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1.
Kawahara H Kubota A Hasegawa T Okuyama H Ueno T Watanabe T Morishita Y Saka R Fukuzawa M 《Journal of pediatric surgery》2007,42(12):2017-2021
Background/Purpose
The objective of this study is to investigate the characteristics of esophageal motor activity responsible for the development of gastroesophageal reflux (GER) in patients with esophageal atresia (EA).Methods
The subjects consisted of 29 patients with EA (1 month to 19 years). Computerized esophageal manometry was conducted to investigate esophageal contractions at swallow. A topographic esophageal manometric analysis was conducted in each subject, providing 3-dimensional displays to reveal the pressure continuum representing esophageal contractions.Results
Significant contractions in the middle esophagus just below the anastomosis were absent in all subjects. Contractions in the distal esophagus were conspicuously absent in 17 subjects. Of these 17, 6 had already undergone fundoplication, and 9 had symptomatic GER requiring fundoplication subsequent to this study. The remaining 12 patients had contractions in the distal esophagus and did not require medical/surgical intervention. A lack of distal esophageal contractions was significantly correlated with the development of GER (P < .001). There was a significant difference in esophageal acid exposure between the 2 groups (median, 38% vs 4%, P < .001).Conclusion
Lack of distal esophageal contractions indicating an impaired clearing capacity is considered a potential key determinant of GER in patients with EA. 相似文献2.
Hisayoshi Kawahara Hiroomi Okuyama Yasuyuki Mitani Motonari Nomura Keisuke Nose Akihiro Yoneda Toshimichi Hasegawa Akio Kubota Masahiro Fukuzawa 《Journal of pediatric surgery》2009,44(12):2282-2286
Background/Purpose
Thoracoscopic repair has recently been attempted in newborns with esophageal atresia (EA), but it remains unclear whether thoracoscopic dissection reduces pathological gastroesophageal reflux. We investigated the influence of a thoracoscopic approach on esophageal motor function in patients with EA.Methods
Clinical and gastrointestinal data of 10 patients with EA with open repair (group A) and 7 with thoracoscopic repair (group B) were analyzed retrospectively. Videomanometry was conducted to investigate esophageal motor patterns. Esophageal acid exposure was evaluated with 24-hour esophageal pH monitoring. Data are expressed as medians and ranges.Results
Contractions in the distal esophagus were conspicuously absent in 1 and 3 patients in groups A and B, respectively (P = .26). There were no significant differences in esophageal acid exposure (5.5% [0.7%-24.6%] vs 3.7% [0.3%-56.8%]; P = .71) or mean esophageal acid reflux time (0.5 minutes [0.1-1.4 minutes] vs 0.5 minutes [0.1-1.3 minutes]; P = .87) between the 2 groups. Fundoplication was conducted in 2 patients in each group (P = .60), all of whom had conspicuously absent distal esophageal contractions. Those contractions were preserved in the remaining patients with the exception of 1 group B patient.Conclusion
There are unlikely to be benefits from thoracoscopic repair of EA in terms of postoperative esophageal motor function. 相似文献3.
Di Pace MR Caruso AM Catalano P Casuccio A Cimador M De Grazia E 《Journal of pediatric surgery》2011,46(3):443-451
Background
Gastroesophageal reflux (GER) and dysmotility are frequent in patients treated for esophageal atresia (EA). This aim of this study is to evaluate GER and dysmotility in young EA patients using pH-multichannel intraluminal impedance (pH-MII).Methods
Fifteen patients with a mean age of 7.5 years (group 1) have been studied and compared with 15 children without congenital malformation, submitted to pH-MII for suspected GER (group 2). These latter patients serve as a control group of healthy subjects. The following impedance reflux and motility parameters have been studied on 10 standardized swallows: number of reflux episodes, mean acid clearing time, median bolus clearing time, bolus presence time, total bolus transit time, segmental transit time, and total propagation velocity.Results
In the group of EA patients, mean acid clearing time and median bolus clearing time were pathological. In the control group, all reflux parameters were normal. Patients with EA had significantly longer median bolus presence time at each measuring site, median total bolus transit time, and median segmental transit time and slower total propagation velocity (P < .001).Conclusions
pH-multichannel intraluminal impedance evaluates both GER and motility patterns. Our report studies impedance parameters of esophageal motility in healthy children and in EA patients using only pH-MII. 相似文献4.
