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Sample records for acid reflux episodes

  1. Esophageal motility in nonacid reflux compared with acid reflux.

    PubMed

    Wang, Victor S; Feldman, Natan; Maurer, Rie; Burakoff, Robert

    2009-09-01

    Esophageal motility has been well studied in gastroesophageal reflux disease (GERD) and acid reflux, but not in nonacid reflux. Consecutive patients who had both 24-h multichannel intraluminal impedance-pH (MII-pH) and esophageal motility tests for suspected GERD were studied. Patients were grouped into nonacid refluxers, acid refluxers, and nonrefluxers based on positive symptom correlation and objective findings of acid reflux. Of 96 patients enrolled, 21 patients (22%) were nonacid refluxers, 44 patients (46%) were acid refluxers, and 31 patients (32%) had no objective evidence of reflux. Normal motility was recorded in 86% of nonacid refluxers, 71% of acid refluxers, and 60% of nonrefluxers. Ineffective esophageal motility was seen in 24% of acid refluxers, and 5% of nonacid refluxers (P = 0.11). Symptomatic nonacid reflux events comprised 22% of patients studied for GERD symptoms by MII-pH. Esophageal motility in nonacid reflux is normal 86% of the time.

  2. Acid Rather than Non-Acid Reflux Burden is a Predictor of Tooth Erosion

    PubMed Central

    Ganesh, Meenakshi; Hertzberg, Anne; Nurko, Samuel; Needleman, Howard; Rosen, Rachel

    2015-01-01

    Objectives The relationship between tooth erosion (TE) and gastroesophageal reflux (GER) in children has not been clearly established and there are no studies to determine the relationship with refluxate height, non-acid reflux and erosions. The aim of this study was to determine the relationship between TE and acid and non-acid GER measured using combined pH and multichannel intraluminal impedance (pH-MII). Methods We conducted a prospective cohort study of children presenting for pH-MII testing. Once consented, patients completed questionnaires about their reflux symptoms and diet, and then underwent pH-MII catheter placement and a dental examination. The Keels-Coffield erosion index was used to score extent and severity of TE. Reflux parameters of patients with and without TE were compared using Student's t test. Results Twenty-seven patients participated in the study, all of whom were on acid suppression at the time of pH-MII testing. Ten out of 27 patients (37%) had TE. There were significant positive correlations between acid reflux episodes (r=0.44, p=0.02), the % time that acid reflux was present in the distal esophagus (r=0.44, p=0.02), and reflux index (r=0.54, p=0.004) with number of TE in a given patient. The % time that acid reflux was present in the proximal esophagus was positively correlated with the number of teeth erosions per patient with borderline significance (r=0.38, p=0.05). Conclusions There was a positive correlation between acid reflux parameters and TE. Acid, rather than non-acid reflux, seems to have a significant role in the pathogenesis of TE. PMID:26230904

  3. Toxic bile acids in gastro-oesophageal reflux disease: influence of gastric acidity

    PubMed Central

    Nehra, D; Howell, P; Williams, C; Pye, J; Beynon, J

    1999-01-01

    BACKGROUND—Bile acid toxicity has been shown in the gastric, colonic, and hepatic tissues; the effect on oesophageal mucosa is less well known. 
AIMS—To determine the spectrum of bile acids refluxing in patients with gastro-oesophageal reflux disease and its relation to oesophageal pH using a new technique of combined oesophageal aspiration and pH monitoring. 
METHODS—Ten asymptomatic subjects and 30 patients with symptoms of gastro-oesophageal reflux disease (minimal mucosal injury, erosive oesophagitis (grade 2 or 3 Savary-Miller), Barrett's oesophagus/stricture; n=10 in each group) underwent 15 hour continuous oesophageal aspiration with simultaneous pH monitoring. Bile acid assay of the oesophageal samples was performed using modified high performance liquid chromatography. 
RESULTS—The peak bile acid concentration and DeMeester acid scores were significantly higher in the patients with oesophagitis (median bile acid concentration 124 µmol/l; acid score 20.2) and Barrett's oesophagus/stricture (181 µmol/l; 43.3) than patients with minimal injury (14 µmol/l; 12.5) or controls (0 µmol/l; 11.1). The predominant bile acids detected were cholic, taurocholic, and glycocholic acids but there was a significantly greater proportion of secondary bile acids, deoxycholic and taurodeoxycholic acids, in patients with erosive oesophagitis and Barrett's oesophagus/stricture. Although bile acid reflux episodes occurred at variable pH, a temporal relation existed between reflux of taurine conjugates and oesophageal acid exposure (r=0.58, p=0.009). 
CONCLUSION—Toxic secondary bile acid fractions have been detected in patients with extensive mucosal damage. Mixed reflux is more harmful than acid reflux alone with possible toxic synergism existing between the taurine conjugates and acid. 

 Keywords: bile acids; reflux oesophagitis; Barrett's oesophagus PMID:10205192

  4. How reflux causes symptoms: reflux perception in gastroesophageal reflux disease.

    PubMed

    Weijenborg, Pim W; Bredenoord, Albert J

    2013-06-01

    In gastroesophageal reflux disease (GERD) symptoms arise due to reflux of gastric content into the oesophagus. However, the relation between magnitude and onset of reflux and symptom generation in GERD patients is far from simple; gastroesophageal reflux occurs several times a day in everyone and the majority of reflux episodes remains asymptomatic. This review aims to address the question how reflux causes symptoms, focussing on factors leading to enhanced reflux perception. We will highlight esophageal sensitivity variance between subtypes of GERD, which is influenced by peripheral sensitization of primary afferents, central sensitization of spinal dorsal horn neurons, impaired mucosal barrier function and genetic factors. We will also discuss the contribution of specific refluxate characteristics to reflux perception, including acidity, and the role of bile, pepsin and gas and proximal extent. Further understanding of reflux perception might improve GERD treatment, especially in current partial responders to therapy.

  5. The Mystery and Misery of Acid Reflux in Children

    ERIC Educational Resources Information Center

    Davenport, Mike; Davenport, Tracy

    2006-01-01

    When a child is sick, parents want answers. They want to know what is wrong, what they can do, and how to get their child healthy--pronto. Regrettably, there are some puzzling illnesses affecting children that are surrounded by mystery. One of them is gastroesophageal reflux (GER), otherwise known as acid reflux--or "reflux" for short. Reflux…

  6. The Role of the Acid Pocket in Gastroesophageal Reflux Disease.

    PubMed

    Mitchell, David R; Derakhshan, Mohammad H; Robertson, Elaine V; McColl, Kenneth E L

    2016-02-01

    Gastroesophageal reflux disease is one of the commonest chronic conditions in the western world and its prevalence is increasing worldwide. The discovery of the acid pocket explained the paradox of acid reflux occurring more frequently in the postprandial period despite intragastric acidity being low due to the buffering effect of the meal. The acid pocket was first described in 2001 when it was detected as an area of low pH immediately distal to the cardia using dual pH electrode pull-through studies 15 minutes after a meal. It was hypothesized that there was a local pocket of acid close to the gastroesophageal junction that escapes the buffering effect of the meal, and that this is the source of postprandial acidic reflux. The presence of the acid pocket has been confirmed in other studies using different techniques including high-resolution pHmetry, Bravo capsule, magnetic resonance imaging, and scintigraphy. This review aims to describe what we know about the acid pocket including its length, volume, fluid constituents, and its relationship to the lower esophageal sphincter and squamocolumnar junction. We will discuss the possible mechanisms that lead to the formation of the acid pocket and examine what differences exist in patients who suffer from acid reflux. Treatments for reflux disease that affect the acid pocket will also be discussed.

  7. Lower pH values of weakly acidic refluxes as determinants of heartburn perception in gastroesophageal reflux disease patients with normal esophageal acid exposure.

    PubMed

    de Bortoli, N; Martinucci, I; Savarino, E; Franchi, R; Bertani, L; Russo, S; Ceccarelli, L; Costa, F; Bellini, M; Blandizzi, C; Savarino, V; Marchi, S

    2016-01-01

    Multichannel impedance pH monitoring has shown that weakly acidic refluxes are able to generate heartburn. However, data on the role of different pH values, ranging between 4 and 7, in the generation of them are lacking. The aim of this study was to evaluate whether different pH values of weakly acidic refluxes play a differential role in provoking reflux symptoms in endoscopy-negative patients with physiological esophageal acid exposure time and positive symptom index and symptom association probability for weakly acidic refluxes. One hundred and forty-three consecutive patients with gastroesophageal reflux disease, nonresponders to proton pump inhibitors (PPIs), were allowed a washout from PPIs before undergoing: upper endoscopy, esophageal manometry, and multichannel impedance pH monitoring. In patients with both symptom index and symptom association probability positive for weakly acidic reflux, each weakly acidic reflux was evaluated considering exact pH value, extension, physical characteristics, and correlation with heartburn. Forty-five patients with normal acid exposure time and positive symptom association probability for weakly acidic reflux were identified. The number of refluxes not heartburn related was higher than those heartburn related. In all distal and proximal liquid refluxes, as well as in distal mixed refluxes, the mean pH value of reflux events associated with heartburn was significantly lower than that not associated. This condition was not confirmed for proximal mixed refluxes. Overall, a low pH of weakly acidic reflux represents a determinant factor in provoking heartburn. This observation contributes to better understand the pathophysiology of symptoms generated by weakly acidic refluxes, paving the way toward the search for different therapeutic approaches to this peculiar condition of esophageal hypersensitivity.

  8. Fewer acute respiratory infection episodes among patients receiving treatment for gastroesophageal reflux disease

    PubMed Central

    Xirasagar, Sudha; Chung, Shiu-Dong; Tsai, Ming-Chieh; Chen, Chao-Hung

    2017-01-01

    Patients with gastroesophageal reflux disease (GERD) present with comorbid complications with implications for healthcare utilization. To date, little is known about the effects of GERD treatment with a proton-pump inhibitor (PPI) on patients’ subsequent healthcare utilization for acute respiratory infections (ARIs). This population-based study compared ARI episodes captured through outpatient visits, one year before and one year after GERD patients received PPI treatment. We used retrospective data from the Longitudinal Health Insurance Database 2005 in Taiwan, comparing 21,486 patients diagnosed with GERD from 2010 to 2012 with 21,486 age-sex matched comparison patients without GERD. Annual ARI episodes represented by ambulatory care visits for ARI (visits during a 7-day period bundled into one episode), were compared between the patient groups during the 1-year period before and after the index date (date of GERD diagnosis for study patients, first ambulatory visit in the same year for their matched comparison counterpart). Multiple regression analysis using a difference-in-difference approach was performed to estimate the adjusted association between GERD treatment and the subsequent annual ARI rate. We found that the mean annual ARI episode rate among GERD patients reduced by 11.4%, from 4.39 before PPI treatment, to 3.89 following treatment (mean change = -0.5 visit, 95% confidence interval (CI) = (-0.64, -0.36)). In Poisson regression analysis, GERD treatment showed an independent association with the annual ARI rate, showing a negative estimate (with p<0.001). The study suggests that GERD treatment with PPIs may help reduce healthcare visits for ARIs, highlighting the importance of treatment-seeking by GERD patients and compliance with treatment. PMID:28222168

  9. Effect of amino acids on lower esophageal sphincter characteristics and gastroesophageal reflux in humans.

    PubMed

    Gielkens, H A; Lamers, C B; Masclee, A A

    1998-04-01

    The effect of a commercially available mixed amino acids solution, when given either intravenously or intragastrically, on lower esophageal sphincter (LES) pressure, frequency of transient LES relaxations (TLESRs) and gastroesophageal reflux (GER) was investigated in six healthy volunteers. LES pressure and esophageal pH were simultaneously recorded on three separate occasions 1 hr before (basal) and 3 hr during intravenous or intragastric infusion of amino acids (250 mg protein/kg/hr) or saline (control). No significant changes in LES pressure were seen in the control experiment. Intravenous amino acids caused a rapid and sustained (P < 0.01) decrease in LES pressure whereas intragastric amino acids decreased LES pressure only gradually and temporarily (P < 0.01). In the three experiments no significant differences were observed in TLESR frequency, the number of GER episodes, the mechanism of reflux, or duration of acid exposure. In healthy subjects both intragastric and, especially, intravenous infusion of amino acids significantly decrease LES pressure but do not affect the frequency of TLESRs or GER episodes during a continuous liquid gastric load.

  10. Management of Vesicoureteral Reflux by Endoscopic Injection of Dextranomer/Hyaluronic Acid in Adults

    PubMed Central

    Stark, Timothy W; Lacy, John M; Preston, David M

    2016-01-01

    A 74-year-old man presented for evaluation after discovery of a left bladder-wall tumor. He underwent transurethral resection of bladder tumor (TURBT) operation for treatment of low-grade, Ta urothelial cancer of the bladder. The patient developed recurrent disease and returned to the operating room for repeat TURBT, circumcision, and administration of intravesical mitomycin C. The patient developed balanitis xerotica obliterans 4 years post-circumcision, requiring self-dilation with a catheter. He subsequently developed 3 consecutive episodes of left-sided pyelonephritis. Further investigation with voiding cystourethrogram (VCUG) revealed Grade 3, left-sided vesicoureteral reflux (VUR). Due to existing comorbidities, the patient elected treatment with endoscopic dextranomer/hyaluronic acid injection. A post-operative VCUG demonstrated complete resolution of left-sided VUR. This patient has remained symptom free for 8 months post-injection, with no episodes of pyelonephritis. PMID:27162514

  11. Helicobacter pylori infection prevents erosive reflux oesophagitis by decreasing gastric acid secretion

    PubMed Central

    Koike, T; Ohara, S; Sekine, H; Iijima, K; Abe, Y; Kato, K; Toyota, T; Shimosegawa, T

    2001-01-01

    BACKGROUND—Helicobacter pylori infection is less prevalent and atrophic gastritis is less extensive in patients with reflux oesophagitis than those without it, but few studies have examined this relationship directly.
AIMS—We investigated the relationship between H pylori infection, acid secretion, and reflux oesophagitis in Japanese subjects.
SUBJECTS—A total of 105 patients with erosive reflux oesophagitis were compared with 105 sex and age matched patients without reflux oesophagitis.
METHODS—The diagnosis of H pylori infection was made by histological examination of gastric mucosal biopsy specimens, rapid urease test, and detection of serum IgG antibodies. Acid secretion was assessed by the endoscopic gastrin test.
RESULTS—H pylori infection was present in 36 patients with erosive reflux oesophagitis (34.3%) and in 80 control subjects (76.2%) (odds ratio 0.163, 95% confidence interval 0.09-0.29). Overall acid secretion was significantly greater in patients with reflux oesophagitis. Among H pylori positive patients, acid secretion was greater in patients with reflux oesophagitis than those without oesophagitis.
CONCLUSION—In Japan, erosive reflux oesophagitis occurs most often in the absence of H pylori infection and gastric hyposecretion. Even in the presence of H pylori infection, reflux oesophagitis is more likely to develop in patients without gastric hyposecretion. H pylori infection may inhibit reflux oesophagitis by inducing hypoacidity.


Keywords: Helicobacter pylori; gastro-oesophageal reflux disease; reflux oesophagitis; acid secretion PMID:11511552

  12. Oropharyngeal acid reflux and motility abnormalities of the proximal esophagus

    PubMed Central

    Passaretti, Sandro; Mazzoleni, Giorgia; Vailati, Cristian; Testoni, Pier Alberto

    2016-01-01

    AIM To investigate the relationship between pathological oropharyngeal (OP) acid exposure and esophageal motility in patients with extra-esophageal syndromes. METHODS In this prospective study we enrolled consecutive outpatients with extra-esophageal symptoms suspected to be related to gastroesophageal reflux disease (GERD). We enrolled only patients with a reflux symptom index (RSI) score-higher than 13 and with previous lung, allergy and ear, nose and throat evaluations excluding other specific diagnoses. All patients underwent 24-h OP pH-metry with the Dx probe and esophageal high-resolution manometry (HRM). Patients were divided into two groups on the basis of a normal or pathological pH-metric finding (Ryan Score) and all manometric characteristics of the two groups were compared. RESULTS We examined 135 patients with chronic extra-esophageal syndromes. Fifty-one were considered eligible for the study. Of these, 42 decided to participate in the protocol. Patients were divided into two groups on the basis of normal or pathological OP acid exposure. All the HRM parameters were compared for the two groups. Significant differences were found in the median upper esophageal sphincter resting pressure (median 71 mmHg vs 126 mmHg, P = 0.004) and the median proximal contractile integral (median 215.5 cm•mmHg•s vs 313.5 cm•mmHg•s, P = 0.039), both being lower in the group with pathological OP acid exposure, and the number of contractions with small or large breaks, which were more frequent in the same group. This group also had a larger number of peristaltic contractions with breaks in the 20 mmHg isobaric contour (38.7% vs 15.38%, P < 0.0001). CONCLUSION In patients with suspected GERD-related extra-esophageal syndromes pathological OP acid exposure was associated with weaker proximal esophageal motility. PMID:27833390

  13. Oxidative stress is more important than acid in the pathogenesis of reflux oesophagitis in rats

    PubMed Central

    Oh, T; Lee, J; Ahn, B; Cho, H; Kim, W; Kim, Y; Surh, Y; Cho, S; Lee, K; Hahm, K

    2001-01-01

    BACKGROUND—Although antisecretory medications such as histamine type II receptor antagonists or proton pump inhibitors have been used to treat reflux oesophagitis, a considerable number of patients do not achieve complete mucosal healing or suffer from either sustained symptoms or ensuing complications, suggesting other damaging factors or impaired mucosal resistance are also involved in the pathogenesis of reflux oesophagitis.
AIMS—The present study was designed to evaluate oxidative stress as the major pathogenic factor of reflux oesophagitis and to determine the usefulness of antioxidants in the treatment of reflux oesophagitis.
MATERIALS AND METHODS—Reflux oesophagitis was induced by insertion of a 3 mm calibre ring into the duodenum, 1 cm distal to the ligament of Treitz, in Sprague-Dawley rats.
RESULTS—DA-9601, a novel antioxidant substance, significantly attenuated the gross and histopathological scores of reflux oesophagitis compared with those treated with ranitidine alone or reflux oesophagitis controls in a dose dependent manner. Only scattered erosions were observed in the antioxidant pretreated group but acid suppression by ranitidine was not effective in decreasing the severity of reflux oesophagitis. Significantly increased amounts of malondialdehyde (MDA), increased nuclear factor κB (NFκB) activation, and depletion of reduced glutathione (GSH) were observed in experimentally induced reflux oesophagitis. DA-9601 pretreatment attenuated the decrement in mucosal GSH levels and decreased MDA formation significantly. DA-9601 treatment caused significant reductions in activation of NFκB transcription factor, especially the p50 subunit, in accordance with the significantly higher levels of inhibitory protein of NFκB expression.
CONCLUSION—Reflux oesophagitis caused considerable levels of oxidative stress in the oesophageal mucosa and antioxidant treatment should be considered as supplementary therapy in the prevention or treatment

  14. Gastroesophageal and pharyngeal reflux detection using impedance and 24-hour pH monitoring in asymptomatic subjects: defining the normal environment.

    PubMed

    Oelschlager, Brant K; Quiroga, Elina; Isch, John A; Cuenca-Abente, Federico

    2006-01-01

    Airway symptoms are often caused by aspiration of refluxed materials into the larynx. In this study we sought to define the frequency, character, and proximal extent of refluxed contents - including nonacid reflux-in normal subjects using intraluminal impedance to improve our understanding of the relationship between reflux and aspiration. Ten subjects, who had no symptoms of gastroesophageal reflux disease or airway disease, underwent impedance/pH monitoring with a catheter that allowed simultaneous esophageal and pharyngeal monitoring. Impedance detected 496 gastroesophageal reflux episodes in the 10 subjects during 240 hours of study. The majority, 399 (81% of the total) were acid reflux episodes (pH < 4). Ninety-seven were nonacid (pH > 4). Most reflux episodes (348 of 496) reached the mid esophagus (9 cm above lower esophageal sphincter). There were 51 reflux episodes that reached the pharynx (PR). Only 13 (25%) of PR were acidic (pH < 4), while 38 were nonacid. Twenty-six PR episodes were liquid and 25 were mixed (liquid and gas). The median number of PR episodes measured with impedance was 5 (0-10). In asymptomatic subjects, most episodes of gastroesophageal reflux are acidic and reach the midesophagus. Reflux into the PR appears to be more common than previously believed, and most of these episodes are not acidic. Thus, traditional 24-hour pH monitoring may underestimate the presence of pharyngeal reflux. The combination of impedance with pH monitoring markedly enhances our ability to accurately detect potential microaspiration.

  15. Reflux and acid peptic diseases in the elderly.

    PubMed

    Soumekh, Amir; Schnoll-Sussman, Felice H; Katz, Philip O

    2014-02-01

    Gastroesophageal reflux disease (GERD) is a common disorder among elderly patients seeking medical care. Diagnosis and management of GERD in the older patient is a unique challenge for both the primary care provider and the gastroenterologist. Such patients may have atypical symptoms, more severe disease, and a higher rate of complications such as erosive esophagitis, Barrett esophagus, and esophageal cancer. Moreover, the elderly may be more sensitive to the morbidity and mortality of the available treatments for GERD. A careful and vigilant approach to the diagnosis, monitoring, and treatment of reflux disease in the elderly is warranted.

  16. Impaired visceral sensitivity to acid reflux in patients with Barrett's esophagus. The role of esophageal motility*.

    PubMed

    Byrne, P J; Mulligan, E D; O'Riordan, J; Keeling, P W N; Reynolds, J V

    2003-01-01

    Patients with Barrett's esophagus have been reported to have impaired visceral sensitivity to acid perfusion and distension compared with non-Barrett's refluxers, but the mechanism is poorly understood. Esophageal motility and clearance mechanisms may be important, and this study explored the relationship of motility with symptoms. Seventy-four patients with Barrett's esophagus were compared with 216 patients with gastro-esophageal reflux disease (GERD) with abnormal acid reflux scores, and 50 symptomatic patients who had normal acid exposure. All patients had esophageal manometry and 24-h pH monitoring. Thirty-six Barrett's patients also had 24-h bile reflux monitoring. Symptoms were assessed by Symptom Index (SI) during 24-h pH monitoring. Barrett's patients with normal motility had a significantly lower SI than GERD patients for similar acid exposure (P < 0.001). Barrett's patients with abnormal motility had higher acid exposure than those with normal motility (P < 0.05), but the SI values for this group was not significantly different from the GERD patients. SI and Bile reflux in Barrett's esophagus was not significantly different in patients with normal or abnormal motility. Barrett's patients had less sensitivity than GERD patients for similar acid exposure. Normal motility in Barrett's esophagus is associated with the poorest sensitivity and the presence of increased acid exposure is required in order to achieve sensitivity levels comparable with GERD patients.

  17. Patterns of gas and liquid reflux during transient lower oesophageal sphincter relaxation: a study using intraluminal electrical impedance

    PubMed Central

    Sifrim, D; Silny, J; Holloway, R; Janssens, J

    1999-01-01

    Background—Belching has been proposed as a major mechanism underlying acid gastro-oesophageal reflux in normal subjects. However, the presence of oesophageal gas has not been measured directly but only inferred from manometry. 
Aims—To investigate, using intraluminal electrical impedance, the patterns of gas and liquid reflux during transient lower oesophageal sphincter (LOS) relaxations, the main mechanism of acid reflux in normal subjects. 
Methods—Impedance changes associated with the passage of gas were studied in vitro, and in vivo in cats. Oesophageal manometry, pH, and intraluminal electrical impedance measurements were performed in 11 normal subjects after a meal. 
Results—Gas reflux caused a sudden increase in impedance that propagated rapidly to the proximal oesophagus whereas liquid reflux induced a retrogressively propagated fall in impedance. Impedance showed gas or liquid reflux during most (102/141) transient LOS relaxations. When acid reflux occurred, impedance showed evidence of intraoesophageal retrograde flow of liquid in the majority (78%) of events. Evidence of gas retroflow was found in almost half (47%) of acid reflux episodes. When present together, however, liquid preceded gas on 44% of occasions. Overall, gas reflux occurred as the initial event in only 25% of acid reflux episodes. 
Conclusions—These findings suggest that in upright normal subjects, although belching can precipitate acid reflux, most acid reflux occurs as a primary event. 

 Keywords: belching; gastro-oesophageal reflux disease; oesophageal manometry; intraluminal electrical impedance; lower oesophageal sphincter PMID:9862825

  18. Disease progression in non-erosive reflux disease (NERD): impact of initial esophageal acid exposure.

    PubMed

    Chen, C L; Liu, T T; Yi, C H

    2010-11-01

    We investigated the 5-year clinical course in a cohort of patients with typical reflux symptoms and negative endoscopy. Prospective follow-up was conducted in patients with non-erosive reflux disease (NERD) for at least 5 years after initial evaluation with esophageal pH monitoring and upper gastrointestinal endoscopy. Within the last year of follow-up, reflux symptoms occurred in 27 of the 30 patients (90%). Twenty-five of twenty-seven symptomatic patients (93%) were on acid suppression therapy. The majority of our patients (70%) remained unchanged regarding their endoscopic status over 5 years. Progression to erosive esophagitis occurred in four patients with Los Angeles (LA) A (13%), three patients with LA B (10%), and two patients with LA C (7%). The presence of pathological acid exposure did not alter the presence of reflux symptoms over 5 years. Disease progression to erosive esophagitis occurred more frequently in patients with pathological acid exposure than those without pathological acid exposure (P= 0.025). Most NERD patients have symptoms and require acid suppression therapy 5 years after their initial diagnosis. Initial pathological acid exposure does not influence the use of acid suppression; however, it does influence the progression of NERD within 5 years of follow-up.

  19. Gastroesophageal reflux - slideshow

    MedlinePlus

    ... page: //medlineplus.gov/ency/presentations/100181.htm Gastroesophageal reflux - series—Normal anatomy To use the sharing features ... junction of the esophagus and the stomach prevents reflux of food and acid from the stomach into ...

  20. Role of Mixed Reflux and Hypomotility with Delayed Reflux Clearance in Patients with Non-cardiac Chest Pain

    PubMed Central

    Ribolsi, Mentore; Balestrieri, Paola; Biasutto, Dario; Emerenziani, Sara; Cicala, Michele

    2016-01-01

    Background/Aims Gastroesophageal reflux disease (GERD) is the most common cause of non-cardiac chest pain (NCCP). Currently available data reveal a weak relationship between NCCP and dysmotility. Moreover, it is unclear why some refluxes are perceived as heartburn and others as NCCP. We aimed to evaluate the role of the reflux pattern and the esophageal motility in patients with NCCP. Methods Forty-eight patients with NCCP (Group 1) and 50 only typical GERD symptoms (Group 2) were included and underwent high-resolution manometry (HRM) and multichannel intraluminal impedance-pH monitoring. Results Impaired peristalsis was found in 60% of patients with NCCP and in 24% of patients with typical symptoms (P < 0.05). In patients belonging to Group 1, the majority of reflux episodes associated with chest pain were acid and mixed. The proportion of mixed refluxes was higher than that in Group 2. In Group 1, the reflux clearing time at 5, 9, and 15 cm, measured in reflux episodes associated to NCCP was longer than in reflux episodes associated to typical symptoms (mean ± 95% CI: 27.2 ± 5.6, 23.3 ± 4.4, and 14.6 ± 2.3 seconds vs 18.3 ± 3.5, 13.3 ± 2.2, and 11.1 ± 1.8 seconds; P < 0.01). Conclusions The presence of gas in the refluxate seems to be associated with NCCP. The impaired motility observed in NCCP patients may play a relevant role in delaying reflux clearing, hence increasing the time of contact between refluxate and esophageal mucosa. PMID:27095707

  1. Gastroesophageal Reflux Disease in Children with Cystic Fibrosis.

    PubMed

    Dziekiewicz, Marcin A; Banaszkiewicz, Aleksandra; Urzykowska, Agnieszka; Lisowska, Aleksandra; Rachel, Marta; Sands, Dorota; Walkowiak, Jaroslaw; Radzikowski, Andrzej; Albrecht, Piotr

    2015-01-01

    Previously published studies have indicated that gastroesophageal reflux (GER) disease is common in pediatric patients with cystic fibrosis. The aim of the present study was to get insight into the incidence of GER and to characterize the nature of reflux episodes in children with cystic fibrosis. This was a multicenter, prospective study of children with cystic fibrosis older than 18 months. Forty four consecutive patients (22 boys, mean age 10.4 ± 3.6, range 3.0-17.8 years) were enrolled into the study. All patients underwent 24 h pH-impedance monitoring. GER were classified according to the widely recognized criteria as an acid, weakly acid, weakly alkaline, or proximal. The pH-impedance trace was considered abnormal when acid exposure was >6 %. GER was diagnosed in 24/44 (54.5 %) children. A total of 1585 (median 35, range 7-128) reflux episodes were detected; 1199 (75.6 %) were acidic, 382 (24.1 %) weakly acidic, and 4 (0.3 %) weakly alkaline. Six hundred and ninety-one (43.6 %) reflux episodes reached the proximal esophagus. In 14/44 patients typical GER symptoms were present. We conclude that the incidence of GER in children with cystic fibrosis is very high. In the majority of patients typical GER symptoms are absent. Therefore, diagnostic procedures should be considered, regardless of lacking symptoms. Although acid reflux episodes predominate in children with cystic fibrosis, classical pH-metry may not constitute a sufficient diagnostic method in this population because of a relatively high number of proximal reflux episodes. Such episodes also indicate an increased risk for aspiration. The pH-impedance diagnostic measurement is advocated when suspecting GER in children with cystic fibrosis.

  2. Gastroesophageal Reflux Disease in Children with Interstitial Lung Disease.

    PubMed

    Dziekiewicz, M A; Karolewska-Bochenek, K; Dembiński, Ł; Gawronska, A; Krenke, K; Lange, J; Banasiuk, M; Kuchar, E; Kulus, M; Albrecht, P; Banaszkiewicz, A

    2016-01-01

    Gastroesophageal reflux disease is common in adult patients with interstitial lung disease. However, no data currently exist regarding the prevalence and characteristics of the disease in pediatric patients with interstitial lung disease. The aim of the present study was to prospectively assess the incidence of gastroesophageal reflux disease and characterize its features in children with interstitial lung disease. Gastroesophageal reflux disease was established based on 24 h pH-impedance monitoring (MII-pH). Gastroesophageal reflux episodes (GERs) were classified according to widely recognized criteria as acid, weakly acid, weakly alkaline, or proximal. Eighteen consecutive patients (15 boys, aged 0.2-11.6 years) were enrolled in the study. Gastroesophageal reflux disease was diagnosed in a half (9/18) of children. A thousand GERs were detected by MII-pH (median 53.5; IQR 39.0-75.5). Of these, 585 (58.5 %) episodes were acidic, 407 (40.7 %) were weakly acidic, and eight (0.8 %) were weakly alkaline. There were 637 (63.7 %) proximal GERs. The patients in whom gastroesophageal reflux disease was diagnosed had a significantly higher number of proximal and total GERs. We conclude that the prevalence of gastroesophageal reflux disease in children with interstitial lung disease is high; thus, the disease should be considered regardless of presenting clinical symptoms. A high frequency of non-acid and proximal GERs makes the MII-pH method a preferable choice for the detection of reflux episodes in this patient population.

  3. Hypersensitivity to acid is associated with impaired esophageal mucosal integrity in patients with gastroesophageal reflux disease with and without esophagitis.

    PubMed

    Weijenborg, Pim W; Smout, André J P M; Verseijden, Caroline; van Veen, Henk A; Verheij, Joanne; de Jonge, Wouter J; Bredenoord, Albert J

    2014-08-01

    Increased esophageal sensitivity and impaired mucosal integrity have both been described in patients with gastroesophageal reflux disease, but the relationship between hypersensitivity and mucosal integrity is unclear. The aim of the present study was to investigate acid sensitivity in patients with erosive and nonerosive reflux disease and control subjects to determine the relation with functional esophageal mucosal integrity changes as well as to investigate cellular mechanisms of impaired mucosal integrity in these patients. In this prospective experimental study, 12 patients with nonerosive reflux disease, 12 patients with esophagitis grade A or B, and 11 healthy control subjects underwent an acid perfusion test and upper endoscopy. Mucosal integrity was measured during endoscopy by electrical tissue impedance spectroscopy and biopsy specimens were analyzed in Ussing chambers for transepithelial electrical resistance, transepithelial permeability and gene expression of tight junction proteins and filaggrin. Patients with nonerosive reflux disease and esophagitis were more sensitive to acid perfusion compared with control subjects, having a shorter time to perception of heartburn and higher perceived intensity of heartburn. In reflux patients, enhanced acid sensitivity was associated with impairment of in vivo and vitro esophageal mucosal integrity. Mucosal integrity was significantly impaired in patients with esophagitis, displaying higher transepithelial permeability and lower extracellular impedance. Although no significant differences in the expression of tight junction proteins were found in biopsies among patient groups, mucosal integrity parameters in reflux patients correlated negatively with the expression of filaggrin. In conclusion, sensitivity to acid is enhanced in patients with gastroesophageal reflux disease, irrespective of the presence of erosions, and is associated with impaired esophageal mucosal integrity. Mucosal integrity of the esophagus

  4. Response of Chronic Cough to Acid-Suppressive Therapy in Patients With Gastroesophageal Reflux Disease

    PubMed Central

    Howden, Colin W.; Hughes, Nesta; Molloy-Bland, Michael

    2013-01-01

    Background: Epidemiologic and physiologic studies suggest an association between gastroesophageal reflux disease (GERD) and chronic cough. However, the benefit of antireflux therapy for chronic cough remains unclear, with most relevant trials reporting negative findings. This systematic review aimed to reevaluate the response of chronic cough to antireflux therapy in trials that allowed us to distinguish patients with or without objective evidence of GERD. Methods: PubMed and Embase systematic searches identified clinical trials reporting cough response to antireflux therapy. Datasets were derived from trials that used pH-metry to characterize patients with chronic cough. Results: Nine randomized controlled trials of varied design that treated patients with acid suppression were identified (eight used proton pump inhibitors [PPIs], one used ranitidine). Datasets from two crossover studies showed that PPIs significantly improved cough relative to placebo, albeit only in the arm receiving placebo first. Therapeutic gain in seven datasets was greater in patients with pathologic esophageal acid exposure (range, 12.5%-35.8%) than in those without (range, 0.0%-8.6%), with no overlap between groups. Conclusions: A therapeutic benefit for acid-suppressive therapy in patients with chronic cough cannot be dismissed. However, evidence suggests that rigorous patient selection is necessary to identify patient populations likely to be responsive, using physiologically timed cough events during reflux testing, minimal patient exclusion because of presumptive alternative diagnoses, and appropriate power to detect a modest therapeutic gain. Only then can we hope to resolve this vexing clinical management problem. PMID:23117307

  5. Protective Effects of Chlorogenic Acid against Experimental Reflux Esophagitis in Rats

    PubMed Central

    Kang, Jung-Woo; Lee, Sun-Mee

    2014-01-01

    Esophageal reflux of gastric contents causes esophageal mucosal damage and inflammation. Recent studies show that oxygen-derived free radicals mediate mucosal damage in reflux esophagitis (RE). Chlorogenic acid (CGA), an ester of caffeic acid and quinic acid, is one of the most abundant polyphenols in the human diet and possesses anti-inflammatory, antibacterial and anti-oxidant activities. In this context, we investigated the effects of CGA against experimental RE in rats. RE was produced by ligating the transitional region between the forestomach and the glandular portion and covering the duodenum near the pylorus ring with a small piece of catheter. CGA (10, 30 and 100 mg/kg) and omeprazole (positive control, 10 mg/kg) were administered orally 48 h after the RE operation for 12 days. CGA reduced the severity of esophageal lesions, and this beneficial effect was confirmed by histopathological observations. CGA reduced esophageal lipid peroxidation and increased the reduced glutathione/oxidized glutathione ratio. CGA attenuated increases in the serum level of tumor necrosis factor-α, and expressions of inducible nitric oxide synthase and cyclooxygenase-2 protein. CGA alleviates RE-induced mucosal injury, and this protection is associated with reduced oxidative stress and the anti-inflammatory properties of CGA. PMID:25414772

  6. Acid Reflux

    MedlinePlus

    ... in consultation with the FDA to discontinue the marketing of the drug. The product will remain available ... Diabetes, Digestive and Kidney Diseases Infographics Heartburn: A Global Perspective Infographic [ DOWNLOADS: WEB | FLYER ] GI Health Centers ...

  7. Effects of Transcutaneous Electrical Acustimulation on Refractory Gastroesophageal Reflux Disease

    PubMed Central

    2016-01-01

    Objective. To investigate effects and possible mechanisms of transcutaneous electrical acustimulation (TEA) performed by a wearable watch-size stimulator for refractory gastroesophageal reflux disease (RGERD). Methods. Twenty patients diagnosed as RGERD were enrolled in the study and randomly divided into four groups: esomeprazole group (Group A), esomeprazole combined with TEA group (Group B), esomeprazole combined with sham-TEA group (Group C), and esomeprazole combined with domperidone group (Group D). HRM and 24 h pH-impedance monitoring and GerdQ score were used to measure related indexes before and after treatment. Results. (1) TEA significantly increased LESP, compared with PPI treatment only or PPI plus sham-TEA. After pairwise comparison, LESP of Group B was increased more than Group A (P = 0.008) or Group C (P = 0.021). (2) PPI plus TEA decreased not only the number of acid reflux episodes but also the number of weak acid reflux episodes (P = 0.005). (3) Heartburn and reflux symptoms were improved more with PPI + TEA than with PPI treatment only or PPI plus sham-TEA (GerdQ scores, P = 0.001). Conclusion. TEA can improve symptoms in RGERD patients by increasing LESP and decreasing events of weak acid reflux and acid reflux; addition of TEA to esomeprazole significantly enhances the effect of TEA. PMID:27648103

  8. Size distributions of nano/micron dicarboxylic acids and inorganic ions in suburban PM episode and non-episodic aerosol

    NASA Astrophysics Data System (ADS)

    Hsieh, Li-Ying; Kuo, Su-Ching; Chen, Chien-Lung; Tsai, Ying I.

    The distribution of nano/micron dicarboxylic acids and inorganic ions in size-segregated suburban aerosol of southern Taiwan was studied for a PM episode and a non-episodic pollution period, revealing for the first time the distribution of these nanoscale particles in suburban aerosols. Inorganic species, especially nitrate, were present in higher concentrations during the PM episode. A combination of gas-to-nuclei conversion of nitrate particles and accumulation of secondary photochemical products originating from traffic-related emissions was likely a crucial cause of the PM episode. Sulfate, ammonium, and oxalic acid were the dominant anion, cation, and dicarboxylic acid, respectively, accounting for a minimum of 49% of the total anion, cation or dicarboxylic acid mass. Peak concentrations of these species occurred at 0.54 μm in the droplet mode during both non-episodic and PM episode periods, indicating an association with cloud-processed particles. On average, sulfate concentration was 16-17 times that of oxalic acid. Oxalic acid was nevertheless the most abundant dicarboxylic acid during both periods, followed by succinic, malonic, maleic, malic and tartaric acid. The mass median aerodynamic diameter (MMAD) of oxalic acid was 0.77 μm with a bi-modal presence at 0.54 μm and 18 nm during non-episodic pollution and an MMAD of 0.67 μm with mono-modal presence at 0.54 μm in PM episode aerosol. The concomitant formation of malonic acid and oxalic acid was attributed to in-cloud processes. During the PM episode in the 5-100 nm nanoscale range, an oxalic acid/sulfate mass ratio of 40.2-82.3% suggested a stronger formation potential for oxalic acid than for sulfate in the nuclei mode. For total cations (TC), total inorganic anions (TIA) and total dicarboxylic acids (TDA), major contributing particles were in the droplet mode, with least in the nuclei mode. The ratio of TDA to TIA in the nuclei mode increased greatly from 8.40% during the non-episodic pollution

  9. Gastroesophageal Reflux Affects Sleep Quality in Snoring Obese Children

    PubMed Central

    Woodley, Frederick W; Skaggs, Beth; Di Lorenzo, Carlo; Eneli, Ihuoma; Splaingard, Mark; Mousa, Hayat

    2016-01-01

    Purpose This study was performed to evaluate the quality of sleep in snoring obese children without obstructive sleep apnea (OSA); and to study the possible relationship between sleep interruption and gastroesophageal reflux (GER) in snoring obese children. Methods Study subjects included 13 snoring obese children who were referred to our sleep lab for possible sleep-disordered breathing. Patients underwent multichannel intraluminal impedance and esophageal pH monitoring with simultaneous polysomnography. Exclusion criteria included history of fundoplication, cystic fibrosis, and infants under the age of 2 years. Significant association between arousals and awakenings with previous reflux were defined by symptom-association probability using 2-minute intervals. Results Sleep efficiency ranged from 67-97% (median 81%). A total of 111 reflux episodes (90% acidic) were detected during sleep, but there were more episodes per hour during awake periods after sleep onset than during sleep (median 2.3 vs. 0.6, p=0.04). There were 279 total awakenings during the sleep study; 56 (20.1%) of them in 9 patients (69.2%) were preceded by reflux episodes (55 acid, 1 non-acid). In 5 patients (38.5%), awakenings were significantly associated with reflux. Conclusion The data suggest that acid GER causes sleep interruptions in obese children who have symptoms of snoring or restless sleep and without evidence of OSA. PMID:27066445

  10. [Update on gastroesophageal reflux disease].

    PubMed

    Serra Pueyo, Jordi

    2014-02-01

    Gastroesophageal reflux disease is a highly frequent disorder classically characterized by the presence of heartburn and/or acid regurgitation that improves with drug therapy that reduces acid content in the stomach. However, especially in patients with non-erosive disease, response to proton pump inhibitors is unsatisfactory in approximately 1 out of 3 patients, and consequently, in these patients, it is important to establish a definitive diagnosis and an alternative therapeutic strategy. In the last few years, advances have been made in knowledge of the physiopathology of reflux, such as identification of the role of the acid pocket in producing reflux, technological advances that allow differentiation among acid reflux, non-acid reflux and slightly acid reflux, and advances in the treatment of reflux with drugs that attempt to act on the barrier function of the esophagogastric junction.

  11. Efficacy of a potassium-competitive acid blocker for improving symptoms in patients with reflux esophagitis, non-erosive reflux disease, and functional dyspepsia

    PubMed Central

    Asaoka, Daisuke; Nagahara, Akihito; Hojo, Mariko; Matsumoto, Kenshi; Ueyama, Hiroya; Matsumoto, Kohei; Izumi, Kentaro; Takeda, Tsutomu; Komori, Hiroyuki; Akazawa, Yoichi; Shimada, Yuji; Osada, Taro; Watanabe, Sumio

    2017-01-01

    The aim of the present study was to investigate the efficacy of a potassium-competitive acid blocker (PCAB) named vonoprazan (VPZ) for improving symptoms in patients with reflux esophagitis (RE), non-erosive reflux disease (NERD), and functional dyspepsia (FD). A hospital-based, retrospective study of outpatients in our department (Department of Gastroenterology, University of Juntendo, Tokyo, Japan) between March 2015 and August 2016 was performed. The patients who were experiencing heartburn, acid regurgitation, gastric pain, and/or a heavy feeling in the stomach of at least moderate severity at baseline were treated with 20 mg VPZ once daily for 4 weeks. The patients completed the global overall symptom (GOS) scale to determine their symptom severity at baseline and after the 4 week treatment period. The proportions of patients with RE, NERD, and FD achieving improvement of their symptoms, defined as a GOS scale score of 1 (‘no problem’) or 2 (‘minimal problem’), were evaluated. During 4 weeks of VPZ therapy, changes in the gastroesophageal reflux disease (GERD) score, which was defined as the total points for heartburn and acid regurgitation on the GOS scale in patients with RE and NERD, and in the FD score, which was defined as the total points for gastric pain and a heavy feeling in the stomach on the GOS scale in patients with FD, were also evaluated. A total of 88 eligible cases were included in the present study, comprising 20 patients with RE, 25 patients with NERD, and 43 patients with FD. The rates of symptomatic improvement in patients with RE, NERD, and FD were 75.0, 60.0, and 48.8%, respectively. For the patients who were first administered VPZ, the rates of symptomatic improvement were 90.9, 66.7, and 58.8% in patients with RE, NERD, and FD, respectively. For those patients who were resistant to 8 weeks of proton pump inhibitor therapy, the rates of symptomatic improvement were 55.6, 53.8, and 42.3% in patients with RE, NERD, and FD

  12. Episodic hypoglycemia with psi-hydroxy fatty acid excretion.

    PubMed

    Colle, E; Mamer, O A; Montgomery, J A; Miller, J D

    1983-02-01

    We present case histories of two young children with episodes of hypoglycemia, elevation of SGOT, low insulin levels, increased urinary excretion of psi-hydroxy fatty acids (5-hydroxyhexanoic, 7-hydroxyoctanoic and 9-hydroxydecanoic), traces of the corresponding psi-ketoacids and elevations of urinary adipic, suberic, and sebacic acids. The ratio of psi-hydroxy fatty acids to 3-hydroxybutyric in the urine of these patients is higher than in patients of similar ages with similar illnesses. These acids persisted while the patients were well. Increased urinary psi-hydroxy fatty acids could be reproduced by a load of medium chain triglycerides without precipitating other clinical symptoms. Three children with hypoglycemia were found not to excrete measurable amounts of these unusual acids while ill. A medium chain triglyceride load in one of these children after recovery failed to elicit psi-hydroxy acid excretion. Small amounts of urinary 5-hydroxyhexanoic acid only were found in two patients with acute Reye's syndrome and in three of five severely ill children with starvation ketonuria. In this last group, no urinary psi-hydroxyacids could be detected after recovery. Normal children do not excrete measurable amounts (less than 1 mg/g creatinine) of these psi-hydroxyacids.

  13. Novel therapeutics for gastro-esophageal reflux symptoms.

    PubMed

    Zerbib, Frank; Simon, Mireille

    2012-09-01

    Approximately 20-30% of patients with gastro-esophageal reflux symptoms report inadequate symptom relief while on proton-pump inhibitor therapy. The mechanisms involved are failure of the antireflux barrier (transient lower esophageal sphincter relaxations), high proximal extent of the refluxate, esophageal hypersensitivity and impaired mucosal integrity. Persisting acid or nonacid reflux can be demonstrated in 40-50% of cases, suggesting that there is room for antireflux therapy in these patients. New antireflux compounds have been shown to decrease the occurrence of transient lower esophageal sphincter relaxations. The most promising classes of compounds are GABA type B agonists and metabotropic glutamate receptor 5 antagonists, which can reduce both reflux episodes and symptoms, but the development of these compounds has been abandoned for either safety issues or lack of efficacy. Esophageal hypersensitivity and impaired mucosal integrity may prove to be relevant therapeutic targets in the future.

  14. Efficacy of acid suppression therapy in gastroesophageal reflux disease-related chronic laryngitis

    PubMed Central

    Yang, Yue; Wu, Haitao; Zhou, Jian

    2016-01-01

    Abstract Background: This research aims to assess the response to acid suppression therapy in gastroesophageal reflux disease (GERD)-related chronic laryngitis (CL). Methods: Data were extracted from Web of Knowledge, Embase, and PubMed for English language article published up to March 2016. Pooled overall response rate (ORR) rates were evaluated to determine acid suppression treatment efficacy. Random effects model was used with standard approaches to sensitivity analysis, quality assessment, heterogeneity, and exploration of publication bias. Results: Pooled data from 21 reports (N = 2864, antireflux medicine: 2741; antireflux surgery: 123, study duration 4–108 week) were analyzed. With the random-effect model, the ORR was 66% (95% confidence interval [CI] 54%–78%). The ORRs were 80% for antireflux surgery (95% CI 67%–93%, 3 studies, 123 patients), whereas 64% for antireflux medicine (95% CI 50%–77%, 18 studies, 2741 patients), and the ORR was 70% (95% CI 55%–85%, 15 reports, 2731 patients) for >8 weeks’ therapy duration, whereas 57% (95% CI 48%–65%, 6 reports, 133 patients) for ≤8 weeks’ duration of therapy. Conclusions: Acid suppression seems to be an effective therapy for GERD-related CL. There was an increase in effect among patients with surgery therapeutic method and longer therapy duration. PMID:27749540

  15. Reflux and cough.

    PubMed

    Merati, Albert L

    2010-02-01

    Reflux is a significant contributor to cough in otolaryngology practice; cough is just one marker of its many negative effects on the upper aerodigestive tract. Reflux causes cough both by direct irritation/inflammation and by increasing sensitivities to other noxious agents. Detailed and diligent clinical evaluation, including laryngoscopy, is useful in advancing the working diagnosis of reflux-associated cough. Supplemental testing, including impedance monitoring of esophageal refluxate, can be important to evaluate for both acidic and nonacidic reflux exposure. The mainstay of treatment continues to be dietary and other lifestyle interventions and drug therapy. Although proton-pump inhibitor therapy is effective in most patients, especially those with acid reflux disease, prokinetic therapy is probably very important with those with combined acid and nonacid disease and those with pure nonacid disease. It is likely that failure to improve can be due to behavioral and drug compliance issues. Antireflux surgery can yield long-lasting positive outcomes in carefully selected patients despite the lower efficacy of treatment for primary upper aerodigestive tract symptoms (cough, hoarseness, sore throat) compared with heartburn and regurgitation.

  16. Gastroesophageal reflux disease and dysphagia in children.

    PubMed

    Putnam, P E

    1997-02-01

    Gastroesophageal reflux disease (GERD) is a common problem in children that is sometimes associated with dysphagia. Choking, food refusal, and food "getting stuck" are non-specific symptoms that may arise consequent to reflux and esophagitis. Swallowing plays a role in reflux physiology, functioning as a major clearance mechanism after reflux episodes. Therefore, failure of swallowing to effectively perform that function contributes to reflux pathophysiology. The diagnosis and treatment of GERD in children must be carried out systematically and thoroughly. Multiple interacting factors are common, thus complicating the process.

  17. Serum uric acid levels during leprosy reaction episodes

    PubMed Central

    Alves-Junior, Eduardo R.; Arruda, Talita A.; Lopes, Jose C.; Fontes, Cor J.F.

    2016-01-01

    Background. Leprosy reactions are acute inflammatory episodes that occur mainly in the multibacillary forms of the disease. The reactions are classified as type 1 (reverse reaction) or type 2 (erythema nodosum leprosum). Leprosy-associated oxidative stress has been widely demonstrated. Several recent studies have shown uric acid (UA) to have antioxidative effects under pathologic conditions. The objective of this study was to assess serum levels of UA in patients with leprosy reactions, with the aim of monitoring their levels before and after treatment, compared with levels in leprosy patients without reactions. Methods. The study included patients aged 18–69 years assisted at a leprosy treatment reference center in the Central Region of Brazil. Patients who were pregnant; were using immunosuppressant drugs or immunobiologicals; or had an autoimmune disease, human immunodeficiency virus infection, acquired immune deficiency syndrome, or tuberculosis were excluded. Upon recruitment, all individuals were clinically assessed for skin lesions and neural or systemic impairment. Some patients had already completed treatment for leprosy, while others were still undergoing treatment or had initiated treatment after being admitted. The treatment of the reactional episode was started only after the initial evaluation. Laboratory assessments were performed upon admission (baseline) and at approximately 30 and 60 days (time points 1 and 2, respectively). Results. A total of 123 leprosy patients were recruited between June 2012 and June 2015; among them, 56, 42, and 25 presented with type 1, type 2, and no reactions, respectively. Serum UA levels were significantly reduced in patients with type 2 leprosy reactions compared with patients in the control group and remained lower in the two subsequent assessments, after initiation of anti-reaction treatments, with similar values to those recorded before the treatment. Discussion. The decreased serum UA levels in patients with

  18. Speciation and temporal characterization of dicarboxylic acids in PM 2.5 during a PM episode and a period of non-episodic pollution

    NASA Astrophysics Data System (ADS)

    Hsieh, Li-Ying; Chen, Chien-Lung; Wan, Meng-Wei; Tsai, Cheng-Hsien; Tsai, Ying I.

    PM 2.5 aerosol was collected during a PM episode and a non-episodic pollution period between September and November 2004 in suburban southern Taiwan and dicarboxylic acid and inorganic species content and provenance were investigated. Oxalic acid was the dominant dicarboxylic acid species, followed by succinic acid and malonic acid. Tartaric acid concentrations were the lowest. There was 49.3% more dicarboxylic acid in PM episode aerosol than in non-episodic aerosol. However, daily oxalic acid concentration increased 72.7% in PM episode aerosol, while succinic acid fell 20.9% and malonic acid fell 21.6%, indicating higher conversion of these acids into oxalic acid in PM episode aerosol. Dicarboxylic acid concentrations, particularly oxalic acid, peaked at night during the PM episode, due to accumulation of daytime oxalic acid combined with low wind velocity and low mixing layer height at this time. SO 42-, NO 3- and NH 4+ were the dominant ionic species in both PM episode and non-episodic aerosols. NO 3- concentration increased 106% during the PM episode, while HNO 3, a gaseous precursor of NO 3-, fell 57%, indicating a large conversion of HNO 3 to aerosol phase NO 3- in PM episode aerosol. Backward trajectory data indicate that burning of paddy fields may also contribute to oxalic acid content in PM episode aerosol in the study area, especially during nighttime. Principal component analyses showed that succinic acid, malonic acid and oxalic acid were important factors in both pollution periods and also that there was high correlation between tartaric acid and NO x or HNO 2, indicative of vehicle emissions. The mass ratio of oxalic acid to sulfate in this aerosol was as high as 60.3‰, 35.5% higher than in non-episodic aerosol. Principal component analyses showed that photochemical aerosols contributed by succinic acid, malonic acid and oxalic acid were important factors in both periods. There was high correlation between tartaric acid and NO x or HNO 2

  19. [Fat, spices and gastro-oesophageal reflux].

    PubMed

    v Schönfeld, J; Evans, D F

    2007-02-01

    In spite of poor evidence, many patients with gastro-oesophageal reflux are advised to avoid fat and spices. We therefore measured gastro-oesophageal reflux after fatty and spicy meals. During three 24-h pH monitoring sessions, eight volunteers ate two identical, low fat and mild beef stews, or a hot and fatty Indian curry for lunch. Meals for dinner were the beef stew, the hot Indian curry or a mild curry. Day-time acid exposure was significantly longer after the hot curry (7.5 % [1.4 - 27.1]) than after the beef stews (2.3 % [0.4 - 9.8] and 2.5 % [0.7 - 15.7]). Night-time acid exposure was also significantly shorter after the beef stew (1.3 % [0 - 9]) than after the mild curry (2.9 % [0 - 19.1]) or the hot curry (4.6 % [0.2 - 22.5]). Within two hours postprandially, reflux was not different between the meals. The number of episodes, however, that occurred more than two hours after lunch was significantly lower after the beef stews (4 [2 - 14] and 4.5 [2 - 10]) than after the hot curry (9 [5 - 16]). The same phenomenon was observed after beef stew (0.5 [0 - 2]), mild curry (2 [0 - 4]) and hot curry (2 [1 - 9]) for dinner. We conclude that meals high in fat can provoke reflux, possibly through delayed gastric emptying. Additional spices, however, do not further increase reflux.

  20. Esophageal Acidification During Nocturnal Acid-breakthrough with Ilaprazole Versus Omeprazole in Gastroesophageal Reflux Disease

    PubMed Central

    Karyampudi, Arun; Ghoshal, Uday C; Singh, Rajan; Verma, Abhai; Misra, Asha; Saraswat, Vivek A

    2017-01-01

    Background/Aims Though nocturnal acid-breakthrough (NAB) is common in gastroesophageal reflux disease (GERD) patients, its clinical importance results from esophageal acidification, which has been shown to be uncommon. Ilaprazole, a long-acting proton pump inhibitor, may cause NAB infrequently. Accordingly, we studied prospectively, (1) frequency and degree of esophageal acidification during NAB, and (2) frequency and severity of NAB while on ilaprazole versus omeprazole. Methods Fifty-eight consecutive patients with GERD on once daily ilaprazole, 10 mg (n = 28) or omeprazole, 20 mg (n = 30) for > one month underwent 24-hour impedance-pH monitoring prospectively. NAB was defined as intra-gastric pH < 4 for > one hour during night, and esophageal acidification as pH < 4 for any duration. Nocturnal symptoms (heartburn, regurgitation, and chest pain) were also recorded. Results Of the 58 patients (age 35.5 [inter-quartile range 26.5–46.0] years, 38 [65.5%], 42 (72.4%) had NAB. Though patients with NAB had lower nocturnal intra-gastric pH than without (2.8 [1.9–4.1] vs 5.7 [4.6–6.8], P < 0.001), frequency and duration of nocturnal esophageal acidification (17/42 vs 4/16, P = 0.360 and 0.0 [0.0–1.0] vs 0.0 [0.0–0.3] minutes, P = 0.260, respectively) and symptoms were comparable (13/42 vs 6/16, P = 0.750). Though ilaprazole was associated with less NABs (1 [range 1–2, n = 19] vs 1 [range 1–3, n = 23], P = 0.010) than omeprazole, the frequency, duration, and mean intra-gastric pH during NAB were comparable (19/28 vs 23/30, P = 0.560; 117 [0–315] vs 159 [69–287] minutes, P = 0.500; 1.02 [0.7–1.4] vs 1.04 [0.44–1.3], P = 0.620, respectively). Conclusions Though NAB was common while patients were on a proton pump inhibitor, esophageal acidification was uncommon. Frequency and severity of NAB were comparable among patients on ilaprazole and omeprazole, except for the lesser number of NABs with ilaprazole. PMID:27585842

  1. Reflux nephropathy

    MedlinePlus

    ... with multiple sclerosis, spinal cord injury, or other nervous system (neurological) conditions Reflux nephropathy can also occur from swelling of the ureters after a kidney transplant or from injury to the ureter. Risk factors ...

  2. Persistent episodic acidification of streams linked to acid rain effects on soil

    USGS Publications Warehouse

    Lawrence, G.B.

    2002-01-01

    Episodic acidification of streams, identified in the late 1980s as one of the most significant environmental problems caused by acidic deposition, had not been evaluated since the early 1990s despite decreasing levels of acidic deposition over the past decade. This analysis indicates that episodic acidification of streams in upland regions in the northeastern United States persists, and is likely to be much more widespread than chronic acidification. Depletion of exchangeable Ca in the mineral soil has decreased the neutralization capacity of soils and increased the role of the surface organic horizon in the neutralization of acidic soil water during episodes. Increased accumulation of N and S in the forest floor from decades of acidic deposition will delay the recovery of soil base status, and therefore, the elimination of acidic episodes, which is anticipated from decreasing emissions.

  3. Anti-reflux surgery

    MedlinePlus

    ... much stomach acid is coming back into your esophagus). Upper endoscopy. Almost all people who have this anti-reflux surgery have already had this test. If you have not had this test, ... of the esophagus. Always tell your provider if: You could be ...

  4. Effect of gastroesophageal reflux on esophageal speech.

    PubMed

    Mathis, J G; Lehman, G A; Shanks, J C; Blom, E D; Brunelle, R L

    1983-12-01

    Gastroesophageal reflux has been incriminated as a factor-inhibiting acquisition of esophageal speech after laryngectomy. Fourteen proficient esophageal speakers and 10 nonproficient speakers underwent esophageal manometry, esophageal pH probe testing, and Bernstein acid perfusion testing. Additionally, 175 laryngectomized members of Lost Chord Clubs answered mailed questionnaires about the frequency of reflux symptoms. Nonproficient and proficient esophageal speakers had a similar frequency of gastroesophageal reflux by pH probe testing, esophageal mucosal acid sensitivity by Bernstein testing, lower esophageal sphincter pressures, and gastroesophageal reflux symptoms. Gastroesophageal reflux does not appear to be a major factor in preventing esophageal speech.

  5. Delayed-onset ureteral obstruction after endoscopic dextranomer/hyaluronic acid copolymer (Deflux) injection for treatment of vesicoureteral reflux in children: a case series.

    PubMed

    Rubenwolf, Peter C; Ebert, Anne-Karoline; Ruemmele, Petra; Rösch, Wolfgang H

    2013-03-01

    We report 4 patients with upper urinary tract (UUT) obstruction requiring ureteric reimplantation at 1, 7, 28, and 63 months after dextranomer/hyaluronic acid copolymer (Dx/HA) injection for vesicoureteric reflux. Histopathologic evaluation of ureteric segments revealed extensive foreign body formation in all cases. We conclude that UUT obstruction is a rare but serious complication after Dx/HA injection that can occur even years after surgery. The incidence of delayed-onset UUT obstruction may be higher than previously noted. Long-term follow-up and a critical reappraisal of the method are needed to assess the late sequelae of Dx/HA injection therapy for vesicoureteric reflux.

  6. Endoscopic Treatment of Vesicoureteral Reflux in Children with Dextranomer/Hyaluronic Acid-A Single Surgeon's 6-Year Experience.

    PubMed

    Chen, Hou-Chuan; Yeh, Chou-Ming; Chou, Chia-Man

    2010-01-01

    Endoscopic treatment for vesicoureteral reflux (VUR) has become an established alternative to long-term antibiotic prophylaxis and ureteral reimplantation. We present the outcome of endoscopic treatment with dextranomer/hyaluronic acid copolymer (Deflux) for VUR in children by a single surgeon at our institute from October 2003 to October 2009. We reviewed the cases of 150 patients (total 239 ureters), 56 girls (37%) and 94 boys (63%), with a mean age of 2.2 years and a median followup of 2.5 years (range 3-68 months). Among the 239 ureters treated, 67.4% (161/239) were cured with a single injection, and a second and third injection raised the cure rate to 86.6% (207/239) and 88.3% (211/239), respectively. None had postoperative ureteral obstruction.

  7. PERSISTENT EPISODIC ACIDIFICATION OF STREAMS LINKED TO ACID RAIN EFFECTS ON SOIL

    EPA Science Inventory

    Episodic acidification of streams, identified in the late 1980s as one of the most significant environmental problems caused by acidic deposition, had not been evaluated since the early 1990s despite decreasing levels of acidic deposition over the past decade. This analysis indic...

  8. Animal model of acid-reflux esophagitis: pathogenic roles of acid/pepsin, prostaglandins, and amino acids.

    PubMed

    Takeuchi, Koji; Nagahama, Kenji

    2014-01-01

    Esophagitis was induced in rats within 3 h by ligating both the pylorus and transitional region between the forestomach and glandular portion under ether anesthesia. This esophageal injury was prevented by the administration of acid suppressants and antipepsin drug and aggravated by exogenous pepsin. Damage was also aggravated by pretreatment with indomethacin and the selective COX-1 but not COX-2 inhibitor, whereas PGE2 showed a biphasic effect depending on the dose; a protection at low doses, and an aggravation at high doses, with both being mediated by EP1 receptors. Various amino acids also affected this esophagitis in different ways; L-alanine and L-glutamine had a deleterious effect, while L-arginine and glycine were highly protective, both due to yet unidentified mechanisms. It is assumed that acid/pepsin plays a major pathogenic role in this model of esophagitis; PGs derived from COX-1 are involved in mucosal defense of the esophagus; and some amino acids are protective against esophagitis. These findings also suggest a novel therapeutic approach in the treatment of esophagitis, in addition to acid suppressant therapy. The model introduced may be useful to test the protective effects of drugs on esophagitis and investigate the mucosal defense mechanism in the esophagus.

  9. Size-controlled synthesis and formation mechanism of manganese oxide OMS-2 nanowires under reflux conditions with KMnO4 and inorganic acids

    NASA Astrophysics Data System (ADS)

    Zhang, Qin; Cheng, Xiaodi; Qiu, Guohong; Liu, Fan; Feng, Xionghan

    2016-05-01

    This study presents a simplified approach for size-controlled synthesis of manganese oxide octahedral molecular sieve (OMS-2) nanowires using potassium permanganate (KMnO4) and different inorganic acids (HCl, HNO3, and H2SO4) under reflux conditions. The morphology and nanostructure of the synthesized products are characterized by X-ray diffraction, Ar adsorption, and electron microscopy analysis, in order to elucidate the controlling effects of acid concentration and type as well as the formation mechanism of OMS-2 nanowires. The concentration of inorganic acid is a crucial factor controlling the phase of the synthesized products. OMS-2 nanowires are obtained with HCl at the concentration ≥0.96 mol/L or with HNO3 and H2SO4 at the concentrations ≥0.72 mol/L. Differently, the type of inorganic acid effectively determines the particle size of OMS-2 nanowires. When the acid is changed from HCl to HNO3 and H2SO4 in the reflux system, the average length of OMS-2 declines significantly by 60-70% (1104-442 and 339 nm), with minor decreased in the average width (43-39 and 34 nm). The formation of OMS-2 nanowires under reflux conditions with KMnO4 and inorganic acids involves a two-step process, i.e., the initial formation of layered manganese oxides, and subsequent transformation to OMS-2 via a dissolution-recrystallization process under acidic conditions. The proposed reflux route provides an alternative approach for synthesizing OMS-2 nanowires as well as other porous nano-crystalline OMS materials.

  10. Diagnostic value of dilated intercellular space and histopathologic scores in gastroesophageal reflux disease.

    PubMed

    Cui, R; Zhang, H; Zhou, L; Lu, J; Xue, Y; Wang, Y; Yan, X; Lin, L; Lin, S

    2015-01-01

    The aim of this paper is to investigate the diagnostic value of histopathologic score and the dilated intercellular space (DIS) in patients with gastroesophageal reflux disease (GERD) and functional heartburn (FH). Participants with GERD symptoms including reflux esophagitis, non-erosive reflux disease (NERD), Barrett's esophagus (BE), functional heartburn (FH), along with a control group with atypical GERD-like symptom (Sym-C), and asymptomatic healthy volunteers (H-C) were administered GERD questionnaire, and subjected to endoscopy and biopsies, as well as 24-hour pH-impedance monitoring. Biopsies were evaluated using standards from the 2011 Esohisto Project after Hematoxylin-Eosin staining. DIS was measured quantitatively under light microscopy. Among the total of 565 participants with qualified biopsy specimens, the mean DIS of the reflux esophagitis (RE) group was significantly wider compared with the other five groups. DIS in patients with GERD-like symptoms was significantly wider compared with the H-C. No significant differences were observed between NERD and FH. Results from 24-hour pH-impedance monitoring indicated that only the DIS of patients with acid reflux or the amount of acid reflux episodes in patients with DIS was significantly wider compared with patients with nonacid reflux or patients without DIS (P < 0.001). With DIS = 0.9 μm as the cutoff value, the sensitivity and specificity were 62.6% and 54.1%, respectively. Using the total histopathologic score > 3 as the diagnostic criterion, the sensitivity and specificity were 71.7% and 47.4%. DIS is closely associated with GERD and acid reflux. The diagnostic value of histological scores in lower esophagus in GERD is very similar to that of the quantitative measurement of DIS.

  11. Banhasasim-Tang Treatment Reduces the Severity of Esophageal Mucosal Ulcer on Chronic Acid Reflux Esophagitis in Rats

    PubMed Central

    2017-01-01

    The present study was conducted to evaluate both antioxidant and anti-inflammatory activity of Banhasasim-tang (BHSST) on chronic acid reflux esophagitis (CRE) model. Rat CRE model was established operatively and then treated with BHSST (1 g/kg body weight per day) for 15 days Esophageal pathological changes were analyzed using macroscopic examination and hematoxylin/eosin staining. The antioxidant and inflammatory protein levels were determined using Western blotting. The administration of BHSST significantly reduced both the overexpression of serum reactive oxygen species (ROS) and an excessive formation of thiobarbituric acid-reactive substances (TBARS) in esophagus tissue. Thus, the severity of esophageal ulcer was lower in BHSST treated rats than control rats on the gross and histological evaluation. Nuclear factor-erythroid 2-related factor 2 (Nrf2) led to the upregulation of antioxidant enzyme including SOD, GPx-1/2, and HO-1 by binding to antioxidant response element (ARE). Moreover, BHSST administration markedly reduced the expression of inflammatory proteins through mitogen-activated protein kinase- (MAPK-) related signaling pathways and decreased significantly the protein expressions of inflammatory mediators and cytokines by inhibition of nuclear factor-kappa B (NF-κB) activation. Taken together, these results support the fact that BHSST administration can suppress the development of esophageal mucosal ulcer via regulating inflammation through the activation of the antioxidant pathway. PMID:28349065

  12. Vesicoureteral reflux (image)

    MedlinePlus

    ... in the bladder wall, which can cause vesicoureteral reflux. Vesicoureteral reflux is a condition that allows urine to go ... and kidneys causing repeated urinary tract infections. The reflux of urine exposes the ureters and kidney to ...

  13. Esophagogastric Junction Contractility Integral Reflect the Anti-reflux Barrier Dysfunction in Patients with Gastroesophageal Reflux Disease

    PubMed Central

    Xie, Chenxi; Wang, Jinhui; Li, Yuwen; Tan, Niandi; Cui, Yi; Chen, Minhu; Xiao, Yinglian

    2017-01-01

    Background/Aims Anti-reflux barrier dysfunction is one of the primary mechanisms in gastroesophageal reflux disease (GERD) pathogenesis. The esophagogastric junction contractile integral (EGJ-CI) is a new metric adopted to evaluate the EGJ contractility, which implies the anti-reflux barrier function. The aim of the current study was to validate this new metric in patients with GERD and its correlation with the esophageal acid exposure, as well as the efficacy of proton pump inhibitor treatment. Methods Ninety-eight patients with GERD and 21 healthy controls were included in the study. Upper endoscopy, high-resolution manometry (HRM) and 24-hour multichannel intraluminal impedance-pH monitoring were performed in all patients. Three respiration cycles were chosen at the initial HRM resting frame and the value computed with distal contractile integral tool was then divided by the duration of the cycles to yield EGJ-CI. All the patients were treated with esomeprazole 20 mg twice-daily for 8 weeks. Results EGJ-CI was lower in the patients with GERD than that of the controls (P < 0.05). For patients with GERD, EGJ-CI was lower in those with hiatal hernia (P < 0.05). The new metric correlated with esophageal acid exposure in the supine position (P < 0.05), and it also negatively correlated to the total reflux episodes (P < 0.05). There was no significant difference on EGJ-CI between patients with and without response to the esomeprazole treatment (P = 0.627). Conclusions EGJ-CI reflected the dysfunction of the anti-reflux barrier in patients with GERD, but it had little impact on the esomeprazole response. PMID:27426485

  14. Pathophysiology of gastroesophageal reflux disease.

    PubMed

    Orlando, Roy C

    2008-01-01

    The pathophysiology of gastroesophageal reflux disease remains incompletely understood. Its hallmark symptom is "heartburn" and, on the basis of endoscopy, those with heartburn are subdivided into nonerosive reflux disease and erosive esophagitis. Although subjects with nonerosive reflux disease have no gross damage on endoscopy, a characteristic histopathologic feature of this disease is present on endoscopic biopsy. This lesion is known as "dilated intercellular spaces," a finding present within squamous epithelium. This report details how acid in contact with a damaged esophageal epithelium leads to heartburn and to the progression of nonerosive reflux disease to erosive esophagitis. It also addresses the fact that esophageal pH monitoring may be normal in a significant number of subjects with heartburn, particularly with nonerosive reflux disease, and details how this observation suggests that in addition to defects in the antireflux barrier, for example, transient lower esophageal sphincter relaxations and low lower esophageal sphincter pressure, defects in tissue resistance created by contact with ingested products may also be etiologic in some subjects with gastroesophageal reflux disease.

  15. Esophageal Acid Stimulation Alters Insular Cortex Functional Connectivity in Gastroesophageal Reflux Disease

    PubMed Central

    Siwiec, Robert M.; Babaei, Arash; Kern, Mark; Samuel, Erica A.; Li, Shi-Jiang; Shaker, Reza

    2014-01-01

    Background The insula plays a significant role in the interoceptive processing of visceral stimuli. We have previously shown that GERD patients have increased insular cortex activity during esophageal stimulation, suggesting a sensitized esophago-cortical neuraxis. However, information regarding the functional connectivity (FC) of the insula during visceral stimulation is lacking. The primary aim of this study was to investigate the FC of insular subregions during esophageal acid stimulation. Methods Functional imaging data was obtained from 12 GERD patients and 14 healthy subjects during four steady state conditions: (1) presence of transnasal esophageal catheter (pre-infusion); (2) neutral solution; (3) acid infusion; (4) presence of transnasal esophageal catheter following infusions (post-infusion). The insula was parcellated into 6 regions of interest (ROI). FC maps between each insular ROI and interoceptive regions were created. Differences in FC between GERD patients and healthy subjects were determined across the 4 study conditions. Key Results All GERD patients experienced heartburn during and after esophageal acidification. Significant differences between GERD patients and healthy subjects were seen in: (1) insula-thalamic FC (neutral solution infusion, acid infusion, post-infusion); (2) insula-amygdala FC (acid infusion, post-infusion); (3) insula-hippocampus and insula-cingulate FC (post-infusion). Conclusions & Inferences Esophageal stimulation in GERD patients revealed significant insular cortex FC differences with regions involved in viscerosensation and interoception. The results of our study provide further evidence that the insula, located at the transition of afferent physiologic information to human feelings, is essential for both visceral homeostasis and the experience of heartburn in GERD patients. PMID:25367277

  16. Dose-Finding Study of Omeprazole on Gastric pH in Neonates with Gastro-Esophageal Acid Reflux Using a Bayesian Sequential Approach

    PubMed Central

    Kaguelidou, Florentia; Alberti, Corinne; Biran, Valerie; Bourdon, Olivier; Farnoux, Caroline; Zohar, Sarah; Jacqz-Aigrain, Evelyne

    2016-01-01

    Objective Proton pump inhibitors are frequently administered on clinical symptoms in neonates but benefit remains controversial. Clinical trials validating omeprazole dosage in neonates are limited. The objective of this trial was to determine the minimum effective dose (MED) of omeprazole to treat pathological acid reflux in neonates using reflux index as surrogate marker. Design Double blind dose-finding trial with continual reassessment method of individual dose administration using a Bayesian approach, aiming to select drug dose as close as possible to the predefined target level of efficacy (with a credibility interval of 95%). Setting Neonatal Intensive Care unit of the Robert Debré University Hospital in Paris, France. Patients Neonates with a postmenstrual age ≥ 35 weeks and a pathologic 24-hour intra-esophageal pH monitoring defined by a reflux index ≥ 5% over 24 hours were considered for participation. Recruitment was stratified to 3 groups according to gestational age at birth. Intervention Five preselected doses of oral omeprazole from 1 to 3 mg/kg/day. Main outcome measures Primary outcome, measured at 35 weeks postmenstrual age or more, was a reflux index <5% during the 24-h pH monitoring registered 72±24 hours after omeprazole initiation. Results Fifty-four neonates with a reflux index ranging from 5.06 to 27.7% were included. Median age was 37.5 days and median postmenstrual age was 36 weeks. In neonates born at less than 32 weeks of GA (n = 30), the MED was 2.5mg/kg/day with an estimated mean posterior probability of success of 97.7% (95% credibility interval: 90.3–99.7%). The MED was 1mg/kg/day for neonates born at more than 32 GA (n = 24). Conclusions Omeprazole is extensively prescribed on clinical symptoms but efficacy is not demonstrated while safety concerns do exist. When treatment is required, the daily dose needs to be validated in preterm and term neonates. Optimal doses of omeprazole to increase gastric pH and decrease reflux

  17. Efficacy of dextranomer hyaluronic acid and polyacrylamide hydrogel in endoscopic treatment of vesicoureteral reflux: A comparative study

    PubMed Central

    Blais, Anne-Sophie; Morin, Fannie; Cloutier, Jonathan; Moore, Katherine; Bolduc, Stéphane

    2015-01-01

    Introduction: Various bulking agents are available for vesicoureteral reflux (VUR) endoscopic treatment, but their inconsistent success rates and costs are concerns for urologists. Recently, polyacrylamide hydrogel (PAHG) has been shown to have a good overall success rate, which seems comparable to dextranomer hyaluronic acid (Dx/HA), currently the most popular bulking agent. Our objective was to compare the short-term success rate of PAHG and Dx/HA for VUR endoscopic treatment in children. Methods: We performed a prospective non-randomized study using PAHG and Dx/HA to treat VUR grades I to IV in pediatric patients. All patients underwent endoscopic sub-ureteric injection of PAHG or Dx/HA, using the double-HIT technique, followed by a 3-month postoperative renal ultrasound and voiding cystourethrogram. Treatment success was defined as the absence of de novo or worsening hydronephrosis and absence of VUR. Results: A total of 90 pediatric patients underwent an endoscopic injection: 45 patients (78 ureters) with PAHG and 45 patients (71 ureters) with Dx/HA. The mean injected volume of PAHG and Dx/HA was 1.1 mL and 1.0 mL, respectively. The overall success rate 3 months after a single treatment was 73.1% for PAHG and 77.5% for Dx/HA. Postoperatively, 1 patient in each group presented with acute pyelonephritis and 2 patients in the Dx/HA group developed symptomatic ureteral obstruction. Conclusion: Success rates of PAGH and Dx/HA in endoscopic injections for VUR treatment were comparable. The rate of resolution obtained with Dx/HA was equivalent to those previously published. The lower cost of PAHG makes it an interesting option. PMID:26225173

  18. Refractory gastroesophageal reflux disease: advances and treatment.

    PubMed

    Ates, Fehmi; Francis, David O; Vaezi, Michael F

    2014-08-01

    'Refractory gastroesophageal reflux disease' is one of the most common misnomers in the area of gastroesophageal reflux disease. The term implies reflux as the underlying etiology despite unresponsiveness to aggressive proton pump inhibitor therapy. The term should be replaced with 'refractory symptoms.' We must acknowledge that in many patients symptoms of reflux often overlap with non-GERD causes such as gastroparesis, dyspepsia, hypersensitive esophagus and functional disorders. Lack of response to aggressive acid suppressive therapy often leads to diagnostic testing. In majority of patients these tests are normal. The role of non-acid reflux in this group is uncertain and patients should not undergo surgical fundoplication based on this parameter. In patients unresponsive to acid suppressive therapy GERD is most commonly not causal and a search for non-GERD causes must ensue.

