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Lacombe D, Bloch-Zupan A, Bredrup C, Cooper EB, Houge SD, García-Miñaúr S, Kayserili H, Larizza L, Lopez Gonzalez V, Menke LA, Milani D, Saettini F, Stevens CA, Tooke L, Van der Zee JA, Van Genderen MM, Van-Gils J, Waite J, Adrien JL, Bartsch O, Bitoun P, Bouts AHM, Cueto-González AM, Dominguez-Garrido E, Duijkers FA, Fergelot P, Halstead E, Huisman SA, Meossi C, Mullins J, Nikkel SM, Oliver C, Prada E, Rei A, Riddle I, Rodriguez-Fonseca C, Rodríguez Pena R, Russell J, Saba A, Santos-Simarro F, Simpson BN, Smith DF, Stevens MF, Szakszon K, Taupiac E, Totaro N, Valenzuena Palafoll I, Van Der Kaay DCM, Van Wijk MP, Vyshka K, Wiley S, Hennekam RC. Diagnosis and management in Rubinstein-Taybi syndrome: first international consensus statement. J Med Genet 2024; 61:503-519. [PMID: 38471765 PMCID: PMC11137475 DOI: 10.1136/jmg-2023-109438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 02/15/2024] [Indexed: 03/14/2024]
Abstract
Rubinstein-Taybi syndrome (RTS) is an archetypical genetic syndrome that is characterised by intellectual disability, well-defined facial features, distal limb anomalies and atypical growth, among numerous other signs and symptoms. It is caused by variants in either of two genes (CREBBP, EP300) which encode for the proteins CBP and p300, which both have a function in transcription regulation and histone acetylation. As a group of international experts and national support groups dedicated to the syndrome, we realised that marked heterogeneity currently exists in clinical and molecular diagnostic approaches and care practices in various parts of the world. Here, we outline a series of recommendations that document the consensus of a group of international experts on clinical diagnostic criteria for types of RTS (RTS1: CREBBP; RTS2: EP300), molecular investigations, long-term management of various particular physical and behavioural issues and care planning. The recommendations as presented here will need to be evaluated for improvements to allow for continued optimisation of diagnostics and care.
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Affiliation(s)
- Didier Lacombe
- Department of Medical Genetics, University Hospital of Bordeaux, and INSERM U1211, University of Bordeaux, 33076 Bordeaux, France
| | - Agnès Bloch-Zupan
- Faculté de Chirurgie Dentaire, Université de Strasbourg, and Centre de référence des maladies rares orales et dentaires, Hôpitaux Universitaires de Strasbourg, Strasbourg, and Institut de Génétique et de Biologie Moléculaire et Cellulaire, INSERM U1258, Illkirch, France
| | - Cecilie Bredrup
- Department of Clinical Medicine, University of Bergen, 5020 Bergen, Norway
| | - Edward B Cooper
- Department of Anesthesiology, Cincinnati Children's Hospital, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Sofia Douzgou Houge
- Department of Medical Genetics, Haukeland University Hospital, Bergen, Norway and Division of Evolution, Infection and Genomics, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Sixto García-Miñaúr
- Instituto de Genética Médica y Molecular (INGEMM), Hospital Universitario La Paz, Madrid, Spain
| | - Hülya Kayserili
- Department of Medical Genetics, Koc University School of Medicine (KUSOM), 34010 Istanbul, Turkey
| | - Lidia Larizza
- Laboratorio di Ricerca in Citogenetica medica e Genetica Molecolare, Centro di Ricerche e Tecnologie Biomediche IRCCS-Istituto Auxologico Italiano, Milano, Italy
| | - Vanesa Lopez Gonzalez
- Department of Pediatrics, Medical Genetics Section, Virgen de la Arrixaca University Hospital, IMIB, CIBERER, Murcia, Spain
| | - Leonie A Menke
- Department of Pediatrics, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Donatella Milani
- Fondazione IRCCS, Ca'Granda Ospedale Maggiore, 20122 Milan, Italy
| | - Francesco Saettini
- Fondazione Matilde Tettamanti Menotti De Marchi Onlus, Fondazione Monza e Brianza per il Bambino e la sua Mamma, Monza, Italy
| | - Cathy A Stevens
- Department of Pediatrics, University of Tennessee College of Medicine, Chattanooga, Tennessee, USA
| | - Lloyd Tooke
- Department of Pediatrics, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Jill A Van der Zee
- Department of Pediatric Urology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Maria M Van Genderen
- Bartiméus Diagnostic Center for complex visual disorders, Zeist and Department of Ophthalmology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Julien Van-Gils
- Department of Medical Genetics, University Hospital of Bordeaux, and INSERM U1211, University of Bordeaux, 33076 Bordeaux, France
| | - Jane Waite
- School of Psychology, College of Health and Life Sciences, Aston University, Birmingham, UK
| | - Jean-Louis Adrien
- Université de Paris, Laboratoire de Psychopathologie et Processus de Santé, Boulogne Billancourt, France
| | - Oliver Bartsch
- MVZ - Humangenetik, University Medical Center, Johannes Gutenberg University Mainz, 55131 Mainz, Germany
| | - Pierre Bitoun
- Département de Genetique, SIDVA 91, Juvisy-sur-Orge, France
| | - Antonia H M Bouts
- Department of Pediatric Nephrology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Anna M Cueto-González
- Department of Clinical and Molecular Genetics, University Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | | | - Floor A Duijkers
- Department of Human Genetics, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Patricia Fergelot
- Department of Medical Genetics, University Hospital of Bordeaux, and INSERM U1211, University of Bordeaux, 33076 Bordeaux, France
| | - Elizabeth Halstead
- Psychology and Human Development Department, University College London, London, UK
| | - Sylvia A Huisman
- Department of Pediatrics, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- Zodiak, Prinsenstichting, Purmerend, Netherlands
| | - Camilla Meossi
- Fondazione IRCCS, Ca'Granda Ospedale Maggiore, 20122 Milan, Italy
| | - Jo Mullins
- Rubinstein-Taybi Syndrome Support Group, Registered Charity, Rickmansworth, UK
| | - Sarah M Nikkel
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Chris Oliver
- School of Psychology, University of Birmingham, Edgbaston, UK
| | - Elisabetta Prada
- Fondazione IRCCS, Ca'Granda Ospedale Maggiore, 20122 Milan, Italy
| | - Alessandra Rei
- Associazione Rubinstein-Taybi Syndrome-Una Vita Speciale, Organizzazione di Volontariato (ODV), Gornate Olona, Varese, Italy
| | - Ilka Riddle
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | | | | | - Janet Russell
- Associazione Rubinstein-Taybi Syndrome-Una Vita Speciale, Organizzazione di Volontariato (ODV), Gornate Olona, Varese, Italy
| | | | - Fernando Santos-Simarro
- Unit of Molecular Diagnostics and Clinical Genetics, Hospital Universitari Son Espases, Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
| | - Brittany N Simpson
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, Cincinnati School of Medicine, Cincinnati, Ohio, USA
| | - David F Smith
- Department of Pediatric Otolaryngology, Cincinnati Children's Hospital Medical Center, and Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Markus F Stevens
- Department of Anesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Katalin Szakszon
- Institution of Pediatrics, University of Debrecen Clinical Centre, Debrecen, Hungary
| | - Emmanuelle Taupiac
- Department of Medical Genetics, University Hospital of Bordeaux, and INSERM U1211, University of Bordeaux, 33076 Bordeaux, France
| | - Nadia Totaro
- Associazione Rubinstein-Taybi Syndrome-Una Vita Speciale, Organizzazione di Volontariato (ODV), Gornate Olona, Varese, Italy
| | - Irene Valenzuena Palafoll
- Department of Clinical and Molecular Genetics, University Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Daniëlle C M Van Der Kaay
- Division of Paediatric Endocrinology, Department of Paediatrics, Erasmus University Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Michiel P Van Wijk
- Department of Pediatric Gastroenterology, Emma Children's Hospital, Amsterdam UMC, University Amsterdam, Amsterdam, Netherlands
| | - Klea Vyshka
- European Reference Network on Rare Congenital Malformations and Rare Intellectual Disability (ERN-ITHACA), Robert Debré University Hospital, Paris, France
| | - Susan Wiley
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Raoul C Hennekam
- Department of Pediatrics, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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Ryan MA, Ermarth A. Inflammatory Causes of Dysphagia in Children. Otolaryngol Clin North Am 2024:S0030-6665(24)00043-4. [PMID: 38637195 DOI: 10.1016/j.otc.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
Gastroesophageal reflux (GER) and eosinophilic esophagitis (EoE) are the most common inflammatory causes of pediatric dysphagia, but several other less prevalent conditions should be considered. These conditions can affect one or several aspects of the swallowing process. In some inflammatory conditions dysphagia may be an early symptom. Esophagoscopy and instrumental swallow studies are often needed to determine the underlying diagnosis and best treatment plan. In some inflammatory conditions dysphagia can portend a worse outcome and need for more aggressive treatment of the underlying condition. Consultations with speech language pathology, gastroenterology, dietetics, allergy/immunology and/or rheumatology are often needed to optimize management.
