the neurological status.Keywords: gastro-esophageal reflux disease, chromosome 21, Down syndrome

  4. Which drugs are risk factors for the development of gastroesophageal reflux disease?

    Science.gov (United States)

    Mungan, Zeynel; Pınarbaşı Şimşek, Binnur

    2017-12-01

    Gastroesophageal reflux disease (GERD), which is common in many communities, is associated with structural factors, eating habits, and the use of certain drugs. The use of such drugs can lead to the emergence of GERD and can also exacerbate existing reflux symptoms. These drugs can contribute to GERD by directly causing mucosal damage, by reducing lower esophageal sphincter pressure (LESP), or by affecting esophagogastric motility. In this article, we report our investigation of the relationships between GERD and medications within the scope of the "Turkish GERD Consensus Group." For the medication groups for which sufficient data were obtained (Figure 1), a systematic literature review in English was conducted using the keywords "gastroesophageal reflux" [MeSH Terms] and "anti-inflammatory agents, non-steroidal" [MeSH Terms], "gastroesophageal reflux" [MeSH Terms] and "acetylsalicylic acid" [MeSH Terms], "gastroesophageal reflux" [All Fields] and "estrogenic agents" [All Fields], "gastroesophageal reflux" [All Fields] and "progesterones" [All Fields], "gastroesophageal reflux" [All Fields] and "hormone replacement therapy" [All Fields], "gastroesophageal reflux" [MeSH Terms] and "diphosphonates" [MeSH Terms] OR "diphosphonates" [All Fields], "calcium channel blockers" [MeSH Terms] and "gastroesophageal reflux" [MeSH Terms], "gastroesophageal reflux" [MeSH Terms] and "nitrates" [MeSH Terms], "gastroesophageal reflux" [MeSH Terms] and "antidepressive agents" [MeSH Terms], "gastroesophageal reflux" [MeSH Terms] and "benzodiazepines" [MeSH Terms] and "hypnotic drugs" [MeSH Terms], "gastroesophageal reflux" [MeSH Terms] and "cholinergic antagonists" [MeSH Terms], "gastroesophageal reflux" [MeSH Terms] and "theophylline" [MeSH Terms], and "gastroesophageal reflux [MeSH Terms] AND "anti-asthmatic agents" [MeSH Terms]. The studies were analyzed and the results are presented here.

  5. 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.

  6. Outcomes of targeted treatment for vesicoureteral reflux in children with nonneurogenic lower urinary tract dysfunction.

    Science.gov (United States)

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

    2013-09-01

    There is a known association between nonneurogenic lower urinary tract conditions and vesicoureteral reflux. Whether reflux is secondary to the lower urinary tract condition or coincidental is controversial. We determined the rate of reflux resolution in patients with lower urinary tract dysfunction using targeted treatment for the underlying condition. Patients diagnosed and treated for a lower urinary tract condition who had concomitant vesicoureteral reflux at or near the time of diagnosis were included. Patients underwent targeted treatment and antibiotic prophylaxis, and reflux was monitored with voiding cystourethrography or videourodynamics. Vesicoureteral reflux was identified in 58 ureters in 36 females and 5 males with a mean age of 6.2 years. After a mean of 3.1 years of treatment reflux resolved with targeted treatment in 26 of 58 ureters (45%). All of these patients had a history of urinary tract infections before starting targeted treatment. Resolution rates of vesicoureteral reflux were similar for all reflux grades. Resolution or significant improvement of reflux was greater in the ureters of patients with dysfunctional voiding (70%) compared to those with idiopathic detrusor overactivity disorder (38%) or detrusor underutilization (40%). Vesicoureteral reflux associated with lower urinary tract conditions resolved with targeted treatment and antibiotic prophylaxis in 45% of ureters. Unlike the resolution rates reported in patients with reflux without a coexisting lower urinary tract condition, we found that there were no differences in resolution rates among grades I to V reflux in patients with lower urinary tract conditions. Patients with dysfunctional voiding had the most improvement and greatest resolution of reflux. Additionally grade V reflux resolved in some patients. Copyright © 2013 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  7. CT and MR imaging of non-cavernous cranial dural arteriovenous fistulas: Findings associated with cortical venous reflux

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    Letourneau-Guillon, Laurent; Cruz, Juan Pablo; Krings, Timo, E-mail: Timo.Krings@uhn.ca

    2015-08-15

    Highlights: • The conventional neuroimaging manifestations of dural arteriovenous fistulas are highly variable. • Identification of cortical venous reflux is important to prevent complications. • Tortuous and dilated vessels without a nidus are associated with cortical venous reflux. • Digital subtraction angiography remains the gold standard for DAVF diagnosis. - Abstract: Purpose: To compare the conventional CT and MR findings of DAVFs in relation to the venous drainage pattern on digital subtraction angiography (DSA). Materials and Methods: Cross-sectional imaging findings (CT and/or MR) in 92 patients were compared to the presence of cortical venous reflux (CVR) on DSA. Results: Imaging features significantly more prevalent in patients with CVR included: abnormally dilated and tortuous leptomeningeal vessels (92% vs. 4%, p < 0.001) or medullary vessels (69% vs. 0%, p < 0.001), venous ectasias (45% vs. 0%, p < 0.001) and focal vasogenic edema (38% vs. 0%, p < 0.001). The following findings trended towards association but did not reach the p value established following Bonferroni correction: dilated external carotid artery branches (71% vs. 38%, p = 0.005), cluster of vessels surrounding dural venous sinus (50% vs. 19%, p = 0.009), presence of hemorrhage (33 vs. 12%, p = 0.040), and parenchymal enhancement (21% vs. 0%, p = 0.030). Conclusion: In the appropriate clinical setting, recognition of ancillary signs presumably related to venous arterialization and congestion as well as arterial feeder hypertrophy should prompt DSA confirmation to identify DAVFs associated with CVR.

  8. Gastro-oesophageal reflux monitoring: review and consensus report on detection and definitions of acid, non-acid, and gas reflux

    Science.gov (United States)

    Sifrim, D; Castell, D; Dent, J; Kahrilas, P J

    2004-01-01

    To date, most concepts on the frequency of gastro-oesophageal reflux episodes and the efficiency of the antireflux barrier have been based on inferences derived from measurement of oesophageal pH. The development of intraluminal impedance monitoring has highlighted the fact that pH monitoring does not detect all gastro-oesophageal reflux events when little or no acid is present in the refluxate, even if special pH tracing analysis criteria are used. In November 2002, a workshop took place at which 11 specialists in the field of gastro-oesophageal reflux disease discussed and criticised all currently available techniques for measurement of reflux. Here, a summary of their conclusions and recommendations of how to achieve the best results from the various techniques now available for reflux measurement is presented. PMID:15194656

  9. [The Additional Role of Symptom-Reflux Association Analysis of Diagnosis of Gastroesophageal Reflux Disease Using Bravo Capsule pH Test].

    Science.gov (United States)

    Jung, Kyoungwon; Park, Moo In; Park, Seun Ja; Moon, Won; Kim, Sung Eun; Kim, Jae Hyun

    2017-10-25

    Since the development of ambulatory esophageal pH monitoring test to diagnose gastroesophageal reflux disease (GERD), several parameters have been introduced. The aim of this study was to assess whether using the symptom index (SI), symptom sensitivity index (SSI), and symptom association probability (SAP), in addition to the DeMeester score (DS), would be useful for interpreting the Bravo pH monitoring test. A retrospective study, which included 68 patients with reflux symptoms refractory to proton pump inhibitor (PPI) therapy who underwent a Bravo capsule pH test between October 2006 and May 2015, was carried out. Acid reflux parameters and symptom reflux association parameters were analyzed. The median percent time of total pHvariation in percent time of total pHpH test, diagnosis of GERD, including reflux hypersensitivity, can be improved by performing an analysis of the symptom-reflux association and of the day-to-day variation.