5.
Keith W. Ashcraft Charles Goodwin Raymond A. Amoury Thomas M. Holder 《Journal of pediatric surgery》1977,12(3):317-321
Twelve patients with gastroesophageal reflux following repair of esophageal atresia are presented. Reflux produced recurrent stricture, failure to thrive, repeated pneumonitis, and in one patient, respiratory arrest and nearly death. Treatment consists of positional therapy or fundoplication operation both of which seem less successful in this combination of lesions than with GER and a normal esophagus. There was one death as a late postoperative complication of fundoplication. 相似文献
6.
Tiboni SG Patel Y Lander AD Parikh DH Jawaheer G Arul GS 《Journal of pediatric surgery》2011,46(2):289-291
Aim
Children being investigated for gastroesophageal reflux (GOR) have a high incidence of malrotation. Current literature suggests these patients should be managed with a combined antireflux and Ladd's procedure. We review our experience, the largest series to date, of performing an elective Ladd's procedure as the first-line intervention.Method
Retrospective case note review of 20 children with significant symptoms of GOR and an incidental finding of malrotation. Children presenting immediately with bilious vomiting were excluded. All patients underwent a Ladd's procedure as their sole primary operative intervention.Results
Median age at operation was 7 months (21 days-12 years). Fifteen patients (75%) had evidence of reflux on barium contrast study. All children were followed up for at least 6 months. Eighteen (90%) had resolution or significant improvement of their symptoms postsurgery. Only 3 have not managed to tolerate a full oral diet, all unrelated to GOR. None of our series required an antireflux procedure.Conclusion
In children with debilitating vomiting necessitating surgical management, a contrast study is imperative in the work up. The high incidence of GOR and the significant improvement after correction of malrotation show the relationship between delayed gastric emptying and GOR. We suggest that when an abnormally placed duodenojejunal flexure is found, a Ladd's procedure alone is sufficient and may obviate the need for a more invasive antireflux procedure. 相似文献7.
Patients with esophageal atresia and/or tracheoesophageal fistula are known to have disordered esophageal motility, but the incidence of significant gastroesophageal reflux requiring anti-reflux surgery remains undocumented. We have studied a series of patients from 2 wk to 13 yr post-repair, utilizing manometric motility and acid reflux techniques. All demonstrated abnormalities of esophageal motility, including aperistalsis, low amplitude contraction, and simultaneous contractions. Lower esophageal sphincter pressures ranged from 7 to 50 mm Hg. Fourteen patients demonstrated signifcant reflux and six patients required anti-reflux surgery for recurrent pneumonia or recurrent stricture. The incidence of significant gastroesophageal reflux requiring antireflux surgery appears significant following repair of esophageal atresia and/or tracheoesophageal fistula. 相似文献
8.
Charlotte Kristensen Knatten Tone Lise Åvitsland Asle W. Medhus Jan Gunnar Fjeld Are Hugo Pripp Ragnhild Emblem Kristin Bjørnland 《Journal of pediatric surgery》2013
Purpose
The aim of this report is to examine whether children with gastroesophageal reflux (GER) have delayed gastric emptying compared to healthy children.Methods
All patients had GER verified by 24-hour pH monitoring. Gastric emptying of cow’s milk was examined by radionuclide scintigraphy in 51 patients with GER and in 24 controls. Gastric emptying rate was expressed as exponential half time (T1/2).Results
Median age was 4.4 years [range 0.1–15.4] in patients and 6.1 years [range 2.5–10.0] in controls (p = .10). A wide range of gastric emptying rates was observed both in GER patients [range 16–121] and controls [range 29–94]. One GER patient (2%) had slower gastric emptying (T1/2 = 121 min) than the healthy child with the longest T1/2 (94 min). Mean T1/2 was 49 minutes (SD 20.1) and 46 minutes (SD 14.2) in GER patients and controls, respectively (p = .51).Conclusions
Gastric emptying rate of milk was not significantly different between children with GER and healthy children. A wide range of gastric emptying rates was observed in both groups. 相似文献9.