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Affiliation(s)
- Marisa A Ryan
- Pediatric Otolaryngology, Peak ENT Associates, 1055 North 300 West, Suite 401, Provo, UT 84604, USA.
| | - Anna Ermarth
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, University of Utah School of Medicine, 81 Mario Capecchi Drive, Salt Lake City, UT 84113, USA
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Maassel NL, Shaughnessy MP, Solomon DG, Cowles RA. Trends in fundoplication volume for pediatric gastroesophageal reflux disease. J Pediatr Surg 2021; 56:1495-1499. [PMID: 33745746 DOI: 10.1016/j.jpedsurg.2021.02.045] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/10/2021] [Accepted: 02/19/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Fundoplication for gastro-esophageal reflux disease (GERD) has been commonly performed by pediatric surgeons, however there are no recent data documenting fundoplication trends. Changes in fundoplication volume impact pediatric surgical training and may reflect changes in care for children with severe GERD. MATERIALS & METHODS The Pediatric Health Information System (PHIS) was queried from 2010-2019 for children with ICD-9/ICD-10 codes for GERD, fundoplication, and gastrostomy. Institutional surgical volume and patient demographics were examined over time. A secondary analysis using the Accreditation Council for Graduate Medical Education case logs for pediatric surgery fellows was performed across the same years to assess effects upon surgical volume for trainees. RESULTS Mean institutional fundoplication case volume decreased from 50 in 2010 to 17 in 2019. Trends were similar between institutions with and without fellowship programs when corrected by total operative volume. Patient characteristics were relatively unchanged between 2010 and 2019. Fundoplication volume reported in fellow case logs decreased from 46 in 2010 to 26 in 2019, mirroring national data. CONCLUSIONS Institutional volume for fundoplication in children with GERD has seen a 3-fold decrease over the last decade, mirrored by an almost 2-fold decrease in case volume reported by pediatric surgery fellows.
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Affiliation(s)
- Nathan L Maassel
- Yale University School of Medicine, Department of Surgery, Division of Pediatric Surgery, New Haven, CT, USA
| | - Matthew P Shaughnessy
- Yale University School of Medicine, Department of Surgery, Division of Pediatric Surgery, New Haven, CT, USA
| | - Daniel G Solomon
- Yale University School of Medicine, Department of Surgery, Division of Pediatric Surgery, New Haven, CT, USA
| | - Robert A Cowles
- Yale University School of Medicine, Department of Surgery, Division of Pediatric Surgery, New Haven, CT, USA.
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Akhparov NN, Boranbayeva R, Suleimanova SB, Temirkhanova M. Current issues of gastro-oesophageal reflux disease surgical treatment in children. Afr J Paediatr Surg 2021; 18:127-132. [PMID: 34341194 PMCID: PMC8362913 DOI: 10.4103/ajps.ajps_104_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Gastro-oesophageal reflux (GER) disease is one of the most common diseases amongst a wide range of chronic inflammatory diseases of the gastrointestinal tract in children of all ages, significantly impairing the quality of life of the child and posing a serious threat to the health of the patient. From 2008 to 2019, 134 patients aging from 6 months to 12 years were hospitalised at the Scientific Center for Pediatrics and Pediatric Surgery including 69 (51%) infants. Of them, 51 (38%) were the patients with persistent manifestations of regurgitation, despite an outpatient course of conservative therapy; 29 (22%) patients with recurrent reflux-associated pneumonia; also, 35 (26%) children with GER in the structure of the main pathology of the central nervous system, as well as 19 (14%) patients after surgery of the anastomosis of the oesophagus with its atresia. One hundred and seven (79.8%) patients underwent surgery. Nissen oesophagofundoplication was traditionally performed in 41 (38%) patients, in combination with Stamm gastrostomy in 14 (34%), with Mikulich pyloroplasty in 9 (22%) and in combination with gastrostomy and pyloroplasty in 12 (29%) children. Laparoscopic Nissen oesophagofundoplication was used in 16 (15%) cases. Thall oesophagofundoplication was performed in 48 (45%) patients, while in two (2%) cases, Boerema gastropexy was conducted. The immediate results were studied in all 107 patients. Complications in the form of gastric distress syndrome were revealed in four (3.7%) patients who did not undergo pyloroplasty, which in two (1.9%) cases required additional surgery of the stomach draining, whereas in the other two (1.9%) patients, the distress syndrome was stopped conservatively. A dumping syndrome was identified in two (1.9%) patients. Timely recognition of the pathological process, its nature and prevalence determines the indications for the use of various methods of operation, which are based on an individual approach to each patient.
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Affiliation(s)
| | - Riza Boranbayeva
- Department of Pediatrics, The Scientific Center of Pediatrics and Pediatric Surgery, Almaty, Kazakhstan
| | | | - Madina Temirkhanova
- Department of Pediatrics, The Scientific Center of Pediatrics and Pediatric Surgery, Almaty, Kazakhstan
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Akhparov NN, Boranbayeva RZ, Suleimanova SB, Temirkhanova M. Current issues of GERD surgical treatment in children. Afr J Paediatr Surg 2021; 18:47-52. [PMID: 33595542 PMCID: PMC8109759 DOI: 10.4103/ajps.ajps_61_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Gastroesophageal reflux disease is one of the most common diseases among a wide range of chronic inflammatory diseases of the gastrointestinal tract in children of all ages, significantly impairing the quality of life of the child and posing a serious threat to the health of the patient. MATERIALS AND METHODS From 2008 to 2019, 134 patients aging from 6 months to 12 years were hospitalized at the Scientific Center for Pediatrics and Pediatric Surgery, including 69 (51%) infants. Of them, 51 (38%) were the patients with persistent manifestations of regurgitation, despite an outpatient course of conservative therapy; 29 (22%) patients with recurrent reflux-associated pneumonia; also, 35 (26%) children with gastroesophageal reflux in the structure of the main pathology of the central nervous system, as well as 19 (14%) patients after surgery of the anastomosis of the esophagus with its atresia. One hundred and seven (79.8%) patients underwent surgery. Nissen esophagofundoplication was traditionally performed in 41 (38%) patients, in combination with Stamm gastrostomy in 14 (34%), with Mikulich pyloroplasty in 9 (22%), and in combination with gastrostomy and pyloroplasty in 12 (29%) children. Laparoscopic Nissen esophagofundoplication was used in 16 (15%). Thall esophagofundoplication was performed in 48 (45%) patients, whereas in two (2%) cases, Borema gastropexy was conducted. RESULTS The immediate results were studied in all 107 patients. Complications in the form of gastric distress syndrome were revealed in four (3.7%) patients who did not undergo pyloroplasty, which in two (1.9%) cases required additional surgery of the stomach draining, whereas in the other two (1.9%) patients, the distress syndrome was stopped conservatively. A dumping syndrome was identified in two (1.9%) patients. CONCLUSION Timely recognition of the pathological process, its nature, and prevalence determines the indications for the use of various methods of operation, which are based on an individual approach to each patient.
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Affiliation(s)
- Nurlan Nurkinovich Akhparov
- Department of Surgery, The Scientific Center of Pediatrics and Pediatric Surgery, Almaty, Republic of Kazakhstan
| | | | | | - Madina Temirkhanova
- Department of Pediatrics, The Scientific Center of Pediatrics and Pediatric Surgery, Almaty, Republic of Kazakhstan
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Kim SY, Kim HR, Min C, Oh DJ, Park B, Choi HG. Bidirectional association between GERD and asthma in children: two longitudinal follow-up studies using a national sample cohort. Pediatr Res 2020; 88:320-324. [PMID: 31923915 DOI: 10.1038/s41390-020-0749-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 10/09/2019] [Accepted: 12/29/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND The causal relationship between asthma and gastroesophageal reflux disease (GERD) is unknown in children. METHODS The Korean Health Insurance Review and Assessment Service-National Sample Cohort 2002-2013 was used. The population age <15 years was selected. In study I, 86,096 asthmatic children were 1:1 matched with 86,096 control I participants. In study II, 532 GERD children were 1:2 matched with 1064 control II participants. The stratified Cox proportional hazard ratios for GERD in patients with asthma (study I) and asthma in patients with GERD (study II) were analyzed. RESULTS In total, 0.7% (583/86,096) of the asthma group and 0.5% (430/86,096) of the control I group had GERD (P < 0.001). The asthma group demonstrated a 1.36 times higher HR for GERD than the control I group (95% CI = 1.20-1.54, P < 0.001). Subgroup analyses according to age and sex showed consistent results. In total, 15.0% (80/532) of the GERD group and 10.0% (106/1,064) of the control II group had asthma (P < 0.001). The GERD group showed a 1.62-fold higher HR for asthma than the control II group (95% CI = 1.21-2.18, P < 0.001). CONCLUSION GERD and asthma demonstrated a bidirectional relationship in children.