  10. Adam, Eve and the reflux enigma: age and sex differences across the gastro-oesophageal reflux spectrum.

    Science.gov (United States)

    Royston, Christine; Bardhan, Karna D

    2017-06-01

    We present demographic differences across the gastro-oesophageal reflux disease (GORD) spectrum in a UK District General Hospital. Data were prospectively collected over 37 years. At endoscopy patients were categorized as: erosive oesophagitis (EO), Barrett's oesophagus (BO) or nonerosive reflux disease (NER). Analysis 1: comparison of EO, BO and NER 1977-2001 when the database for GORD without BO closed. Analysis 2: demographic differences in oesophageal adenocarcinoma (OAC) in total BO population diagnosed 1977-2011. GORD 1977-2001 (n=11 944): sex, male predominance in EO and BO but not NER; male : female ratios, 1.81, 1.65, 0.87, respectively (P<0.0001); mean age at presentation, EO 54 years, BO 62 years, NER 50 years; women were older than men by 10, 7 and 6 years, respectively.BO 1977-2011: prevalent OAC, 87/1468 (6%); male : female ratio, 4.1 (P<0.0001); incident OAC, 54/1381 (3.9%); male : female ratio, 3.5 (P<0.0001). Among all BO, more men developed OAC (3 vs. 0.9%). Within each sex, proportion of OAC higher among men (4.9 vs. 2.3%); at OAC diagnosis women were slightly but not significantly older (69.9 vs. 72.3 years, P=0.322). Two views may explain our findings. First, women have either milder reflux, or reduced mucosal sensitivity hence reflux remains silent for longer. Alternatively, women genuinely develop reflux later, that is, are more protected and for longer from developing GORD and its complications. Early evidence is emerging that female sex hormones may indeed have a protective role in GORD during the reproductive period. We suggest reflux and its consequences may be an example of 'protection' conferred on Eve.

  11. Prevalence of gastro-oesophageal reflux disease symptoms and reflux-associated respiratory symptoms in asthma

    Science.gov (United States)

    2010-01-01

    Background Gastro-oesophageal reflux disease (GORD) symptoms are common in asthma and have been extensively studied, but less so in the Asian continent. Reflux-associated respiratory symptoms (RARS) have, in contrast, been little-studied globally. We report the prevalence of GORD symptoms and RARS in adult asthmatics, and their association with asthma severity and medication use. Methods A cross-sectional analytical study. A validated interviewer-administered GORD scale was used to assess frequency and severity of seven GORD symptoms. Subjects were consecutive asthmatics attending medical clinics. Controls were matched subjects without respiratory symptoms. Results The mean (SD) composite GORD symptom score of asthmatics was significantly higher than controls (21.8 (17.2) versus 12.0 (7.6); P < 0.001) as was frequency of each symptom and RARS. Prevalence of GORD symptoms in asthmatics was 59.4% (95% CI, 59.1%-59.6%) versus 28.5% in controls (95% CI, 29.0% - 29.4%). 36% of asthmatics experienced respiratory symptoms in association with both typical and atypical GORD symptoms, compared to 10% of controls (P < 0.001). An asthmatic had a 3.5 times higher risk of experiencing a GORD symptom after adjusting for confounders (OR 3.5; 95% CI 2.5-5.3). Severity of asthma had a strong dose-response relationship with GORD symptoms. Asthma medication use did not significantly influence the presence of GORD symptoms. Conclusions GORD symptoms and RARS were more prevalent in a cohort of Sri Lankan adult asthmatics compared to non-asthmatics. Increased prevalence of RARS is associated with both typical and atypical symptoms of GORD. Asthma disease and its severity, but not asthma medication, appear to influence presence of GORD symptoms. PMID:20843346

  12. 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.)

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

    Energy Technology Data Exchange (ETDEWEB)

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

    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.

  14. Influence of Cisapride on food-stimulated gastro-oesophageal reflux: A radiological study

    International Nuclear Information System (INIS)

    Gelineck, J.; Aksglade, K.; Funch-Jensen, P.; Thommesen, P.

    1990-01-01

    The influence of Cisapride on food-stimulated gastro-oesophageal reflux meachanisms was studied in a double-blind cross-over investigation in 24 consecutive patients selected by endoscopy, 12 with microscopical evidence of gastro-oesophageal reflux and 12 with additional macroscopic oesoghagitis. 63% had food-stimulated gastro-oesophageal reflux, and Cisapride significantly reduced the tendency to gastro-oesophageal reflux and mucosal contact time between gastric content and the oesophageal mucosa in 73% of these patients. It is concluded that Cisapride could be valuable in the treatment of gastro-oesophageal reflux. (orig.) [de

  15. 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...... significantly dependent on type of fundic wrap with reoperation of Nissen fundoplication being dysphagia and reoperation of Toupet being recurrent reflux (p = 0.008). There was no clearly determined learning curve. Conclusions RAAS was safe, feasible and with equal efficacy to CLAS. There were however...

  16. High-Resolution Wellbore Temperature Logging Combined with a Borehole-Scale Heat Budget: Conceptual and Analytical Approaches to Characterize Hydraulically Active Fractures and Groundwater Origin

    Directory of Open Access Journals (Sweden)

    Guillaume Meyzonnat

    2018-01-01

    Full Text Available This work aims to provide an overview of the thermal processes that shape wellbore temperature profiles under static and dynamic conditions. Understanding of the respective influences of advection and conduction heat fluxes is improved through the use of a new heat budget at the borehole scale. Keeping in mind the thermal processes involved, a qualitative interpretation of the temperature profiles allows the occurrence, the position, and the origin of groundwater flowing into wellbores from hydraulically active fractures to be constrained. With the use of a heat budget developed at the borehole scale, temperature logging efficiency has been quantitatively enhanced and allows inflow temperatures to be calculated through the simultaneous use of a flowmeter. Under certain hydraulic or pumping conditions, both inflow intensities and associated temperatures can also be directly modelled from temperature data and the use of the heat budget. Theoretical and applied examples of the heat budget application are provided. Applied examples are shown using high-resolution temperature logging, spinner flow metering, and televiewing for three wells installed in fractured bedrock aquifers in the St-Lawrence Lowlands, Quebec, Canada. Through relatively rapid manipulations, thermal measurements in such cases can be used to detect the intervals or discrete positions of hydraulically active fractures in wellbores, as well as the existence of ambient flows with a high degree of sensitivity, even at very low flows. Heat budget calculations at the borehole scale during pumping indicate that heat advection fluxes rapidly dominate over heat conduction fluxes with the borehole wall. The full characterization of inflow intensities provides information about the distribution of hydraulic properties with depth. The full knowledge of inflow temperatures indicates horizons that are drained from within the aquifer, providing advantageous information on the depth from which

  17. Is this a reflux patient or is it a patient with functional dyspepsia with additional reflux symptoms?

    DEFF Research Database (Denmark)

    Funch-Jensen, Peter

    1995-01-01

    Patients with pyrosis or regurgitation as the dominating symptoms have gastro-oesophageal reflux disease (GORD). However, patients with more atypical symptoms may also suffer from it. The disease is usually chronic and patients who have additional oesophagitis are at risk of developing complicati......Patients with pyrosis or regurgitation as the dominating symptoms have gastro-oesophageal reflux disease (GORD). However, patients with more atypical symptoms may also suffer from it. The disease is usually chronic and patients who have additional oesophagitis are at risk of developing...

  18. The Development and Test of a Sensor for Measurement of the Working Level of Gas–Liquid Two-Phase Flow in a Coalbed Methane Wellbore Annulus

    OpenAIRE

    Chuan Wu; Huafeng Ding; Lei Han

    2018-01-01

    Coalbed methane (CBM) is one kind of clean-burning gas and has been valued as a new form of energy that will be used widely in the near future. When producing CBM, the working level within a CBM wellbore annulus needs to be monitored to dynamically adjust the gas drainage and extraction processes. However, the existing method of measuring the working level does not meet the needs of accurate adjustment, so we designed a new sensor for this purpose. The principle of our sensor is a liquid pres...

  19. Assessment of Gastroesophageal Reflux in Children(2-12 Month Based on Clinical Findings and Ultrasonography

    Directory of Open Access Journals (Sweden)

    F Jassemi Zergani

    2012-07-01

    Full Text Available Introduction: Gastroesophageal reflux is a common gastrointestinal disorder among infants, which can cause complications, such as esophagitis and Barrett's esophagus if its diagnosis and treatment are delayed. On the other hand, similarity of Gastro esophageal Reflux symptoms with symptoms of other childhood diseases makes its diagnosis and treatment difficult. So a proper tool for early screening and diagnostic test is essential. Methods: This study was conducted on 221 infants(2 to 12 months with initial symptoms of gastro esophageal reflux(frequent vomiting, restlessness after feeding, no weight gain, coughing repeatedly and refusing to eat that referred to pediatric Clinic of Rajai Hospital in Tonekabon. Data was collected with demographic and infant gastro esophageal reflux questionnaire by use of the information in records and interview with parents. Then the samples were examined via sonography for gastroesophagial reflux. Results: After initial screening based on infants gastro esophageal reflux tool, gastro esophageal reflux by ultrasound was positive in 63/3% of infants. The mean esophageal diameter was (20/73±2/54mm in infants with gastro esophageal reflux and (23/71±2/35mm in infants without gastro esophageal reflux. Conclusion: Due to the similarity of gastro esophageal Reflux symptoms with clinical symptoms of other childhood diseases, use of an initial screening measurement for early assessment of gastro esophageal reflux in infants is necessary. Moreover, appropriate, available and low costs diagnostic method with little complication seems essential such as ultrasonography for confirm diagnosis and early treatment.

