Comparison of upper gastrointestinal contrast studies and pH/impedance tests for the diagnosis of childhood gastro-oesophageal reflux

Assessment of discomfort as a sign for early postoperative complications in neurologically impaired (NI) children is challenging. The necessity of early routine upper gastrointestinal (UGI) contrast studies following laparoscopic Nissen fundoplication in NI children is unclear. We aimed to evaluate the role of scheduled UGI contrast studies to identify early postoperative complications following laparoscopic Nissen fundoplication in NI children. Data for laparoscopic Nissen fundoplications performed in NI children between January 2004 and June 2021 were reviewed. A total of 103 patients were included, with 60 of these being boys. Mean age at initial operation was 6.51 (0.11–18.41) years. Mean body weight was 16.22 (3.3–62.5) kg. Mean duration of follow up was 4.15 (0.01–16.65 years) years. Thirteen redo fundoplications (12.5%) were performed during the follow up period; eleven had one redo and two had 2 redos. Elective postoperative UGI contrast studies were performed in 94 patients (91%). Early postoperative UGI contrast studies were able to identify only one complication: an intrathoracal wrap herniation on postoperative day five, necessitating a reoperation on day six. The use of early UGI contrast imaging following pediatric laparoscopic Nissen fundoplication is not necessary as it does not identify a significant number of acute postoperative complications requiring re-intervention.

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Bilious Vomiting in the Newborn: A Three-Year Experience in a Tertiary Medical and Surgical Centre

Case Reports in Pediatrics ◽

10.1155/2020/8824556 ◽

2020 ◽

Vol 2020 ◽

pp. 1-3

Author(s):

Rebecca A Lee ◽

Theodore Dassios ◽

Ravindra Bhat ◽

Anne Greenough

Keyword(s):

Ovarian Cyst ◽

Skeletal Dysplasia ◽

Brain Mri ◽

Correct Diagnosis ◽

Medical Centre ◽

Medical Team ◽

Bilious Vomiting ◽

Surgical Unit ◽

Upper Gastrointestinal ◽

Contrast Studies

Background. Bilious vomiting in the newborn is common and requires urgent attention to exclude malrotation. The proportion of neonates with surgical abnormalities, however, is small, and there are other causes. Study Objectives. We reviewed our experience of infants with bilious vomiting to demonstrate the importance of input from the tertiary surgical and medical team to arrive at the correct diagnosis. Design. Admissions with bilious vomiting/aspirates of term born infants over a three-year period to a tertiary medical and surgical unit were reviewed. Results. During the study period, 48 infants were admitted with bilious vomiting. Forty-five infants had upper gastrointestinal (UGI) contrast studies, and only six had an abnormal study: four had malrotation and two had Hirschsprung’s disease. Of the infants with a normal UGI study, no cause was identified in 20 cases, 13 infants were treated for sepsis, one had a meconium plug, one an ovarian cyst, and two infants were polycythaemic. One infant was diagnosed with bilateral polymicrogyria (PMG) on brain MRI and another was found to have hypochondroplasia FGFR3 skeletal dysplasia. Conclusion. Neonates with bilious vomiting may have a variety of underlying diagnoses and need to be referred to a tertiary surgical and medical centre to ensure appropriate diagnosis is made.

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Contribution of acid and duodenogastrooesophageal reflux to oesophageal mucosal injury and symptoms in partial gastrectomy patients

Gut ◽

10.1136/gut.41.3.297 ◽

1997 ◽

Vol 41 (3) ◽

pp. 297-302 ◽

Cited By ~ 51

Author(s):

M F Vaezi ◽

J E Richter

Keyword(s):

Patient Group ◽

Partial Gastrectomy ◽

Mucosal Injury ◽

Acid Reflux ◽

Glass Electrode ◽

Oesophageal Reflux ◽

Upper Gi ◽

Gi Symptoms ◽

Upper Gastrointestinal

Background—The role of acid and pepsin in causing symptoms and oesophagitis is well established; however, the significance of duodenogastro-oesophageal reflux (DGOR) in this disorder is unclear.Aims—To understand the role of acid and DGOR in causing upper gastrointestinal (GI) symptoms and oesophageal mucosal injury in partial gastrectomy (PG) patients.Methods—Thirty two PG patients with upper GI symptoms were studied. Twenty four hour ambulatory acid and bilirubin measurements were obtained with Bilitec 2000 using glass electrode and fibreoptic sensor. Upper GI symptoms and oesophagitis were correlated with either acid or DGOR.Results—The PG patients were a heterogeneous group: 28% (9/32) had mixed reflux (acid+/DGOR+); 50% (16/32) had only DGOR (acid−/DGOR+); and 22% (7/32) had neither (acid−/DGOR−). Upper GI symptoms were associated with both mixed reflux (69%) and DGOR (24%). Six patients (67%) in the acid+/DGOR+ group had oesophagitis; no acid−/DGOR+ or acid−/DGOR− patients had oesophagitis. Mixed reflux showed a significant (p<0.0001) association with oesophagitis, while DGOR did not (p=0.3).Conclusions—(1) The majority of upper GI symptoms and all cases of oesophagitis in the PG patients occurred in patients who had mixed refluxate (acid and DGOR); (2) DGOR without simultaneous acid reflux may cause symptoms, but was not associated with oesophagitis in this patient group.

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