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Sample records for segment promotes reflux

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

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    Jin Hyun Kim

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

  2. Nocturnal weakly acidic reflux promotes aspiration of bile acids in lung transplant recipients.

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    Blondeau, Kathleen; Mertens, Veerle; Vanaudenaerde, Bart A; Verleden, Geert M; Van Raemdonck, Dirk E; Sifrim, Daniel; Dupont, Lieven J

    2009-02-01

    Gastroesophageal reflux (GER) and aspiration of bile acids have been implicated as non-alloimmune risk factors for the development of bronchiolitis obliterans syndrome (BOS) after lung transplantation. The aim of our study was to investigate the association between GER and gastric aspiration of bile acids and to establish which reflux characteristics may promote aspiration of bile acids into the lungs and may feature as a potential diagnostic tool in identifying lung transplantation (LTx) patients at risk for aspiration. Twenty-four stable LTx recipients were studied 1 year after transplantation. All patients underwent 24-hour ambulatory impedance-pH recording for the detection of acid (pH acidic (pH 4 to 7) reflux. On the same day, bronchoalveolar lavage fluid (BALF) was collected and then analyzed for the presence of bile acids (Bioquant enzymatic assay). Increased GER was detected in 13 patients, of whom 9 had increased acid reflux and 4 had exclusively increased weakly acidic reflux. Sixteen patients had detectable bile acids in the BALF (0.6 [0.4 to 1.5] micromol/liter). The 24-hour esophageal volume exposure was significantly increased in patients with bile acids compared to patients without bile acids in the BALF. Acid exposure and the number of reflux events (total, acid and weakly acidic) were unrelated to the presence of bile acids in the BALF. However, both nocturnal volume exposure and the number of nocturnal weakly acidic reflux events were significantly higher in patients with bile acids in the BALF. Weakly acidic reflux events, especially during the night, are associated with the aspiration of bile acids in LTx recipients and may therefore feature as a potential risk factor for the development of BOS.

  3. [Impact of reflux on the kidney].

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    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.

  4. Deoxycholic acid promotes development of gastroesophageal reflux disease and Barrett's oesophagus by modulating integrin-αv trafficking.

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    Prichard, David O; Byrne, Anne Marie; Murphy, James O; Reynolds, John V; O'Sullivan, Jacintha; Feighery, Ronan; Doyle, Brendan; Eldin, Osama Sharaf; Finn, Stephen P; Maguire, Aoife; Duff, Deirdre; Kelleher, Dermot P; Long, Aideen

    2017-12-01

    The fundamental mechanisms underlying erosive oesophagitis and subsequent development of Barrett's oesophagus (BO) are poorly understood. Here, we investigated the contribution of specific components of the gastric refluxate on adhesion molecules involved in epithelial barrier maintenance. Cell line models of squamous epithelium (HET-1A) and BO (QH) were used to examine the effects of bile acids on cell adhesion to extracellular matrix proteins (Collagen, laminin, vitronectin, fibronectin) and expression of integrin ligands (α 3 , α 4, α 5 , α 6 and α ν ). Experimental findings were validated in human explant oesophageal biopsies, a rat model of gastroesophageal reflux disease (GORD) and in patient tissue microarrays. The bile acid deoxycholic acid (DCA) specifically reduced adhesion of HET-1A cells to vitronectin and reduced cell-surface expression of integrin-α ν via effects on endocytic recycling processes. Increased expression of integrin-α v was observed in ulcerated tissue in a rat model of GORD and in oesophagitis and Barrett's intestinal metaplasia patient tissue compared to normal squamous epithelium. Increased expression of integrin-α ν was observed in QH BO cells compared to HET-1A cells. QH cells were resistant to DCA-mediated loss of adhesion and reduction in cell-surface expression of integrin-α ν . We demonstrated that a specific component of the gastric refluxate, DCA, affects the epithelial barrier through modulation of integrin α ν expression, providing a novel mechanism for bile acid-mediated erosion of oesophageal squamous epithelium and promotion of BO. Strategies aimed at preventing bile acid-mediated erosion should be considered in the clinical management of patients with GORD. © 2017 The Authors. Journal of Cellular and Molecular Medicine published by John Wiley & Sons Ltd and Foundation for Cellular and Molecular Medicine.

  5. Hyperinsulinemia Promotes Esophageal Cancer Development in a Surgically-Induced Duodeno-Esophageal Reflux Murine Model

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    Diletta Arcidiacono

    2018-04-01

    Full Text Available Hyperinsulinemia could have a role in the growing incidence of esophageal adenocarcinoma (EAC and its pre-cancerous lesion, Barrett’s Esophagus, a possible consequence of Gastro-Esophageal Reflux Disease. Obesity is known to mediate esophageal carcinogenesis through different mechanisms including insulin-resistance leading to hyperinsulinemia, which may mediate cancer progression via the insulin/insulin-like growth factor axis. We used the hyperinsulinemic non-obese FVB/N (Friend leukemia virus B strain MKR (muscle (M-IGF1R-lysine (K-arginine (R mouse model to evaluate the exclusive role of hyperinsulinemia in the pathogenesis of EAC related to duodeno-esophageal reflux. FVB/N wild-type (WT and MKR mice underwent jejunum-esophageal anastomosis side—to end with the exclusion of the stomach. Thirty weeks after surgery, the esophagus was processed for histological, immunological and insulin/Insulin-like growth factor 1 (IGF1 signal transduction analyses. Most of the WT mice (63.1% developed dysplasia, whereas most of the MKR mice (74.3% developed squamous cell and adenosquamous carcinomas, both expressing Human Epidermal growth factor receptor 2 (HER2. Hyperinsulinemia significantly increased esophageal cancer incidence in the presence of duodenal-reflux. Insulin receptor (IR and IGF1 receptor (IGF1R were overexpressed in the hyperinsulinemic condition. IGF1R, through ERK1/2 mitogenic pattern activation, seems to be involved in cancer onset. Hyperinsulinemia-induced IGF1R and HER2 up-regulation could also increase the possibility of forming of IGF1R/HER2 heterodimers to support cell growth/proliferation/progression in esophageal carcinogenesis.

  6. Hyperinsulinemia Promotes Esophageal Cancer Development in a Surgically-Induced Duodeno-Esophageal Reflux Murine Model.

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    Arcidiacono, Diletta; Dedja, Arben; Giacometti, Cinzia; Fassan, Matteo; Nucci, Daniele; Francia, Simona; Fabris, Federico; Zaramella, Alice; Gallagher, Emily J; Cassaro, Mauro; Rugge, Massimo; LeRoith, Derek; Alberti, Alfredo; Realdon, Stefano

    2018-04-14

    Hyperinsulinemia could have a role in the growing incidence of esophageal adenocarcinoma (EAC) and its pre-cancerous lesion, Barrett's Esophagus, a possible consequence of Gastro-Esophageal Reflux Disease. Obesity is known to mediate esophageal carcinogenesis through different mechanisms including insulin-resistance leading to hyperinsulinemia, which may mediate cancer progression via the insulin/insulin-like growth factor axis. We used the hyperinsulinemic non-obese FVB/N (Friend leukemia virus B strain) MKR (muscle (M)-IGF1R-lysine (K)-arginine (R) mouse model to evaluate the exclusive role of hyperinsulinemia in the pathogenesis of EAC related to duodeno-esophageal reflux. FVB/N wild-type (WT) and MKR mice underwent jejunum-esophageal anastomosis side-to end with the exclusion of the stomach. Thirty weeks after surgery, the esophagus was processed for histological, immunological and insulin/Insulin-like growth factor 1 (IGF1) signal transduction analyses. Most of the WT mice (63.1%) developed dysplasia, whereas most of the MKR mice (74.3%) developed squamous cell and adenosquamous carcinomas, both expressing Human Epidermal growth factor receptor 2 (HER2). Hyperinsulinemia significantly increased esophageal cancer incidence in the presence of duodenal-reflux. Insulin receptor (IR) and IGF1 receptor (IGF1R) were overexpressed in the hyperinsulinemic condition. IGF1R, through ERK1/2 mitogenic pattern activation, seems to be involved in cancer onset. Hyperinsulinemia-induced IGF1R and HER2 up-regulation could also increase the possibility of forming of IGF1R/HER2 heterodimers to support cell growth/proliferation/progression in esophageal carcinogenesis.

  7. Bile Reflux

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    ... 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 ...

  8. Gastroesophageal reflux disease

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    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 ...

  9. 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

  10. Optimal pricing and promotional effort control policies for a new product growth in segmented market

    Directory of Open Access Journals (Sweden)

    Jha P.C.

    2015-01-01

    Full Text Available Market segmentation enables the marketers to understand and serve the customers more effectively thereby improving company’s competitive position. In this paper, we study the impact of price and promotion efforts on evolution of sales intensity in segmented market to obtain the optimal price and promotion effort policies. Evolution of sales rate for each segment is developed under the assumption that marketer may choose both differentiated as well as mass market promotion effort to influence the uncaptured market potential. An optimal control model is formulated and a solution method using Maximum Principle has been discussed. The model is extended to incorporate budget constraint. Model applicability is illustrated by a numerical example. P.C. Jha, P. Manik, K. Chaudhary, R. Cambini / Optimal Pricing and Promotional 2 Since the discrete time data is available, the formulated model is discretized. For solving the discrete model, differential evolution algorithm is used.

  11. Translocations of chromosome end-segments and facultative heterochromatin promote meiotic ring formation in evening primroses.

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    Golczyk, Hieronim; Massouh, Amid; Greiner, Stephan

    2014-03-01

    Due to reciprocal chromosomal translocations, many species of Oenothera (evening primrose) form permanent multichromosomal meiotic rings. However, regular bivalent pairing is also observed. Chiasmata are restricted to chromosomal ends, which makes homologous recombination virtually undetectable. Genetic diversity is achieved by changing linkage relations of chromosomes in rings and bivalents via hybridization and reciprocal translocations. Although the structural prerequisite for this system is enigmatic, whole-arm translocations are widely assumed to be the mechanistic driving force. We demonstrate that this prerequisite is genome compartmentation into two epigenetically defined chromatin fractions. The first one facultatively condenses in cycling cells into chromocenters negative both for histone H3 dimethylated at lysine 4 and for C-banding, and forms huge condensed middle chromosome regions on prophase chromosomes. Remarkably, it decondenses in differentiating cells. The second fraction is euchromatin confined to distal chromosome segments, positive for histone H3 lysine 4 dimethylation and for histone H3 lysine 27 trimethylation. The end-segments are deprived of canonical telomeres but capped with constitutive heterochromatin. This genomic organization promotes translocation breakpoints between the two chromatin fractions, thus facilitating exchanges of end-segments. We challenge the whole-arm translocation hypothesis by demonstrating why reciprocal translocations of chromosomal end-segments should strongly promote meiotic rings and evolution toward permanent translocation heterozygosity. Reshuffled end-segments, each possessing a major crossover hot spot, can furthermore explain meiotic compatibility between genomes with different translocation histories.

  12. 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

  13. Vesicoureteral Reflux

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    ... 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 ...

  14. Reflux in Children

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    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 ...

  15. Reflux in Infants

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    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 ...

  16. Laryngopharyngeal reflux

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    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.

  17. Audience segmentation to promote lifestyle for cancer prevention in the Korean community.

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    Jo, Heui-Sug; Jung, Su-Mi

    2011-01-01

    This study was designed to segment the audience group of '10 lifestyle for cancer prevention' based on demographic characteristics and the level of knowledge about each guideline for cancer prevention among the community in South Korea. Participants were chosen through stratified random sampling according to the age and gender distribution of Gangwon province in South Korea. A telephone survey was conducted from 6 to 15 calls among 2,025 persons on October 2008. A total of 1,687 persons completed the survey (response rate: 83.3%). Survey items were composed of socio-demographic characteristics such as age, gender, income, education, and residence area and the knowledge level of '10 guidelines for cancer prevention', developed by 'Korean Ministry of Health and Welfare' and covering smoking cessation, appropriate drinking, condom use, and regular physical activity and so on. We selected the priority needed to promote awareness and segmented the audience group based on the demographic characteristics, homogeneous with respect to the knowledge level using Answer Tree 3.0 with CHAID as a data mining algorithm. The results of analysis showed that each guideline of ' 10 lifestyle for cancer prevention' had its own segmented subgroup characterized by each demographic. Especially, residence area, city or county, and ages were the first split on the perceived level of knowledge and these findings suggested that segmentation of audiences for targeting is needed to deliver more effective education of patients and community people. In developing the strategy for effective education, the method of social marketing using the decision tree analysis could be a useful and appropriate tool. The study findings demonstrate the potential value of using more sophisticated strategies of designing and providing health information based on audience segmentation.

  18. 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.)

  19. Segmenting and targeting American university students to promote responsible alcohol use: a case for applying social marketing principles.

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    Deshpande, Sameer; Rundle-Thiele, Sharyn

    2011-10-01

    The current study contributes to the social marketing literature in the American university binge-drinking context in three innovative ways. First, it profiles drinking segments by "values" and "expectancies" sought from behaviors. Second, the study compares segment values and expectancies of two competing behaviors, that is, binge drinking and participation in alternative activities. Third, the study compares the influence of a variety of factors on both behaviors in each segment. Finally, based on these findings and feedback from eight university alcohol prevention experts, appropriate strategies to promote responsible alcohol use for each segment are proposed.

  20. Preventive maintenance. 'Problem recognition style' can be used to segment the market and promote healthier lifestyles.

    Science.gov (United States)

    Jayanti, R K

    1997-01-01

    Problem recognition styles--desired state types (DSTs) and actual state types (ASTs)--have an effect on preventive health care decision making. Segmenting the market along these lines can help marketers position products and services to educate and attract people who will not see a doctor unless there is something wrong with them. Both groups expect the same benefits from preventive health care actions, but ASTs fail to act on those expectations. Therefore, marketing strategy touting the benefits of preventive health care might be futile. Educational promotional campaigns aimed at both DSTs and ASTs also are wasteful because DSTs already possess much health knowledge, lead wellness-oriented lifestyles, and practice preventive health behaviors.

  1. Reflux and GERD (in Children)

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    ... 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 ...

  2. Translocations of Chromosome End-Segments and Facultative Heterochromatin Promote Meiotic Ring Formation in Evening Primroses[W][OPEN

    Science.gov (United States)

    Golczyk, Hieronim; Massouh, Amid; Greiner, Stephan

    2014-01-01

    Due to reciprocal chromosomal translocations, many species of Oenothera (evening primrose) form permanent multichromosomal meiotic rings. However, regular bivalent pairing is also observed. Chiasmata are restricted to chromosomal ends, which makes homologous recombination virtually undetectable. Genetic diversity is achieved by changing linkage relations of chromosomes in rings and bivalents via hybridization and reciprocal translocations. Although the structural prerequisite for this system is enigmatic, whole-arm translocations are widely assumed to be the mechanistic driving force. We demonstrate that this prerequisite is genome compartmentation into two epigenetically defined chromatin fractions. The first one facultatively condenses in cycling cells into chromocenters negative both for histone H3 dimethylated at lysine 4 and for C-banding, and forms huge condensed middle chromosome regions on prophase chromosomes. Remarkably, it decondenses in differentiating cells. The second fraction is euchromatin confined to distal chromosome segments, positive for histone H3 lysine 4 dimethylation and for histone H3 lysine 27 trimethylation. The end-segments are deprived of canonical telomeres but capped with constitutive heterochromatin. This genomic organization promotes translocation breakpoints between the two chromatin fractions, thus facilitating exchanges of end-segments. We challenge the whole-arm translocation hypothesis by demonstrating why reciprocal translocations of chromosomal end-segments should strongly promote meiotic rings and evolution toward permanent translocation heterozygosity. Reshuffled end-segments, each possessing a major crossover hot spot, can furthermore explain meiotic compatibility between genomes with different translocation histories. PMID:24681616

  3. Gastroesophageal Reflux and Idiopathic Pulmonary Fibrosis: A Review

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    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.

  4. Synergistic promotion of polar phase crystallization of PVDF by ionic liquid with PEG segment

    Science.gov (United States)

    Xu, Pei; Fu, Weijia; Cui, Zhaopei; Ding, Yunsheng

    2018-06-01

    To investigate the effect of imidazolium ionic liquid with poly(ethylene glycol) segment (IL) on the polar phase crystallization behavior of poly(vinylidene fluoride) (PVDF), a series of PVDF/IL composites were prepared using solution-cast method. The crystallization peak temperature of PVDF composites and the growth speed of samples decrease with increasing of IL. The >CF2 groups in amorphous region are retained and >CF2 groups in crystalline region are liberated by the PEG long soft segments of IL. The intensity of peaks represented as α phase reduces, moreover polar phase content increases with increasing of IL. The interaction between the >CF2 and the imidazolium cation can induce the polar phase, and the interaction between the >CF2 and PEG soft segment can strengthen polar crystalline induction. PVDF/12IL composite can form big γ spherulite circled by β phase.

  5. 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 ...

  6. 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

  7. Promoting Hong Kong's Higher Education to Asian Markets: Market Segmentations and Strategies

    Science.gov (United States)

    Cheung, Alan C. K.; Yuen, Timothy W. W.; Yuen, Celeste Y. M.; Cheng, Yin Cheong

    2010-01-01

    Purpose: The main purpose of this study is threefold: to analyze the current conditions of higher education services offered in the three target markets; to conduct market segmentation analysis of these markets; and to recommend the most appropriate market entry strategies for Hong Kong's education service providers. Design/methodology/approach:…

  8. 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 ...