  19. The outcomes of two different bulking agents (dextranomer hyaluronic acid copolymer and polyacrylate-polyalcohol copolymer) in the treatment of primary vesico-ureteral reflux

    PubMed Central

    Taşkinlar, Hakan; Avlan, Dincer; Bahadir, Gokhan Berktug; Delibaş, Ali; Nayci, Ali

    2016-01-01

    ABSTRACT Purpose Subureteral injection of bulking agents in the endoscopic treatment of vesicoureteral reflux is widely accepted therapy with high success rates. Although the grade of vesicoureteric reflux and experience of surgeon is the mainstay of this success, the characteristics of augmenting substances may have an effect particularly in the long term. In this retrospective study, we aimed to evaluate the clinical outcomes of the endoscopic treatment of vesicoureteric reflux (VUR) with two different bulking agents: Dextranomer/hyaluronic acid copolymer (Dx/HA) and Polyacrylate polyalcohol copolymer (PPC). Materials and Methods A total 80 patients (49 girls and 31 boys) aged 1-12 years (mean age 5.3 years) underwent endoscopic subureteral injection for correction of VUR last six years. The patients were assigned to two groups: subureteral injections of Dx/HA (45 patients and 57 ureters) and PPC (35 patients and 45 ureters). VUR was grade II in 27 ureters, grade III in 35, grade IV in 22 and grade V in 18 ureters. Results VUR was resolved in 38 (66.6%) of 57 ureters and this equates to VUR correction in 33 (73.3%) of the 45 patients in Dx/HA group. In PPC group, overall success rate was 88.8% (of 40 in 45 ureters). Thus, Thus, this equates to VUR correction in 31 (88.5%) of the 35 patients. Conclusions Our short term data show that two different bulking agent injections provide a high level of reflux resolution and this study revealed that success rate of PPC was significantly higher than Dx/HA with less material. PMID:27286115

  20. Gastroesophageal reflux and lung disease.

    PubMed

    Meyer, Keith C

    2015-08-01

    Gastroesophageal reflux (GER) can cause respiratory symptoms and may trigger, drive and/or worsen airway disorders, interstitial lung diseases and lung allograft dysfunction. Whether lifestyle changes and acid suppression alone can counter and prevent the adverse effects of GER on the respiratory tract remains unclear. Recent data suggest that antireflux surgery may be more effective in preventing lung disease progression in patients with idiopathic pulmonary fibrosis or lung transplant recipients who have evidence of allograft dysfunction associated with the presence of excessive GER. Additional research and clinical trials are needed to determine the role of GER in various lung disorders and identify which interventions are most efficacious in preventing the respiratory consequences of gastroesophageal reflux disease. In addition, measuring biomarkers that indicate that gastric refluxate has been aspirated into the lower respiratory tract (e.g., pepsin and bile acid concentrations in bronchoalveolar lavage fluid) may prove helpful in both diagnosis and therapeutic decision making.

  1. [Therapeutic principles in gastroesophageal reflux].

    PubMed

    Chassany, O; Elkharrat, D; Bergmann, J F; Segrestaa, J M

    1995-01-01

    Gastroesophageal reflux is a common disease. Its chronic course, even if mild, is sometimes complicated by erosive oesophagitis. Drug therapy acts against gastric acidity and motility disorders. Treatment of gastroesophageal reflux disease has three aims: improvement of symptoms and quality of life, healing erosive lesions and prevention of symptomatic and endoscopic relapses. Non-drug measures are always useful, even if their efficacy is not well established. Initial therapy of a symptomatic reflux or mild oesophagitis is most of the time effective (antacids, prokinetics, H2 receptor antagonists). Proton-pump inhibitors are also effective in healing and preventing severe oesophagitis. Questions about long-term treatment adverse events with powerful acid inhibitors, such as hypergastrinemia and the risk of gastric carcinoid tumours seem to be resolved. Studies are requested to define the optimal long-term maintenance treatment with cisapride, H2 receptor antagonists or proton-pump inhibitors at low doses in prevention of symptomatic and mild oesophagitis relapses.

  2. Part III – Treatment of Ureterovesical Reflux

    PubMed Central

    Govan, Duncan E.; Fair, William R.; Friedland, Gerald W.; Filly, Roy A.

    1974-01-01

    Of 134 girls with demonstrable ureterovesical reflux, 61 (105 ureters) had the reflux surgically corrected with an overall surgical cure rate of 97 percent. In the remaining 73 children (112 ureters), the reflux was treated conservatively with medical management alone. During the follow-up period no significant differences were demonstrated in the overall incidence of urinary tract infection; two years following corrective operation or medical treatment more than 50 percent of both medically and surgically treated children were still experiencing infections. A pronounced decrease, however, occurred in the incidence of clinical pyelonephritis among the surgically treated group. Following correction of reflux, the incidence of pyelonephritis was similar in both medically and surgically treated cases and was approximately the same as that found in a comparable group of children without reflux. In approximately two-thirds of refluxing renal units in which there was evidence of clubbing and scarring before medical or surgical therapy, deterioration progressed during the follow-up period. In most of these cases infection control was felt to be inadequate with episodes of clinical pyelonephritis occurring during the period of medical management, or, in the surgically treated group, occurring just before corrective operation and the scar appearing within two years after operation. The majority of renal units in which calyceal clubbing and parenchymal scarring was present had the most severe grades of reflux. PMID:4460380

  3. Simultaneous tracheal and oesophageal pH measurements in asthmatic patients with gastro-oesophageal reflux.

    PubMed Central

    Jack, C. I.; Calverley, P. M.; Donnelly, R. J.; Tran, J.; Russell, G.; Hind, C. R.; Evans, C. C.

    1995-01-01

    BACKGROUND--An association between asthma and gastro-oesophageal reflux is well recognised but the underlying mechanism is unclear. One suggestion is that gastric juice is aspirated into the tracheal and upper airways but detection of these events is difficult and involves radioisotopic studies. A new method of making direct measurements of tracheal and oesophageal pH over a 24 hour period is described, together with its application to patients with asthma. METHODS--The technique involves insertion of simultaneous tracheal and oesophageal pH probes under general anaesthesia. Continuous monitoring of pH over a 24 hour period is possible, permitting comparison with peak flow readings during wakefulness and at night should the patient be disturbed. Representative data from four patients with asthma (mean FEV1 62% predicted) and symptomatic gastro-oesophageal reflux, together with data from three non-asthmatics, is presented. RESULTS--Thirty seven episodes of gastro-oesophageal reflux lasting more than five minutes were recorded. Of these, five were closely followed by a fall in tracheal pH from a mean (SE) of 7.1 (0.2) to 4.1 (0.4) and a fall in peak expiratory flow (PEFR) of 84 (16) l/min. When gastro-oesophageal reflux occurred without tracheal aspiration the fall in PEFR was 8 (4) l/min. CONCLUSIONS--This new technique was well tolerated and allowed quantitation of the number, duration, and timing of episodes of tracheal micro-aspiration. Unlike acid reflux without aspiration, these events appear to be related to significant acute changes in lung function in asthmatic patients. Further studies with this new method may elucidate the role of gastro-oesophageal reflux in asthma. Images PMID:7701464

  4. Reflux revisited

    SciTech Connect

    Gill, I.; Moore, C.H.; Aharon, P.

    1988-01-01

    The samples and data for this project are derived from 22 test holes drilled to a maximum depth of 91 m, and from rock exposures representing the carbonate section through the Miocene. Dolomite on St. Croix exists in a highly localized region of outcrops and subsurface occurrences in a Miocene-Pliocene reef tract and its related facies. Bioclasts in the dolomitic strata commonly show surprisingly good preservation of microstructure, particularly in large benthic forams and coralline algal clasts. The dolomite is stoichiometrically calcium-rich and exists as euhedral rhombs ranging from 2 to 30 ..mu..m in diameter. The surficial dolomitization occurs in reef, lagoonal, and platform facies that rim the predevelopment shoreline of a coastal lagoon. In the subsurface, dolomitized rock follows the lithifield undersurface of the same lagoon. This spatial distribution of dolomitization suggests a causal relationship between the lagoon hydrology and the process of the dolomitization. The preliminary Sr/sup 87//Sr/sup 86/ isotopic composition of the dolomite is 0.70888, which corresponds to Miocene-Pliocene seawater values, and suggests a Miocene-Pliocene age for the dolomitization event. Stable isotopic values average +2.3 o/oo for delta/sup 13/C and +4.1 o/oo for delta/sup 18/O, both relative to the PDB standard. These data imply that dolomitization took place by reflux of Pliocene fluids enriched in /sup 18/O. The dolomitization was confined to a fault-bounded region, and affected reef, lagoonal, and platform carbonates.

  5. Delayed Obstruction With Asymptomatic Loss of Renal Function After Dextranomer/Hyaluronic Acid Copolymer (Deflux) Injection for Vesicoureteral Reflux: A Close Look at a Disturbing Outcome.

    PubMed

    Papagiannopoulos, Dimitri; Rosoklija, Ilina; Cheng, Earl; Yerkes, Elizabeth

    2017-03-01

    Dextranomer/hyaluronic acid copolymer (Deflux) first received Food and Drug Administration approval in 2001 for endoscopic injection in children with grade II-IV vesicoureteral reflux VUR. As experience has grown, Deflux has been used more liberally with encouraging results. We report 3 cases where Deflux was used in off-label fashion, resulting in delayed ureteral obstruction and loss of renal function (range 18-52 months postoperatively). We now place increased emphasis on the need for long-term follow-up after Deflux in both routine and complex cases, particularly in situations of off-label use.

  6. A novel once daily microparticulate dosage form comprising lansoprazole to prevent nocturnal acid breakthrough in the case of gastro-esophageal reflux disease: preparation, pharmacokinetic and pharmacodynamic evaluation.

    PubMed

    Alai, Milind; Lin, Wen Jen

    2013-01-01

    The objective of this study was to formulate and evaluate the lansoprazole (LPZ)-loaded microparticles to prevent nocturnal acid breakthrough in the case of gastro-esophageal reflux disease (GERD). The microparticulate delivery system was prepared by solvent evaporation method using Eudragit RS100 as a matrix polymer followed by enteric coated with Eudragit S100 and hydroxypropyl methylcellulose phthalate HP55 using spray drying method. The enteric coated microparticles were stable in gastric pH condition. In vivo pharmacokinetic and pharmacodynamic studies in male Wistar rats demonstrated that enteric coated microparticles sustained release of LPZ and promoted ulcer healing activity. In other words, the microparticulate dosage form provided effective drug concentration for a longer period as compared to conventional extended release dosage form, and showed sufficient anti-acid secretion activity to treat acid related disorders including the enrichment of nocturnal acid breakthrough event based on a once daily administration.

  7. From Reflux Esophagitis to Esophageal Adenocarcinoma.

    PubMed

    Souza, Rhonda F

    Reflux esophagitis causes Barrett's metaplasia, an abnormal esophageal mucosa predisposed to adenocarcinoma. Medical therapy for reflux esophagitis focuses on decreasing gastric acid production with proton pump inhibitors. We have reported that reflux esophagitis in a rat model develops from a cytokine-mediated inflammatory injury, not from a caustic chemical (acid) injury. In this model, refluxed acid and bile stimulate the release of inflammatory cytokines from esophageal squamous cells, recruiting lymphocytes first to the submucosa and later to the luminal surface. Emerging studies on acute reflux esophagitis in humans support this new concept, suggesting that reflux-induced cytokine release may be a future target for medical therapies. Sometimes, reflux esophagitis heals with Barrett's metaplasia, a process facilitated by reflux-related nitric oxide (NO) production and Sonic Hedgehog (Hh) secretion by squamous cells. We have shown that NO reduces expression of genes that promote a squamous cell phenotype, while Hh signaling induces genes that mediate the development of the columnar cell phenotypes of Barrett's metaplasia. Agents targeting esophageal NO production or Hh signaling conceivably could prevent the development of Barrett's esophagus. Persistent reflux promotes cancer in Barrett's metaplasia. We have reported that acid and bile salts induce DNA damage in Barrett's cells. Bile salts also cause NF-x03BA;B activation in Barrett's cells, enabling them to resist apoptosis in the setting of DNA damage and likely contributing to carcinogenesis. Oral treatment with ursodeoxycholic acid prevents the esophageal DNA damage and NF-x03BA;B activation induced by toxic bile acids. Altering bile acid composition might be another approach to cancer prevention.

  8. Gastroesophageal reflux - discharge

    MedlinePlus

    Peptic esophagitis - discharge; Reflux esophagitis - discharge; GERD - discharge; Heartburn - chronic - discharge ... You have gastroesophageal reflux disease (GERD). This is a condition in which food or liquid travels backwards from the stomach to the esophagus ( ...

  9. [Gastroesophageal reflux disease].

    PubMed

    Larrosa Haro, Alfredo

    2011-01-01

    Physiological gastroesophageal reflux (GER) is the passage of gastric contents into the esophagus and occurs up 2/3 of normal infants; and, it resolves spontaneously around 9-12 months of age. When GER causes symptoms or complications is considered gastroesophageal reflux disease (GERD) and it is associated to growth impairment, anemia, apnea, wheezing or other chronic respiratory symptoms, asthma, recurrent pneumonia or sleeping problems. Diagnosis of GERD implies studies as upper gastrointestinal series, upper endoscopy and 24 h esophageal pH monitoring; special cases may require motility and nuclear medicine studies. GER may be successfully treated with prone elevated position (30-45 degrees), shortening the feeding intervals to 3 h and anti-GER high-viscosity formulas. The regular use of prokinetic drugs is not recommended. The efficacy of proton pump inhibitors and H2 histamine receptor antagonists in the treatment of GERD has been demonstrated in children by diminishing de acid secretion of parietal cells, lowering the gastric contents and decreasing its ability to cause peptic-acid damage to the esophagus or to the respiratory tract. Surgical treatment is indicated in chronic recurrent GERD, usually in children 5 years or older with dependent proton pump inhibitor erosive esophagitis, chronic respiratory disease and in risk-selected cases.

  10. Relationship between gastro-oesophageal reflux and airway diseases: the airway reflux paradigm.

    PubMed

    Pacheco-Galván, Adalberto; Hart, Simon P; Morice, Alyn H

    2011-04-01

    Our understanding of the relationship between gastro-oesophageal reflux and respiratory disease has recently undergone important changes. The previous paradigm of airway reflux as synonymous with the classic gastro-oesophageal reflux disease (GORD) causing heartburn has been overturned. Numerous epidemiological studies have shown a highly significant association of the acid, liquid, and gaseous reflux of GORD with conditions such as laryngeal diseases, chronic rhinosinusitis, treatment resistant asthma, COPD and even idiopathic pulmonary fibrosis. However, it has become clear from studies on cough hypersensitivity syndrome that much reflux of importance in the airways has been missed, since it is either non- or weakly acid and gaseous in composition. The evidence for such a relationship relies on the clinical history pointing to symptom associations with known precipitants of reflux. The tools for the diagnosis of extra-oesophageal reflux, in contrast to the oesophageal reflux of GORD, lack sensitivity and reproducibility. Unfortunately, methodology for detecting such reflux is only just becoming available and much additional work is required to properly delineate its role.

  11. Gastro-oesophageal reflux in infants. Evaluation of treatment by pH monitoring.

    PubMed

    Vandenplas, Y; Sacré-Smits, L

    1987-09-01

    Forty bottle-fed babies, 4-12 weeks old, with clinical gastro-oesophageal reflux were studied. Continuous 24 h oesophageal pH monitoring in a prone position demonstrated a gastro-oesophageal reflux with all of the following parameters: reflux index, duration of the longest reflux episode, number of reflux episodes in 24 h, number of reflux episodes greater than 5 min in 24 h. Positional therapy (prone-antitrendelenburg position), applied to all infants, resulted in a normalization of these parameters in ten of them. The remaining 30 infants were treated with milk-thickening agents, as recommended by Carre. Nearly all (N = 25) showed an important clinical improvement. A third pH monitoring was performed after 10-14 days of treatment. In six infants the results were completely within normal ranges. In 24 infants a decrease in the number of reflux episodes was demonstrated, with a comparable reflux index and number of long lasting reflux episodes. The duration of the longest reflux episode however increased significantly (P less than 0.001). Drugs (domperidone, Gaviscon) added to the milk-thickening agents in these 24 children, led to normalization of pH tracings. Clinical symptoms were less severe or disappeared in all infants but one. We conclude that if positional therapy (prone-antitrendelenburg) does not correct gastro-oesophageal reflux in infants, pharmacological treatment should be applied. Milk-thickening agents alone can be effective in individual cases but should be prescribed with care as they can lead to more occult gastro-oesophageal reflux with episodes of longer duration, increasing the risk of oesophagitis or respiratory distress.

  12. [Surgical treatment for gastroesophageal reflux disease (GERD)].

    PubMed

    Iida, Atsushi; Yamaguchi, Akio

    2007-05-01

    Proton pump inhibitor (PPI) is major treatment for acid reflux. It reduces major symptom of GERD and effective. However, the cause of GERD is the insufficiency of anti-reflux mechanism of cardia. Only surgical treatment can care for hiatal hernia as the main cause of the disruption. Redundant reflux against conservative treatment or obvious hiatal hernia is indication for laparoscopic Nissen fundoplication. Late diagnosis might request radical operation, so we need to know the indication for laparoscopic treatment. For the safer laparoscopic procedure, we perform curtain retraction technique and Floppy Nissen -short cuff method. The former contribute to prevent hemorrhage or pneumothorax, and the latter can reduce the post-operative disphagia.

  13. The Value of PIC Cystography in Detecting De Novo and Residual Vesicoureteral Reflux after Dextranomer/Hyaluronic Acid Copolymer Injection.

    PubMed

    Palmer, B W; Hemphill, M; Wettengel, K; Kropp, B P; Frimberger, D

    2011-01-01

    The endoscopic injection of Dx/HA in the management of vesicoureteral reflux (VUR) has become an accepted alternative to open surgery. In the current study we evaluated the value of cystography to detect de novo contralateral VUR in unilateral cases of VUR at the time of Dx/HA injection and correlated the findings of immediate post-Dx/HA injection cystography during the same anesthesia to 2-month postoperative VCUG to evaluate its ability to predict successful surgical outcomes. The current study aimed to evaluate whether an intraoperatively performed cystogram could replace postoperative studies. But a negative intraoperative cystogram correlates with the postoperative study in only 80%. Considering the 75-80% success rate of Dx/HA implantation, the addition of intraoperative cystograms cannot replace postoperative studies. In patients treated with unilateral VUR, PIC cystography can detect occult VUR and prevent postoperative contralateral new onset of VUR.

  14. [Reflux nephropathy in absence of obvious vesicoureteral reflux].

    PubMed

    Vino, L; Pedrolli, A; Portuese, A; Dal Cerè, M; Pizzini, C; Sinaguglia, G; Fanos, V

    2000-01-01

    Although the majority of patients with vesicoureteric reflux presents DMSA scan alterations, parenchimal renal scars are found also in children without vesicoureteric reflux. Two clinical cases of reflux nephropathy without evidence of reflux are presented. Several explanations could be advocated to justify this picture, including haematogenous source of infection, inadequate timing and/or procedure of cystouretrography, intermittency of reflux, ascending bacteria, previous presence of reflux, and appearance of controlateral reflux during the natural history of a monolateral documented reflux. Tailored diagnostic and therapeutic strategy should discussed for each patient.

  15. Evaluation of Gastroesophageal Reflux Disease Using the Bravo Capsule pH System

    PubMed Central

    Lawenko, Rona Marie A; Lee, Yeong Yeh

    2016-01-01

    Gastroesophageal reflux disease (GERD) is a disease predominantly seen in the West but there is a rising trend in Asia. Ambulatory 24-hour catheter-based pH monitoring has been the de facto gold standard test for GERD that correlates symptoms with acid reflux episodes. However, drawbacks such as patients’ discomfort, and catheter displacement render the test as cumbersome and error-prone. The Bravo pH wireless system is designed to be user-friendly and has an added advantage of prolonged pH monitoring. The system is comparable to the catheter-based pH monitoring system in terms of diagnostic yield and symptom-reflux association. Indications include evaluation of patients with refractory GERD symptoms and prior to anti-reflux surgery. Bravo utilizes a wireless pH-sensing capsule with a complete prepackaged system, and a data processing software. The capsule may be positioned indirectly using endoscopic or manometric landmarks or under direct endoscopic guidance. Optimal threshold cut-off values are yet to be standardized but based on available studies, for the Asian population, it may be recommended for total % time pH < 4 of 5.8 over 48 hours. Cost is a limitation but capsule placement is relatively safe although technical failures may be seen in small percentage of cases. PMID:26717929

  16. [Gastroesophageal reflux in premature: a case report].

    PubMed

    Ndour, Daouda

    2016-01-01

    Gastroesophageal reflux disease (GERD) is a common problem in neonatology. Various physiological protective reflex responses provide a plausible biological link between gastro-esophageal reflux and apnea and bradycardia in premature. It is uncertain whether or not there is a causal relationship between the two diseases. However there is no consensus about the clinical and paraclinical diagnosis. Further explorations and treatment offered to premature infants with symptoms are discussed. We report the case of a preterm infants admitted to neonatal intensive care and with apnea and bradycardia. Clinical examination and exploration results were normal. We retained the gastrointestinal reflux diagnosis complicated of apnea and bradycardia. Pharmacological therapy for gastro-esophageal reflux disease has not definitively been shown to be effective in improving symptoms and should be reserved especially for infants with treatment refractory apnea and bradycardia episodes suspected as being gastro-esophageal reflux in premature infants. From a case report we made a literature review to discuss at length the different aspects of the problem.

  17. Anti-reflux surgery - children

    MedlinePlus

    ... reflux disease. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics . 19th ed. Philadelphia, ... surgery - children - discharge Anti-reflux surgery - discharge ...

  18. Risk factors for renal scarring in children with primary vesicoureteral reflux disease.

    PubMed

    Mir, Sevgi; Ertan, Pelin; Ozkayin, Nese

    2013-01-01

    To determine the incidence of renal scarring among patients with primary vesicoureteral reflux (VUR) and the possible risk factor(s), we studied 90 children (60 girls and 30 boys) with VUR followed in the Pediatric Nephrology Unit at the Ege University Hospital from 1998 to 2003. All the patients were assessed for VUR grade by voiding cystoureterography and for presence of renal scarring by (99 m) technetium dimercapto-succinic acid scintigraphy. All infants with VUR were given low-dose prophylactic antibiotics and followed-up until resolution of the reflux. Grade of reflux and number of urinary tract infection (UTI) episodes (≥3) were found to be statistically significant risk factors for renal scarring (P <0.05). However, gender, familial history and laterality of the disease were not found to be statistically significant risk factors (P >0.05). Similarly, there was no statistically significant difference of frequency of renal scarring among the different age groups (P >0.05). We conclude that recurrences of UTI and VUR severity are significant risk factors for renal scarring in children with VUR. Therefore, identification of VUR at an early age may offer the opportunity to prevent episodes of UTI and possible formation of renal scars that may result in end-stage renal failure.

  19. [Gastroesophageal reflux and asthma--pathogenetic mechanisms and treatment].

    PubMed

    Gabriela, Jimborean; Ianosi, Edith Simona; Aberle, Emese; Comes, Alexandra

    2012-01-01

    Gastroesophageal reflux and bronchial asthma are frequently encountered comorbidities that maintain an ambivalent relationship, generating a vicious circle where gastroesophageal reflux increases asthmatic symptoms or precipitates bronchial asthma and asthma can trigger or worsen gastroesophageal reflux disease. Pathogenetic mechanisms of these interrelation are imperfectly understood, despite intense concerns of specialists in both areas. There have been incriminated: eso-bronchial constrictor vagal mediated reflexes, bronchial hyperreactivity, neurogenic inflammation induced by hydrochloric acid penetration in the oesofagus, airways hydrochloric acid microaspiration with asthmatic trigger effects, increased bronchial resistance or increased immune response to antigens. Bronchial obstruction and some antiasthmatic medication can decrease lower esophageal sphincter pressure and thus triggering or aggravating gastroesophageal reflux. The diagnosis of the gastroesophageal reflux in asthmatics involves a careful clinical exam, digestive functional test (up to 24 hours monitoring esophageal pH) and esogastroscopy. Gastroesophageal reflux treatment in asthmatic patients claims elimination of both disease risk factors, diet, proton-pump inhibitors.

  20. Response of Gammarus pulex and Baetis rhodani to springtime acid episodes in humic brooks.

    PubMed

    Andrén, C M; Eriksson Wiklund, A-K

    2013-10-01

    While chronic acidification of water bodies has been steadily decreasing, episodic acidification continues to affect stream biology by temporarily decreasing pH and mobilizing aluminum. These events are becoming more common as climate change renders more frequent and intense storms and flooding. Throughout Scandinavia, the effects of acidification have been mitigated by liming since the 1980s, but remediation efforts can now be reduced. While transient acidity may reduce fish populations, also other species in streams are affected. In this in-stream study, two macro-invertebrates (Gammarus pulex and Baetis rhodani), both known as salmonid prey organisms, were exposed to snowmelt in six humic brooks with a natural gradient of pH and inorganic monomeric Al (Al(i)). We hypothesize that acid toxicity thresholds can be defined using lethal (mortality) and sublethal (changes in body elemental content) metrics. Periodic observations were made of mortality and whole body concentrations of base cations (BC: Ca, Mg, Na and K) and metals (Al, Fe, Zn and Mn). Mortality increased dramatically at pH<6.0 and Al(i)>15 μg/L for G. pulex and at pH<5.7 and Al(i)>20 μg/L for B. rhodani. No accumulation of Al was found. The invertebrate body Na concentration decreased when pH dropped, suggesting that osmoregulation in both species was affected. In contrast to general BC pattern, Ca concentration in G. pulex and Mg concentration in B. rhodani increased when pH decreased. Although Al(i) strongly correlates to pH, the Al composition of soil and bedrock also influences Al availability, potentially contributing to toxic Al(i) episodes. The estimated values calculated in this study can be used to improve water quality criteria and as thresholds to adjust doses of lime compared to old recommendations in ongoing liming programs. Such adjustments may be critical since both Al(i) and pH levels have to be balanced to mitigate damage to recovering stream ecosystems.

  1. Relationship between multiple water swallows and gastroesophageal reflux in patients with normal esophageal motility.

    PubMed

    Choi, Y J; Park, M I; Park, S J; Moon, W; Kim, S E; Yoo, C H; Kwon, H J

    2015-01-01

    Multiple water swallows (MWS) stimulates neural inhibition, resulting in abolition of contractions in the esophageal body and complete lower esophageal sphincter relaxation, which is followed by peristalsis and the lower esophageal sphincter contraction. We assessed the relationship between MWS and gastroesophageal reflux in patients with esophageal symptoms and with normal findings by high-resolution manometry (HRM). We retrospectively reviewed the clinical records of patients who underwent HRM and a 24-hour ambulatory impedance-pH study. Correlation between the findings of the impedance-pH study and abnormal MWS responses without motility disorders was evaluated. Independent t-tests were used for statistical analysis. Of 28 patients, 20 (71%) had abnormal MWS responses: four (20%) had abnormal responses during MWS, six (30%) had abnormal responses after MWS, and 10 (50%) had abnormal responses both during and after MWS. Total acid exposure times were significantly longer in patients with abnormal MWS responses than in patients with normal MWS responses. In particular, upright acid exposure time and all reflux percent times were significantly longer in patients with abnormal MWS responses. However, bolus clearance time and longest reflux episode were not different between the two groups. Abnormal MWS responses predicted increased acid exposure times in patients with normal findings of HRM by the Chicago classification.

  2. Endoscopic Management of Gastroesophageal Reflux Disease: Revisited

    PubMed Central

    Nabi, Zaheer; Reddy, D. Nageshwar

    2016-01-01

    Gastroesophageal reflux disease (GERD) is defined by the presence of troublesome symptoms resulting from the reflux of gastric contents. The prevalence of GERD is increasing globally. An incompetent lower esophageal sphincter underlies the pathogenesis of GERD. Proton pump inhibitors (PPIs) form the core of GERD management. However, a substantial number of patients do not respond well to PPIs. The next option is anti-reflux surgery, which is efficacious, but it has its own limitations, such as gas bloating, inability to belch or vomit, and dysphagia. Laparoscopic placement of magnetic augmentation device is emerging as a useful alternative to conventional anti-reflux surgery. However, invasiveness of a surgical procedure remains a concern for the patients. The proportion of PPI non-responders or partial responders who do not wish for anti-reflux surgery defines the ‘treatment gap’ and needs to be addressed. The last decade has witnessed the fall and rise of many endoscopic devices for GERD. Major endoscopic strategies include radiofrequency ablation and endoscopic fundoplication devices. Current endoscopic devices score high on subjective improvement, but have been unimpressive in objective improvement like esophageal acid exposure. In this review, we discuss the current endoscopic anti-reflux therapies and available evidence for their role in the management of GERD. PMID:27744659

  3. A new optics-based gastroesophageal reflux probe.

    PubMed

    Macedo, Milton P; Simões, J Basílio; Amorim, Vitor; Fernandes, Ana G; Carneirinho, Ana; Coelho, Carlos; Barros, Catarina; Domingues, José P P; Ferreira, Ricardo; Mota, H Carmona da; Correia, Carlos M

    2002-01-01

    This work was carried out with the purpose of developing a new method of gastroesophageal reflux (GOR) detection. It is based on the emission of a light beam to the inferior part of the oesophagus and on the detection and analysis of the corresponding reflected light intensity. The optical properties of the oesophageal lumen are then used to identify the GOR episodes, solving, in this way, the existing drawback of using pH probes that fail in the cases where GOR episodes are neutral or short duration acid. The necessary instrumentation for the application of this new technique, including the probe itself and its associated optics, was developed. The result is a low-cost portable instrument, based on the Microchip microcontroller PIC16C77, with enough flexibility to be used in other biomedical applications. This new simple apparatus only needs an adequate light source - diode laser - and an adequate photosensor - photodiode - to make the interface to the probe that guides the light to and from oesophagus. Our results show the capability of this new technique to make the identification of GOR episodes.

  4. Mortality of brook trout, mottled sculpins, and slimy sculpins during acidic episodes

    SciTech Connect

    Gagen, C.J.; Sharpe, W.E.; Carline, R.F. )

    1993-07-01

    Brook trout Salvelinus fontinalis, mottled sculpins Cottus bairdi, and slimy sculpins Cottus cognatus occur in many Pennsylvania streams that have depressed pH and elevated aluminum concentrations during episodes of high stream discharge (acidic episodes). We performed 20-d in situ cage exposures with these species to determine their relative sensitivities to field conditions. We also exposed fish in the laboratory to synthetic soft water, without added Al, to elevate possible effects of Al on sodium flux rates and pH toxicity. Exposures were in five streams: two with high pH (>5.60) and low Al concentrations (<80 [mu]g/L) and three with low pH (usually between 5.0 and 5.5) and high Al levels (124-294 [mu]g/L). Exposures were during two low-discharge fall periods, when pH tends to be seasonally higher and Al concentrations lower, and two relatively high-discharge spring seasons, when lower pH and higher Al concentrations are typical. Few fish died (generally <10%) in the two streams that had higher pH and lower al concentrations, whereas mortalities typically exceeded 20% and were as high as 100% during spring exposures in the streams with lower pH and elevated Al concentrations. All three species had higher mortality rates in spring, 20-100%, than in fall, 0-29%. Mottled sculpins and slimy sculpins had similar mortality rates and both had lower mortality rates than brook trout when exposed to similar conditions. We compared Na flux rates of mottled sculpins to those of brook trout in laboratory exposures at pH 4.0, 5.0, and 6.0 to determine if low pH alone could account for mortality rates in the field. Because Na flux rates at pH 5.0, without added Al, were similar to flux rates of the controls for both species, high Al levels were believed to have contributed to the increased mortality observed in streams. 44 refs., 7 figs., 3 tabs.

  5. Effects of Different Ratio of n-6/n-3 Polyunsaturated Fatty Acids on the PI3K/Akt Pathway in Rats with Reflux Esophagitis

    PubMed Central

    Zhuang, Jia-Yuan; Chen, Zhi-Yao; Zhang, Tao; Tang, Du-Peng; Jiang, Xiao-Ying; Zhuang, Ze-Hao

    2017-01-01

    Background We designed this study to investigate the influence of different ratios of n-6/n-3 polyunsaturated fatty acid in the diet of reflux esophagitis (RE) rats’ and the effect on the PI3K/Akt pathway. Material/Methods RE rats were randomly divided into a sham group and modeling groups of different concentrations of n-6/n-3 polyunsaturated fatty acid (PUFA): 12:1 group, 10:1 group, 5:1 group, and 1:1 group. RT-PCR and Western-blot were used to detect the expression of PI3K, Akt, p-Akt, NF-κBp50, and NF-κBp65 proteins in esophageal tissue. Results In the n-6/n-3 PUFAs groups the expression of PI3K, Akt, p-Akt, nf-kbp50, and NF-κBp65 mRNA decreased with the decrease in n-6/n-3 ratios in the diet. The lowest expression of each indicator occurred in the 1:1 n-6/n-3 group compared with other n-6/n-3 groups, the difference was statistically significant (p<0.05). Conclusions The inhibition of n-3 PUFAs in the development of esophageal inflammation in rats with RE was attributed to the function of PI3K/Akt-NF-κB signaling pathway. PMID:28134235

  6. Fish Consumption and Omega-3 Polyunsaturated Fatty Acids in Relation to Depressive Episodes: A Cross-Sectional Analysis

    PubMed Central

    Suominen-Taipale, Anna Liisa; Partonen, Timo; Turunen, Anu W.; Männistö, Satu; Jula, Antti; Verkasalo, Pia K.

    2010-01-01

    High fish consumption and omega-3 polyunsaturated fatty acid (PUFA) intake are suggested to benefit mental well-being but the current evidence is conflicting. Our aim was to evaluate whether a higher level of fish consumption, a higher intake of omega-3 PUFAs, and a higher serum concentration of omega-3 PUFAs link to a lower 12-month prevalence of depressive episodes. We used data from the nationwide Health 2000 Survey (n = 5492) and the Fishermen Study on Finnish professional fishermen and their family members (n = 1265). Data were based on questionnaires, interviews, health examinations, and blood samples. Depressive episodes were assessed with the M-CIDI (the Munich version of the Composite International Diagnostic Interview) and a self-report of two CIDI probe questions, respectively. Fish consumption was measured by a food frequency questionnaire (g/day) and independent frequency questions (times/month). Dietary intake (g/day) and serum concentrations (% from fatty acids) of PUFAs were determined. Fish consumption was associated with prevalence of depressive episodes in men but not in women. The prevalence of depressive episodes decreased from 9% to 5% across the quartiles of fish consumption (g/day) in men of the Health 2000 Survey (p for linear trend = 0.01), and from17% to 3% across the quartiles of fish consumption (times/month) in men of the Fishermen Study (p for linear trend = 0.05). This association was modified by lifestyle; in the Health 2000 Survey a higher level of fish consumption was related to a lower prevalence of depressive episodes in men who consumed the most alcohol, were occasional or former smokers, or had intermediate physical activity. The associations between depressive episodes and the intake or serum concentrations of omega-3 PUFAs were not consistent. In men, fish consumption appears as a surrogate for underlying but unidentified lifestyle factors that protect against depression. PMID:20479881

  7. Guidelines on gastroesophageal reflux disease.

    PubMed

    Niaz, Saad Khalid; Quraishy, Muhammed Saeed; Taj, Muhammad Ali; Abid, Shahab; Alam, Altaf; Nawaz, Arif Amir; Ali Shah, Syed Hasnain; Khan, Ijaz Muhammed; Memon, Abdul Rauf; Zuberi, Bader Fiaz; Tayyab, Ghayasun Nabi; Malik, Kashif; Mirza, Shakeel; Abbas, Zaigham

    2015-05-01

    Gastroesophageal reflux disease (GERD) is the most common acid-related disorder encountered during clinical practice in Pakistan and is associated with significant impairment of health-related quality of life. A number of guidelines and recommendations for the diagnosis and management of GERD have been published in different countries, but a Pakistani accepted directive by the standards of evidence-based medicine is still lacking. Our aim was to create an understanding of the natural history and presentations of reflux disease; evaluating possible treatment options available for the patients with complex and uncomplicated reflux ailments with the development of current and up to date evidence based endorsement, relevant to the needs of Pakistani health care providers in order to treat oesophageal manifestations of GERD. In order to make such guidelines, a comprehensive literature search was conducted with pertinent evidence reviewed, and quality of relevant data assessed. The resultant conclusions were based on the best available evidence and expert opinion of the authors of technical review panel.

  8. Reflux and Lung Disease

    MedlinePlus

    ... lying down. Avoid foods that aggravate reflux including fatty foods, citrus and tomato-containing products, chocolate, mint, spicy foods, carbonated beverages, caffeine, and alcohol. This information has been approved by Emily McCloud, ...

  9. Gastroesophageal reflux disease

    MedlinePlus

    Gastroesophageal reflux disease (GERD) is a condition in which the stomach contents leak backwards from the stomach into the esophagus (the tube from the mouth to the stomach). This can irritate the esophagus ...

  10. Is reflux cough due to gastroesophageal reflux disease or laryngopharyngeal reflux?

    PubMed

    Morice, Alyn H

    2008-01-01

    Reflux is a common cause of chronic cough. Surveys of patients with chronic cough point to a high association with gastroesophageal disease. Because of our bipedalism and speech, humans are prone to both reflux and aspiration. Whether the reflux of stomach contents into the esophagus alone is sufficient to cause cough or whether reflux into the upper airway is required is unknown. In 50 consecutive patients with chronic cough, symptoms of laryngopharangeal reflux (LPR) paralleled those of gastroesophageal reflux, suggesting no unique syndrome of LPR but that it is part of the protean manifestations of reflux disease.

  11. Refractory chronic cough due to gastroesophageal reflux: Definition, mechanism and management.

    PubMed

    Lv, Han-Jing; Qiu, Zhong-Min

    2015-09-26

    Refractory chronic cough due to gastroesophageal reflux is a troublesome condition unresponsive to the standard medical anti-reflux therapy. Its underlying mechanisms may include incomplete acid suppression, non-acid reflux, transient lower esophageal sphincter relaxations and esophageal hypersensitivity. The diagnosis of this disorder depends on both the findings of multi-channel intraluminal impedance-pH monitoring and the subsequent intensified anti-reflux therapy. The strategies of pharmacological treatment for refractory chronic cough due to reflux include the optimization of proton pump inhibitors and add-on therapies with histamine H2 receptor antagonists, baclofen and gabapentin. However, the further study is needed to satisfy its management.

  12. Refractory chronic cough due to gastroesophageal reflux: Definition, mechanism and management

    PubMed Central

    Lv, Han-Jing; Qiu, Zhong-Min

    2015-01-01

    Refractory chronic cough due to gastroesophageal reflux is a troublesome condition unresponsive to the standard medical anti-reflux therapy. Its underlying mechanisms may include incomplete acid suppression, non-acid reflux, transient lower esophageal sphincter relaxations and esophageal hypersensitivity. The diagnosis of this disorder depends on both the findings of multi-channel intraluminal impedance-pH monitoring and the subsequent intensified anti-reflux therapy. The strategies of pharmacological treatment for refractory chronic cough due to reflux include the optimization of proton pump inhibitors and add-on therapies with histamine H2 receptor antagonists, baclofen and gabapentin. However, the further study is needed to satisfy its management. PMID:26413488

  13. Gastroesophageal reflux diagnosed by occlusal splint tintion.

    PubMed

    Cebrián-Carretero, José Luis; López-Arcas-Calleja, José María

    2006-01-01

    The gastroesophageal reflux (GER) disease is a very frequent digestive disorder, mainly characterised by the reflux of the gastric acidic content to the esophage in abnormal quantities. There are different situations that favour this situation but almost in all of them rely an incompetence of the esophagic sphincter. The clinical consequences are many, including oral manifestations. Among all of them the most frequent is the esophagitis followed by symptoms at the pharynx or larynx and finally, the oral cavity. At this level fundamentally we will find enamel and oral mucosa erosions. We report the case of a patient who was indirectly diagnosed of her esophague disease by the observation of the alterations in the occlusal splint induced by the gastric reflux. We review the literature concerning the above topic and its possible association with the miofascial syndrome.

  14. The Many Faces of Reflux

    PubMed Central

    Newman, Alvin

    1991-01-01

    While gastroesophageal reflux frequently presents as heartburn, other symptoms can dominate the clinical picture. This article describes recent advances in understanding the mechanisms of gastroesophageal reflux and in diagnosing and treating it. PMID:21229095

  15. [Postoperative vesico ureteral reflux recurrence diagnosed by positioning the instillation of contrast cystography : a case report].

    PubMed

    Fukui, Shinji; Aoki, Katsuya; Nakai, Yasushi; Matsumoto, Yoshihiro; Kagebayashi, Yoriaki; Fukuda, Kazuyoshi; Samma, Shoji

    2013-11-01

    A 5-year-old boy was diagnosed with febrile urinary tract infection (UTI) at the age of 2 months. Voiding cystourethrography (VCUG) showed grade IV reflux on the left side. Left ureterocystoneostomy was performed at 11 months because of recurrent febrile UTI under antibiotic prophylaxis. VCUG 1 year after surgery showed no reflux. The patient developed acute focal bacterial nephritis (AFBN) when he was 4 years and 2 months of age, and experienced 3 episodes of AFBN during the following 9 months. The patient had normal urinary and bowel habits. Although VCUG showed no recurrence of reflux, AFBN developed in spite of antibiotic prophylaxis. Positioning the instillation of contrast (PIC) cystography under general anesthesia demonstrated the left occult reflux. Endoscopic injection with Deflux○R was performed simultaneously. PIC cystography is a useful examination in patients with persistent, repeated UTI episodes without any signs of reflux employing conventional diagnostic modalities.

  16. Vesicoureteral Reflux in Childhood

    PubMed Central

    Robson, William Lane M.; Leung, Alexander K.C.; Hyndman, William C.

    1992-01-01

    Vesicoureteral reflux (VUR) is the most common anatomical predisposition to pyelonephritis. A retrograde voiding cystourethrogram is the preferred study to assess the severity of VUR. Most children with VUR will respond to medical management. The prevention of urinary tract infections is fundamental to the management of children with VUR. PMID:21221285

  17. [Underlying Mechanisms and Management of Refractory Gastroesophageal Reflux Disease].

    PubMed

    Lee, Kwang Jae

    2015-08-01

    The prevalence of gastroesophageal reflux disease (GERD) in South Korea has increased over the past 10 years. Patients with erosive reflux disease (ERD) shows better response to proton pump inhibitors (PPIs) than those with non-erosive reflux disease (NERD). NERD is a heterogeneous condition, showing pathological gastroesophageal reflux or esophageal hypersensitivity to reflux contents. NERD patients with pathological gastroesophageal reflux or hypersensitivity to acid may respond to PPIs. However, many patients with esophageal hypersensitivity to nonacid or functional heartburn do not respond to PPIs. Therefore, careful history and investigations are required when managing patients with refractory GERD who show poor response to conventional dose PPIs. Combined pH-impedance studies and a PPI diagnostic trial are recommended to reveal underlying mechanisms of refractory symptoms. For those with ongoing reflux-related symptoms, split dose administration, change to long-acting PPIs or PPIs less influenced by CYP2C19 genotypes, increasing dose of PPIs, and the addition of alginate preparations, prokinetics, selective serotonin reuptake inhibitors, or tricyclic antidepressants can be considered. Pain modulators, selective serotonin reuptake inhibitors, or tricyclic antidepressants are more likely to be effective for those with reflux-unrelated symptoms. Surgery or endoscopic per oral fundoplication may be effective in selected patients.

  18. A study of photocatalytic graphene–TiO{sub 2} synthesis via peroxo titanic acid refluxed sol

    SciTech Connect

    Low, Wasu; Boonamnuayvitaya, Virote

    2013-08-01

    Graphical abstract: - Highlights: • TiO{sub 2} synthesized via PTA as a precursor demonstrates exclusively anatase phase. • The TEM image of GR–TiO{sub 2} (PTA) demonstrates that TiO{sub 2} nanoparticles are successfully loaded onto graphene sheet. • The specific surface area seems to increase with increasing weight ratio of graphene oxide. It was observed that GR–TiO{sub 2} showed higher adsorption compared to bare TiO{sub 2} (PTA). • The GR–TiO{sub 2} (PTA, 1:50) catalyst showed higher photocatalytic activity than any other catalyst. - Abstract: In the present work, graphene–TiO{sub 2} (GR–TiO{sub 2}) photocatalyst with various weight ratios of graphene was synthesized using peroxo titanic acid solution (PTA) as a precursor for TiO{sub 2}. Graphene oxide prepared by Hummer's method was converted to graphene under ultraviolet (UV) irradiation in ethanol–water solvent for 48 h. The as-prepared GR–TiO{sub 2} composites were characterized using X-ray diffraction (XRD), Fourier transform infrared (FTIR) spectroscopy, UV–vis spectrophotometry, and transmission electron microscopy (TEM). The automated potentiostat was applied to measure the photocurrent generations of prepared catalysts. The photocatalytic activities of GR–TiO{sub 2} (PTA) catalysts were determined by measuring the percentage methylene blue (MB) degradation. The results showed that TiO{sub 2} nanoparticles were successfully loaded onto graphene sheet and the surface area of catalysts increased with increasing weight ratio of graphene. In addition, GR–TiO{sub 2} (PTA, 1:50) exhibited the highest photocatalytic activity among the catalysts under UV and visible light irradiation. The adsorption edge of GR–TiO{sub 2} was shifted to a longer wavelength of 400 nm in comparison with that of pure TiO{sub 2} (PTA). The increase in the photocatalytic performance of GR–TiO{sub 2} (PTA) catalyst may be attributed to the increase in surface area, the extension of light absorption in

  19. [Gastroesophageal reflux, pulmonary and gastric function in patients with cystic fibrosis. Results of a randomized trial].

    PubMed

    Escobar Castro, H; Perdomo Giraldi, M; Gimeno Benítez, R; Máiz Carro, L; Suárez Cortina, L

    1996-01-01

    We studied ten patients with Cystic fibrosis. The purposes of this study were to investigate the presence of gastroesophageal reflux and establish the probable association between gastroesophageal reflux and pulmonary and gastric involvement. All 10 patients underwent 24-hour esophageal pH recording, spirometry and gastric function. Abnormal reflux index was found in all these patients. Lung function was pathologic in the 3 older children. There were no relationship between the severity of the gastroesophageal reflux and the degree of pulmonary damage. No patient has gastric acid hypersecretion. Eight of 10 patients had steatorrhea. Our findings confirm the high frequence of gastroesophageal reflux in cystic fibrosis.

  20. Are Uric Acid Levels Different from Healthy Subjects in Bipolar Affective Disorder and Schizophrenia?: Relationship Between Clinical Improvement and Episode Severity in Male Patients

    PubMed Central

    GÜLTEKİN, Bülent Kadri; KESEBİR, Sermin; KABAK, Sevgi Gül; ERGÜN, Ferzan Fikret; TATLIDİL YAYLACI, Elif

    2014-01-01

    Introduction Purinergic system dysfunction has been shown both in patients with bipolar disorder (BD) and those with schizophrenia. The aim of this study was to evaluate whether uric acid levels in male BD patients with manic episode and schizophrenia patients with psychotic relapse differ from healthy male subjects. Secondly to assess whether uric acid levels in both patient groups correlate with episode severity and if a decrease in uric acid levels correlate with clinical improvement. Method A total of 55 BD patients with manic episode and 59 schizophrenic patients with psychotic relapse were evaluated at baseline and at weeks 1, 2, 3 using the Young Mania Rating Scale (YMRS) and the Positive and Negative Syndrome Scale (PANSS), and their plasma uric acid levels were measured. 60 age-matched healthy males without history of any previous or current psychiatric diagnosis and treatment constituted the control group. In order to determine plasma uric acid levels, blood samples were centrifuged at 3000 × g for 15 minutes, stored at −80°C and measured in milligrams per deciliter. Results Uric acid levels in both patient groups with manic episode and psychotic relapse were found higher than in healthy controls (f=6.122, p=.027). The difference between repeated measurements of uric acid levels in BD patient group was found to be between baseline and first week measurements (after Bonferroni correction) (p<.001). No correlation was found between YMRS and PANSS scores and uric acid levels at 4 assessment times. Conclusion Uric acid levels in male BD and schizophrenia patients with manic episode and psychotic relapse were similar with each other, and higher than in healthy males. No correlation was found between uric acid levels and episode severity in both groups. However, for patients with BD, a decrease in uric acid levels between baseline and first week seems to be correlated with clinical improvement.

  1. Knowledge and practice of Brazilian pediatricians on gastroesophageal reflux disease in infants

    PubMed Central

    Soares, Ana Cristina Fontenele; de Freitas, Carla Lima; de Morais, Mauro Batista

    2015-01-01

    OBJECTIVE: To assess the knowledge and practice of pediatricians about infants with physiological reflux and gastroesophageal reflux disease. METHODS: 140 pediatricians were interviewed during two scientific events in 2009 and 2010. The questions referred to two clinical cases of infants. One with symptoms of infant regurgitation (physiological reflux) and another with gastroesophageal reflux disease. RESULTS: Among 140 pediatricians, 11.4% (n=16) and 62.1% (n=87) would require investigation tests, respectively for infant regurgitation (physiological reflux) and gastroesophageal reflux disease. A series of upper gastrointestinal exams would be the first requested with a higher frequency. Medication would be prescribed by 18.6% (n=6) in the case of physiological reflux and 87.1% (n=122) in the case of gastroesophageal reflux disease. Prokinetic drugs would be prescribed more frequently than gastric acid secretion inhibitors. Sleeping position would be recommended by 94.2% (n=132) and 92.9% (n=130) of the respondents, respectively for the case of physiological reflux and gastroesophageal reflux disease; however, about half of the respondents would recommend the prone position. Only 10 (7.1%) of the pediatricians would exclude the cow's milk protein from the infants' diet. CONCLUSIONS: Approaches different from the international guidelines are often considered appropriate, especially when recommending a different position other than the supine and prescription of medication. In turn, the interviews enable us to infer the right capacity of the pediatricians to distinguish physiologic reflux and gastroesophageal reflux disease correctly. PMID:25662014

  2. Clinical Management of Infants and Children with Gastroesophageal Reflux Disease

    PubMed Central

    Whitworth, John; Christensen, Michael L.

    2004-01-01

    Gastroesophageal reflux refers to the passage of gastric contents including food, acid, and digestive enzymes up into the esophagus. Reflux is most commonly recognized in infants when it is associated with regurgitation, known as “spitting up,” and it is usually a self-limited, benign process that has little or no effect on normal weight gain or development. Adults and adolescents may also have reflux, which is usually either asymptomatic or recognized as dyspepsia or “heartburn.” Gastroesophageal reflux disease (GERD) is defined as symptoms or complications that result from reflux. Most evidence suggests the mechanism of reflux is due to transient relaxations of the lower esophageal sphincter at inappropriate times. The diagnosis of suspected GERD in infants and children depends on the age and the presenting symptoms. A thorough history, physical examination, and growth charts are sufficient for the evaluation and diagnosis of GERD in most infants with recurrent vomiting or children with regurgitation and heartburn. Additional evaluation may include an upper gastrointestinal series, esophageal pH monitoring, or endoscopy. The goals of GERD management are eliminating symptoms, healing esophagitis, preventing complications, promoting normal weight gain and growth, and maintaining remission. Therapeutic options include lifestyle changes, pharmacologic therapy, and anti-reflux surgery. Currently available pharmacologic agents for the treatment of GERD include antacids, mucosal protectants, prokinetic agents, and acid suppressants. PMID:23118703

  3. LINX® Reflux Management System in chronic gastroesophageal reflux: a novel effective technology for restoring the natural barrier to reflux

    PubMed Central

    Saino, Greta; Lipham, John C.; DeMeester, Tom R.

    2013-01-01

    Gastroesophageal reflux disease (GERD) results from incompetency of the lower esophageal sphincter that allows the contents of the stomach to reflux into the esophagus, the airways, and the mouth. The disease affects about 10% of the western population and has a profound negative impact on quality of life. The majority of patients are successfully treated with proton-pump inhibitors, but up to 40% have incomplete relief of symptoms even after dose adjustment. The laparoscopic Nissen fundoplication represents the surgical gold standard, but is largely underused because of the level of technical difficulty and the prevalence of side effects. These factors have contributed to the propensity of patients to continue with medical therapy despite inadequate symptom control and complications of the disease. As a consequence, a significant ‘therapy gap’ in the treatment of GERD remains evident in current clinical practice. The LINX® Reflux Management System (Torax Medical, St. Paul, MN, USA) is designed to provide a permanent solution to GERD by augmenting the sphincter barrier with a standardized, reproducible laparoscopic procedure that does not alter gastric anatomy and is easily reversible. Two single-group trials confirmed that a magnetic device designed to augment the lower esophageal sphincter can be safely and effectively implanted using a standard laparoscopic approach. The device decreased esophageal acid exposure, improved reflux symptoms and quality of life, and allowed cessation of proton-pump inhibitors in the majority of patients. PMID:23814607

  4. Biomarkers of Reflux Disease.

    PubMed

    Kia, Leila; Pandolfino, John E; Kahrilas, Peter J

    2016-06-01

    Gastroesophageal reflux disease (GERD) encompasses an array of disorders unified by the reflux of gastric contents. Because there are many potential disease manifestations, esophageal and extraesophageal, there is no single biomarker of the entire disease spectrum; a set of GERD biomarkers that each quantifies specific aspects of GERD-related pathology might be needed. We review recent reports of biomarkers of GERD, specifically in relation to endoscopically negative esophageal disease and excluding conventional pH-impedance monitoring. We consider histopathologic biomarkers, baseline impedance, and serologic assays to determine that most markers are based on manifestations of impaired esophageal mucosal integrity, which is based on increased ionic and molecular permeability, and/or destruction of tight junctions. Impaired mucosal integrity quantified by baseline mucosal impedance, proteolytic fragments of junctional proteins, or histopathologic features has emerged as a promising GERD biomarker.

  5. Lower extremity venous reflux

    PubMed Central

    Baliyan, Vinit; Tajmir, Shahein; Ganguli, Suvranu; Prabhakar, Anand M.

    2016-01-01

    Venous incompetence in the lower extremity is a common clinical problem. Basic understanding of venous anatomy, pathophysiologic mechanisms of venous reflux is essential for choosing the appropriate treatment strategy. The complex interplay of venous pressure, abdominal pressure, venous valvular function and gravitational force determine the venous incompetence. This review is intended to provide a succinct review of the pathophysiology of venous incompetence and the current role of imaging in its management. PMID:28123974

  6. Extra-Esophageal Manifestations of Gastroesophageal Reflux Disease: Controversies Between Epidemiology and Clicnic

    PubMed Central

    Saber, Hamid; Ghanei, Mostafa

    2012-01-01

    Gastroesophageal reflux disease (GERD) is widely associated with asthma, chronic cough, and laryngitis. Many studies have focused on acidic reflux; however, acid is just one of many factors that can cause pulmonary injury. The discrepancy between the high frequency of GERD in asthmatic patients and the ineffective reflux therapy outcomes in these patients suggests that GERD may cause injury through other mechanisms, such as pepsinogen, pepsin, bile salts, or other components of reflux materials, instead of the acid. Research using appropriate and innovative methodologies to investigate these potential inflammatory agents in patients with GERD is required to determine the underlying factors associated with pulmonary disorders in these patients. PMID:23166570

  7. Episodic Memories

    ERIC Educational Resources Information Center

    Conway, Martin A.

    2009-01-01

    An account of episodic memories is developed that focuses on the types of knowledge they represent, their properties, and the functions they might serve. It is proposed that episodic memories consist of "episodic elements," summary records of experience often in the form of visual images, associated to a "conceptual frame" that provides a…

  8. Diagnosis and Anti-Reflux Therapy for GERD with Respiratory Symptoms: A Study Using Multichannel Intraluminal Impedance-pH Monitoring

    PubMed Central

    Zhang, Chao; Wu, Jimin; Hu, Zhiwei; Yan, Chao; Gao, Xiang; Liang, Weitao; Liu, Diangang; Li, Fei; Wang, Zhonggao

    2016-01-01

    Stretta procedure (0 vs. 19.4%, p = 0.006). Conclusions MII-pH monitoring effectively detected respiratory-related predictive parameters, including total/proximal reflux episodes and symptom correlations. We found that GERD patients with respiratory symptoms exhibited more proximal and total reflux episodes but not more acid-related episodes, as determined by MII-pH monitoring. Thus, such monitoring could be useful for diagnosing atypical GERD patients with respiratory symptoms. Furthermore, LTF exhibited a more significant effect on controlling typical symptoms in all GERD patients and reducing the recurrence rate than the Stretta procedure in patients with respiratory symptoms. PMID:27532103

  9. Chronic and episodic acidification of Adirondack streams from acid rain in 2003-2005

    USGS Publications Warehouse

    Lawrence, G.B.; Roy, K.M.; Baldigo, Barry P.; Simonin, H.A.; Capone, S.B.; Sutherland, J.W.; Nierzwicki-Bauer, S. A.; Boylen, C.W.

    2008-01-01

    Limited information is available on streams in the Adirondack region of New York, although streams are more prone to acidification than the more studied Adirondack lakes. A stream assessment was therefore undertaken in the Oswegatchie and Black River drainages; an area of 4585 km2 in the western part of the Adirondack region. Acidification was evaluated with the newly developed base-cation surplus (BCS) and the conventional acid-neutralizing capacity by Gran titration (ANCG). During the survey when stream water was most acidic (March 2004), 105 of 188 streams (56%) were acidified based on the criterion of BCS < 0 ??eq L-1, whereas 29% were acidified based on an ANCG value < 0 ??eq L-1. During the survey when stream water was least acidic (August 2003), 15 of 129 streams (12%) were acidified based on the criterion of BCS < 0 ??eq L-1, whereas 5% were acidified based on ANCG value < 0 ??eq L -1. The contribution of acidic deposition to stream acidification was greater than that of strongly acidic organic acids in each of the surveys by factors ranging from approximately 2 to 5, but was greatest during spring snowmelt and least during elevated base flow in August. During snowmelt, the percentage attributable to acidic deposition was 81%, whereas during the October 2003 survey, when dissolved organic carbon (DOC) concentrations were highest, this percentage was 66%. The total length of stream reaches estimated to be prone to acidification was 718 km out of a total of 1237 km of stream reaches that were assessed. Copyright ?? 2008 by the American Society of Agronomy, Crop Science Society of America, and Soil Science Society of America. All rights reserved.

  10. [Vesicoureteral reflux in adults].

    PubMed

    Rollino, Cristiana; D'Urso, Leonardo; Beltrame, Giulietta; Ferro, Michela; Quattrocchio, Giacomo; Quarello, Francesco

    2011-01-01

    Vesicoureteral reflux (VUR) may be congenital or acquired. The most frequent form of congenital VUR is primary VUR. Its prevalence in adults is not exactly known, but it is higher in women, whose greater propensity for urinary tract infections increases the likelihood of an instrumental examination leading to the diagnosis of less severe cases. In men, even severe VUR may go undiagnosed for a long time. Primary VUR is due to a defect in the valve mechanism of the ureterovesical junction. In physiological conditions, the terminal ureter enters the bladder wall obliquely and bladder contraction leads to compression of this intravesical portion. Abnormal length of the intravesical portion of the ureter due to a genetic mutation (whose location is yet to be established) leads to VUR. In its less severe forms VUR may be asymptomatic, but in 50-70% of cases it manifests with recurrent cystitis or pyelonephritis. The manifestations leading to a diagnosis of VUR in adults, besides urinary tract infections, are proteinuria, renal failure and hypertension. The gold-standard diagnostic examination is a micturating cystourethrogram. Reflux nephropathy develops as a result of a pathogenetic mechanism unrelated to high cavity pressure or urinary tract infections but due to reduced formation of the normal renal parenchyma (hypoplasia or dysplasia). Abnormal renal parenchyma development is attributable to the same genes that control the development of the ureters and ureterovesical junction. VUR is considered only a marker of this abnormal development, playing no role in scar formation. There is no conclusive evidence regarding the indications for VUR correction. However, the risk that VUR leads to recurrent pyelonephritis and reflux nephropathy must be kept in mind. VUR certainly has to be corrected in women who contemplate pregnancy.

  11. Nebulization reflux concentrator

    NASA Technical Reports Server (NTRS)

    Collins, V. G.; Cofer, W. R., III

    1986-01-01

    A nebulization reflux concentrator for removing trace gas contaminants from a sample gas is described. Sample gas from a gas supply is drawn by a suction source into a vessel. The gas enters the vessel through an atomizing nozzle, thereby atomizing and entraining a scrubbing liquid solvent drawn through a siphon tube from a scrubbing liquid reservoir. The gas and entrained liquid rise through a concentrator and impinge upon a solvent phobic filter, whereby purified gas exits through the filter housing and contaminated liquid coalesces on the solvent phobic filter and falls into the reservoir.

  12. Nebulization Reflux Concentrator

    NASA Technical Reports Server (NTRS)

    Cofer, Wesley R., III; Collins, V. G.

    1986-01-01

    Nebulization reflux concentrator extracts and concentrates trace quantities of water-soluble gases for subsequent chemical analysis. Hydrophobic membrane and nebulizing nozzles form scrubber for removing trace quantities of soluble gases or other contaminants from atmosphere. Although hydrophobic membrane virtually blocks all transport of droplets, it offers little resistance to gas flow; hence, device permits relatively large volumes of gas scrubbed efficiently with very small volumes of liquid. This means analyzable quantities of contaminants concentrate in extracting solutions in much shorter times than with conventional techniques.

  13. Esophageal Body Motility for Clinical Assessment in Patients with Refractory Gastroesophageal Reflux Symptoms

    PubMed Central

    Jiang, Liuqin; Ye, Bixing; Wang, Ying; Wang, Meifeng; Lin, Lin

    2017-01-01

    Background/Aims Little data exists about esophageal body dysmotility and reflux patterns in refractory gastroesophageal reflux disease (RGERD) patients off therapy. We aimed to evaluate effects of esophageal body dysmotility on reflux parameters in RGERD patients by combining impedance-pH monitoring and high-resolution manometry (HRM). Methods We retrospectively reviewed the impedance-pH data and HRM metrics in patients with refractory gastroesophageal reflux symptoms. Impedance-pH monitoring and manometric data were compared between 2 groups: ineffective esophageal motility (IEM) and normal motility. Results Forty-eight patients (30 males, mean age 54.5 years) were included (16 erosive esophagitis, 24 non-erosive reflux disease, and 8 functional heartburn), amongst which 24 subjects showed IEM, and others had normal motility. Number of patients who had a large break in the IEM group was significantly higher than that of normal motility patients. IEM group had more patients with weakly acid reflux and long term acid reflux than the normal group (P = 0.008, P = 0.004, respectively). There was no statistical difference in baseine impedance levels from z4 to z6 between the 2 groups (2911 ± 1160 Ω vs 3604 ± 1232 Ω, 2766 ± 1254 Ω vs 3752 ± 1439 Ω, 2349 ± 1131 Ω vs 3038 ± 1254 Ω, all P > 0.05). Acid exposure time, numbers of long term acid reflux and weakly acid reflux showed strong negative correlation with esophageal body motility and/or lower esophageal sphincter function. Conclusions IEM was associated more with acid exposure, abnormal weakly acid reflux, and long term acid reflux in RGERD patients. These data suggested the role of esophageal body dysmotility in the pathophysiological mechanisms of RGERD patients. PMID:27599539

  14. Duodenogastric reflux and foregut carcinogenesis.

    PubMed

    Miwa, K; Hattori, T; Miyazaki, I

    1995-03-15

    Epidemiologic cohort studies have established that after distal gastric resection, there is a higher risk of gastric carcinoma. It is likely that a main factor of this higher risk is the excessive duodenogastric reflux induced by surgery, because the incidence of stump carcinomas is higher in Billroth II than in Billroth I, and most of the stump carcinomas are located near the stoma. In addition, several groups of investigators have suggested that duodenogastric reflux per se induces stump carcinomas in rats. There is another human duodenogastric reflux, the primary duodenogastric reflux, through the pylorus. Experiments in animals have demonstrated that this type of duodenal reflux also induces gastric carcinomas in the antrum of the stomach that has not undergone surgery. Recent clinical attention has focused on the role of duodenogastric reflux in the pathogenesis of Barrett's esophagus and subsequent esophageal adenocarcinomas. Experimentally, reflux of duodenal contents into the esophagus can cause not only Barrett's esophagus and subsequent adenocarcinomas, but also squamous cell carcinomas. These findings suggest that duodenogastric reflux may be implicated in gastric and esophageal, that is, foregut carcinogenesis.

  15. Diagnosis and treatment of gastroesophageal reflux disease

    PubMed Central

    Badillo, Raul; Francis, Dawn

    2014-01-01

    Gastroesophageal reflux disease (GERD) is a common disease with a prevalence as high as 10%-20% in the western world. The disease can manifest in various symptoms which can be grouped into typical, atypical and extra-esophageal symptoms. Those with the highest specificity for GERD are acid regurgitation and heartburn. In the absence of alarm symptoms, these symptoms can allow one to make a presumptive diagnosis and initiate empiric therapy. In certain situations, further diagnostic testing is needed to confirm the diagnosis as well as to assess for complications or alternate causes for the symptoms. GERD complications include erosive esophagitis, peptic stricture, Barrett’s esophagus, esophageal adenocarcinoma and pulmonary disease. Management of GERD may involve lifestyle modification, medical therapy and surgical therapy. Lifestyle modifications including weight loss and/or head of bed elevation have been shown to improve esophageal pH and/or GERD symptoms. Medical therapy involves acid suppression which can be achieved with antacids, histamine-receptor antagonists or proton-pump inhibitors. Whereas most patients can be effectively managed with medical therapy, others may go on to require anti-reflux surgery after undergoing a proper pre-operative evaluation. The purpose of this review is to discuss the current approach to the diagnosis and treatment of gastroesophageal reflux disease. PMID:25133039

  16. Efficacy and Safety of a Natural Remedy for the Treatment of Gastroesophageal Reflux: A Double-Blinded Randomized-Controlled Study

    PubMed Central

    Alecci, Umberto; Bonina, Francesco; Bonina, Andrea; Rizza, Luisa; Inferrera, Santi

    2016-01-01

    Gastroesophageal reflux (GER) is a common, chronic, relapsing symptom. Often people self-diagnose and self-treat it even though health-related quality of life is significantly impaired. In the lack of a valid alternative approach, current treatments focus on suppression of gastric acid secretion by the use of proton pump inhibitors (PPIs), but people with GER have a significantly lower response rate to therapy. We designed a randomized double-blinded controlled clinical study to evaluate the efficacy and the safety of a formulation based on sodium alginate/bicarbonate in combination with extracts obtained from Opuntia ficus-indica and Olea europaea associated with polyphenols (Mucosave®; verum), on GER-related symptoms. Male/female 118 (intention to treat) subjects with moderate GER and having at least 2 to 6 days of GER episodes/week were treated with verum (6 g/day) or placebo for two months. The questionnaires Gastroesophageal Reflux Disease-Health-Related Quality of Life (GERD-HRQoL) and Gastroesophageal Reflux Disease Symptom Assessment Scale (GSAS) were self-administered by participants before the treatment and at the end of the treatment. Verum produced statistically significant reduction of GERD-HRQoL and GSAS scores, −56.5% and −59.1%, respectively, in comparison to placebo. Heartburn and acid regurgitation episodes for week were significantly reduced by verum (p < 0.01). Results indicate that Mucosave formulation provides an effective and well-tolerated treatment for reducing the frequency and intensity of symptoms associated with gastroesophageal reflux. PMID:27818697

  17. Gastroesophageal reflux disease: Update on inflammation and symptom perception.

    PubMed

    Altomare, Annamaria; Guarino, Michele Pier Luca; Cocca, Silvia; Emerenziani, Sara; Cicala, Michele

    2013-10-21

    Although gastroesophageal reflux disease (GERD) is a common disorder in Western countries, with a significant impact on quality of life and healthcare costs, the mechanisms involved in the pathogenesis of symptoms remain to be fully elucidated. GERD symptoms and complications may result from a multifactorial mechanism, in which acid and acid-pepsin are the important noxious factors involved. Prolonged contact of the esophageal mucosa with the refluxed content, probably caused by a defective anti-reflux barrier and luminal clearance mechanisms, would appear to be responsible for macroscopically detectable injury to the esophageal squamous epithelium. Receptors on acid-sensitive nerve endings may play a role in nociception and esophageal sensitivity, as suggested in animal models of chronic acid exposure. Meanwhile, specific cytokine and chemokine profiles would appear to underlie the various esophageal phenotypes of GERD, explaining, in part, the genesis of esophagitis in a subset of patients. Despite these findings, which show a significant production of inflammatory mediators and neurotransmitters in the pathogenesis of GERD, the relationship between the hypersensitivity and esophageal inflammation is not clear. Moreover, the large majority of GERD patients (up to 70%) do not develop esophageal erosions, a variant of the condition called non-erosive reflux disease. This summary aims to explore the inflammatory pathway involved in GERD pathogenesis, to better understand the possible distinction between erosive and non-erosive reflux disease patients and to provide new therapeutic approaches.

  18. Ambulatory 24-h oesophageal impedance-pH recordings: reliability of automatic analysis for gastro-oesophageal reflux assessment.

    PubMed

    Roman, S; Bruley des Varannes, S; Pouderoux, P; Chaput, U; Mion, F; Galmiche, J-P; Zerbib, F

    2006-11-01

    Oesophageal pH-impedance monitoring allows detection of acid and non-acid gastro-oesophageal reflux (GOR) events. Visual analysis of impedance recording requires expertise. Our aim was to evaluate the efficacy of an automated analysis for GOR assessment. Seventy-three patients with suspected GORD underwent 24-h oesophageal pH-impedance monitoring. Recordings analysis was performed visually (V) and automatically using Autoscan function (AS) of Bioview software. A symptom index (SI) > or =50% was considered for a significant association between symptoms and reflux events. AS analysis detected more reflux events, especially non-acid, liquid, pure gas and proximal events. Detection of oesophageal acid exposure and acid reflux events was similar with both analyses. Agreement between V and AS analysis was good (Kendall's coefficient W > 0.750, P < 0.01) for all parameters. During pH-impedance studies, 65 patients reported symptoms. As compared to visual analysis, the sensitivity and specificity of a positive SI determined by AS were respectively 85.7% and 80% for all reflux events, 100% and 98% for acid reflux and 33% and 87.5% for non-acid reflux. Despite good agreement with visual analysis, automatic analysis overestimates the number of non-acid reflux events. Visual analysis remains the gold standard to detect an association between symptoms and non-acid reflux events.

  19. [Morphology of the gastroesophageal reflux disease].

    PubMed

    Daum, Ondřej; Kokošková, Bohuslava; Švajdler, Marian

    2016-01-01

    The present definition of gastroesophageal reflux disease is based on clinical criteria that are difficult to reproduce accurately. Pathologists are supposed to confirm the presence of morphological changes induced by gastroesophageal reflux. Traditional evaluation of injury, inflammatory and reactive changes of esophageal squamous epithelium lacks both sufficient sensitivity and specificity, and thus the modern diagnostic focuses on chronic metaplastic changes of esophageal mucosa defined as any mucosal type proximal to the upper border of oxyntic mucosa (also called fundic mucosa of the stomach). In the setting of gastroesophageal reflux the esophageal mucosa, under normal conditions lined with squamous epithelium, undergoes columnar metaplasia. According to morphology and immunophenotype of columnar cells, the columnar metaplasia may be further subdivided to oxyntocardiac mucosa, cardiac mucosa, intestinal metaplasia, and an intermediate type of cardiac mucosa expressing intestinal transcription factor CDX2, but devoid of goblet cells. The latter two mucosal types are currently thought to represent the most probable candidates for neoplastic transformation, whereas oxyntocardiac mucosa is believed to represent a stable compensatory change with no risk of further progression. An evaluation of dysplastic changes (intraepithelial neoplasia) in the setting of columnar lined esophagus necessitates correlation with the second opinion of a GI expert to prevent potentially harmful under- or over-treatment of the patient. Regarding invasive adenocarcinoma, the pathologist should avoid overdiagnosis of the infiltration of the space between the two layers of columnar lined esophagus - associated split muscularis mucosae as invasion of submucosa, as it is associated with different prognosis. Critical evaluation of the real impact of acid suppression on neoplastic transformation in the setting of gastroesophageal reflux disease may represent the greatest challenge for future

  20. [Impact of reflux on the kidney].

    PubMed

    Mollard, P; Louis, D; Basset, T

    1984-03-01

    Description of the reflux nephropathy. Pyelonephritis lesions are undoubtedly linked to the vesico-ureteric reflux. The role of the intra-renal reflux ( Hodson ) and the Big Bang Theory ( Ransley ) are discussed as the data from animal experiments. The role of the sterile reflux and of the segmental hypoplasia is relatively less important. The actual management of vesico-ureteric reflux treatment is questioned.

  1. The effects of acid precipitation runoff episodes on reservoir and tapwater quality in an Appalachian Mountain water supply.

    PubMed Central

    Sharpe, W E; DeWalle, D R

    1990-01-01

    The aluminum concentration and Ryznar Index increased and the pH decreased in a small Appalachian water supply reservoir following acid precipitation runoff episodes. Concomitant increases in tapwater aluminum and decreases in tapwater pH were also observed at two homes in the water distribution system. Lead concentrations in the tapwater of one home frequently exceeded recommended levels, although spatial and temporal variation in tapwater copper and lead concentrations was considerable. Since source water and reservoir water copper and lead concentrations were much lower, the increased copper and lead concentrations in tapwater were attributed to corrosion of household plumbing. Tapwater copper concentration correlated well with tapwater pH and tapwater temperature. Asbestos fibers were not detected in tapwater. The asbestos-cement pipe in the water distribution system was protected by a spontaneous metallic coating that inhibited fiber release from the pipe. Several simultaneous reactions were hypothesized to be taking place in the distribution system that involved corrosion of metallic components and coating of asbestos-cement pipe components in part with corrosion products and in part by cations of watershed origin. Greater water quality changes might be expected in areas of higher atmospheric deposition. Images FIGURE 5. FIGURE 6. PMID:2088742

  2. Gastroesophageal reflux disease in pregnancy.

    PubMed

    Ali, Raja Affendi Raja; Egan, Laurence J

    2007-01-01

    Gastroesophageal reflux disease during pregnancy is common. Altered structure and function of the normal physiological barriers to reflux of gastric contents into the oesophagus explain the high incidence of this problem in pregnant women. For the majority of patients, life-style modifications are helpful, but are not sufficient to control symptoms and medication is required. The optimum management of reflux in pregnant patients requires special attention and expertise, since the safety of the mother, foetus and neonate remain the primary focus. Gastroenterologists and obstetricians should work together to optimise treatment. Typically, one utilises a step-up program that starts with life-style modifications and antacids. If those methods fail, histamine-2 receptor antagonists and proton pump inhibitors are tried. Rarely, promotility agents are used. Initiation of these medications must be undertaken after a careful discussion of risks and benefits with patients. In patients without a prior history of reflux, symptoms usually abate after delivery.

