Retrograde Placement of Ring-Bolster Retained Tubes Facilitates Gastrostomy to Gastrojejunostomy Revision in Children with Esophageal Pathology and Microgastria

Techniques for gastrostomy revision to gastrojejunostomy within the pediatric population, who have failed initial tube placement due to obstructive pathologies, have not been well established. Novel techniques are required to improve outcomes for these patients, and these techniques must be evaluated for both viability and safety. This article describes a technique utilized for gastrostomy to gastrojejunostomy revision and the outcomes for three pediatric patients.

MODERN CONCEPTS OF HEARTBURN PATHOGENESIS

Heartburn is one of the most widely spread symptoms particularly in population of economically developed Western countries. Traditionally it is considered to be related to activation of chemo- and mechanoreceptors of esophageal primary sensory neurons. Repeated stimulation may provoke visceral sensitization. Its development is facilitated by the stress hormone corticotropin-releasing factor. An attentive analysis of heartburn with an assessment of the provoking factors and effectiveness of drug therapy is required for differentiation of gastro-intestinal reflux disease and functional esophageal disease. The lack of response to proton pump inhibitors is an important criterion for suspicion on functional esophageal pathology although sensitization also plays an important role in genesis of heartburn in non-erosive reflux disease. In cases of refractory and «endoscopically negative heartburn», additional studies are justified: endoscopy with esophageal biopsies, 24h-pH-metry/pH-impedansometry, high-resolution manometry. Proton pump inhibitors, highly effective in reflux disease, may relieve heartburn only in some cases of functional heartburn and reflux hypersensitivity. In functional diseases medical therapy affecting visceral hypersensitivity may be used empirically.

Formulation of a 3-months Stability Oral Viscous Budesonide Gel and Development of an Indicating Stability HPLC Method

Background Eosinophilic Esophagitis is an increasing pathology which can cause stomach symptom like dysphagia, vomiting, food blockage. The treatment consists in dietary therapy and topical corticosteroid therapy to avoid the important number of side effects of the oral corticosteroids. There is presently no available topical form adapted for treating esophageal pathology. Methods The aim of this work was to develop an oral viscous budesonide gel (OVBG). A focus on palatability was made in order to use OVBG in children. A stability indicating HLPC method able to quantify budesonide contained in our OVBG has been developed. Results Previous work of Hefner and Al. showed that xanthan gum had a longer esophageal mucosal contact time than sucralose. This encouraged the development of a xanthan gum-based formulation. This OVBG has also the advantage to facilitate compliance thanks to its taste and pleasant texture. The stability length of the preparation can be extended over a 3-months period, stored in a refrigerator at 2–8 °C. Conclusion An adapted pediatric formulation with a 3-months stability was developed. Furthermore, the formulation can be easily reproduced in community pharmacy. Regarding the increasing number of patients concerned OVBG is a good answer to a real clinical need.