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Esposito F, Antonini AE, Brusciano V, Paludi A, Ferrara D, Cardamone A, Zeccolini R, Zeccolini M. Para-oesophageal hernia in 4-month-old girl: possible role of ultrasound-case report and literature review. J Ultrasound 2023; 26:945-950. [PMID: 36445683 PMCID: PMC10632251 DOI: 10.1007/s40477-022-00748-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 10/19/2022] [Indexed: 12/02/2022] Open
Abstract
Hiatal hernia is the passage of digestive tract portions into the posterior mediastinum through a defect in the esophageal diaphragmatic hiatus. By guidelines, the diagnosis uses first-level radiographic investigations such as chest X-ray and contrastographic methods. As of today, use of ultrasonography in the suspicion/diagnosis of hiatal hernia is not standardized although it shows advantages such as not using ionizing radiation, which is essential in the small pediatric patient. We report the case of a little 4-month-old patient who came to our attention for dysphagia, vomiting and borborygmus to whom Type II hiatal hernia was suspected by ultrasound investigation, later confirmed by guidelines approved methods.
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Affiliation(s)
- Francesco Esposito
- UOSD Diagnostic Radiology Imaging of the Emergency Department, AORN Santobono Pausilipon: Azienda Ospedaliera di Rilievo Nazionale Santobono Pausilipon, Via Mario Fiore, 6, 80129, Naples, Italy
| | - Andrea Ennio Antonini
- Federico II University Hospital: Azienda Ospedaliera Universitaria Federico II, Via Sergio Pansini, 5, 80131, Naples, Italy.
| | - Valentina Brusciano
- Federico II University Hospital: Azienda Ospedaliera Universitaria Federico II, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Adriana Paludi
- Federico II University Hospital: Azienda Ospedaliera Universitaria Federico II, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Dolores Ferrara
- AORN Santobono Pausilipon: Azienda Ospedaliera di Rilievo Nazionale Santobono Pausilipon, Via Mario Fiore, 6, 80129, Naples, Italy
| | - Annachiara Cardamone
- Federico II University Hospital: Azienda Ospedaliera Universitaria Federico II, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Raffaele Zeccolini
- University of Campania Luigi Vanvitelli: Universita degli Studi della Campania Luigi Vanvitelli, Viale Abramo Lincoln, 5, 81100, Caserta, Italy
| | - Massimo Zeccolini
- UOC Diagnostic Radiology Imaging AORN Santobono Pausilipon: Azienda Ospedaliera di Rilievo Nazionale Santobono Pausilipon, Via Mario Fiore, 6, 80129, Naples, Italy
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Piotto L, Gent R. Ultrasound evaluation of the stomach and pylorus in the neonate and baby. SONOGRAPHY 2023. [DOI: 10.1002/sono.12345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Lino Piotto
- Department of Medical Imaging Women's and Children's Hospital North Adelaide South Australia Australia
| | - Roger Gent
- Department of Medical Imaging Women's and Children's Hospital North Adelaide South Australia Australia
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Ma L, Zhu Q, Zhang Y, Li J, Jiang Y, Xu D, Zeng X, Hou Y, Liu H. Esophagus involvement in systemic sclerosis: ultrasound parameters and association with clinical manifestations. Arthritis Res Ther 2021; 23:122. [PMID: 33882993 PMCID: PMC8059267 DOI: 10.1186/s13075-021-02505-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 04/06/2021] [Indexed: 11/16/2022] Open
Abstract
Background The esophagus involvement in systemic sclerosis (SSc) is very common yet underestimated due to the lack of suitable screening tools. This study aims to explore the usefulness of ultrasound (US) in the assessment of esophagus involvement and to identify its relationship with clinical and CT manifestations. Methods We performed transabdominal esophageal US in 38 SSc patients and 38 controls. US parameters including the abdominal esophagus length, esophagus wall thickness, shear-wave elastography, gastro-esophageal (His) angle, and reflux were compared. Relationships between distinguishable US parameters and clinical/CT parameters, such as gastro-esophageal reflux disease questionnaire (GERDQ), modified Rodnan skin score (mRSS), interstitial lung disease (ILD) score, the largest esophagus diameter (Dmax), and esophagus dilation percentage (%Eop), were evaluated. Results Abdominal esophagus length was shorter in the SSc group than the control group (2.69 cm vs 3.06 cm, P = 0.018), whereas His angle and the angle change before and after drinking water were larger in the SSc group than the control group (121° vs 108°, P < 0.001; 7.97° vs 2.92°, P = 0.025). Reflux was more frequently seen in the SSc group than the control group (7/38 vs 0/38; P = 0.017). As for correlation with clinical and CT parameters, His angle was higher in patients with GERDQ ≥ 8 than GERDQ < 8 (116.5° vs 125.6°, P = 0.035). Patients with reflux showed higher ILD score than patients without (15.8 vs 9.6, P = 0.043). Furthermore, abdominal esophagus length was negatively correlated with %Eop and Dmax (r = − 0.573, P < 0.001; r = − 0.476, P = 0.003). Conclusion US parameters of the esophagus can distinguish SSc patients from controls, as well as have correlations with clinical and CT characteristics. Our pilot study first shows that US can be used as a noninvasive and convenient method to evaluate the esophagus involvement in SSc.