  3. The Meteorology and Chemistry of High Nitric-Acid Episodes at the South Pole

    NASA Astrophysics Data System (ADS)

    Neff, William; Davis, Douglas

    2016-04-01

    Between 1998 and 2007, a series of field experiments carried out at the South Pole and with aircraft over a wider area revealed a very chemically active boundary layer overlying the east Antarctic ice sheet during the Austral summer. An early discovery was unexpectedly high concentrations of nitric acid (NO) at the South Pole. These were argued to be a result of the UV pholoysis of reactive nitrogen in surface and/or near-surface snow followed by subsequent confinement and non-linear HOx/NOx chemistry within a thin stable atmospheric boundary layer. The concentrations of NO also demonstrated daily, intraseasonal, as well as interannual variability as seen in the four field programs. This paper seeks to elucidate the interplay of large-to-small scale meteorology and chemistry at the South Pole that leads to highly variable NO concentrations and to examine boundary layer depth effects on NO in years when no direct measurements were available, in particular during the latest field program in 2006-2007. The importance of the South Pole is that it, unlike other high-latitude sites, has no diurnal cycle to disturb the evolution of the mostly stable boundary layer and its physics and chemistry. In the spring, as the solar elevation angle increases, nitrate photolysis rates increase. At the same time, the stratospheric vortex warms and with its breakup, the total column ozone increases leading to decreased photolysis rates. In addition, following the formation of the thermal tropopause in early spring, the tropospheric circulation over Antarctica changes dramatically, affecting the transport and dominant source regions for warm air and clouds arriving at the South Pole. The timing of the final warming ranged from early-November to mid-December for the four field experiment years. During the 30 days prior to the final increase in column ozone, as the thermal tropopause forms (~100 hPa), the winds at 300 hPa become bimodal, either along the eastern side of the Weddell Sea

  4. Esophageal mucosal damage may promote dysmotility and worsen esophageal acid exposure.

    PubMed

    Meneghetti, Adam T; Tedesco, Pietro; Damani, Tanuja; Patti, Marco G

    2005-12-01

    This study determines the relationship among esophageal dysmotility, esophageal acid exposure, and esophageal mucosal injury in patients with gastroesophageal reflux disease (GERD). A total of 827 patients with GERD (confirmed by ambulatory pH monitoring) were divided into three groups based on the degree of mucosal injury: group A, no esophagitis, 493 patients; group B, esophagitis grades I to III, 273 patients; and group C, Barrett's esophagus, 61 patients. As mucosal damage progressed from no esophagitis to Barrett's esophagus, there was a significant decrease in lower esophageal sphincter pressure and amplitude of peristalsis in the distal esophagus, with a subsequent increase in the number of reflux episodes in 24 hours, the number of reflux episodes longer than 5 minutes, and the reflux score. These data suggest that in patients with GERD, worsening of esophageal mucosal injury may determine progressive deterioration of esophageal motor function with impairment of acid clearance and increase of esophageal acid exposure. These findings suggest that Barrett's esophagus is an end-stage form of gastroesophageal reflux, and that if surgical therapy is performed early in the course of the disease, this cascade of events might be blocked.

  5. Gastroesophageal reflux disease in children.

    PubMed

    Barnhart, Douglas C

    2016-08-01

    Despite the frequency with which antireflux procedures are performed, decisions about gastroesophageal reflux disease treatment remain challenging. Several factors contribute to the difficulties in managing gastroesophageal reflux. First, the distinction between physiologic and pathologic gastroesophageal reflux (gastroesophageal reflux disease-GERD) is not always clear. Second, measures of the extent of gastroesophageal reflux often poorly correlate to symptoms or other complications attributed to reflux in infants and children. A third challenge is that the outcome of antireflux procedures, predominately fundoplications, are relatively poorly characterized. All of these factors contribute to difficulty in knowing when to recommend antireflux surgery. One of the manifestations of the uncertainties surrounding GERD is the high degree of variability in the utilization of pediatric antireflux procedures throughout the United States. Pediatric surgeons are frequently consulted for GERD and fundoplication, uncertainties notwithstanding. Although retrospective series and anecdotal observations support fundoplication in some patients, there are many important questions for which sufficient high-quality data to provide a clear answer is lacking. In spite of this, surgeons need to provide guidance to patients and families while awaiting the development of improved evidence to aid in these recommendations. The purpose of this article is to define what is known and what is uncertain, with an emphasis on the most recent evidence.

  6. Current Pharmacological Management of Gastroesophageal Reflux Disease

    PubMed Central

    Wang, Yao-Kuang; Hsu, Wen-Hung; Wang, Sophie S. W.; Lu, Chien-Yu; Kuo, Fu-Chen; Su, Yu-Chung; Yang, Sheau-Fang; Chen, Chiao-Yun; Wu, Deng-Chyang

    2013-01-01

    Gastroesophageal reflux disease (GERD), a common disorder with troublesome symptoms caused by reflux of gastric contents into the esophagus, has adverse impact on quality of life. A variety of medications have been used in GERD treatment, and acid suppression therapy is the mainstay of treatment for GERD. Although proton pump inhibitor is the most potent acid suppressant and provides good efficacy in esophagitis healing and symptom relief, about one-third of patients with GERD still have persistent symptoms with poor response to standard dose PPI. Antacids, alginate, histamine type-2 receptor antagonists, and prokinetic agents are usually used as add-on therapy to PPI in clinical practice. Development of novel therapeutic agents has focused on the underlying mechanisms of GERD, such as transient lower esophageal sphincter relaxation, motility disorder, mucosal protection, and esophageal hypersensitivity. Newer formulations of PPI with faster and longer duration of action and potassium-competitive acid blocker, a newer acid suppressant, have also been investigated in clinical trials. In this review, we summarize the current and developing therapeutic agents for GERD treatment. PMID:23878534

  7. Genetics of Vesicoureteral Reflux

    PubMed Central

    Ninoa, F.; Ilaria, M.; Noviello, C.; Santoro, L.; Rätsch, I.M.; Martino, A.; Cobellis, G.

    2016-01-01

    Vesicoureteral reflux (VUR) is the retrograde passage of urine from the bladder to the upper urinary tract. It is the most common congenital urological anomaly affecting 1-2% of children and 30-40% of patients with urinary tract infections. VUR is a major risk factor for pyelonephritic scarring and chronic renal failure in children. It is the result of a shortened intravesical ureter with an enlarged or malpositioned ureteric orifice. An ectopic embryonal ureteric budding development is implicated in the pathogenesis of VUR, which is a complex genetic developmental disorder. Many genes are involved in the ureteric budding formation and subsequently in the urinary tract and kidney development. Previous studies demonstrate an heterogeneous genetic pattern of VUR. In fact no single major locus or gene for primary VUR has been identified. It is likely that different forms of VUR with different genetic determinantes are present. Moreover genetic studies of syndromes with associated VUR have revealed several possible candidate genes involved in the pathogenesis of VUR and related urinary tract malformations. Mutations in genes essential for urinary tract morphogenesis are linked to numerous congenital syndromes, and in most of those VUR is a feature. The Authors provide an overview of the developmental processes leading to the VUR. The different genes and signaling pathways controlling the embryonal urinary tract development are analyzed. A better understanding of VUR genetic bases could improve the management of this condition in children. PMID:27013925

  8. Bile reflux and intestinal metaplasia in gastric mucosa.

    PubMed Central

    Sobala, G M; O'Connor, H J; Dewar, E P; King, R F; Axon, A T; Dixon, M F

    1993-01-01

    AIM: To determine associations between enterogastric bile reflux and gastric mucosal pathology. METHOD: A retrospective study using fasting gastric juice bile acid measurements and antral or prestomal biopsy specimens from 350 patients, 66 of whom had previously undergone surgery that either bypassed or disrupted the pyloric sphincter. RESULTS: Bile reflux was positively associated with reactive gastritis and negatively with Helicobacter pylori density. After stratification for previous surgery, age, and H pylori status, the histological feature most strongly associated with bile reflux was intestinal metaplasia, including all its subtypes. The prevalence of intestinal metaplasia was greatest in patients with both H pylori infection and high bile acid concentrations. Bile reflux was also positively associated with the severity of glandular atrophy, chronic inflammation, lamina propria oedema and foveolar hyperplasia. CONCLUSIONS: Bile reflux is a cause of reactive gastritis. It modifies the features of H pylori associated chronic gastritis. The changes are not confined to patients who have had surgery to their stomachs. The positive associations with atrophy and intestinal metaplasia have implications for models of gastric carcinogenesis. Images PMID:8463417

  9. Definitions of critical environmental conditions for selected Chesapeake Bay finfishes exposed to acidic episodes in spawning and nursery habitats. Final report

    SciTech Connect

    Klauda, R.J.

    1989-10-01

    Definitions of critical environmental conditions associated with acidic episodes are defined for yellow perch, alewife, blueback herring, American shad, and white perch, based on a review of field and laboratory data. These species are an important biological resource in the mid-Atlantic Coastal Plain. Values for blueback herring and alewife reproduction are an acid pulse between pH 5.5 and 6.2 with dissolved Ca at least 2 mg/l, with total monomeric Al levels between 15 and 137 microgram/l. Critical acidic conditions for American shad reproduction are an acid pulse between pH 5.7 and 6.7, dissolved Ca at least 2 micrograms/l, and total monomeric Al levels between 0 and 137 micrograms/l. Using data from the congeneric striped bass as a proxy, critical acidic conditions for white perch are an acid pulse between pH 6.5 and 6.7, total monomeric Al concentration of 25 microgram/l persisting for 7 days, and dissolved Ca at least 2 microgram/l. Based on a combination of life stage exposure and tolerance to acidic conditions the species can be ranked from high to low potential with regard to risks posed by acidic episodes on their early life stages: white perch, alewife/blueback herring, American shad, yellow perch.

  10. Duodenogastric reflux in Chagas' disease

    SciTech Connect

    Troncon, L.E.; Rezende Filho, J.; Iazigi, N.

    1988-10-01

    Increased duodenogastric reflux has been recognized as a cause of gastric mucosa damage. The frequent finding of bile-stained gastric juice and a suggested higher frequency of lesions of the gastric mucosa in patients with Chagas' disease, which is characterized by a marked reduction of myenteric neurons, suggest that impairment of intrinsic innervation of the gut might be associated with increased duodenogastric reflux. Duodenogastric bile reflux was quantified after intravenous injection of 99mtechnetium-HIDA, in 18 patients with chronic Chagas' disease, 12 controls, and 7 patients with Billroth II gastrectomy. All but one of the chagasic patients were submitted to upper digestive tract endoscopy. High reflux values (greater than or equal to 10%) were detected both in chagasic patients and in the controls, but the values for both groups were significantly lower (P less than 0.01) than those obtained for Billroth II patients (median: 55.79%; range: 12.58-87.22%). Reflux values tended to be higher in the Chagas' disease group (median: 8.20%; range: 0.0-29.40%) than in the control group (median: 3.20%; range: 0.0-30.64%), with no statistical difference between the two groups (P greater than 0.10). Chronic gastritis was detected by endoscopy in 12 chagasic patients, benign gastric ulcer in 2 patients, and a pool of bile in the stomach in 11 patients. However, neither the occurrence of gastric lesions nor the finding of bile-stained gastric juice was associated with high reflux values after (99mTc)HIDA injection. This study suggests that lesions of the intramural nervous system of the gut in Chagas' disease do not appear to be associated with abnormally increased duodenogastric reflux.

  11. Increased TRPV1 and PAR2 mRNA expression levels are associated only with the esophageal reflux symptoms, but not with the extraesophageal reflux symptoms

    PubMed Central

    Kim, Jin Joo; Kim, Nayoung; Choi, Yoon Jin; Kim, Joo Sung; Jung, Hyun Chae

    2016-01-01

    Abstract Transient receptor potential vanilloid-1 (TRPV1) receptor and proteinase-activated receptor 2 (PAR2) have been implicated in the mechanism of acid-induced inflammation in gastroesophageal reflux disease (GERD). We aimed to evaluate TRPV1 and PAR2 mRNA expression levels in the GERD patients and their relationship with endoscopic findings and reflux symptoms. Sixteen healthy controls, 45 patients with erosive reflux disease (ERD), and 14 nonerosive reflux disease (NERD) patients received endoscopy and completed questionnaires. Quantitative real-time polymerase chain reactions (qPCR) of TRPV1, glial cell line-derived neurotrophic factor (GDNF), nerve growth factor (NGF), PAR2, and interleukin (IL)-8 were performed in the distal esophagus specimen. The levels of TRPV1, GDNF, NGF, PAR2, and IL-8 mRNA expression were highest in the ERD group followed by NERD and control groups and the differences between control and ERD groups were statistically significant. Within the ERD group, patients with grade B in Los Angeles (LA) classification showed significantly higher levels of TRPV1, GDNF, and NGF mRNA expression than those with grade A. Presence of reflux symptoms was associated with significant higher levels of TRPV1, PAR2, and IL-8. Notably not extraesophageal but esophageal reflux symptoms were significantly associated with them. Upregulation of TRPV1 and PAR2 pathways might play a role in the development of distal esophageal inflammation and reflux symptoms. And extraesophageal reflux symptoms might not be associated with these processes. PMID:27512850

  12. Increased TRPV1 and PAR2 mRNA expression levels are associated only with the esophageal reflux symptoms, but not with the extraesophageal reflux symptoms.

    PubMed

    Kim, Jin Joo; Kim, Nayoung; Choi, Yoon Jin; Kim, Joo Sung; Jung, Hyun Chae

    2016-08-01

    Transient receptor potential vanilloid-1 (TRPV1) receptor and proteinase-activated receptor 2 (PAR2) have been implicated in the mechanism of acid-induced inflammation in gastroesophageal reflux disease (GERD). We aimed to evaluate TRPV1 and PAR2 mRNA expression levels in the GERD patients and their relationship with endoscopic findings and reflux symptoms.Sixteen healthy controls, 45 patients with erosive reflux disease (ERD), and 14 nonerosive reflux disease (NERD) patients received endoscopy and completed questionnaires. Quantitative real-time polymerase chain reactions (qPCR) of TRPV1, glial cell line-derived neurotrophic factor (GDNF), nerve growth factor (NGF), PAR2, and interleukin (IL)-8 were performed in the distal esophagus specimen.The levels of TRPV1, GDNF, NGF, PAR2, and IL-8 mRNA expression were highest in the ERD group followed by NERD and control groups and the differences between control and ERD groups were statistically significant. Within the ERD group, patients with grade B in Los Angeles (LA) classification showed significantly higher levels of TRPV1, GDNF, and NGF mRNA expression than those with grade A. Presence of reflux symptoms was associated with significant higher levels of TRPV1, PAR2, and IL-8. Notably not extraesophageal but esophageal reflux symptoms were significantly associated with them.Upregulation of TRPV1 and PAR2 pathways might play a role in the development of distal esophageal inflammation and reflux symptoms. And extraesophageal reflux symptoms might not be associated with these processes.

  13. First-Episode Bipolar Disorder is Associated with Erythrocyte Membrane Docosahexaenoic Acid Deficits: Dissociation from Clinical Response to Lithium or Quetiapine

    PubMed Central

    McNamara, Robert K.; Jandacek, Ronald; Tso, Patrick; Blom, Thomas J.; Welge, Jeffrey A.; Strawn, Jeffrey R.; Adler, Caleb M.; DelBello, Melissa P.; Strakowski, Stephen M.

    2015-01-01

    Deficits in long-chain omega-3 (LCn-3) fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) may be associated with the pathophysiology of bipolar disorder. However, LCn-3 fatty acid status at the initial onset of mania and its association with treatment response are not known. Erythrocyte membrane fatty acid composition was determined in first-episode bipolar manic or mixed (n=40) and healthy (n=40) subjects. Mood symptom ratings were obtained with the Young Mania Rating Scale (YMRS) and the Hamilton Depression Rating Scale (HDRS). Erythrocyte fatty acid composition and clinical ratings were also determined within a sub-group of bipolar subjects following 8-week (n=19) or 52-week (n=11) open-label treatment with lithium or quetiapine. At baseline bipolar subjects exhibited significantly lower erythrocyte docosahexaenoic acid (DHA, 22:6n-3) composition compared with healthy subjects (−23%, p<0.0001). EPA (20:5n-3) and docosapentanoic acid (22:5n-3), and LCn-6 fatty acids including arachidonic acid were not different. Following 8- or 52-week treatment with lithium or quetiapine, YMRS and HDRS total scores decreased significantly whereas erythrocyte fatty acids including DHA did not change. These data indicate that selective erythrocyte DHA deficits coincide with the initial onset of manic symptoms, and reductions in mood symptoms following treatment are not mediated by changes in fatty acid status. PMID:26477955

  14. First-episode bipolar disorder is associated with erythrocyte membrane docosahexaenoic acid deficits: Dissociation from clinical response to lithium or quetiapine.

    PubMed

    McNamara, Robert K; Jandacek, Ronald; Tso, Patrick; Blom, Thomas J; Welge, Jeffrey A; Strawn, Jeffrey R; Adler, Caleb M; DelBello, Melissa P; Strakowski, Stephen M

    2015-12-15

    Deficits in long-chain omega-3 (LCn-3) fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) may be associated with the pathophysiology of bipolar disorder. However, LCn-3 fatty acid status at the initial onset of mania and its association with treatment response are not known. Erythrocyte membrane fatty acid composition was determined in first-episode bipolar manic or mixed (n=40) and healthy (n=40) subjects. Mood symptom ratings were obtained with the Young Mania Rating Scale (YMRS) and the Hamilton Depression Rating Scale (HDRS). Erythrocyte fatty acid composition and clinical ratings were also determined within a sub-group of bipolar subjects following 8-week (n=19) or 52-week (n=11) open-label treatment with lithium or quetiapine. At baseline bipolar subjects exhibited significantly lower erythrocyte docosahexaenoic acid (DHA, 22:6n-3) composition compared with healthy subjects (-23%, p<0.0001). EPA (20:5n-3) and docosapentanoic acid (22:5n-3), and LCn-6 fatty acids including arachidonic acid were not different. Following 8- or 52-week treatment with lithium or quetiapine, YMRS and HDRS total scores decreased significantly whereas erythrocyte fatty acids including DHA did not change. These data indicate that selective erythrocyte DHA deficits coincide with the initial onset of manic symptoms, and reductions in mood symptoms following treatment are not mediated by changes in fatty acid status.

  15. A Study on the Relationship between Reflux Esophagitis and Periodontitis.

    PubMed

    Adachi, Kyoichi; Mishiro, Tomoko; Tanaka, Shino; Yoshikawa, Hiroo; Kinoshita, Yoshikazu

    2016-01-01

    Objective Metabolic syndrome and dental erosion have been demonstrated to correlate with gastroesophageal acid reflux disease (GERD), while periodontitis has been reported to have a positive relationship with metabolic syndrome. However, no correlation between periodontitis and GERD has yet been reported. We therefore investigated the relationship between periodontitis and GERD. Methods The subjects consisted of 280 individuals who visited the Health Center for a detailed medical checkup examination. Each underwent upper endoscopy and periodontitis examinations, with the latter performed by measuring the concentrations of lactate dehydrogenase and hemoglobin in saliva. The subjects were divided into those with positive and negative periodontitis findings, and the prevalence rates of endoscopically proven reflux esophagitis, dyslipidemia, hypertension, and hyperglycemia were compared. Results The number of subjects positive for periodontitis was 93, while 187 had negative findings. The prevalence of reflux esophagitis was not different between the positive and negative groups (8.6% vs. 8.0%). In addition, a multiple logistic regression analysis did not identify a positive relationship between the presence of periodontitis and reflux esophagitis. On the other hand, dyslipidemia and hypertension were more frequently observed in the subjects that were positive for periodontitis. Conclusion We did not find an association between periodontitis and reflux esophagitis in the present study. On the other hand, the presence of periodontitis was found to correlate with hypertension and dyslipidemia.

  16. The evaluation of gastroesophageal reflux before and after medical therapies

    SciTech Connect

    Malmud, L.S.; Fisher, R.S.

    1981-07-01

    Gastroesophageal scintigraphy is a quantitative technique that can be employed to detect and quantitate gastroesophageal reflux before and after the application of therapeutic modalities, including change in body position, bethanechol, atropine, antacids, and antacid-alginate compounds. Five groups of 10-15 patients each were studied before and after using each therapeutic modality and before and after atropine. The results were compared to the patient's symptomatology and to the acid reflux test. Gastroesophageal scintigraphy was performed following oral administration of 300 microCi 99mTc-sulfur colloid in 300 ml acidified orange juice. Thirty-second gamma camera images were obtained as the gastroesophageal gradient was increased from approximately 10 to 35 mm Hg at 5 mm Hg increments using an inflatable abdominal binder. Data were processed using a digital computer. Reflux was reduced by change in position from recumbent to upright, and by the use of subcutaneous bethanechol, oral antacid, or oral antacidalginate compound. Atropine increased reflux. Gastroesophageal scintigraphy is more sensitive than fluoroscopy, correlates well with clinical symptomatology, and is a reliable and convenient technique for the quantitative estimation of reflux before and after therapy.

  17. Symptom Characteristics and Psychosomatic Profiles in Different Spectrum of Gastroesophageal Reflux Disease

    PubMed Central

    Lim, Chul-Hyun; Baeg, Myong Ki; Moon, Sung Jin; Kim, Jin Su; Cho, Yu Kyung; Park, Jae Myung; Lee, In Seok; Kim, Sang Woo; Choi, Kyu Yong

    2014-01-01

    Background/Aims Gastroesophageal reflux disease (GERD) is diagnosed based on symptoms of heartburn and regurgitation but is a heterogeneous condition which can be subclassified according to endoscopy and esophageal reflux monitoring. The aim of this study was to identify differences in demographic characteristics and reflux symptom patterns among patients with various spectrum of GERD. Methods Patients having weekly heartburn or acid regurgitation were classified into four pathophysiological subgroups according to endoscopy and pH monitoring: reflux esophagitis (RE), endoscopy-negative reflux disease with pathological reflux (PR+), hypersensitive esophagus (HE), and normal acid exposure with negative symptom association (pH-). Results A total of 195 patients were enrolled. The numbers of patients in the subgroups were: RE, 39.0%; PR+, 20.0%; HE, 10.3%; and pH-, 30.8%. Grossly, reflux symptom patterns and relieving/exacerbating factors did not differ between subgroups. Prevalence of extraesophageal syndrome was higher in patients with PR+ than in other groups. Overlapping functional dyspepsia was common in all groups. The SCL-90-R depression score was higher in PR+ patients than in RE patients (p<0.05). Conclusions Demographic characteristics and reflux symptom patterns cannot differentiate pH- group from GERD subtypes. Esophageal pH monitoring could be considered for the initial evaluation of GERD in the tertiary referral setting. PMID:24672658

  18. Stillage reflux in food waste ethanol fermentation and its by-product accumulation.

    PubMed

    Ma, Hongzhi; Yang, Jian; Jia, Yan; Wang, Qunhui; Tashiro, Yukihiro; Sonomoto, Kenji

    2016-06-01

    Raw materials and pollution control are key issues for the ethanol fermentation industry. To address these concerns, food waste was selected as fermentation substrate, and stillage reflux was carried out in this study. Reflux was used seven times during fermentation. Corresponding ethanol and reducing sugar were detected. Accumulation of by-products, such as organic acid, sodium chloride, and glycerol, was investigated. Lactic acid was observed to accumulate up to 120g/L, and sodium chloride reached 0.14mol/L. Other by-products did not accumulate. The first five cycles of reflux increased ethanol concentration, which prolonged fermentation time. Further increases in reflux time negatively influenced ethanol fermentation. Single-factor analysis with lactic acid and sodium chloride demonstrated that both factors affected ethanol fermentation, but lactic acid induced more effects.

  19. Persistent gastro-oesophageal reflux symptoms despite proton pump inhibitor therapy

    PubMed Central

    Ang, Daphne; How, Choon How; Ang, Tiing Leong

    2016-01-01

    About one-third of patients with suspected gastro-oesophageal reflux disease (GERD) do not respond symptomatically to proton pump inhibitors (PPIs). Many of these patients do not suffer from GERD, but may have underlying functional heartburn or atypical chest pain. Other causes of failure to respond to PPIs include inadequate acid suppression, non-acid reflux, oesophageal hypersensitivity, oesophageal dysmotility and psychological comorbidities. Functional oesophageal tests can exclude cardiac and structural causes, as well as help to confi rm or exclude GERD. The use of PPIs should only be continued in the presence of acid reflux or oesophageal hypersensitivity for acid reflux-related events that is proven on functional oesophageal tests. PMID:27779277

  20. Laparoscopic Toupet fundoplication with duodenojejunostomy for the management of superior mesenteric artery syndrome with reflux symptoms

    PubMed Central

    Yan, Chao; Hu, Zhi-Wei; Wu, Ji-Min; Zhang, Chao; Yan, Liang; Wang, Zhong-Gao

    2017-01-01

    Abstract Rationale: The patient had symptoms of GERD and the reflux even caused the symptom of cough. Gaining weight is a risk factor for the treatment of reflux as it could exacerbated symptoms of reflux and the drug treatment is not effective. Surgical intervention becomes necessary when there is failure following conservative medical therapy or the patient. Patient concerns: The patient was not satisfied with the drug treatment. Diagnoses: Superior mesenteric artery syndrome, gastroesophageal reflux disease. Interventions: Laparoscopic Toupet fundoplication with duodenojejunostomy. Outcomes: The patient discharged from hospital 10 days after surgery without any postoperative complication. The patient achieved complete relief of symptoms and discontinuation of drug. Lessons subsections: Superior mesenteric artery (SMA) syndrome may manifest the symptoms of GERD such as heartburn, acid reflux and cough. It is necessary to complete examination to exclude superior mesenteric artery syndrome for these patients. Laparoscopic fundoplication with duodenojejunostomy provided an effective treatment for patients who failed drug treatment. PMID:28099334

  1. Upper Gastrointestinal Cancer and Reflux Disease

    PubMed Central

    2013-01-01

    There is a growing evidence that gastroesophageal reflux disease is related to several upper gastrointestinal cancers, mainly the esophageal adenocarcinoma and a certain type of gastric cardia adenocarcinoma. Currently, the incidence of gastroesophageal reflux disease is rapidly increasing in Korea. Therefore, there is a possibility of such increasing cancerous incidents, similar to the western worlds. In this article, the relationship between gastroesophageal reflux disease and several upper gastrointestinal cancers, the components of refluxate which has possible causal relationship with carcinogenesis, and the clinical implications of such relationship in the management of gastroesophageal reflux disease patients are discussed through the review of literature. PMID:23844321

  2. Associations between peripheral vertigo and gastroesophageal reflux disease.

    PubMed

    Viliušytė, Edita; Macaitytė, Raminta; Vaitkus, Antanas; Rastenytė, Daiva

    2015-09-01

    We hypothesize that peripheral vertigo is associated with gastroesophageal reflux disease (GERD). Two mechanisms could be considered – gastric acids may directly irritate the respiratory mucosa and cause inflammation, or Helicobacter pylori (H. pylori) could be present and cause local infection. Reflux material (Hydrochloric acid (HCl) and pepsin) could get into the middle ear via Eustachian tube and affect osseous structures directly. Disturbance of ossicles could cause tinnitus, which is more common for peripheral vertigo. H. pylori could also get in the esophagus and in the upper respiratory tract via gastroesophageal reflux, and could cause tympanosclerosis and fixation of ossicles. In our study group, 120 of 153 (78.4%) patients had gastroesophageal reflux disease (GERD). Diagnostic tests of H. pylori (rapid urease test or blood antibody test) were performed for 96 of 120 (80%) patients with GERD and were found positive for 32 of 96 (33.3%) patients. Peripheral vertigo was present in 93 of 120 (77.6%) patients with GERD compared to 33 of 126 (26%) patients without GERD (χ(2)=9.016, p=0.003). H. pylori and peripheral vertigo coexisted in 26 of 126 patients (20.6%) (OR 1.36; 95% CI 0.49-3.74, p=0.55). Our study demonstrated statistically significant association between peripheral vertigo and GERD but not between peripheral vertigo and H. pylori. Further more extensive investigations are needed in order to explore our hypothesis.

  3. Gastroesophageal reflux in infants and children. When to reassure and when to go further.

    PubMed Central

    Jones, A. B.

    2001-01-01

    OBJECTIVE: To review current understanding and approach to diseases resulting from gastroesophageal reflux (GER) in infants and children. QUALITY OF EVIDENCE: Very few randomized or blinded controlled trials have been reported in this area. MEDLINE searches for gastroesophageal reflux, gastroesophageal reflux disease, esophagitis, and pulmonary aspiration, using age-limited (all childhood) data, find most articles. Very thorough reviews undertaken by both European and North American societies for pediatric gastroenterology provide up-to-date consensus statements. MAIN MESSAGE: Gastroesophageal reflux is a normal phenomenon recognized in infants as "spitting up." Understanding the mechanism of transient lower esophageal relaxation episodes allows physicians to counsel concerned parents that reflux and spitting up occur universally, but are less visible in children older than 6 to 12 months. In infants and children, GER can result in a variety of diseases and can cause esophageal and tracheopulmonary damage. Investigation of these diseases can be specific and accurate. Therapy is available, but no drug will stop reflux. Some children suffer intractable GER with secondary complications (GERD) despite medical treatment. Failure of therapy could mean patients require surgical intervention. CONCLUSION: Visible GER is very common in infants and children and can usually be managed with explanation, reassurance, and simple measures. Diseases caused by GER can be investigated specifically and managed with accurately defined therapy. PMID:11723599

  4. Sleeve gastrectomy with anti-reflux procedures

    PubMed Central

    Santoro, Sergio; Lacombe, Arnaldo; de Aquino, Caio Gustavo Gaspar; Malzoni, Carlos Eduardo

    2014-01-01

    Objective Sleeve gastrectomy is the fastest growing surgical procedure to treat obesity in the world but it may cause or worsen gastroesophageal reflux disease. This article originally aimed to describe the addition of anti-reflux procedures (removal of periesophageal fats pads, hiatoplasty, a small plication and fixation of the gastric remnant in position) to the usual sleeve gastrectomy and to report early and late results. Methods Eighty-eight obese patients that also presented symptoms of gastroesophageal reflux disease were submitted to sleeve gastrectomy with anti-reflux procedures. Fifty of them were also submitted to a transit bipartition. The weight loss of these patients was compared to consecutive 360 patients previously submitted to the usual sleeve gastrectomy and to 1,140 submitted to sleeve gastrectomy + transit bipartition. Gastroesophageal reflux disease symptoms were specifically inquired in all anti-reflux sleeve gastrectomy patients and compared to the results of the same questionnaire applied to 50 sleeve gastrectomy patients and 60 sleeve gastrectomy + transit bipartition patients that also presented preoperative symptoms of gastroesophageal reflux disease. Results In terms of weight loss, excess of body mass index loss percentage after anti-reflux sleeve gastrectomy is not inferior to the usual sleeve gastrectomy and anti-reflux sleeve gastrectomy + transit bipartition is not inferior to sleeve gastrectomy + transit bipartition. Anti-reflux sleeve gastrectomy did not add morbidity but significantly diminished gastroesophageal reflux disease symptoms and the use of proton pump inhibitors to treat this condition. Conclusion The addition of anti-reflux procedures, such as hiatoplasty and cardioplication, to the usual sleeve gastrectomy did not add morbidity neither worsened the weight loss but significantly reduced the occurrence of gastroesophageal reflux disease symptoms as well as the use of proton pump inhibitors. PMID:25295447

  5. The Angelchik prosthesis for gastro-oesophageal reflux: symptomatic and objective assessment.

    PubMed Central

    Weaver, R. M.; Temple, J. G.

    1985-01-01

    Twenty-three patients with intractable gastro-oesophageal reflux were treated by insertion of the Angelchik antireflux prosthesis. Good symptomatic relief was achieved in over 80% of patients reviewed up to 28 months after operation and there was marked resolution of oesophagitis as seen on endoscopy. Oesophageal manometry and pH studies performed preoperatively and at 3 and 12 months after operation, showed a significant increase in lower oesophageal sphincter pressure with decreased acid reflux. Some technical problems were encountered, but the prosthesis is potentially a simple and effective means of controlling gastro-oesophageal reflux. Images Fig. 1 PMID:4051424

  6. Endoscopic Treatment of Refractory Gastroesohageal Reflux Disease

    PubMed Central

    Kim, Won Hee; Park, Pil Won; Hahm, Ki Baik

    2013-01-01

    Though efficient acid suppression with proton pump inhibitors (PPIs) remains the mainstay of treatment of gastroesophageal reflux disease (GERD), some of the patients showed refractory response to PPIs, necessitating further intervention. After increasing dose of PPIs and other kinds of pharmacological intervention adopting prokinetics or others, variable endoscopic treatments are introduced for the treatment of these refractory cases. The detailed introduction regarding endoscopic treatment for GERD is forwarded in this review article. Implantation of reabsorbable or synthetic materials in the distal esophagus was tried in vain and is expelled from the market due to limited efficacy and serious complication. Radiofrequency energy delivery (Stretta) and transoral incisionless fundoplication (EsophyX) are actively tried currently. PMID:23767031

  7. Extra-esophageal gastroesophageal reflux disease and asthma: understanding this interplay.

    PubMed

    Naik, Rishi D; Vaezi, Michael F

    2015-07-01

    Gastroesophageal reflux disease (GERD) is a condition that develops when there is reflux of stomach contents, which typically manifests as heartburn and regurgitation. These esophageal symptoms are well recognized; however, there are extra-esophageal manifestations of GERD, which include asthma, chronic cough, laryngitis and sinusitis. With the rising incidence of asthma, there is increasing interest in identifying how GERD impacts asthma development and therapy. Due to the poor sensitivity of endoscopy and pH monitoring, empiric therapy with proton pump inhibitors (PPIs) is now considered the initial diagnostic step in patients suspected of having GERD-related symptoms. If unresponsive, diagnostic testing with pH monitoring off therapy and/or impedance/pH monitoring on therapy, may be reasonable in order to assess for baseline presence of reflux with the former and exclude continued acid or weakly acid reflux with the latter tests. PPI-unresponsive asthmatics, without overt regurgitation, usually have either no reflux or causes other than GERD. In this group, PPI therapy should be discontinued. In those with GERD as a contributing factor acid suppressive therapy should be continued as well as optimally treating other etiologies requiring concomitant treatment. Surgical fundoplication is rarely needed but in those with a large hiatal hernia, moderate-to-severe reflux by pH monitoring surgery might be helpful in eliminating the need for high-dose acid suppressive therapy.

  8. Effect of reflux time on nanoparticle shape.

    PubMed

    Srivastava, Chandan; Sushma, K V L

    2014-06-01

    In the present work, Pt nanoparticles were produced from a reaction mixture containing a trace amount of cobalt carbonyl salt acting as a shape inducer. Nanoparticle shape evolution during reaction mixture reflux was monitored by characterizing particles extracted from the reaction mixture at different times. It was observed that 5 min of reflux produced spherical nanoparticles, 30 min of reflux produced cube shaped nanoparticles, and 60 min of reflux produced truncated octahedron morphology nanoparticles. It is illustrated that during nanoparticle synthesis the reflux process can provide energy needed for shape transformation from a metastable cube morphology to a truncated octahedron morphology which is thermodynamically the most stable geometry for fcc crystals. An optimization of the reaction reflux is thus needed for isolating metastable shapes.

  9. Comparison of multichannel intraluminal impedance-pH monitoring and reflux scintigraphy in pediatric patients with suspected gastroesophageal reflux

    PubMed Central

    Uslu Kızılkan, Nuray; Bozkurt, Murat Fani; Saltık Temizel, Inci Nur; Demir, Hülya; Yüce, Aysel; Caner, Biray; Özen, Hasan

    2016-01-01

    AIM To evaluate the agreement of multichannel intraluminal impedance-pH monitoring (MII-pHM) and gastroesophageal reflux scintigraphy (GES) for the diagnosis of gastroesophageal reflux disease. METHODS Seventy-five consecutive patients with suspected gastroesophageal reflux disease (GERD) underwent 24-h combined MII-pHM recording and one hour radionuclide scintigraphy during the course of the MII-pHM study. Catheters with 6 impedance channels and 1 pH sensor were placed transnasally. Impedance and pH data analysis were performed automatically and manually. For impedance monitoring, reflux was defined as a retrograde 50% drop in impedance, starting distally and propagating retrogradely to at least the next two more proximal measuring channels. Reflux index (RI, percentage of the entire record that esophageal pH is < 4.0) greater than 4.2% for pHM and number of refluxes more than 50 for 24 h for MII were accepted as positive test results. At scintigraphy, 240 frames of 15 seconds duration were acquired in the supine position. Gastroesophageal reflux was defined as at least one reflux episode in the esophagus. After scintigraphic evaluation, impedance-pH recordings and scintigraphic images were evaluated together and agreement between tests were evaluated with Cohen’s kappa. RESULTS Sufficient data was obtained from 60 (80%) patients (34 male, 56.7%) with a mean age of 8.7 ± 3.7 years (range: 2.5-17.3 years; median: 8.5 years). Chronic cough, nausea, regurgitation and vomiting were the most frequent symptoms. The mean time for recording of MII-pHM was 22.8 ± 2.4 h (range: 16-30 h; median: 22.7 h). At least one test was positive in 57 (95%) patients. According to diagnostic criteria, GERD was diagnosed in 34 (57.7%), 44 (73.3%), 47 (78.3%) and 51 (85%) patients by means of pHM, MII, GES and MII-pHM, respectively. The observed percentage agreements/κ values for GES and pHM, GES and MII, GES and MII-pHM, and MII and pHM are 48.3%/-0.118; 61.7%/-0.042; 73

  10. Gastroesophageal reflux as a cause of chronic cough, severe asthma, and migratory pulmonary infiltrates

    PubMed Central

    Ribó, Paula; Pacheco, Adalberto; Arrieta, Paola; Teruel, Carlos; Cobeta, Ignacio

    2014-01-01

    Gastroesophageal reflux (GER), asthma-type cough and upper airway disease are the most common causes of chronic cough syndrome. We present a case in which impedance–pH monitoring indicated severe mixed acid–nonacid esophageal reflux reaching the upper third of the esophagus in 75% of nonacid events. GER and the associated aspiration episodes were shown to be the cause of severe asthma attacks and migratory pulmonary infiltrates. GER was caused by a sleeve gastrectomy, which seriously disabled the mechanisms preventing reflux from reaching the airways. Respiratory symptoms improved notably after abdominal surgery to correct the GER, suggesting a close causal relationship between GER and all the symptoms, including asthma. However, this issue remains unresolved in the literature. PMID:25473547

  11. Esophageal motility abnormalities in gastroesophageal reflux disease.

    PubMed

    Martinucci, Irene; de Bortoli, Nicola; Giacchino, Maria; Bodini, Giorgia; Marabotto, Elisa; Marchi, Santino; Savarino, Vincenzo; Savarino, Edoardo

    2014-05-06

    Esophageal motility abnormalities are among the main factors implicated in the pathogenesis of gastroesophageal reflux disease. The recent introduction in clinical and research practice of novel esophageal testing has markedly improved our understanding of the mechanisms contributing to the development of gastroesophageal reflux disease, allowing a better management of patients with this disorder. In this context, the present article intends to provide an overview of the current literature about esophageal motility dysfunctions in patients with gastroesophageal reflux disease. Esophageal manometry, by recording intraluminal pressure, represents the gold standard to diagnose esophageal motility abnormalities. In particular, using novel techniques, such as high resolution manometry with or without concurrent intraluminal impedance monitoring, transient lower esophageal sphincter (LES) relaxations, hypotensive LES, ineffective esophageal peristalsis and bolus transit abnormalities have been better defined and strongly implicated in gastroesophageal reflux disease development. Overall, recent findings suggest that esophageal motility abnormalities are increasingly prevalent with increasing severity of reflux disease, from non-erosive reflux disease to erosive reflux disease and Barrett's esophagus. Characterizing esophageal dysmotility among different subgroups of patients with reflux disease may represent a fundamental approach to properly diagnose these patients and, thus, to set up the best therapeutic management. Currently, surgery represents the only reliable way to restore the esophagogastric junction integrity and to reduce transient LES relaxations that are considered to be the predominant mechanism by which gastric contents can enter the esophagus. On that ground, more in depth future studies assessing the pathogenetic role of dysmotility in patients with reflux disease are warranted.

  12. Interplay between vesicoureteric reflux and kidney infection in the development of reflux nephropathy in mice.

    PubMed

    Bowen, Samantha E; Watt, Christine L; Murawski, Inga J; Gupta, Indra R; Abraham, Soman N

    2013-07-01

    Vesicoureteric reflux (VUR) is a common congenital defect of the urinary tract that is usually discovered after a child develops a urinary tract infection. It is associated with reflux nephropathy, a renal lesion characterized by the presence of chronic tubulointersitial inflammation and fibrosis. Most patients are diagnosed with reflux nephropathy after one or more febrile urinary tract infections, suggesting a potential role for infection in its development. We have recently shown that the C3H mouse has a 100% incidence of VUR. Here, we evaluate the roles of VUR and uropathogenic Escherichia coli infection in the development of reflux nephropathy in the C3H mouse. We find that VUR in combination with sustained kidney infection is crucial to the development of reflux nephropathy, whereas sterile reflux alone fails to induce reflux nephropathy. A single bout of kidney infection without reflux fails to induce reflux nephropathy. The host immune response to infection was examined in two refluxing C3H substrains, HeN and HeJ. HeJ mice, which have a defect in innate immunity and bacterial clearance, demonstrate more significant renal inflammation and reflux nephropathy compared with HeN mice. These studies demonstrate the crucial synergy between VUR, sustained kidney infection and the host immune response in the development of reflux nephropathy in a mouse model of VUR.

  13. Contribution of ultrasound scans in the first episode of urinary tract infection in children.

    PubMed

    Jellouli, Manel; Ben Mansour, Asma; Abidi, Kamel; Ferjani, Meriem; Naija, Ouns; Hammi, Yousra; Zarrouk, Chokri; Gargah, Tahar

    2016-06-01

    Background - Vesicoureteral reflux (VUR) is a common pediatric urologic disorder. After the first urinary tract infection (UTI), imaging studies are recommended, starting with a renal ultrasound (US) and voiding cystourethrography (VCUG). We propose to determine whether abnormalities found on US can help indicate the necessity of VCUG in children after the first urinary tract infection. Methods - A retrospective study included all children admitted with their first episode of urinary tract infection from January 2007 to December 2012. Results - A total of 311 children were included. The median age was 2.5 years, 72.3% were female. VUR Prevalence was 14%.  Forty-four patients were found to have VUR on VCUG, giving a prevalence of 14%. Of these 44 patients, 11 had grade I reflux, 6 had grade II reflux, 3 had grade III reflux, 15had grade IV reflux, and 9 had grade V reflux. Ultrasound findings were positive for VUR in 43 patients, 19 of them had RVU. Twenty five patients had a normal ultrasound but showed VUR on VCUG (11 had grade I reflux, six grade II reflux, three grade III reflux and five grade IV reflux).  The sensitivity and specificity of ultrasound in suggesting VUR were 43% and 91%, respectively. The positive predictive value of ultrasound in suggesting VUR was 44%; the negative predictive value was 91%. Conclusion - Renal ultrasound findings are specific for VUR in children with a first UTI, but no sensitive. Clinicians should consider renal ultrasound results to take decision on whether or not to proceed with a VCUG in the investigation of a first episode UTI in young children.

  14. Role of PH Monitoring in Laryngopharyngeal Reflux Patients with Voice Disorders

    PubMed Central

    Maldhure, Swati; Chandrasekharan, Ramanathan; Dutta, Amit- Kumar; Chacko, Ashok; Kurien, Mary

    2016-01-01

    Introduction: Laryngopharyngeal reflux (LPR) is considered an important cause of voice disorder. We aimed to determine the frequency of LPR in patients with voice disorder and the association between Koufman Reflux Symptom Index (RSI), Reflux Finding Score (RFS), gastroesophageal reflux disease (GERD), and proximal acid reflux in these patients. Materials and Methods: We performed a prospective study in patients aged more than 18 years presenting at the ear, nose, and throat (ENT) clinic with a change in voice lasting more than 3 weeks. All patients underwent nasopharyngolaryngoscopy and a dual-probe esophageal pH study. LPR was diagnosed by a Koufman RSI of >13 and/or RFS of >7. GERD was diagnosed according to a DeMeester Johnson score of >14.7. Proximal acid reflux was diagnosed if acid exposure time was >0.02% in a proximal pH probe. Results: The study included 30 patients with a voice disorder. The mean age of participants was 38.5 years and 40% of patients were female. Using either of the two criteria, LPR was present in 46.7% of patients, half of whom had GERD. Among the remaining 53.3% patients with a voice disorder and no evidence of LPR, GERD was present in 25%. There was no significant association between the presence of LPR based on RSI (P=1) and GERD or RFS and GERD (P=0.06). Proximal acid reflux was present in only 10% patients with a voice disorder, and there was no significant association of this test with RFS (P=1) or RSI (P=1). Conclusions: Approximately half of the patients with a voice disorder have LPR, and only a subset of these patients have evidence of GERD. Fiberoptic laryngoscopic findings (RFS) complementing RSI appears to be important in diagnosing possible reflux etiology in voice disorders and can be an indicator for instituting anti-reflux therapy. However, there is no significant association between RSI, RFS, and GERD suggesting that these tests evaluate different features of the disease. Proximal acid reflux is uncommon in patients

  15. [Gastro-oesophageal reflux--what if physiological? (author's transl)].

    PubMed

    Weiser, H F; Pace, F; Lepsien, G; Müller-Lissner, S A; Blum, A L; Siewert, J R

    1982-03-12

    Gastro-oesophageal reflux was examined by taped long-term pH monitoring in 31 healthy subjects (16 men, 15 women; average age 28 years). The following was found: (1) reflux during the day is normal in health subjects, occurring predominantly after meals; (2) healthy persons have practically no reflux at night, after reaching the phase of deep sleep, the decisive difference between the healthy subject and those with reflux concerning the sleep phase, during which the patient with reflux has significantly increased reflux; (3) gastro-oesophageal reflux during the night is dependent upon depth of sleep, while position-dependent reflux was not observed.

  16. Experimental intrarenal reflux and blood pressure.

    PubMed Central

    Moffat, D. B.

    1977-01-01

    The effect on the blood pressure of experimental vesico-ureteric reflux was investigated in adult female Wistar rats. In 6 rats, reflux with isotonic saline produced a transient rise in systemic blood pressure followed by a fall, with return to normal within 2 min (mean BP readings: 121-130-93 mmHg). In 6 rats during water diuresis, reflux with distilled water produced similar changes (114-120-79 mmHg). In 6 rats in which the ureters were divided before reflux, no rise in blood pressure occurred although in 2 of these the pressure showed a marked fall. The pattern of blood pressure changes which occurred as a result of reflux was similar to that produced by a rapid i.v. injection of a corresponding volume of saline and it was concluded that the changes accompanying reflux are due to pyelovenous backflow. This was confirmed by producing reflux with 5% lissamine green which appeared in the peripheral capillaries within 4 s of the reflux in 3 rats. Slow dilatation of the pelvis with saline in 9 rats showed that rupture of the pelvic epithelium occurred at a mean pressure of 99 mmHg. PMID:607990

  17. Feeding and Reflux: A Parent & Professional Perspective

    ERIC Educational Resources Information Center

    Roche, William J.; Martorana, Pamela; Vitello, Louise; Eicher, Peggy S.; LaCour, Tricia

    2008-01-01

    Gastroesophageal reflux (GER) as a cause of an infant or child's refusal to eat is becoming better recognized. However, the many more subtle influences that reflux can have on feeding are less often recognized. Although vomiting after meals is the classic presentation, infants and children may present with a variety of more subtle symptoms less…

  18. EVALUATION AND TREATMENT OF GASTROESOPHAGEAL REFLUX.

    DTIC Science & Technology

    Although esophageal hiatal hernia and gastroesophageal reflux often occur together, they can occur separately. Reflux of digestive juice into the...esophagus is the physiologic malfunction which causes symptoms and complications, whereas hiatal hernia is an anatomic abnormality which itself rarely

  19. Evaluation of bile reflux in HIDA images based on fluid mechanics.

    PubMed

    Lo, Rong-Chin; Huang, Wen-Lin; Fan, Yu-Ming

    2015-05-01

    We propose a new method to help physicians assess, using a hepatobiliary iminodiacetic acid scan image, whether or not there is bile reflux into the stomach. The degree of bile reflux is an important index for clinical diagnosis of stomach diseases. The proposed method applies image-processing technology combined with a hydrodynamic model to determine the extent of bile reflux or whether the duodenum is also folded above the stomach. This condition in 2D dynamic images suggests that bile refluxes into the stomach, when endoscopy shows no bile reflux. In this study, we used optical flow to analyze images from Tc99m-diisopropyl iminodiacetic acid cholescintigraphy (Tc99m-DISIDA) to ascertain the direction and velocity of bile passing through the pylorus. In clinical diagnoses, single photon emission computed tomography (SPECT) is the main clinical tool for evaluating functional images of hepatobiliary metabolism. Computed tomography (CT) shows anatomical images of the external contours of the stomach, liver, and biliary extent. By exploiting the functional fusion of the two kinds of medical image, physicians can obtain a more accurate diagnosis. We accordingly reconstructed 3D images from SPECT and CT to help physicians choose which cross sections to fuse with software and to help them more accurately diagnose the extent and quantity of bile reflux.

  20. A randomized controlled study of the efficacy of six-month supplementation with concentrated fish oil rich in omega-3 polyunsaturated fatty acids in first episode schizophrenia.

    PubMed

    Pawełczyk, Tomasz; Grancow-Grabka, Marta; Kotlicka-Antczak, Magdalena; Trafalska, Elżbieta; Pawełczyk, Agnieszka

    2016-02-01

    Short-term clinical trials of omega-3 polyunsaturated fatty acids (n-3 PUFA) as add-on therapy in patients with schizophrenia revealed mixed results. The majority of these studies used an 8- to 12-week intervention based on ethyl-eicosapentaenoic acid. A randomized placebo-controlled trial was designed to compare the efficacy of 26-week intervention, composed of either 2.2 g/day of n-3 PUFA, or olive oil placebo, with regard to symptom severity in first-episode schizophrenia patients. Seventy-one patients (aged 16-35) were enrolled in the study and randomly assigned to the study arms. The primary outcome measure of the clinical evaluation was schizophrenia symptom severity change measured by the Positive and Negative Syndrome Scale (PANSS). Mixed models repeated measures analysis revealed significant differences between the study arms regarding total PANSS score change favouring n-3 PUFA (p = 0.016; effect size (ES) = 0.29). A fifty-percent improvement in symptom severity was achieved significantly more frequently in the n-3 PUFA group than in the placebo group (69.4 vs 40.0%; p = 0.017). N-3 PUFA intervention was also associated with an improvement in general psychopathology, measured by means of PANSS (p = 0.009; ES = 0.32), depressive symptoms (p = 0.006; ES = 0.34), the level of functioning (p = 0.01; ES = 0.31) and clinical global impression (p = 0.046; ES = 0.29). The findings suggest that 6-month intervention with n-3 PUFA may be a valuable add-on therapy able to decrease the intensity of symptoms and improve the level of functioning in first-episode schizophrenia patients.

  1. Gastroesophageal scintigraphy to assess the severity of gastroesophageal reflux disease. [/sup 99m/Tc-sulfur colloid

    SciTech Connect

    Menin, R.A.; Malmud, L.S.; Petersen, R.P.; Maier, W.P.; Fisher, R.S.

    1980-01-01

    Thirty-six (36) patients with symptomatic gastroesophageal reflux were studied. Symptoms of heartburn, regurgitation, and dysphagia were scored as to their severity and compared to quantitative tests of gastroesophageal reflux. Patients were studied with the acid reflux test, fiberoptic endoscopy, exophageal mucosal biopsy with a pinch forceps, esophageal manometry, and radioisotopic gastroesophgeal scintigraphy. Symptoms were scored according to an arbitrary grading system as mild, moderate, or severe. There were significant correlations between symptoms scores and both the degree of endoscopic esophagitis and the gastroesophageal reflux indices as measured by the radioisotopic scintiscan, but not with the degree of histologic esophagitis or lower esophageal sphincter pressure. Review of the findings suggest the following profile for patients who might require antireflux surgery: severe symptoms; presence of endoscopic esophagitis; resting lower esophageal sphincter pressure below 10 mmHg; and gastroesophageal reflux index above 10%.

  2. Gastroesophageal reflux in pregnancy: a systematic review on the benefit of raft forming agents.

    PubMed

    Quartarone, G

    2013-10-01

    The prevalence of gastroesophageal reflux disease (GERD) symptoms in pregnancy is very high, up to 80%, with a maximum peak during the third trimester. Together with lifestyle modifications, antacids and antisecretive agents, such as proton pump inhibitors (PPIs) and histamine H2 receptor antagonists (H2RAs), are commonly prescribed in non-pregnant, adult population. In certain Countries these drugs are not allowed in or are allowed only during the late stages of pregnancy. Alginate-based formulations have been used for the symptomatic treatment of heartburn for decades, as they usually contain sodium or potassium bicarbonate. In the presence of gastric acid, a foamy raft is created above the gastric contents. The alginate raft moves into the esophagus in place or ahead of acidic gastric contents during reflux episodes physically preventing reflux of gastric contents into the esophagus. Alginate-based formulations are allowed with no restrictions also in pregnancy: their safety profile make them a very valid option taking into account the risk/benefit ratio for both parturient and unborn baby. This systematic review paper aims to explore the use of medications for treating GERD in pregnancy, including alginate raft-forming-agents, highlighting the benefits for both the mother and the fetus. Electronic search in databases was conducted on databases such as Medline, PubMed, Ovid retrieving data concerning the reflux treatments in pregnancy, with a special focus on alginate raft forming antireflux agents. From the literature on alginate use in pregnancy, no particular risks have been shown to date for both parturient and unborn baby when alginate had been administered during all the pregnancy trimesters. The physical mode of action ensures the maximum esophageal protection by the neutral foam floating in the stomach, maintaining physiological pH values at stomach level, without interfering with the digestive processes. The symptoms' healing has been markedly improved

  3. Acid Reflux (GER & GERD) in Infants

    MedlinePlus

    ... This content is not available in any other language. Related Research See more about digestive diseases research at NIDDK. ... 30 a.m. to 5 p.m. eastern time, M-F Follow Us NIH… Turning Discovery Into Health ® Research & Funding Current Funding Opportunities Research Programs & Contacts Human ...

  4. Acid Reflux (GER & GERD) in Children & Teens

    MedlinePlus

    ... This content is not available in any other language. Related Research See more about digestive diseases research at NIDDK. ... 30 a.m. to 5 p.m. eastern time, M-F Follow Us NIH… Turning Discovery Into Health ® Research & Funding Current Funding Opportunities Research Programs & Contacts Human ...

  5. Acid Reflux (GER and GERD) in Adults

    MedlinePlus

    ... Contacts Human Subjects Research Funding Process Research Training & Career Development Funded Grants & Grant History Research Resources Research at NIDDK Meetings & Events Technology Advancement & Transfer Health Information Diabetes Digestive Diseases Kidney Disease ...

  6. How Acid Reflux Disease Damages Teeth

    MedlinePlus

    ... information you need from the Academy of General Dentistry Sunday, April 9, 2017 About | Contact InfoBites Quick ... in the March/April 2009 issue of General Dentistry , the Academy of General Dentistry's (AGD) clinical, peer- ...

  7. Part I – Young Girls with Non-Refluxing Ureters

    PubMed Central

    Fair, William R.; Govan, Duncan E.; Friedland, Gerald W.; Filly, Roy A.

    1974-01-01

    This paper is the study of 144 girls with histories of urinary tract infection followed at the Stanford Medical Center who were found to be free of ureterovesical reflux. The mean age at onset of infection for the entire group was about four years and ranged from the first few months of life to age 10. Ninety-two percent of the 505 infection episodes in these children presented with symptoms referable to the lower tract, and bacterial localization studies confirmed that 85 percent of the infections were limited to the bladder. Escherichia coli was the most common organism isolated and most infections were caused by a pure culture of a single bacteria. In only two of the 144 patients studied was there any evidence of upper tract damage related to infection. The possibility that these patients had reflux at an earlier age could not be discounted. In response to short-term antibacterial therapy in 66 of the patients followed closely for an average of 40 months each, 20 percent of the patients had no further infections and 80 percent went on to recurrence. With each succeeding treatment an additional 20 percent of the patients were “cured,” but the remainder experienced recurrent infections during the follow-up. This reinfection pattern supports the use of long-term antibacterial prophylaxis in all girls who have more than three or four recurrences of infections. Urethral dilation appeared to have no value in reducing the reinfection rate. While it appears that in the absence of ureterovesical reflux few, if any, of these children will go on to develop upper tract damage, long-term prophylactic suppressive medication can clearly be justified on the grounds of reducing patient morbidity. ImagesChart 1.Chart 2.Chart 3.Chart 4.Chart 5. PMID:4617970

  8. Endoscopic and laparoscopic treatment of gastroesophageal reflux.

    PubMed

    Watson, David I; Immanuel, Arul

    2010-04-01

    Gastroesophageal reflux is extremely common in Western countries. For selected patients, there is an established role for the surgical treatment of reflux, and possibly an emerging role for endoscopic antireflux procedures. Randomized trials have compared medical versus surgical management, laparoscopic versus open surgery and partial versus total fundoplications. However, the evidence base for endoscopic procedures is limited to some small sham-controlled studies, and cohort studies with short-term follow-up. Laparoscopic fundoplication has been shown to be an effective antireflux operation. It facilitates quicker convalescence and is associated with fewer complications, but has a similar longer term outcome compared with open antireflux surgery. In most randomized trials, antireflux surgery achieves at least as good control of reflux as medical therapy, and these studies support a wider application of surgery for the treatment of moderate-to-severe reflux. Laparoscopic partial fundoplication is an effective surgical procedure with fewer side effects, and it may achieve high rates of patient satisfaction at late follow-up. Many of the early endoscopic antireflux procedures have failed to achieve effective reflux control, and they have been withdrawn from the market. Newer procedures have the potential to fashion a surgical fundoplication. However, at present there is insufficient evidence to establish the safety and efficacy of endoscopic procedures for the treatment of gastroesophageal reflux, and no endoscopic procedure has achieved equivalent reflux control to that achieved by surgical fundoplication.

  9. Predictors of renal scar in children with urinary infection and vesicoureteral reflux.

    PubMed

    Soylu, Alper; Demir, Belde Kasap; Türkmen, Mehmet; Bekem, Ozlem; Saygi, Murat; Cakmakçi, Handan; Kavukçu, Salih

    2008-12-01

    We evaluated the predictors of renal scar in children with urinary tract infections (UTIs) having primary vesicoureteral reflux (VUR). Data of patients who were examined by dimercaptosuccinic acid (DMSA) scintigraphy between 1995 and 2005 were evaluated retrospectively. Gender, age, reflux grade, presence/development of scarring, breakthrough UTIs, and resolution of reflux, were recorded. The relation of gender, age and VUR grade to preformed scarring and the relation of gender, age, VUR grade, presence of preformed scarring, number of breakthrough UTIs and reflux resolution to new scarring were assessed. There were 138 patients [male/female (M/F) 53/85]. Multivariate analysis showed that male gender [odds ratio (OR) 2.5], age > or = 27 months in girls (OR 4.2) and grades IV-V reflux (OR 12.4) were independent indicators of renal scarring. On the other hand, only the presence of previous renal scarring was found to be an independent indicator for the development of new renal scar (OR 13.4). In conclusion, while the most predictive variables for the presence of renal scarring among children presenting with a UTI were male gender, age > or = 27 months in girls, and grades IV-V reflux, the best predictor of new scar formation was presence of previous renal scarring.

  10. Fundoplication for laryngopharyngeal reflux despite preoperative dysphagia.

    PubMed

    Falk, G L; Van der Wall, H; Burton, L; Falk, M G; O'Donnell, H; Vivian, S J

    2017-03-01

    INTRODUCTION Fundoplication for laryngopharyngeal disease with oesophageal dysmotility has led to mixed outcomes. In the presence of preoperative dysphagia and oesophageal dysmotility, this procedure has engendered concern in certain regards. METHODS This paper describes a consecutive series of laryngopharyngeal reflux (LPR) patients with a high frequency of dysmotility. Patients were selected for surgery with 24-hour dual channel pH monitoring, oesophageal manometry and standardised reflux scintigraphy. RESULTS Following careful patient selection, 33 patients underwent fundoplication by laparoscopy. Surgery had high efficacy in symptom control and there was no adverse dysphagia. CONCLUSIONS Evidence of proximal reflux can select a group of patients for good results of fundoplication for atypical symptoms.

  11. Extraesophageal manifestations of gastroesophageal reflux disease.

    PubMed

    Hom, Christopher; Vaezi, Michael F

    2013-03-01

    This article discusses the current state of knowledge regarding the relationship between gastroesophageal reflux disease (GERD) and pulmonary and ear/nose/throat manifestations of reflux and outlines the recent developments in the diagnostic and treatment strategies for this difficult group of patients. Upper gastrointestinal endoscopy and pH monitoring are poorly sensitive for diagnosing reflux in this group of patients. Instead it is recommended that in those without warning symptoms, an empiric trial of proton-pump inhibitors be the initial approach to diagnosing and treating the potential underlying cause of these extraesophageal symptoms.

  12. Mechanisms of gastro-oesophageal reflux in cystic fibrosis.

    PubMed Central

    Cucchiara, S; Santamaria, F; Andreotti, M R; Minella, R; Ercolini, P; Oggero, V; de Ritis, G

    1991-01-01

    Abnormal degrees of gastro-oesophageal reflux (GOR) were detected by 24 hour intraoesophageal pH measurement in 12 of 14 children (mean age 7.9 years; range 5 months-16 years) affected by cystic fibrosis and complaining of symptoms suggesting GOR. These patients underwent combined recording of distal oesophageal motility and intraluminal pH in order to investigate mechanisms of GOR. Inappropriate lower oesophageal sphincter relaxation was the most common mechanism of reflux in all patients. Other mechanisms (appropriate relaxation or lowered pressure of the lower oesophageal sphincter, increased intragastric pressure) were detected less frequently. Frequency of inappropriate lower oesophageal sphincter relaxations was significantly higher in patients with cystic fibrosis than in other study groups (symptomatic GOR, GOR disease complicated by respiratory complaints). Inappropriate lower oesophageal sphincter relaxations occurred with the same frequency in patients with cystic fibrosis and in a group of children with GOR disease complicated by oesophagitis. Abnormalities of distal oesophageal contractions such as decreased amplitude or uncoordinated waves were also recorded in cystic fibrosis patients. Seven patients with cystic fibrosis completed a therapeutic trial for eight weeks consisting of postural treatment and oral cisapride, a new prokinetic drug. The oesophageal acid exposure improved in only three patients. We conclude that pathologic GOR is commonly associated with cystic fibrosis. The predominant reflux mechanism in these patients is a transient inappropriate lower oesophageal sphincter relaxation rather than a low steady state basal lower oesophageal sphincter pressure. PMID:2039253

  13. [Gastroesophageal reflux as a cause of vocal dysfunction].

    PubMed

    Young, P; Finn, B C; Fox, M L; Emery, N; Bruetman, J E

    2008-07-01

    Vocal cord dysfunction (VCD), is characterized by a paradoxical adduction of the vocal cords during inspiration, and occurs predominantly in young women. Common symptoms are cough, wheezing, episodic dyspnea, and inspiratory stridor. The true incidence and course of the disease are unknown, and it is usually self limited. It can coexist with, or mimic refractory asthma. Psychological disorders were thought to be the principal cause, subsequently multiple organic diseases have also been reported, like gastroesophageal reflux disease (GERD). Diagnosis is made by clinical suspicion and direct observation. The Gold standard for diagnosis is laryngoscopy with visualization of the paradoxical motion of the vocal cords when the patient is symptomatic. Speech therapy and psychotherapy have been used extensively without any prospective study. We report two cases of VCD associated with GERD, both with excellent respond to treatment.

  14. Gastroesophageal reflux symptoms not responding to proton pump inhibitor: GERD, NERD, NARD, esophageal hypersensitivity or dyspepsia?

    PubMed

    Bashashati, Mohammad; Hejazi, Reza A; Andrews, Christopher N; Storr, Martin A

    2014-06-01

    Gastroesophageal reflux (GER) is a common gastrointestinal process that can generate symptoms of heartburn and chest pain. Proton pump inhibitors (PPIs) are the gold standard for the treatment of GER; however, a substantial group of GER patients fail to respond to PPIs. In the past, it was believed that acid reflux into the esophagus causes all, or at least the majority, of symptoms attributed to GER, with both erosive esophagitis and nonerosive outcomes. However, with modern testing techniques it has been shown that, in addition to acid reflux, the reflux of nonacid gastric and duodenal contents into the esophagus may also induce GER symptoms. It remains unknown how weakly acidic or alkaline refluxate with a pH similar to a normal diet induces GER symptoms. Esophageal hypersensitivity or functional dyspepsia with superimposed heartburn may be other mechanisms of symptom generation, often completely unrelated to GER. Detailed studies investigating the pathophysiology of esophageal hypersensitivity are not conclusive, and definitions of the various disease states may overlap and are often confusing. The authors aim to clarify the pathophysiology, definition, diagnostic techniques and medical treatment of patients with heartburn symptoms who fail PPI therapy.

  15. Gelastic seizures misdiagnosed as gastroesophageal reflux disease.

    PubMed

    Sweetman, Laura L; Ng, Yu-Tze; Kerrigan, John F

    2007-05-01

    Gastroesophageal reflux disease can have variable manifestations including regurgitation, irritability, arching, choking, and apnea. The disorder is also frequently mistaken for seizures (Sandifer syndrome). We report 6 patients in whom the opposite phenomenon occurred: their seizures were mistaken for gastroesophageal reflux disease. Six of 77 patients (6.8%) with gelastic seizures and epilepsy symptomatic of hypothalamic hamartomas were noted to be misdiagnosed with gastroesophageal reflux disease in infancy. As is typical in these patients, gelastic seizures were not diagnosed until months, or often years, later. Delayed diagnosis of hypothalamic hamartomas can lead to a potentially deleterious syndrome involving refractory epilepsy, developmental problems, and precocious puberty. Gelastic seizures should be considered among the conditions that can mimic reflux symptoms.

  16. Cervical venous reflux in dynamic brain scintigraphy.

    PubMed

    Hayt, D B; Perez, L A

    1976-01-01

    Cervical venous reflux, shown by dynamic brain scintigraphy, was investigated through three avenues of approach: (A) by reviewing 371 randomly chosen routine dynamic intracerebral bloodflow studies to estimate its incidence; (B) by correlative positive-contrast superior venacavography in patients with characteristic cervical venous reflux; and (C) by performing dynamic brain scintigraphy while utilizing various positional and physiologic maneuvers to attempt to produce cervical venous reflux in patients who did not exhibit this phenomenon on earlier examination. Although any obstruction of the superior vena cava or a properly timed Valsalva maneuver in selected patients can produce the scintigraphic picture of cervical venous reflux, in most cases it is a normal phenomenon due to incompetent or absent cervical venous valves.

  17. Biomarkers for Gastroesophageal Reflux in Respiratory Diseases

    PubMed Central

    Gíslason, Þórarinn; Olin, Anna-Carin; Janson, Christer; Ólafsson, Ísleifur

    2013-01-01

    Gastroesophageal reflux (GER) is commonly associated with respiratory symptoms, either through a vagal bronchoconstrictive reflex or through microaspiration of gastric contents. No diagnostic test is available, however, to diagnose when respiratory illnesses are caused by GER and when not, but research in this field has been moving forward. Various biomarkers in different types of biosamples have been studied in this context. The aim of this review is to summarize the present knowledge in this field. GER patients with respiratory diseases seem to have a different biochemical profile from similar patients without GER. Inflammatory biomarkers differ in asthmatics based on GER status, tachykinins are elevated in patients with GER-related cough, and bile acids are elevated in lung transplant patients with GER. However, studies on these biomarkers are often limited by their small size, methods of analysis, and case selections. The two pathogenesis mechanisms are associated with different respiratory illnesses and biochemical profiles. A reliable test to identify GER-induced respiratory disorders needs to be developed. Bronchoalveolar lavage is too invasive to be of use in most patients. Exhaled breath condensate samples need further evaluation and standardization. The newly developed particles in exhaled air measurements remain to be studied further. PMID:23653634

  18. A family study of vesicoureteric reflux

    PubMed Central

    Vargas, Aida De; Evans, Kathleen; Ransley, P.; Rosenberg, A. R.; Rothwell, D.; Sherwood, T.; Williams, D. I.; Barratt, T. M.; Carter, C. O.

    1978-01-01

    Vesicoureteric reflux is now considered to be due essentially to congenital malformation of the vesicoureteric junction. It is also considered to be a major cause of renal failure in early adult life. The condition is associated with recurrent urinary tract infection and in some instances with renal scarring. When reflux is detected clinically, in the investigation of patients with recurrent urinary tract infection, renal scarring is often already present. The reflux tends to disappear in later childhood. A family study has been made based on 186 index patients with established primary reflux, with special attention to a history of genitourinary symptoms in the sibs and parents of these patients. There were 39 sibs under the age of 4 years. For these the parents were offered investigation by micturating cystogram. The parents of 20 accepted. Reflux was shown in 3, and in 2 of these there was already renal scarring. The proportion of all infants and young children who have reflux is not accurately known, but the few published surveys of screening of normal infants and young children by micturating cystogram suggest that the prevalence is of the order of 1%. The prevalence in sibs is, then, about 10 times higher. There was a main group of 214 sibs over the age of 4 years. For these the parents were offered investigation by intravenous pyelogram only for those sibs who had a history of recurrent urinary tract infection. If renal scarring was found then a micturating cystogram was done. Of 110 sisters, 12 were `symptomatic', renal scarring was found in 5 of these (1 was on haemodialysis), and reflux was still present in 3. Of 104 brothers 7 were `symptomatic', renal scarring was found in 2 and reflux was present in both. For comparison, the published reports of several surveys of schoolgirls indicate that about 2 in 100 have recurrent urinary tract infection, and in about a quarter of these (0·5%) reflux was present and in about one-eighth (0·25%) renal scarring was

  19. Episodic acidification of small streams in the northeastern united states: ionic controls of episodes

    USGS Publications Warehouse

    Wigington, P.J.; DeWalle, David R.; Murdoch, Peter S.; Kretser, W.A.; Simonin, H.A.; Van Sickle, J.; Baker, J.P.

    1996-01-01

    As part of the Episodic Response Project (ERP), we intensively monitored discharge and stream chemistry of 13 streams located in the Northern Appalachian region of Pennsylvania and in the Catskill and Adirondack Mountains of New York from fall 1988 to spring 1990. The ERP clearly documented the occurrence of acidic episodes with minimum episodic pH ??? 5 and inorganic monomeric Al (Alim) concentrations >150 ??g/L in at least two study streams in each region. Several streams consistently experienced episodes with maximum Alim concentrations >350 ??g/L. Acid neutralizing capacity (ANC) depressions resulted from complex interactions of multiple ions. Base cation decreases often made the most important contributions to ANC depressions during episodes. Organic acid pulses were also important contributors to ANC depressions in the Adirondack streams, and to a lesser extent, in the Catskill and Pennsylvania streams. Nitrate concentrations were low in the Pennsylvania streams, whereas the Catskill and Adirondack study streams had high NO3- concentrations and large episodic pulses (???54 ??eq/L). Most of the Pennsylvania study streams also frequently experienced episodic pulses of SO42- (???78 ??eq/L), whereas the Adirondack and Catskill streams did not. High baseline concentrations of SO42- (all three study areas) and NO3- (Adirondacks and Catskills) reduced episodic minimum ANC, even when these ions did not change during episodes. The ion changes that controlled the most severe episodes (lowest minimum episodic ANC) differed from the ion changes most important to smaller, more frequent episodes. Pulses of NO3- (Catskills and Adirondacks), SO42- (Pennsylvania), or organic acids became more important during major episodes. Overall, the behavior of streamwater SO42- and NO4- is an indicator that acidic deposition has contributed to the severity of episodes in the study streams.

  20. [Severe laryngitis associated to gastroesophageal reflux].

    PubMed

    Botto, Hugo; Antonioli, Cintia; Nieto, Mary; Cocciaglia, Alejandro; Cuestas, Giselle; Roques Revol, Magdalena; López Marti, Jessica; Rodríguez, Hugo

    2014-02-01

    There is a strong association between gastroesophageal reflux and pharyngolaryngeal reflux as factors leading to respiratory disease, manifested as dysphonia, wheezing, coughing, recurrent laryngitis, bronchial obstruction, laryngospasm and apparent life-threatening events (ALTEs). These manifestations can be mild or severe and may sometimes put the patient's life at risk. We present two cases of patients with severe laryngitis who required endotracheal intubation, one of which underwent tracheostomy. The diagnostic methods and their limitations and the patients outcomes are described.

  1. Vesicoureteral reflux, a benign condition.

    PubMed

    Venhola, Mika; Uhari, Matti

    2009-02-01

    The combination of urinary tract infection (UTI) and vesicoureteral reflux (VUR) is commonly thought to predispose the child to pyelonephritis, renal scarring and, later in life, to hypertension or end-stage renal disease (ESRD). This paradigm has led to the active search, follow-up and treatment of VUR, and also prevention of recurrent UTI in children. The causality of VUR and ESRD is controversial, however. According to recent meta-analyses it is uncertain whether we can prevent renal scarring or ESRD by treating VUR. Studies on VUR are abundant, but the findings and conclusions are confounding. Because of the lack of evidence of the role of VUR, reasonable doubt has recently been presented on the rationale of imaging all children with UTI and treating the children with VUR. The overall importance of VUR is confounded because of the natural tendency of VUR to resolve spontaneously, its dynamic nature, and its different grades in children. The historical studies showing that VUR is much more common, even among healthy children, than usually claimed, have been forgotten. Since it seems that we are referring too many healthy children to unpleasant and possibly unnecessary imaging tests for VUR, we are uncertain when and what kind of VUR-if any-we should treat, and whether our present rationale of addressing VUR truly makes any difference to renal scarring or ESRD in children, we should critically revisit the subject of VUR.

  2. High incidence of vesicoureteric reflux in asymptomatic siblings of children with known reflux

    SciTech Connect

    Treves, S.T.; Van den Abbeele, A.D.; Davis, R.T.; Rosen, P.; Bauer, S.; Retik, A.; Colodny, A.

    1985-05-01

    A significant occurrence of vesicoureteric reflux in siblings of children with reflux has been previously suggested. The purpose of this study was to evaluate the incidence of vesicoureteric reflux in asymptomatic siblings of children with vesicoureteric reflux using radionuclide voiding cystography (RNC). A random group of 52 siblings was studied. Their ages were from 2 mos. to 13 yrs. (mean 4 yrs.). Seventy-one percent were female and 29% male, RNC was performed with the patients supine, and Tc-99m pertechnetate (2mCi/1) was infused into the bladder by catheter. A computerized gamma camera recorded the filling and voiding phase of the study at 1 frame/5 sec. Reflux was detected in 40% of the patients. It was bilateral in 17% and unilateral in 23% of the patients. Reflux was identified to the renal pelves in half of the patients. In two of these patients Tc-99m DMSA scans were obtained which revealed significant renal scarring. This study demonstrates the high incidence of reflux of various degrees in these asymptomatic siblings on high risk of developing significant renal disease. Identification and proper treatment of asymptomatic children with vesicoureteric reflux may help prevent the development of renal damage.