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Affiliation(s)
- So Young Kim
- Department of Otorhinolaryngology-Head & Neck Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Hye-Rim Kim
- Department of Pediatrics, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Chanyang Min
- Hallym Data Science Laboratory, Hallym University College of Medicine, Anyang, Korea.,Graduate School of Public Health, Seoul National University, Seoul, Korea
| | - Dong Jun Oh
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Bumjung Park
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University College of Medicine, Anyang, Korea
| | - Hyo Geun Choi
- Hallym Data Science Laboratory, Hallym University College of Medicine, Anyang, Korea. .,Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University College of Medicine, Anyang, Korea.
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Wang LJ, Hu Y, Wang W, Zhang CY, Bai YZ, Zhang SC. Gastroesophageal Reflux Poses a Potential Risk for Late Complications of Bronchopulmonary Dysplasia: A Prospective Cohort Study. Chest 2020; 158:1596-1605. [PMID: 32450238 DOI: 10.1016/j.chest.2020.05.523] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 04/17/2020] [Accepted: 05/09/2020] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Bronchopulmonary dysplasia (BPD) is the most common respiratory disorder in extremely low birth weight infants. Although most symptoms of BPD improve, some late complications exist, even with regular treatment. Gastroesophageal reflux (GER), also common in extremely premature infants, may be related to many cardiorespiratory symptoms. However, the potential of GER as a risk factor for late complications associated with BPD is still unclear. RESEARCH QUESTION The goal of this study was to determine if GER increases the risk of late complications of BPD in infants. STUDY DESIGN AND METHODS A multicenter prospective cohort of 131 infants (79 male subjects, 52 female subjects) with BPD was enrolled. The development of late complications was assessed over an 18-month follow-up period. Twenty-four-hour pH-multichannel intraluminal impedance and gastric sodium concentrations were analyzed in all infants at 36 weeks' postmenstrual age and at the last interview. Prevalence and risk factors of late complications of BPD were analyzed by using forward logistic regression. RESULTS The prevalence of late complications in BPD infants was 63.79% and included respiratory symptoms (49.14%), vomiting (38.79%), retinopathy of prematurity (25.86%), hypoxic-ischemic injury (3.45%), rehospitalization (26.72%), and sudden death (0.86%). Respiratory diseases constituted the most frequent complication. The prevalence of GER in BPD was 42.24% and included acid GER (18.10%) and duodenogastroesophageal reflux (DGER; 24.14%). Risk factors for respiratory symptoms were gestational age ≤ 30 weeks (OR, 3.213; 95% CI, 1.221-8.460), birth weight < 1,500 g (OR, 2.803; 95% CI, 1.014-7.749), invasive ventilation > 7 days (OR, 4.952; 95% CI, 1.508-16.267), acid GER (OR, 4.630; 95% CI, 1.305-16.420), and DGER (OR, 5.588; 95% CI, 1.770-17.648). Infants with BPD and DGER were more prone to late complications than those with acid GER or no reflux. INTERPRETATION The prevalence of late complications is high in infants with BPD. GER (and in particular, DGER) poses a tentative risk for these late complications. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT03014453; URL: www.clinicaltrials.gov.
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Affiliation(s)
- Luo-Jia Wang
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China; Department of Pediatrics, Shanghai General Hospital of Shanghai Jiao Tong University, Shanghai, China
| | - Yu Hu
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Wei Wang
- Department of Nursing, Shengjing Hospital of China Medical University, Shenyang, China
| | - Chun-Yan Zhang
- Department of Pediatrics, the First Hospital of Jilin University, Changchun, China
| | - Yu-Zuo Bai
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Shu-Cheng Zhang
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China.
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Improvement of Inflammation through Antioxidant Pathway of Gardeniae Fructus 50% EtOH Extract (GE) from Acute Reflux Esophagitis Rats. BIOMED RESEARCH INTERNATIONAL 2020; 2020:4826176. [PMID: 32185206 PMCID: PMC7060875 DOI: 10.1155/2020/4826176] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 01/19/2020] [Accepted: 01/21/2020] [Indexed: 02/06/2023]
Abstract
Gardeniae Fructus 50% EtOH extract (GE) is a traditional herb that has been used to treat a variety of diseases. In this study, we investigate the antioxidant, anti-inflammatory, and antiapoptotic properties of GE on acute reflux-induced esophagitis (RE) model in rats. 2,2′-Azino-bis (3-ethylbenzothiazolin-6-sulfonic acid) (ABTS) and 2,2-diphenyl-1-picrylhydrazyl (DPPH) radical scavenging assays were performed to determine the antioxidant activity of GE. GE was given orally at 50 and 100 mg/kg body weight 1h 30 min prior to RE induction. And its effect was assessed in comparison with RE control and normal groups. The administration of the extract of the GE showed remarkable protection of mucosal damage in esophageal tissue, and the histologic observation showed that the gastric lesion was improved. Increased reactive oxygen species (ROS) levels in the serum were diminished by GE treatment. The antioxidative biomarkers including nuclear factor-erythroid 2-related factor 2 (Nrf-2), heme oxygenase-1 (HO-1), superoxide dismutase (SOD), catalase, and glutathione peroxidase (GPX) were significantly increased. GE administration significantly reduced the inflammatory protein expression through MAPK-related signaling pathways and the nuclear factor-kappa B (NF-κB) pathway. These results suggest that GE protects the esophagus mucosal membrane by attenuating oxidative stress and inflammatory response under reflux esophagitis condition through the antioxidant pathway. Therefore, it is suggested that GE may be a potential remedy for the treatment of reflux esophagitis.
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Naeimi M, Kianifar H, Memariani Z, Kamalinejad M, Bijani A, Saghebi R, Gorji N. Comparison of the efficacy of ranitidine and quince syrup on gastroesophageal reflux disease in children. Complement Ther Med 2019; 45:215-221. [DOI: 10.1016/j.ctim.2019.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 06/11/2019] [Accepted: 06/11/2019] [Indexed: 12/31/2022] Open
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Rosales A, Whitehouse J, Laituri C, Herbello G, Long J. Outcomes of laparoscopic nissen fundoplications in children younger than 2-years: single institution experience. Pediatr Surg Int 2018; 34:749-754. [PMID: 29808280 DOI: 10.1007/s00383-018-4281-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/14/2018] [Indexed: 10/14/2022]
Abstract
BACKGROUND Variation exists in the diagnostic testing for gastroesophageal reflux (GER) in infants and in the application of surgical therapy. There has been an increase in antireflux surgery (ARS) since the development of laparoscopy but the outcomes in high-risk infants is unclear. This study examines the results of laparoscopic fundoplication in infants less than 2 years. METHODS The results of infants less than 2 years undergoing laparoscopic Nissen fundoplication (Lap-F) from 2012 to 2015 were retrospectively reviewed and outcomes were followed until 2017. RESULTS There were 106 patients, median gestational age 32.50 weeks ± 6.35 SD and non-corrected age at operation 23.0 weeks ± 19.0 SD, mean weight of 4.81 kg ± 2.10 SD. One of the most common reasons for surgical consultation was improvement in respiratory status after insertion of nasoduodenal feeding tube. Of the Lap-F, 100 were with gastrostomy tube (GT). There were no conversions to open or intraoperative complications. The complication rate was 4.71%, and the reoperation rate was 5.66%, one fundoplication revision and the others gastrostomy revisions. The median time for feeds and to reach goal were 1 (1-14) and 4 (2-279) days, respectively. The 30-day mortality was 0.9% and long-term it was 4.71%. The long-term mortality was related to the underlying medical problems. The median follow-up was 113 (3-286) weeks. One patient required revision of the fundoplication and none required esophageal dilatation during the follow-up period. CONCLUSION Fundoplication is effective for relief of symptoms of GER in children younger than 2 years. The procedure has a low morbidity and mortality in this population.