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Affiliation(s)
- Li Ma
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1 Shuaifuyuan Street, Dongcheng District, Beijing, 100730, China
| | - Qingli Zhu
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1 Shuaifuyuan Street, Dongcheng District, Beijing, 100730, China
| | - Yan Zhang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1 Shuaifuyuan Street, Dongcheng District, Beijing, 100730, China
| | - Jianchu Li
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1 Shuaifuyuan Street, Dongcheng District, Beijing, 100730, China
| | - Yuxin Jiang
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1 Shuaifuyuan Street, Dongcheng District, Beijing, 100730, China
| | - Dong Xu
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), 1 Shuaifuyuan Street, Dongcheng District, Beijing, 100730, China
| | - Xiaofeng Zeng
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), 1 Shuaifuyuan Street, Dongcheng District, Beijing, 100730, China
| | - Yong Hou
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), 1 Shuaifuyuan Street, Dongcheng District, Beijing, 100730, China.
| | - He Liu
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1 Shuaifuyuan Street, Dongcheng District, Beijing, 100730, China.
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Very early onset eosinophilic esophagitis is common, responds to standard therapy, and demonstrates enrichment for CAPN14 genetic variants. J Allergy Clin Immunol 2020; 147:244-254.e6. [PMID: 33446329 DOI: 10.1016/j.jaci.2020.10.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 09/03/2020] [Accepted: 10/02/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Eosinophilic esophagitis (EoE) is a chronic, food antigen-mediated disease characterized by esophageal dysfunction and intraepithelial eosinophil accumulation. OBJECTIVE We hypothesized that very early onset EoE (V-EoE) would be enriched for early-life and genetic factors and have worse presentation and prognosis than later-onset pediatric EoE (L-EoE). METHODS We conducted a single-site, retrospective review comparing patients diagnosed at age 12 months or less (V-EoE, n = 57) and age 14 to 18 years (L-EoE, n = 70). These patients underwent medical record, EoE Histology Scoring System, Endoscopic Reference Score, and EoE Diagnostic Panel assessment when sample availability permitted. Genetic association used 2 EoE genotype repositories. Data were analyzed using chi-square tests, t tests, Wilcoxon rank-sum tests, Spearman correlations, cluster analysis, and logistic regression. RESULTS Among pediatric patients with EoE, diagnosis most commonly occurred within early life (0-24 months, 17%). V-EoE was more likely to attain histologic remission via dietary restriction (P < .0001). Basal zone hyperplasia and eosinophil inflammation were greater in V-EoE (P < .05). Esophageal strictures more commonly occurred in L-EoE (P = .03). V-EoE had lower endoscopic scores (P < .05). Molecular expression was very similar between groups. Cesarean delivery was more common in patients with V-EoE (P = .03). Patients with V-EoE demonstrated enrichment of CAPN14 common genetic variants. CONCLUSIONS Early-life diagnosis of EoE is a common occurrence. V-EoE responds to standard therapy without early evidence for complications, suggesting a less severe prognosis than hypothesized. Molecular pathogenesis is preserved between V-EoE and L-EoE. Cesarean delivery and CAPN14 genetic variation likely promote earlier disease development.
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Gastroesophageal and gastric ultrasound in children: the state of the art. J Ultrasound 2020; 24:11-14. [PMID: 32361921 DOI: 10.1007/s40477-020-00471-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 04/23/2020] [Indexed: 12/16/2022] Open
Abstract
In previous years, the role of gastroesophageal (GE) ultrasound as a diagnostic tool in gastroesophageal reflux disease (GERD) has been disputed. Most authors believe that it is difficult to diagnose GERD without correlation studies between esophageal pathology and ultrasonographic signs. Indeed, there are many anatomic descriptions of the normal GE junction. The fact that GERD diagnosis was made by morphological studies was believed to be an incorrect deduction. We revisit the pathophysiologic data concerning the gastroesophageal junction and gastric function and review the data in the literature of the past 30 years.