Aim
The aim of this study was to investigate the motor activity in the stomach of infants with repaired esophageal atresia (EA).Method
Gastric myoelectrical activity was investigated by cutaneous electrogastrography in 15 infants after the surgical correction of EA. Ten infants with no gastrointestinal upset served as controls. Studies were done before and after a milk feed. The pH of the lower esophagus was measured for 24 hours to assess the gastroesophageal reflux (GER) in the infants with repaired EA.Results
After feeding, a significant increase in bradygastria and decrease in tachygastria were observed as compared with the preprandial period. Compared with healthy infants, the electrogram showed pathological patterns in 73.3% (11/15) of EA patients. Twelve of 15 EA patients showed some clinical sign of GER, and 60% of the EA patients proved to be GER-positive on esophageal pH monitoring. There was no difference in the distribution of gastric myoelectrical waves between the GER-positive and GER-negative EA patients either before or after meal.Conclusion
Cutaneous electrogastrography is a noninvasive, harmless method for obtaining indirect information about the motor function of the stomach. The abnormal changes in physiological gastric myoelectrical activity in EA patients can serve as markers of disturbed neuromuscular function and can play a role in the pathogenesis of feeding disturbances after operative correction of EA. Gastroesophageal reflux, which often occurs after surgical repair of EA, seems to be connected not only with disordered gastric myoelectric activity, but also probably with other factors such as artificially straightened esophagogastric angle or brachyesophagus. 相似文献10.
Edward J. Ruley Glenn H. Bock Benny Kerzner Ann W. Abbott Massoud Majd Irene Chatoor 《Pediatric nephrology (Berlin, Germany)》1989,3(4):424-429
Twenty-two infants (mean age 7.5 months) with chronic renal failure (CRF) were studied for their nutrition, growth, and upper gastrointestinal function. Most infants had a history of poor caloric intake and 7 had received supplemental feeding (SF) prior to the investigation. All infants were undergrown, underweight, and malnourished. The infants were characterized as having only a fair interest in food, refusing feedings, and vomiting excessively. Sixteen of 22 infants (73%) had significant gastroesophageal (GE) reflux demonstrated by 24-h esophageal pH monitoring. Gastroesophageal scintiscans were less sensitive and specific in detecting the reflux. Infants with GE reflux were significantly younger and more often required SF than those without GE reflux. There were no significant differences in the degree of renal failure, growth failure, caloric intake, protein intake, or nutritional status between the infants with and without GE reflux. From these studies we conclude that GE reflux should be considered as one of the factors contributing to the feeding problems of infants with CRF. 相似文献
11.
12.
Yves Borbély Dino Kröll Philipp C. Nett Peter Moreno Radu Tutuian Johannes Lenglinger 《Surgery for obesity and related diseases》2018,14(6):764-768
Background
Roux-en-Y gastric bypass (RYGB) is considered the gold standard in treatment of morbid obesity and gastroesophageal reflux disease (GERD). Resolution of GERD symptoms is reported to be approximately 85% to 90%.Objective
To evaluate patients with persistent GERD symptoms after RYGB and to identify contributing factors.Setting
University hospital, cross-sectional study.Methods
Data of patients evaluated for persistent GERD with a history of RYGB between January 2012 and December 2015 were reviewed. GERD was assessed with questionnaires, endoscopy, 24-hour pH-impendance manometry, and barium swallow.Results
Of 47 patients, 44 (93.6%) presented with typical GERD, 18 (38.3%) with obstruction, 8 (17%) with pulmonary symptoms, and 21 (44.7%) with pain. The interval between RYGB and evaluation was a median of 3.8 years (range .8–12.6); median patient age was 36.5 years (19.1–67.2). Median body mass index was 30.3 kg/m2 (20.3–47.2). Pouch gastric fistulas were seen in 2 (5.1%), enlarged pouches in 5 (10.6%), and hiatal hernias in 25 patients (53.2%). Twelve (23.4%) had esophagitis>Los Angeles (LA) grade B. Manometry was performed in 45 (95.7%) and off–proton pump inhibitor 24-hour pH-impedance-metry in 44 patients (94.6%). Seventeen patients (37.8%) had esophageal hypomotility or aperistalsis; hypotensive lower esophageal sphincter was seen in 26 patients (57.8%). Increased esophageal acid exposure (>4% pH<4) was found in 27 (61.4%), an increased number of reflux episodes (>53) in 30 patients (68.2%). Symptoms were deemed as functional in 6 (12.8%).Conclusion
The evaluation for persistent GERD after RYGB revealed a high percentage of hiatal hernias, hypotensive lower esophageal sphincter, and severe esophageal motility disorders. These findings might have an influence on hiatal hernia closure concomitant with RYGB and the role of pH manometry in the preoperative bariatric assessment. 相似文献13.
