Gastroesophageal reflux in infants and children-comparative accuracy of diagnostic methods

Arasu, Thiru S.; Wyllie, Robert; Fitzgerald, Joseph F.; Franken, Edmund A.; Siddiqui, Aslam R.; Lehman, Glen A.; Eigen, Howard; Grosfeld, Jay L.

doi:10.1016/s0022-3476(80)80545-2

Cited by 145 publications

(75 citation statements)

References 26 publications

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“…These clinical observations suggest that GER is not an all-or-none phenomenon, but that GER becomes symptomatic when it is abnormally frequent or prolonged. Moreover, LES pressure is not consistently decreased in infants with gastroesophageal reflux (2). Recent clinical investigations suggest that delayed gastric emptying, rather than abnormally low LES intraluminal pressure, may be an important feature of severe GER (17).…”

Section: Discussionmentioning

confidence: 99%

Ontogenic Studies of Gastrointestinal Function. II. Lower Esophageal Sphincter Maturation in Neonatal Beagle Puppies

1982

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SummaryThe purpose of the present study was to investigate the postnatal development of lower esophageal spincter (LES) competence in the beagle and to determine the role of gastrin in LES functional ontogeny. Eleven beagle puppies taken from two litters were studied. All puppies were allowed to suckle during the first 3 postnatal wk. In the 4th wk, all puppies were weaned, and by the 5th wk only solid chow was offered. Intraluminal manometric pressure determinations were obtained in unanesthetized, unsedated puppies using twin-lumen, 1.7 mm OD, 1 mm ID polyvinyl catheters. A 12-15 min baseline period of intraluminal pressure was monitored, after which the puppies received successive doses of 0.03, 0.1, 1.0, and 8.0 pg/kg pentagastrin (PC) SC spaced at 45-min intervals.Progressive increases in LES pressure both during basal periods and during gastric contractions and in gastric fundus (GF) pressures during gastric contractions occurred during the 1st 5 weeks of life. An increase in pressure gradient between the LES and GF during gastric contraction occurred from birth through 5 wk of age. There was no response to 0.1-8.0 pg/kg PG until postnatal days 5-6 when the LES pressure gradient in the basal state increased in response to each of these doses. There was also no significant response by the LES to PG during gastric contraction until days 11-12 when all doses of PG evoked enhancement of LES pressure.These studies suggest that an increase in LES-GF intraluminal pressure gradient develops during the initial 2 postnatal wk in this species and that this development does not involve the hormone gastrin. Later, however, the pressure gradient may depend upon both age and gastrin since a two-way analysis of variance indicated that nit only is LES pressure affected bypostnatal age and by PG dose. but that there is an interaction between ~ostnatal age and PG dose which is significant. By the fifth wk, there was an apparent dose-response effect in which the lower two doses produced increased LES pressure and the larger two doses produced decreased LES pressures. SpeculationGastroesophageal reflux (GER) in some infants may occur when the developmental interplay between endogenous gastrin concentration, increasing sensitivity to gastrin by LES, and sensitivity to gastrin by the muscular stomach proceeds abnormally. Alternatively, either the postnatal increase in LES muscle mass or the maturation of a neural pathway that mediates reflex contraction of the LES during gastric contraction, or both, may be delayed or abnormal in some children with GER. A fourth possible abnormality that may permit GER in still other infants is failure to generate the increasing gastric contraction rate and intraluminal pressures observed to occur in normal development, thus permitting delayed gastric emptying.Functional incompetence of the lower esophageal sphincter (LES) that results in gastroesophageal reflux (GER) is a common problem in infants (6,15,20,23,24,28,29). Healthy term and preterm newborn infants normally regurgitate feedings for ...

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Section: Discussionmentioning

confidence: 99%

Ontogenic Studies of Gastrointestinal Function. II. Lower Esophageal Sphincter Maturation in Neonatal Beagle Puppies

1982

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“…Thus, the scintiscan has a specificity of 83% to 100%, but the sensitivity is only 15% to 59% when compared to esophageal pH monitoring. [13][14][15][16] In contrast, esophageal pH monitoring can detect reflux of acidic gastric contents for 24 hours or more. It is performed by the intranasal placement of a pH electrode into the esophagus.…”

Section: Diagnosismentioning

confidence: 99%

Clinical Management of Infants and Children with Gastroesophageal Reflux Disease

Whitworth¹,

Christensen

2004

The Journal of Pediatric Pharmacology and Therapeutics

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Gastroesophageal reflux refers to the passage of gastric contents including food, acid, and digestive enzymes up into the esophagus. Reflux is most commonly recognized in infants when it is associated with regurgitation, known as “spitting up,” and it is usually a self-limited, benign process that has little or no effect on normal weight gain or development. Adults and adolescents may also have reflux, which is usually either asymptomatic or recognized as dyspepsia or “heartburn.” Gastroesophageal reflux disease (GERD) is defined as symptoms or complications that result from reflux. Most evidence suggests the mechanism of reflux is due to transient relaxations of the lower esophageal sphincter at inappropriate times. The diagnosis of suspected GERD in infants and children depends on the age and the presenting symptoms. A thorough history, physical examination, and growth charts are sufficient for the evaluation and diagnosis of GERD in most infants with recurrent vomiting or children with regurgitation and heartburn. Additional evaluation may include an upper gastrointestinal series, esophageal pH monitoring, or endoscopy. The goals of GERD management are eliminating symptoms, healing esophagitis, preventing complications, promoting normal weight gain and growth, and maintaining remission. Therapeutic options include lifestyle changes, pharmacologic therapy, and anti-reflux surgery. Currently available pharmacologic agents for the treatment of GERD include antacids, mucosal protectants, prokinetic agents, and acid suppressants.

