scholarly journals Outcome of Surgery for Pediatric Gastroesophageal Reflux: Clinical and Endoscopic Follow-up after 300 Fundoplications in 279 Consecutive Patients

2017 ◽  
Vol 107 (1) ◽  
pp. 68-75 ◽  
Author(s):  
A. I. Koivusalo ◽  
M. P. Pakarinen
Keyword(s):  
Gastroesophageal Reflux ◽  
Confidence Interval ◽  
Esophageal Atresia ◽  
Risk Ratio ◽  
Ph Monitoring ◽  
Anastomotic Stricture ◽  
Symptom Control ◽  
Neurological Impairment ◽  
Underlying Disorder

Purpose: Clinical and endoscopic assessment of the outcome after fundoplication for pediatric gastroesophageal reflux. Basic procedures: Hospital records of 279 consecutive patients who underwent fundoplication for gastroesophageal reflux from 1991 to 2014 were reviewed. Underlying disorders, clinical and endoscopic findings, imaging studies, pH monitoring, and surgical technique were assessed. Main outcome measures were patency of fundoplication, control of symptoms and esophagitis, complications, redo operations, and predictive factors of failures. Main results: A total of 279 patients underwent 300 fundoplications (277 primaries and 23 redos). Underlying disorders in 217 (72%) patients included neurological impairment (28%) and esophageal atresia (22%). Indications for fundoplication included recalcitrant gastroesophageal reflux symptoms (44%), failure to thrive (22%), respiratory symptoms (15%), esophageal anastomotic stricture (4%), apneic spells (2%), and regurgitation (2%). Preoperative endoscopy was performed in 92% and pH monitoring in 49% of patients. Median age at primary fundoplication was 2.2 ((IQR = 0.5–7.5)) years. Fundoplication was open in 205 (74%; Nissen n = 63, Boix-Ochoa n = 97, Toupet n = 39, and other n = 6), laparoscopic in 72 (24%; Nissen n = 67 and Toupet n = 5), and included hiatoplasty in 73%. Clinical follow-up was a median of 3.9 (IQR = 1.2–9.9) years. Mortality related to surgery was 0.3%. Symptom control was achieved in 87% of patients, and esophagitis rate decreased from 65% to 29% (p < 0.001). Fundoplication failed in 41 (15%) patients. Failure was predicted by esophageal atresia risk ratio = 3.9 (95% confidence interval = 1.3–11, p = 0.01), any underlying disorder risk ratio = 3.1 (95% confidence interval = 1.1–9.1, p = 0.04), and hiatoplasty risk ratio = 2.6 (95% confidence interval = 1.1–6.6, p = 0.03). Of the 23 redo-fundoplications, 32% failed. Conclusion: The majority of patients who underwent fundoplication had an underlying disorder. Primary fundoplication provided control of symptoms in almost 90% of patients and also reduced the rate of esophagitis. Failure of primary fundoplication occurred in 15% of patients, and an underlying disorder, esophageal atresia, and hiatoplasty increased the risk of failure.

scholarly journals Lung Cancer Mortality in the Lung Screening Study Feasibility Trial

2018 ◽  
Vol 2 (3) ◽  
Author(s):  
Maryam Doroudi ◽  
Paul F Pinsky ◽  
Pamela M Marcus
Keyword(s):  
Lung Cancer ◽  
Confidence Interval ◽  
Risk Ratio ◽  
Feasibility Trial ◽  
Lung Cancer Death ◽  
All Cause Mortality ◽  
Screening Study ◽  
Lung Screening

Abstract The Lung Screening Study was a multicenter controlled feasibility trial that randomly assigned subjects to undergo two rounds of screening with either low-dose spiral computed tomography (LDCT) or chest X-ray (CXR). Long-term follow-up was performed to evaluate any differences in lung-cancer-specific and all-cause mortality between arms. In 2000, subjects were randomly assigned at six screening centers. Linkage with the National Death Index was performed to ascertain long-term mortality for subjects. Median follow-up for mortality of the 1660 and 1658 subjects randomly assigned to LDCT and CXR, respectively, was 5.2 years. There were 32 and 26 deaths from lung cancer in the two groups, respectively, corresponding to lung cancer death rates of 3.84 and 3.10 per 1000 person-years, and a risk ratio of 1.24 (95% confidence interval = 0.74 to 2.08). The risk ratio for all-cause mortality was 1.20 (95% confidence interval = 0.94 to 1.54). These findings can contribute to the overall knowledge on LDCT lung cancer screening.