  3. Implication of duodenogastric reflux in the pathogenesis of Barrett's oesophagus.

    PubMed

    Gillen, P; Keeling, P; Byrne, P J; Healy, M; O'Moore, R R; Hennessy, T P

    1988-06-01

    Fasting and postprandial intragastric bile acid concentrations have been estimated and compared in patients with complications of Barrett's oesophagus, patients with Barrett's oesophagus without complications, patients with oesophagitis and a group of normal subjects who acted as controls. There was no significant difference in fasting intragastric bile acid concentrations between the groups. Postprandial bile acid concentrations were significantly greater in the patients with complications of Barrett's than in the remaining groups at 60, 90 and 120 min. Significant concentrations of bile acids were seen in gastric juice of unaltered pH and may be undetected on intra-oesophageal pH monitoring. Duodenogastric reflux may be implicated in the pathogenesis of complications of Barrett's oesophagus.

  4. Episodic Response Pproject research plan

    SciTech Connect

    Thornton, K.; Baker, J.P.; Marmorek, D.; Bernard, D.; Eshleman, K.N.

    1988-02-01

    In some geographic locations, acidic deposition is known to be affecting surface water chemistry on both long-term and short-term time scales. Considerable research in the past decade has greatly improved our understanding of the biological effects of acidification, particularly the relationship between chronic chemical conditions and biological responses. In comparison, relatively little is known about the role that short-term acidification is having on the composition or functioning of aquatic biological communities. Despite this scientific uncertainty, it is generally presumed that short-term acidification ('episodes') can result in significant adverse effects on aquatic resources of interest, particularly fish communities. Recognizing episodes as a potentially important source of uncertainty in index-based estimates of acidic deposition effects on populations of lakes and streams, the EPA has initiated the Episodic Response Project (ERP). From an acidification perspective, the ERP is designed primarily to quantify this component of uncertainty in regional population estimates, and to determine the degree to which acidic episodes adversely affect fish populations.

  5. Long-term medical management of gastro-esophageal reflux disease: how long and when to consider surgery?

    PubMed

    Venkataraman, Jayanthi; Krishnan, Arunkumar

    2012-01-01

    Gastro-esophageal reflux disease is a chronic, long standing disease. Spontaneous remission of GERD is rare and conservative management including life style modification measures is unlikely to relieve symptoms. Majority of patients with reflux disease require long-term acid suppressants. Proton pump inhibitors are the choice of drugs in management of these patients. The end point of treatment is not clear. Duration of treatment is individual based. The symptoms may be intermittent or on most days of the week. The treatment is therefore either a short course which may be for 8 to 12 weeks or 6 months, or continuous, intermittent or 'on-demand' basis. The maintenance therapy is with the lowest proton pump inhibitor (PPI) dose necessary for adequate symptom relief. Whether long-term PPI actually alters the natural history of reflux disease other than to reduce the incidence of peptic stricture is not known. Reported adverse effects due to PPI include Clostridium difficile colitis and bacterial gastroenteritis, osteoporosis, and vitamin B12 deficiency. Anti-reflux surgery is indicated for youngsters, those not willing for long-term PPI i.e. for years, large volume refluxers, especially the supine refluxers and bile refluxers.

  6. Renal Scarring in the Randomized Intervention for Children with Vesicoureteral Reflux (RIVUR) Trial

    PubMed Central

    Chesney, Russell W.; Greenfield, Saul P.; Hoberman, Alejandro; Keren, Ron; Mathews, Ranjiv; Gravens-Mueller, Lisa; Ivanova, Anastasia; Carpenter, Myra A.; Moxey-Mims, Marva; Majd, Massoud; Ziessman, Harvey A.

    2016-01-01

    Background and objectives The main objectives of the Randomized Intervention for Children with Vesicoureteral Reflux (RIVUR) trial were to evaluate the role of antimicrobial prophylaxis in the prevention of recurrent urinary tract infection (UTI) and renal scarring in children with vesicoureteral reflux (VUR). We present a comprehensive evaluation of renal scarring outcomes in RIVUR trial participants. Design, setting, participants, & measurements This multicenter, randomized, placebo-controlled trial enrolled 607 children aged 2–71 months with grade 1–4 VUR diagnosed after a first or second febrile or symptomatic UTI. Study participants received trimethoprim-sulfamethoxazole or placebo and were followed for 2 years. Renal scarring was evaluated by baseline and follow-up 99mtechnetium dimercaptosuccinic acid (DMSA) renal scans that were reviewed independently by two blinded reference radiologists. Results At the end of the study, 58 (10%) of 599 children and 63 (5%) of 1197 renal units had renal scarring. New renal scarring did not differ between the prophylaxis and placebo groups (6% versus 7%, respectively). Children with renal scarring were significantly older (median age, 26 versus 11 months; P=0.01), had a second UTI before enrollment (odds ratio [OR], 2.85; 95% confidence interval [95% CI], 1.38 to 5.92), were more likely to be Hispanic (OR, 2.22; 95% CI, 1.13 to 4.34), and had higher grades of VUR (OR, 2.79; 95% CI, 1.56 to 5.0). The proportion of new scars in renal units with grade 4 VUR was significantly higher than in units with no VUR (OR, 24.2; 95% CI, 6.4 to 91.2). Conclusions Significantly more renal scarring was seen in relatively older children and in those with a second episode of febrile or symptomatic UTI before randomization. Preexisting and new renal scars occurred significantly more in renal units with grade 4 VUR than in those with low-grade or no VUR. Antimicrobial prophylaxis did not decrease the risk of renal scarring. PMID:26555605

  7. Are Clinical, Laboratory, and Imaging Markers Suitable Predictors of Vesicoureteral Reflux in Children With Their First Febrile Urinary Tract Infection?

    PubMed Central

    Ayazi, Parviz; Mavadati, Shiva; Oveisi, Sonia; Habibi, Morteza; Esmaeily, Shiva

    2014-01-01

    Purpose This study was conducted to determine the predictive value of clinical, laboratory, and imaging variables for the diagnosis of vesicoureteral reflux in children with their first febrile urinary tract infection. Materials and Methods One hundred fifty-three children with their first febrile urinary tract infection were divided into two groups according to the results of voiding cystourethrography: 60 children with vesicoureteral reflux and 93 children without. The sensitivity, specificity, positive and negative predictive value, likelihood ratio (positive and negative), and accuracy of the clinical, laboratory, and imaging variables for the diagnosis of vesicoureteral reflux were determined. Results Of the 153 children with febrile urinary tract infection, 60 patients (39.2%) had vesicoureteral reflux. There were significant differences between the two groups regarding fever>38℃, suprapubic pain, C-reactive protein quantitative level, number of red blood cells in the urine, and results of renal ultrasound and dimercaptosuccinic acid renal scanning (p<0.05). There were significant positive correlations between fever>38.2℃ and dimercaptosuccinic acid renal scanning and vesicoureteral reflux. Also, there were significant positive correlations between the erythrocyte sedimentation rate, positive urinary nitrite test, hyaline cast, and renal ultrasound and high-grade vesicoureteral reflux. Conclusions This study revealed fever>38.2℃ and dimercaptosuccinic acid renal scanning as the best predictive markers for vesicoureteral reflux in children with their first febrile urinary tract infection. In addition, erythrocyte sedimentation rate, positive urinary nitrite test, hyaline cast, and renal ultrasound are the best predictive markers for high-grade vesicoureteral reflux. PMID:25132949

  8. Functional dyspepsia and nonerosive reflux disease: clinical interactions and their implications.

    PubMed

    Keohane, John; Quigley, Eamonn M M

    2007-08-08

    Functional dyspepsia or nonulcer dyspepsia, and nonerosive reflux disease (NERD) or endoscopy-negative reflux disease, are common reasons for referral to a gastroenterologist. Although there is much confusion with regard to definition, recent research would suggest that these 2 conditions are linked and may represent components in the spectrum of the same disease entity, in terms of both symptoms and pathophysiology. Several theories have been proposed regarding the etiology of these disorders, including acid exposure, visceral hypersensitivity, impaired fundal accommodation, delayed gastric emptying, and Helicobacter pylori infection.

  9. [Urethrovesical reflux in patients with chronic cystitis].

    PubMed

    Loran, O B; Astapov, A I; Zaĭtsev, A V; Gumin, L M

    2007-01-01

    We studied the role of urethrovesical reflux in the onset and maintenance of chronic inflammation in the urinary bladder in patients suffering from chronic cystitis combined with pseudopolyposis of the neck of the bladder and proximal part of the urethra. We modelled a simplified version of an urination fragment of a special computer graphic station. The original computer model theoretically proves the existance of urethrovesical reflux caused by pseudopolyposis in the zone of the urinary bladder cervix and/or proximal urethra. The data were confirmed by radionuclide investigation. Our studies proved the presence of urethrovesical reflux in patients with pseudopolyposis of the bladder cervix provoking retrograde infection of the lower urinary tract. We think it necessary to combine conventional conservative treatment of cystitis with endourethral surgical interventions aimed at reestablishment of normal urination.

  10. Airway Reflux, Cough and Respiratory Disease

    PubMed Central

    Molyneux, Ian D.; Morice, Alyn H.

    2011-01-01

    It is increasingly accepted that the effects of gastro-oesophageal reflux are not limited to the gastrointestinal tract. The adjacent respiratory structures are also at risk from material ejected from the proximal oesophagus as a result of the failure of anatomical and physiological barriers. There is evidence of the influence of reflux on several respiratory and otorhinological conditions and although in many cases the precise mechanism has yet to be elucidated, the association alone opens potential novel avenues of therapy to clinicians struggling to treat patients with apparently intractable respiratory complaints. This review provides a description of the airway reflux syndrome, its effects on the lung and current and future therapeutic options. PMID:23251752

  11. Endoscopic Options for Gastroesophageal Reflux: Where Are We Now and What Does the Future Hold?

    PubMed

    Triadafilopoulos, George

    2016-09-01

    Early in the twenty-first century, novel endoscopic techniques were introduced for the management of gastroesophageal reflux disease, providing minimally invasive ways to eliminate pharmacologic acid inhibition and avoid the need for anti-reflux surgery. These techniques do not significantly alter the anatomy of the gastroesophageal junction, minimizing short- and long-term adverse effects, such as dysphagia and bloating. After extensive clinical testing, many endoscopic therapies were abandoned due to either lack of durable efficacy or unfavorable safety profile. Today, only four such therapies remain clinically available, each with variable levels of clinical validation and market penetration. This review will provide an assessment of these endoscopic therapies, highlighting their respective strengths and weaknesses and their present and future applicability to patients with gastroesophageal reflux disease.

  12. Physiology and pathogenesis of gastroesophageal reflux disease.

    PubMed

    Mikami, Dean J; Murayama, Kenric M

    2015-06-01

    Gastroesophageal reflux disease (GERD) is one of the most common problems treated by primary care physicians. Almost 20% of the population in the United States experiences occasional regurgitation, heartburn, or retrosternal pain because of GERD. Reflux disease is complex, and the physiology and pathogenesis are still incompletely understood. However, abnormalities of any one or a combination of the three physiologic processes, namely, esophageal motility, lower esophageal sphincter function, and gastric motility or emptying, can lead to GERD. There are many diagnostic and therapeutic approaches to GERD today, but more studies are needed to better understand this complex disease process.

  13. Treatment of Post-Stent Gastroesophageal Reflux by Anti-Reflux Z-Stent

    SciTech Connect

    Davies, Roger Philip; Kew, Jacqueline; Byrne, Peter D.

    2000-11-15

    Severe symptoms of heartburn and retrosternal pain consistent with gastro-esophageal reflux (GER) developed in a patient following placement of a conventional self-expanding 16-24-mm-diameter x 12-cm-long esophageal stent across the gastroesophageal junction to treat an obstructing esophageal carcinoma. A second 18-mm-diameter x 10-cm-long esophageal stent with anti-reflux valve was deployed coaxially and reduced symptomatic GER immediately. Improvement was sustained at 4-month follow-up. An anti-reflux stent can be successfully used to treat significant symptomatic GER after conventional stenting.

  14. Vesicoureteric reflux and reflux nephropathy: from mouse models to childhood disease.

    PubMed

    Fillion, Marie-Lyne; Watt, Christine L; Gupta, Indra R

    2014-04-01

    Vesicoureteric reflux (VUR) is a common congenital urinary tract defect that predisposes children to recurrent kidney infections. Kidney infections can result in renal scarring or reflux nephropathy defined by the presence of chronic tubulo-interstitial inflammation and fibrosis that is a frequent cause of end-stage renal failure. The discovery of mouse models with VUR and with reflux nephropathy has provided new opportunities to understand the pathogenesis of these conditions and may provide insight on the genes and the associated phenotypes that need to be examined in human studies.

  15. Gastroesophageal reflux disease (GERD): is there more to the story?

    PubMed

    Vesper, Benjamin J; Altman, Kenneth W; Elseth, Kim M; Haines, G Kenneth; Pavlova, Sylvia I; Tao, Lin; Tarjan, Gabor; Radosevich, James A

    2008-04-01

    Gastroesophageal reflux disease (GERD) affects both men and women worldwide, with the most common symptom of GERD being frequent heartburn. If left untreated, more serious diseases including esophagitis and/or esophageal cancer may result. GERD has been commonly held to be the result of gastric acid refluxing into the esophagus. Recent work, however, has shown that there are acid-producing cells in the upper aerodigestive tract. In addition, acid-producing bacteria located within the upper gastrointestinal tract and oral cavity may also be a contributing factor in the onset of GERD. Proton pump inhibitors (PPIs) are commonly prescribed for treating GERD; these drugs are designed to stop the production of gastric acid by shutting down the H(+)/K(+)-ATPase enzyme located in parietal cells. PPI treatment is systemic and therefore significantly different than traditional antacids. Although a popular treatment choice, PPIs exhibit substantial interpatient variability and commonly fail to provide a complete cure to the disease. Recent studies have shown that H(+)/K(+)-ATPases are expressed in tissues outside the stomach, and the effects of PPIs in these nongastric tissues have not been fully explored. Likewise, acid-producing bacteria containing proton pumps are present in both the oral cavity and esophagus, and PPI use may also adversely affect these bacteria. The use of PPI therapy is further complicated by the two philosophical approaches to treating this disease: to treat only symptoms or to treat continuously. The latter approach frequently results in unwanted side effects which may be due to the PPIs acting on nongastric tissues or the microbes which colonize the upper aerodigestive tract.

  16. Randomized clinical trial: effect of the 5-HT4 receptor agonist revexepride on reflux parameters in patients with persistent reflux symptoms despite PPI treatment

    PubMed Central

    Tack, J; Zerbib, F; Blondeau, K; des Varannes, S B; Piessevaux, H; Borovicka, J; Mion, F; Fox, M; Bredenoord, A J; Louis, H; Dedrie, S; Hoppenbrouwers, M; Meulemans, A; Rykx, A; Thielemans, L; Ruth, M

    2015-01-01

    Background Approximately, 20–30% of patients with gastro-esophageal reflux disease (GERD) experience persistent symptoms despite treatment with proton pump inhibitors (PPIs). These patients may have underlying dysmotility; therefore, targeting gastric motor dysfunction in addition to acid inhibition may represent a new therapeutic avenue. The aim of this study was to assess the pharmacodynamic effect of the prokinetic agent revexepride (a 5-HT4 receptor agonist) in patients with GERD who have persistent symptoms despite treatment with a PPI. Methods This was a phase II, exploratory, multicenter, randomized, placebo-controlled, double-blind, parallel-group study in patients with GERD who experienced persistent symptoms while taking a stable dose of PPIs (http://ClinicalTrials.gov identifier: NCT01370863). Patients were randomized to either revexepride (0.5 mg, three times daily) or matching placebo for 4 weeks. Reflux events and associated characteristics were assessed by pH/impedance monitoring and disease symptoms were assessed using electronic diaries and questionnaires. Key Results In total, 67 patients were enrolled in the study. There were no significant differences between study arms in the number, the mean proximal extent or the bolus clearance times of liquid-containing reflux events. Changes from baseline in the number of heartburn, regurgitation, and other symptom events were minimal for each treatment group and no clear trends were observed. Conclusions & Inferences No clear differences were seen in reflux parameters between the placebo and revexepride groups. PMID:25530111

  17. Laparoscopic fundoplication for gastroesophageal reflux disease.

    PubMed

    Frazzoni, Marzio; Piccoli, Micaela; Conigliaro, Rita; Frazzoni, Leonardo; Melotti, Gianluigi

    2014-10-21

    Gastroesophageal reflux disease (GERD) is a condition that develops when the reflux of gastric contents into the esophagus leads to troublesome symptoms and/or complications. Heartburn is the cardinal symptom, often associated with regurgitation. In patients with endoscopy-negative heartburn refractory to proton pump inhibitor (PPI) therapy and when the diagnosis of GERD is in question, direct reflux testing by impedance-pH monitoring is warranted. Laparoscopic fundoplication is the standard surgical treatment for GERD. It is highly effective in curing GERD with a 80% success rate at 20-year follow-up. The Nissen fundoplication, consisting of a total (360°) wrap, is the most commonly performed antireflux operation. To reduce postoperative dysphagia and gas bloating, partial fundoplications are also used, including the posterior (Toupet) fundoplication, and the anterior (Dor) fundoplication. Currently, there is consensus to advise laparoscopic fundoplication in PPI-responsive GERD only for those patients who develop untoward side-effects or complications from PPI therapy. PPI resistance is the real challenge in GERD. There is consensus that carefully selected GERD patients refractory to PPI therapy are eligible for laparoscopic fundoplication, provided that objective evidence of reflux as the cause of ongoing symptoms has been obtained. For this purpose, impedance-pH monitoring is regarded as the diagnostic gold standard.

  18. [Analysis of anti-reflux surgery failure].

    PubMed

    Cano Novillo, I; Benavent Gordo, M I; Portela Casalod, E; Delgado Muñoz, M D; Aguado Roncero, P; Vilariño Mosquera, A; Berchi García, F J

    2000-01-01

    Recurrent gastroesophageal reflux following fundoplication is a challenging problem, because it is usually refractory to medical treatment and a second, technically difficult, antireflux operation is required. Different factors that may contribute to surgery failure have been identified in children. We present 8 cases who underwent redofundoplication after failed procedures, from a total number of 96 patients operated on due to gastroesophageal reflux. Four patient's had their initial fundoplication performed at our institution. Six patients were neurologically impaired, six had chronic pulmonary disease, and two had esophageal atresia. The main presenting symptoms were recurrent vomiting (n = 8) and aspiration (n = 4). Gastroesophageal reflux was confirmed by barium swallow and endoscopy. Operative findings showed wrap breakdown in two cases, warp breakdown associated with hiatal hernia in five, wrap breakdown associated with paraesophageal hernia in two cases, and paraesophageal hernia with normal wrap in one. A second Nissen procedure were performed in five cases, whereas a Collis-Nissen gastroplasty was realized in three with a short esophagus. Six patients had a successful outcome remaining symptom free, one has severe disphagia, and one has recurrent vomiting. In our experience, patients with recurrent gastroesophageal reflux disease should undergo an antireflux procedure tailored to specific anatomic or functional abnormalities.

  19. Reflux Laryngitis: Correlation between the Symptoms Findings and Indirect Laryngoscopy

    PubMed Central

    Silva, Carlos Eduardo Dilen da; Niedermeier, Bruno Taccola; Portinho, Fernando

    2015-01-01

    Introduction The indirect laryngoscopy has an important role in the characterization of reflux laryngitis. Although many findings are nonspecific, some strongly suggest that the inflammation is the cause of reflux. Objective The aim of this study was to evaluate the correlation between reflux symptoms and the findings of indirect laryngoscopy. Methods We evaluated 27 patients with symptoms of pharyngolaryngeal reflux disease. Results Laryngoscopy demonstrated in all patients the presence of hypertrophy of the posterior commissure and laryngeal edema. The most frequent symptoms were the presence of dry cough and foreign body sensation. Conclusion There was a correlation between the findings at laryngoscopy and symptoms of reflux. PMID:26157498

  20. Do endoscopic antireflux procedures fit in the current treatment paradigm of gastroesophageal reflux disease?

    PubMed

    Pandolfino, John E; Krishnan, Kumar

    2014-04-01

    Gastroesophageal reflux disease (GERD) is a common condition requiring considerable medical resources. The mainstay of therapy is proton pump inhibitors (PPIs), which are effective at reducing acid reflux. In patients who have refractory acid reflux and esophagitis despite high-dose PPI, or are intolerant of the side effects of PPI therapy, surgical fundoplication is the primary therapy. The risk and cost gap between medical therapy and surgery has resulted in substantial interest in less-invasive endoscopic therapies. In this review, we discuss the underlying physiology of GERD along with the anatomic hurdles that must be overcome to develop an effective antireflux procedure. We also review the current published literature and assess the clinical efficacy of the devices that have been studied or currently are being investigated. Despite promising early studies, many of the devices fall short in high-quality randomized controlled trials. Furthermore, the physiologic aberration resulting in GERD oftentimes is addressed inadequately. Although there is certainly a need for less-invasive, safe, and effective therapy for reflux, therapy will need to withstand the established clinical efficacy of both PPI and surgical fundoplication. At present, we have the luxury of time to wait for such a device to become available.

  1. Gastro-Esophageal Reflux Disease in Healthy Older Children and Adolescents

    PubMed Central

    Park, Kie Young

    2012-01-01

    Gastro-esophageal reflux disease (GERD) in otherwise healthy older children and adolescents is commonly encountered in pediatric clinics and poses a complex treatment problem involving changes of diets and lifestyle. After an initial history taking and a physical examination, typical symptoms of GERD in older children and adolescenct are initially treated with the trials of acid suppressants. With an increase of severe cases, more and more GERD children have been evaluated with endoscopy, which helps to delineate an erosive esophagitis from a non-erosive reflux disease as they are presumed to have different pathogenesis. For the pediatric patients without a significant underlying disease, a reflux esophagitis can be treated adequately with acid suppressants. Recently, the rapid increase of children who are taking anti-reflux medication has brought up a serious alarm among pediatricians. Some at risk pediatric patients with recurrent and/or chronic GERD have been linked to adulthood GERD. In this paper, pediatric GERD with and without erosive esophagitis was reviewed along with treatment options and issues specifically for the otherwise healthy older children and adolescents in the primary clinics or the secondary hospitals. PMID:24010091

  2. Talking about Teaching Episodes

    ERIC Educational Resources Information Center

    Nemirovsky, Ricardo; DiMattia, Cara; Ribeiro, Branca; Lara-Meloy, Teresa

    2005-01-01

    This paper examines two types of discourse in which teachers engage when discussing case studies based on classroom episodes, and the ways in which the availability of video data of these episodes may motivate a shift in the mode of discourse used. We interviewed two pairs of secondary school mathematics teachers after they had read a case study…

  3. [Prolonged esophageal pH monitoring utilization in the diagnosis of pathologic reflux in neonates

    PubMed

    Mezzacappa, M A; Collares, E F

    1999-01-01

    OBJECTIVES: To present indications and results of prolonged esophageal pH monitoring in diagnosing pathologic gastroesophageal reflux in newborns during their stay in the neonatal unit. METHODS: This retrospective descriptive-analytical study of 85 prolonged esophageal pH monitoring in neonates was performed, between October 1995 and March 1998, in a tertiary intensive care unity. A Digitrapper MKIII device, pH probes with one or two channels, and antimony electrodes were utilized. The probe was placed 3 cm above the gastroesophageal junction. RESULTS: The main indications of this esophageal pH study were hypoxemia episodes demanding supplemental oxygen, and caffeine resistant apnea. The means -/+ SD of birth-weight and gestational age in the patients evaluated were, respectively, 1,204-/+460 g and 30.5 -/+ 2.9 weeks. There was no statistical difference observed in newborns with and without pathologic gastroesophageal reflux according to clinical manifestations and monitoring conditions. Forty-eight newborns (56.4%) presented 17.6-/+9.1% of the whole examination time with a pH below 4. Of these patients, 31.1% presented birth-weight below 1,000 g. Duodenogastroesophagic was diagnosed in two cases. Of the studied premature with chronic lung disease, 66.7% presented pathologic reflux. CONCLUSION: Prolonged pH esophageal monitoring is helpful in the differential diagnosis of the unspecific and very frequent clinic manifestations in very low birth-weight infants.

  4. Different risk factors between reflux symptoms and mucosal injury in gastroesophageal reflux disease.

    PubMed

    Li, Chung-Hsien; Hsieh, Tsung-Cheng; Hsiao, Tsung-Hsien; Wang, Pin-Chao; Tseng, Tai-Chung; Lin, Hans Hsienhong; Wang, Chia-Chi

    2015-06-01

    Gastroesophageal reflux disease (GERD) is diagnosed based on typical symptoms in clinical practice. It can be divided into two groups using endoscopy: erosive and nonerosive reflux disease (NERD). This study aims to determine the risk factors of reflux symptoms and mucosal injury. This was a two-step case-control study derived from a cohort of 998 individuals having the data of reflux disease questionnaire (RDQ) and endoscopic findings. Those with minor reflux symptoms were excluded. The first step compared symptomatic GERD patients with healthy controls. The 2(nd) step compared patients with erosive esophagitis with healthy controls. In this study, the prevalence of symptomatic GERD and erosive esophagitis were 163 (16.3%) and 166 (16.6%), respectively. A total of 507 asymptomatic individuals without mucosal injury of the esophagus on endoscopy were selected as healthy controls. Compared with healthy controls, multivariate analyses showed that symptomatic GERD patients had a higher prevalence of hypertriglyceridemia [odds ratio (OR), 1.83; 95% confidence interval (CI) 1.13-2.96] and obesity (OR, 1.85; 95% CI 1.08-3.02). By contrast, male sex (OR, 2.24; 95% CI 1.42-3.52), positive Campylo-like organism (CLO) test (OR, 0.56; 95% CI 0.37-0.84), and hiatus hernia (OR, 14.36; 95% CI 3.05-67.6) were associated with erosive esophagitis. In conclusion, obesity and hypertriglyceridemia were associated with reflux symptoms. By contrast, male sex, negative infection of Helicobacter pylori, and hiatus hernia were associated with mucosal injury. Our results suggested that risk factors of reflux symptoms or mucosal injury might be different in GERD patients. The underlying mechanism awaits further studies to clarify.

  5. Dilated intercellular spaces and chronic cough as an extra-oesophageal manifestation of gastrooesophageal reflux disease.

    PubMed

    Orlando, Roy C

    2011-06-01

    Chronic cough is one of the extra-oesophageal manifestations of gastrooesophageal reflux disease (GORD). It is presumed to occur either directly by microaspiration of acidic gastric contents into the airway or indirectly by a reflex triggered by contact of acidic refluxates with the oesophageal epithelium in GORD. How contact of the oesophageal epithelium with acidic refluxates promotes sensitization for chronic cough is unknown, but like heartburn, which is a necessary accompaniment, it requires acid activation of nociceptors within the oesophageal mucosa. Dilated intercellular spaces within the oesophageal epithelium, a reflection of an increase in paracellular permeability, is a histopathologic feature of both erosive and non-erosive forms of GORD. Since it correlates with the symptom of heartburn, it is hypothesized herein that the increase in paracellular permeability to acid reflected by dilated intercellular spaces in oesophageal epithelium also serves as mediator of the signals that produce the reflex-induced sensitization for cough--a sensitization that can occur centrally within the medullary Nucleus Tractus Solitarius or peripherally within the tracheobronchial tree.

  6. Gastroesophageal Reflux Disease and Sleeve Gastrectomy.

    PubMed

    Melissas, John; Braghetto, Italo; Molina, Juan Carlos; Silecchia, Gianfranco; Iossa, Angelo; Iannelli, Antonio; Foletto, Mirto

    2015-12-01

    Gastroesophageal reflux disease (GERD) and/or hiatus hernia (HH) are one of the most common disorders of the upper gastrointestinal tract. Despite the positive effect of sleeve gastrectomy (SG) regarding weight loss and improvement in obesity co-morbidities, there are concerns about the development of de novo gastroesophageal reflux disease or worsening the existing GERD after this bariatric operation. Furthermore, controversy exists on the consequences of SG in lower esophageal sphincter function and about the ideal procedure when a hiatus hernia is preoperatively diagnosed or discovered during the laparoscopic SG. This review systematically investigates the incidence, the pathophysiology of GERD and/or HH in morbidly obese individuals before and after SG, and the treatment options for concomitant HH repair during laparoscopic sleeve gastrectomy.

  7. Genetic Variations in Vesicoureteral Reflux Sequelae

    PubMed Central

    Hains, David S.; Schwaderer, Andrew L.

    2016-01-01

    Urinary tract infections (UTI) are a common condition in children. Vesicoureteral reflux (VUR) represents a common associated condition with childhood UTI. UTI susceptibility appears to have a genetic component based on family and UTI cohort studies. Targeted analysis of innate immune system genetic variations indicate that these variations are important in UTI susceptibility. In this overview, we discuss how current cohorts and genetic strategies can be implemented to discover new susceptibility loci in patients with UTI. PMID:26848692

  8. [Gastritis associated with duodeno-gastric reflux].

    PubMed

    Diarra, M; Konate, A; Traore, C B; Drabo, M; Soukho, A espouse Diarra; Kalle, A; Dembele, M; Traore, H A; Maiga, M Y

    2007-01-01

    Our main objective was to study gastritis associated to duodeno-gastric reflux. It is about a longitudinal study case/witness, paired according to the sex and the age. It was unrolled from February 2005 to January 2006 in the digestive diseases department of the hospital Gabriél Touré, and endoscopic centers of Promenade des Angevins, and clinique Farako. The patients profited from an upper digestive endoscopy to appreciate endoscopic aspect of gastritis associated to bile in the stomach mucus lake. The gastric biopsies were systematic. This study included 50 patients having gastritis associated to bile in gastric mucus lake compared to 50 patients having gastritis associated to clearly gastric mucus lake. The sex-ratio was 1.26 in favour of men. The average age of the patients was of 41.30 +/- 15.43 years. On the symptomatic hand, fetid breath was significantly met in duodeno-gastric reflux (p = 0.013). Potash consumption in the "tô" (millet cake) was significantly reported in gastritis associated to bile in gastric mucus lake (p = 0.042). The endoscopic aspects were comparable. Histological aspects of nonatrophic chronic gastritis were significantly mint in witnesses as well into the antrum as into the fundus (p = 0.0001 and p = 0.00023). The reactional gastritis aspect was the prerogative of duodenogastric reflux (p ranging between 10(-6) and 3.10 (-6). Helicobacter pylori infection was found comparable in the two groups (p = 0.297). Dysplasia although rare was found only in gastritis associated to duodeno-gastric reflux. Gastritis associated to bile in gastric mucus does not se,nm to have specific clinical, endoscopic and histological presentation. However the presence of dysplasia must have an attentive monitoring.

  9. GPR84 and TREM-1 Signaling Contribute to the Pathogenesis of Reflux Esophagitis

    PubMed Central

    Abdel-Aziz, Heba; Schneider, Mathias; Neuhuber, Winfried; Kassem, Abdel Meguid; Khailah, Saleem; Müller, Jürgen; Eldeen, Hadeel Gamal; Khairy, Ahmed; Khayyal, Mohamed T; Shcherbakova, Anastasiia; Efferth, Thomas; Ulrich-Merzenich, Gudrun

    2015-01-01

    Gastro-esophageal reflux disease (GERD) is one of the most common disorders in gastroenterology. Patients present with or without increased acid exposure indicating a nonuniform etiology. Thus, the common treatment with proton pump inhibitors (PPIs) fails to control symptoms in up to 40% of patients. To further elucidate the pathophysiology of the condition and explore new treatment targets, transcriptomics, proteomics and histological methods were applied to a surgically induced subchronic reflux esophagitis model in Wistar rats after treatment with either omeprazole (PPI) or STW5, a herbal preparation shown to ameliorate esophagitis without affecting refluxate pH. The normal human esophageal squamous cell line HET-1A and human endoscopic biopsies were used to confirm our findings to the G-protein–coupled receptor (GPR) 84 in human tissue. Both treatments reduced reflux-induced macroscopic and microscopic lesions of the esophagi as well as known proinflammatory cytokines. Proteomic and transcriptomic analyses identified CINC1–3, MIP-1/3α, MIG, RANTES and interleukin (IL)-1β as prominent mediators in GERD. Most regulated cyto-/chemokines are linked to the TREM-1 signaling pathway. The fatty acid receptor GPR84 was upregulated in esophagitis but significantly decreased in treated groups, a finding supported by Western blot and immunohistochemistry in both rat tissue and HET-1A cells. GPR84 was also found to be significantly upregulated in patients with grade B reflux esophagitis. The expression of GPR84 in esophageal tissue and its potential involvement in GERD are reported for the first time. IL-8 (CINC1–3) and the TREM-1 signaling pathway are proposed, besides GPR84, to play an important role in the pathogenesis of GERD.org PMID:26650186

  10. Relationship between Depression and Laryngopharyngeal Reflux

    PubMed Central

    Joo, Young-Hoon; Song, Youn-Su

    2017-01-01

    This study investigated the relationship between depression, somatization, anxiety, personality, and laryngopharyngeal reflux (LPR). We prospectively analyzed 231 patients with symptoms with LPR using the laryngopharyngeal reflux symptom index and the reflux finding score. Seventy nine (34.2%) patients were diagnosed with LPR. A significant correlation was detected between the presence of LPR and total scores on the Patient Health Questionnaire-9 (5.6±5.3 vs. 4.0±4.6, p=0.017) and the 7-item Generalized Anxiety Disorder Scale (4.3±4.9 vs. 3.0±4.5, p=0.041). LPR was significantly more frequent in those with depression than in those without (45.6% vs. 27.0%, p=0.004). A multivariate analysis confirmed a significant association between the presence of LPR and depression (odds ratio, 1.068; 95% confidence interval, 1.011–1.128; p=0.019). Our preliminary results suggest that patients with LPR may need to be carefully evaluated for depression. PMID:28326123

  11. Saliva transit in patients with gastroesophageal reflux disease.

    PubMed

    Cassiani, R A; Mota, G A; Aprile, L R O; Dantas, R O

    2015-10-01

    Saliva is an important factor in the neutralization of the acidity of the refluxed material that comes from the stomach to the esophagus. The impairment of saliva transit from oral cavity to distal esophagus may be one of the causes of esophagitis and symptoms in gastroesophageal reflux disease (GERD). With the scintigraphic method, the transit of 2 mL of artificial saliva was measured in 30 patients with GERD and 26 controls. The patients with GERD had symptoms of heartburn and acid regurgitation, a 24-hour pH monitoring with more than 4.2% of the time with pH below four, 26 with erosive esophagitis, and four with non-erosive reflux disease. Fourteen had mild dysphagia for solid foods. Twenty-one patients had normal esophageal manometry, and nine had ineffective esophageal motility. They were 15 men and 15 women, aged 21-61 years, mean 39 years. The control group had 14 men and 12 women, aged 19-61 years, mean 35 years. The subjects swallowed in the sitting and supine position 2 mL of artificial saliva labeled with 18 MBq of (99m) Technetium phytate. The time of saliva transit was measured from oral cavity to esophageal-gastric transition, from proximal esophagus to esophageal-gastric transition, and the transit through proximal, middle, and distal esophageal body. There was no difference between patients and controls in the time for saliva to go from oral cavity to esophageal-gastric transition, and from proximal esophagus to esophageal-gastric transition, in the sitting and supine positions. In distal esophagus in the sitting position, the saliva transit duration was shorter in patients with GERD (3.0 ± 0.8 seconds) than in controls (7.6 ± 1.7 seconds, P = 0.03). In conclusion, the saliva transit from oral cavity to the esophageal-gastric transition in patients with GERD has the same duration than in controls. Saliva transit through the distal esophageal body is faster in patients with GERD than controls.

  12. Endoscopic treatment of vesicoureteral reflux in pediatric patients

    PubMed Central

    Kim, Jong Wook

    2013-01-01

    Endoscopic treatment is a minimally invasive treatment for managing patients with vesicoureteral reflux (VUR). Although several bulking agents have been used for endoscopic treatment, dextranomer/hyaluronic acid is the only bulking agent currently approved by the U.S. Food and Drug Administration for treating VUR. Endoscopic treatment of VUR has gained great popularity owing to several obvious benefits, including short operative time, short hospital stay, minimal invasiveness, high efficacy, low complication rate, and reduced cost. Initially, the success rates of endoscopic treatment have been lower than that of open antireflux surgery. However, because injection techniques have been developed, a recent study showed higher success rates of endoscopic treatment than open surgery in the treatment of patients with intermediate- and high-grade VUR. Despite the controversy surrounding its effectiveness, endoscopic treatment is considered a valuable treatment option and viable alternative to long-term antibiotic prophylaxis. PMID:23646052

  13. Gastroesophageal reflux disease in Asia: A historical perspective and present challenges.

    PubMed

    Goh, Khean-Lee

    2011-01-01

    Gastroesophageal reflux disease (GERD), previously uncommon in Asia, has now become an important disease in the region. Although much variability exists between studies, most endoscopy-based studies show a prevalence of erosive esophagitis of more than 10%. Symptom-based studies also show a prevalence of 6-10%. Two longitudinal follow-up studies on GERD symptoms have shown an increase with time, and several endoscopy-based time trend studies have also shown a significant increase in erosive reflux esophagitis. Studies on Barrett's esophagus have been confounded by the description of short (SSBE) and long segment (LSBE) Barrett's esophagus. Great variation in prevalence rates has been reported. SSBE vary from 0.1% to more than 20% while LSBE vary from 1-2%. Of the putative causative factors, obesity has been the most important. Many studies have linked GERD-esophagitis as well as occurrence of reflux symptoms with an increase in body mass index (BMI), obesity, especially visceral or central obesity, and metabolic syndrome. A decline in Helicobacter pylori infection with growing affluence in Asia has been broadly thought to result in healthier stomachs and a higher gastric acid output resulting in reflux disease. However, variable results have been obtained from association and H. pylori eradication studies.

  14. Gastroesophageal reflux disease vs. Panayiotopoulos syndrome: an underestimated misdiagnosis in pediatric age?

    PubMed

    Parisi, Pasquale; Pacchiarotti, Claudia; Ferretti, Alessandro; Bianchi, Simona; Paolino, Maria Chiara; Barreto, Mario; Principessa, Luigi; Villa, Maria Pia

    2014-12-01

    Autonomic signs and symptoms could be of epileptic or nonepileptic origin, and the differential diagnosis depends on a number of factors which include the nature of the autonomic manifestations themselves, the occurrence of other nonictal autonomic signs/symptoms, and the age of the patient. Here, we describe twelve children (aged from ten months to six years at the onset of the symptoms) with Panayiotopoulos syndrome misdiagnosed as gastroesophageal reflux disease. Gastroesophageal reflux disease and Panayiotopoulos syndrome may represent an underestimated diagnostic challenge. When the signs/symptoms occur mainly during sleep, a sleep EEG or, if available, a polysomnographic evaluation may be the most useful investigation to make a differential diagnosis between autonomic epileptic and nonepileptic disorders. An early detection can reduce both the high morbidity related to mismanagement and the high costs to the national health service related to the incorrect diagnostic and therapeutic approaches. To decide if antiseizure therapy is required, one should take into account both the frequency and severity of epileptic seizures and the tendency to have potentially lethal autonomic cardiorespiratory involvement. In conclusion, we would emphasize the need to make a differential diagnosis between gastroesophageal reflux disease and Panayiotopoulos syndrome in patients with "an unusual" late-onset picture of GERD and acid therapy-resistant gastroesophageal reflux, especially if associated with other autonomic symptoms and signs.

  15. Ambulatory oesophageal bile reflux monitoring in Barrett's oesophagus.

    PubMed

    Caldwell, M T; Lawlor, P; Byrne, P J; Walsh, T N; Hennessy, T P

    1995-05-01

    Bile reflux has been implicated in the pathogenesis of Barrett's oesophagus but evaluation remains difficult. Bilitec 2000 is an ambulatory system that detects bilirubin based on its spectrophotometric properties. Oesophageal bile exposure was evaluated in three groups of patients. Group 1 (n = 11) were normal controls, group 2 (n = 13) were patients with uncomplicated gastro-oesophageal reflux and group 3 (n = 12) were patients with Barrett's oesophagus. Bile reflux was greater in patients with Barrett's mucosa than in controls or those with uncomplicated reflux. This difference was seen in the supine and interdigestive periods. The percentage of time at which gastric pH was greater than 4 and oesophageal pH was above 7 did not differ between the groups. Bilitec 2000 detects greater bile reflux in patients with Barrett's oesophagus. No corresponding gastric or oesophageal alkaline shift is found. This ambulatory bile reflux monitoring system may be a useful tool in clinical practice.

  16. Comparison between the Reflux Finding Score and the Reflux Symptom Index in the Practice of Otorhinolaryngology

    PubMed Central

    Nunes, Heloisa Sobreira; Pinto, José Antonio; Zavanela, Adma Roberta; Cavallini, André Freitas; Freitas, Gabriel Santos; Garcia, Fabiola Esteves

    2016-01-01

    Introduction  The Gastroesophageal Reflux Disease has a prevalence of ∼12% of the urban population in Brazil. Koufman proposed the term to designate Laryngeal Pharyngeal Reflux (LPR) symptoms, signs or tissue damage resulting from aggression of the gastrointestinal contents in the upper aerodigestive tract. Belafsky et al proposed a score that points to inflammatory laryngeal signs through videolaryngoscopic findings, the Reflux Finding Score (RFS). Moreover, in 2002, they published the Reflux Symptom Index (RSI). Objective  The objective of this study is to provide a comparison between the Reflux Finding Score and the Reflux Symptom Index in the practice of Otorhinolaryngology. Methods  Our study involved a total of 135 patients who visited the Ear, Nose, and Throat (ENT) clinic Núcleo de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço de São Paulo between April 2014 and May 2015 with suspected LPR. We excluded nine patients and the study group was 126 patients. All patients were ranked by their RSI and RFS scores. Results  The study group consisted of 126 patients (88 women and 38 men). Their main complaints were cough (40.4%), globus (21.4%), dysphonia (19.8%), throat clearing (15.8%), postnasal drip (3.17%), snoring (1.5%), dysphagia (1.5%), cacosmia (0.7%), and regurgitation (1.5%). The RSI ranges from 13 to 42 with a mean of 20.7 (SD = 6.67). The RFS ranged from 3 to 19 with a mean of 9.53 (SD = 2.64). Conclusion  The RSI and RFS can easily be included in ENT routines as objective parameters, with low cost and high practicality. Based on the clinical index, the specialist can evaluate the need for further tests. PMID:27413402

  17. First Episode Psychosis

    MedlinePlus

    ... About Psychosis Treatment Share Fact Sheet: First Episode Psychosis Download PDF Download ePub Order a free hardcopy En Español Facts About Psychosis The word psychosis is used to describe conditions ...

  18. Surgery for Gastroesophageal Reflux Disease in the Morbidly Obese Patient.

    PubMed

    Duke, Meredith C; Farrell, Timothy M

    2017-01-01

    The prevalence of gastroesophageal reflux disease (GERD) has mirrored the increase in obesity, and GERD is now recognized as an obesity-related comorbidity. There is growing evidence that obesity, specifically central obesity, is associated with the complications of chronic reflux, including erosive esophagitis, Barrett's esophagus, and esophageal adenocarcinoma. While fundoplication is effective in creating a competent gastroesophageal junction and controlling reflux in most patients, it is less effective in morbidly obese patients. In these patients a bariatric operation has the ability to correct both the obesity and the abnormal reflux. The Roux-en-Y gastric bypass is the preferred procedure.

  19. The Effect of Zinc Supplementationon the Symptoms of Gastroesophageal Reflux Disease; a Randomized Clinical Trial

    PubMed Central

    Shafaghi, Afshin; Hasanzadeh, Jalal; Mansour-Ghanaei, Fariborz; Joukar, Farahnaz; Yaseri, Maryam

    2016-01-01

    BACKGROUND Currently, it has been demonstrated that gastroesophageal reflux disease (GERD) is one of the most important disorders of the digestive system and the commixture of regular diet has a significant influence on its incidence, symptoms, and prognosis. The purpose of this study was to evaluate the effect of zinc supplementation, in combination with PPIs(Proton pump inhibitors), on the improvement of GERD symptoms. METHODS In a randomized double blind clinical trial, patients with reflux symptoms, who had obtained Reflux Disease Questionnaire (RDQ) score more than 8, were included and all the demographic features were recorded. Then, using upper gastrointestinal (GI) endoscopy, all the patients were divided into two groups as having non-erosive reflux disorder (NERD),or erosive reflux disorder (ERD). At the next step, based on random block statistical method, we divided the two groups into two subgroups; the drug subgroup [treated with PPIs (40 mg pantoprazole/daily), changing life style, and 220 mgzinc capsules daily] and the placebo subgroup [treated with PPIs, changing life style, and placebo]. After 3 months, we analyzed all data and the RDQ questionnaire was filled out for each patient. This project has been registered in Iranian Registry of Clinical Trials (IRCT) and all data were analyzed using SPSS software version 2. RESULTS A total of 140 patients (81 women and 59 men) with mean age of 42.78±11.5 years were included with 70 patients in each group. The most frequent presentations were heart burn (45.7%), and acid regurgitation (39.3%). The RDQ scores decreased after intervention in both drug (p<0.001) and placebo groups (p<0.001), which were statistically significant. But the difference of RDQ scores between the drug group and placebo group was not statistically significant (p=0.086). CONCLUSION Zinc supplementation cannot improve the severity of GERD. PMID:27957292

  20. Detection of okadaic acid and related esters in mussels during diarrhetic shellfish poisoning (DSP) episodes in Greece using the mouse bioassay, the PP2A inhibition assay and HPLC with fluorimetric detection.

    PubMed

    Prassopoulou, Eleanna; Katikou, Panagiota; Georgantelis, Dimitrios; Kyritsakis, Apostolos

    2009-02-01

    An approach involving chemical, functional and biological techniques was taken for the detection and quantification of the marine toxin okadaic acid (OA) in mussels from Thermaikos and Saronikos Gulfs, Greece, during DSP episodes that occurred in 2006-2007. Samples were analyzed using the mouse bioassay, high performance liquid chromatography with fluorimetric detection (HPLC-FLD), using l-bromoacetylpyrene (BAP), as a precolumn derivatisation reagent, and the protein phosphatase 2A inhibition assay (PP2AIA) using a commercially available kit. Okadaic acid (OA) and its polar and non-polar esters were detected and quantified by HPLC-FLD, after hydrolysis of the samples during preparation. The detection limit of the HPLC method for OA was 5.86 microg OA/kg, which permits this method to be used for the regulatory control of these toxins in shellfish. Comparison of the results by all three methods revealed excellent consistency.

  1. Extra-esophageal manifestations of gastroesophageal reflux disease: diagnosis and treatment.

    PubMed

    Hom, Christopher; Vaezi, Michael F

    2013-08-01

    Gastroesophageal reflux disease (GERD) is a common disease that is often diagnosed based on typical symptoms of heartburn and regurgitation. In addition to these more classic manifestations, GERD is increasingly associated with extra-esophageal symptoms, including chronic cough, asthma, laryngitis, and dental erosions. Due to the poor sensitivity of endoscopy and pH monitoring, and the poor specificity of laryngoscopy, empiric therapy with proton pump inhibitors (PPIs) is now considered the initial diagnostic step in patients suspected of having GERD-related symptoms. For those who improve with PPIs, GERD is the presumed etiology, but for those who remain unresponsive to such therapy, further diagnostic testing with impedance/pH monitoring may be necessary in order to exclude refractory acid or weakly acid reflux. In those with normal test results despite PPI therapy and continued symptoms, causes other than GERD may be pursued. Recent data suggest that in patients with extra-esophageal symptoms, objective findings of moderate-sized hiatal hernia and moderate reflux on pH testing may predict response to acid suppressive therapy. PPI-unresponsive patients usually have causes other than GERD for their extra-esophageal symptoms and continued PPI therapy in this group is not recommended.

  2. An analysis of 342 patients with refractory gastroesophageal reflux disease symptoms using questionnaires, high-resolution manometry, and impedance-pH monitoring

    PubMed Central

    Wang, Fei; Li, Ping; Ji, Guo-Zhong; Miao, Lin; Fan, Zhining; You, Sihong; Pan, Xueqin; Chen, Xia

    2017-01-01

    Abstract Symptoms of refractory gastroesophageal reflux disease (GERD) are commonly encountered in clinical practice. The aim of this study was to analyze the data obtained from questionnaires, high-resolution manometry (HRM), and ambulatory impedance-pH monitoring in patients with persisting GERD symptoms and to explore the possible underlying causes for this clinical presentation. After completing the questionnaires, the selected patients underwent endoscopy, HRM, and ambulatory impedance-pH monitoring. Based on the results of these investigations, we divided the patients into 4 groups: reflux esophagitis (RE), hypersensitive esophagus (HE), functional heartburn (FH), and nonerosive gastroesophageal reflux disease (NERD). The data from 342 patients were analyzed. One hundred twenty-nine (37.72%) patients experienced refractory GERD symptoms related to acid reflux. The scores on some scales in the Gastrointestinal Symptom Rating Scale (GSRS) questionnaire differed significantly among groups (all P < 0.05). Liquid reflux occurred more frequently in patients with GERD (RE and NERD), while gas reflux was more common in non-GERD patients (FH and HE; all P < 0.05). The RE and NERD groups showed more percent bolus exposure time (BET) when upright (all P < 0.05). Acid exposure time (AET) in the RE and NERD groups was longer than that in the HE and FH groups (all P < 0.05). Fewer than half of the patient symptoms were related to acid reflux. The GSRS questionnaire may be an optimal indicator for patients with refractory GERD symptoms. BET and AET are useful indices to distinguish GERD from other diseases. Gas reflux is probably related to persisting symptoms in FH and HE patients. PMID:28151867

  3. Evaluation of Helicobacter pylori in reflux oesophagitis and Barrett's oesophagus.

    PubMed Central

    Newton, M; Bryan, R; Burnham, W R; Kamm, M A

    1997-01-01

    BACKGROUND: One of the major pathophysiological abnormalities in patients with gastro-oesophageal reflux disease is thought to involve transient lower oesophageal sphincter (LOS) relaxations. One component of the neural mechanism controlling the LOS appears to be a reflex are whose afferent limb originates in the gastric fundus. As inflammation is known to be associated with neural activation an investigation was made to determine whether gastric infection with H pylori is altered in prevalence or distribution in patients with reflux disease. METHODS: Five groups of subjects referred for endoscopy-group 1: 25 controls (asymptomatic individuals with anaemia and normal endoscopy); group 2: 36 subjects with erosive oesophagitis alone (Savary-Millar grades I-III); group 3: 16 subjects with duodenal ulcer alone; group 4: 15 subjects with oesophagitis with duodenal ulcer; group 5: 16 subjects with Barrett's oesophagus. No patients were receiving acid suppressants or antibiotics. An antral biopsy specimen was taken for a rapid urease test, and two biopsy specimens were taken from the antrum, fundus, and oesophagus (inflamed and non-inflamed) for histological evidence of inflammation and presence of H pylori using a Giemsa stain. RESULTS: Nine (36%) controls had H pylori. Patients with duodenal ulcer alone had a significantly higher incidence of colonisation by H pylori than other groups (duodenal ulcer 15 (94%); oesophagitis 13 (36%); oesophagitis+duodenal ulcer 6 (40%); Barrett's oesophagus 4 (25%)). H pylori was not more common in oesophagitis. When H pylori colonised the gastric antrum it was usually found in the gastric fundus. There was no difference in anatomical distribution of H pylori in the different patient groups. In Barrett's oesophagus H pylori was found in two of 16 in the metaplastic epithelium. CONCLUSION: H pylori is not more common and its distribution does not differ in those with oesophagitis compared with control subjects, and is therefore unlikely

  4. Vesicoureteral reflux: From prophylaxis to surgery

    PubMed Central

    Blais, Anne-Sophie; Bolduc, Stéphane; Moore, Katherine

    2017-01-01

    Vesicoureteral reflux (VUR) is one of the most common pathologies encountered in pediatric urology. Better understanding of the evolution of VUR and new endoscopic surgical techniques in the last decades have led to major changes in the management of this pathology. However, the treatment algorithm remains complex and is composed of a wide variety of options, from active surveillance to surgical treatment. Herein, we propose to review treatment options for VUR in order to help clinicians make the right treatment decision for the right patient. PMID:28265309

  5. Evaluation of the likelihood of reflux developing in patients with recurrent upper respiratory infections, recurrent sinusitis or recurrent otitis seen in ear-nose-throat outpatient clinics.

    PubMed

    Önal, Zerrin; Çullu-Çokuğraş, Fügen; Işıldak, Hüseyin; Kaytaz, Asım; Kutlu, Tufan; Erkan, Tülay; Doğusoy, Gülen

    2015-01-01

    Gastroesophageal reflux is considered a risk factor for recurrent or persistent upper and lower respiratory tract conditions including asthma, chronic cough, sinusitis, laryngitis, serous otitis and paroxysmal laryngospasm. Fifty-one subjects with recurrent (more than three) episodes of upper respiratory tract infection (URTI), serous otitis or sinusitis who had been admitted to an earnose- throat (ENT) outpatient clinic during the previous year were enrolled in the present study to evaluate the presence of laryngeal and/or esophageal reflux. The participants, who were randomly selected, were questioned about symptoms of reflux, including vomiting, abdominal pain, failure to thrive, halitosis, bitter taste in the mouth, chronic cough, heartburn, constipation and hoarseness. All subjects had an endoscopic examination, an otoscopic examination, a tympanogram and upper GI system endoscopy. Esophagitis was diagnosed endoscopically and histologically. The likelihood of occurrence of esophagitis was found to be higher only among subjects with postglottic edema/erythema as determined by pathological laryngeal examination. The reflux complaints reported did not predict the development of esophagitis, but the odds of esophagitis occurring were ninefold greater among subjects with recurrent otitis. Of the subjects, 45.1% were Helicobacter pylori-positive. However, no association was found between esophagitis and Helicobacter pylori positivity. The likelihood of the occurrence of esophagitis was found to be increased in the presence of recurrent otitis media and/or postglottic edema, irrespective of the presence of reflux symptoms. We concluded that, in contrast to the situation where adults are concerned, the boundaries for discriminating laryngopharyngeal reflux from gastroesophageal reflux are somewhat blurred in pediatric patients.

  6. Analytical Investigation of a Reflux Boiler

    NASA Technical Reports Server (NTRS)

    Simon, William E.; Young, Fred M.; Chambers, Terrence L.

    1996-01-01

    A thermal model of a single Ultralight Fabric Reflux Tube (UFRT) was constructed and tested against data for an array of such tubes tested in the NASA-JSC facility. Modifications to the single fin model were necessary to accommodate the change in radiation shape factors due to adjacent tubes. There was good agreement between the test data and data generated for the same cases by the thermal model. The thermal model was also used to generate single and linear array data for the lunar environment (the primary difference between the test and lunar data was due to lunar gravity). The model was also used to optimize the linear spacing of the reflux tubes in an array. The optimal spacing of the tubes was recommended to be about 5 tube diameters based on maximizing the heat transfer per unit mass. The model also showed that the thermal conductivity of the Nextel fabric was the major limitation to the heat transfer. This led to a suggestion that the feasibility of jacketing the Nextel fiber bundles with copper strands be investigated. This jacketing arrangement was estimated to be able to double the thermal conductivity of the fabric at a volume concentration of about 12-14%. Doubling the thermal conductivity of the fabric would double the amount of heat transferred at the same steam saturation temperature.

  7. Duodeno-gastric reflux and gastric adenomas: a scintigraphic study in patients with familial adenomatous polyposis.

    PubMed Central

    Spigelman, A D; Granowska, M; Phillips, R K

    1991-01-01

    To test whether the presence of gastric adenomas (dysplasia) was associated with gastric reflux of duodenal contents, six patients with familial adenomatous polyposis (FAP) who had gastric adenomas and nine matched FAP patients without gastric adenomas underwent scintigraphic duodeno-gastric reflux scanning. Reflux was graded 0-6, where 0 = no reflux, 1 = intermittent reflux into antrum only, 2 = prolonged reflux into antrum only, 3 = intermittent reflux into body, 4 = prolonged reflux into body, 5 = intermittent reflux into body and fundus, and 6 = prolonged reflux into body and fundus. FAP patients with gastric adenomas had more severe reflux (median 6, range 4-6) than did controls (median 3, range 0-6; P = 0.009, Mann-Whitney U test). These results are consistent with a role for bile in the development of gastric adenomatous polyps and suggest that bile is involved in the dysplasia-carcinoma sequence. PMID:1653358

  8. Low unesterified:esterified eicosapentaenoic acid (EPA) plasma concentration ratio is associated with bipolar disorder episodes, and omega-3 plasma concentrations are altered by treatment

    PubMed Central

    Saunders, Erika FH; Reider, Aubrey; Singh, Gagan; Gelenberg, Alan J; Rapoport, Stanley I

    2015-01-01

    Objectives Omega (n)-3 and n-6 polyunsaturated fatty acids (PUFA) are molecular modulators of neurotransmission and inflammation. We hypothesized that plasma concentrations of n-3 PUFA would be lower and of n-6 PUFA higher in subjects with bipolar disorder (BD) compared to healthy controls (HC), and would correlate with symptom severity in subjects with BD, and that effective treatment would correlate with increased n-3 but lower n-6 PUFA levels. Additionally, we explored clinical correlations and group differences in plasma levels of saturated and monounsaturated fatty acids. Methods This observational, parallel group study compared biomarkers between HC (n = 31), and symptomatic subjects with BD (n = 27) when ill and after symptomatic recovery (follow-up). Plasma concentrations of five PUFA [linoleic acid (LA), arachidonic acid (AA), alpha-linolenic acid (ALA), docosahexaenoic acid (DHA), and eicosapentaenoic acid (EPA)], of two saturated fatty acids (palmitic acid and stearic acid) and of two monounsaturated fatty acids (palmitoleic acid, oleic acid) were measured in esterified (E) and unesterified (UE) forms. Calculated ratios included UE:E for the five PUFA, ratios of n-3 PUFA (DHA:ALA, EPA:ALA, EPA:DHA), and the ratio of n-6:n-3 AA:EPA. Comparisons of plasma fatty acid levels and ratios between BD and HC groups were made with Student t-tests, between the BD group at baseline and follow-up using paired t-tests. Comparison of categorical variables was performed using Chi-square tests. Pearson’s r was used for bivariate correlations with clinical variables, including depressive and manic symptoms, current panic attacks, and psychosis. Results UE EPA was lower in BD than HC, with a large effect size (Cohen’s d = 0.86, p < 0.002), however, it was not statistically significant after correction for multiple comparisons. No statistically significant difference was seen in any plasma PUFA concentration between BD and HC after Bonferroni correction for 40

  9. Heartburn during sleep: a clinical marker of gastro-oesophageal reflux disease in morbidly obese patients.

    PubMed

    Fornari, F; Madalosso, C A S; Callegari-Jacques, S M; Gurski, R R

    2009-02-01

    Gastro-oesophageal reflux disease (GORD) and morbid obesity are entities with increasing prevalence. New clinical strategies are cornerstones for their management. The aim of this study was to assess the prevalence of heartburn during sleep (HDS) and whether this symptom predicts the presence of objective GORD parameters and increased heartburn perception in morbidly obese patients. Ninety-one consecutive morbidly obese patients underwent clinical evaluation, upper gastrointestinal endoscopy and oesophageal pH monitoring. HDS was characterized when patients replied positively to the question, 'Does heartburn wake you from sleep?'. A General Score for Heartburn (GSH) ranging between 0 and 5 was assessed with the question 'How bad is your heartburn?'. HDS was reported by 33 patients (36%). More patients with HDS had abnormal acid contact time or reflux oesophagitis than patients without HDS (94%vs 57%, P < 0.001). HDS had a positive predictive value of 94% (0.95 CI 82-98), sensitivity of 48% (0.95 CI 37-60%) and specificity of 93% (0.95 CI 77-98%) for detection of GORD. A higher proportion of patients with HDS perceived heartburn preceded by acid reflux in diurnal (39%vs 9%; P < 0.001) periods during pH-metry. HDS patients showed higher GSH (2.4 +/- 0.5 vs 1.7 +/- 0.4; P < 0.0001) compared with patients who denied HDS but reported diurnal heartburn. HDS occurs in a significant minority of patients with morbid obesity and has high positive predictive value for GORD. Symptomatic reflux during the sleep seems to be a marker of increased heartburn perception in this population.

  10. Alginate controls heartburn in patients with erosive and nonerosive reflux disease

    PubMed Central

    Savarino, Edoardo; de Bortoli, Nicola; Zentilin, Patrizia; Martinucci, Irene; Bruzzone, Luca; Furnari, Manuele; Marchi, Santino; Savarino, Vincenzo

    2012-01-01

    AIM: To evaluate the effect of a novel alginate-based compound, Faringel, in modifying reflux characteristics and controlling symptoms. METHODS: In this prospective, open-label study, 40 patients reporting heartburn and regurgitation with proven reflux disease (i.e., positive impedance-pH test/evidence of erosive esophagitis at upper endoscopy) underwent 2 h impedance-pH testing after eating a refluxogenic meal. They were studied for 1 h under basal conditions and 1 h after taking 10 mL Faringel. In both sessions, measurements were obtained in right lateral and supine decubitus positions. Patients also completed a validated questionnaire consisting of a 2-item 5-point (0-4) Likert scale and a 10-cm visual analogue scale (VAS) in order to evaluate the efficacy of Faringel in symptom relief. Tolerability of the treatment was assessed using a 6-point Likert scale ranging from very good (1) to very poor (6). RESULTS: Faringel decreased significantly (P < 0.001), in both the right lateral and supine decubitus positions, esophageal acid exposure time [median 10 (25th-75th percentil 6-16) vs 5.8 (4-10) and 16 (11-19) vs 7.5 (5-11), respectively] and acid refluxes [5 (3-8) vs 1 (1-1) and 6 (4-8) vs 2 (1-2), respectively], but increased significantly (P < 0.01) the number of nonacid reflux events compared with baseline [2 (1-3) vs 3 (2-5) and 3 (2-4) vs 6 (3-8), respectively]. Percentage of proximal migration decreased in both decubitus positions (60% vs 32% and 64% vs 35%, respectively; P < 0.001). Faringel was significantly effective in controlling heartburn, based on both the Likert scale [3.1 (range 1-4) vs 0.9 (0-2); P < 0.001] and VAS score [7.1 (3-9.8) vs 2 (0.1-4.8); P < 0.001], but it had less success against regurgitation, based on both the Likert scale [2.6 (1-4) vs 2.2 (1-4); P = not significant (NS)] and VAS score [5.6 (2-9.6) vs 3.9 (1-8.8); P = NS]. Overall, the tolerability of Faringel was very good 5 (2-6), with only two patients reporting modest adverse

  11. Gastroesophageal reflux disease and postlaryngectomy tracheoesophageal fistula.

    PubMed

    Cocuzza, Salvatore; Bonfiglio, Marco; Chiaramonte, Rita; Aprile, Giuseppe; Mistretta, Antonio; Grosso, Giuseppe; Serra, Agostino

    2012-05-01

    The objective of this study is to evaluate the incidence of pathologic gastroesophageal reflux in laryngectomized patient with phonatory prosthesis, analyzing potential related problems and appraising, at the same time, the effectiveness of a therapeutic protocol. A retrospective study was conducted on 43 phonatory prosthesis patients who had problems with regard to recurrent tracheoesophageal granulations, the need of frequent prosthesis replacement, within a 3-month period, and unsatisfactory vocal results. Such patients underwent physical examination of the fistula region and of the neopharynx and were submitted to esophagogastroduodenoscopy. Moreover the group of patients underwent a therapeutic protocol and were re-evaluated posttreatment, examining fistula region both on the tracheal side and on the esophageal side through videolaryngostroboscopy. Of the 43 recruited patients 13 (30%) presented tracheoesophageal granulations, 20 (46.5%) unsatisfactory vocal results and 10 (23.5%) frequent prosthesis replacement, within a 3-month period, due to abnormal biofilm development. In particular, of the 13 patients who had recurrent granulations, the evaluation results revealed the presence of gastroesophageal reflux disease (GERD) in 6 cases (46%). In the group of patients presenting unsatisfactory vocal results GERD was shown in 13 cases (65%). In the third group of patients GERD was found in two cases (20%). The overall analysis of the data gathered, allowed to identify GERD in 21 (49%) of the 43 patients submitted to the study. The results posttreatment indicated, in the first group, the disappearance or a significant (>75%) volume reduction of such formation in five cases (38%, p = 0.002). In the second group an overall improvement in the quality of voice was displayed at least for 12 patients (60%, p = 0.0001). Finally in the last group an increase of the prosthesis life was recorded in four (40%, p = 0.05) of the ten patients who had the need of prosthesis

  12. Reduced γ-Aminobutyric Acid and Glutamate+Glutamine Levels in Drug-Naïve Patients with First-Episode Schizophrenia but Not in Those at Ultrahigh Risk

    PubMed Central

    Tang, Yingying; Zhang, Tianhong; Cui, Huiru; Xu, Lihua; Zeng, Botao; Li, Yu; Li, Gaiying; Li, Chunbo; Liu, Hui; Zhang, Jianye

    2016-01-01

    Altered γ-aminobutyric acid (GABA), glutamate (Glu) levels, and an imbalance between GABAergic and glutamatergic neurotransmissions have been involved in the pathophysiology of schizophrenia. However, it remains unclear how these abnormalities impact the onset and course of psychosis. In the present study, 21 drug-naïve subjects at ultrahigh risk for psychosis (UHR), 16 drug-naïve patients with first-episode schizophrenia (FES), and 23 healthy controls (HC) were enrolled. In vivo GABA and glutamate+glutamine (Glx) levels in the medial prefrontal cortex were measured using proton magnetic resonance spectroscopy. Medial prefrontal GABA and Glx levels in FES patients were significantly lower than those in HC and UHR, respectively. GABA and Glx levels in UHR were comparable with those in HC. In each group, there was a positive correlation between GABA and Glx levels. Reduced medial prefrontal GABA and Glx levels thus may play an important role in the early stages of schizophrenia. PMID:28003912

  13. Similar symptom patterns in gastroesophageal reflux patients with and without hiatal hernia.

    PubMed

    Antoniou, S A; Koch, O O; Antoniou, G A; Asche, K U; Kaindlstorfer, A; Granderath, F A; Pointner, R

    2013-07-01

    Gastroesophageal reflux disease is a common clinical entity in Western societies. Its association with hiatal hernia has been well documented; however, the comparative clinical profile of patients in the presence or absence of hiatal hernia remains mostly unknown. The aim of the present study was to delineate and compare symptom, impedance, and manometric patterns of patients with and without hiatal hernia. A cumulative number of 120 patients with reflux disease were enrolled in the study. Quality of life score, demographic, symptom, manometric, and impedance data were prospectively collected. Data comparison was undertaken between patients with and without hiatal hernia. A P-value < 0.05 was considered statistically significant. Patients with hiatal hernia tended to be older than patients without hernia (52.3 vs. 48.6 years, P < 0.05), whereas quality of life scores were slightly better for the former (97.0 vs. 88.2, P= 0.005). Regurgitation occurred more frequently in patients without hiatal hernia (78.3% vs. 93.9%, P < 0.05). Otherwise, no differences were found with regard to esophageal and extraesophageal symptoms. However, lower esophageal sphincter pressures (7.7 vs. 10.0 mmHg, P= 0.007) and more frequent reflux episodes (upright, 170 vs. 134, P= 0.01; supine, 41 vs. 24, P < 0.03) were documented for patients with hiatal hernia on manometric and impedance studies. Distinct functional characteristics in patients with and without hiatal hernia may suggest a tailored therapeutic management for these diverse patient groups.

  14. Gastro-oesophageal reflux and gastrooesophageal reflux disease in infants and children.

    PubMed

    Falconer, Jackie

    2010-01-01

    Gastro-oesophageal reflux (GOR) is a norma physiological process occurring daily in healthy infants with similar frequency in both breast- and bottle-fed infants. It is generally considered uncomplicated and self-limiting, resolving spontaneously by 12-14 months of age. In contrast, gastro-oesophageal reflux disease (GORD) is associated with more severe symptoms and, on occasions, oesophagitis. In the small percentage of cases that do not respond to simple feeding measures, a trial for 2-4 weeks using an extensively hydrolysed formula may be considered. Thickeners and antiregurgitation feeds may help with the frequency of overt regurgitation. Feeding difficulties can be a problem in infants with reflux, with some suffering extreme aversion to texture. In the small percentage of infants who experience faltering growth, high-calorie formulae can be used. In those with severe feeding difficulties or severe faltering growth, tube feeding may be required. Infants should ideally be managed within a multidisciplinary team including a speech and language therapist, psychologist, dietitian and paediatrician.

  15. Usefulness of echocystography in the study of vesicoureteral reflux.

    PubMed

    Escape, I; Martínez, J; Bastart, F; Solduga, C; Sala, P

    2001-02-01

    The aim of our study was to assess the usefulness of contrast-enhanced sonography in detecting and staging vesicoureteral reflux in pediatric patients. Forty-nine children between birth and 5 years of age were studied for vesicoureteral reflux. Echocystography with the use of an endovesical signal enhancer was performed first, followed immediately by conventional voiding cystourethrography. The findings obtained by echocystography and voiding cystourethrography were consistent in 89 (90.8%) of 98 ureterorenal units (a ureterorenal unit is 1 kidney with its own ureter). Reflux was demonstrated by voiding cystourethrography in 13 cases; in 9 of these cases diagnosis had also been made by echocystography. Five cases of reflux detected by echocystography were not identified by voiding cystourethrography. With voiding cystourethrography as the standard of reference, sensitivity was 69%; specificity, 94%; positive predictive value, 64%; and negative predictive value, 95%. In conclusion, echocystography is a useful tool for the diagnosis of vesicoureteral reflux. Its ability to detect reflux is similar to that of cystography in cases of high-grade reflux, and it may be an appropriate complementary technique to voiding cystourethrography, because it avoids exposure to radiation.

  16. Laparoscopic revision surgery for gastroesophageal reflux disease

    PubMed Central

    Celasin, Haydar; Genc, Volkan; Celik, Suleyman Utku; Turkcapar, Ahmet Gökhan

    2017-01-01

    Abstract Laparoscopic antireflux surgery is a frequently performed procedure for the treatment of gastroesophageal reflux in surgical clinics. Reflux can recur in between 3% and 30% of patients on whom antireflux surgery has been performed, and so revision surgery can be required due to recurrent symptoms or dysphagia in approximately 3% to 6% of the patients. The objective of this study is to evaluate the mechanism of recurrences after antireflux surgery and to share our results after revision surgery in recurrent cases. From 2001 to 2014, revision surgery was performed on 43 patients (31 men, 12 women) between the ages of 24 and 70 years. The technical details of the first operation, recurrence symptoms, endoscopy, and manometry findings were evaluated. The findings of revision surgery, surgical techniques, morbidity rates, length of hospitalization, and follow-up period were also recorded and evaluated. The first operation was Nissen fundoplication in 34 patients and Toupet fundoplication in 9 patients. Mesh hiatoplasty was performed for enforcement in 18 (41.9%) of these patients. The period between the first operation and the revision surgery ranged from 4 days to 60 months. The most common finding was slipped fundoplication and presence of hiatal hernia during revision surgery. Revision fundoplication and hernia repair with mesh reinforcement were used in 33 patients. The other techniques were Collis gastroplasty, revision fundoplication, and hernia repair without mesh. The range of follow-up period was from 2 to 134 months. Recurrence occurred in 3 patients after revision surgery (6.9%). Although revision surgery is difficult and it has higher morbidity, it can be performed effectively and safely in experienced centers. PMID:28072725

  17. Episodes, events, and models

    PubMed Central

    Khemlani, Sangeet S.; Harrison, Anthony M.; Trafton, J. Gregory

    2015-01-01

    We describe a novel computational theory of how individuals segment perceptual information into representations of events. The theory is inspired by recent findings in the cognitive science and cognitive neuroscience of event segmentation. In line with recent theories, it holds that online event segmentation is automatic, and that event segmentation yields mental simulations of events. But it posits two novel principles as well: first, discrete episodic markers track perceptual and conceptual changes, and can be retrieved to construct event models. Second, the process of retrieving and reconstructing those episodic markers is constrained and prioritized. We describe a computational implementation of the theory, as well as a robotic extension of the theory that demonstrates the processes of online event segmentation and event model construction. The theory is the first unified computational account of event segmentation and temporal inference. We conclude by demonstrating now neuroimaging data can constrain and inspire the construction of process-level theories of human reasoning. PMID:26578934

  18. Perspectives on Episodic-Like and Episodic Memory

    PubMed Central

    Pause, Bettina M.; Zlomuzica, Armin; Kinugawa, Kiyoka; Mariani, Jean; Pietrowsky, Reinhard; Dere, Ekrem

    2013-01-01

    Episodic memory refers to the conscious recollection of a personal experience that contains information on what has happened and also where and when it happened. Recollection from episodic memory also implies a kind of first-person subjectivity that has been termed autonoetic consciousness. Episodic memory is extremely sensitive to cerebral aging and neurodegenerative diseases. In Alzheimer’s disease deficits in episodic memory function are among the first cognitive symptoms observed. Furthermore, impaired episodic memory function is also observed in a variety of other neuropsychiatric diseases including dissociative disorders, schizophrenia, and Parkinson disease. Unfortunately, it is quite difficult to induce and measure episodic memories in the laboratory and it is even more difficult to measure it in clinical populations. Presently, the tests used to assess episodic memory function do not comply with even down-sized definitions of episodic-like memory as a memory for what happened, where, and when. They also require sophisticated verbal competences and are difficult to apply to patient populations. In this review, we will summarize the progress made in defining behavioral criteria of episodic-like memory in animals (and humans) as well as the perspectives in developing novel tests of human episodic memory which can also account for phenomenological aspects of episodic memory such as autonoetic awareness. We will also define basic behavioral, procedural, and phenomenological criteria which might be helpful for the development of a valid and reliable clinical test of human episodic memory. PMID:23616754

  19. The Role of Episodic and Semantic Memory in Episodic Foresight

    ERIC Educational Resources Information Center

    Martin-Ordas, Gema; Atance, Cristina M.; Louw, Alyssa

    2012-01-01

    In this paper we describe a special form of future thinking, termed "episodic foresight" and its relation with episodic and semantic memory. We outline the methodologies that have largely been developed in the last five years to assess this capacity in young children and non-human animals. Drawing on Tulving's definition of episodic and semantic…

  20. Genetics Home Reference: episodic ataxia

    MedlinePlus

    ... Ebers GC. A genome-wide screen and linkage mapping for a large pedigree with episodic ataxia. Neurology. ... investigators. Primary episodic ataxias: diagnosis, pathogenesis and treatment. Brain. 2007 Oct;130(Pt 10):2484-93. Epub ...