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Affiliation(s)
- Armando Rosales
- Department of Surgery, Cleveland Clinic Florida, Weston, USA
| | - Jill Whitehouse
- Department of Pediatric Surgery, Joe DiMaggio Children's Hospital, 1150 N 35th Ave, Suite 555, Hollywood, FL, 33021, USA
| | - Carrie Laituri
- Department of Pediatric Surgery, Joe DiMaggio Children's Hospital, 1150 N 35th Ave, Suite 555, Hollywood, FL, 33021, USA
| | - Glenda Herbello
- Department of Pediatric Surgery, Joe DiMaggio Children's Hospital, 1150 N 35th Ave, Suite 555, Hollywood, FL, 33021, USA
| | - Julie Long
- Department of Pediatric Surgery, Joe DiMaggio Children's Hospital, 1150 N 35th Ave, Suite 555, Hollywood, FL, 33021, USA.
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11
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Ruigómez A, Johansson S, Nagy P, García Rodríguez LA. Utilization and safety of proton-pump inhibitors and histamine-2 receptor antagonists in children and adolescents: an observational cohort study. Curr Med Res Opin 2017; 33:2201-2209. [PMID: 28699796 DOI: 10.1080/03007995.2017.1354830] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Little is known about the use of acid-suppressing treatments and related safety events in children. OBJECTIVE This study compared patient characteristics and safety outcomes among children prescribed acid-suppressing drugs for the first time. METHODS The Health Improvement Network was used to determine the characteristics of children prescribed a proton pump inhibitor (PPI; esomeprazole or another PPI) or a histamine-2 receptor antagonist (H2RA) by UK primary care physicians between October 2009 and September 2012. Pre-defined safety outcomes were compared among the treatment groups in up to 18 months of follow-up. RESULTS The cohorts comprised 8,172 patients on PPIs (including 24 patients on esomeprazole) and 7,905 on H2RAs. The baseline characteristics were similar between cohorts, although the children in the PPI cohorts tended to be older. No safety outcomes occurred in the esomeprazole cohort. In the other-PPIs cohort, 92 safety outcomes occurred, most commonly gastroenteritis (n = 36; 39.1%). In the H2RAs cohort, 193 safety outcomes occurred, most commonly gastroenteritis (n = 62; 32.1%). The incidence of most safety outcomes was higher in the H2RAs cohort than in the other-PPIs cohort, including failure to thrive (3.11 [95% confidence interval (CI) = 2.25-4.28] vs 0.49 per 1,000 person-years [95% CI = 0.22-1.07]) and gastroenteritis (5.27 [95% CI = 4.11-6.75] vs 3.04 per 1,000 person-years [95% CI = 2.20-4.20]). CONCLUSION Esomeprazole is rarely prescribed to children when they first require acid-suppressing medication, compared with other PPIs/H2RAs. Overall, more safety outcomes occurred in the H2RAs cohort than in the PPI cohorts.
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Affiliation(s)
- A Ruigómez
- a Spanish Centre for Pharmacoepidemiologic Research (CEIFE) , Madrid , Spain
| | | | - P Nagy
- c Former employee of AstraZeneca Gothenburg , Mölndal , Sweden
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12
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Short HL, Zhu W, McCracken C, Travers C, Waller LA, Raval MV. Exploring regional variability in utilization of antireflux surgery in children. J Surg Res 2017. [PMID: 28624059 DOI: 10.1016/j.jss.2017.02.075] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND There is significant variation surrounding the indications, surgical approaches, and outcomes for children undergoing antireflux procedures (ARPs) resulting in geographic variation of care. Our purpose was to quantify this geographic variation in the utilization of ARPs in children. METHODS A cross-sectional analysis of the 2009 Kid's Inpatient Database was performed to identify patients with gastroesophageal reflux disease or associated diagnoses. Regional surgical utilization rates were determined, and a mixed effects model was used to identify factors associated with the use of ARPs. RESULTS Of the 148,959 patients with a diagnosis of interest, 4848 (3.3%) underwent an ARP with 2376 (49%) undergoing a laparoscopic procedure. The Northeast (2.0%) and Midwest (2.2%) had the lowest overall utilization of surgery, compared with the South (3.3%) and West (3.4%). After adjustment for age, case-mix, and surgical approach, variation persisted with the West and the South demonstrating almost two times the odds of undergoing an ARP compared with the Northeast. Surgical utilization rates are independent of state-level volume with some of the highest case volume states having surgical utilization rates below the national rate. In the West, the use of laparoscopy correlated with overall utilization of surgery, whereas surgical approach was not correlated with ARP use in the South. CONCLUSIONS Significant regional variation in ARP utilization exists that cannot be explained entirely by differences in patient age, race/ethnicity, case-mix, and surgical approach. In order to decrease variation in care, further research is warranted to establish consensus guidelines regarding indications for the use ARPs for children.
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Affiliation(s)
- Heather L Short
- Division of Pediatric Surgery, Department of Surgery, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia
| | - Wanzhe Zhu
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University School of Medicine, Atlanta, Georgia
| | - Courtney McCracken
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Curtis Travers
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Lance A Waller
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University School of Medicine, Atlanta, Georgia
| | - Mehul V Raval
- Division of Pediatric Surgery, Department of Surgery, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia.
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Laje P, Blinman TA, Nance ML, Peranteau WH. Laparoscopic fundoplication in neonates and young infants: Failure rate and need for redo at a high-volume center. J Pediatr Surg 2017; 52:257-259. [PMID: 27890313 DOI: 10.1016/j.jpedsurg.2016.11.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 11/08/2016] [Indexed: 10/20/2022]
Abstract
AIM OF THE STUDY Present the outcomes of patients younger than 2years who underwent laparoscopic fundoplication, highlighting the failure rate and need for redo fundoplication. METHODS Retrospective review of patients <2years who underwent laparoscopic fundoplication between January 2009 and December 2014. MAIN RESULTS 458 infants younger than 2years underwent laparoscopic fundoplication in the 6-year period (360 Nissen, 77 Toupet and 21 Thal fundoplications). Median age at surgery was 5 (1-23) months. Median follow-up was 3 (1-6) years. The conversion rate was 0.87% (4 of 458 cases). Patients did not undergo routine studies to assess the incidence of postoperative GER but were instead followed clinically. Failure of the fundoplication was determined when a patient was unable to gain weight and/or protect the airway while receiving gastric feedings because of GER. The failure rate in our experience was 2.6% (12 redo out of 458 cases [11/360 Nissen, 1/77 Toupet and 0/21 Thal]). All failed cases occurred because of migration of the fundoplication, confirmed preoperatively by a contrast study. Median time between the initial fundoplication and the redo was 13 (5-27) months. There were no failures within a contemporaneous group of 101 patients <2years who underwent open fundoplication. CONCLUSION The need for a redo fundoplication after a laparoscopic fundoplication was an uncommon event in our experience (12 of 458 cases). Our results contrast with published studies that report higher failure rates. Case volume per surgeon may explain in part the dissimilar results among studies. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Pablo Laje
- Division of General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, USA.
| | - Thane A Blinman
- Division of General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, USA
| | - Michael L Nance
- Division of General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, USA
| | - William H Peranteau
- Division of General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, USA
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14
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Fortunato JE, D'Agostino RB, Lively MO. Pepsin in saliva as a biomarker for oropharyngeal reflux compared with 24-hour esophageal impedance/pH monitoring in pediatric patients. Neurogastroenterol Motil 2017; 29. [PMID: 27604397 DOI: 10.1111/nmo.12936] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 08/06/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Pepsin in saliva is a proposed biomarker for oropharyngeal reflux. Pepsin may be prevalent in saliva from subjects with gastro-esophageal reflux and may correlate with proximal reflux by intraluminal impedance/pH monitoring (MII/pH). METHODS Patients (3 days to 17.6 years, n=90) undergoing 24-hour MII/pH monitoring and asymptomatic controls (2 months to 13.7 years, n=43) were included. Salivary pepsin was determined using a pepsin enzyme-linked immunosorbent assay. Eight saliva samples were collected from patients undergoing 24-hr MII/pH: (i) before catheter placement, (ii) before and 30 minutes after each of three meals, and (iii) upon awakening. One sample was collected from each control. KEY RESULTS In MII/pH subjects, 85.6% (77/90) had at least one pepsin-positive sample compared with 9.3% (4/43) in controls. The range of pepsin observed in individual subjects varied widely over 24 hours. The average pepsin concentration in all samples obtained within 2 hours following the most recent reflux event was 30.7±135 ng/mL, decreasing to 16.5±39.1 ng/mL in samples collected more than 2 hours later. The frequency of pepsin-positive samples correlated significantly with symptom index (rS =0.332, P=.0014), proximal (rS =0.340, P=.0010), and distal (rS =0.272, P=.0095) MII events. CONCLUSIONS & INFERENCES Concentration of salivary pepsin may not be an accurate measure of severity of reflux because of the wide range observed in individuals over 24 hours. Saliva samples must be obtained soon after a reflux event. Defining a regimen for optimal saliva collection may help to achieve the goal of using salivary pepsin as a biomarker for oropharyngeal reflux. CLINICAL TRIAL REGISTRY NCT01091805.