  20. 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.

  1. The Burden of Gastroesophageal Reflux Disease on Patients' Daily Lives: A Cross-Sectional Study Conducted in a Primary Care Setting in Serbia.

    Science.gov (United States)

    Bjelović, Miloš; Babić, Tamara; Dragicević, Igor; Corac, Aleksandar; Goran Trajković

    2015-01-01

    Recent data from the studies conducted in the Western countries have proved that patients with gastroesophageal reflux disease have significantly impaired health-related quality of life compared to general population. The study is aimed at evaluating the burden of reflux symptoms on patients'health-related quality of life. The study involved 1,593 patients with diagnosed gastroesophageal reflux disease.The Serbian version of a generic self-administered Centers for Disease Control and Prevention questionnaire was used. Statistical analyses included descriptive statistics, Pearson chi-square test and a multiple regression model. Among all participants, 43.9% reported fair or poor health. Mean value of unhealthy days during the past 30 days was 10.4 days, physically unhealthy days 6.4 days, mentally unhealthy days 5.3 days and activity limitation days 4.3 days. Furthermore, 24.8% participants reported having ≥ 14 unhealthy days, 14.9% had 14 physically unhealthy days, 11.8% reported 14 mentally unhealthy days, and 9.4% had ≥ 14 activity limitation days. This study addressed complex relationships between reflux symptoms and patients'impaired everyday lives.

  2. The burden of gastroesophageal reflux disease on patients’ daily lives: A cross-sectional study conducted in a primary care setting in Serbia

    Directory of Open Access Journals (Sweden)

    Bjelović Miloš

    2015-01-01

    Full Text Available Introduction. Recent data from the studies conducted in the Western countries have proved that patients with gastroesophageal reflux disease have significantly impaired health-related quality of life compared to general population. Objective. The study is aimed at evaluating the burden of reflux symptoms on patients’ health-related quality of life. Methods. The study involved 1,593 patients with diagnosed gastroesophageal reflux disease. The Serbian version of a generic self-administered Centers for Disease Control and Prevention questionnaire was used. Statistical analyses included descriptive statistics, Pearson chi-square test and a multiple regression model. Results. Among all participants, 43.9% reported fair or poor health. Mean value of unhealthy days during the past 30 days was 10.4 days, physically unhealthy days 6.4 days, mentally unhealthy days 5.3 days and activity limitation days 4.3 days. Furthermore, 24.8% participants reported having ≥14 unhealthy days, 14.9% had ≥14 physically unhealthy days, 11.8% reported ≥14 mentally unhealthy days, and 9.4% had ≥14 activity limitation days. Conclusion. This study addressed complex relationships between reflux symptoms and patients’ impaired everyday lives.

  3. 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.

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

    NARCIS (Netherlands)

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

    2015-01-01

    Numerous questionnaires with a wide variety of characteristics have been developed for the assessment of gastroesophageal reflux disease (GERD). Four well-defined dimensions are noticeable in these GERD questionnaires, which are symptoms, response to treatment, diagnosis, and burden on the quality

  5. Cineoesophagogastroscintigraphy and positioning therapy of infant gastroesophageal reflux

    International Nuclear Information System (INIS)

    Peyraud, J.; Guillet, J.; Bouix, G.; Brendel, A.J.

    1985-01-01

    During this prospective study, using cineoesophagogastroscintigraphy carried out in 27 infants under seven months of age, the positioning of the infants in the infant seat for the treatment of the gastroesophageal reflux was not detrimental in comparison to prone positioning [fr

  6. Epidemiology of Gastroesophageal Reflux Disease in Asia: A Systematic Review

    Science.gov (United States)

    2011-01-01

    Ethnic and geographical differences are important factors in studying disease frequencies, because they may highlight the environmental or genetic influences in the etiology. We retrieved the studies which have been published regarding the epidemiologic features of gastroesophageal reflux disease (GERD) in Asia, based on the definitions of GERD, study settings, publication years and geographical regions. From the population-based studies, the prevalence of symptom-based GERD in Eastern Asia was found to be 2.5%-4.8% before 2005 and 5.2%-8.5% from 2005 to 2010. In Southeast and Western Asia, it was 6.3%-18.3% after 2005, which was much higher than those in Eastern Asia. There were robust epidemiologic data of endoscopic reflux esophagitis in medical check-up participants. The prevalence of endoscopic reflux esophagitis in Eastern Asia increased from 3.4%-5.0% before 2000, to 4.3%-15.7% after 2005. Although there were only limited studies, the prevalence of extra-esophageal syndromes in Asia was higher in GERD group than in controls. The prevalence of Barrett's esophagus was 0.06%-0.84% in the health check-up participants, whereas it was 0.31%-2.00% in the referral hospital settings. In summary, the prevalence of symptom-based GERD and endoscopic reflux esophagitis has increased in Asian countries. However, the prevalence of Barrett's esophagus in Asia has not changed and also still rare. PMID:21369488

  7. Gastroesophageal reflux demonstrated by hepatobiliary imaging in scleroderma

    International Nuclear Information System (INIS)

    Sawaf, N.W.; Orzel, J.A.; Weiland, F.L.

    1987-01-01

    Radionuclide hepatobiliary imaging was performed on a patient with a longstanding history of scleroderma who presented with abdominal pain suggestive of biliary disease. Cystic duct patency was documented after 10 min with tracer accumulation in the second portion of the duodenum which failed to progress consistent with the duodenal hypomotility of scleroderma. The patient was given intravenous Kinevac resulting in gastroesophageal reflux of radionuclide

  8. Asthma and gastroesophageal reflux disease: a multidisciplinary point of view.

    Science.gov (United States)

    Solidoro, Paolo; Patrucco, Filippo; Fagoonee, Sharmila; Pellicano, Rinaldo

    2017-08-01

    Asthma and gastroesophageal reflux (GORD) are widespread and potentially coexisting diseases. Incidence and prevalence of concomitant asthma and GORD are highly variable among studies. This is mainly due to the heterogeneity of study designs. To explain a potential link, some pathophysiological anomaly has been proposed such as the altered pressure gradient between thorax and abdomen, the parasympathetic reflex, the heightened bronchial reactivity and chemical effects of microaspired gastric juice. An accurate diagnosis of asthma and GORD is pivotal in order to lead effective treatment and to reach a significant positive outcome, in terms of quality of life and respiratory function amelioration. Gastroenterological evaluation of GORD includes the empiric proton pump-inhibitors (PPIs) trial, the esophageal pH monitoring and endoscopic evaluation. Besides spirometric investigations, pulmonologist have more specific examens such as bronchoalveolar lavage and exhaled breath condensate. Actually, international recommendations regarding the management of asthma suggest the assessment of potential comorbidities, including the presence of GORD, mostly in children, only in patients with normal pulmonary functional tests with frequent respiratory symptoms, and in case of uncontrolled asthma. Symptomatic gastro-esophageal reflux patients should be treated, but those with uncontrolled asthma should not be treated with anti-reflux drugs unless they are symptomatic for reflux. This review explores the state of the art about the pathogenesis and the management of the relationship between asthma and GORD.

  9. Possibilities and shortcomings of maintenance therapy in gastroesophageal reflux disease

    NARCIS (Netherlands)

    Tytgat, G. N.

    1999-01-01

    An overview is given of the current possibilities and shortcomings of medical therapy in reflux disease. With H2-receptor antagonists and prokinetics, roughly 60% of the patients can be maintained in remission; with proton pump inhibitors, remission can be maintained in approximately 90%. Whether

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

    African Journals Online (AJOL)

    2014-06-02

    Jun 2, 2014 ... Objective: To summarize the diagnostic protocol and treatment of dental erosion due to GERD. Methods: A Medline ..... reflux in children with cerebral palsy and its relationship to erosion of ... phate (ACP) on root surface hypersensitivity. Operative ... Lussi A. Dental erosion clinical diagnosis and case.

  11. Monitoring of laryngopharyngeal reflux: Influence of meals and beverages

    NARCIS (Netherlands)

    Smit, Conrad F.; Mathus-Vliegen, Lisbeth M. H.; Devriese, Pieter P.; van Leeuwen, Justin A. M. J.; Semin, Astrid

    2003-01-01

    Ambulatory 24-hour double-probe pH monitoring seems to be the best test to measure reflux. Artifacts caused by intake of acid foods and beverages have to be excluded, necessitating a time-consuming manual review of the 24-hour data. Dietary restrictions used to bypass these artifacts would interfere

  12. Gastroesophageal reflux demonstrated by hepatobiliary imaging in scleroderma

    Energy Technology Data Exchange (ETDEWEB)

    Sawaf, N.W.; Orzel, J.A.; Weiland, F.L.