  9. Role of chloride ions in the promotion of auxin-induced growth of maize coleoptile segments.

    Science.gov (United States)

    Burdach, Zbigniew; Kurtyka, Renata; Siemieniuk, Agnieszka; Karcz, Waldemar

    2014-10-01

    The mechanism of auxin action on ion transport in growing cells has not been determined in detail. In particular, little is known about the role of chloride in the auxin-induced growth of coleoptile cells. Moreover, the data that do exist in the literature are controversial. This study describes experiments that were carried out with maize (Zea mays) coleoptile segments, this being a classical model system for studies of plant cell elongation growth. Growth kinetics or growth and pH changes were recorded in maize coleoptiles using two independent measuring systems. The growth rate of the segments was measured simultaneously with medium pH changes. Membrane potential changes in parenchymal cells of the segments were also determined for chosen variants. The question of whether anion transport is involved in auxin-induced growth of maize coleoptile segments was primarily studied using anion channel blockers [anthracene-9-carboxylic acid (A-9-C) and 4,4'-diisothiocyanatostilbene-2,2'-disulphonic acid (DIDS)]. In addition, experiments in which KCl was replaced by KNO3 were also performed. Both anion channel blockers, added at 0·1 mm, diminished indole-3-acetic acid (IAA)-induced elongation growth by ~30 %. Medium pH changes measured simultaneously with growth indicated that while DIDS stopped IAA-induced proton extrusion, A-9-C diminished it by only 50 %. Addition of A-9-C to medium containing 1 mm KCl did not affect the characteristic kinetics of IAA-induced membrane potential changes, while in the presence of 10 mm KCl the channel blocker stopped IAA-induced membrane hyperpolarization. Replacement of KCl with KNO3 significantly decreased IAA-induced growth and inhibited proton extrusion. In contrast to the KCl concentration, the concentration of KNO3 did not affect the growth-stimulatory effect of IAA. For comparison, the effects of the cation channel blocker tetraethylammonium chloride (TEA-Cl) on IAA-induced growth and proton extrusion were also determined. TEA

  10. Anti-reflux surgery

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    ... 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: ...

  11. 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 ...

  12. 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

  13. 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

  14. 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.

  15. 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 ...

  16. 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 ...

  17. 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.

  18. 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.

  19. 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.

  20. 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

  1. [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.

  2. 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

  3. 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

  4. 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.)

  5. 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.

  6. 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...

  7. 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

  8. WHAT IS THE REAL IMPAIRMENT ON ESOPHAGEAL MOTILITY IN PATIENTS WITH GASTROESOPHAGEAL REFLUX DISEASE?

    Directory of Open Access Journals (Sweden)

    Angela FALCÃO

    2013-04-01

    Full Text Available Context Impairment of esophageal motility is a common finding in patients with gastroesophageal reflux disease (GERD as reduced lower esophageal sphincter (LES basal pressure. A very low LES pressure might facilitate the occurrence of more gastroesophageal reflux whereas abnormal esophageal peristalsis may contribute to impaired esophageal clearance after reflux. Objective Evaluate the esophageal motor function of the lower esophageal sphincter and esophageal body in the various forms of gastroesophageal reflux disease. Methods The manometrics records of 268 patients, who had evaluation of the esophageal motility as part of the diagnostic gastroesophageal reflux disease were split into four groups, as follows: 33 patients who had no esophagitis; 92 patients who had erosive esophagitis; 101 patients who had short Barrett's esophagus and 42 patients who had long Barrett's esophagus. Results The group who had long Barrett's esophagus showed smaller mean LES pressure and higher percentage of marked LES hypotonia; in the distal segment of the esophageal body the this group showed higher percentage of marked hypocontractility of the distal segment (<30 mm Hg; this same group showed higher percentage of esophageal motility disorders. Conclusions The most intense esophageal motility disorders and lower pressure of lower esophageal sphincter were noted in the group with long Barrett's esophagus. Those with reflux esophagitis and short Barrett's esophagus had esophageal motility impairment, intermediate among patients with esophagitis and long Barrett's esophagus. Patients with typical symptoms of gastroesophageal reflux but without esophagitis by endoscopy study showed no impairment of esophageal motility.

  9. What is the real impairment on esophageal motility in patients with gastroesophageal reflux disease?

    Science.gov (United States)

    Falcão, Angela; Nasi, Ary; Brandão, Jeovana; Sallum, Rubens; Cecconello, Ivan

    2013-04-01

    Impairment of esophageal motility is a common finding in patients with gastroesophageal reflux disease (GERD) as reduced lower esophageal sphincter (LES) basal pressure. A very low LES pressure might facilitate the occurrence of more gastroesophageal reflux whereas abnormal esophageal peristalsis may contribute to impaired esophageal clearance after reflux. Evaluate the esophageal motor function of the lower esophageal sphincter and esophageal body in the various forms of gastroesophageal reflux disease. The manometrics records of 268 patients, who had evaluation of the esophageal motility as part of the diagnostic gastroesophageal reflux disease were split into four groups, as follows: 33 patients who had no esophagitis; 92 patients who had erosive esophagitis; 101 patients who had short Barrett's esophagus and 42 patients who had long Barrett's esophagus. The group who had long Barrett's esophagus showed smaller mean LES pressure and higher percentage of marked LES hypotonia; in the distal segment of the esophageal body the this group showed higher percentage of marked hypocontractility of the distal segment (disorders. The most intense esophageal motility disorders and lower pressure of lower esophageal sphincter were noted in the group with long Barrett's esophagus. Those with reflux esophagitis and short Barrett's esophagus had esophageal motility impairment, intermediate among patients with esophagitis and long Barrett's esophagus. Patients with typical symptoms of gastroesophageal reflux but without esophagitis by endoscopy study showed no impairment of esophageal motility.

  10. 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

  11. 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

  12. 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.)

  13. 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.).

  14. 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.

  15. 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.

  16. 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

  17. 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

  18. 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)

  19. 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...

  20. 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

  1. 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.

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

    Directory of Open Access Journals (Sweden)

    E.I. Kashkina

    2008-12-01

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

  3. Is channel segmentation necessary to reach a multiethnic population with weight-related health promotion? An analysis of use and perception of communication channels.

    Science.gov (United States)

    Hartman, Marieke A; Nierkens, Vera; Cremer, Stephan W; Verhoeff, Arnoud; Stronks, Karien

    2015-01-01

    To explore similarities and differences in the use and perception of communication channels to access weight-related health promotion among women in three ethnic minority groups. The ultimate aim was to determine whether similar channels might reach ethnic minority women in general or whether segmentation to ethnic groups would be required. Eight ethnically homogeneous focus groups were conducted among 48 women of Ghanaian, Antillean/Aruban, or Afro-Surinamese background living in Amsterdam. Our questions concerned which communication channels they usually used to access weight-related health advice or information about programs and whose information they most valued. The content analysis of data was performed. The participants mentioned four channels - regular and traditional health care, general or ethnically specific media, multiethnic and ethnic gatherings, and interpersonal communication with peers in the Netherlands and with people in the home country. Ghanaian women emphasized ethnically specific channels (e.g., traditional health care, Ghanaian churches). They were comfortable with these channels and trusted them. They mentioned fewer general channels - mainly limited to health care - and if discussed, negative perceptions were expressed. Antillean women mentioned the use of ethnically specific channels (e.g., communication with Antilleans in the home country) on balance with general audience-oriented channels (e.g., regular health care). Perceptions were mixed. Surinamese participants discussed, in a positive manner, the use of general audience-oriented channels, while they said they did not use traditional health care or advice from Surinam. Local language proficiency, time resided in the Netherlands, and approaches and messages received seemed to explain channel use and perception. The predominant differences in channel use and perception among the ethnic groups indicate a need for channel segmentation to reach a multiethnic target group with weight

  4. 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.

  5. 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 & ...

  6. 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.

  7. 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

  8. 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.

  9. 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

  10. 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.

  11. 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

  12. 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.

  13. [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.

  14. 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

  15. 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.

  16. 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.

  17. 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.)

  18. Experimental Investigation of Heat Pipe Startup Under Reflux Mode

    Science.gov (United States)

    Ku, Jentung

    2018-01-01

    In the absence of body forces such as gravity, a heat pipe will start as soon as its evaporator temperature reaches the saturation temperature. If the heat pipe operates under a reflux mode in ground testing, the liquid puddle will fill the entire cross sectional area of the evaporator. Under this condition, the heat pipe may not start when the evaporator temperature reaches the saturation temperature. Instead, a superheat is required in order for the liquid to vaporize through nucleate boiling. The amount of superheat depends on several factors such as the roughness of the heat pipe internal surface and the gravity head. This paper describes an experimental investigation of the effect of gravity pressure head on the startup of a heat pipe under reflux mode. In this study, a heat pipe with internal axial grooves was placed in a vertical position with different tilt angles relative to the horizontal plane. Heat was applied to the evaporator at the bottom and cooling was provided to the condenser at the top. The liquid-flooded evaporator was divided into seven segments along the axial direction, and an electrical heater was attached to each evaporator segment. Heat was applied to individual heaters in various combinations and sequences. Other test variables included the condenser sink temperature and tilt angle. Test results show that as long as an individual evaporator segment was flooded with liquid initially, a superheat was required to vaporize the liquid in that segment. The amount of superheat required for liquid vaporization was a function of gravity pressure head imposed on that evaporator segment and the initial temperature of the heat pipe. The most efficient and effective way to start the heat pipe was to apply a heat load with a high heat flux to the lowest segment of the evaporator.

  19. Increased systemic and epidermal levels of IL-17A and IL-1β promotes progression of non-segmental vitiligo.

    Science.gov (United States)

    Bhardwaj, Supriya; Rani, Seema; Srivastava, Niharika; Kumar, Ravinder; Parsad, Davinder

    2017-03-01

    Non-segmental vitiligo (NSV) results from autoimmune destruction of melanocytes. The altered levels of various cytokines have been proposed in the pathogenesis of vitiligo. However, the exact immune mechanisms have not yet been fully elucidated. To investigate the role of epidermal and systemic cytokines in active and stable NSV patients. Serum levels of inflammatory cytokines were checked in 42 active and 30 stable NSV patients with 30 controls. The lesional, perilesional and normal skin sections were subjected to H&E staining. The mRNA expression of inflammatory cytokines and their respective receptors were assessed by quantitative PCR in lesional skin of both active and stable NSV skin. The MITF and IL-17A were immunolocalized in lesional, perilesional and normal skin tissue. Significant increase in the expression of inflammatory cytokines, IL-17A, IL-1β and TGF-β was observed in active patients, whereas no change was observed in stable patients. A marked reduction in epidermal thickness was observed in lesional skin sections. Significant increase in IL-17A and significant decrease in microphthalmia associated transcription factor (MITF) expression was observed in lesional and perilesional skin sections. Moreover, qPCR analysis showed significant alterations in the mRNA levels of IL-17A, IL-1β, IFN-γ, TGF-β and their respective receptors in active and stable vitiligo patient samples. Increased levels of IL-17A and IL-1β cytokines and decreased expression of MITF suggested a possible role of these cytokines in dysregulation of melanocytic activity in the lesional skin and hence might be responsible for the progression of active vitiligo. Copyright © 2016 Elsevier Ltd. All rights reserved.

  20. 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

  1. 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.

  2. 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.

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

    LENUS (Irish Health Repository)

    Manning, B J

    2012-02-03

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

  4. 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.)

  5. 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...

  6. 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

  7. 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

  8. 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.

  9. 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

  10. 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

  11. 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

  12. 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

  13. 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.

  14. [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.

  15. 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

  16. 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

  17. 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

  18. 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

  19. 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.

  20. 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.

  1. 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

  2. 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

  3. 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

  4. 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 ...

  5. 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.

  6. 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.

  7. 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.

  8. 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...

  9. 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

  10. 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...

  11. Gastroesophageal reflux diagnosis by scintigraphic method - a comparison among different methods

    International Nuclear Information System (INIS)

    Cruz, Maria das Gracas de Almedia; Penas, Maria Exposito; Maliska, Carmelindo; Fonseca, Lea Miriam B. da; Lemme, Eponina M.; Campos, Deisy Guacyaba S.; Rebelo, Ana Maria de O.; Martinho, Maria Jose R.; Dias, Vera Maria

    1996-01-01

    The gastroesophageal reflux disease is characterized by the return of gastric liquid to the esophagus which can origin the reflux esophagitis. The aim is to evaluate the contribution of dynamic quality scintigraphy of reflux (CTR) in the diagnosis of DRGE. We studied a ground of sick people with typical symptoms and compared the results given by digestive endoscopy (EDA), the histopathology and 24 hours pHmetry. There have been evaluated 24 healthy individuals and 97 who were sick. The first ones were submitted to CTR. In 20 controlled and 34 patients, the reflux index (IR) was determined by the evaluation of the reflux material percentage in relation to the basal activity. All the sick patients were submitted to CTR and EDA. This one classified them in: group A with esophagitis 45 patients (46,4%) where 14 did the biopsy of the third segment/part from the esophagus and 16 did the long pHmetry and group B without esophagitis = 52 patients (53.6%), 26 did the biopsy and 36 the pHmetry. In group A the CTR was positive in 38 (84%), the biopsy showed esophagitis in 11 (78,6%) and the pHmetry showed normal reflux in 14 (87,5%). The positivity of the same exams in group B were of 42 (81%), 11 (42,3%) and 19 (53%) respectively. The IR were determined to the controls and the measure to the patients were of 59% and 106% respectively as p<0,0001 (test from Mann Whitney). The correlation of CTR with the other methods showed sensitivity of 84,1%, specificity of 95,8%, positive predictive value of 98,3% and negative predictive value of 67,7%. As it was showed the authors concluded that the scintigraphy method can confirm the diagnosis of DRGE in patients of typical symptomology which can be recommended by the initial of investigation method in these conditions. (author)

  12. 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.

  13. 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.

  14. 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 ...

  15. [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.

  16. 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

  17. 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 ...

  18. 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

  19. 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.)

  20. 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 ...

  1. Active Segmentation.

    Science.gov (United States)

    Mishra, Ajay; Aloimonos, Yiannis

    2009-01-01

    The human visual system observes and understands a scene/image by making a series of fixations. Every fixation point lies inside a particular region of arbitrary shape and size in the scene which can either be an object or just a part of it. We define as a basic segmentation problem the task of segmenting that region containing the fixation point. Segmenting the region containing the fixation is equivalent to finding the enclosing contour- a connected set of boundary edge fragments in the edge map of the scene - around the fixation. This enclosing contour should be a depth boundary.We present here a novel algorithm that finds this bounding contour and achieves the segmentation of one object, given the fixation. The proposed segmentation framework combines monocular cues (color/intensity/texture) with stereo and/or motion, in a cue independent manner. The semantic robots of the immediate future will be able to use this algorithm to automatically find objects in any environment. The capability of automatically segmenting objects in their visual field can bring the visual processing to the next level. Our approach is different from current approaches. While existing work attempts to segment the whole scene at once into many areas, we segment only one image region, specifically the one containing the fixation point. Experiments with real imagery collected by our active robot and from the known databases 1 demonstrate the promise of the approach.

  2. 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

  3. 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

  4. 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.

  5. Fragmented esophageal smooth muscle contraction segments on high resolution manometry: a marker of esophageal hypomotility.

    Science.gov (United States)

    Porter, R F; Kumar, N; Drapekin, J E; Gyawali, C P

    2012-08-01

    Esophageal peristalsis consists of a chain of contracting striated and smooth muscle segments on high resolution manometry (HRM). We compared smooth muscle contraction segments in symptomatic subjects with reflux disease to healthy controls. High resolution manometry Clouse plots were analyzed in 110 subjects with reflux disease (50 ± 1.4 years, 51.5% women) and 15 controls (27 ± 2.1 years, 60.0% women). Using the 30 mmHg isobaric contour tool, sequences were designated fragmented if either smooth muscle contraction segment was absent or if the two smooth muscle segments were separated by a pressure trough, and failed if both smooth muscle contraction segments were absent. The discriminative value of contraction segment analysis was assessed. A total of 1115 swallows were analyzed (reflux group: 965, controls: 150). Reflux subjects had lower peak and averaged contraction amplitudes compared with controls (P value to HRM analysis. Specifically, fragmented smooth muscle contraction segments may be a marker of esophageal hypomotility. © 2012 Blackwell Publishing Ltd.

  6. 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.

  7. 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.).

  8. 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

  9. 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.

  10. 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

  11. 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

  12. 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.

  13. 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

  14. Segmentation: Identification of consumer segments

    DEFF Research Database (Denmark)

    Høg, Esben

    2005-01-01

    It is very common to categorise people, especially in the advertising business. Also traditional marketing theory has taken in consumer segments as a favorite topic. Segmentation is closely related to the broader concept of classification. From a historical point of view, classification has its...... origin in other sciences as for example biology, anthropology etc. From an economic point of view, it is called segmentation when specific scientific techniques are used to classify consumers to different characteristic groupings. What is the purpose of segmentation? For example, to be able to obtain...... a basic understanding of grouping people. Advertising agencies may use segmentation totarget advertisements, while food companies may usesegmentation to develop products to various groups of consumers. MAPP has for example investigated the positioning of fish in relation to other food products...