scholarly journals Can pH Monitoring Predict Gastric Emptying Measured by <sup>13</sup>C-Acetate Breath Test in Gastroesophageal Reflux with Neurological Impairment?

2014 ◽  
Vol 05 (01) ◽  
pp. 20-24
Author(s):  
Tadao Okada ◽  
Shohei Honda ◽  
Hisayuki Miyagi ◽  
Masashi Minato ◽  
Akinobu Taketomi
Keyword(s):  
Gastric Emptying ◽  
Gastroesophageal Reflux ◽  
Breath Test ◽  
Ph Monitoring ◽  
Neurological Impairment

DOZ047.76: Eosinophilic esophagitis and esophageal atresia. Is there an association?

2019 ◽  
Vol 32 (Supplement_1) ◽  
Author(s):  
L García ◽  
C Giné ◽  
A Laín ◽  
M Martín ◽  
J A Molino ◽  
...  
Keyword(s):  
Gastroesophageal Reflux ◽  
Diagnostic Criteria ◽  
Esophageal Atresia ◽  
Eosinophilic Esophagitis ◽  
Esophageal Mucosa ◽  
Early Puberty ◽  
High Power Field ◽  
Esophageal Biopsy ◽  
Macroscopic Appearance

Abstract Aim of the Study Eosinophilic esophagitis (EoE) is a recently diagnosed entity and seems to be more prevalent in patients with esophageal atresia (EA). It can mimic dysphagia and gastroesophageal reflux (GER) symptoms frequently observed in EA, but treatment is different. Methods Retrospective review (2002–2019) of patients with EA who underwent esophagogastroduodenoscopy (EGD) and esophageal biopsy was performed. EGD was performed in symptomatic patients and in all patients at 12–15 years. Diagnostic criteria for EoE included >15 eosinophils for a high-power field in the esophageal mucosa. Main Results From a total of 110 patients with EA, 27 lost follow-up. In the remaining 83, 56 patients (67, 5%) underwent EGD because of dysphagia or gastroesophageal reflux (GER) studies. Esophageal biopsies were performed in 35 patients and the diagnostic criteria for EoE were achieved in 5 (14,3%). The mean age at diagnosis of EoE was 10 + 2 years and the indication for EGD was GER symptoms (3) or dysphagia (2). In one case an antireflux surgery was previously performed but symptoms slightly persisted, while in 4 cases contrast studies and pH-metry showed no or minimal GER. EGD demonstrated light distal esophagitis in 2 cases, white exudates in 2, and was completely normal in the remaining one. On follow-up, 4 patients remain asymptomatic with proton pump inhibitor medication, and periodic EGD shows macroscopic improvement with a decreased eosinophilic peak on esophageal biopsies. Conclusions Patients with EA seem to have a higher risk of developing EoE at early puberty. EGD on follow-up should be focused not only on studying GER or Barrett, but also on actively search for EoE with an esophageal biopsy, even when the macroscopic appearance is normal.

scholarly journals SLEEVE GASTRECTOMY AND FUNDOPLICATION AS A SINGLE PROCEDURE IN PATIENTS WITH OBESITY AND GASTROESOPHAGEAL REFLUX

2017 ◽  
Vol 30 (3) ◽  
pp. 216-221 ◽  
Author(s):  
Juan Pablo LASNIBAT ◽  
Italo BRAGHETTO ◽  
Luis GUTIERREZ ◽  
Felipe SANCHEZ
Keyword(s):  
Sleeve Gastrectomy ◽  
Gastroesophageal Reflux ◽  
Hiatal Hernia ◽  
Revision Surgery ◽  
Ph Monitoring ◽  
Obese Patients ◽  
Group A ◽  
Clinical Records