    1987-03-01

    Radionuclide hepatobiliary imaging was performed on a patient with a longstanding history of scleroderma who presented with abdominal pain suggestive of biliary disease. Cystic duct patency was documented after 10 min with tracer accumulation in the second portion of the duodenum which failed to progress consistent with the duodenal hypomotility of scleroderma. The patient was given intravenous Kinevac resulting in gastroesophageal reflux of radionuclide.

  13. 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 reflux disease (n = 378) and NERD (n = 293). NERD was also a predictive factor for frequent belching during EGD (odds ratio = 6.61, P Diseases of the Esophagus.

  14. Associations between peripheral vertigo and gastroesophageal reflux disease.

    Science.gov (United States)

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

    2015-09-01

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

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

    African Journals Online (AJOL)

    M.C. Arya

    2016-12-26

    Dec 26, 2016 ... side vesicoureteric reflux). Intravenous urogram (IVU) showed diagnostic dilemma between pelviureteric junction obstruction and retrocaval ureter (Fig. 2 – IVU suggestive of pelviureteric junction obstruction). For confirmation of the diagnosis magnetic resonance urography (MRU) (T2 weighted) was done ...

  16. Clinical efficacy of sucralfate in reflux esophagitis. Comparison with cimetidine

    NARCIS (Netherlands)

    Tytgat, G. N.

    1987-01-01

    Sucralfate has been evaluated in reflux esophagitis, based on its protective adherence to denuded surfaces, its bile salt-binding properties, and its cytoprotective properties. Histamine (H2)-receptor blockers are currently considered the standard therapy. The goal of this study was to compare the

  17. Urodynamics in boys after prenatally diagnosed vesicoureteric reflux

    DEFF Research Database (Denmark)

    Thorup, Jørgen Mogens

    1996-01-01

    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...

  18. Erroneous diagnosis of gastroesophageal reflux disease in achalasia

    NARCIS (Netherlands)

    Kessing, Boudewijn F.; Bredenoord, Albert J.; Smout, André J. P. M.

    2011-01-01

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

  19. The acid pocket: a target for treatment in reflux disease?

    Science.gov (United States)

    Kahrilas, Peter J; McColl, Kenneth; Fox, Mark; O'Rourke, Lisa; Sifrim, Daniel; Smout, Andre J P M; Boeckxstaens, Guy

    2013-07-01

    The nadir esophageal pH of reflux observed during pH monitoring in the postprandial period is often more acidic than the concomitant intragastric pH. This paradox prompted the discovery of the "acid pocket", an area of unbuffered gastric acid that accumulates in the proximal stomach after meals and serves as the reservoir for acid reflux in healthy individuals and gastroesophageal reflux disease (GERD) patients. However, there are differentiating features between these populations in the size and position of the acid pocket, with GERD patients predisposed to upward migration of the proximal margin onto the esophageal mucosa, particularly when supine. This upward migration of acid, sometimes referred to as an "acid film", likely contributes to mucosal pathology in the region of the squamocolumnar junction. Furthermore, movement of the acid pocket itself to a supradiaphragmatic location with hiatus hernia increases the propensity for acid reflux by all conventional mechanisms. Consequently, the acid pocket is an attractive target for GERD therapy. It may be targeted in a global way with proton pump inhibitors that attenuate acid pocket development, or with alginate/antacid combinations that colocalize with the acid pocket and displace it distally, thereby demonstrating the potential for selective targeting of the acid pocket in GERD.

  20. The acid pocket: a target for treatment in reflux disease?

    NARCIS (Netherlands)

    Kahrilas, Peter J.; McColl, Kenneth; Fox, Mark; O'Rourke, Lisa; Sifrim, Daniel; Smout, Andre J. P. M.; Boeckxstaens, Guy

    2013-01-01

    The nadir esophageal pH of reflux observed during pH monitoring in the postprandial period is often more acidic than the concomitant intragastric pH. This paradox prompted the discovery of the "acid pocket", an area of unbuffered gastric acid that accumulates in the proximal stomach after meals and

  1. 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.

  2. 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...

  3. Gastroesophageal reflux disease - unit description, diagnosis and treatment

    Directory of Open Access Journals (Sweden)

    Michał Raban

    2017-07-01

    Full Text Available Many GPs are increasingly dealing with patients complaining of ailments likely to suggest gastro-esophageal reflux disease (GERD. These symptoms include heartburn, abdominal pain, and a feeling of esophageal reflux (regurgitation. GERD is one of the most common gastrointestinal diseases that gastroenterologists meet in their practice (1, 2. In North America the problem is affected from 18.1% to even 27.8% of the population. The situation is similar in Europe, where the proportion of people with reflux symptoms is in the range of 8.8% - 25.9%. Among European countries, the prevalence of GERD symptoms is higher in the north of the continent than in the south. The growing problem of overweight and obesity that makes GERD more and more recognized in the population of children and adolescents (3 is a worrying fact. Interestingly, reflux-related complaints are much less frequent in eastern Asia, affecting only 2.5% -7.8% of the population (4.

  4. Gastroesophageal reflux disease. Scintigraphic, endoscopic and histologic considerations

    Energy Technology Data Exchange (ETDEWEB)

    Kault, B.; Halvorsen, T.; Petersen, H.; Grette, K.; Myrvold, H.E.

    1986-01-01

    Radionucleotide scintigraphy and esophagoscopy with biopsy were carried out in 101 patients with symptoms strongly suggestive of gastroesophageal reflux (GER) disease. GER was visualized by scintigraphy in 86.1% of the patients. Endoscopic and histologic esophagitis were found in 68.1% and 58.4% of the patients, respectively, whereas both examinations taken together showed evidence of esophagitis in 82%. Histologic evidence of esophagitis was found in nearly all patients with severe endoscopic changes, and in 43.7% of the patients with no endoscopic abnormality. Scintigraphic reflux was demonstrated more frequently in the patients with severe endoscopic esophagitis (97.5%) than in those with no or only mild endoscopic changes (78.6%). Scintigraphic reflux was found in 91.5% and 78.5% of the patients with and without histologic evidence of esophagitis. 15 of the 18 patients (83.3%) without endoscopic and histologic abnormalities in the esophagus had scintigraphic evidence of reflux. The present study strongly supports the clinical significance of scintigraphy in GER disease and confirms that esophageal biopsy specimens increase the sensitivity of endoscopic evaluation. 31 refs.

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

    NARCIS (Netherlands)

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

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

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

    NARCIS (Netherlands)

    de Jong, Justin R.; van Ramshorst, Bert; Timmer, Robin; Gooszen, Hein G.; Smout, André J. P. M.

    2004-01-01

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

  7. 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...

  8. Gastroesophageal reflux disease in children with chronic otitis media with effusion.

    Science.gov (United States)

    Yüksel, Fatih; Doğan, Mansur; Karataş, Duran; Yüce, Salim; Şentürk, Mehmet; Külahli, Ismail

    2013-03-01

    We aimed to evaluate a possible relation between gastroesophageal reflux disease and middle ear effusion in children. Children who came to ear, nose, and throat (ENT) department with the symptoms of hearing loss or aural fullness and diagnosed as OME by examination and tympanometry were included into the study. Children were reviewed gastroesophageal reflux disease symptoms including the following: (a) airway symptoms: stridor, frequent cough, recurrent croup, wheezing, nasal congestion, obstructive apnea, hoarseness, and throat clearing; (b) feeding symptoms: frequent emesis, dysphagia, choking: gagging, sore throat, halitosis, food refusal, regurgitation, pyrosis, irritability, failure to thrive, and anemia. Diagnosis is made with at least one positive test of radionuclide gastroesophageal scintigraphy or 24 h pH probe in the patients with reflux. ENT findings were also examined between gastroesophageal reflux disease positive and gastroesophageal reflux disease negative groups. Approximately 39 (54.9%) of 71 children had at least 1 positive test for gastroesophageal reflux disease. Between the gastroesophageal reflux disease-positive and gastroesophageal reflux disease-negative groups, symptoms of reflux were not significantly different. Two pooled variables were created: airway complex (stridor, frequent cough, throat clearing), and feeding complex (irritability, pyrosis, failure to thrive). Percentage of positive symptom complexes were no statistically different between gastroesophageal reflux disease-positive and gastroesophageal reflux disease-negative groups (>0.05). Ear, nose, and throat disorders (including rhinitis/sinusitis, adenoid hypertrophy, tonsillitis/pharyngitis, and laryngitis) were more frequent in gastroesophageal reflux disease-positive group. Tonsillitis/pharyngitis was significantly different between the gastroesophageal reflux disease positive and gastroesophageal reflux disease-negative groups. Upper respiratory tract infections were seen

  9. 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

  10. Gastroesophageal reflux (GER) and respiratory disease in children

    International Nuclear Information System (INIS)

    Shazia, F.