  1. Persistent reflux symptoms cause anxiety, depression, and mental health and sleep disorders in gastroesophageal reflux disease patients

    PubMed Central

    Kimura, Yoshihide; Kamiya, Takeshi; Senoo, Kyouji; Tsuchida, Kenji; Hirano, Atsuyuki; Kojima, Hisayo; Yamashita, Hiroaki; Yamakawa, Yoshihiro; Nishigaki, Nobuhiro; Ozeki, Tomonori; Endo, Masatsugu; Nakanishi, Kazuhisa; Sando, Motoki; Inagaki, Yusuke; Shikano, Michiko; Mizoshita, Tsutomu; Kubota, Eiji; Tanida, Satoshi; Kataoka, Hiromi; Katsumi, Kohei; Joh, Takashi

    2016-01-01

    Some patients with gastroesophageal reflux disease experience persistent reflux symptoms despite proton pump inhibitor therapy. These symptoms reduce their health-related quality of life. Our aims were to evaluate the relationship between proton pump inhibitor efficacy and health-related quality of life and to evaluate predictive factors affecting treatment response in Japanese patients. Using the gastroesophageal reflux disease questionnaire, 145 gastroesophageal reflux disease patients undergoing proton pump inhibitor therapy were evaluated and classified as responders or partial-responders. Their health-related quality of life was then evaluated using the 8-item Short Form Health Survey, the Pittsburgh Sleep Quality Index, and the Hospital Anxiety and Depression Scale questionnaires. Sixty-nine patients (47.6%) were partial responders. These patients had significantly lower scores than responders in 5/8 subscales and in the mental health component summary of the 8-item Short Form Health Survey. Partial responders had significantly higher Pittsburgh Sleep Quality Index and Hospital Anxiety and Depression Scale scores, including anxiety and depression scores, than those of responders. Non-erosive reflux disease and double proton pump inhibitor doses were predictive factors of partial responders. Persistent reflux symptoms, despite proton pump inhibitor therapy, caused mental health disorders, sleep disorders, and psychological distress in Japanese gastroesophageal reflux disease patients. PMID:27499583

  2. Role of the Teflon deposit in the recurrence of vesicoureteral reflux.

    PubMed

    Oberritter, Zsolt; Somogyi, Reka; Juhasz, Zsolt; Pinter, Andrew B

    2008-05-01

    A relationship between the Teflon deposit, visible with ultrasound, and long-term success of subureteric Teflon injection (STING) treatment was investigated. The study included only those patients with primary vesicoureteral reflux (VUR), in whom the reflux had disappeared and the Teflon deposits were visible 6 weeks following STING treatment. Cessation of VUR was proven by voiding cysto-urethrography (VCUG) in 99 patients (143 ureters). Average follow-up time was 9 (4-12) years. Patients were divided into two groups: group I, deposits visible with ultrasound [deposit (+)], and group II, no visible deposits at the end of the follow-up period [deposit (-)]. Reflux recurrence, the occurrence of urinary tract infection (UTI), and pyelonephritis were investigated, and technetium scintigraphy scans were examined. The deposit (+) group included 43 patients (65 ureters), and the deposit (-) group contained 56 patients (78 ureters). In the deposit (+) group there were no recurrences of VUR; however, 17 recurrences were found in the deposit (-) group (P < 0.05). Dimercaptosuccinic acid (DMSA) scintigraphy scans and occurrence of UTI showed significant difference between the groups (P < 0.05). A close relationship was found between the disappearance of the Teflon deposit and the recurrence of VUR. Disappearance of the Teflon deposit and repeated bacteriuria is a warning sign of the recurrence of VUR; therefore, VCUG might be warranted for these patients.

  3. Neutronic analysis of the 1D and 1E banks reflux detection system

    SciTech Connect

    Blanchard, A.

    1999-12-21

    Two H Canyon neutron monitoring systems for early detection of postulated abnormal reflux conditions in the Second Uranium Cycle 1E and 1D Mixer-Settle Banks have been designed and built. Monte Carlo neutron transport simulations using the general purpose, general geometry, n-particle MCNP code have been performed to model expected response of the monitoring systems to varying conditions.The confirmatory studies documented herein conclude that the 1E and 1D neutron monitoring systems are able to achieve adequate neutron count rates for various neutron source and detector configurations, thereby eliminating excessive integration count time. Neutron count rate sensitivity studies are also performed. Conversely, the transport studies concluded that the neutron count rates are statistically insensitive to nitric acid content in the aqueous region and to the transition region length. These studies conclude that the 1E and 1D neutron monitoring systems are able to predict the postulated reflux conditions for all examined perturbations in the neutron source and detector configurations. In the cases examined, the relative change in the neutron count rates due to postulated transitions from normal {sup 235}U concentration levels to reflux levels remain satisfactory detectable.

  4. Proton pump inhibitor resistance, the real challenge in gastro-esophageal reflux disease.

    PubMed

    Cicala, Michele; Emerenziani, Sara; Guarino, Michele Pier Luca; Ribolsi, Mentore

    2013-10-21

    Gastro-esophageal reflux disease (GERD) is one of the most prevalent chronic diseases. Although proton pump inhibitors (PPIs) represent the mainstay of treatment both for healing erosive esophagitis and for symptom relief, several studies have shown that up to 40% of GERD patients reported either partial or complete lack of response of their symptoms to a standard PPI dose once daily. Several mechanisms have been proposed as involved in PPIs resistance, including ineffective control of gastric acid secretion, esophageal hypersensitivity, ultrastructural and functional changes in the esophageal epithelium. The diagnostic evaluation of a refractory GERD patients should include an accurate clinical evaluation, upper endoscopy, esophageal manometry and ambulatory pH-impedance monitoring, which allows to discriminate non-erosive reflux disease patients from those presenting esophageal hypersensitivity or functional heartburn. Treatment has been primarily based on doubling the PPI dose or switching to another PPI. Patients with proven disease, not responding to PPI twice daily, are eligible for anti-reflux surgery.

  5. In situ acidity and pH of size-fractionated aerosols during a recent smoke-haze episode in Southeast Asia.

    PubMed

    Behera, Sailesh N; Cheng, Jinping; Balasubramanian, Rajasekhar

    2015-10-01

    The characterization of aerosol acidity has received increased attention in recent years due to its influence on atmospheric visibility, climate change and human health. Distribution of water soluble inorganic (WSI) ions in 12 different size fractions of aerosols was investigated under two different atmospheric conditions (smoke-haze and non-haze periods) in 2012 using the Micro-Orifice Uniform Deposit Impactor (MOUDI) and nano-MOUDI for the first time in Singapore. To estimate the in situ acidity ([H(+)]Ins) and in situ aerosol pH (pHIS), the Aerosol Inorganic Model version-IV under deliquescent mode of airborne particles was used at prevailing ambient temperature and relative humidity. The study revealed an increase in the levels of airborne particulate matter (PM) mass and concentrations of WSI ions for all size fractions during the smoke-haze period, which was caused by the trans-boundary transport of biomass burning-impacted air masses from Indonesia. A bimodal distribution was observed for concentrations of SO4(2-), NO3(-), Cl(-), K(+) and Na(+), whereas concentrations of NH4(+), Ca(2+) and Mg(2+) showed a single mode distribution. The concentration of WSI ions in PM1.8 during the smoke-haze period increased by 3.8 (for SO4(2-)) to 10.5 (for K(+)) times more than those observed during the non-haze period. The pHIS were observed to be lower during the smoke-haze period than that during the non-haze period for all size fractions of PM, indicating that atmospheric aerosols were more acidic due to the influence of biomass burning emissions. The particles in the accumulation mode were more acidic than those in the coarse mode.

  6. Attentional Episodes in Visual Perception

    ERIC Educational Resources Information Center

    Wyble, Brad; Potter, Mary C.; Bowman, Howard; Nieuwenstein, Mark

    2011-01-01

    Is one's temporal perception of the world truly as seamless as it appears? This article presents a computationally motivated theory suggesting that visual attention samples information from temporal episodes (episodic simultaneous type/serial token model; Wyble, Bowman, & Nieuwenstein, 2009). Breaks between these episodes are punctuated by periods…

  7. Atrial fibrillation and gastroesophageal reflux disease: From the cardiologist perspective.

    PubMed

    Floria, Mariana; Drug, Vasile Liviu

    2015-03-14

    We have read with interest the paper by Roman C. and colleagues discussing the relationship between gastroesophageal reflux disease and atrial fibrillation. The review is presenting the available evidence for the common pathogenic mechanisms. However, from a cardiologist perspective, some available data were not highlighted in the review, cardiovascular involvement in gastroesophageal reflux is less assessed. Hypertension, obesity or diabetes mellitus are substrate for left atrial remodeling that initiate and sustained atrial fibrillation development. One of the pathophysiologic mechanisms in atrial fibrillation is the presence of a trigger. Gastroesophageal reflux could be only a trigger for this arrhythmia. We believe that atrial fibrillation should be considered as possible extraesophageal syndrome in the gastroesophageal reflux classification.

  8. Vesicoureteral reflux and urinary tract infections in renal transplant recipients.

    PubMed

    Hanevold, C D; Kaiser, B A; Palmer, J; Polinsky, M S; Baluarte, H J

    1987-09-01

    Fifty-six children who received kidney transplants were evaluated for postoperative vesicoureteral reflux and frequency of urinary tract infection. Two methods of ureteral implantation were compared: a nonantireflux extravesicular ureteroneocystostomy and an antireflux intravesicular ureteroneocystostomy. Reflux was found in 79% of children who had the nonantireflux procedure vs 19% of children who had the antireflux procedure. This disparity was present regardless of sex and age. Infections occurred at a rate of one per 11 patient-months after the nonantireflux procedure vs one per 40 patient-months after the antireflux procedure. Regardless of surgical technique, the incidence of infection was higher in children with reflux. The potentially harmful effect of infection with reflux warrants concern. Because of the need to maximize allograft function for a longer time period, an antireflux procedure is recommended in all pediatric kidney transplants.

  9. Prediction of transition from ultra-high risk to first-episode psychosis using a probabilistic model combining history, clinical assessment and fatty-acid biomarkers.

    PubMed

    Clark, S R; Baune, B T; Schubert, K O; Lavoie, S; Smesny, S; Rice, S M; Schäfer, M R; Benninger, F; Feucht, M; Klier, C M; McGorry, P D; Amminger, G P

    2016-09-20

    Current criteria identifying patients with ultra-high risk of psychosis (UHR) have low specificity, and less than one-third of UHR cases experience transition to psychosis within 3 years of initial assessment. We explored whether a Bayesian probabilistic multimodal model, combining baseline historical and clinical risk factors with biomarkers (oxidative stress, cell membrane fatty acids, resting quantitative electroencephalography (qEEG)), could improve this specificity. We analyzed data of a UHR cohort (n=40) with a 1-year transition rate of 28%. Positive and negative likelihood ratios were calculated for predictor variables with statistically significant receiver operating characteristic curves (ROCs), which excluded oxidative stress markers and qEEG parameters as significant predictors of transition. We clustered significant variables into historical (history of drug use), clinical (Positive and Negative Symptoms Scale positive, negative and general scores and Global Assessment of Function) and biomarker (total omega-3, nervonic acid) groups, and calculated the post-test probability of transition for each group and for group combinations using the odds ratio form of Bayes' rule. Combination of the three variable groups vastly improved the specificity of prediction (area under ROC=0.919, sensitivity=72.73%, specificity=96.43%). In this sample, our model identified over 70% of UHR patients who transitioned within 1 year, compared with 28% identified by standard UHR criteria. The model classified 77% of cases as very high or low risk (P>0.9, <0.1) based on history and clinical assessment, suggesting that a staged approach could be most efficient, reserving fatty-acid markers for 23% of cases remaining at intermediate probability following bedside interview.

  10. Design and testing of ultralite fabric reflux tubes

    SciTech Connect

    Pauley, K.A.; Antoniak, Z.I.; King, L.L.; Hollenberg, G.W.

    1993-01-01

    This paper describes the design, fabrication, and testing of Ultralite Fabric Reflux Tubes intended to provide thermal control for a Lunar Colony. The Ultralite Fabric Reflux Tubes, under this phase of development, are constructed of thin-walled copper liners overwrapped with aluminoborosilicate fabric. These devices were constructed and tested in air at the Pacific Northwest Laboratory and subsequently taken to the NASA Johnson Space Center for thermal vacuum experimentation.

  11. Is Gastroesophageal Reflux Disease and Achalasia Coincident or Not?

    PubMed Central

    Jung, Da Hyun; Park, Hyojin

    2017-01-01

    Achalasia and gastroesophageal reflux disease (GERD) are on opposite ends of the spectrum of lower esophageal sphincter dysfunction. Heartburn is the main symptom of GERD. However, heartburn and regurgitation are frequently observed in patients who have achalasia. The diagnosis of achalasia might be delayed because these symptoms are misinterpreted as gastroesophageal reflux. Here, we reviewed the clinical characteristics of patients with the erroneous diagnosis of GERD who actually had untreated achalasia. PMID:27771944

  12. Recurrent Episodes of Dissociative Fugue

    PubMed Central

    Angothu, Hareesh; Pabbathi, Lokeswar Reddy

    2016-01-01

    Dissociative fugue is rare entity to encounter with possible differentials of epilepsy and malingering. It is one of the dissociative disorders rarely seen in clinical practice more often because of the short lasting nature of this condition. This might also be because of organized travel of the individuals during the episodes and return to their families after the recovery from episodes. This is a case description of a patient who has experienced total three episodes of dissociative fugue. The patient has presented during the third episode and two prior episodes were diagnosed as fugue episodes retrospectively based on the history. Planned travel in this case by the patient to a distant location was prevented because of early diagnosis and constant vigilance till the recovery. As in this case, it may be more likely that persons with Dissociative fugue may develop similar episodes if they encounter exceptional perceived stress. However, such conclusions may require follow-up studies. PMID:27114633

  13. DIAGNOSIS AND MANAGEMENT OF GASTROESOPHAGEAL REFLUX DISEASE

    PubMed Central

    Henry, Maria Aparecida Coelho de Arruda

    2014-01-01

    Introduction Gastroesophageal reflux disease (GERD) is probably one of the most prevalent diseases in the world that also compromises the quality of life of the affected significantly. Its incidence in Brazil is 12%, corresponding to 20 million individuals. Objective To update the GERD management and the new trends on diagnosis and treatment, reviewing the international and Brazilian experience on it. Method The literature review was based on papers published on Medline/Pubmed, SciELO, Lilacs, Embase and Cochrane crossing the following headings: gastroesophageal reflux disease, diagnosis, clinical treatment, surgery, fundoplication. Results Various factors are involved on GERD physiopathology, the most important being the transient lower esophageal sphincter relaxation. Clinical manifestations are heartburn, regurgitation (typical symptoms), cough, chest pain, asthma, hoarseness and throat clearing (atypical symptoms), which may be followed or not by typical symptoms. GERD patients may present complications such as peptic stenosis, hemorrhage, and Barrett's esophagus, which is the most important predisposing factor to adenocarcinoma. The GERD diagnosis must be based on the anamnesis and the symptoms must be evaluated in terms of duration, intensity, frequency, triggering and relief factors, pattern of evolution and impact on the patient's quality of life. The diagnosis requires confirmation with different exams. The goal of the clinical treatment is to relieve the symptoms and surgical treatment is indicated for patients who require continued drug use, with intolerance to prolonged clinical treatment and with GERD complications. Conclusion GERD is a major digestive health problem and affect 12% of Brazilian people. The anamnesis is fundamental for the diagnosis of GERD, with special analysis of the typical and atypical symptoms (duration, intensity, frequency, triggering and relief factors, evolution and impact on the life quality). High digestive endoscopy and

  14. The role of Tc-99m dimercaptosuccinic acid renal cortical scintigraphy in acute and recurrent episodes of renal infarction in a patient with a tendency toward thrombosis.

    PubMed

    Kanat, Nazm Barş; Aslan, Mehmet; Bozkurt, Murat Fani; Ergün, Eser Lay

    2009-10-01

    Tc-99m dimercaptosuccinic acid (DMSA) renal cortical scintigraphy (RCS) of a 46-year-old man with abdominal and right flank pain who had history of a tendency toward thrombosis revealed extensive renal parenchymal changes secondary to renal infarction and a small size defect in the right kidney in addition to the patient's prior computed tomography results. The patient had Coumadin treatment. Two months later, he was referred to the hospital with the same symptoms. DMSA RCS established that the small defect in the right kidney had enlarged; other scarred areas persisted. This case indicates the value of DMSA RCS for early diagnosis, follow-up of acute/recurrent renal parenchymal scarring in patients with thrombophilia.

  15. Loss of Autonoetic Awareness of Recent Autobiographical Episodes and Accelerated Long-Term Forgetting in a Patient with Previously Unrecognized Glutamic Acid Decarboxylase Antibody Related Limbic Encephalitis.

    PubMed

    Witt, Juri-Alexander; Vogt, Viola Lara; Widman, Guido; Langen, Karl-Josef; Elger, Christian Erich; Helmstaedter, Christoph

    2015-01-01

    We describe a 35-year-old male patient presenting with depressed mood and emotional instability, who complained about severe anterograde and retrograde memory deficits characterized by accelerated long-term forgetting and loss of autonoetic awareness regarding autobiographical memories of the last 3 years. Months before he had experienced two breakdowns of unknown etiology giving rise to the differential diagnosis of epileptic seizures after various practitioners and clinics had suggested different etiologies such as a psychosomatic condition, burnout, depression, or dissociative amnesia. Neuropsychological assessment indicated selectively impaired figural memory performance. Extended diagnostics confirmed accelerated forgetting of previously learned and retrievable verbal material. Structural imaging showed bilateral swelling and signal alterations of temporomesial structures (left >right). Video-EEG monitoring revealed a left temporal epileptic focus and subclincal seizure, but no overt seizures. Antibody tests in serum and liquor were positive for glutamic acid decarboxylase antibodies. These findings led to the diagnosis of glutamic acid decarboxylase antibody related limbic encephalitis. Monthly steroid pulses over 6 months led to recovery of subjective memory and to intermediate improvement but subsequent worsening of objective memory performance. During the course of treatment, the patient reported de novo paroxysmal non-responsive states. Thus, antiepileptic treatment was started and the patient finally became seizure free. At the last visit, vocational reintegration was successfully in progress. In conclusion, amygdala swelling, retrograde biographic memory impairment, accelerated long-term forgetting, and emotional instability may serve as indicators of limbic encephalitis, even in the absence of overt epileptic seizures. The monitoring of such patients calls for a standardized and concerted multilevel diagnostic approach with repeated assessments.

  16. Ineffective esophageal motility is a primary motility disorder in gastroesophageal reflux disease.

    PubMed

    Ho, Shih-Chi; Chang, Chi-Sen; Wu, Chun-Ying; Chen, Gran-Hum

    2002-03-01

    The relationship between esophageal motor abnormalities and GERD has been widely studied. The purpose of this study was to identify the prevalence of ineffective esophageal motility (IEM) in patients with GERD. In addition, we also evaluated esophageal acid exposure, acid clearance, and endoscopic esophagitis in GERD patients with IEM. Of 89 patients enrolled in this study, 47 (52.8%) were found to have nonspecific esophageal motility disorder (NEMD). Forty-four of the 47 (93.6%) patients with NEMD met the diagnostic criteria for IEM. The overall incidence of IEM in GERD patients was 49.4%. Patients with IEM had significant increases in upright and recumbent mean fraction of time pH < 4 (6.70% and 4.38%) and mean recumbent esophageal acid clearance (12.45 min/reflux) when compared to those with other motility findings. Seventeen of the 44 (39%) IEM patients did not have endoscopic esophagitis. On the other hand, 26 of the 39 (67%) patients with normal manometry had endoscopic esophagitis. We concluded that not only is the prevalence of IEM high in GERD, but also that IEM patients have more recumbent gastroesophageal reflux and delayed acid clearance. Combined with endoscopic findings, we propose that IEM can be viewed as a specific entity of primary esophageal motility disorder in patients with GERD.

  17. Imaging strategies for vesicoureteral reflux diagnosis.

    PubMed

    Stefanidis, Constantinos J; Siomou, Ekaterini

    2007-07-01

    The prevalence of vesicoureteral reflux (VUR), although reported to be low in the general population, is high in children with urinary tract infection (UTI), first degree relatives of patients with known VUR and children with antenatal hydronephrosis. In addition, it has been shown that VUR and UTIs are associated with renal scarring, predisposing to serious long-term complications, i.e., hypertension, chronic renal insufficiency and complications of pregnancy. Therefore, diagnostic imaging for the detection of VUR in the high-risk groups of children has been a standard practice. However, none of these associations has been validated with controlled studies, and recently the value of identifying VUR after a symptomatic UTI has been questioned. In addition, several studies have shown that renal damage may occur in the absence of VUR. On the other hand, some patients, mainly males, may have primary renal damage, associated with high-grade VUR, without UTI. Recently, increasing skepticism has been noted concerning how and for whom it is important to investigate for VUR. It has been suggested that the absence of renal lesions after the first UTI in children may rule out VUR of clinical significance and reinforces the redundancy of invasive diagnostic techniques. Therefore, the priority of imaging strategies should focus on early identification of renal lesions to prevent further deterioration.

  18. Gastroesophageal reflux and congenital gastrointestinal malformations

    PubMed Central

    Marseglia, Lucia; Manti, Sara; D’Angelo, Gabriella; Gitto, Eloisa; Salpietro, Carmelo; Centorrino, Antonio; Scalfari, Gianfranco; Santoro, Giuseppe; Impellizzeri, Pietro; Romeo, Carmelo

    2015-01-01

    Although the outcome of newborns with surgical congenital diseases (e.g., diaphragmatic hernia; esophageal atresia; omphalocele; gastroschisis) has improved rapidly with recent advances in perinatal intensive care and surgery, infant survivors often require intensive treatment after birth, have prolonged hospitalizations, and, after discharge, may have long-term sequelae including gastro-intestinal comorbidities, above all, gastroesophageal reflux (GER). This condition involves the involuntary retrograde passage of gastric contents into the esophagus, with or without regurgitation or vomiting. It is a well-recognized condition, typical of infants, with an incidence of 85%, which usually resolves after physiological maturation of the lower esophageal sphincter and lengthening of the intra-abdominal esophagus, in the first few months after birth. Although the exact cause of abnormal esophageal function in congenital defects is not clearly understood, it has been hypothesized that common (increased intra-abdominal pressure after closure of the abdominal defect) and/or specific (e.g., motility disturbance of the upper gastrointestinal tract, damage of esophageal peristaltic pump) pathological mechanisms may play a role in the etiology of GER in patients with birth defects. Improvement of knowledge could positively impact the long-term prognosis of patients with surgical congenital diseases. The present manuscript provides a literature review focused on pathological and clinical characteristics of GER in patients who have undergone surgical treatment for congenital abdominal malformations. PMID:26229394

  19. [Effect of eradication of Helicobacter pylori infection on endoscopic findings and symptoms of gastroesophageal reflux].

    PubMed

    Mesihović, Rusmir; Vucelić, Boris; Bratović, Ismet; Gribajcević, Mehmed; Selak, Ivan

    2002-01-01

    Gastroesophageal reflux disease (GORD) represents an illness which reflects a syndrome caused by returning of acid gastric, alkaline pancreatic and bowels content into the oesophagus, which is in the stomach, because of the protective mechanisms of oesophageal loss. The aim of this study was that this prospective study should explain the role of Helicobacter pylori infection in modification of GORD, respectively whether the Helicobacter pylori infection acts protectively or by deterioration of the disease. According to the settled rules, the inquiry was performed as well as the selection of 97 candidates to undergo research in this study. Helicobacter pylori infection has been proved by immunoassay in all pts in the beginning of this study. Endoscopy has been performed in all pts, the degree of gastroesophageal reflux disease by Sawary-Miller was done. The main group consisted of 50 candidates in whom the eradication of Helicobacter pylori infection was done with triple therapy, pantoprazol + amoxycilin + klaritromicin, which was proven by an immunoassay test. Two groups of pts were formed: the main one with eradicated Helicobacter infection, and a controlled one with a Helicobacter positive infection, which was subject to modification of life style. During 12 months, this study consisted of endoscopic evaluations and monthly evaluation of pts daily difficulties. The eradication of Helicobacter pylori infection acts on the improvement of gastroesophageal disease course by improvement of endoscopic findings by Sawary-Miller, and by decreasing daily acid symptoms. The eradication of Helicobacter pylori infection in gastroesophageal reflux disease does it act at the symptoms such as heartburn, weekly acid symptoms and chest pain.

  20. Metoclopramide, H2 blockers, and proton pump inhibitors: pharmacotherapy for gastroesophageal reflux in neonates.

    PubMed

    Malcolm, William F; Cotten, C Michael

    2012-03-01

    Pharmacotherapy for gastroesophageal reflux (GER) in neonates, aimed at interfering with this physiologic process and potentially reducing the negative sequelae that providers often attribute to GER, consists primarily of drugs that increase the viscosity of feeds, reduce stomach acidity, or improve gut motility. Medications used to treat clinical signs thought to be from GER, such as apnea, bradycardia, or feeding intolerance, are among the most commonly prescribed medications in neonatal intensive care units in the United States, despite the lack of evidence of safety and efficacy in this population.

  1. Extravasation of Urine Associated with Bilateral Complete Ureteral Duplication, Vesicoureteral Reflux and Benign Prostatic Hyperplasia.

    PubMed

    Suzuki, Issei; Kaga, Kanya; Takei, Kohei; Tokura, Yuumi; Sakamoto, Kazumasa; Nishihara, Daisaku; Mizuno, Tomoya; Yuki, Hideo; Betsunoh, Hironori; Abe, Hideyuki; Yashi, Masahiro; Fukabori, Yoshitatsu; Yamanishi, Tomonori; Kamai, Takao

    2017-02-01

    We report a rare case of extravasation of urine, which may be associated with bilateral complete ureteral duplication, vesicoureteral reflux (VUR), and benign prostatic hyperplasia (BPH). A 71-year-old male presented with a complaint of right abdominal pain. An extravasation of urine was noted, and was improved by indwelling urethral catheterization. Transurethral resection of the prostate and the endoscopic subureteral injection of dextanomer/hyaluronic acid were performed for the treatment of BPH and VUR, respectively. The post-surgery recovery was successful.

  2. Sex and Gender Differences in Gastroesophageal Reflux Disease

    PubMed Central

    Kim, Young Sun; Kim, Nayoung; Kim, Gwang Ha

    2016-01-01

    It is important to understand sex and gender-related differences in gastroesophageal reflux disease (GERD) because gender-related biologic factors might lead to better prevention and therapy. Non-erosive reflux disease (NERD) affects more women than men. GERD symptoms are more frequent in patients with NERD than in those with reflux esophagitis. However, men suffer pathologic diseases such as reflux esophagitis, Barrett’s esophagus (BE), and esophageal adenocarcinoma (EAC) more frequently than women. The prevalence of reflux esophagitis is significantly increased with age in women, especially after their 50s. The mean age of EAC incidence in women is higher than in men, suggesting a role of estrogen in delaying the onset of BE and EAC. In a chronic rat reflux esophagitis model, nitric oxide was found to be an aggravating factor of esophageal injury in a male-predominant way. In addition, the expression of esophageal occludin, a tight junction protein that plays an important role in the esophageal defense mechanism, was up-regulated in women. This explains the male predominance of reflux esophagitis and delayed incidence of BE or EAC in women. Moreover, the symptoms such as heartburn, regurgitation, and extra-esophageal symptoms have been more frequently reported by women than by men, suggesting that sex and gender play a role in symptom perception. Differential sensitivity with augmented symptoms in women might have diagnostic and therapeutic influence. Furthermore, recent studies have suggested that hormone replacement therapy has a protective effect against esophageal cancer. However, an anti-inflammatory role of estrogen remains compelling, which means further study is necessary in this area. PMID:27703114

  3. Multidimensional voice analysis of reflux laryngitis patients.

    PubMed

    Pribuisienë, Rûta; Uloza, Virgilijus; Saferis, Viktoras

    2005-01-01

    The aim of the study was to analyze and quantify the voice characteristics of reflux laryngitis (RL) patients and to determine the most important voice tests and voice-quality parameters in the functional diagnostics of RL. The voices of 83 RL patients and 31 persons in the control group were evaluated. Vocal function was assessed using a multidimensional set of video laryngostroboscopic, perceptual, acoustic, aerodynamic and subjective measurements according to the protocol elaborated by the Committee on Phoniatrics of the European Laryngological Society. The mean values of the hoarseness visual analogue scale assessment and voice handicap index were significantly higher (P<0.05) in the group of RL patients as compared to the controls. Objective voice assessment revealed a significant increase in mean values of jitter, shimmer and normalized noise energy (NNE), along with a significant decrease in pitch range, maximum frequency, phonetogram area (S) and maximum phonation time (MPT) in RL patients, both in the male and female subgroups. According to the results of discriminant analysis, the NNE, MPT, S and intensity range were determined as an optimum set for functional diagnostics of RL. The derived function (equation) makes it possible to assign the person to the group of RL patients with an accuracy of 86.7%. The sensitivity and specificity of eight voice parameters were found to be higher than 50%. The results of the present study demonstrate a reduction of phonation capabilities and voice quality in RL patients. Multidimensional voice evaluation makes it possible to detect significant differences in mean values of perceptual, subjective and objective voice quality parameters between RL patients and controls groups. Therefore, multidimensional voice analysis is an important tool in the functional diagnostics of RL.

  4. National trends in gastroesophageal reflux surgery

    PubMed Central

    McMahon, Ross L.; Mercer, C. Dale

    2000-01-01

    Objectives To assess the surgical technique and the frequency of different types of antireflux surgery used in Canada after the introduction of laparoscopic antireflux surgery. Design Gastroesophageal reflux (GER) surgery and population data in fiscal years 1992 through 1996. were accessed through the Canadian Institute of Health Information, provincial health ministries, MED ECHO and Statistics Canada databases. Data were also analysed by province and nationally for type of surgery (e.g., open abdominal, thoracic, thoracoscopic and laparoscopic). Results National data showed a slight increase in GER surgery in the last 5 years. Laparoscopic surgery increased 2.8 fold in 1993 and 1.6 fold in 1995 over the previous years. Open abdominal cases decreased 1.1 fold from 1992 to 1996. Thoracic cases remained essentially unchanged. Provincial and regional disparities in procedures per 100 000 population exist (Ontario 7.1 versus Nova Scotia 20.7). Areas in which little or no laparoscopic surgery was done had an average increase of 3%, whereas areas in which laparoscopic surgery was done had an average increase of 16% in GER surgery during the course of the study. In provinces west of Quebec (with the exception of Manitoba) more than 50% of GER surgery is laparoscopic; in areas east of Ontario less than 25% of GER surgery is performed laparoscopically. Five provinces (Manitoba, Quebec, Nova Scotia, Prince Edward Island and Newfoundland) performed significantly fewer laparoscopic procedures than the national average. Conclusions The frequency of GER surgery is increasing modestly in Canada and is performed most often by the open abdominal route. Regional disparities in open and laparoscopic techniques are apparent. Laparoscopic surgery for GER is increasing rapidly and accounts for the decrease in open GER surgery. PMID:10714258

  5. Enterogastric reflux and gastric clearance of refluxate in normal subjects and in patients with and without bile vomiting following peptic ulcer surgery

    SciTech Connect

    Mackie, C.; Hulks, G.; Cuschieri, A.

    1986-11-01

    A noninvasive scintigraphic technique was used to estimate enterogastric reflux and subsequent gastric evacuation of refluxate in 35 normal, healthy subjects and 55 patients previously treated by vagotomy or partial gastrectomy. Reflux was provoked by a milk drink and quantitated by counting 99Tcm-EHIDA activity within the gastric area during gamma camera imaging. Seven normal subjects (20%) showed reflux of 5-18% of initial activity (mean: 10%), with peak values occurring at 5-30 minutes (mean: 14 minutes) following the milk. Gastric evacuation of activity in these subjects was monoexponential (r = 0.993, T1/2 = 24.1 minutes). Reflux occurred more frequently than normal in patients with truncal vagotomy and drainage (22/28 patients) and partial gastrectomy (20/21 patients). All of 16 patients with Billroth II anastomoses exhibited reflux, which was excessive compared with refluxing normal subjects (mean: 25%; p less than 0.01) and occurred later into the study (mean: 34 minutes; p less than 0.01). Ten of 11 asymptomatic patients showed reflux of similar amounts of activity (mean: 21%) compared with 16 patients who complained of bile vomiting (mean: 22%). However, asymptomatic patients exhibited gastric evacuation of refluxate at a rate similar to that of refluxing normal subjects, while bile vomiters showed significant gastric retention of refluxate at 25-30 minutes following peak gastric activity (p less than 0.05). This result confirms that post-operative bile vomiting is essentially a problem of gastric emptying.

  6. The Episodic Nature of Episodic-Like Memories

    ERIC Educational Resources Information Center

    Easton, Alexander; Webster, Lisa A. D.; Eacott, Madeline J.

    2012-01-01

    Studying episodic memory in nonhuman animals has proved difficult because definitions in humans require conscious recollection. Here, we assessed humans' experience of episodic-like recognition memory tasks that have been used with animals. It was found that tasks using contextual information to discriminate events could only be accurately…

  7. Jugular venous reflux on magnetic resonance angiography and radionuclide venography

    PubMed Central

    Okada, Tomohisa; Okuchi, Sachi; Yamamoto, Akira; Kanagaki, Mitsunori; Fujimoto, Koji; Togashi, Kaori

    2016-01-01

    Background The relationship between the signal from retrograde venous flow on magnetic resonance angiography (MRA) and retrograde upward flow from the left brachiocephalic vein has not been explored. Purpose To reveal the frequency of jugular venous reflux using MRA and nuclear venography in patients being evaluated for cerebral volume and blood flow. Material and Methods A total of 229 patients with cognitive disturbance who had undergone brain magnetic resonance imaging (MRI) and single-photon emission computed tomography (SPECT) on the same day to evaluate cerebral blood flow were evaluated. Jugular venous reflux was measured on MRA and nuclear venography, which was conducted just after injection of N-isopropyl-123I-p-iodoamphetamine for the SPECT study. Results MRA showed jugular reflux in seven patients on the right side, and in 22 on the left. Nuclear venography showed jugular reflux in six patients on the right side, and in 20 on the left. Conclusion Jugular venous reflux was observed mostly on the left side. Retrograde flow was observed on both MRA and nuclear venography in half of the cases, with the rest only on one of the modalities. PMID:27994882

  8. Do you Suffer from Heartburn or Acid Reflux?

    MedlinePlus

    ... state settlement of consumer fraud claims regarding the marketing of the prescription drug Neurontin. This brief should not be viewed as a substitute for a consultation with a medical or health professional. It is provided to enhance communication with your doctor, not replace it. 3 Are ...

  9. Evaluation of reflux nephropathy, pyelonephritis and renal dysplasia.

    PubMed

    Grattan-Smith, J Damien; Little, Stephen B; Jones, Richard A

    2008-01-01

    MR urography has the potential to significantly improve our understanding of the relationship between reflux nephropathy, pyelonephritis, vesicoureteric reflux and renal dysplasia. MR urography utilizes multiple parameters to assess both renal anatomy and function and provides a more complete characterization of acquired and congenital disease. Pyelonephritis and renal scarring can be distinguished by assessing the parenchymal contours and signal intensity. Characteristic imaging features of renal dysplasia include small size, subcortical cysts, disorganized architecture, decreased and patchy contrast enhancement as well as a dysmorphic pelvicalyceal system. Because of its ability to subdivide and categorize this heterogeneous group of disorders, it seems inevitable that MR urography will replace DMSA renal scintigraphy as the gold standard for assessment of pyelonephritis and renal scarring. MR urography will contribute to our understanding of renal dysplasia and its relationship to reflux nephropathy.

  10. An updated review on gastro-esophageal reflux in pediatrics.

    PubMed

    Vandenplas, Yvan; Hauser, Bruno

    2015-01-01

    Comprehensive guidelines for the diagnosis and management of gastro-esophageal reflux (GER) and GER disease (GERD) were developed by the European and North American Societies for Pediatric Gastroenterology, Hepatology and Nutrition. GERD is reflux associated with troublesome symptoms or complications. The recognition of GER and GERD is relevant to implement best management practices. A conservative management is indicated in infants with uncomplicated physiologic reflux. Children with GERD may benefit from further evaluation and treatment. Since the publications of the European and North American Societies for Pediatric Gastroenterology, Hepatology and Nutrition guidelines in 2009, no important novelties in drug treatment have been reported. Innovations are mainly restricted to the management of regurgitation in infants. During the last 5 years, pros and cons of multichannel intraluminal impedance have been highlighted. However, overall 'not much has changed' in the diagnosis and management of GER and GERD in infants and children.

  11. [Voice disturbances in young children with gastroesophageal reflux disease].

    PubMed

    Viaz'menov, E O; Radtsig, E Iu; Bogomil'skiĭ, M R; Vodolazov, S Iu; Poliudov, S A; Myzin, A V

    2010-01-01

    The objective of the present work was to study voice disturbances in young children with gastroesophageal reflux disease. Diagnostic algorithm included direct transnasal examination of the larynx using an Olympus fibroscope (Japan), fibrogastroduodenoscopy, 24-hour potentiometry, biopsy of oesophageal mucosa, and acoustic analysis of the voice. A total of 26 children at the age from 8 months to 3 years with voice disturbances were examined, including 12 children below one year, 5 between 1 and 2 years, and 9 between 2 and 3 years. The main signs of laryngoesophageal reflux were dysphonia, oedema, hyperemia, and altered light reflex of mucous membrane of arytenoid cartilages, interarytenoid space, and vocal cords. It is concluded that voice disturbances are the most common symptoms of laryngoesophageal reflux in young children which necessitates the earliest possible endoscopic study of the larynx in all cases of dysphonia.

  12. The human aerodigestive tract and gastroesophageal reflux: an evolutionary perspective.

    PubMed

    Laitman, J T; Reidenberg, J S

    1997-11-24

    In order to appreciate fully the nature of supraesophageal complications of gastroesophageal reflux in humans, it is essential to view the problem within an evolutionary framework. Examination of the aerodigestive tract anatomy of our mammalian relatives shows that this region in humans is highly derived as compared to other mammals. Among the specializations that adult humans exhibit is a caudal position of the larynx, which results in a permanently expanded oropharynx. These anatomical features underlie our distinctive breathing and swallowing patterns and provide the substrate that allows for the production of articulate speech. While the selection factors that have shaped human evolution obviously favored our derived aerodigestive tract, aspects of this anatomy appear particularly unsuited to accommodate gastroesophageal reflux. Indeed, our unique aerodigestive tract morphology may predispose us to an array of supraesophageal complications of gastroesophageal reflux.

  13. [Sulglicotide in the treatment of dyspeptic patients with duodenogastric reflux].

    PubMed

    Bertoldi, M; Bigliazzi, S; Taddeucci, S; Cangioni, G; Psilogenis, M

    The therapeutic efficacy of sulglicotide was tested in an open study of dyspeptic patients suffering from proven duodenogastric reflux. Twenty outpatients with non-ulcer dyspepsia and alkaline reflux demonstrated by measurement of enterogastric flux were enrolled in the study. All patients could be evaluated at the end of 8 weeks' treatment with 200 mg sulglicotide t.i.d. This treatment did not cause any change for the better of alkaline reflux but did induce marked improvement of subjective symptoms (p less than 0.05 vs baseline), giving the impression that in spite of the continued presence of the damaging agent the drug had reduced the mucosal lesion by increasing gastro-protective capacity.

  14. The Role of Helicobacter pylori in Laryngopharyngeal Reflux.

    PubMed

    Campbell, Ross; Kilty, Shaun J; Hutton, Brian; Bonaparte, James P

    2017-02-01

    Objective The primary objective was to determine the prevalence of Helicobacter pylori among patients with laryngopharyngeal reflux. The secondary objective was determining if H pylori eradication leads to greater symptom improvement in patients with laryngopharyngeal reflux as compared with standard proton pump inhibitor therapy alone. Data Sources EMBASE, Cumulative Index to Nursing and Allied Health Literature, MEDLINE, World Health Organization International Clinical Trials Registry Platform, European Union Clinical Trials Register, Cochrane Library databases of clinical trials, and ClinicalTrials.gov. Review Methods A systematic review was performed of studies assessing the diagnosis or treatment of H pylori among patients with laryngopharyngeal reflux. Randomized controlled trials, cohort studies, case-control studies, and case series were included. A meta-analysis of prevalence data and assessment of heterogeneity was performed on relevant studies. Results Fourteen studies were analyzed in the review, with 13 eligible for the meta-analysis. We determined that the prevalence of H pylori among patients with laryngopharyngeal reflux was 43.9% (95% confidence interval, 32.1-56.5). The heterogeneity of studies was high, with an overall I(2) value of 92.3%. We were unable to quantitatively assess findings for our secondary outcome, since H pylori identification and treatment were not the primary focus of the majority of studies. Conclusion There is a high rate of H pylori infection among patients with laryngopharyngeal reflux. The infection rate in North America and Western Europe has not been adequately studied. There is insufficient evidence to make a recommendation regarding the testing and treatment of H pylori infection among patients with laryngopharyngeal reflux.

  15. Managing peptic ulcer and gastroesophageal reflux disease in elderly Chinese patients--focus on esomeprazole.

    PubMed

    Tang, Raymond S Y; Wu, Justin C Y

    2013-01-01

    Peptic ulcer disease (PUD) and gastroesophageal reflux disease (GERD) are not uncommon in elderly patients. Clinical presentations of these acid-related disorders may be atypical in the geriatric population. Older individuals are at increased risk for poor outcomes in complicated PUD and for development of GERD complications. Multiple risk factors (eg, Helicobacter pylori [HP], use of nonsteroidal anti-inflammatory drugs [NSAIDs], aspirin) contribute to the development of PUD. Recent data has shown that HP-negative, NSAID-negative idiopathic peptic ulcers are on the rise and carry a higher risk of recurrent ulcer bleeding and mortality. Effective management of PUD in the geriatric population relies on identification and modification of treatable risk factors. Elderly patients with GERD often require long-term acid suppressive therapy. Proton pump inhibitors (PPI) including esomeprazole are effective in the treatment of reflux esophagitis, maintenance of GERD symptomatic control, and management of PUD as well as its complications. Potential safety concerns of long-term PPI use have been reported in the literature. Clinicians should balance the risks and benefits before committing elderly patients to long-term PPI therapy.

  16. Liquid in the gastroesophageal segment promotes reflux, but compliance does not: a mathematical modeling study.

    PubMed

    Ghosh, Sudip K; Kahrilas, Peter J; Brasseur, James G

    2008-11-01

    The mechanical force relationships that distinguish normal from chronic reflux at sphincter opening are poorly understood and difficult to measure in vivo. Our aim was to apply physics-based computer simulations to determine mechanical pathogenesis of gastroesophageal reflux. A mathematical model of the gastroesophageal segment (GES) was developed, incorporating the primary anatomical and physiomechanical elements that drive GES opening and reflux. In vivo data were used to quantify muscle stiffness, sphincter tone, and gastric pressure. The liquid lining the mucosa was modeled as an "effective liquid film" between the mucosa and a manometric catheter. Newton's second law was solved mathematically, and the space-time details of opening and reflux were predicted for systematic variations in gastric pressure increase, film thickness, muscle stiffness, and tone. "Reflux" was defined as "2 ml of refluxate entering the esophagus within 1 s." GES opening and reflux were different events. Both were sensitive to changes in gastric pressure and sphincter tone. Reflux initiation was extremely sensitive to the liquid film thickness; the protective function of the sphincter was destroyed with only 0.4 mm of liquid in the GES. Compliance had no effect on reflux initiation, but affected reflux volume. The presence of abnormal levels of liquid within the collapsed GES can greatly increase the probability for reflux, suggesting a mechanical mechanism that may differentiate normal reflux from gastroesophageal reflux disease. Compliance does not affect the probability for reflux, but affects reflux volume once it occurs. Opening without reflux suggests the existence of "gastroesophageal pooling" in the distal esophagus, with clinical implications.

  17. Factors associated with residual gastroesophageal reflux disease symptoms in patients receiving proton pump inhibitor maintenance therapy

    PubMed Central

    Kawara, Fumiaki; Fujita, Tsuyoshi; Morita, Yoshinori; Uda, Atsushi; Masuda, Atsuhiro; Saito, Masaya; Ooi, Makoto; Ishida, Tsukasa; Kondo, Yasuyuki; Yoshida, Shiei; Okuno, Tatsuya; Yano, Yoshihiko; Yoshida, Masaru; Kutsumi, Hiromu; Hayakumo, Takanobu; Yamashita, Kazuhiko; Hirano, Takeshi; Hirai, Midori; Azuma, Takeshi

    2017-01-01

    AIM To elucidate the factors associated with residual gastroesophageal reflux disease (GERD) symptoms in patients receiving proton pump inhibitor (PPI) maintenance therapy in clinical practice. METHODS The study included 39 GERD patients receiving maintenance PPI therapy. Residual symptoms were assessed using the Frequency Scale for Symptoms of GERD (FSSG) questionnaire and the Gastrointestinal Symptom Rating Scale (GSRS). The relationships between the FSSG score and patient background factors, including the CYP2C19 genotype, were analyzed. RESULTS The FSSG scores ranged from 1 to 28 points (median score: 7.5 points), and 19 patients (48.7%) had a score of 8 points or more. The patients’ GSRS scores were significantly correlated with their FSSG scores (correlation coefficient = 0.47, P < 0.005). In erosive esophagitis patients, the FSSG scores of the CYP2C19 rapid metabolizers (RMs) were significantly higher than the scores of the poor metabolizers and intermediate metabolizers (total scores: 16.7 ± 8.6 vs 7.8 ± 5.4, P < 0.05; acid reflux-related symptom scores: 12 ± 1.9 vs 2.5 ± 0.8, P < 0.005). In contrast, the FSSG scores of the CYP2C19 RMs in the non-erosive reflux disease patients were significantly lower than those of the other patients (total scores: 5.5 ± 1.0 vs 11.8 ± 6.3, P < 0.05; dysmotility symptom-related scores: 1.0 ± 0.4 vs 6.0 ± 0.8, P < 0.01). CONCLUSION Approximately half of the GERD patients receiving maintenance PPI therapy had residual symptoms associated with a lower quality of life, and the CYP2C19 genotype appeared to be associated with these residual symptoms. PMID:28373773

  18. Imagining the personal past: Episodic counterfactuals compared to episodic memories and episodic future projections.

    PubMed

    Özbek, Müge; Bohn, Annette; Berntsen, Dorthe

    2017-04-01

    Episodic counterfactuals are imagined events that could have happened, but did not happen, in a person's past. Such imagined past events are important aspects of mental life, affecting emotions, decisions, and behaviors. However, studies examining their phenomenological characteristics and content have been few. Here we introduced a new method to systematically compare self-generated episodic counterfactuals to self-generated episodic memories and future projections with regard to their phenomenological characteristics (e.g., imagery, emotional valence, and rehearsal) and content (e.g., reference to a cultural life script), and how these were affected by temporal distance (1 month, 1 year, 5+ years). The findings showed that the three types of events differed phenomenologically. First, episodic memories were remembered more easily, with more sensory details, and from a dominantly field perspective, as compared to both future projections and episodic counterfactuals. Second, episodic future projections were more positive, more voluntarily rehearsed, and more central to life story and identity than were both episodic memories and episodic counterfactuals. Third, episodic counterfactuals differed from both episodic memories and future projections by neither having the positivity bias of the future events nor the enhanced sensory details of the past events. Across all three event types, sensory details decreased, whereas importance, reference to a cultural life script, and centrality increased with increasing temporal distance. The findings show that imagined events are phenomenologically different from memories of experienced events, consistent with reality-monitoring theory, and that imagined future events are different from both actual and imagined past events, consistent with some theories of motivation.

  19. Helping Families Understand and Manage Pediatric Gastroesophageal Reflux

    ERIC Educational Resources Information Center

    Pulsifer-Anderson, Elizabeth

    2009-01-01

    Gastroesophageal reflux is a common medical problem affecting about 5% of otherwise healthy children. It is extremely common among children with special needs and affects more than half of children with cerebral palsy, Down syndrome, premature birth, and several other common conditions. The disease is becoming more widely recognized, but children…

  20. [Severe interstitial lung disease from pathologic gastroesophageal reflux in children].

    PubMed

    Ahrens, P; Weimer, B; Hofmann, D

    1999-07-01

    Interstitial lung diseases comprise a heterogeneous group of pulmonary conditions that cause restrictive lung disease of poor prognosis, especially if growth failure, pulmonary hypertension and fibrosis appears. We report on the case of a girl of 11 years of age who suffered from severe nonallergic asthma in early childhood and who developed severe interstitial pulmonary disease caused by gastro-oesophageal reflux at the age of 8 years. This diagnosis was established by lung biopsy, bronchoalveolar lavage and a high amount of lipid-laden alveolar macrophages, 2-level pH measurement and oesophageal biopsy. Because therapy with oral and inhaled steroids failed and Omeprazol showed benificial effects, hemifundoplication according to THAL was performed. At present the lung function is clearly normal and there is no need of any medicaments. Following the history, we can assume the pathological gastro-oesophageal reflux to be the cause of the disease. It is important to state that there were no typical symptoms at any time pointing to gastro-oesophageal reflux disease. The development of pulmonary disease by pathological reflux is very often caused by "silent aspiration". Very typically there are no symptoms such as vomiting, heartburn and pain but only signs of chronic lung disease.

  1. The human laryngeal microbiome: effects of cigarette smoke and reflux

    PubMed Central

    Jetté, Marie E.; Dill-McFarland, Kimberly A.; Hanshew, Alissa S.; Suen, Garret; Thibeault, Susan L.

    2016-01-01

    Prolonged diffuse laryngeal inflammation from smoking and/or reflux is commonly diagnosed as chronic laryngitis and treated empirically with expensive drugs that have not proven effective. Shifts in microbiota have been associated with many inflammatory diseases, though little is known about how resident microbes may contribute to chronic laryngitis. We sought to characterize the core microbiota of disease-free human laryngeal tissue and to investigate shifts in microbial community membership associated with exposure to cigarette smoke and reflux. Using 454 pyrosequencing of the 16S rRNA gene, we compared bacterial communities of laryngeal tissue biopsies collected from 97 non-treatment-seeking volunteers based on reflux and smoking status. The core community was characterized by a highly abundant OTU within the family Comamonadaceae found in all laryngeal tissues. Smokers demonstrated less microbial diversity than nonsmokers, with differences in relative abundances of OTUs classified as Streptococcus, unclassified Comamonadaceae, Cloacibacterium, and Helicobacter. Reflux status did not affect microbial diversity nor community structure nor composition. Comparison of healthy laryngeal microbial communities to benign vocal fold disease samples revealed greater abundance of Streptococcus in benign vocal fold disease suggesting that mucosal dominance by Streptococcus may be a factor in disease etiology. PMID:27775059

  2. Liquid in the gastroesophageal segment promotes reflux, but compliance does not: a mathematical modeling study

    PubMed Central

    Ghosh, Sudip K.; Kahrilas, Peter J.; Brasseur, James G.

    2008-01-01

    The mechanical force relationships that distinguish normal from chronic reflux at sphincter opening are poorly understood and difficult to measure in vivo. Our aim was to apply physics-based computer simulations to determine mechanical pathogenesis of gastroesophageal reflux. A mathematical model of the gastroesophageal segment (GES) was developed, incorporating the primary anatomical and physiomechanical elements that drive GES opening and reflux. In vivo data were used to quantify muscle stiffness, sphincter tone, and gastric pressure. The liquid lining the mucosa was modeled as an “effective liquid film” between the mucosa and a manometric catheter. Newton's second law was solved mathematically, and the space-time details of opening and reflux were predicted for systematic variations in gastric pressure increase, film thickness, muscle stiffness, and tone. “Reflux” was defined as “2 ml of refluxate entering the esophagus within 1 s.” GES opening and reflux were different events. Both were sensitive to changes in gastric pressure and sphincter tone. Reflux initiation was extremely sensitive to the liquid film thickness; the protective function of the sphincter was destroyed with only 0.4 mm of liquid in the GES. Compliance had no effect on reflux initiation, but affected reflux volume. The presence of abnormal levels of liquid within the collapsed GES can greatly increase the probability for reflux, suggesting a mechanical mechanism that may differentiate normal reflux from gastroesophageal reflux disease. Compliance does not affect the probability for reflux, but affects reflux volume once it occurs. Opening without reflux suggests the existence of “gastroesophageal pooling” in the distal esophagus, with clinical implications. PMID:18718998

  3. Short-term and long-term effect of diaphragm biofeedback training in gastroesophageal reflux disease: an open-label, pilot, randomized trial.

    PubMed

    Sun, X; Shang, W; Wang, Z; Liu, X; Fang, X; Ke, M

    2016-10-01

    This study investigated the effectiveness of diaphragm biofeedback training (DBT) for patients with gastroesophageal reflux disease (GERD). A total of 40 patients with GERD treated at the Peking Union Medical College Hospital between September 2004 and July 2006 were randomized to receive DBT and rabeprazole proton pump inhibitor (PPI) or rabeprazole alone. The DBT + rabeprazole group received DBT during the 8-week initial treatment; the rabeprazole group did not. During the 6-month follow up, all patients took acid suppression according to their reflux symptoms, and the patients in the DBT + rabeprazole group were required to continue DBT. The primary outcome (used for power analysis) was the amount of acid suppression used at 6 months. Secondary outcomes were reflux symptoms, health-related quality of life (HRQL), and esophageal motility differences after the 8-week treatment compared with baseline. Acid suppression usage significantly decreased in the DBT + rabeprazole group compared with the rabeprazole group at 6 months (P < 0.05). At 8 weeks, reflux symptoms and GERD-HRQL were significantly improved in both groups (P < 0.05), without difference between them. Crural diaphragm tension (CDT) and gastroesophageal junction pressure (GEJP) significantly increased in the DBT + rabeprazole group (P < 0.05), but without change in lower esophageal sphincter (LES) pressure. There was no significant change in CDT, GEJP, and LES pressure compared with baseline in the rabeprazole group. In conclusion, long-term DBT could reduce acid suppression usage by enhancing the anti-reflux barrier, providing a non-pharmacological maintenance therapy and reducing medical costs for patients with GERD.

  4. Behind the Webb Episode 27

    NASA Video Gallery

    This episode of "Behind the Webb" explores the multi-tasking capabilities of one of the cameras on the Webb Space Telescope, the Near-Infrared Spectrograph. Newly designed technology known as "micr...

  5. Hypoxic Episodes in Bronchopulmonary Dysplasia

    PubMed Central

    Martin, Richard J.; Di Fiore, Juliann M.; Walsh, Michele C.

    2015-01-01

    Hypoxic episodes are troublesome components of bronchopulmonary dysplasia in preterm infants. Immature respiratory control appears to be the major contributor, typically superimposed upon abnormal respiratory function. As a result, relatively short respiratory pauses may precipitate desaturation and accompanying bradycardia. As this population is predisposed to pulmonary hypertension, it is likely that pulmonary vasoconstriction may also play a role in hypoxic episodes. The natural history of intermittent hypoxic episodes has been well characterized in the preterm population at risk for BPD. However, the consequences of these episodes are less clear. Proposed associations of intermittent hypoxia include retinopathy of prematurity, sleep disordered breathing, and neurodevelopmental delay. Future study should address whether these associations are causal relationships. PMID:26593081

  6. Episodic acidification of Adirondack lakes during snowmelt

    SciTech Connect

    Schaefer, D.A.; Driscoll, C.T.; Van Dreason, R.; Yatsko, C.P.

    1990-07-01

    Maximum values of acid neutralizing capacity (ANC) in Adirondack, New York lake outlets generally occur during summer and autumn. During spring snowmelt, transport of acidic water through acid-sensitive watersheds causes depression of upper lake water ANC. In some systems lake outlet ANC reaches negative values. The authors examined outlet water chemistry from II Adirondack lakes during 1986 and 1987 snowmelts. In these lakes, SO concentrations were diluted during snowmelt and did not depress ANC. For lakes with high baseline ANC values, springtime ANC depressions were primarily accompanied by basic cation dilution. For lakes with low baseline ANC, No increases dominated ANC depressions. Lakes with intermediate baseline ANC were affected by both processes and exhibited larger ANC depressions. Ammonium dilution only affected wetland systems. A model predicting a linear relationship between outlet water ANC minima and autumn ANC was inappropriate. To assess watershed response to episodic acidification, hydrologic flow paths must be considered. (Copyright (c) 1990 by the American Geophysical Union.)

  7. [Guideline 'Gastroesophageal reflux disease in children from 0-18 years'].

    PubMed

    Benninga, Marc A; Berger, Marjolein Y; Venmans, Leonie M A J; Tabbers, Merit M

    2014-01-01

    In 2102, a multidiscplinary guideline was developed on behalf of the Dutch Association of Pediatrics entitled 'Gastroesophageal reflux disease in children from 0-18 years'. The North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) and the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) guideline from 2009 served for guidance. History and physical examination are usually sufficient for diagnosing gastroesophageal reflux disease. It is important to make a distinction between gastroesophageal reflux, a physiological phenomenon in children, and gastroesophageal reflux disease. In practice, medications are provided too often, especially in infants. Only children suffering from gastroesophageal reflux disease should be treated according to the therapeutical action plan.

  8. Treatment of reflux gastritis: double blind comparison between clebopride and domperidone. A preliminary report.

    PubMed

    Angelini, G; Castagnini, A; Rizzoli, R; Pasini, A F; Lavarini, E; Brocco, G; Scuro, L A

    1990-02-01

    Altered gastro-duodenal motility seems to be a major factor of alkaline gastritis. Therefore prokinetic drugs have been extensively used for the treatment of this disease. Aim of this study has been to compare the effects of domperidone with those of a more recent drug of the orthopramide class, clebopride. Thirty patients affected by reflux gastritis have been randomly allocated to one of the two treatments. Clinical symptoms, endoscopic and histologic appearance of gastric mucosa, gastric pH and bile acid concentration in gastric juice have been evaluated before and after a four week course of therapy. A statistically significant improvement was observed for the clinical symptoms in the subjects treated with clebopride. Even if no statistical difference has been pointed out for the other parameters between and within the two groups, a slight trend in favour of clebopride was observed. It is concluded that clebopride is at least as effective as domperidone for the treatment of reflux gastritis but that more prolonged studies and different administration schedules are requested for a better evaluation.

  9. H2 antagonists in the treatment of reflux oesophagitis: can physiological studies predict the response?

    PubMed Central

    Robertson, D A; Aldersley, M A; Shepherd, H; Lloyd, R S; Smith, C L

    1987-01-01

    Ambulatory oesophageal pH, oesophageal manometry and fasting serum gastrin concentrations were carried out on 28 patients with reflux oesophagitis, before and during treatment with ranitidine 300 mg bd. Fourteen patients healed endoscopically at six weeks (group A) and 14 had residual oesophagitis (group B). Group A were characterised by a lower serum gastrin concentration before treatment (4.52 pmol/l; 2.4-10: mean and range) than group B (11.1 pmol/l; 3.5-21: p less than 0.05) and showed a marked reduction in acid reflux on treatment to near normal values. Mean per cent time below pH4 fell from 14.9 to 4.2 in group A (p less than 0.05) but was not affected in group B (14.2-15.6, not significant). Abnormal oesophageal motility was found in 13 patients from each group. This did not inhibit the response to ranitidine, and was not improved by healing of oesophagitis. PMID:3666562

  10. Comparative safety and efficacy of proton pump inhibitors in paediatric gastroesophageal reflux disease.

    PubMed

    Kierkus, Jaroslaw; Oracz, Grzegorz; Korczowski, Bartosz; Szymanska, Edyta; Wiernicka, Anna; Woynarowski, Marek

    2014-05-01

    Gastroesophageal reflux is one of the most common reasons for referrals to paediatricians or paediatric gastroenterologists. Gastric acid-buffering agents, mucosal surface barriers and gastric anti-secretory agents are the main groups of medications currently used for treating gastroesophageal reflux disease (GERD) in children. Recently, the use of proton pump inhibitors (PPIs) for the treatment of GERD in children has increased considerably. Their effectiveness in healing erosive oesophagitis in paediatric subjects and in improving GERD symptoms has been established in many studies. However, the effectiveness in other clinical conditions and the long-term safety of PPIs for paediatric GERD have not been fully established yet and thus are still under debate. Therefore, the aim of this article is to provide a comparative review of the efficacy, safety and tolerability of PPIs in paediatric GERD. The available data suggest that short-term use of PPIs is well tolerated. Adverse events tend to be of a mild-to-moderate nature, with headache being the most frequently reported treatment-related adverse event. However, further well-designed trials and observational studies are still needed to clarify the efficacy and safety of PPIs in the paediatric population, especially in infants under the age of 12 months.

  11. Diatom diversity in chronically versus episodically acidified adirondack streams

    USGS Publications Warehouse

    Passy, S.I.; Ciugulea, I.; Lawrence, G.B.

    2006-01-01

    The relationship between algal species richness and diversity, and pH is controversial. Furthermore, it is still unknown how episodic stream acidification following atmospheric deposition affects species richness and diversity. Here we analyzed water chemistry and diatom epiphyton dynamics and showed their contrasting behavior in chronically vs. episodically acidic streams in the Adirondack region. Species richness and diversity were significantly higher in the chronically acidic brown water stream, where organic acidity was significantly higher and the ratio of inorganic to organic monomeric aluminum significantly lower. Conversely, in the episodically acidic clear water stream, the inorganic acidity and pH were significantly higher and the diatom communities were very species-poor. This suggests that episodic acidification in the Adirondacks may be more stressful for stream biota than chronic acidity. Strong negative linear relationships between species diversity, Eunotia exigua, and dissolved organic carbon against pH were revealed after the influence of non-linear temporal trends was partialled out using a novel way of temporal modeling. ?? 2006 WILEY-VCH Verlag GmbH & Co. KGaA.

  12. Clinical Characteristics of Patients with Gastroesophageal Reflux Disease Refractory to Proton Pump Inhibitors and the Effects of Switching to 20 mg Esomeprazole on Reflux Symptoms and Quality of Life

    PubMed Central

    Takeshima, Fuminao; Hashiguchi, Keiichi; Onitsuka, Yasunori; Tanigawa, Ken; Minami, Hitomi; Matsushima, Kayoko; Akazawa, Yuko; Shiozawa, Ken; Yamaguchi, Naoyuki; Taura, Naota; Ohnita, Ken; Ichikawa, Tatsuki; Isomoto, Hajime; Nakao, Kazuhiko

    2015-01-01

    Background Refractory gastroesophageal reflux disease (GERD) may deteriorate patient quality of life (QOL) despite proton pump inhibitor (PPI) therapy. Material/Methods Nineteen Japanese institutions were surveyed to determine the clinical characteristics and QOL of patients with refractory GERD. Those patients treated with a conventional PPI were switched to 20 mg esomeprazole for 4 weeks. Symptoms and QOL were assessed using Global Overall Symptom and Gastrointestinal Symptom Rating Scale (GSRS) questionnaires at baseline and at 2 and/or 4 weeks of esomeprazole treatment. Results Of 120 patients who completed the survey, 58 (48.3%) had refractory GERD. Of these, 69.0% were aged ≥65 years, 79.3% were prescribed a PPI at a standard or high dose, and 22.4% were prescribed a PPI together with another drug. After switching to esomeprazole, patients reported significant improvements in heartburn, acid regurgitation, and excessive belching at 2 weeks using a symptom diary, as well as the total score, reflux, abdominal pain, and indigestion, which were assessed using the GSRS at 4 weeks. Conclusions About half of Japanese patients with GERD may be refractory to conventional PPIs. Their reflux-related symptoms are often severe and may impair QOL. Switching to esomeprazole could be used to improve their symptoms and QOL. PMID:26719012

  13. The epidemiology of gastroesophageal reflux disease: a survey on the prevalence and the associated factors in a random sample of the general population in the Northern part of Iran

    PubMed Central

    Mansour-Ghanaei, Fariborz; Joukar, Farahnaz; Atshani, Seyed Mehrbod; Chagharvand, Sepideh; Souti, Fatemeh

    2013-01-01

    Many people with gastro-esophageal reflux symptoms do not consult a physician; therefore studies on gastro-esophageal reflux in general practice or in hospitals may not accurately describe the burden of gastro-esophageal reflux symptoms in the general population. The aim of this study was to assess the prevalence of gastro-esophageal reflux disease and its association with some life-style parameters in Rasht-Iran. A telephone survey was performed. Phone numbers was randomly collected from the telecommunication service center of Rasht. 1473 people (Mean age: 38.31 ± 13.09) were included in the study. People who didn’t answer the phone after three times or didn’t have consent to enter the study were excluded. Data were collected by an examiner using a GerdQ questionnaire. The validity and reliability of the questionnaire was tested by translation and retranslation and a pilot study was performed to assess its appropriateness. The prevalence of gastro-esophageal reflux was achieved 2.4% daily, 9.1% weekly and 11.3% monthly. Among the patients with gastro-esophageal reflux, 69.5% were female. There was a significant positive association between gastro-esophageal reflux prevalence and body mass index, smoking habits, eating salted or smoked foods, lying down immediately after the meal, taking certain drugs as non-steroidal anti-inflammatory drugs/Amino salicylic acid and the age group of 30-45 year old. Overall, the prevalence of the weekly gastro-esophageal reflux in the present survey was 9.1% which was less than other similar studies in Iran and some other countries. PMID:24046810

  14. Effects of episodic acidification on Atlantic salmon (Salmo salar) smolts

    USGS Publications Warehouse

    Magee, J.A.; Obedzinski, M.; McCormick, S.D.; Kocik, J.F.

    2003-01-01

    The effect of episodic acidification on Atlantic salmon (Salmo salar) smolt physiology and survival in fresh water (FW) and seawater (SW) was investigated. Smolts were held in either ambient (control, pH 6.0-6.6), acidified (chronic, pH 4.4-6.1), or episodically acidified (episodic, pH reduction from control levels to pH ???5.2 for 48 h once weekly) river water for 31 days and then transferred to 34??? SW. Smolts fed little while in acidified conditions and chronic smolts did not grow in length or weight. In FW, chronic smolts experienced increases in hematocrit and plasma potassium and reductions in plasma sodium and chloride. Upon transfer to SW, chronic and episodic smolts experienced reductions in hematocrit, increases in plasma sodium, chloride, and potassium levels, and suffered mortalities. Gill Na+,K+-ATPase and citrate synthase activities were reduced by exposure to acid. For most parameters, the effect of episodic acid exposure was less than that of chronic acidification. Exposure to acidic conditions, even when short in duration and followed by a 30-h recovery period in suitable water (pH 6.5), led to a 35% mortality of smolts upon transfer to SW. This study highlights the importance of measuring and assessing sublethal stresses in FW and their ultimate effects in marine ecosystems.

  15. Factitious psychogenic nonepileptic paroxysmal episodes.

    PubMed

    Romano, Alissa; Alqahtani, Saeed; Griffith, James; Koubeissi, Mohamad Z

    2014-01-01

    Mistaking psychogenic nonepileptic paroxysmal episodes (PNEPEs) for epileptic seizures (ES) is potentially dangerous, and certain features should alert physicians to a possible PNEPE diagnosis. Psychogenic nonepileptic paroxysmal episodes due to factitious seizures carry particularly high risks of morbidity or mortality from nonindicated emergency treatment and, often, high costs in wasted medical treatment expenditures. We report a case of a 28-year-old man with PNEPEs that were misdiagnosed as ES. The patient had been on four antiseizure medications (ASMs) with therapeutic serum levels and had had multiple intubations in the past for uncontrolled episodes. He had no episodes for two days of continuous video-EEG monitoring. He then disconnected his EEG cables and had an episode of generalized stiffening and cyanosis, followed by jerking and profuse bleeding from the mouth. The manifestations were unusually similar to those of ES, except that he was clearly startled by spraying water on his face, while he was stiff in all extremities and unresponsive. There were indications that he had sucked blood from his central venous catheter to expel through his mouth during his PNEPEs while consciously holding his breath. Normal video-EEG monitoring; the patient's volitional and deceptive acts to fabricate the appearance of illness, despite pain and personal endangerment; and the absence of reward other than remaining in a sick role were all consistent with a diagnosis of factitious disorder.

  16. Gastroesophageal reflux in morbidly obese patients treated with gastric banding or vertical banded gastroplasty.

    PubMed Central

    Ovrebø, K K; Hatlebakk, J G; Viste, A; Bassøe, H H; Svanes, K

    1998-01-01

    OBJECTIVE: To compare gastric banding (GB) and vertical banded gastroplasty (VBG) with respect to postsurgical gastroesophageal reflux (GER) and to investigate the role of preexisting hiatus hernia. SUMMARY BACKGROUND DATA: GB and VBG have for a long time been used in the treatment of morbidly obese patients. The introduction of laparoscopic techniques has renewed the interest in these operations. The long-term results after GB have, however, been poor. VBG was suggested to have antireflux properties because it involves repositioning and retaining the gastroesophageal junction within the abdomen and constructing an elongated intraabdominal tube. METHODS: Forty-three morbidly obese patients accepted for GB or VBG were evaluated for GER before and at regular intervals after surgery. All patients were questioned about adverse symptoms and need for antireflux medication. Both before and after surgery, 24-hour pH measurement and upper gastrointestinal endoscopies were performed. RESULTS: The prevalence of heartburn and acid regurgitation among patients treated with GB increased from 14% and 13% to 63% and 69%, respectively. Heartburn and acid regurgitation were present before surgery in 32% and 23% of patients treated with VBG, percentages unchanged by the procedure. The 24-hour reflux time increased significantly from 6.4% to 30.9% in patients treated with GB but was essentially unchanged in patients treated with VBG. The prevalence of esophagitis after GB and VBG was 75% and 20%. Acid inhibitors were needed in 81% of patients after GB and 29% of patients after VBG. CONCLUSIONS: The prevalence of GER was unchanged by VBG, but VBG did not demonstrate antireflux properties. The incidence of GER increased markedly after GB. PMID:9671066

  17. Episodic Memory: A Comparative Approach

    PubMed Central

    Martin-Ordas, Gema; Call, Josep

    2013-01-01

    Historically, episodic memory has been described as autonoetic, personally relevant, complex, context-rich, and allowing mental time travel. In contrast, semantic memory, which is theorized to be free of context and personal relevance, is noetic and consists of general knowledge of facts about the world. The field of comparative psychology has adopted this distinction in order to study episodic memory in non-human animals. Our aim in this article is not only to reflect on the concept of episodic memory and the experimental approaches used in comparative psychology to study this phenomenon, but also to provide a critical analysis of these paradigms. We conclude the article by providing new avenues for future research. PMID:23781179

  18. [Differencial diagnosis of gastroesophageal reflux disease -- eosinophilic esophagitis: case report].

    PubMed

    Franzius, M; Stolte, M; Porschen, R

    2005-04-01

    We report on a 22-year-old man with dysphagia and repeated bolus impaction in the esophagus for 10 years. Bolus impactions were frequently mobilised using an endoscope. At endoscopy, esophagitis IV degrees was described. After treatment with omeprazol there was no improvement. The patient was submitted to our hospital for fundoplication. pH-metry demonstrated an increased reflux. At endoscopy of the esophagus, we found red stripes which did not show the typical appearance of erosions. Manometry and X-ray films of the esophagus did not reveal any pathological findings. In combination with anamnesis, symptoms, and endoscopy, the diagnosis of eosinophilic esophagitis was documented by histology. After administration of oral corticosteroids a rapid improvement of the clinical symptoms was observed. The diagnosis of eosinophilic esophagitis should be kept in mind in patients with chronic symptoms of gastroesophageal reflux persisting despite medical therapy, pathological pH-metry and repeated bolus impactions.

  19. Hot electrons transverse refluxing in ultraintense laser-solid interactions.

    PubMed

    Buffechoux, S; Psikal, J; Nakatsutsumi, M; Romagnani, L; Andreev, A; Zeil, K; Amin, M; Antici, P; Burris-Mog, T; Compant-La-Fontaine, A; d'Humières, E; Fourmaux, S; Gaillard, S; Gobet, F; Hannachi, F; Kraft, S; Mancic, A; Plaisir, C; Sarri, G; Tarisien, M; Toncian, T; Schramm, U; Tampo, M; Audebert, P; Willi, O; Cowan, T E; Pépin, H; Tikhonchuk, V; Borghesi, M; Fuchs, J

    2010-07-02

    We have analyzed the coupling of ultraintense lasers (at ∼2×10{19}  W/cm{2}) with solid foils of limited transverse extent (∼10  s of μm) by monitoring the electrons and ions emitted from the target. We observe that reducing the target surface area allows electrons at the target surface to be reflected from the target edges during or shortly after the laser pulse. This transverse refluxing can maintain a hotter, denser and more homogeneous electron sheath around the target for a longer time. Consequently, when transverse refluxing takes places within the acceleration time of associated ions, we observe increased maximum proton energies (up to threefold), increased laser-to-ion conversion efficiency (up to a factor 30), and reduced divergence which bodes well for a number of applications.

  20. Update on childhood urinary tract infection and vesicoureteral reflux.

    PubMed

    Bell, Lorraine E; Mattoo, Tej K

    2009-07-01

    Urinary tract infection (UTI) is a leading cause of serious bacterial infection in young children. Vesicoureteral reflux (VUR), a common pediatric urologic disorder, is believed to predispose to UTI, and both are associated with renal scarring. The complex interaction of bacterial virulence factors and host defense mechanisms influence renal damage. However, some renal parenchymal abnormalities associated with VUR are noninfectious in origin. Long-term, renal parenchymal injury may be associated with hypertension, pregnancy complications, proteinuria, and renal insufficiency. Optimal management of VUR and UTI is controversial because of the paucity of appropriate randomized controlled trials; there is a need for well-designed studies. The recently launched Randomized Intervention for children with VesicoUreteral Reflux (RIVUR) study hopefully will provide insight into the role of antimicrobial prophylaxis of UTI in children with VUR.

  1. Migration of objects and inferences across episodes.

    PubMed

    Hannigan, Sharon L; Reinitz, Mark Tippens

    2003-04-01

    Participants viewed episodes in the form of a series of photographs portraying ordinary routines (e.g., eating at a restaurant) and later received a recognition test. In Experiment 1, it was shown that objects (e.g., a vase of flowers, a pewter lantern) that appeared in a single episode during the study phase migrated between memories of episodes described by the same abstract schema (e.g., from Restaurant Episode A at study to Restaurant Episode B at test), and not between episodes anchored by different schemas. In Experiment 2, it was demonstrated that backward causal inferences from one study episode influenced memories of other episodes described by the same schema, and that high-schema-relevant items viewed in one episode were sometimes remembered as having occurred in another episode of the same schematic type.

  2. Belching during gastroscopy and its association with gastroesophageal reflux disease.

    PubMed

    Lee, B S; Lee, S H; Jang, D K; Chung, K H; Hwang, J H; Jang, S E; Cha, B H; Ryu, J K; Kim, Y-T

    2016-05-01

    Belching may result from transient lower esophageal sphincter relaxation; therefore, it has been proposed that belching may be a manifestation of gastroesophageal reflux disease (GERD). This study was conducted to investigate the frequency of belching during esophagogastroduodenoscopy (EGD) and its association with GERD. A retrospective review was performed on prospectively collected clinical and endoscopic data from 404 subjects who underwent EGD without sedation from December 2012 to May 2013 in a training hospital in Korea. All detectable belching events during endoscopy were counted. Frequency and severity of belching events were compared between the group with and without GERD using an ordinal logistic regression model. There were 145 GERD patients (26 erosive reflux disease and 119 nonerosive reflux disease [NERD]). In the multivariable analysis, GERD was significantly associated with a higher frequency of belching events (odds ratio = 6.59, P < 0.001). Central obesity, female, and younger age were also risk factors for frequent belching during EGD. Subgroup analyses were performed in subjects without erosive reflux disease (n = 378) and NERD (n = 293). NERD was also a predictive factor for frequent belching during EGD (odds ratio = 6.61, P < 0.001), and the frequency of belching was significantly correlated with GERD severity according to the Los Angeles classification (P < 0.05). Frequent belching during EGD was associated with GERD, including NERD. Future research should focus on its adjuvant role in the diagnosis of GERD/NERD and the necessity for applying differentiated endoscopy strategies for GERD patients, leading to less discomfort during EGD in patients at risk for intolerability.

  3. Recent reflux receiver developments under the US DOE program

    NASA Astrophysics Data System (ADS)

    Andraka, C. E.; Diver, R. B.; Moreno, J. B.; Moss, T. A.; Adkins, D. R.

    The United States Department of Energy (DOE) Solar Thermal Program, through Sandia National Laboratories (SNL), is cooperating with industry to commercialize dish-Stirling technology. Sandia and the DOE have actively encouraged the use of liquid metal reflux receivers in these systems to improve efficiency and lower the levelized cost of electricity. The reflux receiver uses two-phase heat transfer as a 'thermal transformer' to transfer heat from a parabolic tracking-concentrator to the heater heads of the Stirling engine. The two-phase system leads to a higher available input temperature, lower thermal stresses, longer life, and independent design of the absorber and engine sections. Two embodiments of reflux receivers have been investigated: Pool boilers and heat pipes. Several pool-boiler reflux receivers have been successfully demonstrated on sun at up to 64 kWt throughput at SNL. In addition, a bench-scale device was operated for 7500 hours to investigate materials compatibility and boiling stability. Significant progress has also been made on heat pipe receiver technology. Sintered metal wick heat pipes have been investigated extensively for application to 7.5 kWe and 25 kWe systems. One test article has amassed over 1800 hours of on-sun operation. Another was limit tested at Sandia to 65 kWt throughput. These devices incorporate a nickel-powder thick wick structure with condensate return directly to the wick surface. Circumferential tubular arteries are optionally employed to improve the operating margin. In addition, DOE has begun a development program for advanced wick structures capable of supporting the Utility Scale Joint Venture Program, requiring up to 100 kWt throughput. Promising technologies include a brazed stainless steel powdered metal wick and a stainless steel metal felt wick. Bench-scale testing has been encouraging, and on-sun testing is expected this fall. Prototype gas-fired hybrid solar receivers have also been demonstrated.