ABSTRACT Background: Bariatric surgery in Chile has seen an exponential increase in recent years, especially in sleeve gastrectomy. Its use is currently discussed in patients suffering from gastroesophageal reflux disease. Different options have been considered for the management of these patients but up to now laparoscopic Roux-en-Y gastric bypass seems to be the best option. Sleeve gastrectomy plus concomitant fundoplication or hiatal hernia repair also has been suggested in patients having reflux or small hiatal hernia. Aim: To present a cohort of obese patients with gatroesophageal reflux undergoing this procedure, which seeks to provide the benefits of both laparoscopic gastric sleeve (LSG) and antireflux surgery focused on the evaluation of presence of reflux and BMI after surgery, and to compare the result observed in this cohort with a previous group of obese patients without reflux submitted to sleeve gastrectomy alone. Methods: Retrospective case series in 15 patients who underwent this surgery between the years 2003 and 2012. Clinical records were analyzed and values of 24 hr pH monitoring, esophageal manometry and clinical outcome were recorded. Results were compared to a previous series of patients who underwent LSG. No statistical analyses were made. Results: Group A consisted of 15 patients submitted to LSG plus fundoplication. 93% (n=14) were female. Mean age was 46.2 years. Mean preoperative body mass index (BMI) was 33.9. All patients had altered pH monitoring and manometry preoperatively. There was one minor complication corresponding to a seroma. There was no perioperative mortality. Group B consisted of 23 obese patients who underwent LSG. These patients developed de novo reflux, hypotensive LES and esophagitis after the surgery. Group A patients showed improvement in esophageal pH monitoring and manometry at three months. During long-term follow-up, six underwent revision surgery, four for weight regain, one regained weight associated with symptomatic reflux, and one underwent re-intervention for reflux. Conclusions: Good results are observed in the short-term follow up in both reflux resolution and weight loss. Nevertheless, results at long term are discouraging, with 53.3% of the patients requiring revision surgery during follow-up.

Gastroesophageal Reflux and Related Pathology in Adults Who Were Born With Esophageal Atresia: A Long-Term Follow-up Study

2007 ◽  
Vol 5 (6) ◽  
pp. 702-706 ◽  
Author(s):  
Andrew C.F. Taylor ◽  
Kerry J. Breen ◽  
Alex Auldist ◽  
Anthony Catto–Smith ◽  
Tom Clarnette ◽  
...  
Keyword(s):  
Gastroesophageal Reflux ◽  
Esophageal Atresia ◽  
Follow Up Study ◽  
Long Term Follow Up

Assessment and Treatment of Gastroesophageal Reflux in Healthy Infants With Apneic Episodes

2011 ◽  
Vol 50 (12) ◽  
pp. 1096-1102 ◽  
Author(s):  
Antti I. Koivusalo ◽  
Mikko P. Pakarinen ◽  
Anne Wikström ◽  
Risto J. Rintala
Keyword(s):  
Gastroesophageal Reflux ◽  
Ph Monitoring ◽  
Pathological Finding ◽  
Treatment Modalities ◽  
Main Indication ◽  
Diagnostic Measures ◽  
Healthy Infants ◽  
Esophageal Ph ◽  
Assessment And Treatment

This retrospective study sought to assess whether gastroesophageal reflux (GER) is associated with recurrent infant apneic episodes (AEs) and whether its treatment prevents AEs. Symptoms, diagnostic measures, and treatment of GER in 87 infants admitted for AEs were recorded. The effect of GER on recurrent AEs and survival were assessed. Esophageal pH monitoring was done to 58/87 (67%) patients, of whom 53/58 (91%) had a pathological finding; 48 patients had treatment for GER (medical 43%/49%; surgical 5%/6%) with continuing AEs during hospitalization (25%/29% patients) as the main indication. Follow-up (65 patients) disclosed recurrent AEs in 12 (18%) patients (no treatment 4/21, medical 8/39, surgical 0/5, P = NS). All 87 patients survived. Recurrent AEs after discharge was predicted by AEs during hospitalization but not by pathological GER. AEs observed during hospitalization predicted postdischarge AE recurrence. Of GER treatment modalities, only surgery prevented recurrent AEs.