  15. Segmental Vitiligo.

    Science.gov (United States)

    van Geel, Nanja; Speeckaert, Reinhart

    2017-04-01

    Segmental vitiligo is characterized by its early onset, rapid stabilization, and unilateral distribution. Recent evidence suggests that segmental and nonsegmental vitiligo could represent variants of the same disease spectrum. Observational studies with respect to its distribution pattern point to a possible role of cutaneous mosaicism, whereas the original stated dermatomal distribution seems to be a misnomer. Although the exact pathogenic mechanism behind the melanocyte destruction is still unknown, increasing evidence has been published on the autoimmune/inflammatory theory of segmental vitiligo. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. 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

  17. 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.

  18. Self-Paced Segmentation of Written Words on a Touchscreen Tablet Promotes the Oral Production of Nonverbal and Minimally Verbal Children with Autism

    Science.gov (United States)

    Vernay, Frédérique; Kahina, Harma; Thierry, Marrone; Jean-Yves, Roussey

    2017-01-01

    We investigated in a pilot study the effects of various types of visual mediation (photos, written words and self-paced syllabic segmentation of written words displayed on a touchscreen tablet) that are thought to facilitate the oral production of nonverbal and minimally verbal children with autism, according to the participants' level of oral…

  19. [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.

  20. 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.

  1. 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.

  2. 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 ...

  3. 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.

  4. 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.

  5. 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 ...

  6. 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

  7. 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.

  8. 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

  9. 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.

  10. 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.

  11. 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.

  12. 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.

  13. 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.

  14. 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.

  15. 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

  16. 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.)

  17. 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…

  18. 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.

  19. 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.

  20. Vesical-ureteral reflux in children

    International Nuclear Information System (INIS)

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

    1995-01-01

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

  1. 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

  2. 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)

  3. 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.

  4. 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

  5. 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

  6. 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.

  7. 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.

  8. 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).

  9. 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)

  10. 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

  11. Histologic definition of gastro-esophageal reflux disease.

    Science.gov (United States)

    Chandrasoma, Parakrama T

    2013-07-01

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

  12. 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

  13. Mixed segmentation

    DEFF Research Database (Denmark)

    Hansen, Allan Grutt; Bonde, Anders; Aagaard, Morten

    content analysis and audience segmentation in a single-source perspective. The aim is to explain and understand target groups in relation to, on the one hand, emotional response to commercials or other forms of audio-visual communication and, on the other hand, living preferences and personality traits...

  14. Audience segmentation as a social-marketing tool in health promotion: use of the risk perception attitude framework in HIV prevention in Malawi.

    Science.gov (United States)

    Rimal, Rajiv N; Brown, Jane; Mkandawire, Glory; Folda, Lisa; Böse, Kirsten; Creel, Alisha H

    2009-12-01

    We sought to determine whether individuals' risk perceptions and efficacy beliefs could be used to meaningfully segment audiences to assist interventions that seek to change HIV-related behaviors. A household-level survey of individuals (N=968) was conducted in 4 districts in Malawi. On the basis of responses about perceptions of risk and beliefs about personal efficacy, we used cluster analysis to create 4 groups within the risk perception attitude framework: responsive (high risk, strong efficacy), avoidance (high risk, weak efficacy), proactive (low risk, strong efficacy), and indifference (low risk, weak efficacy). We ran analysis of covariance models (controlling for known predictors) to determine how membership in the risk perception attitude framework groups would affect knowledge about HIV, HIV-testing uptake, and condom use. A significant association was found between membership in 1 or more of the 4 risk perception attitude framework groups and the 3 study variables of interest: knowledge about HIV (F8, 956=20.77; Paudience segmentation technique that can be used to determine whether messages should augment perceptions of risk, beliefs about personal efficacy, or both.

  15. Study of the morphology exhibited by linear segmented polyurethanes

    International Nuclear Information System (INIS)

    Pereira, I.M.; Orefice, R.L.

    2009-01-01

    Five series of segmented polyurethanes with different hard segment content were prepared by the prepolymer mixing method. The nano-morphology of the obtained polyurethanes and their microphase separation were investigated by infrared spectroscopy, modulated differential scanning calorimetry and small-angle X-ray scattering. Although highly hydrogen bonded hard segments were formed, high hard segment contents promoted phase mixture and decreased the chain mobility, decreasing the hard segment domain precipitation and the soft segments crystallization. The applied techniques were able to show that the hard-segment content and the hard-segment interactions were the two controlling factors for determining the structure of segmented polyurethanes. (author)

  16. 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

  17. 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.

  18. 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...

  19. 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

  20. 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

  1. 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

  2. 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

  3. 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.

  4. 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.

  5. Is channel segmentation necessary to reach a multiethnic population with weight-related health promotion? An analysis of use and perception of communication channels

    NARCIS (Netherlands)

    Hartman, M.A.; Nierkens, V.; Cremer, S.W.; Verhoeff, A.; Stronks, K.

    2015-01-01

    Objective. To explore similarities and differences in the use and perception of communication channels to access weight-related health promotion among women in three ethnic minority groups. The ultimate aim was to determine whether similar channels might reach ethnic minority women in general or

  6. Is channel segmentation necessary to reach a multiethnic population with weight-related health promotion? An analysis of use and perception of communication channels

    NARCIS (Netherlands)

    Hartman, Marieke A.; Nierkens, Vera; Cremer, Stephan W.; Verhoeff, Arnoud; Stronks, Karien

    2015-01-01

    To explore similarities and differences in the use and perception of communication channels to access weight-related health promotion among women in three ethnic minority groups. The ultimate aim was to determine whether similar channels might reach ethnic minority women in general or whether

  7. 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.

  8. Mucosal integrity and sensitivity to acid in the proximal esophagus in patients with gastroesophageal reflux disease.

    Science.gov (United States)

    van Hoeij, Froukje B; Weijenborg, Pim W; van den Bergh Weerman, Marius A; van den Wijngaard, René M J G J; Verheij, J; Smout, André J P M; Bredenoord, Albert J

    2016-07-01

    Acid reflux episodes that extend to the proximal esophagus are more likely to be perceived. This suggests that the proximal esophagus is more sensitive to acid than the distal esophagus, which could be caused by impaired mucosal integrity in the proximal esophagus. Our aim was to explore sensitivity to acid and mucosal integrity in different segments of the esophagus. We used a prospective observational study, including 12 patients with gastroesophageal reflux disease (GERD). After stopping acid secretion-inhibiting medication, two procedures were performed: an acid perfusion test and an upper endoscopy with electrical tissue impedance spectroscopy and esophageal biopsies. Proximal and distal sensitivity to acid and tissue impedance were measured in vivo, and mucosal permeability and epithelial intercellular spaces at different esophageal levels were measured in vitro. Mean lag time to heartburn perception was much shorter after proximal acid perfusion (0.8 min) than after distal acid perfusion (3.9 min) (P = 0.02). Median in vivo tissue impedance was significantly lower in the distal esophagus (4,563 Ω·m) compared with the proximal esophagus (8,170 Ω·m) (P = 0.002). Transepithelial permeability, as measured by the median fluorescein flux was significantly higher in the distal (2,051 nmol·cm(-2)·h(-1)) than in the proximal segment (368 nmol·cm(-2)·h(-1)) (P = 0.033). Intercellular space ratio and maximum heartburn intensity were not significantly different between the proximal and distal esophagus. In GERD patients off acid secretion-inhibiting medication, acid exposure in the proximal segment of the esophagus provokes symptoms earlier than acid exposure in the distal esophagus, whereas mucosal integrity is impaired more in the distal esophagus. These findings indicate that the enhanced sensitivity to proximal reflux episodes is not explained by increased mucosal permeability. Copyright © 2016 the American Physiological Society.

  9. Persistent below-knee great saphenous vein reflux after above-knee endovenous laser ablation with 1470-nm laser: a prospective study

    Directory of Open Access Journals (Sweden)

    Walter Junior Boim de Araujo

    2016-01-01

    Full Text Available Abstract Background In endovenous laser ablation (EVLA, the great saphenous vein (GSV is usually ablated from the knee to the groin, with no treatment of the below-knee segment regardless of its reflux status. However, persistent below-knee GSV reflux appears to be responsible for residual varicosities and symptoms of venous disease. Objectives To evaluate clinical and duplex ultrasound (DUS outcomes of the below-knee segment of the GSV after above-knee EVLA associated with conventional surgical treatment of varicosities and incompetent perforating veins. Methods Thirty-six patients (59 GSVs were distributed into 2 groups, a control group (26 GSVs with normal below-knee flow on DUS and a test group (33 GSVs with below-knee reflux. Above-knee EVLA was performed with a 1470-nm bare-fiber diode laser and supplemented with phlebectomies of varicose tributaries and insufficient perforating-communicating veins through mini-incisions. Follow-up DUS, clinical evaluation using the venous clinical severity score (VCSS, and evaluation of complications were performed at 3-5 days after the procedure and at 1, 6, and 12 months. Results Mean patient age was 45 years, and 31 patients were women (86.12%. VCSS improved in both groups. Most patients in the test group exhibited normalization of reflux, with normal flow at the beginning of follow-up (88.33% of GSVs at 3-5 days and 70% at 1 month. However, in many of these patients reflux eventually returned (56.67% of GSVs at 6 months and 70% at 1 year. Conclusions These data suggest that reflux in the below-knee segment of the GSV was not influenced by the treatment performed.

  10. 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.

  11. 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.

  12. 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.

  13. 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

  14. Brookhaven segment interconnect

    International Nuclear Information System (INIS)

    Morse, W.M.; Benenson, G.; Leipuner, L.B.

    1983-01-01

    We have performed a high energy physics experiment using a multisegment Brookhaven FASTBUS system. The system was composed of three crate segments and two cable segments. We discuss the segment interconnect module which permits communication between the various segments

  15. 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

  16. 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.

  17. 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.

  18. 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.

  19. 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

  20. [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.

  1. 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. 

  2. 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

  3. 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

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

    Directory of Open Access Journals (Sweden)

    Campagnolo, Andrea Maria

    2014-01-01

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

  5. Radionuclide voiding cystography in intrarenal reflux detection

    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

  6. 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.

  7. 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.

  8. Characterization of the N-terminal segment used by the barley yellow dwarf virus movement protein to promote interaction with the nuclear membrane of host plant cells.

    Science.gov (United States)

    Dennison, Sarah Rachel; Harris, Frederick; Brandenburg, Klaus; Phoenix, David Andrew

    2007-11-01

    The barley yellow dwarf virus movement protein (BYDV-MP) requires its N-terminal sequence to promote the transport of viral RNA into the nuclear compartment of host plant cells. Here, graphical analysis predicts that this sequence would form a membrane interactive amphiphilic alpha-helix. Confirming this prediction, NT1, a peptide homologue of the BYDV-MP N-terminal sequence, was found to be alpha-helical (65%) in the presence of vesicles mimics of the nuclear membrane. The peptide increased the fluidity of these nuclear membrane mimics (rise in wavenumber of circa 0.5-1.0 cm(-1)) and induced surface pressure changes of 2 mN m(-1) in lipid monolayers with corresponding compositions. Taken with isotherm analysis these results suggest that BYDV-MP forms an N-terminal amphiphilic alpha-helix, which partitions into the nuclear membrane primarily through thermodynamically stable associations with the membrane lipid headgroup region. We speculate that these associations may play a role in targeting of the nuclear membrane by BYDM-MP.

  9. 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.

  10. 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

  11. 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.

  12. 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

  13. 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.

  14. [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.

  15. 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

  16. 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

  17. 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

  18. 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

  19. 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.

  20. 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.

  1. 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.

  2. 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 ...

  3. Respiratory repercussions of gastroesophageal reflux and cine-esophagogastroscintigraphy

    International Nuclear Information System (INIS)

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

    1984-01-01

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

  4. 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

  5. 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

  6. Differences in the risk factors of reflux esophagitis according to age in Korea.

    Science.gov (United States)

    Park, C H; Kim, K O; Baek, I H; Choi, M H; Jang, H J; Kae, S H; Kim, J B; Baik, G H; Shin, W G; Kim, K H; Kim, H Y

    2014-01-01

    The prevalence of gastroesophageal reflux disease in Korea has been believed to be low, but the incidence of gastroesophageal reflux disease in Korea is expected to increase because of the longer life expectancy and more ingestion of westernized food. The aim of this study was to report differences in the risk factors of reflux esophagitis (RE) according to age in Korea. We prospectively recruited the subjects who had RE among those who visited a health promotion center for upper gastrointestinal cancer surveillance at Hallym Medical Center (five institutions) between January 2008 and February 2009. The enrolled study participants comprised 742 subjects with RE and 1484 healthy controls. The independent risk factors of RE in young and adult group were male sex, smoking, coffee, body mass index ≥ 25, hiatal hernia, and Helicobacter pylori negativity. The risk factors of RE in elderly group were smoking, coffee, and hiatal hernia. The risk factors for RE according to age group were found to differ. In elderly group, Helicobacter pylori infection was not a significant protective factor contrary to young and adult groups. © 2012 Copyright the Authors. Journal compilation © 2012, Wiley Periodicals, Inc. and the International Society for Diseases of the Esophagus.

  7. 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.

  8. 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

  9. 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)

  10. 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.

  11. 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.

  12. 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.

  13. 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.

  14. 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%

  15. 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.

  16. 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

  17. General gastroscopy of gastroesophageal reflux disease: Analysis of 4086 cases

    Directory of Open Access Journals (Sweden)

    Zhi-wei HU

    2018-04-01

    Full Text Available Objective To analyze the characteristics of gastroesophageal reflux disease (GERD under general gastroscope. Methods The detection rates of GERD related abnormalities such as esophagitis, Barrett esophagus and hiatal hernia under the first gastroscopy of the adult GERD patients from January 2013 to January 2017 in our center and the statistical relationship between the abnormal findings were analyzed retrospectively. Results A total of 4086 GERD patients, 2004 males and 2082 females, were included in this study, and the age was 18-89(50.4±13.3 years old. The detection rate of non erosive GERD was 78.7%, esophagitis 21.3%; non Barrett esophagus 87.7%, suspected Barrett esophagus 8.3%, Barrett esophagus 3.9%; generally normal cardia 61.4%, short segment hiatus hernia 20.4%, and long segment hiatal hernia 18.2%. The detection rates of esophagitis showed statistically significant differences (P0.013. Comparing the three age groups of 18-39, 40-59 and ≥60 years old, the detection rate of hiatal hernia was significantly higher in the group of ≥60 years old than in the 18-39 and 40-59 years old groups (P=0.007, while there was no significant difference (P>0.013 between the 18-39 and 40-59 years old groups. The detection rate of esophagitis was significantly higher in ≥60 years old group than in 18-39 and 40-59 years old groups (P=0.004, P=0.008, while no significant statistically difference (P>0.013 was found between the later two groups. Conclusions Gastroscopy can be used as a basic examination means for GERD; short segment hiatal hernia can be regarded as an early form of hiatal hernia, and is of importantreference value for the diagnosis and treatment of GERD; more serious hiatal hernia and esophagitis could be found in elderly GERD patients. DOI: 10.11855/j.issn.0577-7402.2018.01.08

  18. 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.

  19. 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

  20. 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.

  1. 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 ...

  2. [The novel approaches to the rehabilitation of the patients presenting with gastroesophageal reflux disease and co-morbid pathology].

    Science.gov (United States)

    Komleva, N E; Marjanovsky, A A; Danilov, A N; Agasarov, L G

    This paper was designed to discuss the problems of co-morbidity and approaches to the rehabilitation of the patients presenting with gastroesophageal reflux disease and a concomitant pathology and to analyze the issues concerning the possible vertebro-visceral correlations inherent in the diseases of the internal organs. To evaluate the vertebro-neurological status of the thoracic segment of the vertebral column in the patients suffering from gastroesophageal reflux disease and to further improve the methods for their treatment taking into consideration the concomitant pathology, if any. A total of 290 patients at the age varying from 25 to 60 (mean 44,3±11,3) years with the non-erosive form of gastroesophageal reflux disease were examined in the phase of its exacerbation. They included 132 (45.5%) men and 158 (54.5%) women. The duration of the disease averaged 13.1±3.3 years and that of the exacerbation period 1.2±0.5 months. All the patients underwent the vertebro-neurological examination. The visual analog scale was used to obtain the subjective characteristics of the pain syndrome associated with thoracalgia The quality of life of the patients was estimated based on the Medical Outcomes Study Short Form-36 (scores of MOS SF-36). To evaluate the effectiveness of the proposed approach to the treatment of the gastroesophageal reflux disease, the 260 participants of the study were randomly allocated to two groups, the main and control ones. The latter group was comprised of 130 patients given the standard treatment including the use of histamine H2-receptor antagonists, proton pump inhibitors, stimulators of the motility of the gastrointestinal tract, alginates, and other drugs, as indicated. The former group consisted of the remaining 130 patients undergoing the standard course of pharmacopuncture to correct the functional disorders in the thoracic segment of the vertebral column. The medications of choice for the purpose were the anti-homotoxic agents, such as

  3. 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.

  4. [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.

  5. 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.

  6. 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.)

  7. 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.

  8. 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 ...

  9. 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 ...

  10. 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

  11. [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.

  12. 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.