    2002-01-01

    Full text: The aim of this study is: to identify any possible relationship between recurrent lower respiratory tract infection and GER, to identify any possible relationship between asthma and GER, to determine the prevalence of GER in children suffering from RLRTI and bronchial asthma, and to evaluate the sensitivity and accuracy of different GER diagnostic modalities. Thirty children with recurrent lower respiratory tract infection and bronchial asthma were evaluated for possible presence of the GER. Radionuclide gastroesophageal scintigraphy was performed in all these 30 patients (age range 6 months - 10 years). Patients also underwent ultrasonography and/or barium swallow or fluoroscopy on separate day. Patients were grouped according to presenting coinplaints and investigative modalities. Group A was the patients of RLRTI, which underwent GER scintigraphy, barium studies and ultrasonography. Group B patients were patients with bronchial asthma who underwent all 3 investigations. Group C was patients with RLRTI who under went GER scintigraphy and barium studies only. Patients with bronchial asthma who underwent barium studies and GER scintigraphy were included in group D. Group E and F were patients with RLRTI and bronchial asthma who underwent ultrasonography and GER scintigraphy only respectively. For each group, reflux index was calculated in all positive patients. GER reflux of varying degrees was observed in 20 % patients. The severity of the clinical symptoms was directly proportional to the severity of gastroesophageal reflux. Reflux index was positively correlating with clinical symptoms as well. When compared with other investigative modalities employed GER scintigraphy was found to be more superior in terms of sensitivity and specificity. Objective assessment of gastroesophageal reflux with the help of GER scintigraphy is feasible and is superior to other modalities and it should be employed much more frequently as an initial investigative procedure

  11. Laparoscopic surgery for gastro-esophageal acid reflux disease.

    Science.gov (United States)

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

    2014-02-01

    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 reflux and physician preferences. Success of treatment depends on tailoring treatment modalities to the individual patient and adequate selection of treatment choice. PubMed, Embase, The Cochrane Database of Systematic Reviews, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched for systematic reviews with an abstract, publication date within the last five years, in humans only, on key terms (laparosc* OR laparoscopy*) AND (fundoplication OR reflux* OR GORD OR GERD OR nissen OR toupet) NOT (achal* OR pediat*). Last search was performed on July 23nd and in total 54 articles were evaluated as relevant from this search. The laparoscopic Toupet fundoplication is the therapy of choice for normal-weight GERD patients qualifying for laparoscopic surgery. No better pharmaceutical, endoluminal or surgical alternatives are present to date. No firm conclusion can be stated on its cost-effectiveness. Results have to be awaited comparing the laparoscopic 180-degree anterior fundoplication with the Toupet fundoplication to be a possible better surgical alternative. Division of the short gastric vessels is not to be recommended, nor is the use of a bougie or a mesh in the vast majority of GERD patients undergoing surgery. The use of a robot is not recommended. Anti-reflux surgery is to be considered expert surgery, but there is no clear consensus what is to be called an 'expert surgeon'. As for setting, ambulatory settings seem promising although high-level evidence is lacking. Copyright © 2013 Elsevier Ltd. All rights reserved.

  12. Efficacy of Vonoprazan for Gastroesophageal Reflux Symptoms in Patients with Proton Pump Inhibitor-resistant Non-erosive Reflux Disease.

    Science.gov (United States)

    Niikura, Ryota; Yamada, Atsuo; Hirata, Yoshihiro; Hayakawa, Yoku; Takahashi, Akihiro; Shinozaki, Tomohiro; Takeuchi, Yoshinori; Fujishiro, Mitsuhiro; Koike, Kazuhiko

    2018-03-30

    Objective Clinically, patients with proton pomp inhibitor (PPI)-resistant gastro-esophageal reflux disease (GERD) are very challenging to treat. The aim of this study was to determine the rates of symptom relief and adverse events among PPI-resistant GERD patients that changed their therapy from a PPI to vonoprazan. Methods Patients with severe gastroesophageal reflux symptoms (total GERD-Q score ≥8) without endoscopic findings of mucosal breaks who changed their medication from a PPI to vonoprazan during a 12-week period from 2015 to 2016 at 2 hospitals were selected. The primary outcome was the self-reported relief of gastroesophageal reflux symptoms. The odds ratio (OR) for the improvement of symptoms was calculated based on an exact binomial distribution using a matched-pair analysis. The secondary outcome was the GERD-Q score and adverse events. Results Twenty-six patients (6 men) with a mean age of 67.5 years were analyzed. After the therapy was changed from a PPI to vonoprazan, 18 patients (69.2%) reported an improvement, 6 (23.1%) reported no change, and 2 (7.7%) reported an exacerbation of symptoms. A change in therapy was significantly associated with improved self-reported symptoms (OR 9.0, pgastroesophageal reflux symptoms. Vonoprazan is one of the most promising treatment options for patients with PPI-resistant GERD.

  13. Effect of baclofen on esophagogastric motility and gastroesophageal reflux in children with gastroesophageal reflux disease: a randomized controlled trial

    NARCIS (Netherlands)

    Omari, Taher I.; Benninga, Marc A.; Sansom, Lloyd; Butler, Ross N.; Dent, John; Davidson, Geoffrey P.

    2006-01-01

    OBJECTIVE: To evaluate the effect of baclofen, a gamma-amino-butyric-acid B receptor agonist that inhibits transient lower esophageal sphincter relaxation (TLESR), on the rates of TLESR, gastroesophageal reflux (GER), and gastric emptying (GE) in children with GER disease. STUDY DESIGN: The efficacy

  14. 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

  15. Relationship between the mechanism of gastro-oesophageal reflux and oesophageal acid exposure in patients with reflux disease

    NARCIS (Netherlands)

    Scheffer, R. C. H.; Wassenaar, E. B.; Herwaarden, M. A.; Holloway, R. H.; Samsom, M.; Smout, A. J. P. M.; Akkermans, L. M. A.

    2005-01-01

    This study investigated the relationship between the oesophageal acid exposure time and the underlying manometric motor events in patients with gastro-oesophageal reflux disease (GORD). In 31 patients, 3-hour oesophageal motility and pH were measured after a test meal. Ten patients underwent 24-hour

  16. Corrosion of Pipeline and Wellbore Steel by Liquid CO2 Containing Trace Amounts of Water and SO2

    Science.gov (United States)

    McGrail, P.; Schaef, H. T.; Owen, A. T.

    2009-12-01

    Carbon dioxide capture and storage in deep saline formations is currently considered the most attractive option to reduce greenhouse gas emissions with continued use of fossil fuels for energy production. Transporting captured CO2 and injection into suitable formations for storage will necessarily involve pipeline systems and wellbores constructed of carbon steels. Industry standards currently require nearly complete dehydration of liquid CO2 to reduce corrosion in the pipeline transport system. However, it may be possible to establish a corrosion threshold based on H2O content in the CO2 that could allow for minor amounts of H2O to remain in the liquid CO2 and thereby eliminate a costly dehydration step. Similarly, trace amounts of sulfur and nitrogen compounds common in flue gas streams are currently removed through expensive desulfurization and catalytic reduction processes. Provided these contaminants could be safely and permanently transported and stored in the geologic reservoir, retrofits of existing fossil-fuel plants could address comprehensive emissions reductions, including CO2 at perhaps nearly the same capital and operating cost. Because CO2-SO2 mixtures have never been commercially transported or injected, both experimental and theoretical work is needed to understand corrosion mechanisms of various steels in these gas mixtures containing varying amounts of water. Experiments were conducted with common tool steel (AISI-01) and pipeline steel (X65) immersed in liquid CO2 at room temperature containing ~1% SO2 and varying amounts of H2O (0 to 2500 ppmw). A threshold concentration of H2O in the liquid CO2-SO2 mixture was established based on the absence of visible surface corrosion. For example, experiments exposing steel to liquid CO2-SO2 containing ~300 ppmw H2O showed a delay in onset of visible corrosion products and minimal surface corrosion was visible after five days of testing. However increasing the water content to 760 ppmw produced extensive

  17. 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

  18. Gas Migration Project: Risk Assessment Tool and Computational Analyses to Investigate Wellbore/Mine Interactions, Secretary's Potash Area, Southeastern New Mexico

    Energy Technology Data Exchange (ETDEWEB)

    Sobolik, Steven R. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States). Geomechanics Dept.; Hadgu, Teklu [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States). Nuclear Waste Disposal Research and Analysis Dept.; Rechard, Robert P. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States). Nuclear Waste Disposal Research and Analysis Dept.