  4. Design and testing of Ultralite Fabric Reflux Tubes

    SciTech Connect

    Pauley, K.A.; Antoniak, Z.I.; King, L.L.; Hollenberg, G.W. )

    1993-01-10

    This paper describes the design, fabrication, and testing of Ultralite Tubes intended to provide thermal management for habitat modules in a lunar colony. The Ultralite Fabric Reflux Tubes, under this phase of development, are constructed of thin-walled copper liners overwrapped with aluminoborosilicate fabric. These devices were constructed and tested in air at the Pacific Northwest Laboratory and subsequently taken to the NASA Johnson Space Center for thermal vacuum experimentation.

  5. Cough · 3: Chronic cough and gastro-oesophageal reflux

    PubMed Central

    Fontana, G; Pistolesi, M

    2003-01-01

    The pathogenesis and clinical features of gastro-oesophageal reflux related cough are complex and the diagnostic tests available are of limited reliability. Treatment needs to be tailored to the specific needs of individual patients and other possible causes of chronic cough should be investigated. Treatment should only be considered to have failed when cough persists after administration of proton pump inhibitors at an adequate dosage for a sufficient length of time. PMID:14645983

  6. Recent reflux receiver developments under the US DOE program

    SciTech Connect

    Andraka, C.E.; Diver, R.B.; Moreno, J.B.; Moss, T.A.; Adkins, D.R.

    1994-10-01

    The United States Department of Energy (DOE) Solar Thermal Program, through Sandia National Laboratories (SNL), is cooperating with industry to commercialize dish-Stirling technology. Sandia and the DOE have actively encouraged the use of liquid metal reflux receivers in these systems to improve efficiency and lower the levelized cost of electricity. The reflux receiver uses two-phase heat transfer as a {open_quotes}thermal transformer{close_quotes} to transfer heat from a parabolic tracking-concentrator to the heater heads of the Stirling engine. The two-phase system leads to a higher available input temperature, lower thermal stresses, longer life, and independent design of the absorber and engine sections. Two embodiments of reflux receivers have been investigated: Pool boilers and heat pipes. Several pool-boiler reflux receivers have been successfully demonstrated on sun at up to 64 kWt throughput at SNL. In addition, a bench-scale device was operated for 7500 hours to investigate materials compatibility and boiling stability. Significant progress has also been made on heat pipe receiver technology. Sintered metal wick heat pipes have been investigated extensively for application to 7.5 kWe and 25 kWe systems. One test article has a massed over 1800 hours of on-sun operation. Another was limit tested at Sandia to 65 kWt throughput. These devices incorporate a nickel-powder thick wick structure with condensate return directly to the wick surface. Circumferential tubular arteries are optionally employed to improve the operating margin. In addition, DOE has begun a development program for advanced wick structures capable of supporting the Utility Scale Joint Venture Program, requiring up to 100 kWt throughput. Promising technologies include a brazed stainless steel powdered metal wick and a stainless steel metal felt wick. Bench-scale testing has been encouraging, and on-sun testing is expected this fall. Prototype gas-fired hybrid solar receivers have also been.

  7. Fabrication of hydroxyapatite from fish bones waste using reflux method

    NASA Astrophysics Data System (ADS)

    Cahyanto, A.; Kosasih, E.; Aripin, D.; Hasratiningsih, Z.

    2017-02-01

    The aim of this present study was to investigate the fabrication of hydroxyapatites, which were synthesized from fish bone wastes using reflux method. The fish bone wastes collected from the restaurant were brushed and boiled at 100°C for 10 minutes to remove debris and fat. After drying, the fish bones were crushed, and ball milled into a fine powder. The fish bone wastes were then processed by refluxing using KOH and H3PO4 solutions. The samples were calcined at 900°C and characterized by X-Ray Diffraction (XRD) and Fourier Transform Infrared Spectrometry (FT-IR). The XRD pattern of samples after treatment revealed that the peak of hydroxyapatite was observed and the bands of OH- and PO4 3- were observed by FT-IR. The scanning electron microscope evaluation of sample showed the entangled crystal and porous structure of hydroxyapatite. In conclusion, the hydroxyapatite was successfully synthesized from fish bone wastes using reflux method.

  8. Impact of obesity treatment on gastroesophageal reflux disease.

    PubMed

    Khan, Abraham; Kim, Aram; Sanossian, Cassandra; Francois, Fritz

    2016-01-28

    Gastroesophageal reflux disease (GERD) is a frequently encountered disorder. Obesity is an important risk factor for GERD, and there are several pathophysiologic mechanisms linking the two conditions. For obese patients with GERD, much of the treatment effort is focused on weight loss and its consistent benefit to symptoms, while there is a relative lack of evidence regarding outcomes after novel or even standard medical therapy is offered to this population. Physicians are hesitant to recommend operative anti-reflux therapy to obese patients due to the potentially higher risks and decreased efficacy, and these patients instead are often considered for bariatric surgery. Bariatric surgical approaches are broadening, and each technique has emerging evidence regarding its effect on both the risk and outcome of GERD. Furthermore, combined anti-reflux and bariatric options are now being offered to obese patients with GERD. However, currently Roux-en-Y gastric bypass remains the most effective surgical treatment option in this population, due to its consistent benefits in both weight loss and GERD itself. This article aims to review the impact of both conservative and aggressive approaches of obesity treatment on GERD.

  9. Does surgery correct esophageal motor dysfunction in gastroesophageal reflux

    SciTech Connect

    Russell, C.O.; Pope, C.E.; Gannan, R.M.; Allen, F.D.; Velasco, N.; Hill, L.D.

    1981-09-01

    The high incidence of dysphagia in patients with symptomatic gastroesophageal reflux (GER) but no evidence of peptic stricture suggests esophageal motor dysfunction. Conventional methods for detecting dysfunction (radiologic and manometric examinations) often fail to detect abnormality in these patients. Radionuclide transit (RT), a new method for detecting esophageal motor dysfunction, was used to prospectively assess function in 29 patients with symptomatic GER uncomplicated by stricture before and three months after antireflux surgery (HILL). The preoperative incidence of dysphagia and esophageal dysfunction was 73% and 52%, respectively. During operation (Hill repair), intraoperative measurement of the lower esophageal sphincter pressure was performed and the LESP raised to levels between 45 and 55 mmHg. The preoperative lower esophageal sphincter pressure was raised from a mean of 8.6 mmHg, to mean of 18.5 mmHg after operation. No patient has free reflux after operation. Postoperative studies on 20 patients demonstrated persistence of all preoperative esophageal dysfunction despite loss of dysphagia. RT has demonstrated a disorder of esophageal motor function in 52% of patients with symptomatic GER that may be responsible for impaired esophageal clearance. This abnormality is not contraindication to surgery. The results indicate that construction of an effective barrier to reflex corrects symptoms of reflux, even in the presence of impaired esophageal transit. Radionuclide transit is a safe noninvasive test for assessment of esophageal function.

  10. Integrative Treatment of Reflux and Functional Dyspepsia in Children

    PubMed Central

    Yeh, Ann Ming; Golianu, Brenda

    2014-01-01

    Gastroesophageal reflux disease (GERD) and functional dyspepsia (FD) are common problems in the pediatric population, with up to 7% of school-age children and up to 8% of adolescents suffering from epigastric pain, heartburn, and regurgitation. Reflux is defined as the passage of stomach contents into the esophagus, while GERD refers to reflux symptoms that are associated with symptoms or complications—such as pain, asthma, aspiration pneumonia, or chronic cough. FD, as defined by the Rome III classification, is a persistent upper abdominal pain or discomfort, not related to bowel movements, and without any organic cause, that is present for at least two months prior to diagnosis. Endoscopic examination is typically negative in FD, whereas patients with GERD may have evidence of esophagitis or gastritis either grossly or microscopically. Up to 70% of children with dyspepsia exhibit delayed gastric emptying. Treatment of GERD and FD requires an integrative approach that may include pharmacologic therapy, treating concurrent constipation, botanicals, mind body techniques, improving sleep hygiene, increasing physical activity, and traditional Chinese medicine and acupuncture. PMID:27417471

  11. Tower microneedle minimizes vitreal reflux in intravitreal injection.

    PubMed

    Lee, Chang Yeol; You, Yong Sung; Lee, Sung Ho; Jung, Hyungil

    2013-10-01

    Intravitreal injection is widely used for easy control of drug levels in posterior segment of the eye by injecting the drug directly with hypodermic needles. Patients, however, often experience complications from intravitreal injection due to repeated injections, increased intraocular pressure, and infection. In addition, injected drug reflux after intravitreal injection makes it challenging to maintain predetermined drug dose due to the drug loss through backward effusions. Here, we described that the Tower Microneedle can reduce initial reflux and bleb formation due to its smaller outer diameter compared to a traditional hypodermic needle. Furthermore, we use phenylephrine hydrochloride for pupil expansion and demonstrated that Tower Microneedle induced similar pupil expansions using only half the drug volume, in the same period of time, compared to the 31 Gauge hypodermic needle. Consequently, Tower Microneedle achieves the same therapeutic effect in the vitreous body using fewer drugs than a traditional hypodermic needle due to the decreased backward drug effusion. Tower Microneedle described herein holds great promise for intravitreal injection with less reflux and lower drug dosage.

  12. [Aging-related physical and life style changes in the patients with reflux esophagitis].

    PubMed

    Uetake, T; Fujino, M A

    2000-09-01

    Incidence of reflux esophagitis(RE) has increased over the past 10 years in Japan, where aging of the population is rapidly progressing. The majority(73.6%) of the patients with RE consisted of non-elderly males having life style problems and of elderly females suffering from posture alterations. This suggested the importance of the disease onset among elderly female population in addition to that of the non-elderly male population. The risk factors specific to the elderly patients include not only persistent acid secretion and presbyesophagus, but also complication with orthopedic regression diseases with posture changes and osteoporosis. The association with the latter orthopedic regression diseases has been significantly increasing and is suggested to promote development of RE. Further increase in the prevalence of RE is foreseen in this aging-accelerating country.

  13. Myrtus communis L. Freeze-Dried Aqueous Extract Versus Omeprazol in Gastrointestinal Reflux Disease: A Double-Blind Randomized Controlled Clinical Trial.

    PubMed

    Zohalinezhad, Mohammad E; Hosseini-Asl, Mohammad Kazem; Akrami, Rahimeh; Nimrouzi, Majid; Salehi, Alireza; Zarshenas, Mohammad M

    2016-01-01

    The current work assessed a pharmaceutical dosage form of Myrtus communis L. (myrtle) in reflux disease compared with omeprazol via a 6-week double-blind randomized controlled clinical trial. Forty-five participants were assigned randomly to 3 groups as A (myrtle berries freeze-dried aqueous extract, 1000 mg/d), B (omeprazol capsules, 20 mg/d), and C (A and B). The assessment at the beginning and the end of the study was done by using a standardized questionnaire of frequency scale for the symptoms of gastroesophageal reflux disease (FSSG). In all groups, both reflux and dyspeptic scores significantly decreased in comparison with the respective baselines. Concerning each group, significant changes were found in FSSG, dysmotility-like symptoms and acid reflux related scores. No significant differences were observed between all groups in final FSSG total scores (FSSG2). Further studies with more precise design and larger sample size may lead to a better outcome to suggest the preparation as an alternative intervention.

  14. RAGG - R EPISODIC AGGREGATION PACKAGE

    EPA Science Inventory

    The RAGG package is an R implementation of the CMAQ episodic model aggregation method developed by Constella Group and the Environmental Protection Agency. RAGG is a tool to provide climatological seasonal and annual deposition of sulphur and nitrogen for multimedia management. ...

  15. Gender differences in episodic memory.

    PubMed

    Herlitz, A; Nilsson, L G; Bäckman, L

    1997-11-01

    The relationship between gender and memory has been largely neglected by research, despite occasional studies reporting gender differences in episodic memory performance. The present study examined potential gender differences in episodic memory, semantic memory, primary memory, and priming. Five hundred thirty women and 470 men, randomly sampled from the city of Umeå, Sweden, 35-80 years of age, participated in the study. There were no differences between men and women with regard to age or education, or on a measure of global intellectual functioning. As has been demonstrated previously, men out performed women on a visuospatial task and women outperformed men on tests of verbal fluency. In addition, the results demonstrated that women consistently performed at a higher level than did men on the episodic memory tasks, although there were no differences between men and women on the tasks assessing semantic memory, primary memory, or priming. The women's higher level of performance on the episodic memory tasks could not be fully explained by their higher verbal ability.

  16. Three-dimensional imaging of the lower esophageal sphincter in gastroesophageal reflux disease.

    PubMed Central

    Stein, H J; DeMeester, T R; Naspetti, R; Jamieson, J; Perry, R E

    1991-01-01

    The resistance of the lower esophageal sphincter to reflux of gastric juice is determined by the integrated effects of radial pressures exerted over the entire length of the sphincter. This can be quantitated by three-dimensional computerized imaging of sphincter pressures obtained by a pullback of radially oriented pressure transducers and by calculating the volume of this image, in other words, the sphincter pressure vector volume. Validation studies showed that sphincter imaging based on a stepwise pullback of a catheter with four or eight radial side holes is superior to a rapid motorized pullback. Compared with 50 healthy volunteers, the total and abdominal sphincter pressure vector volume was lower in 150 patients with increased esophageal acid exposure (p less than 0.001) and decreased with increasing esophageal mucosal damage (p less than 0.01). Calculation of the sphincter pressure vector volume was superior to standard techniques in identifying a mechanically defective sphincter as the cause of increased esophageal acid exposure, particularly in patients without mucosal damage. The Nissen and Belsey fundoplication increased the total and intra-abdominal sphincter pressure vector volume (p less than 0.001) and normalized the three-dimensional sphincter image. Failure to do so was associated with recurrent or persistent reflux. These data indicate that three-dimensional imaging of the lower esophageal sphincter improves the identification of patients who would benefit from an antireflux procedure. Analysis of the three-dimensional sphincter pressure profile should become the standard for evaluation of the lower esophageal sphincter. PMID:1953093

  17. Incidental vesicoureteral reflux in neonates with antenatally detected hydronephrosis and other renal abnormalities.

    PubMed

    Zerin, J M; Ritchey, M L; Chang, A C

    1993-04-01

    Postnatal imaging findings were reviewed in 130 neonates and young infants referred for imaging evaluation of antenatally detected renal abnormalities. All children underwent voiding cystourethrography and upper urinary tract imaging with sonography and/or renal scintigraphy. Vesicoureteral reflux was present in 49 patients (38%) and was bilateral in 24. All grades of reflux were observed. Reflux occurred in 41 of 98 neonates (42%) in whom postnatal imaging revealed persistent upper tract abnormalities (eg, hydronephrosis, cysts, renal agenesis) and in eight of 32 (25%) with normal findings at postnatal sonography and/or renal scintigraphy. Reflux was the single most common urologic diagnosis and was the only postnatal abnormality in 12 patients (9%). The authors conclude that neonates with antenatally detected hydronephrosis should be routinely screened for reflux with voiding cystography. Detection and aggressive management of reflux in the asymptomatic neonate in whom renal growth and function are unimpaired theoretically offer the best opportunity for preventing renal injury later in childhood.

  18. [Proton pump inhibitors in gastro-oesophageal reflux disease: what is the further step?].

    PubMed

    Simon, Mireille; Zerbib, Frank

    2013-01-01

    Optimisation of proton pump inhibitors use may improve reflux symptoms in 20-25% of the patients. Pathological gastro-oesophageal reflux should be documented in a patient with refractory reflux symptoms using upper endoscopy and/or pH testing. While on proton pump inhibitors twice daily, persistent symptoms are not related to gastro-oesophageal refluxdisease(GERD) in 50% of the patients. The new anti-reflux compounds have yet a limited efficacy and side effects that currently limit their development.

  19. Effect of GutsyGum(tm), A Novel Gum, on Subjective Ratings of Gastro Esophageal Reflux Following A Refluxogenic Meal.

    PubMed

    Brown, Rachel; Sam, Cecilia H Y; Green, Tim; Wood, Simon

    2015-06-01

    Chewing gum alleviates symptoms of gastro-esophageal reflux (GER) following a refluxogenic meal. GutsyGum(tm), a chewing gum developed to alleviate the symptoms of GER contains calcium carbonate, with a proprietary blend of licorice extract, papain, and apple cider vinegar (GiGs®). The efficacy of GutsyGum(tm) was determined in alleviating the symptoms of GER after a refluxogenic meal compared to placebo gum. This double-blind, placebo-controlled-crossover trial with a one-week washout between treatments had 24 participants with a history of GER consume a refluxogenic meal and then chew GutsyGum(tm) or placebo gum. Participants completed GER symptom questionnaires, consisting of symptom based 10 cm Visual Analogue Scales, immediately following the meal and then at regular intervals out to four hours postmeal. Adjusted mean ± SEM heartburn score (15-min postmeal to 240 min) was significantly lower in GutsyGum(tm) than in placebo gum treatment (0.81 ± 0.20 vs. 1.45 ± 0.20 cm; p = 0.034). Mean acid reflux score was significantly lower in GutsyGum(tm) than in placebo treatment (0.72 ± 0.19 vs. 1.46 ± 0.19 cm; p = 0.013). There were no significant differences for any of the secondary outcomes. However, pain approached significance with less pain reported in GutsyGum(tm) versus placebo treatment (0.4 ± 0.2 vs. 0.9 ± 0.2 cm; p = 0.081). Although nausea (p = 0.114) and belching (p = 0.154) were lower following GutsyGum(tm), the difference was not statistically significant. GutsyGum(tm) is more effective than a placebo gum in alleviating primary symptoms of heartburn and acid reflux (Clinical Trial Registration: ACTRN12612000973819).

  20. Valproic Acid

    MedlinePlus

    Valproic acid is used alone or with other medications to treat certain types of seizures. Valproic acid is also used to treat mania (episodes of ... to relieve headaches that have already begun. Valproic acid is in a class of medications called anticonvulsants. ...

  1. Lack of association of IL8 gene polymorphisms with familial vesico-ureteral reflux.

    PubMed

    Kuroda, Seika; Puri, Prem

    2007-05-01

    Vesico-ureteral reflux (VUR) is the most common inherited disorder of the lower urinary tract. Children with VUR are at risk for ongoing renal damage with subsequent infections. IL8 is an important inflammatory mediator which can be produced by epithelial cells of the renal tract in response to a variety of inflammatory stimuli. High serum concentrations of IL-8 have been reported in patients with chronic renal failure. Elevated IL-8 levels have been reported in the urine of patients with VUR and renal parenchymal scarring (RPS). More recently it was reported that urine IL-8 levels remain elevated in infants with VUR even in the absence of a urinary tract infection (UTI). Increased IL-8 expression has been shown to be associated with polymorphism at position -251 (rs4073) of the IL-8 promoter. The aim of this study was to examine the association of IL-8 gene polymorphism with familial VUR in a cohort of 219 siblings from 109 families affected with VUR, the largest such cohort tested to date. RPS was assessed using dimercaptosuccinic acid scintigraphy. Genotyping was performed in 219 siblings with VUR (157 without RPS, 62 with RPS) and 292 controls for the position -251 of IL-8 gene by polymerase chain reaction with tetra primers and gel analysis. Genotype was compared using the chi square test. Statistical significance was taken as a value of P < 0.05. There were no significant differences in IL-8 -251 genotype frequency between VUR patients and controls. Similarly, gender, severity of VUR and renal parenchymal scarring had no effect on IL-8 -251 genotype frequency. Although IL-8 urinary levels have been reported to be elevated in VUR, our data indicate that IL-8 gene is not involved in the pathogenesis of familial VUR or reflux nephropathy.

  2. Fundoplication for Gastroesophageal Reflux Disease: Tips for Success.

    PubMed

    Patti, Marco G; Schlottmann, Francisco; Farrell, Timothy M

    2017-01-01

    Gastroesophageal reflux disease affects almost 20% of the population in the United States. Today, proton pump inhibitors are the most frequently prescribed drugs, with an estimated cost of 10 billion dollars per year. Although these medications control heartburn in the majority of patients, other symptoms such as regurgitation and respiratory symptoms often are not controlled, particularly in patients with large hiatal hernias. In these patients a properly performed laparoscopic fundoplication controls esophageal and extraesophageal symptoms and avoids life-long medical therapy. Key elements for the success of a fundoplication are careful patient selection, a complete preoperative evaluation, and a properly executed operation.

  3. Antibiotic prophylaxis and reflux: critical review and assessment

    PubMed Central

    Baquerizo, Bernarda Viteri

    2014-01-01

    The use of continuous antibiotic prophylaxis (CAP) was critical in the evolution of vesicoureteral reflux (VUR) from a condition in which surgery was the standard of treatment to its becoming a medically managed condition. The efficacy of antibiotic prophylaxis in the management of VUR has been challenged in recent years, and significant confusion exists as to its clinical value. This review summarizes the critical factors in the history, use, and investigation of antibiotic prophylaxis in VUR. This review provides suggestions for assessing the potential clinical utility of prophylaxis. PMID:25580258

  4. Complications of gastroesophageal reflux in patients with cystic fibrosis.

    PubMed

    Bendig, D W; Seilheimer, D K; Wagner, M L; Ferry, G D; Barrison, G M

    1982-04-01

    Seven patients with cystic fibrosis who had complications of gastroesophageal reflux including abdominal pain, peptic esophagitis, upper gastrointestinal hemorrhage, and esophageal stricture are described. We believe that these are gastrointestinal complications of CF and that they may be responsible for significant morbidity. The mechanical influence of a depressed diaphragm caused by hyperinflation, along with increased abdominal pressure with chronic coughing, may contribute to GER in CF. Early detection and treatment are important not only to prevent esophageal complications but also to increase the quality of life by relief of pain and by avoiding the resultant decrease in appetite, which can contribute to malnutrition.

  5. Urinary tract infection in the setting of vesicoureteral reflux

    PubMed Central

    Garcia-Roig, Michael L.; Kirsch, Andrew J.

    2016-01-01

    Vesicoureteral reflux (VUR) is the most common underlying etiology responsible for febrile urinary tract infections (UTIs) or pyelonephritis in children. Along with the morbidity of pyelonephritis, long-term sequelae of recurrent renal infections include renal scarring, proteinuria, and hypertension. Treatment is directed toward the prevention of recurrent infection through use of continuous antibiotic prophylaxis during a period of observation for spontaneous resolution or by surgical correction. In children, bowel and bladder dysfunction (BBD) plays a significant role in the occurrence of UTI and the rate of VUR resolution. Effective treatment of BBD leads to higher rates of spontaneous resolution and decreased risk of UTI. PMID:27408706

  6. Mothers' internal working models with infants with gastroesophageal reflux.

    PubMed

    Thoyre, S M

    1994-01-01

    Gastroesophageal reflux (GER) places infants both at biological risk and developmental risk. Care of an infant with GER requires an integration of the physiologic and developmental needs of the infant. The author explores the physiologic bases for GER, current treatment modalities impacting caregiver problem solving, and the potential impact of GER on infants' development of self-regulatory processes. The concept of internal working models is presented as a framework for nurses to use to individualize anticipatory guidance for parents of infants with GER.

  7. Planning Physical Education Lessons as Teaching "Episodes"

    ERIC Educational Resources Information Center

    Chatoupis, Constantine

    2016-01-01

    An "episode" is a unit of time within which teachers and students are working on the same objective and are engaged in the same teaching/learning style. The duration of each episode, as well as the number of them in a single lesson, may vary. Additionally, the multiple episodes of a lesson may have similar objectives, offer similar…

  8. Procedure for the semi-automatic detection of gastro-oesophageal reflux patterns in intraluminal impedance measurements in infants.

    PubMed

    Trachterna, M; Wenzl, T G; Silny, J; Rau, G; Heimann, G

    1999-04-01

    The diagnosis of gastro-oesophageal reflux (GOR) is of great interest for paediatric gastroenterologists. pH monitoring is the commonly used procedure for GOR diagnosis but a major amount of postprandial GOR is missed due to the mostly non-acidic gastric contents in infants. The multiple intraluminal impedance technique is based on the recording of the impedance changes during bolus transport inside the oesophagus. It is the first method which allows the pH-independent, long-term registration of GOR. The use of the impedance technology in clinical practice has been limited so far by the time-consuming, visual evaluation of the impedance traces. The new approach of a semi-automatic analysis of the impedance measurements allows the automated detection of reflux patterns. It is based on event marking and an optimised feature description of the impedance traces combined with a fuzzy system for pattern recognition. The classifier is developed and tested on 50 investigations in infants. Compared to the comprehensive, multiple visual evaluation the achieved precision is 75% sensitivity and 48% positive prediction. In comparison to a single visual evaluation the analysis of the automatically proposed patterns corresponds to a 96% reduction of the evaluation time with no loss of precision. Thus the applicability of the impedance technology is enhanced significantly. A combined measurement of pH and impedance gives evidence about the occurrence of GOR, its pH and the acidic exposure of the oesophagus.

  9. A Preliminary Study Into the Significance of Intrarenal Reflux in BK Virus Nephropathy After Kidney Transplantation

    PubMed Central

    Kawanishi, Kunio; Honda, Kazuho; Koike, Junki; Hattori, Motoshi; Fuchinoue, Shouhei; Tanabe, Kazunari; Oda, Hideaki; Nagashima, Yoji

    2016-01-01

    Background The BK virus typically colonizes the lower urinary tract and is the causative agent in BK virus nephropathy (BKVN), which can progress to allograft dysfunction and graft loss. Urinary reflux in kidney allografts is induced by vesicoureteral reflux or disturbances in intrarenal reflux (IRR), believed to be associated with BKVN. This study was designed to elucidate the relationship between BKVN and IRR. Methods We examined 30 renal transplant recipients histologically diagnosed with BKVN using anti-Simian virus 40 immunohistochemistry and 60 clinically matched control recipients. The BKVN patients were divided into stable (n = 12) and progressive (n = 18) groups according to allograft kidney function 1 year after diagnosis. Histological rejection scores according to the pathological classification of rejection in renal allografts (Banff classification), histological BKVN stages, and histological polyomavirus load levels (pvl) proposed by the Banff working group were evaluated. The IRR was quantified by histological reflux scores defined with retention and reflux of immunostained Tamm-Horsfall protein in renal tubules and glomeruli. Results Higher reflux scores were observed in the BKVN group compared with that in the control group. No differences in clinical parameters were observed between the BKVN and control groups. Reflux scores and pvl were significantly higher in the progressive group than in the stable BKVN group with no significant difference in BK stage observed between groups. Reflux scores were found to be significantly correlated with pvl. Conclusions Our preliminary study suggested that IRR might be a predisposing and prognostic factor in BKVN. PMID:27500256

  10. Improvements of deep vein reflux following radiofrequency ablation for saphenous vein incompetence.

    PubMed

    Kim, Suh Min; Jung, In Mok; Chung, Jung Kee

    2017-02-01

    Objectives The aim of this study was to describe the changes of deep vein reflux after radiofrequency ablation for great saphenous vein incompetence. Method The data on 139 limbs which were treated with radiofrequency ablation for great saphenous vein incompetence were prospectively collected and reviewed. Results Deep vein reflux was present in 43 of 139 limbs (30.9%). There were no significant differences in the rate of successful closure, the incidence of procedure-related complications, and the improvements of symptoms and quality of life between the limbs with or without deep vein reflux. With a mean follow-up of 5.9 months, the peak reflux velocity and duration of reflux were improved in all limbs with deep vein reflux and it was completely corrected in 13 limbs (30.2%) after radiofrequency ablation. Conclusions The presence of deep vein reflux does not affect the treatment outcomes of radiofrequency ablation for great saphenous vein incompetence and is improved in all patients. Deep vein reflux is not a barrier to performing radiofrequency ablation.

  11. The Effect of Helicobacter Pylori on Gastroesophageal Reflux Disease

    PubMed Central

    Polat, Sabriye

    2012-01-01

    Background and Objectives: Helicobacter pylori infection represents one of the most common and medically prominent infections worldwide. Gastroesophageal reflux disease (GERD) has a multifactorial etiology. The nature of the relationship between Helicobacter pylori infection (HP) and reflux esophagitis is still not clear. This study is designed to find the influence of HP on GERD. Patients and Methods: The study was conducted retrospectively at Sakarya Newcity Hospital between January 2006 and January 2009. Data were collected on patient's age, sex, weight, the grade of GERD and the severity of HP. Results: There were 1,307 women and 1,135 men in this review with a mean age of 39,54 (range, 17 to 70) years. Helicobacter pylori positive (1 to 3 severity) was frequently seen in patients with GERD. A statistically significant relationship was found between HP positivity and the grade of GERD. The Helicobacter pylori infection (1 to 3 severity) was found in 1,437 (82.5%) of patients with GERD in our series. Conclusions: Controversy still exists about the association between GERD and HP infection. Based on our findings, significant evidence suggests the potential role of HP infection in the development of GERD. Also, the current data provide sufficient evidence to define the relationship between GERD and HP infection. PMID:23477175

  12. Episodic Memories in Anxiety Disorders: Clinical Implications

    PubMed Central

    Zlomuzica, Armin; Dere, Dorothea; Machulska, Alla; Adolph, Dirk; Dere, Ekrem; Margraf, Jürgen

    2014-01-01

    The aim of this review is to summarize research on the emerging role of episodic memories in the context of anxiety disorders (AD). The available literature on explicit, autobiographical, and episodic memory function in AD including neuroimaging studies is critically discussed. We describe the methodological diversity of episodic memory research in AD and discuss the need for novel tests to measure episodic memory in a clinical setting. We argue that alterations in episodic memory functions might contribute to the etiology of AD. We further explain why future research on the interplay between episodic memory function and emotional disorders as well as its neuroanatomical foundations offers the promise to increase the effectiveness of modern psychological treatments. We conclude that one major task is to develop methods and training programs that might help patients suffering from AD to better understand, interpret, and possibly actively use their episodic memories in a way that would support therapeutic interventions and counteract the occurrence of symptoms. PMID:24795583

  13. Is There Hope for Renal Growth on Imaging Studies Following Ureteral Reimplant for Boys With Fetal Hydronephrosis and Urinary Reflux?

    PubMed Central

    Wang, Ming-Hsien

    2015-01-01

    Reflux nephropathy is thought to be the etiology for renal maldevelopment. We present two boys with fetal hydronephrosis and sterile vesicoureteral reflux (VUR). There was lack of renal growth of the refluxing renal units on surveillance renal ultrasound. Parents elected to undergo open ureteral reimplants. Post-surgical ultrasounds demonstrated improved renal growth. PMID:26793522

  14. Reflux-free cannula for convection-enhanced high-speed delivery of therapeutic agents

    PubMed Central

    Krauze, Michal T.; Saito, Ryuta; Noble, Charles; Tamas, Matyas; Bringas, John; Park, John W.; Berger, Mitchel S.; Bankiewicz, Krystof

    2013-01-01

    Object Clinical application of the convection-enhanced delivery (CED) technique is currently limited by low infusion speed and reflux of the delivered agent. The authors developed and evaluated a new step-design cannula to overcome present limitations and to introduce a rapid, reflux-free CED method for future clinical trials. Methods The CED of 0.4% trypan blue dye was performed in agarose gel to test cannula needles for distribution and reflux. Infusion rates ranging from 0.5 to 50 μl/minute were used. Agarose gel findings were translated into a study in rats and then in cynomolgus monkeys (Macaca fascicularis) by using trypan blue and liposomes to confirm the efficacy of the reflux-free step-design cannula in vivo. Results of agarose gel studies showed reflux-free infusion with high flow rates using the step-design cannula. Data from the study in rats confirmed the agarose gel findings and also revealed increasing tissue damage at a flow rate above 5-μl/minute. Robust reflux-free delivery and distribution of liposomes was achieved using the step-design cannula in brains in both rats and nonhuman primates. Conclusions The authors developed a new step-design cannula for CED that effectively prevents reflux in vivo and maximizes the distribution of agents delivered in the brain. Data in the present study show reflux-free infusion with a constant volume of distribution in the rat brain over a broad range of flow rates. Reflux-free delivery of liposomes into nonhuman primate brain was also established using the cannula. This step-design cannula may allow reflux-free distribution and shorten the duration of infusion in future clinical applications of CED in humans. PMID:16304999

  15. Bluetongue in Belgium: episode II.

    PubMed

    Méroc, E; Herr, C; Verheyden, B; Hooyberghs, J; Houdart, P; Raemaekers, M; Vandenbussche, F; De Clercq, K; Mintiens, K

    2009-03-01

    Bluetongue (BT) is an arthropod-borne viral disease of ruminants. In August 2006, domestic ruminant populations in Northern Europe became infected with BT virus serotype 8 (BTV-8). The first BTV-8-case of the year 2007 in Belgium was notified in July. This case was the starting point of a second wave of BT outbreaks. The main objective of this study was to describe the evolution and the clinical impact of the second episode of BT in Belgium. In addition, the main differences with the previous episode (August-December 2006) are reported. Both outbreak and rendering plant data were analysed. Overall cumulative incidence at herd level was estimated at 11.5 (11.2-11.8) and 7.5 (7.3-7.8) per cent in cattle and sheep populations respectively. The findings went in favour of a negative association between within-herd prevalence in 2006 and the risk of showing clinical signs of BT in 2007 (via protective immunity). A high level of correlation was demonstrated between BT incidence and small ruminant mortality data when shifting the latter of 1-week backwards. This result supports the hypothesis that the high increase in small ruminant mortality observed in 2007 was the consequence of the presence of BT. For cattle, the correlation was not as high. An increase in cattle foetal mortality was also observed during the year 2007 and a fair correlation was found between BT incidence and foetal mortality.

  16. Episodic future thinking and episodic counterfactual thinking: intersections between memory and decisions.

    PubMed

    Schacter, Daniel L; Benoit, Roland G; De Brigard, Felipe; Szpunar, Karl K

    2015-01-01

    This article considers two recent lines of research concerned with the construction of imagined or simulated events that can provide insight into the relationship between memory and decision making. One line of research concerns episodic future thinking, which involves simulating episodes that might occur in one's personal future, and the other concerns episodic counterfactual thinking, which involves simulating episodes that could have happened in one's personal past. We first review neuroimaging studies that have examined the neural underpinnings of episodic future thinking and episodic counterfactual thinking. We argue that these studies have revealed that the two forms of episodic simulation engage a common core network including medial parietal, prefrontal, and temporal regions that also supports episodic memory. We also note that neuroimaging studies have documented neural differences between episodic future thinking and episodic counterfactual thinking, including differences in hippocampal responses. We next consider behavioral studies that have delineated both similarities and differences between the two kinds of episodic simulation. The evidence indicates that episodic future and counterfactual thinking are characterized by similarly reduced levels of specific detail compared with episodic memory, but that the effects of repeatedly imagining a possible experience have sharply contrasting effects on the perceived plausibility of those events during episodic future thinking versus episodic counterfactual thinking. Finally, we conclude by discussing the functional consequences of future and counterfactual simulations for decisions.

  17. Electrical stimulation for gastroesophageal reflux disease: current state of the art

    PubMed Central

    Kim, Sharon E; Soffer, Edy

    2016-01-01

    Patients with gastroesophageal reflux disease (GERD) who are not satisfied with acid suppression therapy can benefit primarily from fundoplication, a surgical intervention. Fundoplication has been the standard surgical procedure for GERD. It is effective but is associated with adverse effects, resulting in a declining number of interventions, creating a need for alternative interventions that are effective, yet have a better adverse effect profile. One such alternative involves the application of electrical stimulation to the lower esophageal sphincter. A number of animal studies showed that such stimulation can increase resting lower esophageal sphincter pressure. An acute human study confirmed this effect, and was followed by two open-label studies, with a follow-up of up to 3 years. Results thus far show that the therapy is associated with a significant improvement in symptoms, a significant reduction in esophageal acid exposure, and a very good safety profile. This review will describe the evolution of electrical stimulation therapy for GERD, as well as the safety and efficacy of this intervention. PMID:26834494

  18. Exploring the physiologic role of human gastroesophageal reflux by analyzing time-series data from 24-h gastric and esophageal pH recordings.

    PubMed

    Lu, Luo; Mu, John C; Sloan, Sheldon; Miner, Philip B; Gardner, Jerry D

    2014-07-16

    Our previous finding of a fractal pattern for gastric pH and esophageal pH plus the statistical association of sequential pH values for up to 2 h led to our hypothesis that the fractal pattern encodes information regarding gastric acidity and that depending on the value of gastric acidity, the esophagus can signal the stomach to alter gastric acidity by influencing gastric secretion of acid or bicarbonate. Under our hypothesis values of gastric pH should provide information regarding values of esophageal pH and vice versa. We used vector autoregression, a theory-free set of inter-related linear regressions used to measure relationships that can change over time, to analyze data from 24-h recordings of gastric pH and esophageal pH. We found that in pH records from normal subjects, as well as from subjects with gastroesophageal reflux disease alone and after treatment with a proton pump inhibitor, gastric pH values provided important information regarding subsequent values of esophageal pH and values of esophageal pH provided important information regarding subsequent values of gastric pH. The ability of gastric pH and esophageal pH to provide information regarding subsequent values of each other was reduced in subjects with gastroesophageal reflux disease compared to normal subjects. Our findings are consistent with the hypothesis that depending on the value of gastric acidity, the esophagus can signal the stomach to alter gastric acidity, and that this ability is impaired in subjects with gastroesophageal reflux disease.

  19. [VESICOURETERAL REFLUX INTO SMALL KIDNEY DIAGNOSTIC AND THERAPEUTIC PARADIGM].

    PubMed

    Korol'kova, I A; Kolobova, L M; Dutov, V V

    2015-01-01

    The causes of renal size reductionin children by 20 percent or more from the age norm include abnormalities of urodynamics of upper (UUT) and lower (LUT) urinary tract, combined with vesicoureteral reflux (VUR) and infra-vesical obstruction (IVO). Several issues regarding diagnosis and choice of treatment in children with small kidneys depending on the severity of functional abnormalities and the presence of comorbidities still remain controversial. 101 children with small kidneys accounting for 3.1% of the entire number of urologic patients admitted to the clinic were followed for 25 years. 78 (77.2%) patients were simultaneously diagnosed as having ipsilateral vesicoureteral reflux (VUR) (2.4% of the total number of hospitalized children). Moreover, contralateral VUR was found in 63% of patients. In 5.1% of children, anomalies of the contralateral kidney were identified: lumbar dystopia (3.8%), duplication of the renal pelvis and ureter (1.3%). Combination with IVO was found in 25.5% of cases. 75 (96%) children with vesicoureteral reflux into the small kidney were operated on. Reconstructive plastic surgery was made in 72 (92%) those patients. Indications for conservative management were identified in patients with intermittent VUR of I-II degree into small kidney or both kidneys. In case of detection of IVO, initial surgery was carried out to eliminate the obstruction. Conservative therapy was aimed at getting rid of the inflammatory process, restoring the function of kidney and bladder, and at the treatment of concomitant vulvovaginitis. In the absence of positive results of 6-8 months of conservative treatment or in case of the negative clinical course, the operation was considered justified. Indications for antireflux surgery were the failure of conservative therapy for intermittent VUR into small kidney or both kidneys, the presence of VUR of III-V degree into one or both kidneys. In cases of bilateral VUR antireflux surgery was performed simultaneously

  20. Controls on reflux dolomitisation of epeiric-scale ramps: Insights from reactive transport simulations of the Mississippian Madison Formation (Montana and Wyoming)

    NASA Astrophysics Data System (ADS)

    Gabellone, Tatyana; Whitaker, Fiona; Katz, David; Griffiths, Graham; Sonnenfeld, Mark

    2016-11-01

    Prediction of the geometry and petrophysical properties of dolomite geobodies depends on understanding both the hydrological system supplying reactive fluids and the chemistry of these fluids. However, patterns are complicated by the non-linear response of the diagenetic system to depositional texture, which controls both fluid flux via permeability architecture and reaction rate via effective surface area. This study explores interactions between extrinsic controls (spatial distribution of brine composition and temperature) and intrinsic controls (permeability and reactivity) using local and regional scale reactive transport models of sequential episodes of brine reflux that resulted in partial dolomitisation of the Mississippian Madison ramp. Inter-well scale models show preferential early dolomitisation of fine grained, more reactive beds. Pervasive dolomitisation can occur most readily beneath the brine pool where flow is perpendicular to bedding, and is most rapid at high brine fluxes. Down-dip of the brine pool, bedding-parallel flow is focused in relatively permeable coarse grained beds, providing reactants for strongly preferential alteration of intervening more reactive fine grained beds. In contrast, thicker sequences of fine grained beds dolomitise more slowly, limited by the rate of supply of magnesium. Regional-scale models, with injection of brines of increasing salinity towards the ramp interior, reproduce the observed pattern of dolomitisation. However, more realistic simulations in which reflux is driven by lateral density contrasts, generate flow rates orders of magnitude too low for significant dolomitisation. Simulations suggest pervasive dolomitisation of epeiric-scale ramps by a platform-wide reflux circulation, as often invoked, is not feasible. Rather, dolomitisation of such extensive systems critically requires local-scale flow systems, such as may result from topographically-controlled variations in restriction of platform-top seawater

  1. An Episodic Reddening of Triton

    NASA Astrophysics Data System (ADS)

    Pascu, D.; Rohde, J. R.; Seidelmann, P. K.; Wells, E. N.; Hershey, J. L.; Zellner, B. H.; Storrs, A. D.; Currie, D. G.; Bosh, A. S.

    1999-09-01

    In July of 1997 we obtained 39 HST images of Neptune and satellites in the BVI filters for photometric, as well as astrometric and dynamical studies. Our preliminary photometric reductions (Pascu et al. BAAS 30 1101, 1998) indicated leading/trailing brightness asymmetries for both Triton and Proteus, as well as a large color difference between the two moons. The color difference, in (B-V) and (V-I), implied an unusually blue color for Proteus, or a red color for Triton. However, HST/NICMOS observations indicate that Proteus is a red object (B.A. Smith 1998, Pers. Comm.), and Buratti et al. (BAAS 30 1107, 1998) report a reddening in Triton's spectrum in observations made in October, 1997. We have reanalyzed our observations, with results in substantial agreement with our earlier determinations. We are now left with the conclusion that we have observed an "episodic" reddening of Triton, of the type described by Buratti et al. (Icarus 110, 1994).

  2. Congenital renal damage associated with primary vesicoureteral reflux detected prenatally in male infants.

    PubMed

    Marra, G; Barbieri, G; Dell'Agnola, C A; Caccamo, M L; Castellani, M R; Assael, B M

    1994-05-01

    To assess the course of vesicoureteral reflux, we performed cystography, renal scintigraphy, and urography in all neonates with the prenatal diagnosis of renal pelvic dilation and revealed the presence of primary reflux (grades I to V) in 27 cases. Higher grades of reflux were associated with congenital renal damage, as shown by reduced tracer uptake during scintigraphy. Reflux was diagnosed more frequently in male infants (male/female ratio, 6:1), in many of whom bladder abnormalities were found by cystography. In another group of seven infants, in whom the reflux was associated with other urologic abnormalities, there was no sex prevalence. We conclude that severe primary reflux associated with hydronephrosis usually affects male infants and may be due to abnormal embryologic development of the male urethra, and that the kidney damage is primary and not the result of urinary tract infections. This pattern differs from that of vesicoureteric reflux diagnosed at an older age, which is observed most commonly in female patients.

  3. Gastroesophageal scintigraphy and endoscopy in the diagnosis of esophageal reflux and esophagitis

    SciTech Connect

    Fung, W.P.; Van der Schaaf, A.; Grieve, J.C.

    1985-04-01

    The value of gastroesophageal (G/E) scintigraphy in the diagnosis of gastroesophageal reflux was assessed in 51 subjects, who presented with heartburn and had endoscopic evidence of reflux esophagitis. G/E scintigraphy was done using /sup 99m/Tc sulfur-colloid in acidified orange juice. The G/E reflux index was calculated according to previous reports. The mean (+/- SD) G/E reflux index in 18 patients with severe esophagitis and 30 patients with moderate esophagitis were 1.6% (+/- 1.5) and 3.2% (+/- 5.0), respectively. The mean G/E reflux index in 14 control subjects was 2.4% (+/- 1.1). There was no significant difference between the esophagitis and control groups. Furthermore, if 4% was taken as upper limit of normal, this will include almost all the esophagitis patients and controls. It is concluded that the G/E reflux index based on G/E scintigraphy is of little value in the diagnosis of G/E reflux.

  4. The Role of Sleep in the Modulation of Gastroesophageal reflux and Symptoms in NICU Neonates

    PubMed Central

    Qureshi, Aslam; Malkar, Manish; Splaingard, Mark; Khuhro, Abdul; Jadcherla, Sudarshan

    2015-01-01

    Background Newborns sleep about 80% of the time. Gastroesophageal reflux (GER) disease is prevalent in about 10% of NICU infants. Concurrent polysomnography and pH-impedance studies clarify relationship of GER with sleep. Aims To characterize spatio-temporal and chemical characteristics of impedance-positive GER and define symptom associations in sleep and wake states in symptomatic neonates. We hypothesized that frequency of impedance-positive GER events and their association with cardiorespiratory symptoms is greater during sleep. Methods Eighteen neonates underwent concurrent polysomnography with pH-impedance study. Impedance-positive GER events (weakly acidic or acidic) were categorized between sleep vs. wake states: Symptom Index = # of symptoms with GER/total symptoms*100, Symptom Sensitivity Index = # of GER with symptoms/Total GER*100 and Symptom Association Probability = [(1-Probability of observed association between reflux and symptoms)*100]). Results We analyzed 317 GER events during 116 hours of polysomnography. During wake vs. sleep respectively, the median (interquartile range) frequency of impedance-positive GER was 4.9(3.1–5.8) vs. 1.4(0.7–1.7)events/hour (P<0.001), proximal migration was 2.6(0.8–3.3) vs. 0.2(0.0–0.9)events/hour (P<0.001); Symptom Index for cardiorespiratory symptoms for impedance-positive events was 22.5 (0–55.3) vs. 6.1(0–13), P=0.04 while Symptom Sensitivity Index was 9.1(0–23.1) vs. 18.4 (0–50), P=0.04 though Symptom Association Probability was similar, (P=0.68). Conclusions Contrary to our hypothesis, frequency of GER in sleep is lesser; however, spatio-temporal and chemical characteristics of GER and symptom generation mechanisms are distinct. For cardiorespiratory symptoms during sleep, lower Symptom Index entails evaluation for etiologies other than GER disease, higher Symptom Sensitivity Index implies heightened esophageal sensitivity and similar Symptom Association Probability indicates other mechanistic

  5. Gastroesophageal reflux disease and non-digestive tract diseases.

    PubMed

    Chen, Ying

    2015-05-01

    Over the past decade, incidence of gastroesophageal reflux disease (GERD) showed an increasing trend resulting from factors, including lifestyle and dietary habits; however, both etiology and pathological mechanisms remain controversial. GERD occurs as a result of a variety of mechanisms and there is no single factor. Symptoms of GERD are often non-typical, with a likelihood of being overlooked by non-gastroenterology professionals. Therefore, improving GERD awareness in non-gastroenterology practitioners, along with early diagnosis and treatment, provide potential benefit to clinicians and patients alike. Increasing evidence suggests GERD has specific connections with a variety of non-digestive tract conditions, may contribute an aggravating compounding effect on other diseases, prolong hospitalization, and increase subsequent medical costs. This review considers and emphasizes the association between GERD and non-digestive tract conditions, including atrial fibrillation, chronic obstructive pulmonary disease, primary pulmonary fibrosis and energy metabolism related to diet.

  6. Effectiveness of voice therapy in reflux-related voice disorders.

    PubMed

    Vashani, K; Murugesh, M; Hattiangadi, G; Gore, G; Keer, V; Ramesh, V S; Sandur, V; Bhatia, S J

    2010-01-01

    Gastroesophageal reflux (GER) with laryngopharyngeal reflux plays a significant role in voice disorders. A significant proportion of patients attending ear, nose, and throat clinics with voice disorders may have gastroesophageal reflux disease (GERD). There is no controlled study of the effect of voice therapy on GERD. We assessed the effect of voice therapy in patients with dysphonia and GERD. Thirty-two patients with dysphonia and GERD underwent indirect laryngoscopy and voice analysis. Esophageal and laryngeal symptoms were assessed using the reflux symptom index (RSI). At endoscopy, esophagitis was graded according to Los Angeles classification. Patients were randomized to receive either voice therapy and omeprazole (20 mg bid) (n=16, mean [SD] age 36.1 [9.6] y; 5 men; Gp A) or omeprazole alone (n=16, age 31.8 [11.7] y; 9 men; Gp B). During voice analysis, jitter, shimmer, harmonic-to-noise ratio (HNR) and normalized noise energy (NNE) were assessed using the Dr. Speech software (version 4 1998; Tigers DRS, Inc). Hoarseness and breathiness of voice were assessed using a perceptual rating scale of 0-3. Parameters were reassessed after 6 weeks, and analyzed using parametric or nonparametric tests as applicable. In Group A, 9 patients had Grade A, 3 had Grade B, and 1 had Grade C esophagitis; 3 had normal study. In Group B, 8 patients had Grade A, 2 had Grade B esophagitis, and 6 had normal study. Baseline findings: median RSI scores were comparable (Group A 20.0 [range 14-27], Group B 19.0 [15-24]). Median rating was 2.0 for hoarseness and breathiness for both groups. Values in Groups A and B for jitter 0.5 (0.6) versus 0.5 (0.8), shimmer 3.1 (2.5) versus 2.8 (2.0), HNR 23.0 (5.6) versus 23.1 (4.2), and NNE -7.3 (3.2) versus -7.2 (3.4) were similar. Post-therapy values for Groups A and B: RSI scores were 9.0 (5-13; P<0.01 as compared with baseline) and 13.0 (10-17; P<0.01), respectively. Ratings for hoarseness and breathiness were 0.5 (P<0.01) and 1.0 (P<0

  7. The Quality of Care for Gastroesophageal Reflux Disease.

    PubMed

    Yadlapati, Rena; Dakhoul, Lara; Pandolfino, John E; Keswani, Rajesh N

    2017-03-01

    Improving the quality of healthcare delivery is a cornerstone of modern medical care shared between all stakeholders. However, effectively improving quality requires both an understanding of the tenets of healthcare quality and how they relate to an individual disease process. This is especially important for common diseases, such as gastroesophageal reflux disease (GERD), where wide variations in practice exist. The high prevalence of GERD coupled with wide variation in clinical approach results in significant economic burden and poor quality of care. Thus, GERD serves as a useful framework to highlight the opportunities and current challenges of delivering high-quality care. In this article, we identify quality metrics in GERD and the areas in need of research to improve the quality of the management of GERD. Additionally, we suggest strategies for improvement as it relates to the proper diagnostic testing utilization and the decision-making process.

  8. Massive reflux and aspiration after radiographically inserted gastrostomy tube placement.

    PubMed

    Chesoni, Sandra A; Bach, John R; Okamura, Erica Mia

    2015-01-01

    To the authors' knowledge, fatal postgastrostomy aspiration within 2 days of enteral nutrition has not been reported. The authors report consecutive cases of severe postgastrotomy aspiration with one being fatal for a 26-yr-old with Duchenne muscular dystrophy 2 days after initiation of gastrostomy feedings. Previous to these consecutive radiographically inserted gastrostomies, all gastrotomies at the institution were percutaneous endoscopic gastrostomies or open gastrostomies. Radiographically inserted gastrostomy tubes have an increased likelihood of being oriented toward the esophagus as opposed to the duodenum, which may increase the risk for reflux. Elimination of invasive airway tubes should be delayed until after gastrostomy feedings are documented to be well tolerated. Oximetry and repeated measurements of vital capacity can suggest changes in the status of airway clearance.

  9. Neopylorus: a functional reflux-free gastroenteral anastomosis.

    PubMed

    Eloff, S J

    1992-10-01

    To minimize the loss of pyloric function associated with partial gastrectomy (PG), a functional surrogate pylorus, or neopylorus, was made by means of a pantaloon jejunoplastic pouch into which the gastrojejunal stoma was invaginated. This report concerns a consecutive series of 84 patients who underwent PG according to currently accepted criteria. The results showed that formation of the neopylorus apparently prevents dumping and may avoid the necessity for vagotomy in cases without serious hypersecretion. PG patients with a neopylorus formed over 13 years ago still exhibit no enterogastric reflux, gastritis, anaemia, steatorrhoea or sequelae of impaired digestion. Patient satisfaction has been most encouraging. Because this report is a feasibility trial only, no statistical analysis is presented.

  10. Nonpharmacological Management of Gastroesophageal Reflux in Preterm Infants

    PubMed Central

    Corvaglia, Luigi; Arcuri, Santo; Rossini, Roberto; Faldella, Giacomo

    2013-01-01

    Gastroesophageal reflux (GOR) is very common among preterm infants, due to several physiological mechanisms. Although GOR should not be usually considered a pathological condition, its therapeutic management still represents a controversial issue among neonatologists; pharmacological overtreatment, often unuseful and potentially harmful, is increasingly widespread. Hence, a stepwise approach, firstly promoting conservative strategies such as body positioning, milk thickening, or changes of feeding modalities, should be considered the most advisable choice in preterm infants with GOR. This review focuses on the conservative management of GOR in the preterm population, aiming to provide a complete overview, based on currently available evidence, on potential benefits and adverse effects of nonpharmacological measures. Nonpharmacological management of GOR might represent a useful tool for neonatologists to reduce the use of antireflux medications, which should be limited to selected cases of symptomatic babies. PMID:24073393

  11. A physiologic approach to laparoscopic fundoplication for gastroesophageal reflux disease.

    PubMed Central

    Hunter, J G; Trus, T L; Branum, G D; Waring, J P; Wood, W C

    1996-01-01

    OBJECTIVE: The authors examined indications, evaluations, and outcomes after laparoscopic fundoplication in patients with gastroesophageal reflux through this single-institution study. SUMMARY OF BACKGROUND DATA: Laparoscopic fundoplication has been performed for less than 5 years, yet the early and intermediate results suggest that this operation is safe and equivalent in efficacy to open techniques of antireflux surgery. METHODS: Over a 4-year period, 300 patients underwent laparoscopic Nissen fundoplication (252) or laparoscopic Toupet fundoplication (48) for gastroesophageal reflux refractory to medical therapy or requiring daily therapy with omeprazole or high-dose H2 antagonists. Preoperative evaluation included symptom assessment, esophagogastroduodenoscopy, 24-hour pH evaluation, and esophageal motility study. Physiologic follow-up included 24-hour pH study and esophageal motility study performed 6 weeks and 1 to 3 years after operation. RESULTS: The most frequent indication for surgery was the presence of residual typical and atypical gastroesophageal reflux symptoms (64%) despite standard doses of proton pump inhibitors. At preoperative evaluation, 51% of patients had erosive esophagitis, stricture, or Barrett's metaplasia. Ninety-eight percent of patients had an abnormal 24-hour pH study. Seventeen percent had impaired esophageal motility and 2% had aperistalsis. There were four conversions to open fundoplication (adhesions, three; large liver, one). Intraoperative technical difficulties occurred in 19(6%) patients and were dealt with intraoperatively in all but 1 patient (bleeding from enlarged left liver lobe). Minor complications occurred in 6% and major complications in 2%. There was no mortality. Median follow-up was 17 months. One year after operation, heartburn was absent in 93%. Four percent took occasional H2 antagonists, and 3% were back on daily therapy. Atypical reflux symptoms (e.g., asthma, hoarseness, chest pain, or cough) were eliminated

  12. Episodic Accretion in Young Stars

    NASA Astrophysics Data System (ADS)

    Audard, M.; Ábrahám, P.; Dunham, M. M.; Green, J. D.; Grosso, N.; Hamaguchi, K.; Kastner, J. H.; Kóspál, Á.; Lodato, G.; Romanova, M. M.; Skinner, S. L.; Vorobyov, E. I.; Zhu, Z.

    In the last 20 years, the topic of episodic accretion has gained significant interest in the star-formation community. It is now viewed as a common, although still poorly understood, phenomenon in low-mass star formation. The FU Orionis objects (FUors) are long-studied examples of this phenomenon. FU Orionis objects are believed to undergo accretion outbursts during which the accretion rate rapidly increases from typically 10-7 to a few 10-4 M⊙ yr-1, and remains elevated over several decades or more. EXors, a loosely defined class of pre-main-sequence stars, exhibit shorter and repetitive outbursts, associated with lower accretion rates. The relationship between the two classes, and their connection to the standard pre-main-sequence evolutionary sequence, is an open question: Do they represent two distinct classes, are they triggered by the same physical mechanism, and do they occur in the same evolutionary phases? Over the past couple of decades, many theoretical and numerical models have been developed to explain the origin of FUor and EXor outbursts. In parallel, such accretion bursts have been detected at an increasing rate, and as observing techniques improve, each individual outburst is studied in increasing detail. We summarize key observations of pre-main-sequence star outbursts, and review the latest thinking on outburst triggering mechanisms, the propagation of outbursts from star/disk to disk/jet systems, the relation between classical EXors and FUors, and newly discovered outbursting sources — all of which shed new light on episodic accretion. We finally highlight some of the most promising directions for this field in the near- and long-term.

  13. Role of tight junction proteins in gastroesophageal reflux disease

    PubMed Central

    2012-01-01

    Background Gastroesophageal reflux disease (GERD) is associated with impaired epithelial barrier function that is regulated by cell-cell contacts. The aim of the study was to investigate the expression pattern of selected components involved in the formation of tight junctions in relation to GERD. Methods Eighty-four patients with GERD-related symptoms with endoscopic signs (erosive: n = 47) or without them (non-erosive: n = 37) as well as 26 patients lacking GERD-specific symptoms as controls were included. Endoscopic and histological characterization of esophagitis was performed according to the Los Angeles and adapted Ismeil-Beigi criteria, respectively. Mucosal biopsies from distal esophagus were taken for analysis by histopathology, immunohistochemistry and quantitative reverse-transcription polymerase chain reaction (RT-PCR) of five genes encoding tight junction components [Occludin, Claudin-1, -2, Zona occludens (ZO-1, -2)]. Results Histopathology confirmed GERD-specific alterations as dilated intercellular spaces in the esophageal mucosa of patients with GERD compared to controls (P < 0.05). Claudin-1 and −2 were 2- to 6-fold upregulation on transcript (P < 0.01) and in part on protein level (P < 0.015) in GERD, while subgroup analysis of revealed this upregulation for ERD only. In both erosive and non-erosive reflux disease, expression levels of Occludin and ZO-1,-2 were not significantly affected. Notably, the induced expression of both claudins did not correlate with histopathological parameters (basal cell hyperplasia, dilated intercellular spaces) in patients with GERD. Conclusions Taken together, the missing correlation between the expression of tight junction-related components and histomorphological GERD-specific alterations does not support a major role of the five proteins studied in the pathogenesis of GERD. PMID:22994974

  14. Bioelectric Impedance Analysis in the Diagnosis of Vesicoureteral Reflux

    PubMed Central

    Bayram, Meral Torun; Alaygut, Demet; Turkmen, Mehmet; Soylu, Alper; Kavukcu, Salih

    2015-01-01

    Background: Vesicoureteral reflux (VUR) is a common abnormality of the urinary tract in childhood. Objectives: As urine enters the ureters and renal pelvis during voiding in vesicoureteral reflux (VUR), we hypothesized that change in body water composition before and after voiding may be less different in children with VUR. Patients and Methods: Patients were grouped as those with VUR (Group 1) and without VUR (Group 2). Bioelectric impedance analysis was performed before and after voiding, and third space fluid (TSF) (L), percent of total body fluid (TBF%), extracellular fluid (ECF%), and intracellular fluid (ICF%) were recorded. After change of TSF, TBF, ECF, ICF (ΔTSF, ΔTBF%, ΔECF%, ΔICF%), urine volume (mL), and urine volume/body weight (mL/kg) were calculated. Groups 1 and 2 were compared for these parameters. In addition, pre- and post-voiding body fluid values were compared in each group. Results: TBF%, ECF%, ICF%, and TSF in both pre- and post-voiding states and ΔTBF%, ΔECF%, ΔICF%, and ΔTSF after voiding were not different between groups. However, while post-voiding TBF%, ECF% was significantly decreased in Group 1 (64.5 ± 8.1 vs 63.7 ± 7.2, P = 0.013 for TBF%), there was not post-voiding change in TSF in the same group. On the other hand, there was also a significant TSF decrease in Group 2. Conclusions: Bladder and ureter can be considered as the third space. Thus, we think that BIA has been useful in discriminating children with VUR as there was no decreased in patients with VUR, although there was decreased TSF in patients without VUR. However, further studies are needed to increase the accuracy of this hypothesis. PMID:26396698

  15. Effect of stellate ganglion block on laryngopharyngeal reflux disease

    PubMed Central

    Chun, Hye Jung; Lee, Mi Soon; Ahn, Ki Ryang; Kim, Chun Sook; Kang, Kyu Sik; Yoo, Sie Hyeon; Chung, Jin Hun; Kim, Nan-Seol; Seo, Yong Han; Gong, Hyung Youn; Lee, Yong Man

    2013-01-01

    Background Laryngopharyngeal reflux (LPR) disease has many symptoms such as globus pharyngeus, excessive throat clearing and hoarseness. The aim of this study was to investigate the effect of stellate ganglion block (SGB) in addition to proton pump inhibitors (PPI) on LPR. Methods Fifty patients complaining of more than 3 typical LPR symptoms for over 3 months were enrolled in the study. The P group took PPI for 8 weeks. The SP group took PPI and interwent a series of 8 SGB procedure once a week during the period of treatment. The blocks were performed one at a time unilaterally on the right and left stellate ganglions by injecting 1% mepivacaine 6 ml. We evaluated the reflux symptom index (RSI) before treatment and following 4 weeks and 8 weeks of treatment in both groups. Results After 4 weeks of treatment, the RSI of the P group decreased, but not significantly, to 16.6 ± 6.8 compared with the baseline value of 19.2 ± 2.7 (P = 0.093), whereas the RSI of the SP group decreased significantly to 9.8 ± 3.3 compared with the baseline value of 19.0 ± 4.7 (P = 0.000). After 8 weeks of treatment, the RSI of the P group decreased significantly to 13.7 ± 6.7 (P = 0.001) and the RSI of the SP group also decreased significantly to 7.7 ± 3.4 (P = 0.000). There were significant differences in the RSI between the two groups after 4 weeks (P = 0.000) and 8 weeks (P = 0.001) of treatment. Conclusions The symptoms of LPR improved earlier when PPI therapy was combined with SGB compared with PPI therapy alone. PMID:23741567

  16. Systematic review: questionnaires for assessment of gastroesophageal reflux disease.

    PubMed

    Bolier, E A; Kessing, B F; Smout, A J; Bredenoord, A J

    2015-01-01

    Numerous questionnaires with a wide variety of characteristics have been developed for the assessment of gastroesophageal reflux disease (GERD). Four well-defined dimensions are noticeable in these GERD questionnaires, which are symptoms, response to treatment, diagnosis, and burden on the quality of life of GERD patients. The aim of this review is to develop a complete overview of all available questionnaires, categorized per dimension of the assessment of GERD. A systematic search of the literature up to January 2013 using the Pubmed database and the Embase database, and search of references and conference abstract books were conducted. A total number of 65 questionnaires were extracted and evaluated. Thirty-nine questionnaires were found applicable for the assessment of GERD symptoms, three of which are generic gastrointestinal questionnaires. For the assessment of response to treatment, 14 questionnaires were considered applicable. Seven questionnaires with diagnostic purposes were found. In the assessment of quality of life in GERD patients, 18 questionnaires were found and evaluated. Twenty questionnaires were found to be used for more than one assessment dimension, and eight questionnaires were found for GERD assessment in infants and/or children. A wide variety of GERD questionnaires is available, of which the majority is used for assessment of GERD symptoms. Questionnaires differ in aspects such as design, validation and translations. Also, numerous multidimensional questionnaires are available, of which the Reflux Disease Questionnaire is widely applicable. We provided an overview of GERD questionnaires to aid investigators and clinicians in their search for the most appropriate questionnaire for their specific purposes.

  17. Rabeprazole and esomeprazole in mild-to-moderate erosive gastroesophageal reflux disease: A comparative study of efficacy and safety

    PubMed Central

    Maiti, Rituparna; Jaida, Jyothirmai; Israel, P. L. John; Koyagura, Narendar; Mukkisa, Sruthi; Palani, Anuradha

    2011-01-01

    Objective: To compare the efficacy and safety of rabeprazole and esomeprazole in mild-to-moderate erosive gastroesophageal reflux disease (GERD). Materials and Methods: A randomized, single-blinded, outdoor-based clinical study was conducted on 60 patients of mild-to-moderate erosive GERD. After baseline clinical assessment and investigations, rabeprazole (40 mg) was prescribed to 30 patients and esomeprazole (40 mg) to another 30 patients for 4 weeks. The efficacy variables were change in GERD symptom scoring, endoscopic findings, and Quality of Life in Reflux and Dyspepsia (QOLRAD) scoring over 4 weeks. Result: Heartburn, acid regurgitation, and overall GERD symptom scoring (P = 0.01) were significantly decreased with rabeprazole in comparison to esomeprazole. The comparative study of all five domains of the QOLARD questionnaire including overall scoring revealed a statistically significant improvement in the rabeprazole group. Endoscopic findings in the rabeprazole group showed an absolute improvement of 30% and relative improvement of 55% over esomeprazole. Both the drugs were well tolerated having no significant difference in the incidence of adverse effects. Conclusion: Rabeprazole (40 mg) is a better choice for mild-to-moderate GERD compared with esomeprazole (40 mg) because of its better efficacy and safety profile. PMID:21897706

  18. The Role of Microaspiration in the Pathogenesis of Gastroesophageal Reflux-related Chronic Cough

    PubMed Central

    Özdemir, Pelin; Erdinç, Münevver; Vardar, Rukiye; Veral, Ali; Akyıldız, Serdar; Özdemir, Özer; Bor, Serhat

    2017-01-01

    Background/Aims Gastroesophageal reflux disease (GERD) is one of the main causes of chronic cough. We evaluated the role of microaspiration in the pathogenesis of reflux-related cough by determining the amount of lipid-laden macrophages (LLMs) in bronchoalveolar lavage (BAL) specimens. Methods A total of 161 cases of chronic cough were evaluated, and 36 patients (average age 48.2 years) were recruited for this single center prospective study. Patients with a history of smoking, angiotensin converting enzyme inhibitor usage, any abnormality on pulmonary function tests, abnormal chest X-rays, occupational or environmental exposures, or upper airway cough syndrome were excluded. GERD was evaluated by 24-hour esophageal impedance-pH monitoring. BAL specimens for LLM determination were obtained from 34 patients by flexible bronchoscopy. Results Patients with pathological intra-esophageal reflux according to multichannel intraluminal impedance and pH monitoring had higher LLM positivity in BAL specimens than patients without pathological reflux (8/14 in reflux positive group vs 1/22 in reflux negative group; P = 0.004). The BAL cell distribution was not different between the 2 groups (P = 0.574 for macrophages, P = 0.348 for lymphocytes, P = 0.873 for neutrophils and P = 0.450 for eosinophils). Conclusions Our results confirm the role of the microaspiration of refluxate in the pathogenetic mechanism of chronic cough. While bronchoscopy is indicated in patients with chronic cough, in addition to the routine airway evaluation, BAL and LLM detection should be performed. LLM can be used to diagnose aspiration in reflux-related chronic cough. Future studies are needed to evaluate the response to anti-reflux medications or surgery in patients with LLM positivity. PMID:27605525

  19. Impact of episodic thinking on altruism.

    PubMed

    Yi, Richard; Pickover, Alison; Stuppy-Sullivan, Allison M; Baker, Sydney; Landes, Reid D

    2016-07-01

    Episodic future thinking, which refers to the use of prospective imagery to concretely imagine oneself in future scenarios, has been shown to reduce delay discounting (enhance self-control). A parallel approach, in which prospective imagery is used to concretely imagine other's scenarios, may similarly reduce social discounting (i.e., enhance altruism). In study 1, participants engaged in episodic thinking about the self or others, in a repeated-measures design, while completing a social discounting task. Reductions in social discounting were observed as a function of episodic thinking about others, though an interaction with order was also observed. Using an independent-measures design in study 2, the effect of episodic thinking about others was replicated. Study 3 addressed a limitation of studies 1 and 2, the possibility that simply thinking about others decreased social discounting. Capitalizing on Construal Level Theory, which specifies that social distance and time in the future are both dimensions of a common psychological distance, we hypothesized that episodic future thinking should also decrease social discounting. Participants engaged in episodic future thinking or episodic present thinking, in a repeated-measures design, while completing a social discounting task. The pattern of results was similar to study 1, providing support for the notion that episodic thinking about psychologically distant outcomes (for others or in the future) reduces social discounting. Application of similar episodic thinking approaches may enhance altruism.

  20. [Esophageal diseases: gastroesophageal reflux disease, Barrett's esophagus, achalasia and eosinophilic esophagitis].

    PubMed

    Calvet, Xavier; Villoria, Albert

    2013-10-01

    Important new advances were presented in esophageal disease in Digestive Disease Week 2013. A highlight was confirmation of the high efficacy of weight loss to treat symptoms of reflux and an interesting pilot study suggesting that a simple ligature with supra- and infracardial bands could be an effective technique in esophageal reflux. If the excellent results and safety and efficacy of this technique are confirmed in the long term, it could revolutionize the management of gastroesophageal reflux disease. Also of note this year was the presentation of multiple studies validating a new technique, peroral endoscopic myotomy (POEM) for the endoscopic treatment of achalasia. This technique seems to have excellent efficacy and safety.

  1. Relief of Night-time Symptoms Associated With Gastroesophageal Reflux Disease Following 4 Weeks of Treatment With Pantoprazole Magnesium: The Mexican Gastroesophageal Reflux Disease Working Group

    PubMed Central

    Orr, William; Vargas-Romero, José Antonio; Remes-Troche, José María; Morales-Arámbula, Miguel; Soto-Pérez, Julio César; Mateos-Pérez, Gualberto; Sobrino-Cossío, Sergio; Teramoto-Matsubara, Oscar; López-Colombo, Aurelio; Orozco-Gamiz, Antonio; Saez-Ríos, Adolfo; Arellano-Plancarte, Araceli; Chiu-Ugalde, Jazmin; Tholen, Anne; Horbach, Silke; Lundberg, Lars; Fass, Ronnie

    2014-01-01

    Background/Aims To evaluate the effectiveness of pantoprazole magnesium (pantoprazole-Mg) 40 mg in the relief of esophageal and extra-esophageal symptoms of gastroesophageal reflux disease (GERD), particularly night-time symptoms. Methods Patients (aged 18-50 years) with 3-month history of heartburn and/or acid regurgitation plus at least one other symptom in the last week were enrolled in a nationwide, prospective and observational study in Mexico. Patients received pantoprazole-Mg 40 mg once daily during 4 weeks. Symptoms were assessed through a physician-administered structured interview and the patient-completed ReQuest in Practice™ questionnaire. Night-time GERD was defined as arousal from sleep during the night due to GERD-associated symptoms. Results Out of 4,343 patients included at basal visit, 3,665 were considered for the effectiveness per protocol analysis. At baseline, patients had a median of 8 GERD related symptoms. Patients with night-time GERD symptoms (42.7%) were more likely to have extra-esophageal symptoms (P < 0.001) than other GERD patients. Pantoprazole-Mg 40 mg once daily for 4 weeks improved a broad range of GERD-associated symptoms from baseline (80% reduction on physicians assessments; 68-77% reduction on ReQuest in Practice™ dimensions), including both day- and night-time GERD symptoms; improvements were the greatest for extra-esophageal symptoms in patients with night-time symptoms. Pantoprazole-Mg was well tolerated. Conclusions Pantoprazole-Mg 40 mg significantly improved a broad range of esophageal and extra-esophageal GERD related symptoms including sleep disturbances, as well as well-being, in patients with daytime or night-time GERD, making it a good option for patients with GERD, especially when extra-esophageal and night-time symptoms are present. PMID:24466446

  2. Episodic plate tectonics on Venus

    NASA Technical Reports Server (NTRS)

    Turcotte, Donald

    1992-01-01

    Studies of impact craters on Venus from the Magellan images have placed important constraints on surface volcanism. Some 840 impact craters have been identified with diameters ranging from 2 to 280 km. Correlations of this impact flux with craters on the Moon, Earth, and Mars indicate a mean surface age of 0.5 +/- 0.3 Ga. Another important observation is that 52 percent of the craters are slightly fractured and only 4.5 percent are embayed by lava flows. These observations led researchers to hypothesize that a pervasive resurfacing event occurred about 500 m.y. ago and that relatively little surface volcanism has occurred since. Other researchers have pointed out that a global resurfacing event that ceased about 500 MYBP is consistent with the results given by a recent study. These authors carried out a series of numerical calculations of mantle convection in Venus yielding thermal evolution results. Their model considered crustal recycling and gave rapid planetary cooling. They, in fact, suggested that prior to 500 MYBP plate tectonics was active in Venus and since 500 MYBP the lithosphere has stabilized and only hot-spot volcanism has reached the surface. We propose an alternative hypothesis for the inferred cessation of surface volcanism on Venus. We hypothesize that plate tectonics on Venus is episodic. Periods of rapid plate tectonics result in high rates of subduction that cool the interior resulting in more sluggish mantle convection.

  3. Prediction of episodic acidification in North-eastern USA: An empirical/mechanistic approach

    USGS Publications Warehouse

    Davies, T.D.; Tranter, M.; Wigington, P.J.; Eshleman, K.N.; Peters, N.E.; Van Sickle, J.; DeWalle, David R.; Murdoch, Peter S.

    1999-01-01

    Observations from the US Environmental Protection Agency's Episodic Response Project (ERP) in the North-eastern United States are used to develop an empirical/mechanistic scheme for prediction of the minimum values of acid neutralizing capacity (ANC) during episodes. An acidification episode is defined as a hydrological event during which ANC decreases. The pre-episode ANC is used to index the antecedent condition, and the stream flow increase reflects how much the relative contributions of sources of waters change during the episode. As much as 92% of the total variation in the minimum ANC in individual catchments can be explained (with levels of explanation >70% for nine of the 13 streams) by a multiple linear regression model that includes pre-episode ANC and change in discharge as independent variable. The predictive scheme is demonstrated to be regionally robust, with the regional variance explained ranging from 77 to 83%. The scheme is not successful for each ERP stream, and reasons are suggested for the individual failures. The potential for applying the predictive scheme to other watersheds is demonstrated by testing the model with data from the Panola Mountain Research Watershed in the South-eastern United States, where the variance explained by the model was 74%. The model can also be utilized to assess 'chemically new' and 'chemically old' water sources during acidification episodes.Observations from the US Environmental Protection Agency's Episodic Response Project (ERP) in the Northeastern United States are used to develop an empirical/mechanistic scheme for prediction of the minimum values of acid neutralizing capacity (ANC) during episodes. An acidification episode is defined as a hydrological event during which ANC decreases. The pre-episode ANC is used to index the antecedent condition, and the stream flow increase reflects how much the relative contributions of sources of waters change during the episode. As much as 92% of the total variation in

  4. Inducible nitric oxide synthase (iNOS) and nitric oxide (NO) are important mediators of reflux-induced cell signalling in esophageal cells.

    PubMed

    McAdam, E; Haboubi, H N; Forrester, G; Eltahir, Z; Spencer-Harty, S; Davies, C; Griffiths, A P; Baxter, J N; Jenkins, G J S

    2012-11-01

    Nitric oxide (NO) produced by inducible nitric oxide synthase (iNOS) has been implicated in both DNA damage induction and aberrant cell signalling in various tissue and cell backgrounds. We investigated here the role of iNOS and NO in DNA damage induction and nuclear factor-kappa B (NF-κB) signalling in esophageal cells in vitro. As esophageal adenocarcinoma develops in a background of Barrett's esophagus secondary to reflux disease, it is possible that inflammatory mediators like NO may be important in esophageal cancer development. We show that reflux components like stomach acid and bile acids [deoxycholic acid (DCA)] can induce iNOS gene and protein expression and produce NO generation in esophageal cells, using real-time PCR, western blotting and NO sensitive fluorescent probes, respectively. This up-regulation of iNOS expression was not dependent on NF-κB activity. DCA-induced DNA damage was independent of NF-κB and only partially dependent on iNOS and NO, as measured by the micronucleus assay. These same reflux constituents also activated the oncogenic transcription factor NF-κB, as measured by transcription factor enzyme-linked immunosorbent assay and gene expression studies with NF-κB linked genes (e.g. interleukin-8). Importantly, we show here for the first time that basal levels of NF-κB activity (and possibly acid and DCA-induced NF-κB) are dependent on iNOS/NO and this may lead to a positive feedback loop whereby induced iNOS is upstream of NF-κB, hence prolonging and potentially amplifying this signalling, presumably through NO activation of NF-κB. Furthermore, we confirm increased protein levels of iNOS in esophageal adenocarcinoma and, therefore, in neoplastic development in the esophagus.