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Rabinowitz SS, Grossman E, Feng L, Ebigbo N, Lin B, Gupta R, Sklar R, Schwarz SM, Weedon J, Gress F. Predicting pediatric esophageal wall thickness: An EUS study. Endosc Ultrasound 2020; 9:259-266. [PMID: 32801228 PMCID: PMC7529003 DOI: 10.4103/eus.eus_15_20] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background and Objective EUS has been shown in two small series to be capable of documenting increases in the total esophageal wall thickness (TWT) in children and adults with eosinophilic esophagitis (EoE). To apply EUS-derived TWT in clinical situations or in scientific investigations in pediatric EoE, measurements of esophageal TWT in children of differing ages and heights are required. Materials and Methods Thirty patients (18M: 12F, 7 months to 20 years and 10 months) with a history of esophageal symptoms, but no endoscopic or histologic criteria of EoE were studied using a through the scope 20 MHZ Olympus Ultrasound miniprobe UM-3R (Olympus America, Center Valley Pa 18034) through a GIF Q180 or 160 (Olympus) standard pediatric upper endoscope. The mucosa, the mucosa plus submucosa, and the TWT were measured in the mid- and distal esophagus immediately before taking diagnostic biopsies. Results Measurements from both sites showed a statistically significant increase in TWT as a function of age (P < 0.001) and height (P < 0.001), as did the individual layers. The width of the mucosa and the submucosa were equivalent and together, they contributed more than half of the entire TWT. There were no significant differences between the means of the mid- and distal esophageal measurements. A multiple regression equation that can predict TWT based on age, with 95% confidence limits, is presented. Conclusions EUS has demonstrated that esophageal TWT in a cohort of control children correlates with height and with age and has provided insights into the organization of the esophageal wall. Esophageal TWT values obtained by EUS can now be interpreted to recognize esophageal wall thickening throughout childhood.
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Affiliation(s)
- Simon S Rabinowitz
- Division of Pediatric Gastroenterology, Children's Hospital at Brooklyn, New York, USA
| | - Evan Grossman
- Division of Gastroenterology & Hepatology, Department of Medicine, SUNY Downstate College of Medicine, Brooklyn, New York, USA
| | - Lisa Feng
- Division of Pediatric Gastroenterology, Children's Hospital at Brooklyn, New York, USA
| | - Nonyelum Ebigbo
- Division of Pediatric Gastroenterology, Children's Hospital at Brooklyn, New York, USA
| | - Bo Lin
- Department of Pathology, SUNY Downstate College of Medicine, Brooklyn, New York, USA
| | - Raavi Gupta
- Department of Pathology, SUNY Downstate College of Medicine, Brooklyn, New York, USA
| | - Rachel Sklar
- Division of Pediatric Gastroenterology, Children's Hospital at Brooklyn, New York, USA
| | - Steven M Schwarz
- Division of Pediatric Gastroenterology, Children's Hospital at Brooklyn, New York, USA
| | - Jeremy Weedon
- Statistical Design & Analysis, Research Division, SUNY Downstate College of Medicine, Brooklyn, New York, USA
| | - Frank Gress
- Division of Gastroenterology & Hepatology, Department of Medicine, SUNY Downstate College of Medicine, Brooklyn, New York, USA
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Gory G, Rault DN, Gatel L, Dally C, Belli P, Couturier L, Cauvin E. Ultrasonographic characteristics of the abdominal esophagus and cardia in dogs. Vet Radiol Ultrasound 2014; 55:552-60. [PMID: 24629089 DOI: 10.1111/vru.12156] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Accepted: 01/01/2014] [Indexed: 11/29/2022] Open
Abstract
Differential diagnoses for regurgitation and vomiting in dogs include diseases of the gastroesophageal junction. The purpose of this cross-sectional study was to describe ultrasonographic characteristics of the abdominal esophagus and gastric cardia in normal dogs and dogs with clinical disease involving this region. A total of 126 dogs with no clinical signs of gastrointestinal disease and six dogs with clinical diseases involving the gastroesophageal junction were included. For seven euthanized dogs, ultrasonographic features were also compared with gross pathology and histopathology. Cardial and abdominal esophageal wall thicknesses were measured ultrasonographically for all normal dogs and effects of weight, sex, age, and stomach filling were tested. Five layers could be identified in normal esophageal and cardial walls. The inner esophageal layer was echogenic, corresponding to the cornified mucosa and glandular portion of the submucosa. The cardia was characterized by a thick muscularis, and a transitional zone between echogenic esophageal and hypoechoic gastric mucosal layers. Mean (±SD) cardial wall thicknesses for normal dogs were 7.6 mm (±1.6), 9.7 mm (±1.8), 10.8 mm (±1.6), 13.3 mm (±2.5) for dogs in the <10 kg, 10-19.9 kg, 20-29.9 kg and ≥30 kg weight groups, respectively. Mean (±SD) esophageal wall thicknesses were: 4.1 mm (±0.6), 5.1 mm (±1.3), 5.6 mm (±1), and 6.4 mm (±1.1) for the same weight groups, respectively. Measurements of wall thickness were significantly correlated with dog weight group. Ultrasonography assisted diagnosis in all six clinically affected dogs. Findings supported the use of transabdominal ultrasonography as a diagnostic test for dogs with suspected gastroesophageal disease.