    2016-05-01

    The Bureau of Land Management (BLM), US Department of the Interior has asked Sandia National Laboratories (SNL) to perform scientific studies relevant to technical issues that arise in the development of co-located resources of potash and petroleum in southeastern New Mexico in the Secretary’s Potash Area. The BLM manages resource development, issues permits and interacts with the State of New Mexico in the process of developing regulations, in an environment where many issues are disputed by industry stakeholders. The present report is a deliverable of the study of the potential for gas migration from a wellbore to a mine opening in the event of wellbore leakage, a risk scenario about which there is disagreement among stakeholders and little previous site specific analysis. One goal of this study was to develop a framework that required collaboratively developed inputs and analytical approaches in order to encourage stakeholder participation and to employ ranges of data values and scenarios. SNL presents here a description of a basic risk assessment (RA) framework that will fulfill the initial steps of meeting that goal. SNL used the gas migration problem to set up example conceptual models, parameter sets and computer models and as a foundation for future development of RA to support BLM resource development.

  19. Effect of Matrix-Wellbore Flow and Porosity on Pressure Transient Response in Shale Formation Modeling by Dual Porosity and Dual Permeability System

    Directory of Open Access Journals (Sweden)

    Daolun Li

    2015-01-01

    Full Text Available A mathematical dual porosity and dual permeability numerical model based on perpendicular bisection (PEBI grid is developed to describe gas flow behaviors in shale-gas reservoirs by incorporating slippage corrected permeability and adsorbed gas effect. Parametric studies are conducted for a horizontal well with multiple infinite conductivity hydraulic fractures in shale-gas reservoir to investigate effect of matrix-wellbore flow, natural fracture porosity, and matrix porosity. We find that the ratio of fracture permeability to matrix permeability approximately decides the bottom hole pressure (BHP error caused by omitting the flow between matrix and wellbore and that the effect of matrix porosity on BHP is related to adsorption gas content. When adsorbed gas accounts for large proportion of the total gas storage in shale formation, matrix porosity only has a very small effect on BHP. Otherwise, it has obvious influence. This paper can help us understand the complex pressure transient response due to existence of the adsorbed gas and help petroleum engineers to interpret the field data better.

  20. Quality of life, patient satisfaction, and disease burden in patients with gastroesophageal reflux disease with or without laryngopharyngeal reflux symptoms.

    Science.gov (United States)

    Gong, Eun Jeong; Choi, Kee Don; Jung, Hye-Kyung; Youn, Young Hoon; Min, Byung-Hoon; Song, Kyung Ho; Huh, Kyu Chan

    2017-07-01

    Patients with gastroesophageal reflux disease (GERD) have decreased health-related quality of life (HRQL). The quality of life in patients with laryngopharyngeal reflux (LPR) symptoms is also significantly impaired. However, the impact of LPR symptoms on HRQL in GERD patients has not been studied. A nationwide, random-sample, and face-to-face survey of 300 Korean patients with GERD was conducted from January to March 2013. Gastroesophageal reflux symptoms were assessed using the Rome III questionnaire, LPR symptoms using the reflux symptom index, and HRQL using the EuroQol five dimensions (EQ-5D) questionnaire. A structured questionnaire on patient satisfaction, sickness-related absences, and health-related work productivity was also used. Among the 300 patients with GERD, 150 had LPR symptoms. The mean EQ-5D index was lower in patients with GERD and LPR symptoms than in those without LPR (0.88 vs 0.91, P = 0.002). A linear regression model showed that the severity of LPR symptoms was related to decreased HRQL and was independent of age, marital status, body mass index, or household income. The overall satisfaction rate regarding treatment was lower in patients with GERD and LPR (40.0% vs 69.1%, P = 0.040). GERD patients with LPR symptoms reported greater sickness-related absent hours per week (0.36 vs 0.02 h, P = 0.016) and greater percentages of overall work impairment than those without LPR (31.1% vs 20.8%, P Gastroesophageal reflux disease patients with LPR symptoms have a poorer HRQL, a lower satisfaction rate, and a greater disease burden than those without LPR. © 2017 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

  1. Influence of gastric emptying on gastro-esophageal reflux: a combined pH-impedance study.

    Science.gov (United States)

    Gourcerol, G; Benanni, Y; Boueyre, E; Leroi, A M; Ducrotte, P

    2013-10-01

    The involvement of delayed gastric emptying (GE) in the pathophysiology of gastro-esophageal reflux disease (GERD) remains debated and has been to date only assessed using esophageal pH-metry that only detects acidic reflux. We therefore investigated whether delay in GE could impact on liquid, mixed, and gas reflux detected using combined esophageal pH-impedance recording. Thirty consecutive patients were explored with GE and esophageal pH-impedance measurement in the workup of typical symptoms of GERD. Gastric emptying was assessed using the (13) C-octanoic acid breath test and an ambulatory esophageal pH-impedance recording was performed off proton pump inhibitors (PPIs) for 24 h. Gastric emptying was normal in 17 patients and delayed in 13 patients. Delay in GE increased the daily number of liquid/mixed reflux events detected by combined esophageal pH-impedance monitoring, but had no effect of esophageal acid exposure or gas reflux. This translated in increased number of postprandial reflux events, with a longer bolus clearance time and increased esophageal proximal extension. In patient with delayed GE, symptomatic reflux had a higher proximal extension and a longer bolus clearance time compared to symptomatic reflux events from patients with normal GE. Delay in GE increases daily and postprandial liquid/mixed reflux events. Reflux characteristics differently trigger symptoms in patients with normal and delayed GE, and may impact on the therapeutic strategy. © 2013 John Wiley & Sons Ltd.

  2. PP-16 WEAK ACID REFLUX A TRIGGER FOR RECURRENT RESPIRATORY DISEASES IN CHILDREN.

    Science.gov (United States)

    Kostovski, Aco; Zdraveska, Nikolina

    2015-10-01

    The main advantage of multichannel intraluminar impedance (MII) compared with pH monitoring is its ability to detect both acid and non-acid gastroesophageal reflux (GER) and to determine the characteristics of reflux (liquid or gas). To compare the value of pH monitoring and MII for diagnosis of GER in children who present with refractory respiratory symptoms. A prospective study that included 37 patients, aged 4.25 ± 3.15 years, using combined MII-pH monitoring was performed. Patients were referred for investigation because of suspected GER as the etiology of recurrent respiratory diseases, including recurrent obstructive bronchitis, recurrent pneumonia, laryngitis, and chronic cough. We analyzed the percentage of time during which the pH was less than 4, the numeric and percentile values of acid, weak acid, and non-acid reflux episodes, and the values of liquid and mixed reflux. Diagnostic values were determined separately for pH monitoring and MII using Fisher's exact test. Reflux was detected in 31 patients. pH monitoring was positive in 20 patients (% time during which pH acid and weak acid reflux episodes, 3 had only acid reflux, 8 had weak acid reflux, and 3 had non-acid reflux. Sixteen patients had mixed (liquid and gas) reflux, and 14 had both liquid and mixed reflux. This study suggests that significant numbers of GER include weak acid reflux that cannot be detected by pH probes alone. The weak acid reflux could be a trigger for recurrent respiratory symptoms. Combining pH with MII monitoring is a valuable diagnostic method for diagnosing GER in children.