  13. Gastroesophageal reflux diagnosis by scintigraphic method - a comparison among different methods; Diagnostico de refluxo gastro-esofagico por metodo cintilografico - correlacao com outros metodos

    Energy Technology Data Exchange (ETDEWEB)

    Cruz, Maria das Gracas de Almedia; Penas, Maria Exposito; Maliska, Carmelindo; Fonseca, Lea Miriam B. da; Lemme, Eponina M.; Campos, Deisy Guacyaba S.; Rebelo, Ana Maria de O.; Martinho, Maria Jose R.; Dias, Vera Maria [Hospital Universitario Clementino Fraga Filho, Rio de Janeiro, RJ (Brazil). Servico de Medicina Nuclear

    1996-07-01

    The gastroesophageal reflux disease is characterized by the return of gastric liquid to the esophagus which can origin the reflux esophagitis. The aim is to evaluate the contribution of dynamic quality scintigraphy of reflux (CTR) in the diagnosis of DRGE. We studied a ground of sick people with typical symptoms and compared the results given by digestive endoscopy (EDA), the histopathology and 24 hours pHmetry. There have been evaluated 24 healthy individuals and 97 who were sick. The first ones were submitted to CTR. In 20 controlled and 34 patients, the reflux index (IR) was determined by the evaluation of the reflux material percentage in relation to the basal activity. All the sick patients were submitted to CTR and EDA. This one classified them in: group A with esophagitis 45 patients (46,4%) where 14 did the biopsy of the third segment/part from the esophagus and 16 did the long pHmetry and group B without esophagitis = 52 patients (53.6%), 26 did the biopsy and 36 the pHmetry. In group A the CTR was positive in 38 (84%), the biopsy showed esophagitis in 11 (78,6%) and the pHmetry showed normal reflux in 14 (87,5%). The positivity of the same exams in group B were of 42 (81%), 11 (42,3%) and 19 (53%) respectively. The IR were determined to the controls and the measure to the patients were of 59% and 106% respectively as p<0,0001 (test from Mann Whitney). The correlation of CTR with the other methods showed sensitivity of 84,1%, specificity of 95,8%, positive predictive value of 98,3% and negative predictive value of 67,7%. As it was showed the authors concluded that the scintigraphy method can confirm the diagnosis of DRGE in patients of typical symptomology which canbe recommended by the initial of investigation method in these conditions. (author)

  14. 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.

  15. 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)

  16. 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)

  17. 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

  18. 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

  19. 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.

  20. [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.

  1. 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.

  2. 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.

  3. 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.

  4. 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.

  5. 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:

  6. 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

  7. 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

  8. 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.

  9. 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...

  10. 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.)

  11. 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.

  12. 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.

  13. Laparoscopic Nissen fundoplication for severe gastroesophageal reflux disease: pros and cons.

    Science.gov (United States)

    DeMaria, E J; Siuta, M; Widmeyer, J; Zfass, A M

    1997-03-01

    The advent of the laparoscopic approach to Nissen fundoplication has led to a resurgence in enthusiasm for the surgical treatment of gastroesophageal reflux disease (GERD). However, controversy exists as to which subgroups of GERD patients are best treated surgically. The relative success of treatment with medical and surgical intervention in terms of both symptom control and objective resolution of esophageal injury must be weighed against the relative costs of each therapeutic strategy in both the short and long term, given that GERD tends to be a lifelong disorder. The following is the transcribed text of a debate held at the Medical College of Virginia as part of a continuing medical education program in which the statement "Laparoscopic antireflux surgery is superior to medical treatment for severe gastroesophageal reflux disease" was contested. Representatives from the departments of surgery and gastroenterology provided arguments supporting their respective sides of this issue. The purpose was not to promote polarization in treatment selection, but to review the available data in a forum that could promote development of a rational algorithm for clinical decision-making in patients with GERD who might benefit from antireflux surgery. Final comments from the authors are provided in an attempt to synthesize the arguments into a reasonable strategy for individual case management.

  14. 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.

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

    Directory of Open Access Journals (Sweden)

    Clarissa B. Araújo

    2003-12-01

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

  16. 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

  17. 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)

  18. 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.

  19. 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

  20. 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)

  1. 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

  2. Segmented trapped vortex cavity

    Science.gov (United States)

    Grammel, Jr., Leonard Paul (Inventor); Pennekamp, David Lance (Inventor); Winslow, Jr., Ralph Henry (Inventor)

    2010-01-01

    An annular trapped vortex cavity assembly segment comprising includes a cavity forward wall, a cavity aft wall, and a cavity radially outer wall there between defining a cavity segment therein. A cavity opening extends between the forward and aft walls at a radially inner end of the assembly segment. Radially spaced apart pluralities of air injection first and second holes extend through the forward and aft walls respectively. The segment may include first and second expansion joint features at distal first and second ends respectively of the segment. The segment may include a forward subcomponent including the cavity forward wall attached to an aft subcomponent including the cavity aft wall. The forward and aft subcomponents include forward and aft portions of the cavity radially outer wall respectively. A ring of the segments may be circumferentially disposed about an axis to form an annular segmented vortex cavity assembly.

  3. Pavement management segment consolidation

    Science.gov (United States)

    1998-01-01

    Dividing roads into "homogeneous" segments has been a major problem for all areas of highway engineering. SDDOT uses Deighton Associates Limited software, dTIMS, to analyze life-cycle costs for various rehabilitation strategies on each segment of roa...

  4. 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

  5. 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.

  6. Speaker segmentation and clustering

    OpenAIRE

    Kotti, M; Moschou, V; Kotropoulos, C

    2008-01-01

    07.08.13 KB. Ok to add the accepted version to Spiral, Elsevier says ok whlile mandate not enforced. This survey focuses on two challenging speech processing topics, namely: speaker segmentation and speaker clustering. Speaker segmentation aims at finding speaker change points in an audio stream, whereas speaker clustering aims at grouping speech segments based on speaker characteristics. Model-based, metric-based, and hybrid speaker segmentation algorithms are reviewed. Concerning speaker...

  7. Spinal segmental dysgenesis

    Directory of Open Access Journals (Sweden)

    N Mahomed

    2009-06-01

    Full Text Available Spinal segmental dysgenesis is a rare congenital spinal abnormality , seen in neonates and infants in which a segment of the spine and spinal cord fails to develop normally . The condition is segmental with normal vertebrae above and below the malformation. This condition is commonly associated with various abnormalities that affect the heart, genitourinary, gastrointestinal tract and skeletal system. We report two cases of spinal segmental dysgenesis and the associated abnormalities.

  8. 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.)

  9. 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

  10. Automatic Melody Segmentation

    NARCIS (Netherlands)

    Rodríguez López, Marcelo

    2016-01-01

    The work presented in this dissertation investigates music segmentation. In the field of Musicology, segmentation refers to a score analysis technique, whereby notated pieces or passages of these pieces are divided into “units” referred to as sections, periods, phrases, and so on. Segmentation

  11. 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.

  12. Gastroesophageal reflux leads to esophageal cancer in a surgical model with mice

    Directory of Open Access Journals (Sweden)

    Chen Xiaoxin

    2009-07-01

    Full Text Available Abstract Background Esophago-gastroduodenal anastomosis with rats mimics the development of human Barrett's esophagus and esophageal adenocarcinoma by introducing mixed reflux of gastric and duodenal contents into the esophagus. However, use of this rat model for mechanistic and chemopreventive studies is limited due to lack of genetically modified rat strains. Therefore, a mouse model of esophageal adenocarcinoma is needed. Methods We performed reflux surgery on wild-type, p53A135V transgenic, and INK4a/Arf+/- mice of A/J strain. Some mice were also treated with omeprazole (1,400 ppm in diet, iron (50 mg/kg/m, i.p., or gastrectomy plus iron. Mouse esophagi were harvested at 20, 40 or 80 weeks after surgery for histopathological analysis. Results At week 20, we observed metaplasia in wild-type mice (5%, 1/20 and p53A135V mice (5.3%, 1/19. At week 40, metaplasia was found in wild-type mice (16.2%, 6/37, p53A135V mice (4.8%, 2/42, and wild-type mice also receiving gastrectomy and iron (6.7%, 1/15. Esophageal squamous cell carcinoma developed in INK4a/Arf+/- mice (7.1%, 1/14, and wild-type mice receiving gastrectomy and iron (21.4%, 3/14. Among 13 wild-type mice which were given iron from week 40 to 80, twelve (92.3% developed squamous cell carcinoma at week 80. None of these mice developed esophageal adenocarcinoma. Conclusion Surgically induced gastroesophageal reflux produced esophageal squamous cell carcinoma, but not esophageal adenocarcinoma, in mice. Dominant negative p53 mutation, heterozygous loss of INK4a/Arf, antacid treatment, iron supplementation, or gastrectomy failed to promote esophageal adenocarcinoma in these mice. Further studies are needed in order to develop a mouse model of esophageal adenocarcinoma.

  13. 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

  14. 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.

  15. 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.

  16. 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.

  17. 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

  18. 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.

  19. 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

  20. 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)

  1. 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.

  2. 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.)

  3. 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.

  4. 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.)

  5. 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

  6. 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 ...

  7. 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.

  8. 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.

  9. 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.

  10. 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

  11. 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

  12. 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.

  13. 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.

  14. 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

  15. 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%.

  16. 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%

  17. 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.)

  18. 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.)

  19. 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.

  20. 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.

  1. 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.

  2. 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.)

  3. 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.

  4. 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.

  5. 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.)

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

    Directory of Open Access Journals (Sweden)

    John K Marshall

    1998-01-01

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

  7. 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.

  8. 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.

  9. Treatment of clinically diagnosed laryngopharyngeal reflux disease.

    Science.gov (United States)

    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.

  10. 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

  11. 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.

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

    Science.gov (United States)

    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

  13. 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.

  14. 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

  15. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  17. 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.

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

    Directory of Open Access Journals (Sweden)

    Ferhat Kilinc

    2013-10-01

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

  19. 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.

  20. 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

  1. [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.

  2. 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.

  3. 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

  4. 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.)

  5. 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.

  6. 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

  7. 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...

  8. 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...

  9. [Oesophageal diseases: gastroesophageal reflux disease, Barrett's disease, achalasia and eosinophilic oesophagitis].

    Science.gov (United States)

    Calvet, Xavier

    2015-09-01

    The most important novel findings presented on oesophageal disease in DDW 2015 were the following: 1) GERD: a) hypervigilance seems to be a key pathogenic factor in reflux symptoms refractory to PPI; b) post-reflux swallowing-induced peristaltic waves could be an excellent diagnostic criterion for GERD; c) laryngeal pH-metry is not useful in the diagnosis of extra-oesophageal symptoms; d) the recommendation of weight loss adequately recorded in the clinical reports of patients with GERD and obesity or overweight is an excellent quality indicator and is associated with better outcomes. 2) Barrett's oesophagus: a) persistent low-grade dysplasia in more than one endoscopy and a diagnosis of "indefinite for dysplasia" are associated with a high risk of neoplastic progression; b) narrow-band imaging allows areas of dysplasia on Barrett's oesophagus to be identified with high sensitivity and specificity; c) initial endoscopy fails to identify a high percentage of advanced neoplasms in Barrett's oesophagus. Early re-endoscopy should be considered; d) endoscopists specialized in Barret's oesophagus obtain a much higher yield in the diagnosis of advanced lesions. Patients at high risk-men, older patients, smokers and those with long-segment Barrett's oesophagus-could benefit from follow-up in a referral center. 3) Achalasia: POEM seems safe and effective, independently from patient characteristics (age, comorbidity) and the technical variations used. 4) Eosinophilic esophagitis: topical budesonide and exclusion diets are reasonably effective in PPI non-responders. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

  10. 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.

  11. 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.

  12. [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.

  13. Segmentation, advertising and prices

    NARCIS (Netherlands)

    Galeotti, Andrea; Moraga González, José

    This paper explores the implications of market segmentation on firm competitiveness. In contrast to earlier work, here market segmentation is minimal in the sense that it is based on consumer attributes that are completely unrelated to tastes. We show that when the market is comprised by two

  14. Sipunculans and segmentation

    DEFF Research Database (Denmark)

    Wanninger, Andreas; Kristof, Alen; Brinkmann, Nora

    2009-01-01

    mechanisms may act on the level of gene expression, cell proliferation, tissue differentiation and organ system formation in individual segments. Accordingly, in some polychaete annelids the first three pairs of segmental peripheral neurons arise synchronously, while the metameric commissures of the ventral...

  15. 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.

  16. 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

  17. 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

  18. [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.

  19. 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

  20. 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

  1. 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.

  2. 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

  3. 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.

  4. 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

  5. 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.

  6. 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.

  7. 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.

  8. 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 ...

  9. 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

  10. 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...

  11. 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

  12. 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.

  13. 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

  14. 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.

  15. 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...

  16. 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.

  17. 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.

  18. 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

  19. 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

  20. 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...

  1. 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

  2. Lack of differential pattern in central adiposity and metabolic syndrome in Barrett's esophagus and gastroesophageal reflux disease.

    LENUS (Irish Health Repository)

    Healy, L A

    2012-02-01

    Obesity is an established risk factor for esophageal adenocarcinoma, although the mechanism is unclear. A pathway from reflux to inflammation through metaplasia is the dominant hypothesis, and an added role relating to visceral adiposity and the metabolic syndrome has been mooted in Barrett\\'s esophagus (BE) patients. Whether BE differs from gastroesophageal reflux disease (GERD) in obesity and metabolic syndrome profiles is unclear, and this was the focus of this study. Patients with proven BE or GERD were randomly selected from the unit data registry and invited to attend for metabolic syndrome screening, anthropometry studies including segmental body composition analysis, and laboratory tests including fasting lipids, insulin, and C-reactive protein. Metabolic syndrome was defined using the National Cholesterol Education Program (NCEP) and the International Diabetes Federation (IDF) criteria. One hundred and eighteen BE patients and 113 age- and sex-matched GERD controls were studied. The incidence of obesity (body mass index >30 kg\\/m(2)) was 36% and 38%, respectively, with the pattern of fat deposition predominantly central and an estimated trunk fat mass of 13 and 14 kg, respectively. Using the NCEP criteria, metabolic syndrome was significantly more common in the BE cohort (30% vs 20%, P < 0.05), but there was no significant difference using IDF criteria (42% vs 37%, P= 0.340). Central obesity and the metabolic syndrome are common in both Barrett\\'s and GERD cohorts, but not significantly different, suggesting that central obesity and the metabolic syndrome does not per se impact on the development of BE in a reflux population. In BE, the importance of obesity and the metabolic syndrome in disease progression merits further study.

  3. Gastro-esophageal reflux disease symptoms and demographic factors as a pre-screening tool for Barrett's esophagus.

    Directory of Open Access Journals (Sweden)

    Xinxue Liu

    Full Text Available Barrett's esophagus (BE occurs as consequence of reflux and is a risk factor for esophageal adenocarcinoma. The current "gold-standard" for diagnosing BE is endoscopy which remains prohibitively expensive and impractical as a population screening tool. We aimed to develop a pre-screening tool to aid decision making for diagnostic referrals.A prospective (training cohort of 1603 patients attending for endoscopy was used for identification of risk factors to develop a risk prediction model. Factors associated with BE in the univariate analysis were selected to develop prediction models that were validated in an independent, external cohort of 477 non-BE patients referred for endoscopy with symptoms of reflux or dyspepsia. Two prediction models were developed separately for columnar lined epithelium (CLE of any length and using a stricter definition of intestinal metaplasia (IM with segments ≥ 2 cm with areas under the ROC curves (AUC of 0.72 (95%CI: 0.67-0.77 and 0.81 (95%CI: 0.76-0.86, respectively. The two prediction models included demographics (age, sex, symptoms (heartburn, acid reflux, chest pain, abdominal pain and medication for "stomach" symptoms. These two models were validated in the independent cohort with AUCs of 0.61 (95%CI: 0.54-0.68 and 0.64 (95%CI: 0.52-0.77 for CLE and IM ≥ 2 cm, respectively.We have identified and validated two prediction models for CLE and IM ≥ 2 cm. Both models have fair prediction accuracies and can select out around 20% of individuals unlikely to benefit from investigation for Barrett's esophagus. Such prediction models have the potential to generate useful cost-savings for BE screening among the symptomatic population.

  4. Gastro-esophageal reflux disease symptoms and demographic factors as a pre-screening tool for Barrett's esophagus.

    Science.gov (United States)

    Liu, Xinxue; Wong, Angela; Kadri, Sudarshan R; Corovic, Andrej; O'Donovan, Maria; Lao-Sirieix, Pierre; Lovat, Laurence B; Burnham, Rodney W; Fitzgerald, Rebecca C

    2014-01-01

    Barrett's esophagus (BE) occurs as consequence of reflux and is a risk factor for esophageal adenocarcinoma. The current "gold-standard" for diagnosing BE is endoscopy which remains prohibitively expensive and impractical as a population screening tool. We aimed to develop a pre-screening tool to aid decision making for diagnostic referrals. A prospective (training) cohort of 1603 patients attending for endoscopy was used for identification of risk factors to develop a risk prediction model. Factors associated with BE in the univariate analysis were selected to develop prediction models that were validated in an independent, external cohort of 477 non-BE patients referred for endoscopy with symptoms of reflux or dyspepsia. Two prediction models were developed separately for columnar lined epithelium (CLE) of any length and using a stricter definition of intestinal metaplasia (IM) with segments ≥ 2 cm with areas under the ROC curves (AUC) of 0.72 (95%CI: 0.67-0.77) and 0.81 (95%CI: 0.76-0.86), respectively. The two prediction models included demographics (age, sex), symptoms (heartburn, acid reflux, chest pain, abdominal pain) and medication for "stomach" symptoms. These two models were validated in the independent cohort with AUCs of 0.61 (95%CI: 0.54-0.68) and 0.64 (95%CI: 0.52-0.77) for CLE and IM ≥ 2 cm, respectively. We have identified and validated two prediction models for CLE and IM ≥ 2 cm. Both models have fair prediction accuracies and can select out around 20% of individuals unlikely to benefit from investigation for Barrett's esophagus. Such prediction models have the potential to generate useful cost-savings for BE screening among the symptomatic population.