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Affiliation(s)
- J E Fortunato
- Section of Pediatric Gastroenterology, Hepatology and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - R B D'Agostino
- Department of Biostatistical Sciences, Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - M O Lively
- Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, NC, USA
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15
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Jabri MA, Tounsi H, Rtibi K, Marzouki L, Sakly M, Sebai H. Ameliorative and antioxidant effects of myrtle berry seed ( Myrtus communis) extract during reflux-induced esophagitis in rats. PHARMACEUTICAL BIOLOGY 2016; 54:1575-1585. [PMID: 26810811 DOI: 10.3109/13880209.2015.1107748] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 10/09/2015] [Indexed: 06/05/2023]
Abstract
Context Myrtle, Myrtus communis L. (Myrtaceae), is a medicinal plant well known for its richness in phenolic compounds and its beneficial effects for the treatment of gastrointestinal disorders.Objective In the present work, the protective effect of the myrtle berry seed aqueous extract (MBSAE) against esophageal reflux (ER)-induced damage in esophagus mucosa as well as the mechanisms implicated was determined.Materials and methods In this respect, adult male Wistar rats were used and divided into seven groups: Control, ER, ER + various doses of MBSAE, ER + famotidine or ER + gallic acid. The ER was induced and animals were per orally (p.o.) treated with MBSAE or reference molecules during 6 h. The phytochemical screening was determined using colourimetric analysis.Results MBSAE is rich in total polyphenols and anthocyanins and exhibited an important in vitro antioxidant activity. In vivo, we firstly found that ER led to marked macroscopic and histopathological changes in esophagus. The results showed, also, that the ER was accompanied by a state of oxidative stress as assessed by an increase of lipid peroxidation, a decrease of the sulphhydryl groups and glutathione levels, as well as antioxidant enzyme activities depletion. MBSAE abrogated all morphological, histopathological and biochemical alterations. We showed also that ER increased esophageal calcium, hydrogen peroxide (H2O2) and free iron levels while MBSAE treatment protected against intracellular mediators deregulation.Conclusion Our data suggest that MBSAE exerted a potential protective effect against ER-induced damage in rat esophagus, at least in part, due to its antioxidant properties.
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Affiliation(s)
- Mohamed-Amine Jabri
- Laboratoire De Physiologie Intégrée, Faculté Des Sciences De Bizerte, Zarzouna, Tunisia
- Laboratoire De Physiologie Fonctionnelle Et Valorisation Des Bio-Ressources - Institut Supérieur De Biotechnologie De Béja, Université De Jendouba, Béja, Tunisia
| | - Haifa Tounsi
- Laboratoire D'anatomie Pathologique Humaine Et Expérimentale, Institut Pasteur De Tunis, Tunis, Tunisia
| | - Kais Rtibi
- Laboratoire De Physiologie Fonctionnelle Et Valorisation Des Bio-Ressources - Institut Supérieur De Biotechnologie De Béja, Université De Jendouba, Béja, Tunisia
| | - Lamjed Marzouki
- Laboratoire De Physiologie Fonctionnelle Et Valorisation Des Bio-Ressources - Institut Supérieur De Biotechnologie De Béja, Université De Jendouba, Béja, Tunisia
| | - Mohsen Sakly
- Laboratoire De Physiologie Intégrée, Faculté Des Sciences De Bizerte, Zarzouna, Tunisia
| | - Hichem Sebai
- Laboratoire De Physiologie Intégrée, Faculté Des Sciences De Bizerte, Zarzouna, Tunisia
- Laboratoire De Physiologie Fonctionnelle Et Valorisation Des Bio-Ressources - Institut Supérieur De Biotechnologie De Béja, Université De Jendouba, Béja, Tunisia
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Abstract
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.
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Affiliation(s)
- Douglas C Barnhart
- Department of Pediatric Surgery, Primary Children's Hospital, University of Utah, Suite 3800, 100 N Mario Capecchi Dr, Salt Lake City, UT.
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17
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Buisman WJ, Mauritz FA, Westerhuis WE, Gilja OH, van der Zee DC, van Herwaarden-Lindeboom MYA. Evaluation of Gastric Volumes: Comparison of 3-D Ultrasound and Magnetic Resonance Imaging. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:1423-1430. [PMID: 27067418 DOI: 10.1016/j.ultrasmedbio.2016.01.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 01/14/2016] [Accepted: 01/23/2016] [Indexed: 06/05/2023]
Abstract
To investigate gastric accommodation, accurate measurements of gastric volumes are necessary. An excellent technique to measure gastric volumes is dynamic magnetic resonance imaging (MRI). Unfortunately, dynamic MRI is expensive and not always available. A new 3-D ultrasound (US) method using a matrix transducer was developed to measure gastric volumes. In this prospective study, 14 healthy volunteers underwent a dynamic MRI and a 3-D US. Gastric volumes were calculated with intra-gastric liquid content and total gastric volume. Mean postprandial liquid gastric content was 397 ± 96.5 mL. Mean volume difference was 1.0 mL with limits of agreement of -8.9 to 10.9 mL. When gastric air was taken into account, mean total gastric volume was 540 ± 115.4 mL SD. Mean volume difference was 2.3 mL with limits of agreement of -21.1 to 26.4 mL. The matrix 3-D US showed excellent agreement with dynamic MRI. Therefore matrix 3-D US is a reliable alternative to measure gastric volumes.
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Affiliation(s)
- Wijnand J Buisman
- Department of Pediatric Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Femke A Mauritz
- Department of Pediatric Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Wouter E Westerhuis
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Odd Helge Gilja
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - David C van der Zee
- Department of Pediatric Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
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18
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Pascoe E, Falvey T, Jiwane A, Henry G, Krishnan U. Outcomes of fundoplication for paediatric gastroesophageal reflux disease. Pediatr Surg Int 2016; 32:353-61. [PMID: 26646409 DOI: 10.1007/s00383-015-3843-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/17/2015] [Indexed: 12/16/2022]
Abstract
PURPOSE Outcomes of fundoplication in children. METHODS In this monocentric retrospective study, chart review was performed on children who underwent fundoplication between 2006 and 2013. Outcomes were defined as the need for redo fundoplication and recommencement of anti-reflux medication (ARM) at 6-month follow-up. RESULTS 119 patients underwent fundoplication with a mean age of 4.76 years and 55.5% of these were male. At 6-month follow-up, 21 (17.6%) required redo fundoplication and 64 (53.8%) were recommenced on ARM. Post-operative complications occurred in 50 (42.2%) of children; 30% of those with complications had surgery at less than 1 year of age, and 36% had an associated comorbid condition. Neither being under the age of one nor associated comorbidity was significantly associated with a poor outcome. Concurrent gastrostomy was associated with a higher risk of being back on ARM at 6-month follow-up (p = 0.003). Neither gastrointestinal or respiratory symptoms pre-surgery nor abnormal pre-operative investigations including pH monitoring and endoscopy were predictive of poor outcome post-fundoplication. CONCLUSION Although fundoplication has a role in the treatment of severe GORD in children, the majority of children in this study needed to restart their anti-reflux medications within 6 months of surgery.
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Affiliation(s)
- E Pascoe
- Sydney Children's Hospital Randwick (SCH), Sydney, Australia.
| | - T Falvey
- University of New South Wales (UNSW), Sydney, Australia
| | - A Jiwane
- Department of Paediatric Surgery, SCH, Sydney, Australia
- School of Women's and Children's Health, UNSW, Sydney, Australia
| | - G Henry
- Department of Paediatric Surgery, SCH, Sydney, Australia
| | - U Krishnan
- School of Women's and Children's Health, UNSW, Sydney, Australia
- Department of Paediatric Gastroenterology, SCH, Sydney, Australia
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19
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Hassan ME. Unilateral versus bilateral wrap crural fixation in laparoscopic Nissen fundoplication for children. JSLS 2016; 18:JSLS-D-14-001294. [PMID: 25516705 PMCID: PMC4266228 DOI: 10.4293/jsls.2014.001294] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction: Gastroesophageal reflux (GERD) is common in neurologically impaired (NI) children. Fundoplication and gastrostomy have previously been indicated in NI children with GERD who have not responded to medical treatment. The most common reason for fundoplication failure is intrathoracic migration of the wrap. Objective: The aim of the study is to measure the effect of wrap fixation on the final outcome of laparoscopic Nissen fundoplication in NI children. Patients and Methods: A retrospective file review was conducted for all NI children who underwent laparoscopic Nissen fundoplication in 2 tertiary pediatric surgery centers in the United Arab Emirates from February 15, 2006 to February 15, 2013. Redo fundoplication patients were excluded from the study. Patients were divided into 2 groups: group 1 in which the fundoplication wrap was fixed to the right crus only, and group 2 in which the wrap was fixed to the right and left crus simultaneously. Results: The study population included 68 patients; there were 47 male and 21 female children. Mean age at time of surgery was 8.2 years. Recurrent GERD at 1 year postoperatively was 26% versus 7% in group 1 and group 2, respectively, by upper contrast study. Redo surgery was required in 21% versus 3% in group 1 and group 2, respectively. Conclusions: Bilateral fixation of the wrap to diaphragmatic crura significantly reduced recurrent GERD, in laparoscopic Nissen fundoplication for neurologically impaired children, with no increased risk of morbidities. Future prospective studies should be conducted with larger patient populations and longer follow-up periods.