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Affiliation(s)
- Guillaume Gory
- Azurvet, Referral Center in Veterinary Diagnostic Imaging and Neurology, 06800, Cagnes-sur-Mer, France
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Cakmakci E, Tahtabasi M, Celebi I, Cakmakci S, Bayram A, Tokgoz S, Dogru M, Basak M. Diagnostic significance of periesophageal fat pad in ultrasonography for sliding hiatal hernias: sonographic fat pad sign. Clin Imaging 2013; 38:170-3. [PMID: 24231624 DOI: 10.1016/j.clinimag.2013.09.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2013] [Revised: 08/17/2013] [Accepted: 09/26/2013] [Indexed: 12/11/2022]
Abstract
The aim of the present study was to investigate the diagnostic significance of visualization of periesophageal fat pad in ultrasonography or computed tomography for sliding hiatal hernias. Forty-six controls and 21 esophageal hiatal hernia patients were compared in terms of sonographic and tomographic esophageal diameters. We suggest that absence of periesophageal fat pad sign in ultrasonography or computerized tomography is a noteworthy finding that calls for further investigation for the diagnosis of sliding hiatal hernias.
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Affiliation(s)
- Emin Cakmakci
- Department of Radiology, Sisli Etfal Training and Research Hospital, Istanbul, Turkey.
| | - Mehmet Tahtabasi
- Department of Radiology, Sisli Etfal Training and Research Hospital, Istanbul, Turkey
| | - Irfan Celebi
- Department of Radiology, Sisli Etfal Training and Research Hospital, Istanbul, Turkey
| | - Selma Cakmakci
- Department of Pediatrics, Kaçkar Government Hospital, Rize, Turkey
| | - Aysel Bayram
- Department of Radiology, Sisli Etfal Training and Research Hospital, Istanbul, Turkey
| | - Safiye Tokgoz
- Department of Radiology, Sisli Etfal Training and Research Hospital, Istanbul, Turkey
| | - Mucahit Dogru
- Department of Radiology, Sisli Etfal Training and Research Hospital, Istanbul, Turkey
| | - Muzaffer Basak
- Department of Radiology, Sisli Etfal Training and Research Hospital, Istanbul, Turkey
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Palabiyik FB, Bayramoglu S, Guner NT, Daglar S, Cimilli T. Use of sonography for evaluation of the cervical and thoracic esophagus in children. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2012; 31:1375-1379. [PMID: 22922617 DOI: 10.7863/jum.2012.31.9.1375] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVES The purpose of this study was to determine the normal sonographic appearance of the cervical and thoracic esophagus and to provide corresponding measurements in healthy children. METHODS In this prospective study, 93 children (51 girls and 42 boys) 1 to 15 years of age were examined sonographically. With the patient in a supine position for evaluation of the cervical esophagus, the ultrasound transducer was placed on both sides of the trachea. To evaluate the thoracic esophagus, the hands were raised over the head, and the ultrasound transducer was placed along the left side of the sternum. The length of the cervical esophagus was measured longitudinally, and the anteroposterior and transverse diameters of the cervical and thoracic esophagus were measured transversely, as was the thickness of the cervical esophageal wall. RESULTS The cervical esophagus was identified in all of the children, whereas the thoracic esophagus was shown in 41 (44%) of the 93 participants. The length of the cervical esophagus and anteroposterior and transverse diameters of the cervical and thoracic esophagus increased with age. The mean thickness of the cervical esophagus was 2.8 mm at all ages. The cervical esophageal wall appeared as 5 layers on the sonograms, and the lumen was distinct. CONCLUSIONS Evaluation of the cervical esophagus was readily achievable with sonography in children, whereas visualization of the thoracic esophagus was difficult because of the deep location, small size, and influence of bones and gas in the lungs. Conventional sonography can be easily used in the evaluation of cervical esophageal diseases in children.
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Affiliation(s)
- Figen B Palabiyik
- Department of Radiology, Bakirkoy Dr Sadi Konuk Training and Research Hospital, 11 Tevfik Saglam Ave, 34147 Zuhuratbaba, Bakirkoy, Istanbul, Turkey.
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Savino A, Cecamore C, Matronola MF, Verrotti A, Mohn A, Chiarelli F, Pelliccia P. US in the diagnosis of gastroesophageal reflux in children. Pediatr Radiol 2012; 42:515-24. [PMID: 22402830 DOI: 10.1007/s00247-012-2344-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Revised: 08/22/2011] [Accepted: 09/17/2011] [Indexed: 12/13/2022]
Abstract
Several techniques have been used to diagnose gastroesophageal reflux (GER) in children, but no single test is sufficiently accurate to completely investigate the problem. Gastroesophageal US has been described as a widely available, noninvasive and sensitive method. It provides morphological and functional information, but its role in the diagnosis of GER in children is still debated. In this paper we review diagnostic approaches to GER in children. We focus on current use of US in the management of children with suspected GER. Reports suggest that US allows exclusion of several non-GER causes of symptoms and that it provides morphological and functional data with high sensitivity and positive predictive value for the diagnosis of GER. Sonographic assessment of findings such as abdominal esophageal length, esophageal diameter, esophageal wall thickness and gastroesophageal angle provide important diagnostic indicators of reflux and related to the degree of GER. There is a need for standardization of the procedure and for defining diagnostic criteria.
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Affiliation(s)
- Alessandra Savino
- Department of Pediatrics, University of Chieti, Via dei Vestini 5, 66013, Chieti, Italy.