  5. 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

  6. 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.

  7. 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.

  8. 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

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

    NARCIS (Netherlands)

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

    2013-01-01

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

  10. 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

  11. 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

  12. Pancreas and cyst segmentation

    Science.gov (United States)

    Dmitriev, Konstantin; Gutenko, Ievgeniia; Nadeem, Saad; Kaufman, Arie

    2016-03-01

    Accurate segmentation of abdominal organs from medical images is an essential part of surgical planning and computer-aided disease diagnosis. Many existing algorithms are specialized for the segmentation of healthy organs. Cystic pancreas segmentation is especially challenging due to its low contrast boundaries, variability in shape, location and the stage of the pancreatic cancer. We present a semi-automatic segmentation algorithm for pancreata with cysts. In contrast to existing automatic segmentation approaches for healthy pancreas segmentation which are amenable to atlas/statistical shape approaches, a pancreas with cysts can have even higher variability with respect to the shape of the pancreas due to the size and shape of the cyst(s). Hence, fine results are better attained with semi-automatic steerable approaches. We use a novel combination of random walker and region growing approaches to delineate the boundaries of the pancreas and cysts with respective best Dice coefficients of 85.1% and 86.7%, and respective best volumetric overlap errors of 26.0% and 23.5%. Results show that the proposed algorithm for pancreas and pancreatic cyst segmentation is accurate and stable.

  13. Segmentation of consumer's markets and evaluation of market's segments

    OpenAIRE

    ŠVECOVÁ, Iveta

    2013-01-01

    The goal of this bachelor thesis was to explain a possibly segmentation of consumer´s markets for a chosen company, and to present a suitable goods offer, so it would be suitable to the needs of selected segments. The work is divided into theoretical and practical part. First part describes marketing, segmentation, segmentation of consumer's markets, consumer's market, market's segments a other terms. Second part describes an evaluation of questionnaire survey, discovering of market's segment...

  14. 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.

  15. 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.

  16. 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.

  17. 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.

  18. 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.

  19. 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

  20. [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.

  1. 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

  2. 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

  3. 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....

  4. Segmental tuberculosis verrucosa cutis

    Directory of Open Access Journals (Sweden)

    Hanumanthappa H

    1994-01-01

    Full Text Available A case of segmental Tuberculosis Verrucosa Cutis is reported in 10 year old boy. The condition was resembling the ascending lymphangitic type of sporotrichosis. The lesions cleared on treatment with INH 150 mg daily for 6 months.

  5. Chromosome condensation and segmentation

    International Nuclear Information System (INIS)

    Viegas-Pequignot, E.M.

    1981-01-01

    Some aspects of chromosome condensation in mammalians -humans especially- were studied by means of cytogenetic techniques of chromosome banding. Two further approaches were adopted: a study of normal condensation as early as prophase, and an analysis of chromosome segmentation induced by physical (temperature and γ-rays) or chemical agents (base analogues, antibiotics, ...) in order to show out the factors liable to affect condensation. Here 'segmentation' means an abnormal chromosome condensation appearing systematically and being reproducible. The study of normal condensation was made possible by the development of a technique based on cell synchronization by thymidine and giving prophasic and prometaphasic cells. Besides, the possibility of inducing R-banding segmentations on these cells by BrdU (5-bromodeoxyuridine) allowed a much finer analysis of karyotypes. Another technique was developed using 5-ACR (5-azacytidine), it allowed to induce a segmentation similar to the one obtained using BrdU and identify heterochromatic areas rich in G-C bases pairs [fr

  6. International EUREKA: Initialization Segment

    International Nuclear Information System (INIS)

    1982-02-01

    The Initialization Segment creates the starting description of the uranium market. The starting description includes the international boundaries of trade, the geologic provinces, resources, reserves, production, uranium demand forecasts, and existing market transactions. The Initialization Segment is designed to accept information of various degrees of detail, depending on what is known about each region. It must transform this information into a specific data structure required by the Market Segment of the model, filling in gaps in the information through a predetermined sequence of defaults and built in assumptions. A principal function of the Initialization Segment is to create diagnostic messages indicating any inconsistencies in data and explaining which assumptions were used to organize the data base. This permits the user to manipulate the data base until such time the user is satisfied that all the assumptions used are reasonable and that any inconsistencies are resolved in a satisfactory manner

  7. 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

  8. Fluence map segmentation

    International Nuclear Information System (INIS)

    Rosenwald, J.-C.

    2008-01-01

    The lecture addressed the following topics: 'Interpreting' the fluence map; The sequencer; Reasons for difference between desired and actual fluence map; Principle of 'Step and Shoot' segmentation; Large number of solutions for given fluence map; Optimizing 'step and shoot' segmentation; The interdigitation constraint; Main algorithms; Conclusions on segmentation algorithms (static mode); Optimizing intensity levels and monitor units; Sliding window sequencing; Synchronization to avoid the tongue-and-groove effect; Accounting for physical characteristics of MLC; Importance of corrections for leaf transmission and offset; Accounting for MLC mechanical constraints; The 'complexity' factor; Incorporating the sequencing into optimization algorithm; Data transfer to the treatment machine; Interface between R and V and accelerator; and Conclusions on fluence map segmentation (Segmentation is part of the overall inverse planning procedure; 'Step and Shoot' and 'Dynamic' options are available for most TPS (depending on accelerator model; The segmentation phase tends to come into the optimization loop; The physical characteristics of the MLC have a large influence on final dose distribution; The IMRT plans (MU and relative dose distribution) must be carefully validated). (P.A.)

  9. Gamifying Video Object Segmentation.

    Science.gov (United States)

    Spampinato, Concetto; Palazzo, Simone; Giordano, Daniela

    2017-10-01

    Video object segmentation can be considered as one of the most challenging computer vision problems. Indeed, so far, no existing solution is able to effectively deal with the peculiarities of real-world videos, especially in cases of articulated motion and object occlusions; limitations that appear more evident when we compare the performance of automated methods with the human one. However, manually segmenting objects in videos is largely impractical as it requires a lot of time and concentration. To address this problem, in this paper we propose an interactive video object segmentation method, which exploits, on one hand, the capability of humans to identify correctly objects in visual scenes, and on the other hand, the collective human brainpower to solve challenging and large-scale tasks. In particular, our method relies on a game with a purpose to collect human inputs on object locations, followed by an accurate segmentation phase achieved by optimizing an energy function encoding spatial and temporal constraints between object regions as well as human-provided location priors. Performance analysis carried out on complex video benchmarks, and exploiting data provided by over 60 users, demonstrated that our method shows a better trade-off between annotation times and segmentation accuracy than interactive video annotation and automated video object segmentation approaches.

  10. Strategic market segmentation

    Directory of Open Access Journals (Sweden)

    Maričić Branko R.

    2015-01-01

    Full Text Available Strategic planning of marketing activities is the basis of business success in modern business environment. Customers are not homogenous in their preferences and expectations. Formulating an adequate marketing strategy, focused on realization of company's strategic objectives, requires segmented approach to the market that appreciates differences in expectations and preferences of customers. One of significant activities in strategic planning of marketing activities is market segmentation. Strategic planning imposes a need to plan marketing activities according to strategically important segments on the long term basis. At the same time, there is a need to revise and adapt marketing activities on the short term basis. There are number of criteria based on which market segmentation is performed. The paper will consider effectiveness and efficiency of different market segmentation criteria based on empirical research of customer expectations and preferences. The analysis will include traditional criteria and criteria based on behavioral model. The research implications will be analyzed from the perspective of selection of the most adequate market segmentation criteria in strategic planning of marketing activities.

  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. Segmented block copolymers with monodisperse aramide end-segments

    NARCIS (Netherlands)

    Araichimani, A.; Gaymans, R.J.

    2008-01-01

    Segmented block copolymers were synthesized using monodisperse diaramide (TT) as hard segments and PTMO with a molecular weight of 2 900 g · mol-1 as soft segments. The aramide: PTMO segment ratio was increased from 1:1 to 2:1 thereby changing the structure from a high molecular weight multi-block

  18. [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.

  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.

  1. Predictors of low compliance with treatment in the patients with gastro-esophageal reflux disease

    Directory of Open Access Journals (Sweden)

    S. V. Tikhonov

    2013-01-01

    Full Text Available Gastroesophageal reflux disease is a widespread pathology requiring a long-term initial and maintaining therapy. Identification of the risk factors of low compliance of the patient with the treatment of the gastroesophageal reflux disease may be helpful in optimization of the patient - the doctor contact and thus may improve the compliance. The paper describes the predictors of low compliance that may be disclosed in the period of primary contact with the patients with gastroesophagial reflux pathology.

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

    Science.gov (United States)

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

    2015-02-01

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

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

    Science.gov (United States)

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

    2011-01-01

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

  4. 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

  5. Foods Inducing Typical Gastroesophageal Reflux Disease Symptoms in Korea

    OpenAIRE

    Choe, Jung Wan; Joo, Moon Kyung; Kim, Hyo Jung; Lee, Beom Jae; Kim, Ji Hoon; Yeon, Jong Eun; Park, Jong-Jae; Kim, Jae Seon; Byun, Kwan Soo; Bak, Young-Tae

    2017-01-01

    Background/Aims Several specific foods are known to precipitate gastroesophageal reflux disease (GERD) symptoms and GERD patients are usually advised to avoid such foods. However, foods consumed daily are quite variable according to regions, cultures, etc. This study was done to elucidate the food items which induce typical GERD symptoms in Korean patients. Methods One hundred and twenty-six Korean patients with weekly typical GERD symptoms were asked to mark all food items that induced typic...

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

    Science.gov (United States)

    Ferreira, Cristina Targa; Carvalho, Elisa de; Sdepanian, Vera Lucia; Morais, Mauro Batista de; Vieira, Mário César; Silva, Luciana Rodrigues

    2014-01-01

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

  7. Gastroesophageal reflux in infants: How much imaging is necessary

    International Nuclear Information System (INIS)

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

    1987-01-01

    Because of the current emphasis on gastroesophageal reflux in infants, overimaging is common. This occurs because of lack of proper patient selection and categorization and because of overemphasis on complications such as esophagitis, stricture, and the like. Asking the question, ''What are we looking for in each patient?'', the authors present a scheme they believe to be efficient and cost effective. In most patients, only one imaging procedure is required

  8. Dyspepsia and gastroesophageal reflux disease (GERD): is there any correlation?

    Science.gov (United States)

    Simadibrata, Marcellus

    2009-10-01

    Dyspepsia is a syndrome characterized by symptoms and signs of upper gastrointestinal tract and the adjacent organs. It is estimated that 25% of the community have symptoms of dyspepsia syndrome. One-third of patients who visit general physician practices are patients with dyspepsia syndrome; and half of patients who visit gastroenterologists are also patients with dyspepsia syndrome. Dyspepsia syndrome and gastroesophageal reflux disease (GERD) are very prevalent in the community throughout the world.Gastroesophageal reflux disease (GERD) is more and more commonly found in daily medical practice. Until now,the natural history of disease on GERD and dyspepsia is hardly understood, even though many scientists studied both conditions and there are frequently overlapping. In an individual, GERD and dyspepsia may occur simultaneously and therefore they are hardly to be discriminated.The management of GERD is performed in keeping with Indonesia and Asia Pacific consensus, life-style modification and administering the acid suppression agents (Proton pump inhibitor (drug of choice), H2-receptor antagonist, etc),prokinetic agents (Cisapride, domperidone, etc). Life-style modification shall be performed as follows, i.e. sleep with 30-45 degree elevated head or upper chest, do not avoid sour beverages, chocolate, coffee or alcohol, avoid fat and various fried foods, sour food, less stress, stop smoking, small but frequent feeding, etc. There is a correlation between dyspepsia syndrome and gastroesophageal reflux disease(GERD), particularly between the functional dyspepsia and non-erosive gastroesophageal reflux (NERD). More appropriate definition is necessary to differentiate the dyspepsia syndrome and GERD. Further studies are needed to establish distinct definition and criteria between dyspepsia syndrome and GERD.

  9. [Differentiation therapy for non-acidic gastroesophageal reflux disease].

    Science.gov (United States)

    Lishchuk, N B; Simanenkov, V I; Tikhonov, S V

    2017-01-01

    To investigate the clinical and pathogenetic features of the non-acidic types of gastroesophageal reflux disease (GERD) and to evaluate the impact of combined therapy versus monotherapy on the course of this disease. The investigation enrolled 62 patients with non-acidic GERD. The follow-up period was 6 weeks. The patients were divided into 2 groups: 1) weakly acidic gastroesophageal refluxes (GER); 2) weakly alkaline GER. Then each group was distributed, thus making up 4 groups: 1) 19 patients with weakly acidic GER who received monotherapy with rabeprazole 20 mg/day; 2) 21 patients with weakly acidic GER had combined therapy with rabeprazole 20 mg and itopride; 3) 8 patients with weakly alkaline GER who received ursodeoxycholic acid (UDCA) monotherapy; and 4) 14 patients with weakly alkaline GER who had combined therapy with UDCA and itopride, The clinical symptoms of the disease, the endoscopic pattern of the upper gastrointestinal tract (GIT) mucosa, histological changes in the esophageal and gastric mucosa, and the results of 24-hour impedance pH monitoring were assessed over time. During differentiation therapy, the majority of patients reported positive clinical changes and an improved or unchanged endoscopic pattern. Assessment of impedance pH monitoring results revealed decreases in the overall number of GERs, the presence of a bolus in the esophagus, and the number of proximal refluxes. These changes were noted not only in patients taking proton pump inhibitors (PPIs), but also in those treated with UDCA monotherapy or combined PPI and prokinetic therapy. A differentiated approach to non-acidic GER treatment contributes to its efficiency. Adding the prokinetic itomed (itopride hydrochloride) to PPI therapy in a patient with weakly acidic GER enhances the efficiency of treatment, by positively affecting upper GIT motility. The mainstay of therapy for GERD with a predominance of weakly alkaline refluxes is UDCA, the combination of the latter and the

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

    International Nuclear Information System (INIS)

    Boult, K.A.

    1979-10-01

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

  11. Evaluation of the Dental Effects of Laryngopharyngeal Reflux

    Science.gov (United States)

    2015-03-01

    relationship between GERD symptoms and obesity with associated increased body mass index, waist circumference and weight gain (Corley & Kubo , 2006; Hampel...literature shows a definite relationship between increased body mass index and GERD symptoms {Corley & Kubo , 2006; Hampel, Abraham, & El-Se rag, 2005). Of...Gastroenterology & Hepatology, 25(7), 764- 771. Corley, D., & Kubo , A. {2006 ). Body mass index and gastroesophageal reflux disease: a systematic review

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2006-07-15

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

  13. Rediscovering market segmentation.

    Science.gov (United States)

    Yankelovich, Daniel; Meer, David

    2006-02-01

    In 1964, Daniel Yankelovich introduced in the pages of HBR the concept of nondemographic segmentation, by which he meant the classification of consumers according to criteria other than age, residence, income, and such. The predictive power of marketing studies based on demographics was no longer strong enough to serve as a basis for marketing strategy, he argued. Buying patterns had become far better guides to consumers' future purchases. In addition, properly constructed nondemographic segmentations could help companies determine which products to develop, which distribution channels to sell them in, how much to charge for them, and how to advertise them. But more than 40 years later, nondemographic segmentation has become just as unenlightening as demographic segmentation had been. Today, the technique is used almost exclusively to fulfill the needs of advertising, which it serves mainly by populating commercials with characters that viewers can identify with. It is true that psychographic types like "High-Tech Harry" and "Joe Six-Pack" may capture some truth about real people's lifestyles, attitudes, self-image, and aspirations. But they are no better than demographics at predicting purchase behavior. Thus they give corporate decision makers very little idea of how to keep customers or capture new ones. Now, Daniel Yankelovich returns to these pages, with consultant David Meer, to argue the case for a broad view of nondemographic segmentation. They describe the elements of a smart segmentation strategy, explaining how segmentations meant to strengthen brand identity differ from those capable of telling a company which markets it should enter and what goods to make. And they introduce their "gravity of decision spectrum", a tool that focuses on the form of consumer behavior that should be of the greatest interest to marketers--the importance that consumers place on a product or product category.