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20
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Suksamanapun N, Mauritz FA, Franken J, van der Zee DC, van Herwaarden-Lindeboom MY. Laparoscopic versus percutaneous endoscopic gastrostomy placement in children: Results of a systematic review and meta-analysis. J Minim Access Surg 2016; 13:81-88. [PMID: 27251841 PMCID: PMC5363129 DOI: 10.4103/0972-9941.181776] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND: Percutaneous endoscopic gastrostomy (PEG) and laparoscopic-assisted gastrostomy (LAG) are widely used in the paediatric population. The aim of this study was to determine which one of the two procedures is the most effective and safe method. METHODS: This systematic review was conducted according to the preferred reporting items for systematic reviews and meta-analyses statement. Primary outcomes were success rate, efficacy of feeding, quality of life, gastroesophageal reflux and post-operative complications. RESULTS: Five retrospective studies, comparing 550 PEG to 483 LAG placements in children, were identified after screening 2347 articles. The completion rate was similar for both procedures. PEG was associated with significantly more adjacent bowel injuries (P = 0.047), early tube dislodgements (P = 0.02) and complications that require reintervention under general anaesthesia (P < 0.001). Minor complications were equally frequent after both procedures. CONCLUSIONS: Because of the lack of well-designed studies, we have to be cautious in making definitive conclusions comparing PEG to LAG. To decide which type of gastrostomy placement is best practice in paediatric patients, randomised controlled trials comparing PEG to LAG are highly warranted.
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Affiliation(s)
- Nutnicha Suksamanapun
- Department of Pediatric Surgery, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Femke A Mauritz
- Department of Pediatric Surgery, Wilhelmina Children's Hospital; Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Josephine Franken
- Department of Pediatric Surgery, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - David C van der Zee
- Department of Pediatric Surgery, Wilhelmina Children's Hospital, Utrecht, The Netherlands
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21
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Zohalinezhad ME, Imanieh MH, Samani SM, Mohagheghzadeh A, Dehghani SM, Haghighat M, Salehi A, Faridi P, Akbarzadeh AR. Effects of Quince syrup on clinical symptoms of children with symptomatic gastroesophageal reflux disease: A double-blind randomized controlled clinical trial. Complement Ther Clin Pract 2015; 21:268-76. [PMID: 26573454 DOI: 10.1016/j.ctcp.2015.09.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 09/09/2015] [Accepted: 09/17/2015] [Indexed: 02/08/2023]
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22
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Lansdale N, McNiff M, Morecroft J, Kauffmann L, Morabito A. Long-term and 'patient-reported' outcomes of total esophagogastric dissociation versus laparoscopic fundoplication for gastroesophageal reflux disease in the severely neurodisabled child. J Pediatr Surg 2015. [PMID: 26210817 DOI: 10.1016/j.jpedsurg.2015.06.021] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AIM Fundoplication has high failure rates in neurodisability: esophagogastric dissociation (TOGD) has been proposed as an alternative. This study aimed to compare the long-term and 'patient-reported' outcomes of TOGD and laparoscopic fundoplication (LapFundo). METHODS Matched cohort comparison comprises (i) retrospective analysis from a prospective database and (ii) carer questionnaire survey of symptoms and quality of life (CP-QoL-Child). Children were included if they had severe neurodisability (Gross Motor Function Classification System five) and spasticity. RESULTS Groups were similar in terms of previous surgery and comorbidities. The TOGD group was younger (22 vs. 31.5months, p=0.038) with more females (18/23 vs. 11/24, p=0.036). TOGD was more likely to require intensive care: operative time, length of stay and time to full feeds were all longer (p<0.0001). Median follow-up was 6.3 and 5.8years. Rates of complications were comparable. Symptom recurrence (5/24 vs. 1/23, p=0.34) and use of acid-reducing medication (13/24 vs. 4/23, p=0.035) were higher for LapFundo. Carer-reported symptoms and QoL were similar. CONCLUSIONS TOGD had similar efficacy to LapFundo (with suggestion of lower failure), with comparable morbidity and carer-reported outcomes. However, TOGD was more 'invasive,' requiring longer periods of rehabilitation. Families should be offered both procedures as part of comprehensive preoperative counseling.
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Affiliation(s)
- Nick Lansdale
- Royal Manchester Children's Hospital, Oxford Road, Manchester, M13 9WL, UK.
| | - Melanie McNiff
- School of Medicine, University of Manchester, Oxford Road, Manchester, M13 9PT, UK
| | - James Morecroft
- Royal Manchester Children's Hospital, Oxford Road, Manchester, M13 9WL, UK
| | - Lisa Kauffmann
- Royal Manchester Children's Hospital, Oxford Road, Manchester, M13 9WL, UK
| | - Antonino Morabito
- Royal Manchester Children's Hospital, Oxford Road, Manchester, M13 9WL, UK
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23
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Mitchell A, Lamb K, Sanders R. Gastro-oesophageal reflux in the neonate: Clinical complexities and impact on midwifery practice. ACTA ACUST UNITED AC 2015. [DOI: 10.12968/bjom.2015.23.5.323] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Alex Mitchell
- 4th Year Medical Student Norwich Medical School University of East Anglia
| | - Kathryn Lamb
- Midwife Norfolk and Norwich University Hospital Foundation Trust Norwich
| | - Ruth Sanders
- Midwife Norfolk and Norwich University Hospital Foundation Trust Norwich
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24
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Inoue M, Uchida K, Otake K, Okigami M, Maji T, Kusunoki M. Development of acute pancreatitis after Nissen fundoplication. Pediatr Int 2015; 57:e48-9. [PMID: 25868962 DOI: 10.1111/ped.12610] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2014] [Revised: 09/08/2014] [Accepted: 10/02/2014] [Indexed: 11/28/2022]
Abstract
Acute pancreatitis subsequent to Nissen fundoplication for gastroesophageal reflux disease (GERD) is an extremely rare adverse event. We describe a pediatric case of acute pancreatitis resulting from superior mesenteric artery syndrome (SMAS) and gas bloat after fundoplication. Gas bloat is one of the known postoperative complications after Nissen fundoplication. Poor nutrition status, which is often associated with severe pediatric GERD, is a risk factor for SMAS. In this case, development of gas bloat and SMAS led to the formation of a closed loop and increased intraluminal pressure of the duodenum and pancreatic duct. Many pediatric patients who need anti-reflux surgery face the risk of developing this entity. Preventive measures, such as treatment with prokinetics and frequent small-volume meals, should be considered until improvement of nutritional status after fundoplication.
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Affiliation(s)
- Mikihiro Inoue
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Japan
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Weinstein RB, Fife D, Sloan S, Voss EA, Treem W. Prevalence of Chronic Metoclopramide Use and Associated Diagnoses in the US Pediatric Population. Paediatr Drugs 2015; 17:331-7. [PMID: 26014368 PMCID: PMC4516863 DOI: 10.1007/s40272-015-0136-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Metoclopramide is the only medication widely used to promote gastrointestinal motility in the USA. Despite its appreciable risk of central nervous system complications, it continues to be prescribed to children for chronic use. We sought to estimate the prevalence of chronic metoclopramide use among US children and identify the diagnoses that may have prompted this use. The US metoclopramide label lists only two indications in adults: symptomatic gastroesophageal reflux (GERD) and diabetic gastroparesis. The latter is rare in children so, in examining the indications likely to have prompted chronic metoclopramide use, we focused on GERD. METHODS From two health services databases representing privately and publically insured children, respectively, we estimated the number of US children who used metoclopramide chronically and identified the diagnoses recorded at approximately the time when the chronic use began. We defined chronic use liberally as ≥ 35 days' supply, or conservatively as ≥ 130 days' supply in a 6-month period. For each chronic-use definition, insurance type, and age group, we estimated the proportion of children using metoclopramide chronically. We applied these proportions to US population estimates. RESULTS Under the liberal and conservative definitions, respectively, 89,020 and 28,222 US children used metoclopramide chronically. CONCLUSION In spite of its risk, substantial numbers of US children use metoclopramide chronically for symptoms suggestive of GERD.