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Sakate M, Yamashita S, Toledo CGC, Sanches P, Padovani CR, Henry MACDA. Avaliação do tempo de trânsito esofágico pelo ultrassom: influência do gênero e índice de massa corpórea. Radiol Bras 2011. [DOI: 10.1590/s0100-39842011000600006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Utilizar a ultrassonografia do esôfago intra-abdominal para avaliar o tempo de trânsito esofágico para água e iogurte, em posição ortostática, e avaliar a influência do gênero e índice de massa corpórea. MATERIAIS E MÉTODOS: Foram estudados 89 indivíduos adultos jovens, sem clínica de doenças do trato gastrintestinal superior, sendo 40 do gênero feminino (média de 20,13 ± 1,62 anos) e 49 do gênero masculino (média de 20,43 ± 2,17 anos). O tempo de trânsito esofágico foi cronometrado, com o paciente em posição ortostática, durante a deglutição de água e iogurte. RESULTADOS: O tempo de trânsito esofágico para as mulheres e para os homens foi, respectivamente: para água, de 5,84 ± 1,60 segundos versus 6,66 ± 1,68 segundos, e para iogurte, de 9,12 ± 1,96 segundos versus 9,28 ± 1,70 segundos. Não se constatou diferença entre os gêneros masculino e feminino, apesar de o fator índice de massa corpórea ser menor nas mulheres. CONCLUSÃO: Os dados obtidos do tempo de trânsito esofágico para alimento líquido (água) e pastoso (iogurte), em posição ortostática, em adultos jovens não mostraram diferença entre os gêneros, mesmos nas mulheres com índice de massa corpórea menor em relação aos homens.
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Dehdashti H, Dehdashtian M, Rahim F, Payvasteh M. Sonographic measurement of abdominal esophageal length as a diagnostic tool in gastroesophageal reflux disease in infants. Saudi J Gastroenterol 2011; 17:53-7. [PMID: 21196654 PMCID: PMC3099082 DOI: 10.4103/1319-3767.74483] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND/AIM This study was conducted to provide sonographic measurements of the abdominal esophagus length in neonates and infants with and without gastroesophageal reflux disease (GERD) and to investigate its diagnostic value. GERD severity was also evaluated and correlated with esophageal length. It is a prospective case-control study. MATERIALS AND METHODS This prospective case-control study comprised 235 neonates and infants (120 without reflux and 115 with reflux). There were 40 children without reflux in each of three age categories: less than 1 month, 1-6 months, and 6-12 months. Of the children with reflux, 40 were less than 1 month old; 37, 1-6 months; and 38, 6-12 months. The abdominal esophagus was measured from its entrance into the diaphragm to the base of gastric folds in fed infants. GERD was sonographically diagnosed and confirmed by a barium meal. The number of refluxes during a 10-min period were recorded. RESULTS Neonates and infants with reflux had a significantly shorter abdominal esophagus than subjects without reflux: the mean difference in neonates, 4.65 mm; 1-6 months, 4.57 mm; 6-12 months, 3.61 mm. CONCLUSIONS Children with severe reflux had a shorter esophagus compared with those with mild and moderate reflux only in the neonate group. Therefore, thinking of GERD and carefully looking for its symptoms is necessary to avoid unnecessary utilization of healthcare resources in children with severe reflux.
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Affiliation(s)
- Hamid Dehdashti
- Radiology and MRI Department, Golestan Hospital, Ahwaz Jondishapour University of Medical Sciences, Ahwaz, Iran
| | - Masoud Dehdashtian
- Physiology Research Center, Ahwaz Jondishapour University of Medical Sciences, Ahwaz, Iran
| | - Fakher Rahim
- Physiology Research Center, Ahwaz Jondishapour University of Medical Sciences, Ahwaz, Iran,Address for correspondence: Dr. Fakher Rahim, Physiology Research Center, Ahwaz Jondishapour University of Medical Sciences, Ahwaz, Iran. E-mail:
| | - Mehrdad Payvasteh
- Paediatric Surgery Ward, Imam Khomeini Hospital, Ahwaz Jondishapour University of Medical Sciences, Ahwaz, Iran
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Sakate M, Teixeira AS, Yamashita S, Medeiros TR, Silva PGD, Henry MACDA. Um novo método de avaliação do "tempo esofágico" com ultra-sonografia por abordagem externa. Radiol Bras 2008. [DOI: 10.1590/s0100-39842008000500008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Utilizar a ultra-sonografia como método de avaliação do "tempo esofágico" e sua capacidade de discriminação entre as substâncias não-sólidas ingeridas (água e iogurte). MATERIAIS E MÉTODOS: Foram estudados 22 adultos jovens, sem queixa gástrica e esofágica, de ambos os sexos. Foi utilizado transdutor de ultra-som de 3,5 MHz, convexo, em modo B, colocado na região epigástrica. O intervalo de tempo esofágico foi determinado utilizando-se um cronômetro que foi acionado no momento da movimentação da glote (início da deglutição) e interrompido ao se visualizar a passagem do conteúdo deglutido no esôfago intra-abdominal. RESULTADOS: O tempo médio de trânsito para a água foi de 6,64 ± 1,83 segundos e para o iogurte foi de 8,59 ± 2,70 segundos. A análise estatística comparativa pelo teste t pareado mostrou que as médias apresentaram diferenças significativas entre as substâncias. CONCLUSÃO: O novo método experimental de avaliar o "tempo esofágico" com ultra-som é capaz de propiciar diferenças significativas do tempo necessário para um determinado alimento (líquido ou pastoso) percorrer o esôfago, esclarecendo as suspeitas clínicas e possibilitando a indicação mais precisa de exames clínicos mais complexos.