  14. Diagnosis and treatment of gastroesophageal reflux disease complicated by Barrett's esophagus.

    Science.gov (United States)

    Stasyshyn, Andriy

    2017-08-31

    The aim of the study was to evaluate the effectiveness of a diagnostic and therapeutic algorithm for gastroesophageal reflux disease complicated by Barrett's esophagus in 46 patients. A diagnostic and therapeutic algorithm for complicated GERD was developed. To describe the changes in the esophagus with reflux esophagitis, the Los Angeles classification was used. Intestinal metaplasia of the epithelium in the lower third of the esophagus was assessed using videoendoscopy, chromoscopy, and biopsy. Quality of life was assessed with the Gastro-Intestinal Quality of Life Index. The used methods were modeling, clinical, analytical, comparative, standardized, and questionnaire-based. Results and their discussion. Among the complications of GERD, Barrett's esophagus was diagnosed in 9 (19.6 %), peptic ulcer in the esophagus in 10 (21.7 %), peptic stricture of the esophagus in 4 (8.7 %), esophageal-gastric bleeding in 23 (50.0 %), including Malory-Weiss syndrome in 18, and erosive ulcerous bleeding in 5 people. Hiatal hernia was diagnosed in 171 (87.7 %) patients (sliding in 157 (91.8%), paraesophageal hernia in 2 (1.2%), and mixed hernia in 12 (7.0%) cases). One hundred ninety-five patients underwent laparoscopic surgery. Nissen fundoplication was conducted in 176 (90.2%) patients, Toupet fundoplication in 14 (7.2%), and Dor fundoplication in 5 (2.6%). It was established that the use of the diagnostic and treatment algorithm promoted systematization and objectification of changes in complicated GERD, contributed to early diagnosis, helped in choosing treatment, and improved quality of life. Argon coagulation and use of PPIs for 8-12 weeks before surgery led to the regeneration of the mucous membrane in the esophagus. The developed diagnostic and therapeutic algorithm facilitated systematization and objectification of changes in complicated GERD, contributed to early diagnosis, helped in choosing treatment, and improved quality of life.

  15. Sodium reflux pool-boiler solar receiver on-sun test results

    Energy Technology Data Exchange (ETDEWEB)

    Andraka, C E; Moreno, J B; Diver, R B; Moss, T A [Oak Ridge National Lab., TN (United States)

    1992-06-01

    The efficient operation of a Stirling engine requires the application of a high heat flux to the relatively small area occupied by the heater head tubes. Previous attempts to couple solar energy to Stirling engines generally involved directly illuminating the heater head tubes with concentrated sunlight. In this study, operation of a 75-kW{sub t} sodium reflux pool-boiler solar receiver has been demonstrated and its performance characterized on Sandia's nominal 75-kW{sub t} parabolic-dish concentrator, using a cold-water gas-gap calorimeter to simulate Stirling engine operation. The pool boiler (and more generally liquid-metal reflux receivers) supplies heat to the engine in the form of latent heat released from condensation of the metal vapor on the heater head tubes. The advantages of the pool boiler include uniform tube temperature, leading to longer life and higher temperature available to the engine, and decoupling of the design of the solar absorber from the engine heater head. The two-phase system allows high input thermal flux, reducing the receiver size and losses, therefore improving system efficiency. The receiver thermal efficiency was about 90% when operated at full power and 800{degree}C. Stable sodium boiling was promoted by the addition of 35 equally spaced artificial cavities in the wetted absorber surface. High incipient boiling superheats following cloud transients were suppressed passively by the addition of small amounts of xenon gas to the receiver volume. Stable boiling without excessive incipient boiling superheats was observed under all operating conditions. The receiver developed a leak during performance evaluation, terminating the testing after accumulating about 50 hours on sun. The receiver design is reported here along with test results including transient operations, steady-state performance evaluation, operation at various temperatures, infrared thermography, x-ray studies of the boiling behavior, and a postmortem analysis.

  16. PSYCHOSOMATIC ASPECTS IN THE TREATMENT OF GASTROESOPHAGEAL REFLUX DISEASE

    Directory of Open Access Journals (Sweden)

    V. I. Trofimov

    2015-01-01

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

  17. Current status of gastroesophageal reflux disease : diagnosis and treatment.

    Science.gov (United States)

    Chuang, Tang-Wei; Chen, Shou-Chien; Chen, Kow-Tong

    2017-01-01

    The aim of this study was to explore the recent advances in diagnosis and treatment of gastroesophageal reflux disease (GERD). Previous studies were searched using the terms "gastroesophageal reflux disease" and "diagnosis" or "treatment" in Medline and Pubmed. Articles that were not published in the English language, manuscripts without an abstract, reviews, meta-analysis, and opinion articles were excluded from the review. After a preliminary screening, all of the articles were reviewed and synthesized to provide an overview of the contemporary approaches to GERD. GERD has a variety of symptomatic manifestations, 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 other alarming symptoms, these symptoms allow one to make a presumptive diagnosis of GERD and initiate empiric therapy. GERD-associated complications include erosive esophagitis, peptic stricture, Barrett's esophagus, esophageal adenocarcinoma and pulmonary disease. Management of GERD may involve lifestyle modifications, medical and surgical therapy. 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 management of this disease requires a complex approach. Maintenance therapy of GERD after using anti-secretory drugs should be continuously monitored. © Acta Gastro-Enterologica Belgica.

  18. Peroral endoscopic cardial constriction in gastroesophageal reflux disease.

    Science.gov (United States)

    Hu, Hai-Qing; Li, Hui-Kai; Xiong, Ying; Zhang, Xiao-Bin; Zhi, Jun-Li; Wang, Xiao-Xiao; Ling-Hu, En-Qiang

    2018-04-01

    Gastroesophageal reflux disease (GERD) is a major digestive health problem with a high and increasing incidence worldwide. Peroral endoscopic cardial constriction (PECC) was developed by our group to provide a less invasive treatment for GERD.In this preliminary follow-up study, 16 patients were enrolled and 13 patients with GERD were targeted for analysis according to the Los Angeles classification of reflux esophagitis. The GERD health-related quality of life (GERD-HRQL) scale and esophageal pH monitoring were applied to assess clinical efficiency at 3 and 6 months after PECC treatment, respectively.All GERD patients successively received PECC, and no severe treatment-related complication was reported. Before PECC treatment, the GERD-HRQL scale was 19.92 ± 7.89. At 3 and 6 months after treatment, the GERD-HRQL scale was 4.46 ± 4.31 and 5.69 ± 5.07, respectively. DeMeester score was 125.50 ± 89.64 before PECC treatment, and 16.97 ± 12.76 and 20.32 ± 15.22 at 3 and 6 months after PECC treatment. Furthermore, the fraction time of a pH below 4 significantly decreased at 3 and 6 months after PECC treatment. Fraction time at pH reflux of stomach contents.

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

    Science.gov (United States)

    Naik, Rishi D; Vaezi, Michael F

    2017-06-01

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

  20. Impact of obesity treatment on gastroesophageal reflux disease.

    Science.gov (United States)

    Khan, Abraham; Kim, Aram; Sanossian, Cassandra; Francois, Fritz

    2016-01-28

    Gastroesophageal reflux disease (GERD) is a frequently encountered disorder. Obesity is an important risk factor for GERD, and there are several pathophysiologic mechanisms linking the two conditions. For obese patients with GERD, much of the treatment effort is focused on weight loss and its consistent benefit to symptoms, while there is a relative lack of evidence regarding outcomes after novel or even standard medical therapy is offered to this population. Physicians are hesitant to recommend operative anti-reflux therapy to obese patients due to the potentially higher risks and decreased efficacy, and these patients instead are often considered for bariatric surgery. Bariatric surgical approaches are broadening, and each technique has emerging evidence regarding its effect on both the risk and outcome of GERD. Furthermore, combined anti-reflux and bariatric options are now being offered to obese patients with GERD. However, currently Roux-en-Y gastric bypass remains the most effective surgical treatment option in this population, due to its consistent benefits in both weight loss and GERD itself. This article aims to review the impact of both conservative and aggressive approaches of obesity treatment on GERD.

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

    Science.gov (United States)

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

    2008-05-01

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

  2. 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.

  3. Epidemiology and natural history of gastro-oesophageal reflux disease.

    Science.gov (United States)

    Spechler, S J

    1992-01-01

    Epidemiological studies of gastro-oesophageal reflux disease (GORD) are confounded by the lack of a standardized definition and a diagnostic 'gold-standard' for the disorder. In Western countries, 20-40% of the adult population experience heartburn, which is the cardinal symptom of GORD, but only some 2% of adults have objective evidence of reflux oesophagitis. The incidence of GORD increases with age, rising dramatically after 40 years of age. There is also wide geographical variation in prevalence. Complications, including oesophageal ulcer and stricture, and Barrett's oesophagus, are found in up to 20% of patients with verified reflux oesophagitis. The signs and symptoms of GORD often wax and wane in intensity, and spontaneous remissions have been reported. In most cases, however, GORD is a chronic condition that returns shortly after discontinuing therapy. Although GORD causes substantial morbidity, the annual mortality rate due to GORD is very low (approximately 1 death per 100,000 patients), and even severe GORD has no apparent effect on longevity, although the quality of life can be significantly impaired. There are data to suggest that the use of non-steroidal anti-inflammatory drugs (NSAIDs) contributes to oesophagitis and stricture formation in patients with GORD. Although these data are not conclusive, it seems prudent, if possible, to avoid the use of NSAIDs in patients with GORD, particularly those with oesophageal stricture.

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

    Science.gov (United States)

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

    2017-02-01

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

  5. Does surgery correct esophageal motor dysfunction in gastroesophageal reflux

    International Nuclear Information System (INIS)

    Russell, C.O.; Pope, C.E.; Gannan, R.M.; Allen, F.D.; Velasco, N.; Hill, L.D.

    1981-01-01

    The high incidence of dysphagia in patients with symptomatic gastroesophageal reflux (GER) but no evidence of peptic stricture suggests esophageal motor dysfunction. Conventional methods for detecting dysfunction (radiologic and manometric examinations) often fail to detect abnormality in these patients. Radionuclide transit (RT), a new method for detecting esophageal motor dysfunction, was used to prospectively assess function in 29 patients with symptomatic GER uncomplicated by stricture before and three months after antireflux surgery (HILL). The preoperative incidence of dysphagia and esophageal dysfunction was 73% and 52%, respectively. During operation (Hill repair), intraoperative measurement of the lower esophageal sphincter pressure was performed and the LESP raised to levels between 45 and 55 mmHg. The preoperative lower esophageal sphincter pressure was raised from a mean of 8.6 mmHg, to mean of 18.5 mmHg after operation. No patient has free reflux after operation. Postoperative studies on 20 patients demonstrated persistence of all preoperative esophageal dysfunction despite loss of dysphagia. RT has demonstrated a disorder of esophageal motor function in 52% of patients with symptomatic GER that may be responsible for impaired esophageal clearance. This abnormality is not contraindication to surgery. The results indicate that construction of an effective barrier to reflex corrects symptoms of reflux, even in the presence of impaired esophageal transit. Radionuclide transit is a safe noninvasive test for assessment of esophageal function

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

    Science.gov (United States)

    Cengiz, Seda; Cengiz, M Inanç; Saraç, Y Sinasi

    2009-07-22

    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. 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. The vertical dimension was re-established and maxillary and mandibular anterior and posterior teeth were prepared for metal-ceramic restorations. Metal-ceramic fixed partial dentures were fabricated as full mouth restorations for both maxillary and mandibular arches because of splinting all teeth. And then maxillary stabilization splint was fabricated for his bruxism history. Significant loss of coronal tooth structure must taken into consideration. Gastroesophageal reflux disease by itself or in combination with attrition, abrasion or bruxism may be responsible for the loss. An extensive diagnostic evaluation is essential for the medical and dental effects of the problem.

  7. Detection of Vesico-Ureteric Reflux Using Voiding Hippuran Ureterograms

    Energy Technology Data Exchange (ETDEWEB)

    Sutherland, J. B.; Palser, R. [Section of Nuclear Medicine, Manitoba Cancer Treatment and Research Foundation, Winnipeg General Hospital, Winnipeg (Canada); Macpherson, R. I. [Children' s Hospital of Winnipeg, Winnipeg (Canada)

    1971-02-15

    Initial results of a technique for the demonstration of vesico-ureteric reflux in children are described. Hippuran-{sup 131}I (15 {mu}Ci) (ortho-iodohippurate) is injected intravenously. A standard renogram is obtained. Additional collimation is added to the recording probes and they are positioned to record the radioactivity from the mid-ureteric region. Recordings of normal and abnormal peristaltic activity during per-ora hydration of the patient are thus obtained. When the child is willing to void, he is placed upright on a bed pan, the probes positioned to record over the lower ureteric region and recordings are made while the child voids. All data are recorded on a 512-channel analyser operated in the multi-scaler node. Data are punched out on paper tape and, after an 11 point computer smoothing program, are displayed graphically. These recordings show different patterns in normal children and those with vesico-ureteric reflux. There are several advantages to this technique over the standard radiological and other radionuclide voiding cystoureterograms. The results are compared with contrast voiding cystourethrograms in both normal children and those with vesico-ureteric reflux. (author)

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

    Science.gov (United States)

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

    2013-06-01

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

  9. Does surgery correct esophageal motor dysfunction in gastroesophageal reflux

    Energy Technology Data Exchange (ETDEWEB)

    Russell, C.O.; Pope, C.E.; Gannan, R.M.; Allen, F.D.; Velasco, N.; Hill, L.D.

    1981-09-01

    The high incidence of dysphagia in patients with symptomatic gastroesophageal reflux (GER) but no evidence of peptic stricture suggests esophageal motor dysfunction. Conventional methods for detecting dysfunction (radiologic and manometric examinations) often fail to detect abnormality in these patients. Radionuclide transit (RT), a new method for detecting esophageal motor dysfunction, was used to prospectively assess function in 29 patients with symptomatic GER uncomplicated by stricture before and three months after antireflux surgery (HILL). The preoperative incidence of dysphagia and esophageal dysfunction was 73% and 52%, respectively. During operation (Hill repair), intraoperative measurement of the lower esophageal sphincter pressure was performed and the LESP raised to levels between 45 and 55 mmHg. The preoperative lower esophageal sphincter pressure was raised from a mean of 8.6 mmHg, to mean of 18.5 mmHg after operation. No patient has free reflux after operation. Postoperative studies on 20 patients demonstrated persistence of all preoperative esophageal dysfunction despite loss of dysphagia. RT has demonstrated a disorder of esophageal motor function in 52% of patients with symptomatic GER that may be responsible for impaired esophageal clearance. This abnormality is not contraindication to surgery. The results indicate that construction of an effective barrier to reflex corrects symptoms of reflux, even in the presence of impaired esophageal transit. Radionuclide transit is a safe noninvasive test for assessment of esophageal function.

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

    Science.gov (United States)

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

    2015-12-01

    Gastroesophageal reflux disease (GERD) frequently occurs in association with chronic respiratory diseases although the casual link is not always clear. Several pathophysiological and experimental factors are considered to support a role for GERD in respiratory disease. Conversely, respiratory diseases and bronchodilator treatment can themselves exacerbate GERD. When cough or severe asthma is being investigated, GERD does not need to be systematically looked for and a therapeutic test with proton pump inhibitors is not always recommended. pH impedance monitoring is now the reference diagnostic tool to detect non acid reflux, a form of reflux for which proton pump inhibitor treatment is ineffective. Recent data have shown a potential role of GERD in idiopathic pulmonary fibrosis and bronchiolitis obliterans following lung transplantation, leading to discussions about the place of surgery in this context. However, studies using pH impedance monitoring are still needed to better understand and manage the association between GERD and chronic respiratory diseases. Copyright © 2015 SPLF. Published by Elsevier Masson SAS. All rights reserved.

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

    Science.gov (United States)

    Chesney, Russell W; Patters, Andrea B

    2013-12-01

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

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

    Science.gov (United States)

    Iskit, Serdar H; Ozçelik, Zerrin; Alkan, Murat; Türker, Selcan; Zorludemir, Unal

    2014-06-01

    Gastro-oesophageal reflux may accompany the corrosive oesophageal damage caused by the ingestion of corrosive substances and affect its treatment. The factors that affect the development of reflux in these cases and their effects on treatment still remain unclear. Our aim is to investigate the prevalence of gastro-oesophageal reflux in children with corrosive oesophageal strictures, the risk factors affecting this prevalence and the effects of gastro-oesophageal reflux on treatment. Case-control study. We enrolled 52 patients with oesophageal stricture due to corrosive substance ingestion who were referred to our clinic between 2003 and 2010. Groups, which were determined according to the presence of gastro-oesophageal reflux (GER), were compared with each other in terms of clinical findings, results of examination methods, characteristics of the stricture and success of the treatment. The total number of patients in our study was 52; 30 of them were male and 22 of them were female. The mean age of our study population was 4.2±2.88 years. Thirty-three patients had gastrooesophageal reflux (63.5%). Patients who had strictures caused by the ingestion of alkali substances were 1.6-times more likely to have reflux. There were no differences between patients with or without reflux in terms of number and localisation of strictures. Mean distance of stricture was longer in patients with reflux (3.7±1.8 cm) than in patients without (2.2±1.0 cm) (preflux. Patients with long stricture were 1.9-times more likely to have reflux. Dilatation treatment was successful in 69.6% of patients with reflux and in 78.9% of patients without. The mean treatment period was 8.41±6.1 months in patients with reflux and 8.21±8.4 months in the other group. There was no significant difference between groups in terms of frequency of dilatation and dilator diameters (p>0.05). Corrosive oesophageal stricture was usually accompanied by gastro-oesophageal reflux and the length of stricture is an

  13. [Proton pump inhibitors in gastro-oesophageal reflux disease: what is the further step?].