  3. The Role of Sleep in the Modulation of Gastroesophageal Reflux and Symptoms in NICU Neonates.

    Science.gov (United States)

    Qureshi, Aslam; Malkar, Manish; Splaingard, Mark; Khuhro, Abdul; Jadcherla, Sudarshan

    2015-09-01

    Newborns sleep about 80% of the time. Gastroesophageal reflux disease is prevalent in about 10% of neonatal intensive care unit infants. Concurrent polysomnography and pH-impedance studies clarify the relationship of gastroesophageal reflux with sleep. To characterize spatiotemporal and chemical characteristics of impedance-positive gastroesophageal reflux and define symptom associations in sleep and wake states in symptomatic neonates. We hypothesized that frequency of impedance-positive gastroesophageal reflux events and their association with cardiorespiratory symptoms is greater during sleep. Eighteen neonates underwent concurrent polysomnography with a pH-impedance study. Impedance-positive gastroesophageal reflux events (weakly acidic or acidic) were categorized between sleep versus wake states: Symptom Index = number of symptoms with gastroesophageal reflux/total symptoms*100; Symptom Sensitivity Index = number of gastroesophageal reflux with symptoms/total gastroesophageal reflux*100; Symptom Association Probability = [(1 - probability of observed association between reflux and symptoms)*100]). We analyzed 317 gastroesophageal reflux events during 116 hours of polysomnography. During wake versus sleep, respectively, the median (interquartile range) frequency of impedance-positive gastroesophageal reflux was 4.9 (3.1-5.8) versus 1.4 (0.7-1.7) events/hour (P sleep is lower; however, spatiotemporal and chemical characteristics of gastroesophageal reflux and symptom-generation mechanisms are distinct. For cardiorespiratory symptoms during sleep, a lower Symptom Index entails evaluation for etiologies other than gastroesophageal reflux disease, a higher Symptom Sensitivity Index implies heightened esophageal sensitivity, and similar Symptom Association Probability indicates other mechanistic possibilities. Copyright © 2015 Elsevier Inc. All rights reserved.

  4. Clinical and polysomnographic predictors of laryngopharyngeal reflux in obstructive sleep apnea syndrome.

    Science.gov (United States)

    Caparroz, Fábio Azevedo; Campanholo, Milena de Almeida Torres; Regina, Caroline Gomez; Park, Sung Woo; Haddad, Leonardo; Gregório, Luís Carlos; Haddad, Fernanda Louise Martinho

    2018-04-14

    Obstructive sleep apnea syndrome and laryngopharyngeal reflux are diseases with a high prevalence in the overall population; however, it remains unclear whether they are diseases with the same risk factors present in the same populations or if there is any association between them. To evaluate and determine the prevalence of laryngopharyngeal reflux in patients with moderate and severe obstructive apnea syndrome and also to determine its predictive factors. Historical cohort, cross-sectional study of patients aged 18-70 years, referred to a tertiary service Otorhinolaryngology outpatient clinic with a polysomnographic diagnosis of moderate or severe obstructive sleep apnea syndrome. The reflux symptom index questionnaire and the reflux finding score at indirect videolaryngoscopy were applied to the assessed population, considering the inclusion and exclusion criteria. Fifty-six patients were evaluated, of which 64.3% had a positive laryngopharyngeal reflux (positive reflux symptom index and/or positive endolaryngeal reflux finding score). Body mass index was a predictor of reflux presence in this group of patients with moderate to severe obstructive sleep apnea syndrome. In patients with positive score for endoscopic findings and reflux symptom index (12.3%), there was a trend toward significance for a higher mean apnea-hypopnea index and a higher percentage of sleep time with oxyhemoglobin saturation below 90% (p=0.05). The prevalence of laryngopharyngeal reflux was higher in this group of patients with moderate to severe obstructive sleep apnea syndrome, and the body mass index was a predictor of laryngopharyngeal reflux in these patients. There was a trend toward greater oxyhemoglobin desaturation in patients with a positive score for reflux symptoms index (RSI) and reflux finding score (RFS). Copyright © 2018 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. All rights reserved.

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

    NARCIS (Netherlands)

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

    1993-01-01

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

  6. [Gastric and duodenal secretory and motor-evacuatory activity in patients with gastroesophageal reflux disease associated with different types of reflux].

    Science.gov (United States)

    Dzhulay, G S; Sekareva, E V

    2016-01-01

    To estimate esophageal and gastric pH values on an empty stomach and after stimulation of gastric secretion and gastric and duodenal motor-evacuatory activity in patients with gastroesophageal reflux disease (GERD) associated with pathological refluxes, such as gastroesophageal reflux (GER) and duodenogastroesophageal reflux (DGER). The observational cross-sectional study was conducted to investigate and compare the parameters of intraesophageal and intragastric pH metry and peripheral electrogastroenterography in 103 GERD patients with endoscopically positive distal reflux esophagitis in GER and DGER. The patients with GERD developed pathological esophageal refluxes (both GER and DGER) in various degrees of impaired gastric production, from anacidity to hyperacidity. The patients with predominant DGER were found to have gastric hyperacidity and normal acidity slightly less frequently than those with predominant GER. The patients with GERD developing in the presence of predominant GER had moderate gastric stasis with discoordinated antroduodenal propulsion resulting from hypomotor dyskinesia of the stomach and duodenum. When DGER was predominant in the patients with GERD, the signs of gastric stasis and duodenal hyperkinesia were concurrent with discoordinated antroduodenal and duodenojejunal propulsion. The specific features of the esophagogastroduodenal secretory and motor evacuatory disorders found create conditions for the pathological refluxes into the esophagus, which differ in the composition of refluxate.

  7. PPI therapy is equally effective in well-defined non-erosive reflux disease and in reflux esophagitis: a meta-analysis

    NARCIS (Netherlands)

    Weijenborg, P. W.; Cremonini, F.; Smout, A. J. P. M.; Bredenoord, A. J.

    2012-01-01

    Background Symptomatic response to proton pump inhibitor (PPI) therapy in patients with non-erosive reflux disease (NERD) is often reported as lower than in patients with erosive reflux disease (ERD). However, the definition of NERD differs across clinical trials. This meta-analysis aims to estimate

  8. New insights in gastroesophageal reflux, esophageal function and gastric emptying in relation to dysphagia before and after anti-reflux surgery in children

    NARCIS (Netherlands)

    Smits, M. J.; Loots, C. M.; Benninga, M. A.; Omari, T. I.; van Wijk, M. P.

    2013-01-01

    In children with gastroesophageal reflux (GER) disease refractory to pharmacological therapies, anti-reflux surgery (fundoplication) may be a treatment of last resort. The applicability of fundoplication has been hampered by the inability to predict which patient may benefit from surgery and which

  9. Partial symptom-response to proton pump inhibitors in patients with non-erosive reflux disease or reflux oesophagitis - a post hoc analysis of 5796 patients

    DEFF Research Database (Denmark)

    Bytzer, P; van Zanten, S Veldhuyzen; Mattsson, H

    2012-01-01

    Although most patients with gastro-oesophageal reflux disease (GERD) benefit from proton pump inhibitor (PPI) therapy, some experience only partial symptom relief.......Although most patients with gastro-oesophageal reflux disease (GERD) benefit from proton pump inhibitor (PPI) therapy, some experience only partial symptom relief....

  10. The relationship between the numbers of reflux episodes with anatomic changes of the esophagus in children under one year with gastroesophageal reflux disease

    Directory of Open Access Journals (Sweden)

    HamidrezaTalari

    2016-07-01

    Full Text Available Gastroesophageal reflux is the most common gastrointestinal disorder in the neonatal period, and the main reason for it is the lack of development in the first months of an infant's digestive system and it gets improved with the aging of baby and development of the digestive system. Some studies have shown that there is a relationship between characteristics of anatomic and esophageal reflux. This study aimed to determine the relationship between the characteristics and frequency of reflux in infants under one year old with gastroesophageal reflux disease. This study is a cross-sectional study that was conducted in 2015 in the hospital of martyr Beheshti. In this study, a group of 120 children with reflux in three age groups less than one month, 1-6 months and 6-12 months were choses and the relationship between reflux episodes with esophagus anatomic characteristics, including distal esophagus distention, Hiss angle, internal angle and length of esophagus were examined. The data were analyzed using the SPSS software and the relationship between the characteristics was compared with the number of reflux in three groups. According to the results, the frequency of reflux and extent of distention of the distal esophageal, Hiss angle, Internal Gastro esophageal angle and length of the esophagus, there was a statistically significant correlation (P <0.001. The correlation between reflux episodes and four parameters, are respectively, 0/95, 0/97, 0/71 and -0/79/. Also there was a direct relation between the frequency of reflux and extent of distention of the distal esophageal, Hiss angle, Internal Gastro esophageal angle and an inverse relation with length of the esophagus. The correlation between the frequency of reflux and esophageal characteristics in separation between all three age groups showed a statistically significant relationship exists between anatomical esophageal characteristics and reflux frequency. Based on the results of this study it

  11. Comparison of barium swallow and ultrasound in diagnosis of gastro-oesophageal reflux in children.

    Science.gov (United States)

    Naik, D R; Bolia, A; Moore, D J

    1985-01-01

    Fifty one infants and older children with suspected gastro-oesophageal reflux entered a study comparing the diagnostic accuracy of a standard barium swallow examination with that of ultrasound scanning. All children were examined by both techniques. In 40 cases there was unequivocal agreement between the examinations. Of the remaining patients, four had definite reflux by ultrasonic criteria but showed no evidence of reflux on barium swallow examination, four had positive findings on ultrasound but showed only minimal reflux on barium swallow, and one showed minimal reflux on ultrasound but had a negative barium meal result. In two children the ultrasound study was inconclusive. Ultrasound has an important role in the diagnosis and follow up of patients under the age of 5 years with gastro-oesophageal reflux. Images FIG 1 FIG 2 PMID:3924317

  12. The once-through mode of steam generator reflux condensation in loss of coolant accident scenarios

    International Nuclear Information System (INIS)

    Liao, Y.; Guentay, S.; Suckow, D.