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Affiliation(s)
- Makoto Sakate
- Universidade Estadual Paulista Júlio de Mesquita Filho, Brasil
| | | | - Seizo Yamashita
- Universidade Estadual Paulista Júlio de Mesquita Filho, Brasil
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Farina R, Pennisi F, La Rosa M, Puglisi C, Mazzone G, Riva G, Foti PV, Ettorre GC. Contrast-enhanced colour-Doppler sonography versus pH-metry in the diagnosis of gastro-oesophageal reflux in children. Radiol Med 2008; 113:591-8. [PMID: 18478190 DOI: 10.1007/s11547-008-0267-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2006] [Accepted: 07/30/2007] [Indexed: 01/29/2023]
Abstract
PURPOSE The aim of this study was to evaluate the accuracy of contrast-enhanced colour-Doppler ultrasound (CDUS) in the diagnosis of gastro-oesophageal reflux in children. MATERIALS AND METHODS One hundred and twenty children (68 boys and 52 girls aged between 1 month and two years) with a clinical suspicion of gastro-oesophageal reflux (postprandial vomiting, weight loss, failure to thrive, anaemia, night-time coughing and crying, regurgitation, etc.) were studied by contrast-enhanced CDUS and subsequently by 24-hour pH-metry. Results of the two techniques were compared using the McNemar test. RESULTS Gastro-oesophageal reflux was detected on CDUS in 84 patients and with 24-h pH-metry in 86. In all cases of reflux, CDUS visualised the passage of contrast material from the stomach into the abdominal and middle and distal third of the thoracic oesophagus, enabling assessment of the segment of oesophagus involved by the reflux. Compared with pH-metry, CDUS had a sensitivity of 98% (p<0.0001 with McNemar's test). CONCLUSIONS In consideration of the results obtained and particularly of the low level of invasiveness, contrast-enhanced CDUS could be used to monitor children undergoing medical or surgical treatment for the complications of gastro-oesophageal reflux disease.
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Affiliation(s)
- R Farina
- Istituto di Radiologia, Policlinico Universitario, Via S. Sofia 89, 95125 Catania, Italy.
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Yabunaka K, Katsuda T, Sanada S, Yatake H, Yamamoto K. Sonographic visualization of the normal stomach: left lateral decubitus position. Radiol Phys Technol 2008; 1:123-7. [PMID: 20821173 DOI: 10.1007/s12194-007-0018-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2007] [Revised: 11/27/2007] [Accepted: 11/27/2007] [Indexed: 11/26/2022]
Abstract
The aim of this study was to evaluate the usefulness of an imaging technique that takes into account the effect of posture change on the stomach in transabdominal ultrasonography (US). A total of 240 adult patients (healthy subjects) underwent gastric US. In all subjects, the lesser curvature of the stomach (LCS) and left liver were measured in two different positions [left lateral decubitus (LLD) and supine]. The maximal length of the LCS was defined as the measured range between the cardial orifice and the left liver tip. The anteroposterior length (L1) and maximal longitudinal length (L2) of the left liver were determined on epigastric longitudinal scans. The mean LCS in the supine and LLD positions was 90.2 +/- 34.7 and 124.4 +/- 44.4 mm, respectively. The mean L1 in the supine and LLD positions was 54.0 +/- 12.7 and 65.6 +/- 14.4 mm, respectively. The mean L2 in the supine and LLD positions was 84.3 +/- 18.5 and 107.0 +/- 25.8 mm, respectively. The results for the measured LCS, L1, and L2 differed significantly between the supine and LLD positions (P < 0.05). This study demonstrated that the LCS could be clearly visualized on longitudinal scanning in the LLD position. Therefore, this position may potentially be more useful for gastric US, even in view of the limitations of this approach.
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Affiliation(s)
- Koichi Yabunaka
- Department of Radiology, Katsuragi Hospital, Kishiwada City, Osaka, Japan.