    Science.gov (United States)

    Simon, Mireille; Zerbib, Frank

    2013-01-01

    Optimisation of proton pump inhibitors use may improve reflux symptoms in 20-25% of the patients. Pathological gastro-oesophageal reflux should be documented in a patient with refractory reflux symptoms using upper endoscopy and/or pH testing. While on proton pump inhibitors twice daily, persistent symptoms are not related to gastro-oesophageal refluxdisease(GERD) in 50% of the patients. The new anti-reflux compounds have yet a limited efficacy and side effects that currently limit their development. Copyright © 2012. Published by Elsevier Masson SAS.

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

    Science.gov (United States)

    2013-01-01

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

  15. Water syphon test and gastrooesophageal reflux during childhood (correlation with the clinical findings and oesophageal manometry)

    Energy Technology Data Exchange (ETDEWEB)

    Fotter, R.; Hoellwarth, M.

    1981-07-01

    The water syphon test is a simple and easily performed method for demonstrating gastro-oesophageal reflux with a high degree of reliability. It is carried out following a conventional barium swallow. Compared with clinical findings and oesophageal manometry, the water syphon test is very reliable for demonstrating gastro-oesophageal reflux during childhood. Prolonged irradiation in order to see spontaneous reflux becomes unnecessary. This results in a significant reduction in radiation dose. Barium swallow and the water syphon test are the most useful initial examinations in children with symptoms which suggest reflux.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2016-06-15

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

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

    International Nuclear Information System (INIS)

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

    2003-01-01

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

  18. The association between gastroesophageal flap valve function and gastroesophageal reflux symptoms.

    Science.gov (United States)

    Keskin, O; Kalkan, Ç; Yaman, A; Tüzün, A; Soykan, I

    2017-01-01

    Upper gastrointestinal endoscopic examination is usually the first step in the evaluation of patients with suspected gastroesopageal reflux disease. The primary aim of this study was to investigate the association between gastroesophageal flap valve function (GEFV) and gastroesophapgeal reflux symptoms in patients undergoing routine upper endoscopy. Patients and methods: 1507 patients were included into the study and the GEFV graded I to IV as follows: Hill I-II: normal GEFV, and Hill III-IV: abnormal GEFV. Patients in abnormal GEFV group had a higher incidence of reflux symptoms compared to normal GEFV group (53.4% vs 47.4% for heartburn p=0.03 and 53.2% vs 42.4% for regurgitation, preflux symptoms were in abnormal GEFV group. In patients undergoing endoscopy because of reflux symptoms, Grade III-IV valve was detected more commonly in patients with reflux symptoms compared to patients without reflux symptoms (p = 0.01). Patients with abnormal valves (Hill grades III and IV) but without reflux symptoms, esophagitis and hiatal hernia should be evaluated individually by means of the presence of gastroesophageal reflux disease which means that GEFV is not a good indicator of reflux disease. © Acta Gastro-Enterologica Belgica.

  19. How to differentiate non-erosive reflux disease from functional heartburn.

    Science.gov (United States)

    Ke, Mei Yun

    2012-12-01

    Heartburn is a common symptom in gastroesophageal reflux disease. Endoscopic examination can differentiate between reflux esophagitis and non-erosive reflux disease (NERD), but not between NERD and functional heartburn. With the development of new techniques, more NERD patients could be identified among those previously diagnosed with functional heartburn. Most patients with NERD, however, could be identified based on their clinical characteristics and response to proton pump inhibitors and/or integrated anti-gastroesophageal reflux therapy. © 2012 The Author. Journal of Digestive Diseases © 2012 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and Wiley Publishing Asia Pty Ltd.

  20. APPLICATION OF AMINO ACID MIXTURE AGAINST ESOPHAGEAL REFLUX IN CHILDREN WITH COW MILK ALLERGY

    Directory of Open Access Journals (Sweden)

    E.A. Vishneva

    2008-01-01

    Full Text Available The esophageal reflux is quite often accompanied by cow milk allergy in infants. For that matter, the authors recommend to examin all infants with esophageal reflux to be sure if they have allergy or not. The authors represent diagnostic methods for both disorders. Besides the authors represent the results of the research work on effectiveness of amino acid mix for cmatreatment which they used in patients with esophageal reflux.Key words: allergy to the protein of the cow milk, esophageal reflux, amino acid mixture, children.

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

    Energy Technology Data Exchange (ETDEWEB)

    Pan, John J.; Levine, Marc S. E-mail: levine@oasis.rad.upenn.edu; Redfern, Regina O.; Rubesin, Stephen E.; Laufer, Igor; Katzka, David A

    2003-08-01

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

  2. 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

  3. Impact of gastro-esophageal reflux on mucin mRNA expression in the esophageal mucosa.

    Science.gov (United States)

    van Roon, Aafke H C; Mayne, George C; Wijnhoven, Bas P L; Watson, David I; Leong, Mary P; Neijman, Gabriëlle E; Michael, Michael Z; McKay, Andrew R; Astill, David; Hussey, Damian J

    2008-08-01

    Changes in the expression of mucin genes in the esophageal mucosa associated with uncomplicated gastro-esophageal reflux disease have not been evaluated even though such changes could be associated with reflux-induced mucosal damage. We therefore sought to identify reflux-induced changes in mucin gene expression using a cell line and biopsies from the esophageal mucosa in patients with and without reflux. MUC-1, MUC-3, MUC-4, and MUC-5AC gene expressions were investigated in the HET-1A cell line following exposure to acid (pH 4) and/or bile (120 muM of a bile salt milieu), and in esophageal mucosal biopsies from controls, subjects with non-erosive gastro-esophageal reflux, and subjects with reflux associated with ulcerative esophagitis (erosive). The mucosal biopsies were also evaluated for IL-6 mRNA expression (inflammatory marker) and CK-14 mRNA expression (mucosal basal cell layer marker). Gene expression was determined using real-time reverse transcriptase-polymerase chain reaction analysis. In the cell line studies, there were differences in mRNA levels for all of the evaluated mucins following treatment with either acid or the acid and bile combination. In the studies which evaluated tissue specimens, IL-6 and CK-14 mRNA levels increased according to degree of reflux pathology. The expression of MUC-1 and MUC-4 in mucosa from patients with erosive reflux was lower than in subjects without reflux and in patients with non-erosive reflux, whereas the expression of MUC-3 and MUC-5AC was increased (although these differences did not reach significance at p reflux groups. The correlation between IL-6 and MUC-3 was significant within the control and erosive reflux groups, and the correlation between MUC-1 and MUC-5AC was significant within the erosive reflux group. The results of this study suggest that the profile of mucin expression in the esophageal mucosa is influenced by the pH and composition of the gastro-esophageal reflux. Further work should explore the

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

    Science.gov (United States)

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

    2010-05-01

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

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

    International Nuclear Information System (INIS)

    Kim, Jeong Woo; Lee, Chang Hee; Park, Yang Shin; Kim, Kyeong Ah; Park, Cheol Min; Yoo, Kee Hwan; Je, Bo-Kyung; Kiefer, Berthold

    2016-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Edward Surjono

    2016-10-01

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

  7. Scorpion image segmentation system

    Science.gov (United States)

    Joseph, E.; Aibinu, A. M.; Sadiq, B. A.; Bello Salau, H.; Salami, M. J. E.

    2013-12-01

    Death as a result of scorpion sting has been a major public health problem in developing countries. Despite the high rate of death as a result of scorpion sting, little report exists in literature of intelligent device and system for automatic detection of scorpion. This paper proposed a digital image processing approach based on the floresencing characteristics of Scorpion under Ultra-violet (UV) light for automatic detection and identification of scorpion. The acquired UV-based images undergo pre-processing to equalize uneven illumination and colour space channel separation. The extracted channels are then segmented into two non-overlapping classes. It has been observed that simple thresholding of the green channel of the acquired RGB UV-based image is sufficient for segmenting Scorpion from other background components in the acquired image. Two approaches to image segmentation have also been proposed in this work, namely, the simple average segmentation technique and K-means image segmentation. The proposed algorithm has been tested on over 40 UV scorpion images obtained from different part of the world and results obtained show an average accuracy of 97.7% in correctly classifying the pixel into two non-overlapping clusters. The proposed 1system will eliminate the problem associated with some of the existing manual approaches presently in use for scorpion detection.

  8. Association of congenital megacalycosis and ipsilateral segmental megaureter

    International Nuclear Information System (INIS)

    Mandell, G.A.; Keller, M.; Kaplan, J.M.

    1987-01-01

    Four cases of congenital megacalycosis associated with ipsilateral segmental megaureter in children are presented. This association has not been emphasized, although review of the English and French literature revealed eight such cases. In al cases, the concurrent entities are unilateral, with a left-sided predominance and a male prevalence. The diagnosis of megacalycosis is resumed in four of the cases by normal function and prompt emptying of the calyceal systems on diuretic renography and/or urography. The presence of normal caliber renal pelvis interposed between the dilated collecting system and the distal dilated ureter without evidence of vesicoureteral reflux implies the coexistence of ipsilateral idiopathic megaureter. The patients usually present because of urinary tract infection and/or calculus formation, but respond well to conservative therapy. (orig.)

  9. Control of transient lower oesophageal sphincter relaxations and reflux by the GABAB agonist baclofen in patients with gastro-oesophageal reflux disease

    Science.gov (United States)

    Zhang, Q; Lehmann, A; Rigda, R; Dent, J; Holloway, R H

    2002-01-01

    Background and aims: Transient lower oesophageal sphincter relaxations (TLOSRs) are the major cause of gastro-oesophageal reflux in normal subjects and in most patients with reflux disease. The gamma aminobutyric acid (GABA) receptor type B agonist, baclofen, is a potent inhibitor of TLOSRs in normal subjects. The aim of this study was to investigate the effect of baclofen on TLOSRs and postprandial gastro-oesophageal reflux in patients with reflux disease. Methods: In 20 patients with reflux disease, oesophageal motility and pH were measured, with patients in the sitting position, for three hours after a 3000 kJ mixed nutrient meal. On separate days at least one week apart, 40 mg oral baclofen or placebo was given 90 minutes before the meal. Results: Baclofen reduced the rate of TLOSRs by 40% from 15 (13.8–18.3) to 9 (5.8–13.3) per three hours (preflux episodes by 43% from 7.0 (4.0–12.0) to 4.0 (1.5–9) per three hours (median (interquartile range); preflux disease, the GABAB agonist baclofen significantly inhibits gastro-oesophageal reflux episodes by inhibition of TLOSRs. These findings suggest that GABAB agonists may be useful as therapeutic agents for the management of reflux disease. PMID:11772961

  10. Ambulatory reflux monitoring for diagnosis of gastro-esophageal reflux disease: Update of the Porto consensus and recommendations from an international consensus group.

    Science.gov (United States)

    Roman, S; Gyawali, C P; Savarino, E; Yadlapati, R; Zerbib, F; Wu, J; Vela, M; Tutuian, R; Tatum, R; Sifrim, D; Keller, J; Fox, M; Pandolfino, J E; Bredenoord, A J

    2017-10-01

    An international group of experts evaluated and revised recommendations for ambulatory reflux monitoring for the diagnosis of gastro-esophageal reflux disease (GERD). Literature search was focused on indications and technical recommendations for GERD testing and phenotypes definitions. Statements were proposed and discussed during several structured meetings. Reflux testing should be performed after cessation of acid suppressive medication in patients with a low likelihood of GERD. In this setting, testing can be either catheter-based or wireless pH-monitoring or pH-impedance monitoring. In patients with a high probability of GERD (esophagitis grade C and D, histology proven Barrett's mucosa >1 cm, peptic stricture, previous positive pH monitoring) and persistent symptoms, pH-impedance monitoring should be performed on treatment. Recommendations are provided for data acquisition and analysis. Esophageal acid exposure is considered as pathological if acid exposure time (AET) is greater than 6% on pH testing. Number of reflux episodes and baseline impedance are exploratory metrics that may complement AET. Positive symptom reflux association is defined as symptom index (SI) >50% or symptom association probability (SAP) >95%. A positive symptom-reflux association in the absence of pathological AET defines hypersensitivity to reflux. The consensus group determined that grade C or D esophagitis, peptic stricture, histology proven Barrett's mucosa >1 cm, and esophageal acid exposure greater >6% are sufficient to define pathological GERD. Further testing should be considered when none of these criteria are fulfilled. © 2017 John Wiley & Sons Ltd.

  11. Segmentation of complex document

    Directory of Open Access Journals (Sweden)

    Souad Oudjemia

    2014-06-01

    Full Text Available In this paper we present a method for segmentation of documents image with complex structure. This technique based on GLCM (Grey Level Co-occurrence Matrix used to segment this type of document in three regions namely, 'graphics', 'background' and 'text'. Very briefly, this method is to divide the document image, in block size chosen after a series of tests and then applying the co-occurrence matrix to each block in order to extract five textural parameters which are energy, entropy, the sum entropy, difference entropy and standard deviation. These parameters are then used to classify the image into three regions using the k-means algorithm; the last step of segmentation is obtained by grouping connected pixels. Two performance measurements are performed for both graphics and text zones; we have obtained a classification rate of 98.3% and a Misclassification rate of 1.79%.

  12. Secretin-stimulating MRCP in patients with pancreatobiliary maljunction and occult pancreatobiliary reflux: direct demonstration of pancreatobiliary reflux

    Energy Technology Data Exchange (ETDEWEB)

    Motosugi, Utaroh; Ichikawa, Tomoaki; Araki, Tsutomu [University of Yamanashi, Department of Radiology, Chuo-shi, Yamanashi (Japan); Kitahara, Fumiaki; Sato, Tadashi [University of Yamanashi, First Department of Internal Medicine, Chuo-shi, Yamanashi (Japan); Itakura, Jun; Fujii, Hideki [University of Yamanashi, First Department of Surgery, Chuo-shi, Yamanashi (Japan)

    2007-09-15

    We propose the hypothesis that the enlargement of the common bile duct (CBD) or gallbladder (GB) that is occasionally demonstrated on magnetic resonance cholangiopancreatography (MRCP) after secretin stimulation is caused by pancreatobiliary reflux. Recently, occult pancreatobiliary reflux (OPR) has been demonstrated in patients without morphological pancreatobiliary maljunction (MPBM). The aim of this study was to evaluate the efficacy of secretin-stimulating MRCP (SMRCP) in the diagnosis of pancreatobiliary reflux. The study included 14 patients with MPBM and 32 patients with a normal pancreatobiliary junction. OPR was evaluated by bile collection and diagnosed in seven of the 32 patients. All the patients underwent SMRCP; the related findings were considered positive when enlargement of the CBD or GB was observed. Positive findings on SMRCP were observed in all MPBM patients. In the patients with normal pancreatobiliary junction, there was significant difference between the mean amylase levels in the patients with positive and negative SMRCP findings (mean, 4,755.7 and 29.7 IU/l). The sensitivity and specificity of SMRCP for diagnosing OPR was 85.7% and 68.0%, respectively. SMRCP provides a non invasive method for excluding PBR and can identify patients who could benefit from bile duct sampling to diagnose OPR. (orig.)

  13. Asia-Pacific consensus on the management of gastro-oesophageal reflux disease: an update focusing on refractory reflux disease and Barrett's oesophagus.

    Science.gov (United States)

    Fock, Kwong Ming; Talley, Nicholas; Goh, Khean Lee; Sugano, Kentaro; Katelaris, Peter; Holtmann, Gerald; Pandolfino, John E; Sharma, Prateek; Ang, Tiing Leong; Hongo, Michio; Wu, Justin; Chen, Minhu; Choi, Myung-Gyu; Law, Ngai Moh; Sheu, Bor-Shyang; Zhang, Jun; Ho, Khek Yu; Sollano, Jose; Rani, Abdul Aziz; Kositchaiwat, Chomsri; Bhatia, Shobna

    2016-09-01

    Since the publication of the Asia-Pacific consensus on gastro-oesophageal reflux disease in 2008, there has been further scientific advancement in this field. This updated consensus focuses on proton pump inhibitor-refractory reflux disease and Barrett's oesophagus. A steering committee identified three areas to address: (1) burden of disease and diagnosis of reflux disease; (2) proton pump inhibitor-refractory reflux disease; (3) Barrett's oesophagus. Three working groups formulated draft statements with supporting evidence. Discussions were done via email before a final face-to-face discussion. We used a Delphi consensus process, with a 70% agreement threshold, using Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria to categorise the quality of evidence and strength of recommendations. A total of 32 statements were proposed and 31 were accepted by consensus. A rise in the prevalence rates of gastro-oesophageal reflux disease in Asia was noted, with the majority being non-erosive reflux disease. Overweight and obesity contributed to the rise. Proton pump inhibitor-refractory reflux disease was recognised to be common. A distinction was made between refractory symptoms and refractory reflux disease, with clarification of the roles of endoscopy and functional testing summarised in two algorithms. The definition of Barrett's oesophagus was revised such that a minimum length of 1 cm was required and the presence of intestinal metaplasia no longer necessary. We recommended the use of standardised endoscopic reporting and advocated endoscopic therapy for confirmed dysplasia and early cancer. These guidelines standardise the management of patients with refractory gastro-oesophageal reflux disease and Barrett's oesophagus in the Asia-Pacific region. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  14. Small volume acid reflux in gastroesophageal reflux disease patients with hiatal hernia is only detectable by pH-metry but not by multichannel intraluminal impedance.