    2009-01-01

    The once-through mode of steam generator reflux condensation in the presence of noncondensable gases and/or aerosols for LOCA scenarios is introduced. This phenomenon is planned to be investigated at Paul Scherrer Institute in the ARTIST/RFLX experimental program. The plausible accident scenarios associated with the once-through reflux condensation are analyzed with MELCOR to study the safety significance and the boundary conditions of this phenomenon. This work presents the recent PSI experimental and analytical work on reflux condensation: the progress of modification to the ARTIST test facility for the purpose to study reflux condensation, and the analytical model for the once-through reflux condensation in the presence of noncondensable gas using the heat and mass transfer analogy approach. Future experimental and analytical work on reflux condensation is also outlined. (author)

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

    DEFF Research Database (Denmark)

    Lødrup, A; Pottegård, A; Hallas, J

    2015-01-01

    BACKGROUND: Guidelines recommend that patients with gastro-oesophageal reflux disease are adequately treated with acid-suppressive therapy before undergoing anti-reflux surgery. Little is known of the use of acid-suppressive drugs before anti-reflux surgery. AIM: To determine the use of proton pump...... inhibitors and H2 -receptor antagonists in the year before anti-reflux surgery. METHODS: A nationwide retrospective study of all patients aged ≥18 undergoing first-time anti-reflux surgery in Denmark during 2000-2012 using data from three different sources: the Danish National Register of Patients......, the Danish National Prescription Register, and the Danish Person Register. RESULTS: The study population thus included 2922 patients (median age: 48 years, 55.7% male). The annual proportion of patients redeeming ≥180 DDD of acid-suppressive therapy increased from 17.0% 5 years before anti-reflux surgery...

  14. 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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1985-06-01

    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.

  16. The management of gastro-oesophageal reflux disease.

    Science.gov (United States)

    Keung, Charlotte; Hebbard, Geoffrey

    2016-02-01

    If there are no features of serious disease, suspected gastro-oesophageal reflux disease can be initially managed with a trial of a proton pump inhibitor for 4-8 weeks. This should be taken 30-60 minutes before food for optimal effect. Once symptoms are controlled, attempt to withdraw acid suppression therapy. If symptoms recur, use the minimum dose that controls symptoms. Patients who have severe erosive oesophagitis, scleroderma oesophagus or Barrett's oesophagus require long-term treatment with a proton pump inhibitor. Lifestyle modification strategies can help gastro-oesophageal reflux disease. Weight loss has the strongest evidence for efficacy. Further investigation and a specialist referral are required if there is no response to proton pump inhibitor therapy. Atypical symptoms or signs of serious disease also need investigation.

  17. [Knowledge and practice of Brazilian pediatricians concerning gastroesophageal reflux disease in infants].

    Science.gov (United States)

    Soares, Ana Cristina Fontenele; de Freitas, Carla Lima; de Morais, Mauro Batista

    2015-01-01

    To assess the knowledge and practice of pediatricians about infants with physiological reflux and gastroesophageal reflux disease. 140 pediatricians were interviewed during two scientific events in 2009 and 2010. The questions referred to two clinical cases of infants. One with symptoms of infant regurgitation (physiological reflux) and another with gastroesophageal reflux disease. Among 140 pediatricians, 11.4% (n=16) and 62.1% (n=87) would require investigation tests, respectively for infant regurgitation (physiological reflux) and gastroesophageal reflux disease. A series of upper gastrointestinal exams would be the first requested with a higher frequency. Medication would be prescribed by 18.6% (n=26) in the case of physiological reflux and 87.1% (n=122) in the case of gastroesophageal reflux disease. Prokinetic drugs would be prescribed more frequently than gastric acid secretion inhibitors. Sleeping position would be recommended by 94.2% (n=132) and 92.9% (n=130) of the respondents, respectively for the case of physiological reflux and gastroesophageal reflux disease; however, about half of the respondents would recommend the prone position. Only 10 (7.1%) of the pediatricians would exclude the cow's milk protein from the infants' diet. Approaches different from the international guidelines are often considered appropriate, especially when recommending a different position other than the supine and prescription of medication. In turn, the interviews enable us to infer the right capacity of the pediatricians to distinguish physiologic reflux and gastroesophageal reflux disease correctly. Copyright © 2014 Associação de Pediatria de São Paulo. Publicado por Elsevier Editora Ltda. All rights reserved.

  18. 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.

  19. Evaluation of prenatal hydronephrosis: novel criteria for predicting vesicoureteral reflux on ultrasonography.

    Science.gov (United States)

    Lee, Nora G; Rushton, H Gil; Peters, Craig A; Groves, Danja S; Pohl, Hans G

    2014-09-01

    Radiographic evaluation for prenatal hydronephrosis often includes voiding cystourethrography to ascertain whether vesicoureteral reflux is present. We sought to determine whether use of voiding cystourethrography could be limited to those patients at greatest risk for vesicoureteral reflux. We hypothesized that vesicoureteral reflux could be predicted by findings on renal/bladder ultrasonography of hydroureter, renal dysmorphia and/or duplication. We reviewed the records of patients with prenatal hydronephrosis who underwent initial postnatal ultrasonography and voiding cystourethrography during a 3-year period. The presence of vesicoureteral reflux on voiding cystourethrogram was correlated to ultrasound findings, including hydronephrosis grade, presence of hydroureter, renal dysmorphia or duplication, with ultrasound considered positive for any of the latter 3 findings. Of 262 patients 47 (18%) had vesicoureteral reflux. Ultrasound was positive in 24 of 29 patients (83%) with high grade reflux and 12 of 18 (67%) with low grade reflux. If ultrasonography showed any of the 3 positive findings, the odds ratio of detecting vesicoureteral reflux was 8.07 (95% CI 3.86, 16.87). Using these criteria, among all cases of prenatal hydronephrosis 5 (2%) with high grade vesicoureteral reflux and 6 (2%) with low grade reflux would have been missed. Among the 47 cases of reflux overall 5 of 29 high grade (17%) and 6 of 18 low grade cases (33%) would have been missed. By using ultrasonography criteria of hydroureter, duplication and renal dysmorphia for patients with prenatal hydronephrosis, vesicoureteral reflux can be detected more specifically. Using our criteria, 165 of 262 voiding cystourethrograms (63%) could have been avoided in patients with prenatal hydronephrosis during a 3-year period. Reducing these evaluations may decrease risks regarding radiation exposure, family anxiety and health care costs. Copyright © 2014 American Urological Association Education and

  20. Acid Rather Than Nonacid Reflux Burden Is a Predictor of Tooth Erosion.

    Science.gov (United States)

    Ganesh, Meenakshi; Hertzberg, Anne; Nurko, Samuel; Needleman, Howard; Rosen, Rachel

    2016-02-01

    The relation between tooth erosion (TE) and gastroesophageal reflux in children has not been clearly established, and there are no studies to determine the relation with refluxate height, nonacid reflux, and erosions. The aim of this study was to determine the relation between TE and acid and nonacid gastroesophageal refluxes measured using combined pH and multichannel intraluminal impedance (pH-MII). We conducted a prospective cohort study of children presenting for pH-MII testing. Once informed consent was obtained, patients completed questionnaires about their reflux symptoms and diet, and then underwent pH-MII catheter placement and a dental examination. The Keels-Coffield erosion index was used to score the extent and severity of TE. Reflux parameters of patients with and without TE were compared using Student t test and correlations were performed using Spearman correlations. A total of 27 patients participated in the study, all of whom were on acid suppression at the time of pH-MII testing. Of the 27 patients, 10 (37%) had TE. There were significant positive correlations between acid reflux episodes (r = 0.44, P = 0.02), the percentage of time that acid reflux was present in the distal esophagus (r = 0.44, P = 0.02), and reflux index (r = 0.54, P = 0.004) with the number of TE in a given patient. The percentage of time that acid reflux was present in the proximal esophagus was positively correlated with the number of teeth erosions per patient with borderline significance (r = 0.38, P = 0.05). There was a positive correlation between acid reflux parameters and TE. Acid, rather than nonacid reflux, seems to have a significant role in the pathogenesis of TE.