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Kacar S, Uysal S, Kuran S, Dagli U, Ozin Y, Karabulut E, Sasmaz N. Transcutaneous cervical esophagus ultrasound in adults: Relation with ambulatory 24-h pH-monitoring and esophageal manometry. World J Gastroenterol 2007; 13:5245-52. [PMID: 17876896 PMCID: PMC4171307 DOI: 10.3748/wjg.v13.i39.5245] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine the gastroesophageal refluxate in the cervical esophagus (CE) and measure transcutaneous cervical esophageal ultrasound (TCEUS) findings [anterior wall thickness (WT) of CE, esophageal luminal diameter (ELD), esophageal diameter (ED)]; to compare TCEUS findings in the patient subgroups divided according to 24-h esophageal pH monitoring and manometry; and to investigate possible cut-off values according to the TCEUS findings as a predictor of gastroesophageal reflux (GER).
METHODS: In 45/500 patients, refluxate was visualized in TCEUS. 38/45 patients underwent esophagogastroduodenoscopy (EGD), 24-h pH monitoring and manometry.
RESULTS: The 38 patients were grouped according to 24-h pH monitoring as follows: Group A: GER-positive (n = 20) [Includes Group B: isolated proximal reflux (PR) (n = 6), Group C: isolated distal reflux (DR) (n = 6), and Group D: both PR/DR (n = 8)]; Group E: no reflux (n = 13); and Group F: hypersensitive esophagus (HSE) (n = 5). Groups B + D indicated total PR patients (n = 14), Groups E + F reflux-negatives with HSE (n = 18), and Groups A + F reflux-positives with HSE (n = 25). When the 38 patients were grouped according to manometry findings, 24 had normal esophageal manometry; 7 had hypotensive and 2 had hypertensive lower esophageal sphincter (LES); and 5 had ineffective esophageal motility disorder (IEM). The ELD measurement was greater in group A + F than group E (P = 0.023, 5.0 ± 1.3 vs 3.9 ± 1.4 mm). In 27/38 patients, there was at least one pathologic acid reflux and/or pathologic manometry finding. The cut-off value for ELD of 4.83 mm had 79% sensitivity and 61% specificity in predicting the PR between Groups B + D and E (AUC = 0.775, P = 0.015).
CONCLUSION: Visualizing refluxate in TCEUS was useful as a pre-diagnostic tool for estimating GER or manometric pathology in 71.1% of adults in our study, but it was not diagnostic for CE WT.
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Affiliation(s)
- Sabite Kacar
- Gastroenterology Department, Turkiye Yuksek Ihtisas Hospital, Dikmen Cad 220/A, No 17 Dikmen, Ankara, Turkey
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Rokade ML. Sonographic demonstration of cervical esophageal web. JOURNAL OF CLINICAL ULTRASOUND : JCU 2006; 34:134-7. [PMID: 16547989 DOI: 10.1002/jcu.20204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
We report a case of esophageal web demonstrated with sonography in a 45-year-old woman with dysphagia. The esophageal web was incidentally detected as a circumferential hypoechoic membrane on sonograms of the cervical esophagus.
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Abstract
The main role of the esophagus is to facilitate passage of food from the mouth to the stomach. A number of conditions can alter esophageal structure or function including congenital anomalies, trauma, infection, and neoplasm. This article reviews the anatomy, imaging evaluation, and common problems seen in the pediatric thoracic esophagus.
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Affiliation(s)
- Lynn Ansley Fordham
- Pediatric Radiology, Department of Radiology, University of North Carolina School of Medicine, 3325 Old Infirmary Building, CB# 7510, Chapel Hill, NC 27599-7510, USA.
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Zhu SY, Liu RC, Chen LH, Luo F, Yang H, Feng X, Liao XH. Sonographic demonstration of the normal thoracic esophagus. JOURNAL OF CLINICAL ULTRASOUND : JCU 2005; 33:29-33. [PMID: 15690445 DOI: 10.1002/jcu.20083] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
PURPOSE Although conventional sonography has been used widely in evaluation of the abdominal and cervical esophagus, its use in the thoracic esophagus is seldom mentioned. The aim of this study was to assess whether conventional sonography could demonstrate the thoracic esophagus and to determine this structure's normal sonographic appearance and measurements. METHODS Transthoracic sonography was performed in 253 healthy volunteers ranging in age from 12 to 72 years (mean, 41 +/- 15 years). The subjects were examined while supine with their hands raised over their heads; the transducer was placed along the left side of the sternum sequentially from the first to the fifth intercostal spaces. The ultrasound beam was directed to the thoracic aorta using the heart as an acoustic window. The detectable length of the thoracic esophagus was measured in the longitudinal scan from the upper most part visualized to the point at which it penetrated the diaphragm. The esophageal thickness was measured on the anterior wall at the level of the left atrium. RESULTS In 188 (74%) of the 253 subjects, the thoracic esophagus could be demonstrated by sonography, except for the portion under the first and second intercostal spaces. In 3 of these 188 subjects, the esophagus also was not visualized at the third intercostal space. In these 188 subjects, the esophageal wall was shown as 3 layers. The esophageal lumen appeared as 1 or 2 hyperechoic bands in longitudinal sonograms. In 163 subjects, gas artifact and the comet-tail sign, with downward movement, were seen in the esophageal lumen after swallowing. The mean demonstrable length of the thoracic esophagus was 10.2 +/- 1.9 cm and the mean thickness 3.2 +/- 0.3 mm. CONCLUSIONS Most of the thoracic esophagus can be visualized by sonography, except for a short portion at the back of the left main bronchus. The heart and the thoracic aorta are 2 important landmarks in scanning.