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Affiliation(s)
- Rachel B. Weinstein
- Epidemiology, Janssen Research and Development LLC, 1125 Trenton-Harbourton Rd, Titusville, NJ 08560 USA
| | - Daniel Fife
- Epidemiology, Janssen Research and Development LLC, 1125 Trenton-Harbourton Rd, Titusville, NJ 08560 USA
| | - Sheldon Sloan
- Global Medical Affairs, Janssen Research and Development LLC, 200 Tournament Drive, Horsham, PA 19044 USA
| | - Erica A. Voss
- Epidemiology, Janssen Research and Development LLC, 1125 Trenton-Harbourton Rd, Titusville, NJ 08560 USA
| | - William Treem
- Global Medical Organization, Child Health Innovation and Leadership Department (CHILD), Janssen Research and Development, LLC, 920 US Route 202, Raritan, NJ 08869 USA
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Franken J, Mauritz FA, Suksamanapun N, Hulsker CCC, van der Zee DC, van Herwaarden-Lindeboom MYA. Efficacy and adverse events of laparoscopic gastrostomy placement in children: results of a large cohort study. Surg Endosc 2014; 29:1545-52. [DOI: 10.1007/s00464-014-3839-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Accepted: 08/19/2014] [Indexed: 11/28/2022]
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Sacco O, Mattioli G, Girosi D, Battistini E, Jasonni V, Rossi GA. Gastroesophageal reflux and its clinical manifestation at gastroenteric and respiratory levels in childhood: physiology, signs and symptoms, diagnosis and treatment. Expert Rev Respir Med 2014; 1:391-401. [DOI: 10.1586/17476348.1.3.391] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Oliviero Sacco
- Pulmonology Unit, G. Gaslini Institute, Largo Gaslini 5, 16147 Genoa, Italy
| | - Girolamo Mattioli
- Division and Chair of Pediatric Surgery, Largo Gaslini 5, 16147 Genoa, Italy
| | - Donata Girosi
- Pulmonology Unit, G. Gaslini Institute, Largo Gaslini 5, 16147 Genoa, Italy
| | - Elena Battistini
- Pulmonology Unit, G. Gaslini Institute, Largo Gaslini 5, 16147 Genoa, Italy
| | - Vincenzo Jasonni
- Division and Chair of Pediatric Surgery, Largo Gaslini 5, 16147 Genoa, Italy
| | - Giovanni A Rossi
- Pulmonology Unit, G. Gaslini Institute, Largo Gaslini 5, 16147 Genoa, Italy
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Complete versus partial fundoplication in children with gastroesophageal reflux disease: results of a systematic review and meta-analysis. J Gastrointest Surg 2013; 17:1883-92. [PMID: 23943388 DOI: 10.1007/s11605-013-2305-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 07/29/2013] [Indexed: 01/31/2023]
Abstract
Complete fundoplication (Nissen) has long been accepted as the gold standard surgical procedure in children with therapy-resistant gastroesophageal reflux disease (GERD); however, increasingly more evidence has become available for partial fundoplication as an alternative. The aim of this study was to perform a systematic review and meta-analysis comparing complete versus partial fundoplication in children with therapy-resistant GERD. PubMed (1960 to 2011), EMBASE (from 1980 to 2011), and the Cochrane Library (issue 3, 2011) were systematically searched according to the PRISMA statement. Results were pooled in meta-analyses and expressed as risk ratios (RRs). In total, eight original trials comparing complete to partial fundoplication were identified. Seven of these studies had a retrospective study design. Short-term (RR 0.64; p = 0.28) and long-term (RR 0.85; p = 0.42) postoperative reflux control was similar for complete and partial fundoplication. Complete fundoplication required significantly more endoscopic dilatations for severe dysphagia (RR 7.26; p = 0.007) than partial fundoplication. This systematic review and meta-analysis showed that reflux control is similar after both complete and partial fundoplication, while partial fundoplication significantly reduces the number of dilatations to treat severe dysphagia. However, because of the lack of a well-designed study, we have to be cautious in making definitive conclusions. To decide which type of fundoplication is the best practice in pediatric GERD patients, more randomized controlled trials comparing complete to partial fundoplication in children with GERD are warranted.
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Forssell L, Cnattingius S, Bottai M, Edstedt Bonamy AK, Lagergren J, Agréus L, Akre O. Increased risk of Barrett's esophagus among individuals born preterm or small for gestational age. Clin Gastroenterol Hepatol 2013; 11:790-4. [PMID: 23376800 DOI: 10.1016/j.cgh.2013.01.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Revised: 01/14/2013] [Accepted: 01/18/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Gastroesophageal reflux is common in infants during their first year of life, especially in those born preterm or small for gestational age (SGA). We assessed whether being born preterm or SGA increased the risk of developing Barrett's esophagus (BE) in adulthood. METHODS We performed a population-based case-control study of patients with BE (cases) that were diagnosed at 2 Swedish hospitals from January 1, 1986, through December 31, 2005. We identified the birth hospital of the cases; data on perinatal characteristics such as gestational age at birth and birth weight were collected from original birth records. We also obtained and collected information on the 3 singleton live births, of the same sex, born after each case at the same maternity ward (controls). In total, we analyzed data from 331 cases and 852 matched controls. We used conditional logistic regression to determine odds ratios (ORs), determined 95% confidence intervals (CIs), and adjusted for potential confounding factors. RESULTS Compared with infants born with a normal birth weight (3000-3999 g), infants with low birth weight (<2500 g) were at increased risk of BE (adjusted OR, 8.22; 95% CI, 2.83-23.88). This was mainly due to an effect of SGA rather than preterm birth. Specifically, compared with infants with normal birth weight for gestational age (25th-75th percentiles), the odds of BE among very SGA infants (<3rd percentile) was nearly tripled (adjusted OR, 2.95; 95% CI, 1.35-6.44). CONCLUSIONS On the basis of a population-based study of patients with BE in Sweden, infants born SGA have a 3-fold increase in risk for developing BE as adults, compared with infants of normal birth weight for gestational age.
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Affiliation(s)
- Lina Forssell
- Department of Neurobiology, Care Sciences and Society, Centre for Family Medicine, Karolinska Institutet, Stockholm, Sweden.
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Abstract
Recent comprehensive guidelines developed by the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition define the common entities of gastroesophageal reflux (GER) as the physiologic passage of gastric contents into the esophagus and gastroesophageal reflux disease (GERD) as reflux associated with troublesome symptoms or complications. The ability to distinguish between GER and GERD is increasingly important to implement best practices in the management of acid reflux in patients across all pediatric age groups, as children with GERD may benefit from further evaluation and treatment, whereas conservative recommendations are the only indicated therapy in those with uncomplicated physiologic reflux. This clinical report endorses the rigorously developed, well-referenced North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition guidelines and likewise emphasizes important concepts for the general pediatrician. A key issue is distinguishing between clinical manifestations of GER and GERD in term infants, children, and adolescents to identify patients who can be managed with conservative treatment by the pediatrician and to refer patients who require consultation with the gastroenterologist. Accordingly, the evidence basis presented by the guidelines for diagnostic approaches as well as treatments is discussed. Lifestyle changes are emphasized as first-line therapy in both GER and GERD, whereas medications are explicitly indicated only for patients with GERD. Surgical therapies are reserved for children with intractable symptoms or who are at risk for life-threatening complications of GERD. Recent black box warnings from the US Food and Drug Administration are discussed, and caution is underlined when using promoters of gastric emptying and motility. Finally, attention is paid to increasing evidence of inappropriate prescriptions for proton pump inhibitors in the pediatric population.
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Park KY, Chang SH. Gastro-esophageal reflux disease in healthy older children and adolescents. Pediatr Gastroenterol Hepatol Nutr 2012; 15:220-8. [PMID: 24010091 PMCID: PMC3746054 DOI: 10.5223/pghn.2012.15.4.220] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2012] [Revised: 12/16/2012] [Accepted: 12/18/2012] [Indexed: 12/30/2022] Open
Abstract
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.