  5. [Use of laparoscopic technic for treatment of patients with reflux diseases].

    PubMed

    Bobrzyński, A; Budzyński, A; Biesiada, Z

    2001-01-01

    Pathophysiology, symptomatology and diagnostic work-out in gastroesophageal reflux disease was presented. Treatment strategies and indication for surgery were discussed. Detailed description of the laparoscopic Nissen fundoplication was given. Complications, drawbacks and advantages of this procedure were discussed.

  6. Managing gastroesophageal reflux symptoms in the very low-birth-weight infant postdischarge.

    PubMed

    Sherrow, Tammy; Dressler-Mund, Donna; Kowal, Kelly; Dai, Susan; Wilson, Melissa D; Lasby, Karen

    2014-12-01

    Gastroesophageal reflux and gastroesophageal reflux disease symptoms are common challenges for very low-birth-weight infants (<1500 g). These symptoms frequently result in feeding difficulties and family stress. Management of symptoms across healthcare disciplines may not be based on current evidence, and inconsistency can result in confusion for families and delayed interventions. The feeding relationship between infant and caregivers may be impaired when symptoms are persistent and poorly managed. An algorithm for managing gastroesophageal reflux-like symptoms in very low-birth-weight infants (from hospital discharge to 12 months corrected age) was developed through the formation of a multidisciplinary community of practice and critical appraisal of the literature. A case study demonstrates how the algorithm results in a consistent approach for identifying symptoms, applying appropriate management strategies, and facilitating appropriate timing of medical consultation. Application to managing gastroesophageal reflux symptoms in the neonatal intensive care unit will be briefly addressed.

  7. Does dimethicone increase the efficacy of antacids in the treatment of reflux oesophagitis?

    PubMed

    Ogilvie, A L; Atkinson, M

    1986-10-01

    Dimethicone is a common additive to antacids, although its value in the treatment of reflux oesophagitis is unproven. Its efficacy was assessed by comparing the effect of a dimethicone-containing antacid gel (Asilone Gel) with a simple antacid gel in a double-blind trial in 45 patients with reflux oesophagitis. Thirty-eight patients completed the eight-week course of therapy. Antacid therapy alone resulted in a significant improvement of both symptoms and oesophagitis in gastro-oesophageal reflux. The inclusion of dimethicone in the antacid gel preparation did not confer any benefit in terms of symptomatic assessment but did confer a small advantage with regard to objective markers of oesophageal inflammation, suggesting that a dimethicone-containing antacid is of value in the treatment of symptomatic gastro-oesophageal reflux.

  8. Operative Treatments for Reflux After Bariatric Surgery: Current and Emerging Management Options.

    PubMed

    Treitl, Daniela; Nieber, Derek; Ben-David, Kfir

    2017-03-01

    Gastroesophageal reflux disease (GERD) is a common disorder that has a well-established connection with obesity. To ameliorate the morbidity associated with obesity, bariatric procedures have become an established pathway to accomplish sustained weight loss. In some procedures, such as with the Roux-en-Y gastric bypass surgery, weight loss is also accompanied by the resolution of GERD symptoms. However, other popular bariatric surgeries, such as the sleeve gastrectomy, have a controversial impact on their effect on reflux. Consequently, increased attention has been given to the development of strategies for the management of de novo or recurrent reflux after bariatric surgery. This article aims to discuss medical and surgical strategies for reflux after bariatric surgery, and their outcomes.

  9. Training Lessons Learned from Peak Performance Episodes.

    ERIC Educational Resources Information Center

    Fobes, James L.

    A major challenge confronting the United States Army is to obtain optimal performance from both its human and machine resources. This study examines episodes of peak performance in soldiers and athletes. Three cognitive components were found to enable episodes of peak performance: psychological readiness (activating optimal arousal and emotion…

  10. Police Response to Family Abduction Episodes.

    ERIC Educational Resources Information Center

    Plass, Peggy S.; And Others

    1995-01-01

    Examines role of police in responding to family abduction episodes using data from a national survey. Addresses questions concerning frequency of police involvement, how abductions to which police respond differ from those to which they don't, actions taken by police, and the effects of their actions on episode outcomes. (LKS)

  11. A Transactional Approach to Transfer Episodes

    ERIC Educational Resources Information Center

    Jornet, Alfredo; Roth, Wolff-Michael; Krange, Ingeborg

    2016-01-01

    In this article we present an analytical framework for approaching transfer episodes--episodes in which participants declare or can be declared to bring prior experience to bear on the current task organization. We build on Dewey's writings about the continuity of experience, Vygotsky's ideas of unit analysis, as well as more recent developments…

  12. Staphylococcus aureus bacteraemia: 400 episodes in St Thomas's Hospital.

    PubMed

    Gransden, W R; Eykyn, S J; Phillips, I

    1984-01-28

    Four hundred episodes of Staphylococcus aureus bacteraemia occurred in St Thomas's Hospital from 1969 to 1983, accounting for 17.5% of all episodes of bacteraemia. The mortality was 24%, half attributable to underlying disease, and was highest in patients over 50. Almost 60% of the bacteraemias were acquired in hospital, and the source of the organism was generally obvious, with vascular access sites the most common (37%). Bone and joint infections accounted for 11.5% of episodes and endocarditis for 7%. Most staphylococci were resistant to penicillin only; three isolates were resistant to methicillin and five to fusidic acid. Microbiologists seldom influenced directly the choice of initial antibiotic treatment (though this usually conformed to the hospital's antibiotic prescribing policy) but had considerable influence over definitive treatment, usually cloxacillin or flucloxacillin alone or in combination with fusidic acid. S aureus bacteraemia is easy to identify and treat, though underlying disease may influence the outcome. Efforts should be made to prevent the largely iatrogenic disease.

  13. Permanent renal parenchymal defects after febrile UTI are closely associated with vesicoureteric reflux.

    PubMed

    Polito, Cesare; Rambaldi, Pier Francesco; Signoriello, Giuseppe; Mansi, Luigi; La Manna, Angela

    2006-04-01

    The finding of scintigraphic renal defects in children with febrile urinary tract infection (UTI) even in the absence of vesicoureteric reflux (VUR) has led to the conclusion that VUR is a weak predictor of renal defects in these patients. We used isotopic cystography (IC) for diagnosis of VUR in children with febrile UTI. Dimercaptosuccinic acid renal scintigraphy was performed 6 months after cure of the last UTI. Renal defects were defined by the finding of focal defects of radionuclide uptake and/or by a split renal function <43%. The study included 206 children with primary VUR and 77 without VUR. Among the subjects with and without VUR, respectively, renal defects were found in 40 and 6% (p=0.0001), focal uptake defects in 33 and 5% (p=0.0001) and split renal function <43% in 26 and 5% (p=0.0001). Permanent renal defects in children with febrile UTI are closely associated with VUR. The possibility that a child will have permanent renal defects can reasonably be ruled out on the basis of the absence of VUR by IC.

  14. Practical approach to screen vesicoureteral reflux after a first urinary tract infection

    PubMed Central

    Fuente, María Álvarez; Costa, Talía Sainz; García, Begoña Santiago; Serrano, Marcelina Algar; Alonso, Manuel Sosa; Luján, Esther Aleo

    2014-01-01

    Introduction: Vesicoureteral reflux (VUR) is a common pediatric urologic disorder. After the first urinary tract infection (UTI), imaging studies are recommended, starting with a renal ultrasound (RUS). Voiding cystourethrography (VCUG) and dimercaptosuccinic acid (DMSA) scan are the other main radiologic studies used to detect VUR. We evaluated the use of RUS as a screening method for VUR in children below 2 years of age, in order to avoid unnecessary VCUG. Materials and Methods: Medical records and imaging studies of infants (<2 years) who had their first UTI in a 6 year period were retrospectively reviewed. We evaluated the sensitivity, specificity, and negative predictive values of RUS and DMSA for diagnosing VUR. Results: Among 155 children (51% males) with their first UTI, 148 RUS were performed, 128 VCUG and 29 DMSA. VUR was detected in 21% patients; 14.5% low grade and 6.5% high grade. One hundred and twenty-one patients underwent both RUS and VCUG, 101 RUS were normal and 20 abnormal. Of the normal RUS 98% had no or low grade VUR. Among those with an abnormality on RUS 30% had high grade VUR (P < 0.001). Conclusions: After the first UTI in infants (<2 years) RUS is a good screening method for VUR. Among such shildren with a normal RUS, we do not recommend VCUG or DMSA. In our opinion, VCUG should be performed only in patients with abnormal findings in RUS or in recurrent UTI. PMID:25378818

  15. The effect of omeprazole pre-treatment on rafts formed by reflux suppressant tablets containing alginate.

    PubMed

    Dettmar, P W; Little, S L; Baxter, T

    2005-01-01

    Alginate-based reflux suppressant preparations provide symptom relief by forming a physical barrier on top of the stomach contents in the form of a neutral floating gel or raft. This study investigated whether reduced acidity in the stomach brought about by omeprazole pre-treatment affected the formation and gastric residence time of alginate rafts. It was a balanced, cross-over study in 12 healthy non-patient volunteers following a single dose of two indium-111-labelled alginate tablets in the presence or absence of 3 days' pre-treatment with omeprazole. Raft formation and gastric residence, in the presence of a technetium-99m-labelled meal, were assessed by gamma scintigraphy for 3 h after alginate tablet administration. The relative raft-forming ability of alginate tablets after omeprazole compared with alginate tablets alone was 0.950 with 95% confidence intervals of 0.882 and 1.018. Pre-treatment and co-administration with omeprazole has no significant effect on the raft-forming ability of alginate tablets.

  16. Prosthetic Rehabilitation of a Patient With Gastroesophageal Reflux Disease: Five-Year Follow-up.

    PubMed

    Moretto, G; Pupo, Y M; Bueno, A L N; Araujo, F O

    2016-01-01

    Tooth wear is a multifactorial process that is a growing concern in dentistry. This phenomenon can be caused by mechanical (attrition, abrasion, or abfraction) or chemical (erosion) processes. Etiologic factors in dental erosion can be due to changes in behavior, an unbalanced diet, or gastrointestinal disorders such as acid regurgitation, which may influence the salivary flow rate and buffering capacity of saliva. This case report describes an esthetic rehabilitation of a patient with gastroesophageal reflux and dental erosion, with a treatment rationale that includes the use of a diagnostic template and five-year follow-up. This technique, presented here in a clinical case with moderate enamel loss, integrates an additive wax-up and a direct intraoral bis-acryl resin mock-up. Lithium disilicate glass-ceramic (IPS e.max Press, Ivoclar Vivadent) laminate veneers were fabricated with the heatpress technique. They were veneered with a layering ceramic (IPS e.max Ceram, Ivoclar Vivadent) to improve the appearance of the incisal edge. The case demonstrated the success of veneers as an effective, conservative, and esthetic treatment for patients with this pathology.

  17. Divergent thinking and constructing episodic simulations.

    PubMed

    Addis, Donna Rose; Pan, Ling; Musicaro, Regina; Schacter, Daniel L

    2016-01-01

    Divergent thinking likely plays an important role in simulating autobiographical events. We investigated whether divergent thinking is differentially associated with the ability to construct detailed imagined future and imagined past events as opposed to recalling past events. We also examined whether age differences in divergent thinking might underlie the reduced episodic detail generated by older adults. The richness of episodic detail comprising autobiographical events in young and older adults was assessed using the Autobiographical Interview. Divergent thinking abilities were measured using the Alternative Uses Task. Divergent thinking was significantly associated with the amount of episodic detail for imagined future events. Moreover, while age was significantly associated with imagined episodic detail, this effect was strongly related to age-related changes in episodic retrieval rather than divergent thinking.

  18. Numerical modelling of geothermal and reflux circulation in Enewetak Atoll: Implications for dolomitization

    USGS Publications Warehouse

    Jones, G.; Whitaker, F.; Smart, P.; Sanford, W.

    2000-01-01

    Two types of regional-scale seawater circulation have been proposed to explain the formation of Enewetak Atoll dolomites: geothermal and reflux circulation. We have used a finite element groundwater flow model to examine the pattern, magnitude and dynamic interaction of these two different circulation mechanisms in Enewetak Atoll. Geothermal circulation is concentrated around the atoll-margin whereas refluxing mesosaline brines flow from the atoll interior towards the margin to restrict and eventually shut off geothermal circulation. Refluxing brines of 36-80??? can account for the salinity signature recorded in dolomite fluid inclusions. Distributions of fluid flux and Mg mass-balance calculations suggest that both geothermal and reflux circulation mechanisms could account for the observed distribution of dolomite in Enewetak Atoll. Furthermore, the atoll interior may be extensively dolomitized as observed in other atolls. (C) 2000 Elsevier Science B.V. All rights reserved.Two types of regional-scale seawater circulation have been proposed to explain the formation of Enewetak Atoll dolomites: geothermal and reflux circulation. We have used a finite element groundwater flow model to examine the pattern, magnitude and dynamic interaction of these two different circulation mechanisms in Enewetak Atoll. Geothermal circulation is concentrated around the atoll-margin whereas refluxing mesosaline brines flow from the atoll interior towards the margin to restrict and eventually shut off geothermal circulation. Refluxing brines of 36-80 per mil can account for the salinity signature recorded in dolomite fluid inclusions. Distributions of fluid flux and Mg mass-balance calculations suggest that both geothermal and reflux circulation mechanisms could account for the observed distribution of dolomite in Enewetak Atoll. Furthermore, the atoll interior may be extensively dolomitized as observed in other atolls.

  19. Endoscopic treatment of vesicoureteral reflux with a chondrocyte-alginate suspension.

    PubMed

    Atala, A; Kim, W; Paige, K T; Vacanti, C A; Retik, A B

    1994-08-01

    Injection of polytetrafluoroethylene (Teflon) or collagen has been used in the endoscopic treatment of vesicoureteral reflux. Although the principle of an endoscopic treatment is valid, there are concerns regarding the long-term safety and effectiveness of these substances. In search of a different injectable material we conducted experiments using chondrocytes in a biodegradable polymer solution for the treatment of vesicoureteral reflux in an animal model. Reflux was created in 4 mini-pigs and confirmed with a cystogram. Cartilage was obtained from the auricular surface of each animal. Chondrocytes were harvested and expanded in vitro. The cells were individually quantitated and concentrated to 40 million cells per cc. The cell suspensions were mixed with a sodium alginate and calcium sulfate solution. Each pig was injected unilaterally in the subureteral region with the autologous chondrocyte suspension. The opposite ureter served as an internal control in all animals. Cystograms showed resolution of reflux in the treated side and persistence of reflux in the opposite untreated side in each instance. Excretory urograms revealed no evidence of obstruction. Histological examination of the subureteral region demonstrated cartilage. Autologous chondrocytes can be readily harvested, expanded in vitro and injected cystoscopically. The cells survive and form a cartilage nidus that is nonantigenic. This system is able to correct reflux without any evidence of obstruction.

  20. Reflux Incidence among Exclusively Breast Milk Fed Infants: Differences of Feeding at Breast versus Pumped Milk.

    PubMed

    Yourkavitch, Jennifer; Zadrozny, Sabrina; Flax, Valerie L

    2016-10-14

    The practice of feeding infants expressed breast milk is increasing in the United States, but the impacts on infant and maternal health are still understudied. This study examines the monthly incidence of regurgitation (gastro-esophageal reflux) in exclusively breast milk fed infants from ages two to six months. Among infants whose mothers participated in the Infant Feeding Practices II Study (IFPS II; 2005-2007), data on reflux and feeding mode were collected by monthly questionnaires. A longitudinal, repeated measures analysis was used, with feeding mode lagged by one month in order to compare reflux incidence among infants fed directly at the breast to infants receiving pumped breast milk. Mothers in both feeding groups had similar characteristics, although a greater proportion feeding at least some pumped milk were primiparous. The number of exclusively breastfed infants decreased steadily between months 2 and 6, although the proportion fed at the breast remained similar over time. An association between feeding mode and reflux incidence was not found; however, the analyses were limited by a small number of reported reflux cases. More studies are needed to further explain the relationship between different feeding modes and infant reflux.

  1. Reflux Incidence among Exclusively Breast Milk Fed Infants: Differences of Feeding at Breast versus Pumped Milk

    PubMed Central

    Yourkavitch, Jennifer; Zadrozny, Sabrina; Flax, Valerie L.

    2016-01-01

    The practice of feeding infants expressed breast milk is increasing in the United States, but the impacts on infant and maternal health are still understudied. This study examines the monthly incidence of regurgitation (gastro-esophageal reflux) in exclusively breast milk fed infants from ages two to six months. Among infants whose mothers participated in the Infant Feeding Practices II Study (IFPS II; 2005–2007), data on reflux and feeding mode were collected by monthly questionnaires. A longitudinal, repeated measures analysis was used, with feeding mode lagged by one month in order to compare reflux incidence among infants fed directly at the breast to infants receiving pumped breast milk. Mothers in both feeding groups had similar characteristics, although a greater proportion feeding at least some pumped milk were primiparous. The number of exclusively breastfed infants decreased steadily between months 2 and 6, although the proportion fed at the breast remained similar over time. An association between feeding mode and reflux incidence was not found; however, the analyses were limited by a small number of reported reflux cases. More studies are needed to further explain the relationship between different feeding modes and infant reflux. PMID:27754430

  2. [Persistent urinary infection in children after antireflux ureterovesical reimplantation in primary vesicorenal reflux].

    PubMed

    Viville, C; Lehmann, J M

    1986-01-01

    This study is the outcome of the analysis of 200 cases and concentrates solely on successful antireflux operations (i.e. with neither stenosis nor persistent reflux) performed on primary refluxes, 54 children, all of them being females, have retained refractory postoperative urinary infections. Of these cases, 24 cases (12%) have not been cured yet. In these postoperative infections, some factors play probably no part: the magnitude of the preoperative reflux, the existence of pyelonephritic lesions, the type of germ. However the fact of being female, the age (over 6), the duration of the preoperative infection and, above all, the existence of predominantly vesical symptomatology (frequency, voiding pain, and continence problems such as imperiousness, diurnal incontinence, enuresis) are basic factors. This makes it possible to compose the model of the child that will come up with a rebellious postoperative urinary infection. For these children, suppressing the reflux is only part of the treatment. It will have to be curried on by treating the vesical instability by drugs, vesical reeducation and even psychotherapy. On hand of these observations, one may question the classification of refluxes: do all of them really come under the name of "primary" refluxes?

  3. Episodic acidification of a coastal plain stream in Virginia

    USGS Publications Warehouse

    O'Brien, A. K.; Eshleman, K.N.

    1996-01-01

    This study investigates the episodic acidification of Reedy Creek, a wetland-influenced coastal plain stream near Richmond, Virginia. Primary objectives of the study were to quantify the episodic variability of acid- base chemistry in Reedy Creek, to examine the seasonal variability in episodic response and to explain the hydrological and geochemical factors that contribute to episodic acidification. Chemical response was similar in each of the seven storms examined, however, the ranges in concentrations observed were commonly greater in summer/fall storms than in winter/spring storms. An increase in SO4/2- concentration with discharge was observed during all storms and peak concentration occurred at or near peak flow. Small increases in Mg2+, Ca2+, K+ concentrations and dissolved organic carbon (DOC) were observed during most storms. At the same time, ANC, Na+ and Cl- concentrations usually decreased with increasing discharge. In summer/fall storms, the absolute increase in SO4/2- concentration was one-third to 15 times the increase observed in winter/spring storms; the decrease in ANC during summer/fall storms was usually within the range of the decrease observed in winter/spring storms. In contrast, the decrease in Na+ and Cl- concentrations during winter/spring storms was much greater than that observed during summer/fall storms. Data show that while base flow anion deficit was higher in summer/fall than in winter/spring, anion deficit decreased during most summer/fall storms. In contrast, base flow anion deficit was lower in spring and winter, but increased during winter/spring storms. Increased SO4/2- concentration was the main cause of episodic acidification during storms at Reedy Creek, but increased anion deficit indicates organic acids may contribute to episodic acidification during winter/spring storms. Changes in SO4/2- concentration coincident with the hydrograph rise indicate quick routing of water through the watershed. Saturation overland flow

  4. Aerosol characteristics of different types of episode.

    PubMed

    Kuo, Chung-Yih; Lin, Yan-Ruei; Chang, Shih-Yu; Lin, Chuan-Yao; Chou, Chun-Hung

    2013-12-01

    Daily and hourly average data from nine air-quality monitoring stations distributed across central Taiwan, which include ten items (i.e., PM₁₀, PM₂.₅, wind direction, wind speed, temperature, relative humidity, SO₂, NO₂, NO, and CO), were collected from 2005 to 2009. Four episode types: long-range transport with dust storms (DS), long-range transport with frontal pollution (FP), river dust (RD), and stagnant weather (SW), and one mixed type of episode were identified. Of these four episode types, the SW was the dominant type, averaging about 70%. The mean ratio of PM₂.₅/PM₁₀ was the lowest during the RD episodes (0.42), while the mean ratio of PM₂.₅/PM₁₀ was the highest during the SW episodes (0.64). Fine aerosol (PM₂.₅) and coarse aerosol (PM₁₀-₂.₅) samples were collected by high-volume samplers for chemical composition analysis, from only three stations (Douliou, Lunbei, and Siansi) during the days of SW, RD, DS, and FP. The concentrations of PM₂.₅ and three ionic species (NH₄⁺, NO₃⁻, and SO₄²⁻) all showed significant differences among the four episode types. The highest levels of NO₃⁻ (12.1 μg/m(3)) and SO₄²⁻ (20.5 μg/m(3)) were found during the SW and FP episodes, respectively. A comparison on the spatial similarity of aerosol compositions among the episodes and/or non-episodes (control) was characterized by the coefficient of divergence (CD). The results showed higher CD values in PM₁₀-₂.₅ than in PM₂.₅, and the CD values between RD episodes and the other three episodes were higher than those between two types of episode for the other three episodes. The ratios of SOR (sulfur oxidation ratio), SO₄²⁻/EC (elemental carbon), NOR (nitrogen oxidation ratio), and NO₃⁻/EC showed that sulfate formation was most rapid during the FP, while nitrate formation was most rapid during the SW.

  5. Evaluation of the Dental Effects of Laryngopharyngeal Reflux

    DTIC Science & Technology

    2015-03-01

    of Clinical Gastroenterology, 8(2), 131-134. Mokdad, A., Ford, E., Bowman, B ., Dietz, W., Vinicor, F ., Bales, V., et al. {2001). Prevalence of...Ernst, T., Gennoni, M., Zeyen, B ., Halter, F ., & Merki, H. (1990). Tolerance to oral HZ-receptor antagonists. Digestive Diseases and Sciences, 35(8...but up to 50 GER episodes per day is considered within the normal range (Demeester, Johnson, Joseph, Toscano, Hall, & Skinner , 1976; Postma, 2000). A

  6. How do episodic and semantic memory contribute to episodic foresight in young children?

    PubMed Central

    Martin-Ordas, Gema; Atance, Cristina M.; Caza, Julian S.

    2014-01-01

    Humans are able to transcend the present and mentally travel to another time, place, or perspective. Mentally projecting ourselves backwards (i.e., episodic memory) or forwards (i.e., episodic foresight) in time are crucial characteristics of the human memory system. Indeed, over the past few years, episodic memory has been argued to be involved both in our capacity to retrieve our personal past experiences and in our ability to imagine and foresee future scenarios. However, recent theory and findings suggest that semantic memory also plays a significant role in imagining future scenarios. We draw on Tulving’s definition of episodic and semantic memory to provide a critical analysis of their role in episodic foresight tasks described in the developmental literature. We conclude by suggesting future directions of research that could further our understanding of how both episodic memory and semantic memory are intimately connected to episodic foresight. PMID:25071690

  7. Ultralight Fabric Reflux Tube (UFRT) Thermal/Vacuum Test

    NASA Technical Reports Server (NTRS)

    Hurlbert, K. M.; Ewert, M. K.; Graf, J. P.; Keller, J. R.; Pauley, K. A.; Guenther, R. J.; Antoniak, Z. I.

    1996-01-01

    Spacecraft thermal control systems are essential to provide the necessary environment for the crew and equipment to function adequately on space missions. The Ultralight Fabric Reflux Tube (UFRT) was developed by Pacific Northwest Laboratory (PNL) as a lightweight radiator concept to be used on planetary-type missions (e.g., Moon, Mars). The UFRT consists of a thin-walled tube (acting as the fluid boundary), overwrapped with a low-mass ceramic fabric (acting as the primary pressure boundary). The tubes are placed in an array in the vertical position with the evaporators at the lower end. Heat is added to the evaporators, which vaporizes the working fluid. The vapor travels to the condenser end above and cools as heat is radiated to the environment. The fluid condensed on the tube wall is then returned to the evaporator by gravity. The primary objectives for the fiscal year 1994 program included the design and fabrication of prototype UFRTs and thermal/vacuum chamber testing of these test articles. Six UFRTS, with improved titanium liners, were successfully manufactured and provided to the Johnson Space Center in July 1994. Five were tested in a thermal/vacuum chamber in September 1994. Data obtained to characterize the performance of the UFRTs under simulated lunar conditions demonstrated the design concept successfully. In addition, a trade study showed that an optimized/improved UFRT could achieve as much as a 25% mass savings in the heat rejection subsystem of future planetary-type thermal control systems.

  8. Numerical modeling of dish-Stirling reflux solar receivers

    SciTech Connect

    Hogan, R.E.

    1990-01-01

    Using reflux solar receivers to collect solar energy for dish-Stirling electric power generation systems is currently being investigated by several organizations, including Sandia National Laboratories, Albuquerque, New Mexico. In support of this program, Sandia has developed two numerical models describing the energy transfer within and thermal performance of pool-boiler and heat-pipe receivers. Both models are applicable to axisymmetric geometries and they both consider the radiative and convective energy transfer within the receiver cavity, the conductive and convective energy transfer within the receiver cavity, the conductive and convective energy transfer from the receiver housing, and the energy transfer to the receiver working fluid. In these models, the radiative transfer within the receiver is analyzed using a two-band (solar and infrared) net-radiation formulation for enclosure radiation. Empirical convective correlations describe the convective heat transfer from the cavity to the surroundings. The primary difference between the models is the level of detail in modeling the heat conduction through the receiver walls. The more detailed model uses a two-dimensional finite control volume method, whereas the simpler model uses a one-dimensional thermal resistance approach. 20 refs., 7 figs., 2 tabs.

  9. Gastroesophageal Reflux in Critically Ill Children: A Review

    PubMed Central

    Solana García, Maria José; López-Herce Cid, Jesús; Sánchez Sánchez, César

    2013-01-01

    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. PMID:23431462

  10. Complications of bariatric surgery: dumping syndrome, reflux and vitamin deficiencies.

    PubMed

    Tack, Jan; Deloose, Eveline

    2014-08-01

    Bariatric surgical procedure are increasingly and successfully applied in the treatment of morbid obesity. Nevertheless, these procedures are not devoid of potential long-term complications. Dumping syndrome may occur after procedures involving at least partial gastric resection or bypass, including Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy. Diagnosis is based on clinical alertness and glucose tolerance testing. Treatment may involve dietary measures, acarbose and somatostatin analogues, or surgical reintervention for refractory cases. Gastro-esophageal reflux disease (GERD) can be aggravated by vertical banded gastroplasty and sleeve gastrectomy procedures, but pre-existing GERD may improve after RYGB and with adjustable gastric banding. Nutrient deficiencies constitute the most important long-term complications of bariatric interventions, as they may lead to haematological, metabolic and especially neurological disorders which are not always reversible. Malabsorptive procedures, poor postoperative nutrient intake, recurrent vomiting and poor compliance with vitamin supplement intake and regular follow-up are important risk factors. Preoperative nutritional assessment and rigourous postoperative follow-up plan with administration of multi-vitamin supplements and assessment of serum levels is recommended in all patients.

  11. Quality of life in children with vesicoureteral reflux.

    PubMed

    Kiddoo, Darcie A; Ajamian, Faria; Senthilselvan, Ambikaipakan; Morgan, Catherine J; Pinsk, Maury N

    2012-03-01

    Vesicoureteral reflux (VUR) is commonly diagnosed in children presenting with urinary tract infections. Antibiotic prophylaxis and ureteric surgery are standard treatments for these children. Our aim was to investigate whether health-related quality of life (HRQOL) was altered in children treated for VUR. Children aged 1-5 years with grade III or higher VUR were identified through electronic records at the Stollery Children's Hospital. Parents of these children were mailed the TNO-AZL Netherlands Organisation for Applied Scientific Research Academic Medical Centre Quality of Life (TAPQOL) questionnaire. QOL scores for this group were compared with normative controls from the instrument's creators using the Mann-Whitney U test. Thirty-two of the 96 (33%) mailed surveys were returned. Eight children had surgery, and 19 were treated with antibiotic prophylaxis. When comparing the VUR group with the control group, we found that anxiety and social functioning scores were significantly better in patients with VUR (p < 0.01). The VUR group had worse scores in problem behavior, stomach complaints ,and communication (p < 0.01). This study reveals that children with VUR have a reasonable QOL when compared with controls. However, the diagnosis of VUR and its management does have an impact on gastrointestinal complaints, behavior, and communication, which may occur as a result of chronic medical intervention.

  12. The effect of bariatric surgery on gastroesophageal reflux disease

    PubMed Central

    El-Hadi, Mustafa; Birch, Daniel W.; Gill, Richdeep S.; Karmali, Shahzeer

    2014-01-01

    Obesity is an epidemic that is known to play a role in the development of gastro-esophageal reflux disease (GERD). Studies have shown that increasing body mass index plays a role in the incompetence of the gastroesophageal junction and that weight loss and lifestyle modifications reduce the symptoms of GERD. As a method of producing effective and sustainable weight loss, bariatric surgery plays a major role in the treatment of obesity. We reviewed the literature on the effects of different types of bariatric surgery on the symptomatic relief of GERD and its complications. Roux-en-Y gastric bypass was considered an effective method to alleviate symptoms of GERD, whereas laparoscopic sleeve gastrectomy appeared to increase the incidence of the disease. Adjustable gastric banding was seen to initially improve the symptoms of GERD; however, a subset of patients experienced a new onset of GERD symptoms during long-term follow-up. The literature suggests that different surgeries have different impacts on the symptomatology of GERD and that careful assessment may be needed before performing bariatric surgery in patients with GERD. PMID:24666452

  13. The effect of bariatric surgery on gastroesophageal reflux disease.

    PubMed

    El-Hadi, Mustafa; Birch, Daniel W; Gill, Richdeep S; Karmali, Shahzeer

    2014-04-01

    Obesity is an epidemic that is known to play a role in the development of gastroesophageal reflux disease (GERD). Studies have shown that increasing body mass index plays a role in the incompetence of the gastroesophageal junction and that weight loss and lifestyle modifications reduce the symptoms of GERD. As a method of producing effective and sustainable weight loss, bariatric surgery plays a major role in the treatment of obesity. We reviewed the literature on the effects of different types of bariatric surgery on the symptomatic relief of GERD and its complications. Roux-en- Y gastric bypass was considered an effective method to alleviate symptoms of GERD, whereas laparoscopic sleeve gastrectomy appeared to increase the incidence of the disease. Adjustable gastric banding was seen to initially improve the symptoms of GERD; however, a subset of patients experienced a new onset of GERD symptoms during long-term follow-up. The literature suggests that different surgeries have different impacts on the symptomatology of GERD and that careful assessment may be needed before performing bariatric surgery in patients with GERD.

  14. [Bipolar disorder: inter-episode symptoms].

    PubMed

    Azorin, J-M

    2012-12-01

    The importance of inter-episode symptoms in bipolar disorder can be traced back to the middle of the 19th century, at a time when the two fathers of the concept in France, Falret and Baillarger were opposed on the issue as to whether the presence of free intervals between the episodes had to be part or not of the disease's definition. Modern studies have reported rates between 50 and 68% for those symptoms which refer to subsyndromal manifestations present between affective episodes but that do not meet the required criteria for episodes definition. These manifestations comprise residual symptoms, prodromes, axis I comorbid psychiatric disorders, side effects of treatment, temperamental features, and comorbidity with personality disorders. Inter- episodes symptoms represent a risk factor for the occurrence of relapses and recurrences and are usually associated with impairments in functioning in almost all domains of psychosocial and family life. As they are easy to miss, it is important in clinical practice, to draw the attention of clinicians, patients and relatives to the role they have in the course of the illness. As far as their management, it may be crucial to achieve a full remission of the episodes, using adequate dosages of psychotropic drugs. Residual symptoms, prodromes as well as other inter-episode symptoms may respond to strategies based on cognitive-behaviour therapy, and/or psychoeducation.

  15. Alginate therapy is effective treatment for gastroesophageal reflux disease symptoms: a systematic review and meta-analysis.

    PubMed

    Leiman, D A; Riff, B P; Morgan, S; Metz, D C; Falk, G W; French, B; Umscheid, C A; Lewis, J D

    2016-09-26

    In patients with gastroesophageal reflux disease (GERD) and erosive esophagitis, treatment with proton pump inhibitors (PPIs) is highly effective. However, in some patients, especially those with non-erosive reflux disease or atypical GERD symptoms, acid suppressive therapy with PPIs is not as successful. Alginates are medications that work through an alternative mechanism by displacing the post-prandial gastric acid pocket. We performed a systematic review and meta-analysis to examine the benefit of alginate-containing compounds in the treatment of patients with symptoms of GERD.PubMed/MEDLINE, Embase and the Cochrane library electronic databases were searched through October 2015 for randomized controlled trials comparing alginate-containing compounds to placebo, antacids, histamine-2 receptor antagonists (H2RAs) or PPIs for the treatment of GERD symptoms. Additional studies were identified through bibliography review. Non-English studies and those with pediatric patients were excluded. Meta-analyses were performed using random-effects models to calculate odds ratios (OR). Heterogeneity between studies was estimated using the I(2) statistic. Analyses were stratified by type of comparator. The search strategy yielded 665 studies and 15 (2.3%) met inclusion criteria. Fourteen were included in the meta-analysis (N = 2095 subjects). Alginate-based therapies increased the odds of resolution of GERD symptoms when compared to placebo or antacids (OR: 4.42; 95% CI 2.45-7.97) with a moderate degree of heterogeneity between studies (I(2)  = 71%, P = .001). Compared to PPIs or H2RAs, alginates appear less effective but the pooled estimate was not statistically significant (OR: 0.58; 95% CI 0.27-1.22). Alginates are more effective than placebo or antacids for treating GERD symptoms.

  16. Bile acid aspiration associated with lung chemical profile linked to other biomarkers of injury after lung transplantation.

    PubMed

    Neujahr, D C; Uppal, K; Force, S D; Fernandez, F; Lawrence, C; Pickens, A; Bag, R; Lockard, C; Kirk, A D; Tran, V; Lee, K; Jones, D P; Park, Y

    2014-04-01

    Aspiration of gastrointestinal contents has been linked to worse outcomes following lung transplantation but uncertainty exists about underlying mechanisms. We applied high-resolution metabolomics of bronchoalveolar lavage fluid (BALF) in patients with episodic aspiration (defined by bile acids in the BALF) to identify potential metabolic changes associated with aspiration. Paired samples, one with bile acids and another without, from 29 stable lung transplant patients were studied. Liquid chromatography coupled to high-resolution mass spectroscopy was used to interrogate metabolomic contents of these samples. Data were obtained for 7068 ions representing intermediary metabolites, environmental agents and chemicals associated with microbial colonization. A substantial number (2302) differed between bile acid positive and negative samples when analyzed by false discovery rate at q = 0.01. These included pathways associated with microbial metabolism. Hierarchical cluster analysis defined clusters of chemicals associated with bile acid aspiration that were correlated to previously reported biomarkers of lung injury including T cell granzyme B level and the chemoattractants CXCL9 and CXCL10. These data specifically link bile acids presence in lung allografts to inflammatory pathways known to segregate with worsening allograft outcome, and provide additional mechanistic insight into the association between reflux and lung allograft injury.

  17. Diagnosis of gastroesophageal reflux and anti-reflux procedures among polish children with gastrostomies: a 10-year nationwide analysis

    PubMed Central

    Toporowska-Kowalska, E; Gębora-Kowalska, B; Fendler, W; Popińska, K; Szlagatys-Sidorkiewicz, A; Grzybowska-Chlebowczyk, U; Wiernicka, A; Borkowska, A; Sibilska, M; Więcek, S; Hapyn, E; Kierkuś, J

    2013-01-01

    Background/Objectives: To analyse the approach to diagnose gastroesophageal reflux (GER) and the qualification criteria for anti-reflux (AR) procedures in Polish children fed via gastrostomy between 2000 and 2010. Subjects/Methods: An electronic questionnaire containing questions on the demographic and clinical data of patients with gastrostomies was distributed to six Polish centres of nutritional therapy. The portion pertaining to GER included data on clinical exponents, diagnostic procedures (pH-metry, pH-impedance, scintigraphy and upper gastrointestinal (GI) series) and AR. Results: In total, 348 children (M199/F149; age at gastrostomy 5.78±5.49 years) were included. Data on the diagnosis of GER and the AR criteria were available for 343 and 336 subjects, respectively. Percutaneous endoscopic gastrostomy was performed in 258/348 patients (74.1%), while surgery was performed in 80/348 patients (23%). The data from 10/348 (2.9%) cases were unavailable. At least one of the tests for GER was conducted in 177/343 (51.6%) of patients: pH-metry in 74/343 (21.6%), pH-impedance in 17/343 (5.0%), scintigraphy in 60/343 (17.5%) and upper GI series in 102/343 (29.7%). GER was reported in 114/343 cases (33.2%), and fundoplication was performed in 87 children (76.3% of patients with GER). The highest congruence between a positive test result and the decision to perform fundoplication was documented in cases of scintigraphy and upper GI series (P=0.00000 and P=0.00191, respectively). A significant increase in the prevalence of simultaneous gastrostomy and AR was observed over the decade analysed (r=0.8, P=0.009). This study revealed a centre-specific attitude towards the diagnosis of GER and the assessment of qualifications for fundoplication in Polish gastrostomy-fed children. Conclusions: The unified diagnostic algorithm of GER and the universal qualification criteria for AR procedures need to be defined for gastrostomy-fed children. PMID:24065062

  18. The case for episodic memory in animals.

    PubMed

    Dere, E; Kart-Teke, E; Huston, J P; De Souza Silva, M A

    2006-01-01

    The conscious recollection of unique personal experiences in terms of their details (what), their locale (where) and temporal occurrence (when) is known as episodic memory and is thought to require a 'self-concept', autonoetic awareness/conciousness, and the ability to subjectively sense time. It has long been held that episodic memory is unique to humans, because it was accepted that animals lack a 'self-concept', 'autonoetic awareness', and the ability to 'subjectively sense time'. These assumptions are now being questioned by behavioral evidence showing that various animal species indeed show behavioral manifestations of different features of episodic memory such as, e.g. 'metacognition', 'conscious recollection' of past events, 'temporal order memory', 'mental time travel' and have the capacity to remember personal experiences in terms of what happened, where and when. The aim of this review is to provide a comprehensive overview on the current progress in attempts to model different prerequisites and features of human episodic memory in animals and to identify possible neural substrates of animal episodic memory. The literature covered includes behavioral and physiological studies performed with different animal species, such as non-human primates, rodents, dolphins and birds. The search for episodic memory in animals has forced researchers to define objective behavioral criteria by which different features of episodic memory can be operationalized experimentally and assessed in both animals and humans. This is especially important because the current definition of episodic memory in terms of mentalistic constructs such as 'self', 'autonoetic awareness/consciousness', and 'subjectively sensed time', not only hinders animal research on the neurobiology of episodic memory but also research with healthy human subjects as well as neuropsychiatric patients with impaired language or in children with less-developed verbal abilities.

  19. Full-thickness myotomy is associated with higher rate of postoperative gastroesophageal reflux disease

    PubMed Central

    Wang, Xue-Hong; Tan, Yu-Yong; Zhu, Hong-Yi; Li, Chen-Jie; Liu, De-Liang

    2016-01-01

    AIM To compare long-term occurrence of gastroesophageal reflux disease (GERD) between two different types of peroral endoscopic myotomy (POEM) for achalasia. METHODS We included all patients with achalasia who underwent POEM at our hospital from August 2011 to October 2012 and had complete GERD evaluation with ≥ 3 years of follow-up. They were divided into circular or full-thickness myotomy groups according to the depth of myotomy. Demographics, Eckardt score, manometry results, 24-h pH monitoring, and GERD symptoms were recorded and compared between the two groups. RESULTS We studied 56 patients (32 circular myotomy and 24 full-thickness myotomy) with complete GERD evaluation. There was no significant difference between the two groups in terms of treatment success (defined as Eckardt score ≤ 3), postoperative Eckardt score, mean basal lower esophageal sphincter pressure, and 4-s integrated relaxation pressure (4sIRP). Postoperative abnormal esophageal acid exposure was found in 25 patients (44.6%). A total of 13 patients (23.2%) had GERD symptoms and 12 had esophagitis (21.4%). Clinically relevant GERD (abnormal esophageal acid exposure associated with GERD symptoms and/or esophagitis) was diagnosed in 13 patients (23.2%). Multivariate analysis revealed that full-thickness myotomy and low level of postoperative 4sIRP were predictive factors for clinically relevant GERD. CONCLUSION Efficacy and manometry are comparable between achalasia patients treated with circular or full-thickness myotomy. But patients with full-thickness myotomy and low postoperative 4sIRP have more GERD. PMID:27895430

  20. Acid-Catalyzed Isomerization of Carvone to Carvacrol

    ERIC Educational Resources Information Center

    Kjonaas, Richard A.; Mattingly, Shawn P.

    2005-01-01

    The acid-catalyzed isomerization of carvone to carvacrol, first reported by Ritter and Ginsburg, is especially well suited with a permanent-magnet FT instrument. The acid-catalyzed isomerization of carvone to carvacrol produced a 61% yield after a three hour reflux with 30% aqueous sulfuric acid.

  1. A Review of New Surgical and Endoscopic Therapies for Gastroesophageal Reflux Disease.

    PubMed

    Ganz, Robert A

    2016-07-01

    Treatment of gastroesophageal reflux disease in the United States today is binary, with the majority of patients with gastroesophageal reflux disease being treated with antisecre-tory medications and a minority of patients, typically those with volume regurgitation, undergoing Nissen fundoplication. However, there has been increasing dissatisfaction with proton pump inhibitor therapy among a significant number of patients with gastroesophageal reflux disease owing to cost, side effects, and refractory symptoms, and there has been a general reluctance to undergo surgical fundoplication due to its attendant side-effect profile. As a result, a therapy gap exists for many patients with gastroesophageal reflux disease. Alternative techniques are available for these gap patients, including 2 endoscopic fundoplication techniques, an endoscopic radiofrequency energy delivery technique, and 2 minimally invasive surgical procedures. These alternative techniques have been extensively evaluated; however, there are limitations to published studies, including arbitrary definitions of success, variable efficacy measurements, deficient reporting tools, inconsistent study designs, inconsistent lengths of follow-up postintervention, and lack of comparison data across techniques. Although all of the techniques appear to be safe, the endoscopic techniques lack demonstrable reflux control and show variable symptom improvement and variable decreases in proton pump inhibitor use. The surgical techniques are more robust, with evidence for adequate reflux control, symptom improvement, and decreased proton pump inhibitor use; however, these techniques are more difficult to perform and are more intrusive. Additionally, these alternative techniques have only been studied in patients with relatively normal anatomy. The field of gastroesophageal reflux disease treatment is in need of consistent definitions of efficacy, standardized study design and outcome measurements, and improved reporting

  2. Lack of correlation between extended pH monitoring and scintigraphy in the evaluation of infants with gastroesophageal reflux

    SciTech Connect

    Tolia, V.; Calhoun, J.A.; Kuhns, L.R.; Kauffman, R.E. )

    1990-05-01

    Sixty-nine infants younger than 1 year of age, with symptoms of persistent vomiting, recurrent choking, apnea, persistent cough, or stridor, were evaluated for gastroesophageal reflux. All infants underwent extended intraesophageal pH monitoring for 16 to 24 hours as well as gastroesophageal scintigraphy with technetium 99m sulfur colloid to study the correlation between the two tests. Forty-eight infants exhibited reflux with extended pH monitoring whereas 46 infants showed reflux with scintigraphy. However, the diagnosis of reflux in individual patients by extended pH monitoring corresponded poorly with the diagnosis of reflux in the same patients by scintigraphy. Similarly, no correlation was observed between extended pH monitoring and scintigraphy results, whether expressed as percent gastric emptying or as gastroesophageal reflux ratio. We conclude that extended pH monitoring and scintigraphy measure different pathophysiologic phenomena and detect reflux under different conditions. The ability of these tests to detect reflux may be complementary and they may be of greatest value when used together to enhance the sensitivity and specificity of the diagnostic evaluation. Extended pH monitoring and scintigraphy should not be used interchangeably to monitor gastroesophageal reflux.

  3. Episodic response project-northern Appalachian plateau: Site description and methodology

    SciTech Connect

    DeWalle, D.R.; Swistock, B.R.; Dow, C.L.; Sharpe, W.E.; Carline, R.F.

    1993-02-01

    The study areas and methods are described for research on acidic streamflow episodes in five forest stream/catchment systems in the northern Appalachian Plateau region of Pennsylvania. Research was conducted from October 1988 to April 1990 and involved both hydrochemical and biological studies. Hydrochemical monitoring included measurements of stream discharge; in situ stream pH, conductivity, and temperature; air temperature, precipitation amounts and intensity, snowpack water equivalents, and snowpack melt rates. Intensive stream sampling during selected events using computer-controlled automatic samplers was used to document episodic stream chemistry. Stream samples were analyzed for a complete suite of common cations and anions along with acid neutralizing content, DOC, total monomeric aluminum, and organic monomeric aluminum. Biological impacts of acidic streamflow episodes on native brook trout and sculpin were assessed using electrofishing, in-situ bioassays, radiotelemetry, and spawning surveys. A rigorous quality assurance/quality control program was established for all measurements during the study, especially for water chemistry.

  4. Hippocampal place cells, context, and episodic memory.

    PubMed

    Smith, David M; Mizumori, Sheri J Y

    2006-01-01

    Although most observers agree that the hippocampus has a critical role in learning and memory, there remains considerable debate about the precise functional contribution of the hippocampus to these processes. Two of the most influential accounts hold that the primary function of the hippocampus is to generate cognitive maps and to mediate episodic memory processes. The well-documented spatial firing patterns (place fields) of hippocampal neurons in rodents, along with the spatial learning impairments observed with hippocampal damage support the cognitive mapping hypothesis. The amnesia for personally experienced events seen in humans with hippocampal damage and the data of animal models, which show severe memory deficits associated with hippocampal lesions, support the episodic memory account. Although an extensive literature supports each of these hypotheses, a specific contribution of place cells to episodic memory has not been clearly demonstrated. Recent data from our laboratory, together with previous findings, indicate that hippocampal place fields and neuronal responses to task-relevant stimuli are highly sensitive to the context, even when the contexts are defined by abstract task demands rather than the spatial geometry of the environment. On the basis of these findings, it is proposed that place fields reflect a more general context processing function of the hippocampus. Hippocampal context representations could serve to differentiate contexts and prime the relevant memories and behaviors. Since episodic memories, by definition, include information about the time and place where the episode occurred, contextual information is a necessary prerequisite for any episodic memory. Thus, place fields contribute importantly to episodic memory as part of the needed context representations. Additionally, recent findings indicate that hippocampal neurons differentiate contexts at progressively finer levels of detail, suggesting a hierarchical coding scheme which

  5. Timing of spontaneous sleep-paralysis episodes.

    PubMed

    Girard, Todd A; Cheyne, J Allan

    2006-06-01

    The objective of this prospective naturalistic field study was to determine the distribution of naturally occurring sleep-paralysis (SP) episodes over the course of nocturnal sleep and their relation to bedtimes. Regular SP experiencers (N = 348) who had previously filled out a screening assessment for SP as well as a general sleep survey were recruited. Participants reported, online over the World Wide Web, using a standard reporting form, bedtimes and subsequent latencies of spontaneous episodes of SP occurring in their homes shortly after their occurrence. The distribution of SP episodes over nights was skewed to the first 2 h following bedtime. Just over one quarter of SP episodes occurred within 1 h of bedtime, although episodes were reported throughout the night with a minor mode around the time of normal waking. SP latencies following bedtimes were moderately consistent across episodes and independent of bedtimes. Additionally, profiles of SP latencies validated self-reported hypnagogic, hypnomesic, and hypnopompic SP categories, as occurring near the beginning, middle, and end of the night/sleep period respectively. Results are consistent with the hypothesis that SP timing is controlled by mechanisms initiated at or following sleep onset. These results also suggest that SP, rather than uniquely reflecting anomalous sleep-onset rapid eye movement (REM) periods, may result from failure to maintain sleep during REM periods at any point during the sleep period. On this view, SP may sometimes reflect the maintenance of REM consciousness when waking and SP hallucinations the continuation of dream experiences into waking life.

  6. Widespread use of gastric acid inhibitors in infants: Are they needed? Are they safe?

    PubMed Central

    Safe, Mark; Chan, Wei H; Leach, Steven T; Sutton, Lee; Lui, Kei; Krishnan, Usha

    2016-01-01

    Gastroesophageal reflux is a common phenomenon in infants, but the differentiation between gastroesophageal reflux and gastroesophageal reflux disease can be difficult. Symptoms are non-specific and there is increasing evidence that the majority of symptoms may not be acid-related. Despite this, gastric acid inhibitors such as proton pump inhibitors are widely and increasingly used, often without objective evidence or investigations to guide treatment. Several studies have shown that these medications are ineffective at treating symptoms associated with reflux in the absence of endoscopically proven oesophagitis. With a lack of evidence for efficacy, attention is now being turned to the potential risks of gastric acid suppression. Previously assumed safety of these medications is being challenged with evidence of potential side effects including GI and respiratory infections, bacterial overgrowth, adverse bone health, food allergy and drug interactions. PMID:27867686

  7. Widespread use of gastric acid inhibitors in infants: Are they needed? Are they safe?

    PubMed

    Safe, Mark; Chan, Wei H; Leach, Steven T; Sutton, Lee; Lui, Kei; Krishnan, Usha

    2016-11-06

    Gastroesophageal reflux is a common phenomenon in infants, but the differentiation between gastroesophageal reflux and gastroesophageal reflux disease can be difficult. Symptoms are non-specific and there is increasing evidence that the majority of symptoms may not be acid-related. Despite this, gastric acid inhibitors such as proton pump inhibitors are widely and increasingly used, often without objective evidence or investigations to guide treatment. Several studies have shown that these medications are ineffective at treating symptoms associated with reflux in the absence of endoscopically proven oesophagitis. With a lack of evidence for efficacy, attention is now being turned to the potential risks of gastric acid suppression. Previously assumed safety of these medications is being challenged with evidence of potential side effects including GI and respiratory infections, bacterial overgrowth, adverse bone health, food allergy and drug interactions.

  8. Postoperative ureteral obstruction after endoscopic treatment for vesicoureteral reflux

    PubMed Central

    Chung, Jae Min; Park, Chang Soo

    2015-01-01

    Purpose We undertook this study to evaluate the incidence, risk factors, management, and outcome of postoperative ureteral obstruction after endoscopic treatment for vesicoureteral reflux (VUR). Materials and Methods Ninety patients undergoing endoscopic treatment for VUR were retrospectively reviewed and classified into two groups according to ureteral obstruction: the nonobstruction group (83 cases, 122 ureters; mean age, 7.0±2.8 years) and the obstruction group (7 cases, 10 ureters; mean age, 6.2±8.1 years). We analyzed the following factors: age, sex, injection material, laterality, voiding dysfunction, constipation, renal scarring, preoperative and postoperative ultrasound findings, endoscopic findings, injection number, and injection volume. Additionally, we reviewed the clinical manifestations, natural course, management, and outcome of ureteral obstruction after endoscopic treatment. Results The incidence of ureteral obstruction after endoscopic treatment was 7.6% (10/132 ureters). The type of bulking agent used and injection volume tended to be associated with ureteral obstruction. However, no significant risk factors for obstruction were identified between the two groups. Three patients showed no symptoms or signs after the onset of ureteral obstruction. Most of the patients with ureteral obstruction experienced spontaneous resolution within 1 month with conservative therapy. Two patients required temporary ureteral stents to release the ureteral obstruction. Conclusions In our experience, the incidence of ureteral obstruction was slightly higher than in previous reports. Our study identified no predictive risk factors for developing ureteral obstruction after endoscopic treatment. Although most of the ureteral obstructions resolved spontaneously within 1 month, some cases required drainage to relieve symptoms or to prevent renal function deterioration. PMID:26175873

  9. Risk factors for gastroesophageal reflux disease: the role of diet

    PubMed Central

    Taraszewska, Anna

    2014-01-01

    Introduction Nutrition can contribute to the development of gastroesophageal reflux disease (GERD). The relevant studies often provide contradictory results. Aim To determine GERD risk factors associated with dietary habits. Material and methods A total of 513 subjects were included. The study group consisted of adults with a recent clinically confirmed diagnosis of GERD, and the control group were healthy adults. The research tool was a proprietary questionnaire. Risk factors were evaluated by logistic regression models. Results An association was found between the severity of typical GERD symptoms and a certain diet (p < 0.001). The symptoms were experienced more often after fatty, fried, sour, or spicy food and sweets. The univariate logistic regression analysis showed the following risk factors: eating 1–2 meals per day (OR = 3.50, 95% CI: 1.75–6.98), everyday consumption of peppermint tea (OR = 2.00, 95% CI: 1.14–3.50), and eating one, big meal in the evening instead of dinner and supper (OR = 1.80, 95% CI: 1.05–3.11). The multivariate analysis confirmed that frequent peppermint tea consumption was a risk factor (OR = 2.00, 95% CI: 1.08–3.70). Conclusions Taking into consideration the results of this study, it seems that patients should be recommended to eat more than three meals a day and eat dinner and supper at appropriate times instead of one, big meal in the evening. The role of frequent peppermint tea consumption in GERD development requires further studies. PMID:25396005

  10. Dolomite from reflux of moderate salinity brine, Enewetak Atoll

    SciTech Connect

    Goldstein, R.H.

    1996-12-31

    Dolomite from the Eocene of Enewetak Atoll provides a model for prediction of dolomite reservoirs. Others have noted dolomite below about 1200 meters at the base of permeable slope strata, and that dolomite postdates compaction, formed from fluids with {sup 87}Sr/{sup 86}Sr higher than the host strata, and that dolomite stable isotope values argue for precipitation from cool seawater or warm evaporated seawater. Dolomite contains cloudy cores, rich in primary fluid inclusions. Fluid inclusion ice melting ranges from -2.4 to -4.4{degrees}C (higher salinity than seawater; 44 to 85 ppt). Ratios of clear rim/cloudy core compared to new {sup 87}Sr/{sup 86}Sr and stable isotope data yield no correlation indicative of differences between clear rims and cloudy cores. Dolomite {sup 87}Sr/{sup 86}Sr are 0.70750 to 0.70873, but fluid inclusion {sup 87}Sr/{sup 86}Sr are 0.70957 to 0.71198, indicating inclusions best preserve end-member compositions for the dolomitizing fluid. Thus, dolomite precipitated from a young fluid that, surprisingly, may have interacted with some unknown source of radiogenic Sr. For fluid inclusions, Na/K is similar to seawater indicating components were derived from seawater evaporation and not from dissolution of an evaporate, Na/Sr and Ca/Mg are similar to seawater modified by rock/water interaction, and Cl/SO{sub 4} suggests removal of SO{sub 4} from pore fluids. The only viable explanation for the Enewetak dolomite is that young fluids evaporated to salinities slightly above seawater in Enewetak lagoon. The density contrast allowed for reflux deep into the atoll, discharging through permeable slope strata. This model could predict distributions of dolomite in any platform with slight restriction and appropriate climate.

  11. Dolomite from reflux of moderate salinity brine, Enewetak Atoll

    SciTech Connect

    Goldstein, R.H. )

    1996-01-01

    Dolomite from the Eocene of Enewetak Atoll provides a model for prediction of dolomite reservoirs. Others have noted dolomite below about 1200 meters at the base of permeable slope strata, and that dolomite postdates compaction, formed from fluids with [sup 87]Sr/[sup 86]Sr higher than the host strata, and that dolomite stable isotope values argue for precipitation from cool seawater or warm evaporated seawater. Dolomite contains cloudy cores, rich in primary fluid inclusions. Fluid inclusion ice melting ranges from -2.4 to -4.4[degrees]C (higher salinity than seawater; 44 to 85 ppt). Ratios of clear rim/cloudy core compared to new [sup 87]Sr/[sup 86]Sr and stable isotope data yield no correlation indicative of differences between clear rims and cloudy cores. Dolomite [sup 87]Sr/[sup 86]Sr are 0.70750 to 0.70873, but fluid inclusion [sup 87]Sr/[sup 86]Sr are 0.70957 to 0.71198, indicating inclusions best preserve end-member compositions for the dolomitizing fluid. Thus, dolomite precipitated from a young fluid that, surprisingly, may have interacted with some unknown source of radiogenic Sr. For fluid inclusions, Na/K is similar to seawater indicating components were derived from seawater evaporation and not from dissolution of an evaporate, Na/Sr and Ca/Mg are similar to seawater modified by rock/water interaction, and Cl/SO[sub 4] suggests removal of SO[sub 4] from pore fluids. The only viable explanation for the Enewetak dolomite is that young fluids evaporated to salinities slightly above seawater in Enewetak lagoon. The density contrast allowed for reflux deep into the atoll, discharging through permeable slope strata. This model could predict distributions of dolomite in any platform with slight restriction and appropriate climate.

  12. The ROKS nomogram for predicting a second symptomatic stone episode.

    PubMed

    Rule, Andrew D; Lieske, John C; Li, Xujian; Melton, L Joseph; Krambeck, Amy E; Bergstralh, Eric J

    2014-12-01

    Most patients with first-time kidney stones undergo limited evaluations, and few receive preventive therapy. A prediction tool for the risk of a second kidney stone episode is needed to optimize treatment strategies. We identified adult first-time symptomatic stone formers residing in Olmsted County, Minnesota, from 1984 to 2003 and manually reviewed their linked comprehensive medical records through the Rochester Epidemiology Project. Clinical characteristics in the medical record before or up to 90 days after the first stone episode were evaluated as predictors for symptomatic recurrence. A nomogram was developed from a multivariable model based on these characteristics. There were 2239 first-time adult kidney stone formers with evidence of a passed, obstructing, or infected stone causing pain or gross hematuria. Symptomatic recurrence occurred in 707 of these stone formers through 2012 (recurrence rates at 2, 5, 10, and 15 years were 11%, 20%, 31%, and 39%, respectively). A parsimonious model had the following risk factors for recurrence: younger age, male sex, white race, family history of stones, prior asymptomatic stone on imaging, prior suspected stone episode, gross hematuria, nonobstructing (asymptomatic) stone on imaging, symptomatic renal pelvic or lower-pole stone on imaging, no ureterovesicular junction stone on imaging, and uric acid stone composition. Ten-year recurrence rates varied from 12% to 56% between the first and fifth quintiles of nomogram score. The Recurrence of Kidney Stone nomogram identifies kidney stone formers at greatest risk for a second symptomatic episode. Such individuals may benefit from medical intervention and be good candidates for prevention trials.

  13. Laparoscopic Sleeve Gastrectomy and Crural Repair as a Treatment of Morbid Obesity Associated with Gastroesophageal Reflux

    PubMed Central

    Attia, Sameh Gabr

    2017-01-01

    Objective The aim of this study was to evaluate the Laparoscopic Sleeve Gastrectomy (LSG) with simultaneous crural repair in treatment of morbid obesity associated with gastroesophageal reflux disease. Methods This prospective observational study was carried out from September 2012 to July 2016 in Al-Azhar University Hospital (Egypt). The study was conducted on 53 patients, 14 males (26.4%) and 39 females (73.6%) with the mean age 36.2 years (range 18–52 years), presenting with morbid obesity and reflux disease either symptomatic patients or asymptomatic (Endoscopic & Manometric), their mean Body Mass Index (BMI) was 50.1 kg/m2 (range 40–62 kg/m2), who underwent LSG and antireflux procedure (crural repair). Results Excess weight Loss (EWL); the mean EWL at 6 months postoperatively was 46.3%, at 12 months was 54%, and at 18 months was 61%. Also, we found that, preoperative co-morbidities are resolved by 53% and improved by 23%. Reflux symptoms were absent in 30 patients (56 %), improved in 14 patients (26.4 %), but persistent in 7 patients (13.2 %). Conclusion Laparoscopic crural closure, during LSG, represents a valuable option for the treatment of morbid obesity and gastroesophageal reflux, and can result in favorable outcomes in terms of weight loss and gastroesophageal reflux disease (GERD) symptoms control. PMID:28243403

  14. Evaluation of a Self-Management Program for Gastroesophageal Reflux Disease in China

    PubMed Central

    Xu, Wenhong; Sun, Changxian; Lin, Lin; Wang, Meifeng; Zhang, Hongjie; Song, Yulei

    2016-01-01

    Gastroesophageal reflux disease is a chronic disease with a high incidence worldwide. The various symptoms have substantial impact on the quality of life of affected individuals. A long-term self-management program can increase the ability of patients to make behavioral changes, and health outcomes can improve as a consequence. This study's aim was to evaluate the effectiveness of a self-management program for gastroesophageal reflux disease. A total of 115 patients with gastroesophageal reflux disease were allocated to the experimental group and the control group. The former received self-management intervention along with conventional drug therapy, whereas the latter received standard outpatient care and conventional drug therapy. After the clinical trial, the control group also received the same self-management intervention. The levels of self-management behaviors, self-efficacy, gastroesophageal reflux disease symptoms, and psychological condition were compared. Those in the experimental group demonstrated significantly higher self-efficacy for managing their illness, showed positive changes in self-management behaviors, and had comparatively better remission of symptoms and improvement in psychological distress. The program helped patients with gastroesophageal reflux disease self-manage their illness as possible. PMID:27684637

  15. Gastroesophageal Reflux in Neurologically Impaired Children: What Are the Risk Factors?

    PubMed Central

    Kim, Seung; Koh, Hong; Lee, Joon Soo

    2017-01-01

    Background/Aims Neurologically impaired patients frequently suffer from gastrointestinal tract problems, such as gastroesophageal reflux disease (GERD). In this study, we aimed to define the risk factors for GERD in neurologically impaired children. Methods From May 2006 to March 2014, 101 neurologically impaired children who received 24-hour esophageal pH monitoring at Severance Children’s Hospital were enrolled in the study. The esophageal pH finding and the clinical characteristics of the patients were analyzed. Results The reflux index was higher in patients with abnormal electroencephalography (EEG) results than in those with normal EEG results (p=0.027). Mitochondrial disease was associated with a higher reflux index than were epileptic disorders or cerebral palsy (p=0.009). Patient gender, feeding method, scoliosis, tracheostomy, and baclofen use did not lead to statistical differences in reflux index. Age of onset of neurological impairment was inversely correlated with DeMeester score and reflux index. Age at the time of examination, the duration of the disease, and the number of antiepileptic drugs were not correlated with GER severity. Conclusions Early-onset neurological impairment, abnormal EEG results, and mitochondrial disease are risk factors for severe GERD. PMID:27840365

  16. Episodic and Semantic Memory Contribute to Familiar and Novel Episodic Future Thinking

    PubMed Central

    Wang, Tong; Yue, Tong; Huang, Xi Ting

    2016-01-01

    Increasing evidence indicates that episodic future thinking (EFT) relies on both episodic and semantic memory; however, event familiarity may importantly affect the extent to which episodic and semantic memory contribute to EFT. To test this possibility, two behavioral experiments were conducted. In Experiment 1, we directly compared the proportion of episodic and semantic memory used in an EFT task. The results indicated that more episodic memory was used when imagining familiar future events compared with novel future events. Conversely, significantly more semantic memory was used when imagining novel events compared with familiar events. Experiment 2 aimed to verify the results of Experiment 1. In Experiment 2, we found that familiarity moderated the effect of priming the episodic memory system on EFT; particularly, it increased the time required to construct a standard familiar episodic future event, but did not significantly affect novel episodic event reaction time. Collectively, these findings support the hypothesis that event familiarity importantly moderates episodic and semantic memory's contribution to EFT. PMID:27891106

  17. Acute Tc-99m DMSA scan for identifying dilating vesicoureteral reflux in children: a meta-analysis.

    PubMed

    Mantadakis, Elpis; Vouloumanou, Evridiki K; Georgantzi, Georgia G; Tsalkidis, Aggelos; Chatzimichael, Athanassios; Falagas, Matthew E

    2011-07-01

    Controversy exists regarding the type and/or sequence of imaging studies needed during the first febrile urinary tract infection (UTI) in young children. Several investigators have claimed that because acute-phase Tc-99m dimercaptosuccinic acid (DMSA) renal-scan results are abnormal in the presence of dilating vesicoureteral reflux, a normal DMSA-scan result makes voiding cystourethrography (VCUG) unnecessary in the primary examination of infants with UTI. To evaluate the accuracy of acute-phase DMSA scanning in identifying dilating (grades III through V) vesicoureteral reflux documented by VCUG in children with a first febrile UTI, we performed a meta-analysis of the accuracy of diagnostic tests as reported from relevant studies identified through the PubMed and Scopus databases. Patient-based and renal unit-based analyses were performed. Overall, 13 cohort studies were identified. Nine studies involved patients younger than 2 years, 3 involved children aged 16 years or younger, and 1 involved exclusively neonates. Girls constituted 22% to 85% of the involved children. Pooled (95% confidence intervals) sensitivity and specificity rates of DMSA scanning were 79% and 53%, respectively, for the patient-based analysis (8 studies) and 60% and 65% for the renal unit-based analysis (5 studies). The respective areas under the hierarchical summary receiver operating curves were 0.71 and 0.67. Marked statistical heterogeneity was observed in both analyses, as indicated by I(2) test values of 91% and 87%, respectively. Acute-phase DMSA renal scanning cannot be recommended as replacement for VCUG in the evaluation of young children with a first febrile UTI.

  18. Concealed semantic and episodic autobiographical memory electrified

    PubMed Central

    Ganis, Giorgio; Schendan, Haline E.

    2013-01-01

    Electrophysiology-based concealed information tests (CIT) try to determine whether somebody possesses concealed information about a crime-related item (probe) by comparing event-related potentials (ERPs) between this item and comparison items (irrelevants). Although the broader field is sometimes referred to as “memory detection,” little attention has been paid to the precise type of underlying memory involved. This study begins addressing this issue by examining the key distinction between semantic and episodic memory in the autobiographical domain within a CIT paradigm. This study also addresses the issue of whether multiple repetitions of the items over the course of the session habituate the brain responses. Participants were tested in a 3-stimulus CIT with semantic autobiographical probes (their own date of birth) and episodic autobiographical probes (a secret date learned just before the study). Results dissociated these two memory conditions on several ERP components. Semantic probes elicited a smaller frontal N2 than episodic probes, consistent with the idea that the frontal N2 decreases with greater pre-existing knowledge about the item. Likewise, semantic probes elicited a smaller central N400 than episodic probes. Semantic probes also elicited a larger P3b than episodic probes because of their richer meaning. In contrast, episodic probes elicited a larger late positive complex (LPC) than semantic probes, because of the recent episodic memory associated with them. All these ERPs showed a difference between probes and irrelevants in both memory conditions, except for the N400, which showed a difference only in the semantic condition. Finally, although repetition affected the ERPs, it did not reduce the difference between probes and irrelevants. These findings show that the type of memory associated with a probe has both theoretical and practical importance for CIT research. PMID:23355816

  19. Clinical usefulness of adherence to gastro-esophageal reflux disease guideline by Spanish gastroenterologists

    PubMed Central

    Mearin, Fermín; Ponce, Julio; Ponce, Marta; Balboa, Agustín; González, Miguel A; Zapardiel, Javier

    2012-01-01

    AIM: To investigate usefulness of adherence to gastro-esophageal reflux disease (GERD) guideline established by the Spanish Association of Gastroenterology. METHODS: Prospective, observational and multicentre study of 301 patients with typical symptoms of GERD who should be managed in accordance with guidelines and were attended by gastroenterologists in daily practice. Patients (aged > 18 years) were eligible for inclusion if they had typical symptoms of GERD (heartburn and/or acid regurgitation) as the major complaint in the presence or absence of accompanying atypical symptoms, such as dyspeptic symptoms and/or supraesophageal symptoms. Diagnostic and therapeutic decisions should be made based on specific recommendations of the Spanish clinical practice guideline for GERD which is a widely disseminated and well known instrument among Spanish in digestive disease specialists. RESULTS: Endoscopy was indicated in 123 (41%) patients: 50 with alarm symptoms, 32 with age > 50 years without alarm symptom. Seventy-two patients (58.5%) had esophagitis (grade A, 23, grade B, 28, grade C, 18, grade D, 3). In the presence of alarm symptoms, endoscopy was indicated consistently with recommendations in 98% of cases. However, in the absence of alarm symptoms, endoscopy was indicated in 33% of patients > 50 years (not recommended by the guideline). Adherence for proton pump inhibitors (PPIs) therapy was 80%, but doses prescribed were lower (half) in 5% of cases and higher (double) in 15%. Adherence regarding duration of PPI therapy was 69%; duration was shorter than recommended in 1% (4 wk in esophagitis grades C-D) or longer in 30% (8 wk in esophagitis grades A-B or in patients without endoscopy). Treatment response was higher when PPI doses were consistent with guidelines, although differences were not significant (95% vs 85%). CONCLUSION: GERD guideline compliance was quite good although endoscopy was over indicated in patients > 50 years without alarm symptoms; PPIs were

  20. Floral aroma improvement of Muscat spirits by packed column distillation with variable internal reflux.

    PubMed

    Matias-Guiu, Pau; Rodríguez-Bencomo, Juan José; Orriols, Ignacio; Pérez-Correa, José Ricardo; López, Francisco

    2016-12-15

    The organoleptic quality of wine distillates depends on raw materials and the distillation process. Previous work has shown that rectification columns in batch distillation with fixed reflux rate are useful to obtain distillates or distillate fractions with enhanced organoleptic characteristics. This study explores variable reflux rate operating strategies to increase the levels of terpenic compounds in specific distillate fractions to emphasize its floral aroma. Based on chemical and sensory analyses, two distillate heart sub-fractions obtained with the best operating strategy found, were compared with a distillate obtained in a traditional alembic. Results have shown that a drastic reduction of the reflux rate at an early stage of the heart cut produced a distillate heart sub-fraction with a higher concentration of terpenic compounds and lower levels of negative aroma compounds. Therefore, this sub-fraction presented a much more noticeable floral aroma than the distillate obtained with a traditional alembic.

  1. HIGH DEFINITION ENDOSCOPY AND "NARROW BAND IMAGING" IN THE DIAGNOSIS OF GASTROESOPHAGEAL REFLUX DISEASE

    PubMed Central

    ASSIRATI, Frederico Salvador; HASHIMOTO, Cláudio Lyoiti; DIB, Ricardo Anuar; FONTES, Luiz Henrique Souza; NAVARRO-RODRIGUEZ, Tomás

    2014-01-01

    Introduction The gastroesophageal reflux disease is a common condition in the western world but less than half of patients present endoscopic abnormalities, making a standard procedure unsuitable for diagnosis. High definition endoscopy coupled with narrow band imaging has shown potential for differentiation of lesions and possible biopsy, allowing early diagnosis and treatment. Methods This review describes the principles of biotic and their influence in obtaining images with better definition of the vessels in the mucosa, through the narrow band imaging. Selected papers using it in patients with reflux disease and Barrett's esophagus are analyzed in several ways, highlighting the findings and limitations. Conclusion The meaning of the narrow band imaging in the endoscopic diagnosis of reflux disease will be defined by large scale studies, with different categories of patients, including assessment of symptoms and response to treatment. PMID:24676302

  2. Motor function of the proximal stomach and visceral perception in gastro-oesophageal reflux disease

    PubMed Central

    Penagini, R; Hebbard, G; Horowitz, M; Dent, J; Bermingham, H; Jones, K; Holloway, R

    1998-01-01

    Background—The abnormally high postprandial rate of transient lower oesophageal sphincter relaxations seen in patients with reflux disease may be related to altered proximal gastric motor function. Heightened visceral sensitivity may also contribute to reporting of symptoms in these patients. 
Aims—To assess motor function of the proximal stomach and visceral perception in reflux disease with a barostat. 
Methods—Fasting and postprandial proximal gastric motility, sensation, and symptoms were measured in nine patients with reflux disease and nine healthy subjects. Gastric emptying of solids and liquids was assessed in six of the patients on a different day (and compared to historical controls). 
Results—Minimal distending pressure and gastric compliance were similar in the two groups, whereas the patients experienced fullness at lower pressures (p<0.05) and discomfort at lower balloon volumes (p<0.005) during isobaric and isovolumetric distensions respectively. Maximal gastric relaxation induced by the meal was similar in the two groups. Late after the meal, however, proximal gastric tone was lower (p<0.01) and the score for fullness higher (p<0.01) in the reflux patients, in whom the retention of both solids and liquids in the proximal stomach was greater (p<0.05). 
Conclusions—Reflux disease is associated with delayed recovery of proximal gastric tone after a meal and increased visceral sensitivity. The former may contribute to the increased prevalence of reflux during transient lower oesophageal sphincter relaxations and the delay in emptying from the proximal stomach, whereas both may contribute to symptom reporting. 