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Affiliation(s)
- Shang-Yong Zhu
- Department of Diagnostic Ultrasound, The First Affiliated Hospital of Guangxi Medical University, 6 South Bin-Hu Road, Nanning, Guangxi 530021, People's Republic of China
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Koumanidou C, Vakaki M, Pitsoulakis G, Anagnostara A, Mirilas P. Sonographic measurement of the abdominal esophagus length in infancy: a diagnostic tool for gastroesophageal reflux. AJR Am J Roentgenol 2004; 183:801-7. [PMID: 15333373 DOI: 10.2214/ajr.183.3.1830801] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Our aim was to provide exact sonographic measurements of the abdominal esophagus length in neonates and infants with and without gastroesophageal reflux (GER) and to investigate its diagnostic value. GER severity and hiatal hernia presence were also evaluated and correlated with esophageal length. MATERIALS AND METHODS This retrospective case-control study comprised 258 neonates and infants (150 without reflux and 108 with reflux). There were 50 children without reflux in each of three age categories: less than 1 month, 1-6 months, and 6-12 months. Of the children with reflux, 42 were less than 1 month old; 34, 1-6 months; and 32, 6-12 months. The abdominal esophagus was measured from its entrance into the diaphragm to the base of gastric folds in fed infants. The number of refluxes during a 10-min period were recorded; GER was categorized as mild, one to three refluxes; moderate, three to six refluxes; and severe, more than six refluxes. Presence of hiatal hernia was recorded. RESULTS Neonates and infants with reflux had a significantly shorter abdominal esophagus than subjects without reflux: the mean difference in neonates, 4.8 mm; 1-6 months, 4.5 mm; 6-12 months, 3.4 mm. Children with severe reflux had a shorter esophagus compared with those with mild and moderate reflux only in the neonate group. In contrast, children with reflux associated with hiatal hernia had a significantly shorter esophagus compared with children with mild reflux in all three age groups. Sonographic sensitivity was 94%. CONCLUSION Sonographic measurement of the abdominal esophagus length is highly diagnostic for GER in neonates and infants. In neonates, it can also indicate GER severity. Hiatal hernia is associated with a significantly shorter abdominal esophagus.
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Affiliation(s)
- C Koumanidou
- Department of Radiology, Agia Sofia Children's Hospital, Thivon and Mikras Asias Sts., Goudi, Athens 11527, Greece
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Zhu SY, Liu RC, Chen LH, Yang H, Feng X, Liao XH. Sonographic anatomy of the cervical esophagus. JOURNAL OF CLINICAL ULTRASOUND : JCU 2004; 32:163-171. [PMID: 15101076 DOI: 10.1002/jcu.20017] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
PURPOSE Although conventional sonography is used widely for evaluation of the gastroesophageal junction, its use in the cervical esophagus is still limited. The aim of this study was to assess the use of sonography to demonstrate this portion of the esophagus. METHODS The cervical esophagi in 60 cadavers and 435 healthy volunteers were examined sonographically. Among the healthy subjects 182 were scanned with a transducer operating at 7.5 MHz, 183 with a 10.0-MHz transducer, and 70 with a 12.0-MHz transducer. Sonographic layer patterns were compared among the groups. Sonographic and histologic analyses were also performed on 3 cadaveric esophageal specimens to correlate the sonographic appearances with the anatomical findings. RESULTS Scans of the cadavers showed that the cervical esophagus lay between the trachea and vertebrae, with its origin at the midline; it gradually moved to the left as it descended toward the trunk. It moved to the right when the cadaver's head was turned to the left and the trachea was pushed gently to the left. Based on these anatomical characteristics, visualization of the cervical esophagus was optimized by scanning from both the left and the right lateral approaches, with manipulation of the trachea as needed. In scans of the 435 healthy subjects, the esophageal wall was shown as 5 layers in 423 (97.2%) and as 7 layers in the remaining 12 (2.8%). The demonstration rate of the 7-layer pattern was significantly higher for subjects scanned at 12.0 MHz than for those scanned at 10.0 and 7.5 MHz (p < 0.01). The layers demonstrated sonographically corresponded to histological structures evident on microscopy. CONCLUSIONS The left lateral approach is essential to sonography of the cervical esophagus. However, the right wall of the esophagus is best seen from the right. In transverse scans, the cervical esophagus wall usually appears to be composed of 5 layers, although 7 layers can also appear, especially as the transducer frequency is increased.
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Affiliation(s)
- Shang-Yong Zhu
- Department of Diagnostic Ultrasound, The First Affiliated Hospital of Guangxi Medical University, 6 South Bin-Hu Road, Nanning, Guangxi 530021, People's Republic of China
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