DOZ047.122: Inadequate response of atretic esophagus during acidic gastroesophageal reflux

2019 ◽  
Vol 32 (Supplement_1) ◽  
Author(s):  
M Scaillon ◽  
S Cadranel
Keyword(s):  
Gastroesophageal Reflux ◽  
Motor Function ◽  
Motor Response ◽  
Acid Reflux ◽  
Motility Disorder ◽  
Inadequate Response ◽  
Total Transmission ◽  
Prolonged Monitoring ◽  
Altered Sensitivity ◽  
Ph Metry

Abstract Patients with atretic esophagus (OA) are candidates to severe gastroesophageal reflux. In a previous study, we observed that in OA operated children the complete transmission of contractions during the whole day and during acid reflux periods is poor compared to controls (C). Investigate the motor response of OA during periods of meal (M) and periods of acid reflux (GOR) in OA patients. Methods Prolonged monitoring of esophageal motor function recorded with three sensors: P1 above and P2, P3 below the suture, combined with pH-metry between P2 and P3. Number/min and amplitude of contractions and transmissions between P1-2-3 or P2-3 are compared during total time, meal and reflux periods and between OA with or without GOR. Population 13 operated patients (OA) mean age 7.75 years and 10 controls (C). Results Contractions/min in OA at P1 M = 1.4 SD 1.2 versus GOR = 0.8 SD 1.1: P < 0.05 at P2 M = 2.0 SD 1.4 versus GOR = 1.4 SD1.4: P < 0.05 at P3 M = 2.2 SD 1.3 versus GOR = 1.5 SD1.4: P < 0.05 Complete transmission (P1-2-3) in OA during M compared with total time (T) is increased (29 vs. 32%: P < 0.5), but not during GOR (29 vs. 28%: NS). No difference in distal transmission (P2-3) between C and OA during M (68.8 vs. 63.2) but difference during GOR (69.8 vs. 43 P < 0.01). Contractions/min are not different during M between 7/13 patients with normal (OAN) and 6/13 with abnormal (OAR) reflux index but differ during GOR: P2 OAN = 2.1 vs. P2 OAR = 0.6, P < 0.01; P3 OAN = 2.2 vs. OAR = 0.6, P < 0.05. Complete transmission (P1-2-3) in OAN is not different during M or GOR but different in OAR (M: 74.2 SD 33.5 vs. GOR 54.7 SD 30.5: P < 0.005); distal transmission (P2-3) is not different between OAN and OAR during M and RGO periods. Conclusion Esophageal motility remains impaired in the operated OA. GOR stimulations produce weaker responses than meals. In OAR alterations of response to GOR are more important in terms of decreased number of distal contractions and total transmission suggesting a motility disorder but also an altered sensitivity reducing primary peristaltic response to reflux.

scholarly journals Frequent Sips of the Water for the Management of Gastroesophageal Reflux Induced Refractory Cough: A Case Report and Review of the Literature

2019 ◽  
Vol 2019 ◽  
pp. 1-5
Author(s):  
Hassan Tariq ◽  
Jasbir Makker ◽  
Rafeeq Ahmed ◽  
Trupti Vakde ◽  
Harish Patel
Keyword(s):  
Gastroesophageal Reflux ◽  
Surgical Management ◽  
Chronic Cough ◽  
Acid Reflux ◽  
Abdominal Pressure ◽  
Sphincter Pressure ◽  
Inadequate Response ◽  
High Resolution Manometry ◽  
Nonacid Reflux ◽  
Ambulatory Ph

Background. Chronic cough is often associated with gastroesophageal reflux disease (GERD). The role of gastroenterologist in the management of the chronic cough is to identify and manage GERD. Ineffective esophageal motility is often associated with GERD induced cough. Chronic cough is often refractory to medical and surgical management despite adequate acid control. Unresponsiveness warrants a thorough pulmonary evaluation. The pathophysiology of refractory cough in these patients is poorly understood, and hence management is often challenging. Case Presentation. A 75-year-old woman from Ghana was evaluated for GERD associated chronic cough. A 48-hour ambulatory pH study revealed acid exposure of 4.9% and high-resolution manometry showed decreased lower esophageal sphincter pressure, an inadequate response to medical and surgical management of GERD. Postfundoplication ambulatory pH testing demonstrated well-controlled acid reflux but her cough still persisted. Repeat manometry showed an ineffective motility disorder (IEM). Taking frequent sips of water eventually resolved her chronic cough. Conclusion. Frequent sips of water can be used in the management of the gastroesophageal reflux and ineffective motility induced cough. It results in increased esophageal clearance of acid, nonacid reflux, and ingested pharyngeal secretions, thus breaking the cycle of cough generated increased intra-abdominal pressure with reflux and more cough.