 Keywords: barostat; tone; compliance; mechanics PMID:9536951

  3. Inhibitory Effect of Nasal Intermittent Positive Pressure Ventilation on Gastroesophageal Reflux

    PubMed Central

    Cantin, Danny; Djeddi, Djamal; Carrière, Vincent; Samson, Nathalie; Nault, Stéphanie; Jia, Wan Lu; Beck, Jennifer; Praud, Jean-Paul

    2016-01-01

    Non-invasive intermittent positive pressure ventilation can lead to esophageal insufflations and in turn to gastric distension. The fact that the latter induces transient relaxation of the lower esophageal sphincter implies that it may increase gastroesophageal refluxes. We previously reported that nasal Pressure Support Ventilation (nPSV), contrary to nasal Neurally-Adjusted Ventilatory Assist (nNAVA), triggers active inspiratory laryngeal closure. This suggests that esophageal insufflations are more frequent in nPSV than in nNAVA. The objectives of the present study were to test the hypotheses that: i) gastroesophageal refluxes are increased during nPSV compared to both control condition and nNAVA; ii) esophageal insufflations occur more frequently during nPSV than nNAVA. Polysomnographic recordings and esophageal multichannel intraluminal impedance pHmetry were performed in nine chronically instrumented newborn lambs to study gastroesophageal refluxes, esophageal insufflations, states of alertness, laryngeal closure and respiration. Recordings were repeated without sedation in control condition, nPSV (15/4 cmH2O) and nNAVA (~ 15/4 cmH2O). The number of gastroesophageal refluxes recorded over six hours, expressed as median (interquartile range), decreased during both nPSV (1 (0, 3)) and nNAVA [1 (0, 3)] compared to control condition (5 (3, 10)), (p < 0.05). Meanwhile, the esophageal insufflation index did not differ between nPSV (40 (11, 61) h-1) and nNAVA (10 (9, 56) h-1) (p = 0.8). In conclusion, nPSV and nNAVA similarly inhibit gastroesophageal refluxes in healthy newborn lambs at pressures that do not lead to gastric distension. In addition, the occurrence of esophageal insufflations is not significantly different between nPSV and nNAVA. The strong inhibitory effect of nIPPV on gastroesophageal refluxes appears identical to that reported with nasal continuous positive airway pressure. PMID:26785264

  4. Controversies in the treatment of gastroesophageal reflux and achalasia

    PubMed Central

    Roberts, Kurt E; Duffy, Andrew J; Bell, Robert L

    2006-01-01

    The immense success of laparoscopic surgery as an effective treatment of gastroesophageal reflux disease (GERD) and achalasia has established minimal invasive surgery as the gold standard for these two conditions with lower morbidity and mortality, shorter hospital stay, faster convalescence, and less postoperative pain. One controversy in the treatment of GERD evolves around laparoscopic antireflux surgery (LARS) as the preferred treatment for Barrett’s esophagus and the procedure’s potential to reduce the risk of adenocarcinoma of the esophagus. GERD has also been associated with respiratory symptoms, asthma and laryngeal injury, and a second controversy prompts discussions about whether total or partial fundoplication is the more appropriate treatment for GERD. A new and promising alternative in the treatment of GERD is endoluminal therapy. Three types of this new treatment option will be discussed: radiofrequency energy delivered to the lower esophageal sphincter, the creation of a mechanical barrier at the gastroesophageal junction, and the direct endoscopic tightening of the lower esophageal sphincter. Laparoscopic surgery is discussed not only as a very effective treatment for GERD but also as permanent cure for achalasia. This review analyzes the three most important treatment options for achalasia: medications, pneumatic dilatation, and surgical therapy. Medications as the only true non-invasive option in the treatment of achalasia are not as effective as LARS because of their short half-life and variable absorption due to the poor esophageal emptying. The second treatment option, pneumatic dilatation, involves the stretching of the lower esophagus and is still considered the most effective non-surgical treatment for achalasia. Finally, surgical therapy for achalasia and the two major controversies concerning this laparoscopic treatment are discussed. The first involves the extent to which the myotomy is extended onto the stomach, and the second

  5. Psychological modulation in patients surgically intervened for gastroesophageal reflux disease.

    PubMed

    Lara, F J Pérez; Carranque, G; Oehling, H; Hernández, J M; Oliva, H

    2014-08-01

    Gastroesophageal reflux disease (GERD) has been related with certain psychological dimensions. The influence of mood, emotional intelligence, and perceived quality of life on clinical symptoms and outcome of antireflux surgery was evaluated in GERD patients with and without hiatal hernia. The study included 61 patients who were diagnosed with GERD between 2003 and 2008: 16 of them without hiatal hernia (group A) and 45 of them with hiatal hernia (group B). All of these patients had undergone laparoscopic antireflux surgery. Patients were clinically examined and evaluated with the following instruments: Short Form (SF)-36 Health Survey, Gastrointestinal Quality of Life Index, Hospital Anxiety and Depression (HAD) Scale, and Trait Meta-Mood Scale (TMMS)-24. Proportions were compared by using the chi-squared test; averages were compared by using the Student's t-test (with Bonferroni's correction). In general, our patients intervened for GERD showed results lower than normal or close to the lower limit of normal in the administered tests. Patients in the group without hernia were younger (P < 0.001) and with lower American Society of Anaesthesiologists risk. They showed higher scores in the SF-36 dimensions: Physical Functioning, Physical Role and Emotional Role, and lower scores in the Social Role (P < 0.001). They showed lower scores in the Emotional dimension of Gastrointestinal Quality of Life Index (P = 0.0068) and worse results in the Hospital Anxiety and Depression subscales of Anxiety (P < 0.001) and Depression (not significant). Men in the group without hernia showed higher scores than men in the group with hernia in the TMMS subscales corresponding to Emotional Clarity and Emotional Repair (P < 0.001). Women in the group with hernia showed higher scores than women in the group without hernia regarding Emotional Clarity (P = 0.0012). GERD patients showed poor results in all the tests, and patients without hiatal hernia compared with patients with hernia showed

  6. Episodic Memory and Episodic Foresight in 3- and 5-Year-Old Children

    ERIC Educational Resources Information Center

    Hayne, Harlene; Gross, Julien; McNamee, Stephanie; Fitzgibbon, Olivia; Tustin, Karen

    2011-01-01

    In the present study, we examined the development of episodic memory and episodic foresight. Three- and 5-year-olds were interviewed individually using a personalised timeline that included photographs of them at different points in their life. After constructing the timeline with the experimenter, each child was asked to discuss a number of…

  7. Prevesical Calcification and Hydronephrosis in a Girl Treated for Vesicoureteral Reflux

    PubMed Central

    Kuipers, Sarah; van der Horst, Eric H. J. R.; Verbeke, Jonathan I. M. L.; Bökenkamp, Arend

    2016-01-01

    The endoscopic STING procedure using Deflux is a common and minimal invasive treatment for vesicoureteral reflux. Herein we present the case of an 11-year-old girl with loin pain and de novo hydronephrosis and megaureter on the left. Ultrasound and plain abdominal X-ray demonstrated a calcification at the ureterovesical junction. She had been treated with Deflux injections 5 years before. The clinical quiz addresses the differential diagnosis, workup, and pathogenesis of calcifications at the ureterovesical junction following endoscopic reflux therapy. PMID:27408905

  8. Screening for vesicoureteral reflux in children using real-time sonography.

    PubMed

    Schneider, K; Jablonski, C; Wiessner, M; Kohn, M; Fendel, H

    1984-01-01

    One hundred and ten children, ages 6 days to 14 years, were investigated for vesicoureteral reflux (VUR) using ultrasound before voiding cystourethrography (VCU). Sonographically a VUR was assumed if a retrovesical dilated ureter and/or an increase of the separation of the central renal echo complex (CRC) could be detected. By means of sonography VUR grades III and IV were seen in 100%, grade II in 84% of all cases. There was a false positive rate of 10%. Sonographic reflux study is a sensitive and specific screening and follow-up procedure for VUR.

  9. [Progression from episodic migraine to chronic migraine].

    PubMed

    Yamane, Kiyomi

    2014-01-01

    Migraine is, essentially, an episodic disease. However, characteristics of headache of some episodic migraine change like as tension-type headache and number of headache days also increased, as a result, develop into chronic migraine.However, it is difficult to distinguish chronic migraine and medication oversuse headache. For this reason, and because of the general rule, The international Classification of Headache Disorders, 3rd edition, beta version (ICHD- 3beta) defined the patients meeting criteria for chronic migraine and for medication overuse headache should be given both diagnoses. The pathophysiology of transformation from episodic to chronic migraine is still unknown. Epidemiological study revealed several risk factors such as medication overusue, frequency of headache, obesity, low education, low income, snoring, depression, neck/head trauma and so on. It is important to control these risk factors for migraine chronification.

  10. Episodic confusional state: Due to insulinoma

    PubMed Central

    Jagadheesan, Venkatesan; Suresh, Stelina Sophie Dina

    2008-01-01

    This case report deals with 45-year-old male who came for consultation in the psychiatry department for the persisting symptoms, after consulting various departments with no relief. He had episodes of confusion with disorganized behavior, restlessness, and symptoms like talking irrelevantly once a week lasting up to 10-30 min in the preceding six months. Investigations like computerized tomography scan, electroencephalogram were not contributory. While under observation in our ward for evaluation and diagnosis, one such episode with intense sweating and clouding of consciousness was witnessed and helped in clinching the diagnosis of insulinoma. The case is reported for its rarity and as one of the causes of episodic confusional state. PMID:19742181

  11. Clinical and pH study characteristics in reflux patients with and without ineffective oesophageal motility (IEM)

    PubMed Central

    Triadafilopoulos, George; Tandon, Apurva; Shetler, Katerina P; Clarke, John

    2016-01-01

    Background The aetiology and clinical impact of ineffective oesophageal motility (IEM) remain poorly understood, but the condition is thought to worsen supine gastro-oesophageal acid reflux (GERD). Aims In this retrospective cohort analysis of symptomatic patients with abnormal oesophageal acid exposure, we sought to determine any clinical or functional characteristics that would distinguish those with normal peristalsis from those with IEM, defined using the Chicago classification. We hypothesised that the impaired oesophageal clearance in IEM would be contributing to more severe degrees of pathological acid exposure, as well as clinical and endoscopic GERD severity. Methods Consecutive symptomatic patients with GERD underwent clinical, endoscopic and functional evaluation that included high-resolution impedance manometry (HRIM) and ambulatory pH monitoring performed ‘off’ acid suppressive therapy. Results Of the 114 patients with abnormal oesophageal acid exposure, 71 had normal oesophageal motility by HRIM and 43 were diagnosed with IEM (38% prevalence). Age, gender and symptom duration were similar between the two groups. Both groups had similar magnitude and frequency of symptoms, making a distinction clinically impossible. Endoscopically, the two groups had similar rates of erosive disease, hiatal hernia and Barrett's oesophagus. Ambulatory pH, proton pump inhibitor (PPI) dosage and PPI response rates were also similar. Nevertheless, patients with IEM had significantly more impairment of oesophageal clearance (mean 56.9±6.4) than those with normal motility (mean 32.4±5.0) (p<0.003). Conclusions Symptomatic patients with IEM exhibit significant impairment of oesophageal clearance but are otherwise clinically indistinguishable from those with normal oesophageal motility and have a similar prevalence of erosive disease and pathological acid exposure. PMID:28074151

  12. Prediction of episodic acidification in Maryland Coastal Plain streams. Final report

    SciTech Connect

    Gerritsen, J.; Dietz, J.; Wilson, H.T.; Janicki, A.J.

    1989-12-01

    Episodic acidification from acidic precipitation in Coastal Plain streams of the Chesapeake Bay watershed is a potential threat to spawning and survival of anadromous fish species. The study is part of a process of selection of streams for mitigation of acidic episodes to increase the spawning success of anadromous fish stocks. It describes the development of practical, empirical models to predict the chemical response of Coastal Plain streams during precipitation events. One of the design criteria for the models was that they predict the response of a stream to precipitation events using data that are relatively easy to obtain. Data used to build and test the models were from several intensive studies of episodic acidification in the Maryland Coastal Plain. Regression models were developed to predict minimum pH during an event, change in pH during an event and minimum ANC (alkalinity) during an event. Two models were developed for each dependent variable.

  13. The Relationship of the Post-reflux Swallow-induced Peristaltic Wave Index and Esophageal Baseline Impedance with Gastroesophageal Reflux Disease Symptoms

    PubMed Central

    Cho, Young Kyu; Lee, Joon Seong; Lee, Tae Hee; Hong, Su Jin; Park, Sang Joon; Jeon, Seong Ran; Kim, Hyun Gun; Kim, Jin-Oh

    2017-01-01

    Background/Aims The post-reflux swallow-induced peristaltic wave (PSPW) index and esophageal baseline impedance (BI) are novel impedance parameters used to evaluate esophageal chemical clearance and mucosal integrity. However, their relationship with reflux symptoms is not known. We aim to evaluate the correlations of PSPW index and esophageal BI with gastroesophageal reflux disease (GERD) symptoms. Methods We performed a retrospective review of multichannel intraluminal impedance and pH (MII-pH) tracings in patients with suspected GERD. Reflux symptoms were also analyzed from checklists using ordinal scales. The PSPW index and esophageal BIs in 6 spots (z1–z6) were measured. Bivariate (Spearman) correlation was used to analyze the relationship between the PSPW index or esophageal BI, and the degree of GERD symptoms measured. Results The MII-pH records of 143 patients were analyzed. The PSPW index was significantly lower in patients who had heartburn and negatively correlated with the degree of heartburn (r = −0.186, P < 0.05). On the contrary, the PSPW index was not significantly correlated with the degree of dysphagia (r = −0.013, P = 0.874). Distal esophageal BI was not significantly correlated with heartburn, but negatively correlated with the degree of dysphagia (z3: r = −0.328, z4: r = −0.361, z5: r = −0.316, z6: r = −0.273; P < 0.05). Conclusions These findings suggest that delayed chemical clearance of the esophagus may induce heartburn, but that it is not related to dysphagia. However, a lack of esophageal mucosal integrity may be related to dysphagia. PMID:28044052

  14. Hemicrania continua evolving from episodic paroxysmal hemicrania.

    PubMed

    Castellanos-Pinedo, F; Zurdo, M; Martínez-Acebes, E

    2006-09-01

    A 45-year-old woman, who had been diagnosed in our unit with episodic paroxysmal hemicrania, was seen 2 years later for ipsilateral hemicrania continua in remitting form. Both types of headache had a complete response to indomethacin and did not occur simultaneously. The patient had a previous history of episodic moderate headaches that met criteria for probable migraine without aura and also had a family history of headache. The clinical course in this case suggests a pathogenic relationship between both types of primary headache.

  15. Numerical analysis of seawater circulation in carbonate platforms: II. The dynamic interaction between geothermal and brine reflux circulation

    USGS Publications Warehouse

    Jones, G.D.; Whitaker, F.F.; Smart, P.L.; Sanford, W.E.

    2004-01-01

    Density-driven seawater circulation may occur in carbonate platforms due to geothermal heating and / or reflux of water of elevated salinity. In geothermal circulation lateral contrasts in temperature between seawater and platform groundwaters warmed by the geothermal heat flux result in upward convective flow, with colder seawater drawn into the platform at depth. With reflux circulation, platform-top waters concentrated by evaporation flow downward, displacing less dense underlying groundwaters. We have used a variable density groundwater flow model to examine the pattern, magnitude and interaction of these two different circulation mechanisms, for mesosaline platform-top waters (50???) and brines concentrated up to saturation with respect to gypsum (150???) and halite (246???). Geothermal circulation, most active around the platform margin, becomes restricted and eventually shut-off by reflux of brines from the platform interior towards the margin. The persistence of geothermal circulation is dependent on the rate of brine reflux, which is proportional to the concentration of platform-top brines and also critically dependent on the magnitude and distribution of permeability. Low permeability evaporites can severely restrict reflux whereas high permeability units in hydraulic continuity enhance brine transport. Reduction in permeability with depth and anisotropy of permeability (kv < < kh) focuses flow laterally in the shallow subsurface (<1 km), resulting in a horizontally elongated brine plume. Aquifer porosity and dispersivity are relatively minor controls on reflux. Platform brines can entrain surficial seawater when brine generating conditions cease but the platform-top remains submerged, a variant of reflux we term "latent reflux". Brines concentrated up to gypsum saturation have relatively long residence times of at least 100 times the duration of the reflux event. They thus represent a long-term control on post-reflux groundwater circulation, and

  16. Clinical and pH-metric characteristics of gastro-oesophageal reflux secondary to cows' milk protein allergy.

    PubMed Central

    Cavataio, F; Iacono, G; Montalto, G; Soresi, M; Tumminello, M; Carroccio, A

    1996-01-01

    AIMS: The primary aim was to assess whether there were differences in symptoms, laboratory data, and oesophageal pH-metry between infants with primary gastro-oesophageal reflux and those with reflux secondary to cows' milk protein allergy (CMPA). PATIENTS AND METHODS: 96 infants (mean(SD) age 7.8(2.0) months) with either primary gastro-oesophageal reflux, reflux with CMPA, CMPA only, or none of these (controls) were studied. Symptoms, immunochemical data, and oesophageal pH were compared between the four groups and the effect of a cows' milk protein-free diet on the severity of symptoms was also assessed. RESULTS: 14 out of 47(30%) infants with gastro-oesophageal reflux had CMPA. These infants had similar symptoms to those with primary gastro-oesophageal reflux but higher concentrations of total IgE and circulating eosinophils (p < 0.005) and IgG anti-beta lactoglobulin (p < 0.003). A progressive constant reduction in oesophageal pH at the end of a feed, which continued up to the next feed, was seen in 12 out of 14 patients with gastro-oesophageal reflux secondary to CMPA and in 24 of 25 infants with CMPA only. No infants with primary gastro-oesophageal reflux and none of the controls had this pattern. A cows' milk protein-free diet was associated with a significant improvement in symptoms only in infants with gastro-oesophageal reflux with CMPA. CONCLUSION: A characteristic oesophageal pH pattern is useful in distinguishing infants with gastro-oesophageal reflux associated with CMPA. PMID:8813871

  17. Reevaluation of patients with bipolar disorder on manic episode: improving the diagnosing of mixed episode.

    PubMed

    Kim, Kyung Ran; Cho, Hyun-Sang; Kim, Se Joo; Seok, Jeong-Ho; Lee, Eun; Jon, Duk-In

    2013-08-01

    Mixed manic/depressive episodes in patients with bipolar disorder are underdiagnosed because of restrictive diagnostic criteria. Using the broader definition of a mixed episode represented by the Cincinnati criteria, we reevaluated the medical records of patients with bipolar disorder hospitalized for a manic episode. We also examined the predictive power of previously unrecognized depressive symptoms. Of 520 inpatients with mania, we retrospectively diagnosed 59 (11.3%) as having a probable mixed episode. Compared with the patients with pure mania, the patients with mixed episodes were more likely to have a family history of psychiatric illness, comorbid personality disorder, and a history of suicide attempts. Binary logistic regression revealed that loss of interest, loss of energy, feelings of worthlessness, and feelings of helplessness had good positive predictive value (>0.7) for mixed episodes. Accurate diagnosis of mixed episodes may require a broadening of diagnostic criteria and emphasis on symptoms such as loss of interest, loss of energy, and feelings of worthlessness and helplessness.

  18. Empirical Considerations of Episodic Perspective Taking.

    ERIC Educational Resources Information Center

    Roen, Duane H.

    To study the effects of writers' attending to the informational needs of their readers (episodic perspective taking), each of 65 college freshmen was randomly assigned to one of three treatment conditions: (1) no attention to audience, (2) attention to audience during prewriting, and (3) attention to audience during revising. All three groups…

  19. Pituitary volume in first-episode schizophrenia.

    PubMed

    Gruner, Patricia; Christian, Christopher; Robinson, Delbert G; Sevy, Serge; Gunduz-Bruce, Handan; Napolitano, Barbara; Bilder, Robert M; Szeszko, Philip R

    2012-07-30

    Pituitary volumes were measured in 55 first-episode schizophrenia patients at a baseline timepoint with 38 receiving a followup scan after antipsychotic treatment. Fifty-nine healthy volunteers had baseline scans with 34 receiving a followup scan. There were no baseline group differences in pituitary volumes or changes in volume following antipsychotic treatment.

  20. Pituitary volume in first-episode schizophrenia

    PubMed Central

    Gruner, Patricia; Christian, Christopher; Robinson, Delbert G.; Sevy, Serge; Gunduz-Bruce, Handan; Napolitano, Barbara; Bilder, Robert M.; Szeszko, Philip R.

    2011-01-01

    Pituitary volumes were measured in 55 first-episode schizophrenia patients at a baseline timepoint with 38 receiving a followup scan after antipsychotic treatment. Fifty-nine healthy volunteers had baseline scans with 34 receiving a followup scan. There were no baseline group differences in pituitary volumes or changes in volume following antipsychotic treatment. PMID:22858406

  1. Spanish for Agricultural Purposes: The Video Episodes.

    ERIC Educational Resources Information Center

    Mainous, Bruce H.; And Others

    The transcripts of dialogues from videotape recordings were developed, along with accompanying language laboratory material, as part of a one-semester course in Spanish for North American agriculture specialists preparing to work in Latin America. Included are 48 episodes covering such topics as: working with a local Spanish-speaking counterpart,…

  2. Episodic Accretion among the Orion Protostars

    NASA Astrophysics Data System (ADS)

    Fischer, William J.; Safron, Emily; Megeath, S. Thomas

    2016-06-01

    Episodic accretion, where a young stellar object undergoes stochastic spikes in its disk-to-star accretion rate one or more times over its formation period, may be a crucial process in the formation of low-mass stars. These spikes result in a factor of 10 to 100 increase in the source luminosity over the course of several months that may persist for years. Six years after the Spitzer survey of the Orion molecular clouds, the WISE telescope mapped Orion with similar wavelength coverage. Thus, the two surveys can be used to explore the mid-infrared variability of young stars on this timescale, which is suitable for discovering episodic accretion events. Out of 319 Orion protostars that were targets of the Herschel Orion Protostar Survey, we identified two examples of episodic accretion with this method. One of them, HOPS 223, was previously known. The other, HOPS 383, is the first known example of episodic accretion in a Class 0 protostar (age < 0.2 Myr). With these and one other outburst that began early in the Spitzer mission, we estimate that the most likely interval between protostellar outbursts is 740 years, with a 90% confidence interval of 470 to 6200 years. These outbursts are weaker than the optically revealed FU Ori events. We will update the mid-infrared light curves of HOPS 223 and HOPS 383 with recent data from FORCAST aboard SOFIA; HOPS 223 shows signs of fading.

  3. Redefining the Criteria for Grading Varicoceles Based on Reflux Times: A Clinicoradiological Correlation.

    PubMed

    Patil, Vikram; Shetty, S M Chandrashekar; Das, Sudha Kiran

    2016-03-01

    The aims of the study were to redefine the criteria used to grade varicoceles, based on reflux times that correlate with Dubin and Amelar clinical grading by overcoming the limitations of clinical grading and to include the less known entity of intratesticular varicoceles in the grading. Prospective correlative study was undertaken at JSS Hospital, Mysore, India during the period from July 2010 to October 2014. All patients with clinical suspicion of varicocele were clinically graded by Dubin and Amelar grading system and were later subjected to duplex ultrasound examination. The duration of the reflux obtained during the Valsalva maneuver was measured in milliseconds. Patients with intratesticular varicocele were noted and they were subgraded. One hundred patients were examined as per the methodology.The mean reflux times obtained as per the clinically graded varicoceles were as follows: subclinical varicocele, 835 ms; grade 1 varicocele, 1907 ms; grade 2 varicocele, 3108 ms; and grade 3 varicocele, 4508 ms.Based on the results obtained, we propose a modified radiological grading of the varicocele that is based on reflux times at Valsalva maneuver for each clinical grade. The presence of an intratesticular varicocele with any of the above grades is to be suffixed with "I."

  4. [The proteomic profiling of blood serum of children with gastroesophageal reflux disease].

    PubMed

    Korkotashvili, L V; Kolesov, S A; Jukova, E A; Vidmanova, T A; Kankova, N Yu; Bashurova, I A; Sidorova, A M; Kulakova, E V

    2015-03-01

    The mass-spectra of proteome of blood serum from healthy children and children with gastroesophageal reflux disease were received. The technology platform including direct proteome mass-spectrometer profiling after pre-fractional rectification using magnetic particles MB WCX was applied. The significant differences in mass-spectra were established manifesting in detection of more mass-spectrometer peaks and higher indicators of their intensity and area in group of healthy children. The study detected 39 particular peptides and low-molecular proteins predominantly intrinsic to healthy or ill children. It was established that two peptides with molecular mass 925 and 909 Da. are registered only in healthy patients and have no traces in group ofpatients with gastroesophageal reflux disease. The peptide 1564 Da is detected only in blood of children with gastroesophageal reflux disease and totally is absent in healthy children. The research data permitted to reveal specific patterns (signatures) of low-molecular proteins and peptides specific for blood serum of healthy children and patients with gastroesophageal reflux disease. The results testify the availability of singularities in metabolism of low-molecular proteins and can be used as a basis for development of minimally invasive mass-spectrometer system for its diagnostic.

  5. [The place of speech therapy in the dysfunctional dysphonias with gastro-esophageal reflux].

    PubMed

    Yana, M; Renard, M C; Stroebel, V

    2001-01-01

    This work deals with the association between dysfunctional dysphonia and gastro-oesophageal reflux. Joint medical and speech therapy management, adapted daily, would seem to be necessary. The authors report the results of a clinical assessment by questionnaire in six patients.

  6. Subjective, laryngoscopic, and acoustic measurements of laryngeal reflux before and after treatment with omeprazole.

    PubMed

    Shaw, G Y; Searl, J P; Young, J L; Miner, P B

    1996-12-01

    Laryngeal manifestation of gastroesophageal reflux is felt to be prevalent in our society. In general, diagnosis has been based primarily on symptoms. Historically, additional testing included laryngoscopy, barium swallow, manometry, and more recently, single- and double-probe pH monitoring. We evaluated 68 patients who were symptomatically suggestive of having reflux laryngitis. We administered surveys grading their symptoms. All patients underwent standardized videolaryngostroboscopic evaluation and computerized acoustic analysis. Patients then underwent a uniform therapy of dietary restrictions and omeprazole, a hydrogen ion inhibitor, for 12 weeks. Patients were then retested. This regimen demonstrated an 85% success of relieving symptoms. Utilizing the new laryngoscopic grading system, improvement was found to be statistically significant in improvement of all findings except granulomas. In patients with the pretherapy complaint of hoarseness, acoustic measures of jitter, shimmer, habitual frequency, and frequency range all showed significant improvement. The authors conclude that in patients with symptomatic reflux laryngitis, standardized videolaryngoscopy and, if hoarse, acoustic analysis are useful exam techniques to aide diagnosis and monitor therapy. Anti-reflux therapy with omeprazole is effective and improvement can be objectively demonstrated with the techniques described.

  7. Clinical Utility of Bronchoalveolar Lavage Pepsin in Diagnosis of Gastroesophageal Reflux among Wheezy Infants

    PubMed Central

    Abdallah, Ahmed Fathi; El-Desoky, Tarek; Fathi, Khalid; Elkashef, Wagdy Fawzi

    2016-01-01

    Background. There is no gold standard test for diagnosis of gastroesophageal reflux disease (GERD) associated infantile wheezing. Objectives. To evaluate the value of bronchoalveolar lavage (BAL) pepsin assay in diagnosis of GERD in wheezy infants. Methods. Fifty-two wheezy infants were evaluated for GERD using esophageal combined impedance-pH (MII-pH) monitoring, esophagogastroduodenoscopy with esophageal biopsies, and BAL pepsin. Tracheobronchial aspirates from 10 healthy infants planned for surgery without history of respiratory problems were examined for pepsin. Results. Wheezy infants with silent reflux and wheezy infants with typical GERD symptoms but normal MII-pH had significantly higher BAL pepsin compared to healthy control (45.3 ± 8.6 and 42.8 ± 8 versus 29 ± 2.6, P < 0.0001 and P = 0.011, resp.). BAL pepsin had sensitivity (61.7%, 72 %, and 70%) and specificity (55.5%, 52.9%, and 53%) to diagnose GERD associated infantile wheeze compared to abnormal MII-pH, reflux esophagitis, and lipid laden macrophage index, respectively. Conclusion. A stepwise approach for assessment of GERD in wheezy infants is advised. In those with silent reflux, a trial of antireflux therapy is warranted with no need for further pepsin assay. But when combined MII-pH is negative despite the presence of typical GERD symptoms, pepsin assay will be needed to rule out GERD related aspiration. PMID:27516725

  8. Validation and Diagnostic Usefulness of Gastroesophageal Reflux Disease Questionnaire in a Primary Care Level in Mexico

    PubMed Central

    Zavala-Gonzáles, Miguel Angel; Azamar-Jacome, Amyra Ali; Meixueiro-Daza, Arturo; de la Medina, Antonio Ramos; Reyes-Huerta J, Job; Roesch-Dietlen, Federico; Remes-Troche, José María

    2014-01-01

    Background/Aims Different non-invasive diagnostics strategies have been used to assess patients with gastroesophageal reflux. Gastroesophageal reflux disease (GERD) questionnaire (GerdQ) is a 6-item, easy to use questionnaire that was developed primarily as a diagnostic tool for GERD in primary care. Our aim was to validate and assess diagnostic utility of GerdQ questionnaire in Mexican patients in the primary care setting. Methods The study was performed in 3 phases: (1) a questionnaire translation and comprehension study (n = 20), (2) are a reproducibility and validation study (50 patients and 50 controls) and (3) a study to assess the clinical utility in 252 subjects with GERD symptoms. Diagnostic accuracy was calculated using endoscopy and/or pH-metry as the gold standard. Results Internal consistency measured by the Cronbach’s α coefficient was 0.81 for patients and 0.90 for healthy controls, with a mixed coefficient of 0.93. Reproducibility for GerdQ was very good and its discriminating validity was 88%. Most of the patients with erosive reflux and non-erosive reflux with abnormal pH-metry had scores > 8, meanwhile most of the patients with functional heartburn and hypersensitive esophagus had < 8. Sensitivity, specificity and positive predictive value of GerdQ com -pared to the gold standard were 72%, 72% and 87%, respectively. Conclusions In Mexico, the GerdQ questionnaire Spanish validated version is useful for GERD diagnosis in the primary care setting. PMID:25273118

  9. VERTICAL GASTRECTOMY AND GASTRIC BYPASS IN ROUX-EN-Y INDUCE POSTOPERATIVE GASTROESOPHAGEAL REFLUX DISEASE?

    PubMed Central

    NASSIF, Paulo Afonso Nunes; MALAFAIA, Osvaldo; RIBAS-FILHO, Jurandir Marcondes; CZECZKO, Nicolau Gregori; GARCIA, Rodrigo Ferreira; ARIEDE, Bruno Luiz

    2014-01-01

    Background The association between obesity and gastroesophageal reflux disease has a high incidence and may be present in half of obese patients with surgical indication. Bariatric operations can also induce reflux alone - differently from BMI factors - and its mechanisms are dependent on the type of procedure performed. Objective To perform a literature review comparing the two procedures currently most used for surgical treatment of obesity and analyze their relationship with the advent of pre-existing reflux disease or its appearance only in postoperative period. Method The literature was reviewed in virtual database Medline/PubMed, SciELO, Lilacs, Embase and Cochrane crossing the following MeSH descriptors: gastric bypass AND / OR anastomosis, Roux-en-Y AND / OR gastroesophageal reflux AND / OR gastroenterostomy AND / OR gastrectomy AND / OR obesity AND / OR bariatric surgery AND / OR postoperative period. A total of 135 relevant references were considered but only 30 were used in this article. Also was added the experience of the authors of this article in handling these techniques on this field. Conclusion The structural changes caused by surgical technique in vertical gastrectomy shows greater commitment of antireflux mechanisms predisposing the induction of GERD postoperatively compared to the surgical technique performed in the gastrointestinal Bypass Roux-en-Y. PMID:25409970

  10. The effect of itopride combined with lansoprazole in patients with laryngopharyngeal reflux disease.

    PubMed

    Chun, Byung-Joon; Lee, Dong-Soo

    2013-03-01

    The objective of this study is to determine the efficacy of adding a prokinetic agent to proton pump inhibitors (PPI) for the treatment of laryngopharyngeal reflux (LPR) disease. A prospective, randomized open trial comparing lansoprazole plus itopride to lansoprazole single therapy was performed for 12 weeks. Sixty-four patients with a reflux finding score (RFS) >7 and a reflux symptom index (RSI) >13 were enrolled and received either lansoprazole 30 mg once daily with itopride 50 mg three times daily or lansoprazole 30 mg once daily for 12 weeks. RSI and RFS were completed at baseline, after 6 weeks, and after 12 weeks. During the treatment period, RSI and RFS were significantly improved compared with the pretreatment scores in both study groups. Reductions of total RSI and globus symptom were significantly higher in the lansoprazole plus itopride group compared to the lansoprazole group. In the RFS, however, there were no significant differences between the two groups. In conclusion, itopride in addition to PPI did not show any superior RFS improvement compared to PPI single therapy, but was helpful in speeding up relief of reflux symptoms in LPR patients. Thus, itopride may be considered as the secondary additive agent in the PPI treatment of LPR patients.

  11. Voiding urosonography: Contrast-enhanced ultrasound cystography to diagnose vesico-ureteric reflux: A pilot study.

    PubMed

    Babu, Ramesh; Gopinath, Vinu; Sai, Venkata

    2015-01-01

    We report two children with hydronephrosis, in whom we have utilized voiding urosonography (VUS) in the evaluation of vesico-ureteric reflux. With wider availability of ultrasound contrast agents and high-end ultrasound machines, VUS is likely to become a popular tool to diagnose or exclude VUR.

  12. Treatment of vesico-ureteral reflux in infants and children using endoscopic approaches

    PubMed Central

    Okawada, Manabu; Escolino, Maria; Farina, Alessandra; Cerulo, Mariapina; Turrà, Francesco; Yamataka, Atsuyuki

    2016-01-01

    Vesicoureteral reflux (VUR) represents one of the most significant risk factors for acute pyelonephritis in children. Endoscopic treatment of VUR dates back to 1981 when Matouschek first described injection of the ureteral orifice in an attempt to correct VUR. In addition, also Politano and colleagues and McDonald described successful correction of reflux using endoscopic techniques. After these reports subureteral Teflon injection (STING) came to be appreciated as a viable new way to less invasively correct one of the most common pediatric urologic problems. The technique is technically easy to perform and is usually performed as an outpatient procedure. It is performed in general anesthesia in children and may require repeat injections, particularly in patients with high-grade reflux. As for endoscopic technique, a main problem existed. The success in children with high grade reflux was less than reported for open or laparoscopic reimplant techniques. However, in the past 10 years, newer products have become available that are changing the indications for endoscopic correction. In these review, we analyzed the papers published in the literature on this topic to give to the readers an updated overview about the results of endoscopic treatment of VUR after 30-years of his first description. PMID:27867853

  13. Delayed onset ureteral obstruction following Deflux® injection for vesicoureteral reflux.

    PubMed

    Zemple, R P; Potretzke, A M; Kryger, J V

    2012-06-01

    Endoscopic injection treatment of vesicoureteral reflux is an increasingly common and successful option. Obstruction is an infrequent postoperative complication, occurring in 1% of patients; delayed onset of obstruction is even rarer. There is a paucity of literature describing possible treatments. We present a novel approach by excision of the implanted material.

  14. What are the precautions with proton pump inhibitor use for reflux disease?

    PubMed

    Mospan, Cortney M

    2015-12-01

    Gastroesophageal reflux disease (GERD) affects 10% to 20% of the western world's population. Current treatment guidelines recommend proton pump inhibitors (PPIs) as first-line therapy. Although PPIs cause mild adverse reactions, they pose risks, particularly for older adults with comorbidities.

  15. The Generalized Quantum Episodic Memory Model.

    PubMed

    Trueblood, Jennifer S; Hemmer, Pernille

    2016-12-21

    Recent evidence suggests that experienced events are often mapped to too many episodic states, including those that are logically or experimentally incompatible with one another. For example, episodic over-distribution patterns show that the probability of accepting an item under different mutually exclusive conditions violates the disjunction rule. A related example, called subadditivity, occurs when the probability of accepting an item under mutually exclusive and exhaustive instruction conditions sums to a number >1. Both the over-distribution effect and subadditivity have been widely observed in item and source-memory paradigms. These phenomena are difficult to explain using standard memory frameworks, such as signal-detection theory. A dual-trace model called the over-distribution (OD) model (Brainerd & Reyna, 2008) can explain the episodic over-distribution effect, but not subadditivity. Our goal is to develop a model that can explain both effects. In this paper, we propose the Generalized Quantum Episodic Memory (GQEM) model, which extends the Quantum Episodic Memory (QEM) model developed by Brainerd, Wang, and Reyna (2013). We test GQEM by comparing it to the OD model using data from a novel item-memory experiment and a previously published source-memory experiment (Kellen, Singmann, & Klauer, 2014) examining the over-distribution effect. Using the best-fit parameters from the over-distribution experiments, we conclude by showing that the GQEM model can also account for subadditivity. Overall these results add to a growing body of evidence suggesting that quantum probability theory is a valuable tool in modeling recognition memory.

  16. Comparison of episodic acidification of Mid-Atlantic Upland and Coastal Plain streams

    NASA Astrophysics Data System (ADS)

    O'Brien, Anne K.; Rice, Karen C.; Kennedy, Margaret M.; Bricker, Owen P.

    1993-09-01

    Episodic acidification was examined in five mid-Atlantic watersheds representing three physiographic provinces: Coastal Plain, Valley and Ridge, and Blue Ridge. Each of the watersheds receives a similar loading of atmospheric pollutants (SO42- and NO3-) and is underlain by different bedrock type. The purpose of this research was to quantify and compare the episodic variability in storm flow chemistry in Reedy Creek, Virginia (Coastal Plain), Mill Run and Shelter Run, Virginia (Valley and Ridge), and Fishing Creek Tributary and Hunting Creek, Maryland (Blue Ridge). Because episodic responses were similar from storm to storm in each of the watersheds, a representative storm from each watershed was discussed. Acidification, defined as the loss of acid-neutralizing capacity (ANC), was observed in all streams except Mill Run. Mill Run chemistry showed little episodic variability. During storms in the other streams, pH decreased while SO42-, NO3-, and K+ concentrations increased. Concentrations of Mg2+ and Ca2+ increased in Reedy Creek and Fishing Creek Tributary, but decreased in Shelter Run and Hunting Creek. Therefore the net effect of episodic changes on the acid-base status differed among the streams. In general, greater losses of ANC were observed during storms at Shelter Run and Hunting Creek, watersheds underlain by reactive bedrock (carbonate, metabasalt); comparatively smaller losses in ANC were observed at Reedy Creek and Fishing Creek Tributary, watersheds underlain by quartzites and unconsolidated quartz sands and cobbles. Increased SO42- concentrations were most important during storms at Reedy Creek and Fishing Creek Tributary, but organic anions (inferred by anion deficit) were also a factor in causing the loss of ANC. Dilution of base cations was the most important factor in the loss of ANC at Shelter Run. Both increased sulfate and dilution of base flow were important in causing the episodic acidification at Hunting Creek. The role of SO42- in

  17. Comparison of episodic acidification of mid-Atlantic upland and Coastal Plain streams

    USGS Publications Warehouse

    O'Brien, Anne K.; Rice, Karen C.; Kennedy, Margaret M.; Bricker, Owen P.

    1993-01-01

    Episodic acidification was examined in five mid-Atlantic watersheds representing three physiographic provinces: Coastal Plain, Valley and Ridge, and Blue Ridge. Each of the watersheds receives a similar loading of atmospheric pollutants (SO42− and NO3−) and is underlain by different bedrock type. The purpose of this research was to quantify and compare the episodic variability in storm flow chemistry in Reedy Creek, Virginia (Coastal Plain), Mill Run and Shelter Run, Virginia (Valley and Ridge), and Fishing Creek Tributary and Hunting Creek, Maryland (Blue Ridge). Because episodic responses were similar from storm to storm in each of the watersheds, a representative storm from each watershed was discussed. Acidification, defined as the loss of acid-neutralizing capacity (ANC), was observed in all streams except Mill Run. Mill Run chemistry showed little episodic variability. During storms in the other streams, pH decreased while SO42−, NO3−, and K+ concentrations increased. Concentrations of Mg2+ and Ca2+ increased in Reedy Creek and Fishing Creek Tributary, but decreased in Shelter Run and Hunting Creek. Therefore the net effect of episodic changes on the acid-base status differed among the streams. In general, greater losses of ANC were observed during storms at Shelter Run and Hunting Creek, watersheds underlain by reactive bedrock (carbonate, metabasalt); comparatively smaller losses in ANC were observed at Reedy Creek and Fishing Creek Tributary, watersheds underlain by quartzites and unconsolidated quartz sands and cobbles. Increased SO42− concentrations were most important during storms at Reedy Creek and Fishing Creek Tributary, but organic anions (inferred by anion deficit) were also a factor in causing the loss of ANC. Dilution of base cations was the most important factor in the loss of ANC at Shelter Run. Both increased sulfate and dilution of base flow were important in causing the episodic acidification at Hunting Creek. The role of SO42

  18. Comparison of a dimethicone/antacid (Asilone gel) with an alginate/antacid (Gaviscon liquid) in the management of reflux oesophagitis.

    PubMed

    Smart, H L; Atkinson, M

    1990-09-01

    Fifty-three patients with symptomatic reflux oesophagitis were entered into a single centre randomized study comparing the effects of a dimethicone/antacid (Asilone Gel) and an alginate/antacid (Gaviscon liquid) on symptoms and endoscopic changes over an 8-week period. Both treatments significantly improved heartburn, acid regurgitation and flatulence. Dimethicone/antacid but not alginate/antacid, produced a significant improvement in oesophagitis, oesophageal ulceration and histological grade of inflammation over the 8-week treatment period so that 14 patients treated with dimethicone/antacid and 10 with alginate/antacid had normal endoscopic oesophageal appearances at the end of the study. The difference in improvement between the two patient groups did not reach significance however, except for dimethicone/antacid improving histological changes (P less than 0.05). These findings suggest that dimethicone/antacid and alginate/antacid are equally effective in treating symptomatic reflux oesophagitis although dimethicone/antacid may have an advantage in improving oesophageal histological appearances.

  19. Diagnosing gastro-oesophageal reflux disease or lactose intolerance in babies who cry a lot in the first few months overlooks feeding problems.

    PubMed

    Douglas, Pamela Sylvia

    2013-04-01

    This paper explores two areas in which the translation of research into practice may be improved in the management of cry-fuss behaviours in the first few months of life. Firstly, babies who cry excessively are often prescribed proton pump inhibitors, despite evidence that gastro-oesophageal reflux disease is very rarely a cause. The inaccuracy of commonly used explanatory mechanisms, the side-effects of acid-suppressive medications, and the failure to identify treatable problems, including feeding difficulty when the diagnosis of 'reflux' is applied, are discussed. Secondly, crying breastfed babies are still prescribed lactase or lactose-free formula, despite evidence that the problem of functional lactose overload is one of breastfeeding management. The mechanisms and management of functional lactose overload are discussed. These two problems of research translation need to be addressed because failure to identify and manage other causes of cry-fuss problems, including feeding difficulty, may have adverse outcomes for a small but significant minority of families.

  20. Optimal use of proton pump inhibitors for treating acid peptic diseases in primary care.

    PubMed

    Tack, J; Louis, E; Persy, V; Urbain, D

    2013-12-01

    Heartburn, reflux and epigastric pain are frequently encountered symptoms in primary care medicine. Acid peptic diseases such as peptic ulcer and gastrointestinal reflux disease have a high prevalence, can have important impact on patient quality of life and represent a considerable health care cost. Proton pump inhibitors (PPIs) are the most potent pharmacological inhibitors of gastric acid secretion currently available and are the mainstay medical therapy for acid peptic diseases. This review summarizes current evidence on treatment of acid-peptic diseases with proton pump inhibitors and provides primary care clinicians with best practice guidelines for optimal use of these drugs.

  1. Episodic future thinking in generalized anxiety disorder.

    PubMed

    Wu, Jade Q; Szpunar, Karl K; Godovich, Sheina A; Schacter, Daniel L; Hofmann, Stefan G

    2015-12-01

    Research on future-oriented cognition in generalized anxiety disorder (GAD) has primarily focused on worry, while less is known about the role of episodic future thinking (EFT), an imagery-based cognitive process. To characterize EFT in this disorder, we used the experimental recombination procedure, in which 21 GAD and 19 healthy participants simulated positive, neutral and negative novel future events either once or repeatedly, and rated their phenomenological experience of EFT. Results showed that healthy controls spontaneously generated more detailed EFT over repeated simulations. Both groups found EFT easier to generate after repeated simulations, except when GAD participants simulated positive events. They also perceived higher plausibility of negative-not positive or neutral-future events than did controls. These results demonstrate a negativity bias in GAD individuals' episodic future cognition, and suggest their relative deficit in generating vivid EFT. We discuss implications for the theory and treatment of GAD.

  2. Antipsychotic medication for early episode schizophrenia

    PubMed Central

    Bola, John; Kao, Dennis; Soydan, Haluk; Adams, Clive E

    2014-01-01

    Background Long-term treatment with antipsychotic medications in early episode schizophrenia spectrum disorders is common, but both short and long-term effects on the illness are unclear. There have been numerous suggestions that people with early episodes of schizophrenia appear to respond differently than those with multiple prior episodes. The number of episodes may moderate response to drug treatment. Objectives To assess the effects of antipsychotic medication treatment on people with early episode schizophrenia spectrum disorders. Search methods We searched the Cochrane Schizophrenia Group register (July 2007) as well as references of included studies. We contacted authors of studies for further data. Selection criteria Studies with a majority of first and second episode schizophrenia spectrum disorders comparing initial antipsychotic medication treatment with placebo, milieu, or psychosocial treatment. Data collection and analysis Working independently, we critically appraised records from 681 studies, of which five studies met inclusion criteria. We calculated risk ratios (RR) and their 95% confidence intervals (CI) where possible. For continuous data, we calculated mean difference (MD). We calculated numbers needed to treat/harm (NNT/NNH) where appropriate. Main results Five studies (combined total n=998) met inclusion criteria. Four studies (n=724) provided leaving the study early data and results suggested that individuals treated with a typical antipsychotic medication are less likely to leave the study early than those treated with placebo (Chlorpromazine: 3 RCTs n=353, RR 0.4 CI 0.3 to 0.5, NNT 3.2, Fluphenaxine: 1 RCT n=240, RR 0.5 CI 0.3 to 0.8, NNT 5; Thioridazine: 1 RCT n=236, RR 0.44 CI 0.3 to 0.7, NNT 4.3, Trifulperazine: 1 RCT n=94, RR 0.96 CI 0.3 to 3.6). Two studies contributed data to assessment of adverse effects and present a general pattern of more frequent side effects among individuals treated with typical antipsychotic medications

  3. DENTAL WEAR CAUSED BY ASSOCIATION BETWEEN BRUXISM AND GASTROESOPHAGEAL REFLUX DISEASE: A REHABILITATION REPORT

    PubMed Central

    Machado, Naila Aparecida de Godoi; Fonseca, Rodrigo Borges; Branco, Carolina Assaf; Barbosa, Gustavo Augusto Seabra; Fernandes, Alfredo Júlio; Soares, Carlos José

    2007-01-01

    Bruxism is a pathological activity of the stomatognathic system that involves tooth grinding and clenching during parafunctional jaw movements. Clinical signs of bruxism are mostly related to dental wear and muscular and joint discomforts, but a large number of etiological factors can be listed, as local, systemic, psychological and hereditary factors. The association between bruxism, feeding and smoking habits and digestive disorders may lead to serious consequences to dental and related structures, involving dental alterations (wear, fractures and cracks), periodontal signs (gingival recession and tooth mobility) and muscle-joint sensivity, demanding a multidisciplinary treatment plan. This paper presents a case report in which bruxism associated with acid feeding, smoking habit and episodes of gastric reflow caused severe tooth wear and great muscular discomfort with daily headache episodes. From the diagnosis, a multidisciplinary treatment plan was established. The initial treatment approach consisted of medical follow up with counseling on diet and smoking habits and management of the gastric disorders. This was followed by the installation of an interocclusal acrylic device in centric relation of occlusion (CRO) for reestablishment of the occlusal stability, vertical dimension of occlusion, anterior guides and return to normal muscle activity (90-day use approximately). After remission of initial symptoms, oral rehabilitation was implemented in CRO by means of full resin composite restorations and new interocclusal device for protection of restorations. Satisfactory esthetics, improved function and occlusal stability were obtained after oral rehabilitation. The patient has attended annual follow-ups for the past 2 years. The multidisciplinary treatment seems to be the key for a successful rehabilitation of severe cases of dental wear involving the association of different health disorders. PMID:19089153

  4. Saharan dust outbreaks and iberulite episodes

    NASA Astrophysics Data System (ADS)

    Diaz-Hernandez, Jose L.; Sanchez-Navas, Antonio

    2016-06-01

    Mineral dust aerosols coming from the arid and semiarid regions of the world can aggregate and form microspherulites under special atmospheric conditions. This is the case for iberulites, formed in the atmosphere from Saharan dust intrusions into the southern Iberian Peninsula during the summer, prompting a noteworthy case of dust accretion unique in the world. This study consists of a long-term monitoring of Saharan dust outbreaks producing haze that reaches the southern Iberian Peninsula. Aerosol concentration, relative humidity, and temperature time series available at the ground stations in this area indicate sharp variations of these atmospheric variables during the iberulite-forming events. Most of these events occurred during the summer (60%), with 65 episodes for the period 2005-2013, in which 107 plumes reached the Iberian Peninsula. Iberulite episodes lasted 5 days on average, during which an initial increase of particulate matter (PM) levels and temperature, accompanied by a decrease in relative humidity, was registered until the third day. These trends reversed when the plume began to abate. Our data also indicate that iberulites form during dusty episodes when a minimum threshold in the content of large aerosol particles (PM10) reached concentrations above 15 µg × m-3. Surface evaporation due to the sharply rising air temperatures give rise to clouds associated with the plume, where the water droplets that formed from condensation capture large amounts of aerosols as they fall. In this sense, muddy raindrop impacts with variable water:dust ratios recorded during red-rain episodes are interpreted as the precursor of the iberulites. A singular process of dust aggregation is here proposed for the formation of iberulites.

  5. Cognitive dissonance resolution depends on episodic memory.

    PubMed

    Chammat, Mariam; Karoui, Imen El; Allali, Sébastien; Hagège, Joshua; Lehongre, Katia; Hasboun, Dominique; Baulac, Michel; Epelbaum, Stéphane; Michon, Agnès; Dubois, Bruno; Navarro, Vincent; Salti, Moti; Naccache, Lionel

    2017-01-23

    The notion that past choices affect preferences is one of the most influential concepts of social psychology since its first report in the 50 s, and its theorization within the cognitive dissonance framework. In the free-choice paradigm (FCP) after choosing between two similarly rated items, subjects reevaluate chosen items as more attractive and rejected items as less attractive. However the relations prevailing between episodic memory and choice-induced preference change (CIPC) remain highly debated: is this phenomenon dependent or independent from memory of past choices? We solve this theoretical debate by demonstrating that CIPC occurs exclusively for items which were correctly remembered as chosen or rejected during the choice stage. We used a combination of fMRI and intra-cranial electrophysiological recordings to reveal a modulation of left hippocampus activity, a hub of episodic memory retrieval, immediately before the occurrence of CIPC during item reevaluation. Finally, we show that contrarily to a previous influential report flawed by a statistical artifact, this phenomenon is absent in amnesic patients for forgotten items. These results demonstrate the dependence of cognitive dissonance on conscious episodic memory. This link between current preferences and previous choices suggests a homeostatic function of this regulative process, aiming at preserving subjective coherence.

  6. Cognitive dissonance resolution depends on episodic memory

    PubMed Central

    Chammat, Mariam; Karoui, Imen El; Allali, Sébastien; Hagège, Joshua; Lehongre, Katia; Hasboun, Dominique; Baulac, Michel; Epelbaum, Stéphane; Michon, Agnès; Dubois, Bruno; Navarro, Vincent; Salti, Moti; Naccache, Lionel

    2017-01-01

    The notion that past choices affect preferences is one of the most influential concepts of social psychology since its first report in the 50 s, and its theorization within the cognitive dissonance framework. In the free-choice paradigm (FCP) after choosing between two similarly rated items, subjects reevaluate chosen items as more attractive and rejected items as less attractive. However the relations prevailing between episodic memory and choice-induced preference change (CIPC) remain highly debated: is this phenomenon dependent or independent from memory of past choices? We solve this theoretical debate by demonstrating that CIPC occurs exclusively for items which were correctly remembered as chosen or rejected during the choice stage. We used a combination of fMRI and intra-cranial electrophysiological recordings to reveal a modulation of left hippocampus activity, a hub of episodic memory retrieval, immediately before the occurrence of CIPC during item reevaluation. Finally, we show that contrarily to a previous influential report flawed by a statistical artifact, this phenomenon is absent in amnesic patients for forgotten items. These results demonstrate the dependence of cognitive dissonance on conscious episodic memory. This link between current preferences and previous choices suggests a homeostatic function of this regulative process, aiming at preserving subjective coherence. PMID:28112261

  7. Effect of Helicobacter pylori Eradication on the Development of Reflux Esophagitis and Gastroesophageal Reflux Symptoms: A Nationwide Multi-Center Prospective Study

    PubMed Central

    Kim, Nayoung; Lee, Sang Woo; Kim, Jin Il; Baik, Gwang Ho; Kim, Sung Jung; Seo, Geom Seog; Oh, Hyo Jeong; Kim, Sang Wook; Jeong, Heyjin; Hong, Su Jin; Shim, Ki-Nam; Shin, Jeong Eun; Park, Seun Ja; Im, Eui Hyeog; Park, Jong-Jae; Cho, Sung-Il

    2011-01-01

    Background/Aims A two-year, prospective, nationwide multicenter study was undertaken to evaluate the effect of Helicobacter pylori eradication on the development of reflux esophagitis (RE) and gastroesophageal reflux disease (GERD) symptoms in the Korean population. Methods In total, 1,489 subjects without RE were enrolled at the outpatient clinics of 12 tertiary hospitals nationwide, and 452 subjects underwent follow-up (F/U) for 2 years to evaluate the development of RE and GERD symptoms. Results RE was found in 33 subjects (7.3% of 452 subjects) and 14 subjects (7.3% of 192 subjects) during the first and second year of F/U, respectively. H. pylori status was not associated with the development of RE. RE was found in six (9.0%) of 67 H. pylori-negative patients, in 26 (11.2%) of 233 eradicated subjects and in eight (7.0%) of 114 noneradicated subjects (p=0.532). Multivariate analysis showed that age ≥60 years (odds ratio [OR], 7.11; 95% confidence interval [CI], 1.92 to 26.41), alcohol consumption (OR, 4.43; 95% CI, 1.03 to 19.19) and F/U cholesterol levels ≥200 mg/dL (OR, 5.03; 95% CI, 1.32 to 19.17) were significant risk factors for the development of RE. There was no significant difference in the development of GERD symptoms or weight according to H. pylori status during the 2-year F/U. Conclusions Eradication of H. pylori did not affect the development of reflux esophagitis or GERD symptoms among patients in outpatient gastroenterology clinics in South Korea. PMID:22195241

  8. Higher Death Rate Among Youth With First Episode Psychosis

    MedlinePlus

    ... Releases News Release Thursday, April 6, 2017 Higher death rate among youth with first episode psychosis NIH- ... experiencing first episode psychosis have a much higher death rate than previously thought. Researchers analyzed data on ...

  9. Efficiency of sodium oxybate in episodic cluster headache.

    PubMed

    Hidalgo, Hildegard; Uhl, Verena; Gantenbein, Andreas R; Sándor, Peter S; Kallweit, Ulf

    2013-10-01

    We report the case of a 60-year-old man suffering from episodic cluster headache treated successfully with sodium oxybate. Sodium oxybate may be a therapeutic option in attacks of episodic cluster headache.

  10. Gastro-oesophageal reflux related cough and its response to laparoscopic fundoplication

    PubMed Central

    Allen, C.; Anvari, M.

    1998-01-01

    BACKGROUND—This study was designed to determine prospectively the rate of cough before and after laparoscopic Nissen fundoplication performed for the control of gastro-oesophageal reflux disease.
METHODS—One hundred and ninety five consecutive patients (76 men) of mean (SD) age 46.9 (14.1) years with proven gastro-oesophageal reflux disease, who were either on long term omeprazole (n = 187) or who had not responded to a trial of omeprazole (n = 8), took part in the study which was carried out in a university teaching hospital that included a regional respiratory referral centre. Patients underwent oesophageal manometry, 24 hour oesophageal pH testing, and symptom score evaluation by an independent observer before and six months after laparoscopic Nissen fundoplication.
RESULTS—One hundred and thirty three patients presented with reflux symptoms and 62 with respiratory symptoms; 68% of patients complained of cough before surgery (86% with respiratory symptoms, 60% with gastrointestinal symptoms). The percentage reflux time in 24 hours fell significantly (p<0.0001) from a mean (SD) of 9.38 (10.99)% to 1.22 (2.92)%, lower oesophageal sphincter tone rose significantly (p<0.0001) from a mean (SD) of 7.71 (5.90) mm Hg to 21.74 (10.84) mm Hg, and the cough score fell from a median value of 8.0 (IQR 12.0) to 0 (IQR 3) following surgery. Of the patients with cough, 51% were cough free after surgery and 31% improved. The patients with respiratory symptoms had a higher cough score before (median 12.0 (IQR 5.5) versus 4.0 (IQR 8.75), p<0.0001) and after surgery (median 1 (7.5) versus 0.0 (IQR 1.0), p = 0.0045) than those with gastrointestinal symptoms.
CONCLUSIONS—Patients who present to gastroenterologists with severe reflux commonly complain of cough. Laparoscopic Nissen fundoplication is effective in the control of cough in patients with gastro-oesophageal reflux disease, with or without primary respiratory disease.

 PMID:10193396

  11. Effects of reflux ratio and feed conditions for the purification of bioethanol in a continuous distillation column

    NASA Astrophysics Data System (ADS)

    Dasan, Y. K.; Abdullah, M. A.; Bhat, A. H.

    2014-10-01

    Continuous distillation column was used for the purification of bioethanol from fermentation of molasses using Saccharomyces cerevisia. Bioethanol produced was at 8.32% (v/v) level. The efficiency of continuous distillation process was evaluated based on reflux ratio, and feed condition. The lab results were validated using COFE simulation Software. The analyses showed that both reflux ratio and feed condition had significant effects on the distillation process. Stages increased from 1.79 to 2.26 as the reflux ratio was decreased from 90% to 45% and the saturated feed produced lower mole fraction of desired product. We concluded that the lower reflux ratio with cold feed condition was suitable for higher mole fraction of top product.

  12. Episodic acidification of streams in the northeastern United States: Chemical and biological results of the episodic response project. Final report

    SciTech Connect

    Wigington, P.J.; Baker, J.P.; DeWalle, D.R.; Kretser, W.A.; Murdoch, P.S.

    1993-10-01

    The document is the result of a cooperative research effort involving scientists from several agencies as part of the Aquatic Effects Research Program (AERP) of the U.S. Environmental Protection Agency (EPA). The Episodic Response Project (ERP) is an intensive study conducted at a limited number of sites, rather than an extensive regional study. The three areas targeted by the ERP are the Northern Appalachian Plateau of Pennsylvania, and the Adirondack and Catskill Mountains of New York. Each stream was monitored from fall 1988 through spring 1990, with continuous measurement of discharge and automated water sampling at fixed time intervals or at specified stage level changes. The water samples underwent chemical analysis for acid neutralizing capacity (ANC), pH, total dissolved aluminum, dissolved organic carbon (DOC), sulfate, nitrate, chloride, calcium, magnesium, potassium, and sodium. Furthermore, a subset of samples were analyzed for inorganic aluminum. Specific streams, participating institutions and cooperators, methods, and results are presented in the report.

  13. The Pretend Play Episode: Location and Resemblance to Story.

    ERIC Educational Resources Information Center

    Roskos, K.

    This paper describes a procedure used to locate pretend play episodes in streams of play activity of 4- and 5-year-olds. A story grammar was used to compare pretend play episode activity with story construction. Participants were five girls and three boys attending the same preschool. Pretend play schemes and episodes were defined in terms of…

  14. Review of Clinical Spectrum of Gastroesophageal Reflux Disease in a General Population; A Study from South-East Iran

    PubMed Central

    Darvishmoghadam, Sodaif; Zahedi, Mohammad Javad; Hayatbakhsh Abbasi, Mohammad Mehdi; Haghdoost, Ali Akbar; Khalilyzade, Mahdieh; Karimi Goughari, Elham

    2016-01-01

    BACKGROUND Gastroesophageal reflux disease (GERD) is one of the most common gastrointestinal problems worldwide. The aim of this study was to evaluate the clinical spectrum, prevalence, and some of the variables that are supposed to be the risk factors of this chronic disorder. METHODS This population- based cross-sectional study was conducted in a one-stage randomized clustered sample of adult inhabitants in Kerman city in 2011-2012. A total of 2265 subjects with age range of 15-85 years were enrolled. Face to face interview was performed for all the subjects. GERD was defined as at least weekly heart burn and/or acid regurgitation during the past year. Association of GERD with factors like demographic variables, medical condition, diet and life habits were analyzed. RESULTS A total of 2265 subjects including 988 (43.8%) male and 1275 (56.3%) female patients were evaluated. The prevalence of GERD was 28%. The prevalence was higher in female patients and with aging. There was also a significant association between GERD and the following risk factors: lower educational level (p <0.0001), higher body mass index (p =003), presence of depression(p<0.0001), and anxiety (p <0=0001). CONCLUSION GERD as a common disorder in our region was seen more in elderly and female patients and was associated with some anthropometric, metabolic, medical conditions, and behavioral habits. PMID:27957295

  15. Long-lasting cytoprotection after pentadecapeptide BPC 157, ranitidine, sucralfate or cholestyramine application in reflux oesophagitis in rats.

    PubMed

    Sikiric, P; Jadrijevic, S; Seiwerth, S; Sosa, T; Deskovic, S; Perovic, D; Aralica, G; Grabarevic, Z; Rucman, R; Petek, M; Jagic, V; Turkovic, B; Ziger, T; Rotkvic, I; Mise, S; Zoricic, I; Sebecic, B; Patrlj, L; Kocman, B; Sarlija, M; Mikus, D; Separovic, J; Hanzevacki, M; Gjurasin, M; Miklic, P

    1999-12-01

    Recently, the effectiveness of pentadecapeptide BPC 157 and other anti-ulcer agents, called 'direct cytoprotection', was evidenced in totally gastrectomized rats duodenum challenged with cysteamine 24 h after surgery, and sacrificed 24 h after ulcerogen application. The further focus was on the possibility that this effect could be seen over a more prolonged period (1, 2, 4 weeks), and in other parts of the gastrointestinal tract (i.e. oesophagus). After the removal of the stomach, the oesophagus and jejunum were joined by a termino-lateral anastomosis. The animals were euthanized 7, 14 or 28 d after surgery, when oesophagitis was blindly assessed both macroscopically (percentage of ulcerations areas) and microscopically (percentage of areas of ulcers, regeneration and hyperplasia; number of inflammatory cells - polymorphonuclear and mononuclear). Starting 24 h after surgery, the medication was continuously given in the drinking water, in a volume of 12.5 mL/rat daily, until euthanasia at the end of the observation period, i.e. 7, 14, 28 d following surgery. Based on previous experiments, the doses of agents were daily calculated per kg b.w. as follows: BPC 157 125 mg or 125 ng, cholestyramine 2.5 mg, ranitidine 125 mg, sucralfate 725 mg, whereas controls received 72.5 mL x kg(-1) water. In support of these initial findings, and considering gastrectomized acid-free rats as an ideal model for long-term cytoprotective studies as well, pentadecapeptide BPC 157 markedly attenuated termino-lateral oesophagojejunal anastomosis-reflux oesophagitis also over a quite prolonged period. This efficacy was only partly shared by other anti-ulcer agents. After 1-week-old oesophagitis (microscopical assessment), but not after 2 or 4 weeks, less damaged mucosa was noted in rats drinking ranitidine or sucralfate compared to controls. Similar effectiveness was noted for cholestyramine. The obtained results were supported also by inflammatory cell assessment. Compared with control

  16. Risk of acute myocardial infarction in patients with gastroesophageal reflux disease: A nationwide population-based study

    PubMed Central

    Lei, Wei-Yi; Wang, Jen-Hung; Wen, Shu-Hui; Yi, Chih-Hsun; Hung, Jui-Sheng; Liu, Tso-Tsai; Orr, William C.

    2017-01-01

    Objective Gastroesophageal reflux disease (GERD) is a common disease which can cause troublesome symptoms and affect quality of life. In addition to esophageal complications, GERD may also be a risk factor for extra-esophageal complications. Both GERD and coronary artery disease (CAD) can cause chest pain and frequently co-exist. However, the association between GERD and acute myocardial infarction (AMI) remain unclear. The purpose of the study was to compare the incidence of acute myocardial infarction in GERD patients with an age-, gender-, and comorbidity matched population free of GERD. We also examine the association of the risk of AMI and the use of acid suppressing agents in GERD patients. Methods We identified patients with GERD from the Taiwan National Health Insurance Research Database. The study cohort comprised 54,422 newly diagnosed GERD patients; 269,572 randomly selected age-, gender-, comorbidity-matched subjects comprised the comparison cohort. Patients with any prior CAD, AMI or peripheral arterial disease were excluded. Incidence of new AMI was studied in both groups. Results A total 1,236 (0.5%) of the patients from the control group and 371 (0.7%) patients from the GERD group experienced AMI during a mean follow-up period of 3.3 years. Based on Cox proportional-hazard model analysis, GERD was independently associated with increased risk of developing AMI (hazard ratio (HR) = 1.48; 95% confidence interval (CI): 1.31–1.66, P < 0.001). Within the GERD group, patients who were prescribed proton pump inhibitors (PPIs) for more than one year had slightly decreased the risk of developing AMI, compared with those without taking PPIs (HR = 0.57; 95% CI: 0.31–1.04, P = 0.066). Conclusions This large population-based study demonstrates an association between GERD and future development of AMI, however, PPIs use only achieved marginal significance in reducing the occurrence of AMI in GERD patients. Further prospective studies are needed to evaluate

  17. Comparison of treatment response in second-episode versus first-episode schizophrenia.

    PubMed

    Emsley, Robin; Oosthuizen, Petrus; Koen, Liezl; Niehaus, Dana; Martinez, Lupe

    2013-02-01

    This study investigated whether illness progression and treatment refractoriness emerge after relapse in schizophrenia. We compared outcomes in a cohort treated with a standardized protocol for the first and second episodes of illness. The sample comprised 31 participants who (1) had successfully completed a 2-year open-label treatment phase with risperidone long-acting injection (RLAI) for a first episode of schizophrenia; (2) underwent an intermittent treatment extension phase up to 3 years or until recurrence, and (3) entered a further 2-year treatment phase with RLAI for a recurrence episode. For the patients who remained in treatment (n = 14 [45%]), Positive and Negative Syndrome Scale score reductions, response rates, remission rates, time to response, time to remission, functional outcome scores, and modal RLAI doses were similar for the 2 treatment periods. However, 17 (55 %) of the 31 patients discontinued the study in the second episode compared with 14 (28%) of 50 patients in the first episode, suggesting reduced effectiveness of antipsychotics when reintroduced after illness recurrence. Most notably, emergent treatment nonresponsiveness was observed in 5 participants (16%), consistent with the hypothesis that relapse may be biologically harmful in a subset of patients.

  18. Auxin reflux between the endodermis and pericycle promotes lateral root initiation.

    PubMed

    Marhavý, Peter; Vanstraelen, Marleen; De Rybel, Bert; Zhaojun, Ding; Bennett, Malcolm J; Beeckman, Tom; Benková, Eva

    2013-01-09

    Lateral root (LR) formation is initiated when pericycle cells accumulate auxin, thereby acquiring founder cell (FC) status and triggering asymmetric cell divisions, giving rise to a new primordium. How this auxin maximum in pericycle cells builds up and remains focused is not understood. We report that the endodermis plays an active role in the regulation of auxin accumulation and is instructive for FCs to progress during the LR initiation (LRI) phase. We describe the functional importance of a PIN3 (PIN-formed) auxin efflux carrier-dependent hormone reflux pathway between overlaying endodermal and pericycle FCs. Disrupting this reflux pathway causes dramatic defects in the progress of FCs towards the next initiation phase. Our data identify an unexpected regulatory function for the endodermis in LRI as part of the fine-tuning mechanism that appears to act as a check point in LR organogenesis after FCs are specified.

  19. [An association between adenoid hypertrophy and exstra-gastroesophageal reflux disease].

    PubMed

    Ren, Jianjun; Zhao, Yu; Ren, Xue

    2015-08-01

    Adenoid hypertrophy is a disease that mostly occurs among children of 3-5 years old. It is caused by repeated inflammation and infection of nasopharynx and its adjoin parts, or the adenoid itself, which will finally leads to pathological hyperplasia of adenoid. With so much information we have acquired about this disease, its specific mechanism remains unknown. In recent years, some researches have indicated that adenoid hypertrophy may have something to do with extra-gastroesophageal reflux, in which pepsin plays a very important role, and pepsin will do a series of pathological damages to the upper airway as it reaches the upper respiratory tract. Based on relative domestic and foreign literature, this paper attempts to make a review about the relationship between gastroesophageal reflux and adenoid hypertrophy.

  20. Gastro-oesophageal reflux and feeding: the speech and language therapist's perspective.

    PubMed

    Strudwick, Sue

    2003-12-01

    Babies and children with gastro-oesophageal reflux often have significant feeding difficulties. The symptoms of reflux are described, including the higher risk of aspiration. Babies can present with motor and sensory feeding disorders and can quickly develop aversive reactions to the feeding process. This effect can be long term, and speech and language therapists use various techniques to provide babies and young children with positive sensory experiences to reduce the aversion and promote successful oral feeding. Advice on grading the introduction of textures to the child's diet, messy play and advice on communication and interaction will also form part of the feeding plan. The stress on the parents will be discussed. Research shows that a truly collaborative multidisciplinary approach is likely to be the most successful, encompassing the nutritional, medical, psychosocial, and developmental aspects of the child.

  1. Patterns of venous reflux and obstruction in patients with skin damage due to chronic venous disease.

    PubMed

    Labropoulos, Nicos; Patel, Parag J; Tiongson, Jay E; Pryor, Landon; Leon, Luis R; Tassiopoulos, Apostolos K

    2007-01-01

    Identified were characteristics of individuals with skin damage related to chronic venous disease. Patients with chronic venous disease (n = 164) were evaluated with duplex ultrasound imaging and were placed in classes 4, 5, and 6 according to the CEAP classification. Their findings were compared with 100 class 2 controls. The prevalence of deep venous thrombosis was higher in the study group (23.7%) versus controls (5.1%; P < .0001), as was the prevalence of deep, perforator, and combined patterns of disease (P < .0001, P < .0007, and P < .0001). The mean duration of disease in controls 2 was shorter compared with the study group (P = .0019). The prevalence of reflux and obstruction within the study group was higher than in controls (P = .0021). Skin changes accurately reflect severity of chronic venous disease. Superficial and perforator vein reflux is the major cause of disease.

  2. The role of dexlansoprazole modified-release in the management of gastroesophageal reflux disease

    PubMed Central

    Fass, Ronnie; Frazier, Rosita

    2017-01-01

    Dexlansoprazole modified-release (MR) is the R-enantiomer of lansoprazole and is currently the only proton-pump inhibitor (PPI) with a novel dual delayed release (DDR) formulation. Overall, dexlansoprazole MR demonstrates a similar safety and side-effect profile as lansoprazole. Dexlansoprazole MR has been shown to be highly efficacious in healing erosive esophagitis, maintaining healed esophageal mucosa in patients with erosive esophagitis and controlling symptoms of patients with nonerosive reflux disease (NERD). Recent studies have also demonstrated that dexlansoprazole MR is highly effective in improving nocturnal heartburn, gastroesophageal reflux disease (GERD) related sleep disturbances and bothersome regurgitation. Dexlansoprazole MR is well tolerated and can be taken without regard to food. PMID:28203282

  3. Pulmonary Disease Secondary to Reflux Mimicking Interstitial Pneumonia in Systemic Sclerosis: Case Report and Literature Review

    PubMed Central

    Montes, Ricardo Azêdo de Luca; Mazolli Veiga, Nathalia; Lanzieri, Pedro Gemal; Mocarzel, Luis Otávio Cardoso

    2016-01-01

    Systemic sclerosis is a complex disease due to the variety of clinical presentations, often superimposed on other conditions, related or not to the connective tissue. We report a 43-year-old Brazilian woman with limited systemic sclerosis and pulmonary symptoms secondary to gastroesophageal reflux disease, with a clinical presentation similar to a diffuse interstitial lung disease. Because of the frequency of interstitial lung injury due to systemic sclerosis, this was an important differential diagnosis, which could be excluded after optimized treatment of reflux disease, with clinical and radiological improvement. Clinical management of patients with collagen diseases requires clinician skills to identify the natural history and understand its nuances. This is a common situation in clinical practice, but with a few discussions in international literature. PMID:26885429

  4. Lower Esophageal Magnetic Sphincter Augmentation for Persistent Reflux After Roux-en-Y Gastric Bypass.

    PubMed

    Muñoz-Largacha, Juan A; Hess, Donald T; Litle, Virginia R; Fernando, Hiran C

    2016-02-01

    Laparoscopic Roux-en-Y gastric bypass (LRYGB) is a good option for the treatment of gastroesophageal reflux disease (GERD) in the obese population. However, some patients have significant reflux despite this procedure, and their treatment might be challenging. Laparoscopic lower esophageal magnetic sphincter augmentation (MSA) has been introduced into clinical practice with encouraging results. Currently, MSA is only approved for patients with hiatal hernias that are less than 3 cm and without history of antireflux procedures. We present two cases of MSA for the treatment of persistent GERD after LRYGB. Since this is an off-label use of this procedure, both patients underwent extensive evaluation before proceeding with surgery. Excellent results were obtained with a significant improvement in symptoms as well as their GERD Health-Related Quality of Life scores.

  5. Complete Resolution of Pseudomalignant Erosion in a Reflux Gastroesophageal Polyp with Proton Pump Inhibitor

    PubMed Central

    Nakajima, Takahiko; Yagi, Haruo; Baba, Hayato; Minamisaka, Takashi; Miwa, Shigeharu; Hayashi, Shinichi; Nishida, Takeshi; Hatta, Hideki; Tsuneyama, Koichi; Imura, Johji

    2015-01-01

    Pseudomalignant erosion is a diagnostic pitfall for pathologists in the differential diagnosis of malignant neoplasms. Here, we present a challenging case of a biopsy specimen from the eroded head of a polyp at the esophagogastric junction. A malignant neoplasm could not be ruled out due to the presence of bizarre stromal cells. A second biopsy performed after the administration of a proton pump inhibitor (PPI) for 4 weeks revealed endoscopic resolution of the polyp along with the complete histological resolution of the bizarre stromal cells and led to the diagnosis of pseudomalignant erosion in a reflux gastroesophageal polyp. In conclusion, histological and endoscopic response to PPI therapy is an important clue for the correct diagnosis of reflux gastroesophageal polyps with pseudomalignant erosion. PMID:26688768

  6. [Reflux and obstructive nephropathy as a cause of renal failure in chronic dialysis children].

    PubMed

    Kałuzyńska, Anna; Jander, Anna; Puczko-Nogal, Barbara; Nowicki, Michał

    2008-01-01

    We carried out a retrospective analysis of medical files to evaluate causes of chronic renal failure in 80 children (M--49, F--31), age 1 month to 20 years) who started renal replacement therapy in the Department of Nephrology and Dialysis of the Polish Mothers Memorial Hospital in the years 1990-2007. In 28 children (35%) reflux and obstructive nephropathy was a cause of renal failure. In 5 children the disease was secondary to the neurogenic bladder. The incidence of these nephropathies in our population was constant in the analyzed years. In our group there were 2 neonates and 7 adolescent who were diagnosed with nephropathy as late as in the endstage phase. Boys with posterior urethral valve required renal replacement therapy earlier (146 +/- 55 months). We conclude that obstructive and reflux nephropathy are still the essential cause of end stage renal disease in children.

  7. The effect of refluxing on the alkoxide-based sodium potassium niobate sol-gel system: Thermal and spectroscopic studies

    SciTech Connect

    Chowdhury, Anirban; Bould, Jonathan; Londesborough, Michael G.S.; Milne, Steven J.

    2011-02-15

    A study on the effects of prolonged heating under reflux conditions of up to 70 h on alkoxides of sodium, potassium and niobium dissolved in 2-methoxyethanol for the synthesis of sols of composition Na{sub 0.5}K{sub 0.5}NbO{sub 3} (NKN) has been carried out using combined thermogravimetric-Fourier transform infrared spectroscopic analyses. Extended refluxing increases the homogeneity of the Na{sub 0.5}K{sub 0.5}NbO{sub 3} (NKN) system. Spectroscopic analyses on the non-refluxed and 70 h refluxed NKN gels reveal the existence of inorganic hydrated carbonates and bicarbonates, which we propose arise from the hydration and carbonation of the samples on standing in air. The X-ray diffraction patterns of these two types of gels show orthorhombic NKN phase evolutions at higher temperatures. -- Graphical abstract: Total organic evolution plots over time for NKN dried gels obtained under different refluxing times show different thermochemical behaviours and these were investigated by thermal and spectroscopic analysis tools to find a correlation between the extent of -M-O-M- chain link formation and the amount of solvent vapour (methoxyethanol) evolution. Display Omitted Research highlights: > Prolonged refluxing of sol-gel NKN precursor solutions improves final properties of an NKN system. > An NKN process thermo-chemistry with thermal and spectroscopic analysis tools was explored. > An FTIR of NKN gels reveals tendency of NKN systems for rehydration and recarbonation on standing.

  8. Positioning the instillation of contrast at the ureteral orifice cystography can be useful to predict postoperative contralateral reflux in children with unilateral vesicoureteral reflux.

    PubMed