    Science.gov (United States)

    Weigt, J; Malfertheiner, P

    2013-07-01

    Until now, it is uncertain if the so-called pH-only reflux episodes that consist of a pH drop without evidence of retrograde bolus movement in multichannel intraluminal impedance (MII) represent reflux episodes or artifacts. Hiatal hernia (HH) may allow reflux of small volumes to occur that can be detected by pH-metry but not by MII. The aim was to search for a mechanism that can explain pH-only reflux, 20 patients (12 females and 8 males, median age 52 years, interquartile range [IQR]: 40.5-60.75 years) were investigated with MII-pH off PPI. Impedance and pH-metry data were analyzed separately. The differences in detection rate of acid reflux between pH-metry and MII were correlated with the presence of HH. In an in vitro experiment, MII-pH probes were flushed with citric acid in plastic tubes of different size with capillary diameter and diameters of 2.5 mm and 4.5 mm, while recording pH values and impedance. HH was present in six patients and absent in 14 patients. In patients with HH in comparison with patients with absent HH, the difference of acid reflux detection between pH-metry and MII is significantly higher (70%, IQR: 15-88% and 3.6%, IQR: 0-31%, respectively). In vitro all simulated reflux lead to a fall in pH whereas a corresponding decrease in impedance was only recognizable in the 4.5-mm plastic tubes. Acid reflux episodes in patients with HH are more frequently detected by pH-metry than by MII. Small volume reflux that does not lead to a decrease in impedance is the likely explanation for this phenomenon. © 2012 Copyright the Authors. Journal compilation © 2012, Wiley Periodicals, Inc. and the International Society for Diseases of the Esophagus.

  15. Connecting textual segments

    DEFF Research Database (Denmark)

    Brügger, Niels

    2017-01-01

    history than just the years of the emergence of the web, the chapter traces the history of how segments of text have deliberately been connected to each other by the use of specific textual and media features, from clay tablets, manuscripts on parchment, and print, among others, to hyperlinks on stand......In “Connecting textual segments: A brief history of the web hyperlink” Niels Brügger investigates the history of one of the most fundamental features of the web: the hyperlink. Based on the argument that the web hyperlink is best understood if it is seen as another step in a much longer and broader...

  16. 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

  17. Relationship between sleep and acid gastro-oesophageal reflux in neonates.

    Science.gov (United States)

    Ammari, Mohamed; Djeddi, Djamal; Léké, André; Delanaud, Stéphane; Stéphan-Blanchard, Erwan; Bach, Véronique; Telliez, Frédéric

    2012-02-01

    The aim of the present study was to investigate the impact of gastro-oesophageal acid reflux on sleep in neonates and, reciprocally, the influence of wakefulness (W) and sleep stages on the characteristics of the reflux (including the retrograde bolus migration of oesophageal acid contents). The pH and multichannel intraluminal impedance were measured during nocturnal polysomnography in 25 infants hospitalised for suspicion of gastro-oesophageal reflux. Two groups were constituted according to whether or not the infants displayed gastro-oesophageal reflux (i.e. a reflux group and a control group). There were no differences between the reflux and control groups in terms of sleep duration, sleep structure and sleep state change frequency. Vigilance states significantly influenced the gastro-oesophageal reflux pattern: the occurrence of gastro-oesophageal reflux episodes was greater during W (59 ± 32%) and active sleep (AS; 35 ± 30%) than during quiet sleep (QS; 6 ± 11%), whereas the mean duration of gastro-oesophageal reflux episodes was higher in QS than in W and AS. The percentage of retrograde bolus migrations of distal oesophageal acid content was significantly higher in AS (62 ± 26%) than in W (42 ± 26%) and QS (4.5 ± 9%). In neonates, gastro-oesophageal reflux occurred more frequently during W, whereas the physiological changes associated with sleep state increase the physiopathological impact of the gastro-oesophageal reflux. The duration of oesophagus-acid contact was greater during sleep; AS facilitated the retrograde migration of oesophageal acid content, and QS was characterised by the risk of prolonged acid mucosal contact. © 2011 European Sleep Research Society.

  18. New bulking agent for the treatment of vesicoureteral reflux: Polymethylmethacrylate/dextranomer

    Directory of Open Access Journals (Sweden)

    Sang Woon Kim

    2018-05-01

    Full Text Available Purpose: The aim of this study was to report preliminary results of endoscopic treatment of vesicoureteral reflux in children with a single injection of a new bulking agent, cross-linked dextran and polymethylmethacrylate mixture. Materials and Methods: We performed a single-center, single surgeon, prospective, off-label study using polymethylmethacrylate/dextranomer to treat vesicoureteral reflux. All patients underwent endoscopic injection, followed by renal ultrasound and voiding cystourethrogram at 3 months postoperatively to identify de novo or worsening hydronephrosis and vesicoureteral reflux correction (to Grade 0 or I. Results: Eighteen patients underwent injection of polymethylmethacrylate/dextranomer at our institution between April 2013 and December 2013. Ten were males and eight were females, with a median age of 58 months (range, 6 months to 5 years. Vesicoureteral reflux was unilateral in three patients and bilateral in 15, for a total of 33 renal refluxing units. Vesicoureteral reflux was Grade I in one renal refluxing unit, Grade II in 12, Grade III in 16, and Grade IV in four. Mean injected volume was 0.86 mL. Reflux was corrected in 23 renal refluxing units (69.7% according to the 3-month voiding cystourethrogram. Complications included urinary retention in one patient. Mild pyelectasis was noted in one patient at 3 months, which spontaneously resolved 3 months later. Conclusions: Our short-term data show that polymethylmethacrylate/dextranomer injection can be used to treat vesicoureteral reflux with comparable efficacy to other substances currently used and a low rate of complications. Long-term follow-up is required to confirm the usefulness of this material in treating vesicoureteral reflux.

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

    NARCIS (Netherlands)

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

    2010-01-01

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

  20. The value of esophageal histology in the diagnosis of gastroesophageal reflux disease in patients with heartburn and normal endoscopy

    NARCIS (Netherlands)

    Tytgat, Guido N. J.

    2008-01-01

    Histologic markers of reflux-induced mucosal injury are demonstrable in patients with nonerosive gastroesophageal reflux disease (neGERD). They include papillary elongation, basal cell hyperplasia, and dilation of intercellular spaces, especially of the prickle layer. These abnormalities are

  1. Segmentation in cinema perception.

    Science.gov (United States)

    Carroll, J M; Bever, T G

    1976-03-12

    Viewers perceptually segment moving picture sequences into their cinematically defined units: excerpts that follow short film sequences are recognized faster when the excerpt originally came after a structural cinematic break (a cut or change in the action) than when it originally came before the break.

  2. Dictionary Based Image Segmentation

    DEFF Research Database (Denmark)

    Dahl, Anders Bjorholm; Dahl, Vedrana Andersen

    2015-01-01

    We propose a method for weakly supervised segmentation of natural images, which may contain both textured or non-textured regions. Our texture representation is based on a dictionary of image patches. To divide an image into separated regions with similar texture we use an implicit level sets...

  3. Unsupervised Image Segmentation

    Czech Academy of Sciences Publication Activity Database

    Haindl, Michal; Mikeš, Stanislav

    2014-01-01

    Roč. 36, č. 4 (2014), s. 23-23 R&D Projects: GA ČR(CZ) GA14-10911S Institutional support: RVO:67985556 Keywords : unsupervised image segmentation Subject RIV: BD - Theory of Information http://library.utia.cas.cz/separaty/2014/RO/haindl-0434412.pdf

  4. Metrics for image segmentation

    Science.gov (United States)

    Rees, Gareth; Greenway, Phil; Morray, Denise

    1998-07-01

    An important challenge in mapping image-processing techniques onto applications is the lack of quantitative performance measures. From a systems engineering perspective these are essential if system level requirements are to be decomposed into sub-system requirements which can be understood in terms of algorithm selection and performance optimization. Nowhere in computer vision is this more evident than in the area of image segmentation. This is a vigorous and innovative research activity, but even after nearly two decades of progress, it remains almost impossible to answer the question 'what would the performance of this segmentation algorithm be under these new conditions?' To begin to address this shortcoming, we have devised a well-principled metric for assessing the relative performance of two segmentation algorithms. This allows meaningful objective comparisons to be made between their outputs. It also estimates the absolute performance of an algorithm given ground truth. Our approach is an information theoretic one. In this paper, we describe the theory and motivation of our method, and present practical results obtained from a range of state of the art segmentation methods. We demonstrate that it is possible to measure the objective performance of these algorithms, and to use the information so gained to provide clues about how their performance might be improved.

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

    Science.gov (United States)

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

    2017-01-01

    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 scores and individual symptom scores correlate with outcomes in esophageal multichannel intraluminal impedance-pH monitoring. A total of 26 patients with gastroesophageal reflux disease-associated symptoms, aged 0-2 years, for whom both esophageal multichannel intraluminal impedance-pH monitoring and Gastroesophageal reflux disease Assessment Symptom Questionnaire survey results were available were included in the study. Gastroesophageal reflux disease Assessment Symptom Questionnaire score data were collected from a 7-day recall of parent's responses about the frequency and severity of gastroesophageal reflux disease symptoms, which determined the individual symptom scores. The composite symptom scores is the sum of all individual symptom scores. Multichannel intraluminal impedance-pH study results were compared to Gastroesophageal reflux disease Assessment Symptom Questionnaire data using Pearson correlation. Among 26 patients, a total number of 2817 (1700 acid and 1117 non-acid) reflux episodes and 845 clinical reflux behaviors were recorded. There were significant correlations between the reflux index and the individual symptom scores for coughing/gagging/choking (r 2 = 0.2842, p = 0.005), the impedance score and individual symptom scores for coughing/gagging/choking (r 2 = 0.2482, p = 0.009), the reflux symptom index for acid reflux-related coughing/gagging/choking and the individual symptom scores for coughing/gagging/choking (r 2 = 0.1900, p = 0.026), the impedance score and

  6. Effects of Obstructive Sleep Apnea and Gastroesophageal Reflux Disease on Asthma Control in Obesity

    Science.gov (United States)

    Dixon, Anne E.; Clerisme-Beaty, Emmanuelle M.; Sugar, Elizabeth A.; Cohen, Rubin I.; Lang, Jason E.; Brown, Ellen D.; Richter, Joel E.; Irvin, Charles G.; Mastronarde, John G.

    2011-01-01

    Background Obesity is a risk factor for asthma. Obese asthmatics often have poor asthma control and respond poorly to therapy. It has been suggested that co-morbidities associated with obesity, such as reflux and obstructive sleep apnea, could be important factors contributing to poor asthma control in obese patients. Objectives The purpose of this study was to determine if (i) reflux and/or (ii) symptoms of sleep apnea contribute to poor asthma control in obesity. Methods We studied asthmatic subjects participating in a trial of reflux treatment. Participants underwent baseline evaluation of asthma symptoms and lung function. 304 participants underwent esophageal pH probe testing. 246 participants were evaluated for obstructive sleep apnea symptoms. Results Of 402 participants in this trial, 51% were obese. Role of reflux in asthma control Those with higher body mass index reported a higher prevalence of reflux symptoms, but the prevalence of pH probe acid reflux was similar in all groups. Reflux was not associated with measures of asthma control in obese patients. Role of obstructive sleep apnea in asthma control Symptoms and self-report of obstructive sleep apnea were more common with increasing body mass index and associated with worse asthma control as measured by the Juniper Asthma Control Questionnaire and Asthma Symptom Utility Index. Conclusions Our data suggest that obstructive sleep apnea, but not gastroesophageal reflux disease may contribute significantly to poor asthma control in obese patients. PMID:21819338

  7. The role of hiatus hernia in gastro-oesophageal reflux disease

    NARCIS (Netherlands)

    van Herwaarden, Margot A.; Samsom, Melvin; Smout, André J. P. M.

    2004-01-01

    This article gives an overview of the role of sliding hiatus hernia in gastro-oesophageal reflux disease (GORD). The crural diaphragm acts as an external sphincter of the anti-reflux barrier. Contractions of the crural diaphragm increase lower-oesophageal-sphincter (LOS) pressure during each

  8. Symptoms of gastroesophageal reflux in severely mentally retarded people: a systematic review.

    NARCIS (Netherlands)

    Veer, A.J.E. de; Bos, J.; Niezen-de Boer, M.C.; Böhmer, C.J.M.; Francke, A.L.

    2008-01-01

    BACKGROUND: Gastroesophageal reflux disease (GERD) occurs when stomach acid frequently backs up (or refluxes) into the gullet (or esophagus), and it has serious consequences for the quality of life. Usually this is felt as heartburn. Because severely mentally retarded people usually do not utter

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

    International Nuclear Information System (INIS)

    Shin, Dong Jae; Lee, Eun Ja; Bae, Jong Myon

    2016-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2016-12-15

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

  11. Effects of anxiety and depression in patients with gastroesophageal reflux disease

    NARCIS (Netherlands)

    Kessing, Boudewijn F.; Bredenoord, Albert J.; Saleh, Caroline M. G.; Smout, André J. P. M.

    2015-01-01

    Increased levels of anxiety and depression have been associated with esophageal hyperalgesia and an increased risk of gastroesophageal reflux disease (GERD). We investigated the effects of anxiety and depression on GERD symptoms and the perception of reflux episodes in a well-characterized group of

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

    Directory of Open Access Journals (Sweden)

    Chien-Lin Chen

    2013-01-01

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

  13. Diagnosis of the bile reflux into the introhepatic biliary ducts using using radionuclide hepatocholecystography

    International Nuclear Information System (INIS)

    Mtvaradze, A.S.

    1984-01-01

    To reveal functional disorders of bile secretion 165 patients with diseases of gastrointestinal tract were examined. It was established that radionuclide hepatocholecystography enables to reveal dyskinesia of bile secretion, as well as bile reflux into the intrahepatic biliary ducts. Bile reflux into the intrahepatic biliary ducts is observed more often in patients with spasm of oddii sphincter and hyperkinetic dyskinesia of bile cyst

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

    NARCIS (Netherlands)

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

    2012-01-01

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

  15. Sleep disorders and the prevalence of asymptomatic nocturnal acid and non-acid reflux.

    Science.gov (United States)

    Herdman, Christine; Marzio, Dina Halegoua-De; Shah, Paurush; Denuna-Rivera, Susie; Doghramji, Karl; Cohen, Sidney; Dimarino, Anthony J

    2013-01-01

    Nocturnal acid reflux is associated with symptomatic and asymptomatic sleep arousals, leading to fragmented sleep. The frequency and influence of acid reflux in patients with various forms of insomnia has not been reported. The aim of this study was to quantify nocturnal acid and nonacid reflux in patients with primary sleep disorders as previously diagnosed by polysomnography. THIRTY ONE SUBJECTS WERE STUDIED: (A) 9 subjects with a polysomnographically diagnosed sleep disorder (1 with restless legs syndrome, 4 with narcolepsy, 4 with periodic limb movement disorder); (B) 12 subjects with primary insomnia (PI) and unrevealing polysomnography; and (C) 10 controls without disturbed sleep. All subjects underwent a physical examination and 24 h transnasal pH and impedance monitoring to detect acid and non-acid reflux. The 21 subjects with fragmented sleep due to a primary sleep disorder had significantly more recumbent acid exposure (>1.2% of time) as compared with control subjects (33% versus 0%). When fragmented sleep subjects were divided into two groups, 17% of PI subjects and 55% of subjects with a diagnosed sleep disorder had significant recumbent acid exposure (P=0.009). Likewise, the median recumbent nonacid events were increased in the sleep disordered group (P=0.011). This study indicates that patients with primary sleep disorders have prominent nocturnal acid reflux without symptoms of daytime acid reflux. Acid reflux is most prominent in patients with polysomnographic findings of disturbed sleep as compared to patients with PI; while non acid reflux is increased minimally in these patients.

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

    Science.gov (United States)

    Nakahara, Kenichi; Fujiwara, Yasuhiro; Tsukahara, Takuya; Yamagami, Hirokazu; Tanigawa, Tetsuya; Shiba, Masatsugu; Tominaga, Kazunari; Watanabe, Toshio; Urade, Yoshihiro; Arakawa, Tetsuo

    2014-01-01

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

  17. Advantages and disadvantages of lumping together gastroesophageal reflux disease and dyspepsia

    NARCIS (Netherlands)

    Smout, André J. P. M.

    2006-01-01

    PURPOSE OF REVIEW: The aim of this article is to identify and to balance the arguments in favor of and against lumping together gastroesophageal reflux disease and functional dyspepsia. RECENT FINDINGS: In at least half of the patients diagnosed with gastroesophageal reflux disease no organic

  18. Snus and risk of gastroesophageal reflux. A population-based case-control study

    DEFF Research Database (Denmark)

    Lie, Tina Malene; Bomme, Maria; Hveem, Kristian

    2017-01-01

    OBJECTIVE: Tobacco smoking is a risk factor for gastroesophageal reflux, but whether other tobacco products increase the risk is unclear. The aim of this study was to investigate if snus increases the risk of gastroesophageal reflux symptoms (GERS). MATERIAL AND METHODS: The study was based...

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

    DEFF Research Database (Denmark)

    Bohnhorst, Idar; Jawad, Samir; Lange, Bibi

    2015-01-01

    BACKGROUND: An increased coexistence of gastroesophageal reflux disease (GERD) and chronic rhinosinusitis (CRS) has been reported in epidemiologic and register studies, and reflux has been shown more frequently in patients with CRS in studies using esophagus pH manometry compared to participants...

  20. 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