scholarly journals AB0545 GASTROINTESTINAL INVOLVEMENT IN SYSTEMIC SCLEROSIS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1569.2-1569
Author(s):  
A. Argibay ◽  
I. Novo ◽  
M. Ávila ◽  
P. Diéguez González ◽  
M. Estévez Gil ◽  
...  
Keyword(s):  
Systemic Sclerosis ◽  
Gastroesophageal Reflux ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Biliary Tree ◽  
Motility Disorder ◽  
Anatomical Site ◽  
Digital Ulcers ◽  
Lung Involvement ◽  
Imaging Results

Background:Systemic sclerosis (SSc) is a chronic, connective tissue disease with an autoimmune pattern characterized by inflammation, fibrosis and microcirculation changes leading to internal organs malfunctions. The gastrointestinal tract (GIT) is affected in up to 90% of patients with SSc. Any part of the GIT from the mouth to the anus can be affected. There are few descriptive studies about SSc-related GIT involvement.Objectives:We aimed to characterize the GIT involvement in patients with SSc.Methods:This retrospective study included all patients from SSc cohort of our autoimmune diseases unit in a tertiary referral centre. All patients fulfilled SSc criteria proposed by the American College of Rheumatology. All subjects’ histories were evaluated. Laboratory and imaging results were obtained from the hospital files. Patients with digestive manifestations were compared with patients without GIT involvement. Chi2 and t-student were used, using the statistical package SPSS25.0.Results:83 subjects with SSc were included, 68 (81,9%) of them were women. The mean age at the onset of SSc was 62,1 ± 15,3 years (range 26-89) with a mean follow-up of 9,6 ± 7,4 years. 80,7% of patients had limited SSc, 12% diffuse SSc, 4.8% SSc sine scleroderma and 2,4% early SSc. Considering the immunological profile 12 (14,5%) had Scl70 antibodies, 49 (59%) anticentromere and 21 (25,3%) had ANA antibodies without specificity for anti-Scl70 or anticentromere. 37,3% patients had lung involvement, 20,5% scleroderma and 30,1% digital ulcers. 79,5% of SSc patients were treated with proton pump inhibitors or H2 blockers. 53 (63,9%) patients with SSc had GIT involvement. In 11 patients (20,7%) digestive involvement was diagnosed before SSc (mean 26,2 months). Esophageal involvement occurred in 83%, gastric involvement in 28,3%, intestine involvement in 24,5% and liver and biliary tree involvement in 26,4%. See table 1. No significant differences in age, sex, SSc subtype, autoantibody profile, lung involvement, skin disease, mortality and therapy were observed between patients with or without GIT manifestations. There were no deaths associated with GIT involvement. The most common pharmacologic therapy used was proton pump inhibitors (86,8%), domperidone (20,8%) and antibiotic rotation (17%).EsophagealGastricIntestinalLiver and biliary tree44/53 (83%)15/53 (28,3%)12/53 (24,5%)14/53 (26,4%)Esophageal motility disorder 8 (15,1%)Gastroparesis 6 (11,3%)Small bacterial overgrowth 7 (13,2%)Primary biliary cholangitis 9 (17%)Gastroesophageal reflux 40 (75,5%)Abdominal pain /nausea 10 (18,9%)Colonic inertia 1 (1,9%)Autoimmune hepatitis 3 (5,7%)Dysphagia 11 (20,8%)Subacute gastritis 7 (13,2%)Diarrhea 6 (11,3%)Cholestatic liver enzymes 11 (20,8%)Flatulence / abdominal discomfort 6 (11,3%)Cirrhosis 2 (3,8%)Conclusion:Almost two thirds of our cohort of SSc have symptomatic gastrointestinal disease. GIT manifestations are heterogeneous. Symptoms are non-specific and overlapping for a particular anatomical site. Esophagus is the most commonly affected. More than seventy-five per cent of patients experience symptoms of gastroesophageal reflux. We did not find differences among patients with and without SSc GIT disease. 17% of patients had a Reynold’s syndrome.References:[1]Alastal Y et al. Gastrointestinal manifestations associated with systemic sclerosis: results from the nationwide inpatient simple. Ann Gastroenterol 2017; 30 (5): 1-6.[2]Savarino E et al. Gastrointestinal motility disorder assessment in systemic sclerosis. Rheumatology. 2013; 52(6):1095–100.[3]Steen VD et al. Severe organ involvement in systemic sclerosis with diffuse scleroderma. Arthritis and rheumatism. 2000; 43(11):2437–44.Disclosure of Interests:None declared