Esophageal cancer development after previous atresia repair is extremely rare in young patients. We present the clinical course of a patient who developed an adenocarcinoma of the esophagus at the age of 22 years, after repair of a tracheoesophageal fistula with esophageal atresia in the neonatal period. She developed a stricture of the esophageal anastomosis requiring frequent dilatations. Six years after an antireflux procedure because of a difficult treatable severe gastroesophageal reflux, an advanced adenocarcinoma was detected at the site of the end-to-end anastomosis of the previous atresia. 相似文献
14.
Emanuele Soricelli Giovanni Casella Giovanni Baglio Roberta Maselli Ilaria Ernesti Alfredo Genco 《Surgery for obesity and related diseases》2018,14(6):751-756
Background
The postoperative development or worsening of gastroesophageal reflux disease (GERD) represents the major drawback of laparoscopic sleeve gastrectomy (SG). A GERD diagnosis is often based only on symptoms and proton pump inhibitors (PPI) intake, while objective tests like esophagogastroduodenoscopy and pH measurements are performed less frequently.Objectives
To evaluate the association between reflux symptoms and GERD-related esophageal lesions.Settings
University hospital, Rome, Italy.Methods
A comprehensive clinical control entailing GERD symptoms, PPI intake, and esophagogastroduodenoscopy was proposed to all patients who underwent SG between June 2007 and February 2011, irrespective of the presence of GERD symptoms. One hundred forty-four of 219 patients agreed to take part in the study (follow-up rate: 65.8%).Results
After a mean follow-up of 66 months, GERD symptoms and PPI intake were recorded in 70.2% and 63.9% of patients, respectively. Mean visual analogue scale score was 2.9 ± 3.3. The overall frequency of erosive esophagitis was 59.8%, while nondysplastic Barrett’s esophagus was detected in 13.1%. The frequency of esophageal biliary reflux was 68%. GERD symptoms and visual analogue scale score were not significantly associated with the development of erosive esophagitis and Barrett’s esophagus and the severity of the esophageal lesions. Moreover, the frequency of erosive esophagitis and Barrett’s esophagus in patients consuming PPI were similar to that of patients without PPI.Conclusion
Symptoms investigation alone is not a reliable tool to diagnose GERD after SG. The use of objective diagnostic tests, such as esophagogastroduodenoscopy, should be carefully considered in the postoperative follow-up schedule of SG patients. 相似文献15.
Background/Purpose: The purpose of this analysis was to investigate outcomes in newborns with esophageal atresia (EA) or tracheoesophageal fistula (TEF) with respect to prognostic classifications and complications.Methods: Charts of all 144 infants with EA/TEF treated at British Columbia Children’s Hospital (BCCH) from 1984 to 2000 were reviewed. Patient demographics, frequency of associated anomalies, and details of management and outcomes were examined.Results: Applying the Waterston prognostic classification to our patient population, survival rate was 100% for class A, 100% for class B, and 80% for class C. The Montreal classification survival rate was 92% for class I and 71% for class II (P = .08). Using the Spitz classification, survival rate was 99% for type I, 84% for type II, and 43% for type III (P < .05). The Bremen classification survival rate was 95% “without complications” and 71% “with complications.” Complications included stricture (52%), gastroesophageal reflux (31%), anastomotic leakage (8%), recurrent fistula (8%), and pneumonia (6%). Seventeen patients underwent fundoplication for gastroesophageal reflux, 16 pre-1992 and one post-1992.Conclusions: Comparing the major prognostic classifications, the Spitz classification scheme was found to be most applicable. In our institution, the trend in management of gastroesophageal reflux after repair of EA/TEF has moved away from fundoplication toward medical management. 相似文献
16.