DOZ047.60: Evaluation of gastroesophageal reflux in children born with esophageal atresia using pH and impedance monitoring

2019 ◽  
Vol 32 (Supplement_1) ◽  
Author(s):  
F W T Vergouwe ◽  
M P van Wijk ◽  
C A ten Kate ◽  
M C W Spaander ◽  
M J Bruno ◽  
...  
Keyword(s):  
Gastroesophageal Reflux ◽  
Esophageal Atresia ◽  
Measurement Data ◽  
Tube Feeding ◽  
Impedance Analysis ◽  
Esophageal Replacement ◽  
Acid Therapy ◽  
School Aged Children ◽  
The Mean

Abstract Aim of the Study The ESPHGAN-NASPGHAN guideline (Krishnan, 2016) recommends routine prescription of proton pump inhibitors in the first year of life after esophageal atresia (EA) repair, and to monitor gastroesophageal reflux (GER) using pH-impedance (pH-MII) monitoring and/or endoscopy at time of discontinuation and during long term follow up of these patients. This study aimed to evaluate acid and non-acid GER in infants and school-aged children with EA using pH-MII monitoring. Methods Children born with EA between 2011–2017, who underwent a 24-hour pH-MII study during infancy (≤18 months) or at 8 years old as part of a standardized longitudinal follow-up program, were included. Exclusion criteria were: isolated tracheoesophageal fistula, esophageal replacement therapy, tube feeding and monitoring < 18 hours. Anti-acid therapy was discontinued before pH-MII measurement. Data was collected on reflux index (RI; exposure to pH < 4 in %, >7% considered abnormal), retrograde bolus movements (RBM) and bolus clearance time (BCT). Automatically detected RBM were manually reviewed and modified/deleted if necessary. Results We included 57 children (51% male, 2% isolated EA, 44% thoracoscopic repair): 24 infants (median age 0.6 years) and 33 school-aged children (median age 8.2 years). In infants, median RI was 2.6% (abnormal in n = 2), median RBM was 61 (62% non-acid, 58% mixed) and median of the mean BCT was 11 seconds. In school-aged children, median RI was 0.3% (abnormal in n = 4), median RBM was 21 (64% non-acid, 75% mixed) and median of the mean BCT was 13 seconds. Of the automatically detected 3,313 RBM, 1,292 were manually deleted from the tracings: 52% of non-acid RBM and 8% of acid RBM (mainly misinterpreted swallows or one event recognized as several events). Conclusions Most children with EA off medication have a normal RI, yet experience a significant number of non-acid RBM. After manual revision of the tracings a high percentage of RBM was deleted. Our data show that automated impedance analysis software needs refinement for use in infants and children with EA, and question the need for standard anti-acid therapy in these patients.

DOZ047.48: Postoperative anastomotic stricture after the operation for esophageal atresia

2019 ◽  
Vol 32 (Supplement_1) ◽  
Author(s):  
M Wolski ◽  
A Jasińska ◽  
A Kamiński
Keyword(s):  
Gastroesophageal Reflux ◽  
Esophageal Atresia ◽  
Satisfactory Result ◽  
Postoperative Period ◽  
Stent Placement ◽  
Anastomotic Stricture ◽  
Early Postoperative Period ◽  
Anastomotic Site ◽  
Common Complication ◽  
Single Calibration