P.1.170: BODY MASS INDEX AND GASTROESOPHAGEAL REFLUX ASSESSED BY PH-METRY

2011 ◽  
Vol 43 ◽  
pp. S204
Author(s):  
V. D'Onofrio ◽  
M. Bruno ◽  
N. Giardullo ◽  
R. Melina ◽  
R. D'Onofrio ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Gastroesophageal Reflux ◽  
Body Mass ◽  
Ph Metry

scholarly journals Gastroesophageal Reflux in Critically Ill Children: A Review

2013 ◽  
Vol 2013 ◽  
pp. 1-8 ◽  
Author(s):  
Maria José Solana García ◽  
Jesús López-Herce Cid ◽  
César Sánchez Sánchez
Keyword(s):  
Gastroesophageal Reflux ◽  
Critically Ill ◽  
Critically Ill Children ◽  
Esophageal Mucosa ◽  
Duration Of Action ◽  
Nasogastric Tubes ◽  
Intraluminal Impedance ◽  
High Incidence ◽  
Antireflux Barrier ◽  
Ph Metry

Gastroesophageal reflux (GER) is very common in children due to immaturity of the antireflux barrier. In critically ill patients there is also a high incidence due to a partial or complete loss of pressure of the lower esophageal sphincter though other factors, such as the use of nasogastric tubes, treatment with adrenergic agonists, bronchodilators, or opiates and mechanical ventilation, can further increase the risk of GER. Vomiting and regurgitation are the most common manifestations in infants and are considered pathological when they have repercussions on the nutritional status. In critically ill children, damage to the esophageal mucosa predisposes to digestive tract hemorrhage and nosocomial pneumonia secondary to repeated microaspiration. GER is mainly alkaline in children, as is also the case in critically ill pediatric patients. pH-metry combined with multichannel intraluminal impedance is therefore the technique of choice for diagnosis. The proton pump inhibitors are the drugs of choice for the treatment of GER because they have a greater effect, longer duration of action, and a good safety profile.

GASTROESOPHAGEAL REFLUX IN NEWBORNS AND INFANTS (II)

2016 ◽  
Vol 65 (1) ◽  
pp. 10-14
Author(s):  
Valeriu V. Lupu ◽  
◽  
Ancuta Ignat ◽  
Gabriela Paduraru ◽  
Marin Burlea ◽  
...  
Keyword(s):  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
Gastric Acidity ◽  
Pharmacological Therapy ◽  
Digestive Endoscopy ◽  
Functional Immaturity ◽  
Esophageal Sphincter ◽  
Medical Recommendations ◽  
Ph Metry ◽  
Infants Feeding

Gastroesophageal reflux in newborns and infants is particularized by pathogeny, diagnosis and therapeutic approach, functional immaturity of the digestive tract, the anatomic immaturity of the Hiss lower esophageal sphincter and lower gastric acidity. In infants, the low compliance with the laborious procedures such as pH-metry, impedance – pH-metry and digestive endoscopy is also considered. The border between regurgitations, physiological gastroesophageal reflux and the reflux disease is sometimes hard to establish. Changing the lifestyle of infants (feeding and position changes) based on the mother’s compliance with the medical recommendations is a first step in the treatment of GER, followed in non-responsive cases by pharmacological therapy and surgery

scholarly journals Gastroesophageal Reflux and Wheezing in Pediatry pH-metry studies

2019 ◽  
Vol 70 (7) ◽  
pp. 2668-2670
Author(s):  
Alina Mihaela Elisei ◽  
Dana Tutunaru ◽  
Camelia Ana Grigore ◽  
Ciprian Adrian Dinu ◽  
Laura Florescu ◽  
...  
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
Pediatric Practice ◽  
First Semester ◽  
Esophageal Ph ◽  
Esophageal Sphincter ◽  
Specific Symptoms ◽  
Acidity Level ◽  
Ph Metry

Analysis of esophageal pH is useful and recommended by specialists when the gastroesophageal reflux disease does not show specific symptoms such as chest pain or burnings, but a form of asthma and chronic cough. The investigation is performed after a mild anesthesia, inserting a thin and flexible catheter in the patient�s nostril; it reaches the esophagus, particularly the esophageal sphincter that connects the stomach to the esophagus. The catheter has a sensor that monitors the acidity level, the number of reflux episodes, their duration and the part of the esophagus reached by the acid in the stomach. Gastroesophageal reflux disease is frequently met in pediatric practice, rooting in the intrauterine life, a physiologic phenomenon in infants during the first semester of life.

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