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“…A definição de SLC utilizada no presente estudo 2 é semelhante àquelas utilizadas por outros autores 18,[32][33][34][35][36] e foi escolhida por ser a mais citada e aceita na literatura brasileira. Dentre os 25 LC atópicos integrantes deste estudo (13 com DRGE e 12 sem DRGE), nossa maior prevalência de pacientes do sexo masculino (64%) está em concordância com os dados da literatura 1 .…”

Section: Protocolo Experimentalunclassified

“…O RGE pós-prandial, embora ocorra em pessoas saudáveis, pode ser responsável por doença pulmonar grave 44 e eventos ameaçadores da vida 10,13,45 . Alguns autores ressaltam que os episódios de aspiração maciça podem ocorrer no período pós-prandial, invalidando a idéia de que o RGE pós-prandial é sempre fisiológico 32,46 .…”

Section: Protocolo Experimentalunclassified

Efeito da cisaprida e da fisioterapia respiratória sobre o refluxo gastroesofágico de lactentes chiadores segundo avaliação cintilográfica

Ribeiro¹,

Cunha²,

Etchebehere³

et al. 2001

J. Pediatr. (Rio J.)

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ResumoObjetivo: analisar o efeito da cisaprida e da fisioterapia respiratória em lactentes chiadores (LC), com doença do refluxo gastroesofágico (DRGE).Métodos: avaliamos, prospectivamente, em 13 LC com DRGE e 12 sem DRGE, a densidade nuclear de tecnécio ( 99 Tc) em 3 topografias esofágicas. Os 2 grupos foram submetidos a investigação clínica, exames laboratoriais, radiológicos e cintilográficos para investigação etiológica da Síndrome do LC e DRGE. A técnica fisioterápica denominada aceleração de fluxo expiratório (AFE) foi realizada antes e após tratamento com cisaprida. O tempos totais de RGE (TTRGE), primeiramente durante a cintilografia basal, e em seguida, durante a AFE, foram analisados e somados, para cada topografia esofágica.Resultados: a cisaprida diminuiu o TTRGE, com significância estatística somente no terço superior do esôfago (p<0,05) e não influenciou o TTRGE durante a AFE. Após tratamento com cisaprida, a AFE causou aumento do TTRGE nas topografias esofágicas média e superior, porém sem significância estatística. Lactentes com DRGE, antes do tratamento com cisaprida, tiveram menor TTRGE em esôfago distal durante a AFE (p<0,05). Após tratamento com cisaprida, essa significância estatística deixou de existir. Os LC sem DRGE também apresentaram menor TTRGE em esôfago distal durante a AFE (p<0,05). Os LC com DRGE apresentaram maior TTRGE em esôfago distal (p<0,05), antes e após tratamento com cisaprida, tanto durante a cintilografia basal como durante a AFE.Conclusão: a cisaprida foi eficaz na diminuição do TTRGE em LC com DRGE, principalmente no terço superior do esôfago. A fisioterapia respiratória, segundo a técnica de AFE, foi potencialmente refluxogênica. Outros estudos são necessários para investigar os efeitos da fisioterapia respiratória segundo posições corporais.J Pediatr (Rio J) 2001; 77 (5):393-400: fisioterapia respiratória, síndrome do lactente chiador, refluxo gastroesofágico, cintilografia. AbstractObjective: to evaluate the effect of cisapride and chest physical therapy on the gastroesophageal reflux of wheezing babies.Methods: we prospectively assessed the presence of technetium ( 99 Tc) in the upper, middle, and lower esophagus of 25 wheezing babies (13 with GERD and 12 without GERD) using scintigraphy. Both groups underwent clinical investigation, including laboratory, X-ray and scintigraphy tests, for the etiology of the wheezing baby syndrome (WBS) and GERD. Expiratory Flow Acceleration (EFA) was performed before and after treatment with cisapride. The total time of GER episodes was accounted for each portion of the esophagus during scintigraphy and during EFA.Results: cisapride significantly reduced the total reflux time in the upper esophagus (P<0.05), but showed no influence during EFA. After cisapride therapy, EFA increased the total reflux time in the upper and medium esophagus; however, no statistical significance was found. Infants with GERD presented a shorter total reflux time in the distal esophagus (P<0.05) during EFA. After cisapride treatment, no statistical signi...

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Gastroesophageal reflux in infants and children-comparative accuracy of diagnostic methods

Cited by 145 publications

References 26 publications

Ontogenic Studies of Gastrointestinal Function. II. Lower Esophageal Sphincter Maturation in Neonatal Beagle Puppies

Ontogenic Studies of Gastrointestinal Function. II. Lower Esophageal Sphincter Maturation in Neonatal Beagle Puppies

Clinical Management of Infants and Children with Gastroesophageal Reflux Disease

Efeito da cisaprida e da fisioterapia respiratória sobre o refluxo gastroesofágico de lactentes chiadores segundo avaliação cintilográfica

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