Abstract Introduction Anastomotic stricture is the most common complication after the treatment of esophageal atresia. It occurs in 20–80% of operated patients. Predisposing factors are the leakage of the anastomosis, undertension anastomosis, elongation, and gastroesophageal reflux. A few dilation techniques are being utilized. Material and Methods Between 2006 and 2018, 79 patients with esophageal atresia were treated in the clinic. Primary or delayed anastomosis was possible in 69 patients. Five patients died in the early postoperative period. Clinical data of the remaining 64 patient were analyzed retrospectively. Results All anastomoses were calibrated with either bougie or balloon dilators. The anticipated diameter of the anastomosis was acquired during calibration in 24 patients (seven of these with bougie and 17 with balloon dilations). The total number of bougie dilations was 29 and balloon dilations 35. The stricture was present in 40 patients. In this group under—tension anastomoses were present in 25 patients, anastomotic leakage in 13 (81% of all leaks), gastroesophageal reflux in 14 (66% of all refluxes). The stricture was dilated with the balloon in 22 cases, bougie in 18 cases, stent placement in 3 cases. The number of required dilations was most often 2 or 3. In 4 patients multiple dilations were necessary. Dilating procedures were finished with a satisfactory result before the age of 6 months in 26 patients, 12 months in 13 and 24 months in 5 patients. Rupture of the anastomotic site during dilation occurred in 4 patients. Conclusions Anastomotic stricture occurred in 63% of patients. The majority of the undertension and leaking anastomoses were complicated with stricture. A single calibration with balloon was successful in 49% of cases compared to 24% bougie calibrations. In 59% of dilated patients, the procedure was finished before the age of 6 months, which enabled physiological feeding pattern.

scholarly journals Long-Term Administration of Tolvaptan in Autosomal Dominant Polycystic Kidney Disease

2018 ◽  
Vol 13 (8) ◽  
pp. 1153-1161 ◽  
Author(s):  
Marie E. Edwards ◽  
Fouad T. Chebib ◽  
Maria V. Irazabal ◽  
Troy G. Ofstie ◽  
Lisa A. Bungum ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Confidence Interval ◽  
Polycystic Kidney Disease ◽  
Risk Ratio ◽  
Autosomal Dominant ◽  
Baseline Risk ◽  
Polycystic Kidney ◽  
Open Label ◽  
Autosomal Dominant Polycystic Kidney

Background and objectivesIn the 3-year Tolvaptan Efficacy and Safety in Management of ADPKD and Its Outcomes (TEMPO) 3:4 and 1-year Replicating Evidence of Preserved Renal Function: an Investigation of Tolvaptan Safety and Efficacy in ADPKD (REPRISE) trials, tolvaptan slowed the decline of eGFR in patients with autosomal dominant polycystic kidney disease at early and later stages of CKD, respectively. Our objective was to ascertain whether the reduction associated with the administration of tolvaptan is sustained, cumulative, and likely to delay the need for kidney replacement therapy.Design, setting, participants, & measurementsOne hundred and twenty-eight patients with autosomal dominant polycystic kidney disease participated in clinical trials of tolvaptan at the Mayo Clinic. All had the opportunity to enroll into open-label extension studies. Twenty participated in short-term studies or received placebo only. The remaining 108 were analyzed for safety. Ninety seven patients treated with tolvaptan for ≥1 year (mean±SD, 4.6±2.8; range, 1.1–11.2) were analyzed for efficacy using three approaches: (1) comparison of eGFR slopes and outcome (33% reduction from baseline eGFR) to controls matched by sex, age, and baseline eGFR; (2) Stability of eGFR slopes with duration of follow-up; and (3) comparison of observed and predicted eGFRs at last follow-up.ResultsPatients treated with tolvaptan had lower eGFR slopes from baseline (mean±SD, −2.20±2.18 ml/min per 1.73 m2 per year) and from month 1 (mean±SD, −1.97±2.44 ml/min per 1.73 m2 per year) compared with controls (mean±SD, −3.50±2.09 ml/min per 1.73 m2 per year; P<0.001), and lower risk of a 33% reduction in eGFR (risk ratio, 0.63; 95% confidence interval, 0.38 to 0.98 from baseline; risk ratio, 0.53; 95% confidence interval, 0.31 to 0.85 from month 1). Annualized eGFR slopes of patients treated with tolvaptan did not change during follow-up and differences between observed and predicted eGFRs at last follow-up increased with duration of treatment.ConclusionsFollow-up for up to 11.2 years (average 4.6 years) showed a sustained reduction in the annual rate of eGFR decline in patients treated with tolvaptan compared with controls and an increasing separation of eGFR values over time between the two groups.

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