Deurloo JA Ekkelkamp S Taminiau JA Kneepkens CM ten Kate FW Bartelsman JF Legemate DA Aronson DC 《Journal of pediatric surgery》2005,40(8):1227-1231
Background
Gastroesophageal reflux is a frequent problem after esophageal atresia (EA) repair. Our aim was to determine the prevalence of esophagitis and Barrett esophagus more than 10 years after repair of EA.Methods
Ninety-two patients treated between 1973 and 1985 were included in this prospective study. A questionnaire was completed by 86 patients; esophagogastroscopy was performed in 49 patients.Results
Only 36 patients had no complaints at all. Thirty-one patients complained of difficulties swallowing solid food; 23 complained of heartburn. Esophagogastroscopy revealed grade 3 esophagitis in 2 patients and a macroscopic image of Barrett esophagus in 2. Histology showed esophagitis in 30 patients, gastric metaplasia in 3, and no intestinal metaplasia (Barrett esophagus).Conclusions
For epidemiologic reasons, that is, the short interval of follow-up (10 years) and the low compliance of the study group, larger numbers are needed to decide if routine long-term endoscopic screening after repair of EA is necessary. For now, it cannot yet be recommended. The prevalence of symptoms of gastroesophageal reflux disease in this study group is higher than that in the general population, but we found no severe complications of gastroesophageal reflux in the pediatric age group. 相似文献17.
目的总结采用管状胃的食管癌手术患者的术后反流情况,探讨管状胃宽度对食管癌切除术后胃食管反流的影响。
方法前瞻性地按照入院顺序,将60例食管癌术中采用管状胃代食管的患者按管状胃裁制宽度是否大于3 cm,随机分为A组30例(管状胃宽度≥3 cm)和B组30例(管状胃宽度<3 cm),分别在术后11~14 d胃肠功能恢复后使用pH监测仪进行24 h食管pH值监测。
结果A组反流次数、反流超过5 min的次数、pH值<4.00的总时间和最长反流时间均多于B组(t=2.735,P=0.012;t=4.502,P=0.001;t=3.435,P=0.023;t=4.286,P=0.002)。
结论管状胃宽度影响反流的发生,细的管状胃可减轻食管癌术后反流的发生。 相似文献
18.
Shuhei Ogita Yukikatsu Goto Kyozo Hashimoto Naomi Iwai Bunzo Nishioka Susumu Majima 《Surgery today》1983,13(6):554-556
To prevent the reflux of gastric contents into the bronchial tree through the tracheoesophageal fistula in patients with esophageal
atresia with tracheoesophageal fistula, Nissen fundoplication was performed in the first-stage repair of staged operations.
After elimination of the pulmonary complication, a correction of esophageal atresia and tracheoesophageal fistula was successfully
performed through the extrapleural route at the age of 16 days. Thus, because Nissen fundoplication is simple to perform and
effective in preventing gastroesophageal reflux, this procedure is considered to be useful in the staged repair of esophageal
atresia with tracheoesophageal fistula. 相似文献
19.
目的探讨管状胃-食管吻合术与全胃-食管吻合术对食管中段癌术后患者胃食管反流(GER)的影响。
方法回顾性分析2014年1月—2017年1月在新疆维吾尔自治区人民医院胸外科行食管癌切除术的56例食管中段癌患者的临床资料,其中观察组(管状胃-食管吻合术)患者27例,对照组(全胃-食管吻合术)患者29例,术后2周进行24 h胃-食管腔pH值监测,术后2周和1、3、6个月依据胃食管反流病调查问卷(GerdQ)评分表对患者的GER相关症状进行评分,比较两组患者术后GER发生情况。
结果所有患者获得随访,观察组和对照组术后2周时24 h酸反流次数、最长酸反流时间和pH值<4的总时间均显著少于对照组,差异有统计学意义(P<0.05);术后1、3、6个月时,观察组GerdQ评分均显著低于对照组,差异也有统计学意义(P<0.05)。
结论管状胃-食管吻合术可显著降低食管中段癌患者术后GER的发生及严重程度。 相似文献
20.
de Lagausie P Bonnard A Schultz A Van den Abbeel T Bellaiche M Hartmann JF Cezard JP Aigrain Y 《Journal of pediatric surgery》2005,40(4):666-669