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Affiliation(s)
- Kie Young Park
- Department of Pediatrics, Gangneung Asan Hospital, College of Medicine, Ulsan University, Gangneung, Korea
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Karli R, Alacam H, Duran L, Alici O, Kati C, Karli A, Guzel A. Analysis of the protective biochemical and pathologic effects of aminoguanidine on an experimental aspiration pneumonitis model induced by bile acids. Curr Ther Res Clin Exp 2012; 73:207-19. [PMID: 24653522 DOI: 10.1016/j.curtheres.2012.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Gastroesophageal reflux (GER) is a common clinical pathology detected in childhood. Bile acids (BAs) are present in reflux and cause various pathologies in the esophagus, the larynx, and the lungs. OBJECTIVE We aimed to show if aminoguanidine (AG) contributes to the biochemical and histopathologic treatment of experimental aspiration pneumonitis induced by BAs. METHODS Twenty-eight female Sprague Dawley rats were used. There were 4 groups in the study: (1) group aspirated with 0.9% saline (n = 7), (2) group aspirated with 0.9% saline and treated with AG (n = 7), (3) group aspirated with a solution of 10 mg/kg taurocholic acid and 5 mg/kg taurochenodeoxycholate (n = 7), and (4) group aspirated with BA and treated with AG (n = 7). The saline and BA solutions were administered as 1 mL/kg intratracheally. The AG was administered intraperitoneally twice a day at a 150 mg/kg dose for 7 days. The different histopathologic and biochemical parameters were analyzed. RESULTS Clara cell protein 16 and malondialdehyde levels were found to be significantly higher in the BA group than in the group where saline was administered; however, they were significantly lower in the BA + AG group than in the BA group. The total superoxide dismutase activity decreased significantly in the BA group compared with the group where saline was administered. A significant increase in superoxide dismutase activity was observed in the BA + AG group when compared with the group where only BA was administered. When the group where BA was administered solely was compared with the group where saline was administered, peribronchial inflammatory cell infiltration, alveolar septal infiltration, alveolar histiocytes, interstitial fibrosis, and granuloma were significantly higher in the BA group than in the saline group. When the BA + AG group was compared with the BA group, peribronchial inflammatory cell infiltration, alveolar septal infiltration, alveolar histiocytes, interstitial fibrosis, and granuloma were found to be significantly lower. CONCLUSIONS Oxidant stress increases and antioxidant capacity decreases in pneumonitis induced by BAs. AG administration as an antioxidant helps in recovery, both biochemically and histopathologically. Consequently, AG seems to be an alternative that should be considered in a conservative approach to treating aspiration pneumonitis.
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Affiliation(s)
- Rifat Karli
- Department of Otorhinolaryngology, Ondokuz Mayis University, Samsun, Turkey
| | - Hasan Alacam
- Department of Medical Biochemistry, Ondokuz Mayis University, Samsun, Turkey
| | - Latif Duran
- Department of Emergency Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Omer Alici
- Department of Pathology, Samsun Education and Research Hospital, Samsun, Turkey
| | - Celal Kati
- Department of Otorhinolaryngology, Ondokuz Mayis University, Samsun, Turkey
| | - Arzu Karli
- Department of Pediatric Infection, Ondokuz Mayis University, Samsun, Turkey
| | - Ahmet Guzel
- Department of Pediatrics, Ondokuz Mayis University, Samsun, Turkey
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Yang L, Cai H, Tou J, Gu W, Shu X, Zhang T, Yang X, Shen Z, Jiang M. The role of the 5-hydroxytryptamine pathway in reflux-induced esophageal mucosal injury in rats. World J Surg Oncol 2012; 10:219. [PMID: 23092450 PMCID: PMC3534590 DOI: 10.1186/1477-7819-10-219] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Accepted: 10/15/2012] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Dysfunction of the 5-hydroxytryptamine (5-HT) signaling pathway can lead to gastrointestinal motility and secretion abnormalities and to visceral hypersensitivity. The aim of this study is to investigate the role of 5-HT in reflux-induced esophageal mucosal injury. METHODS Fifty 8-week-old male Sprague-Dawley (SD) rats were randomly divided into a gastroesophageal reflux (GER) model group (30 rats) and a sham surgery control group (20 rats). Four weeks after surgery, the esophageal mucosa was collected for histological evaluation, 5-HT concentrations, and 5-HT selective reuptake transporter (SERT) mRNA and 5-HT4 receptor (5-HT4R) protein expressions. RESULTS Twenty-seven rats in the GER model group survived, and three rats died. Histologically, in the GER model group, 20 rats had reflux esophagitis (RE group), and 7 rats had non-erosive reflux disease (NERD group). The 5-HT levels in the esophageal tissue from the RE group were significantly higher than those from the control and NERD groups. Both the RE and NERD groups showed significant increases in SERT mRNA expression of the esophageal mucosa than that of the controls, and the SERT mRNA level in the RE group was significantly higher than that in the NERD group. The 5-HT4R protein level of the esophageal mucosa in the RE group was significantly lower than that in the controls and the NERD group. CONCLUSIONS We conclude that a 5-HT signaling pathway disorder could be a major factor in the pathogenesis of GER and RE.
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Affiliation(s)
- Lingrong Yang
- Department of Gastroenterology, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, People’s Republic of China
- Key Laboratory of Reproductive Genetics (Zhejiang University), Ministry of Education, Hangzhou, 310003, People’s Republic of China
- The present address: The Third People's Hospital of Chengdu, Chengdu, 610031, People’s Republic of China
| | - Haifang Cai
- Department of Gastroenterology, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, People’s Republic of China
- Key Laboratory of Reproductive Genetics (Zhejiang University), Ministry of Education, Hangzhou, 310003, People’s Republic of China
- The present address: The Central Hospital of Lishui City, Lishui, 323000, People’s Republic of China
| | - Jinfa Tou
- Department of Gastroenterology, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, People’s Republic of China
- Key Laboratory of Reproductive Genetics (Zhejiang University), Ministry of Education, Hangzhou, 310003, People’s Republic of China
| | - Weizhong Gu
- Department of Gastroenterology, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, People’s Republic of China
- Key Laboratory of Reproductive Genetics (Zhejiang University), Ministry of Education, Hangzhou, 310003, People’s Republic of China
| | - Xiaoli Shu
- Department of Gastroenterology, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, People’s Republic of China
- Key Laboratory of Reproductive Genetics (Zhejiang University), Ministry of Education, Hangzhou, 310003, People’s Republic of China
| | - Ting Zhang
- Department of Gastroenterology, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, People’s Republic of China
- Key Laboratory of Reproductive Genetics (Zhejiang University), Ministry of Education, Hangzhou, 310003, People’s Republic of China
| | - Xi Yang
- Department of Gastroenterology, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, People’s Republic of China
- Key Laboratory of Reproductive Genetics (Zhejiang University), Ministry of Education, Hangzhou, 310003, People’s Republic of China
| | - Zheng Shen
- Department of Gastroenterology, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, People’s Republic of China
- Key Laboratory of Reproductive Genetics (Zhejiang University), Ministry of Education, Hangzhou, 310003, People’s Republic of China
| | - Mizu Jiang
- Department of Gastroenterology, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, People’s Republic of China
- Key Laboratory of Reproductive Genetics (Zhejiang University), Ministry of Education, Hangzhou, 310003, People’s Republic of China
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Hu ZW, Wang ZG, Wu JM, Tan ST. Anti-reflux procedure for difficult-to-treat asthmatic children, case report and literature review. Multidiscip Respir Med 2012; 7:28. [PMID: 22980911 PMCID: PMC3462718 DOI: 10.1186/2049-6958-7-28] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Accepted: 09/07/2012] [Indexed: 01/01/2023] Open
Abstract
Gastroesophageal reflux disease (GERD) is a commonly encountered condition in children, which at times causes respiratory distress, such as asthmatic symptoms, and results in serious morbidity and even mortality. The complexity is sometimes so obscure, that it can cause paradoxical diagnoses and treatment. Here we present two cases of children with difficult-to-treat asthmatic symptoms, which were eventually found to be related to GERD. The two children were treated with anti-reflux procedures and both became symptom free. Literature was also reviewed to shed a light into this complex disease.
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Affiliation(s)
- Zhi-Wei Hu
- Xuanwu Hospital of Capital Medical University, Beijing, China.
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Lee BE, Kim GH. Globus pharyngeus: A review of its etiology, diagnosis and treatment. World J Gastroenterol 2012; 18:2462-71. [PMID: 22654443 PMCID: PMC3360444 DOI: 10.3748/wjg.v18.i20.2462] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Revised: 01/30/2012] [Accepted: 03/09/2012] [Indexed: 02/06/2023] Open
Abstract
Globus is a persistent or intermittent non-painful sensation of a lump or foreign body in the throat. It is a commonly encountered clinical condition that is usually long-lasting, difficult to treat, and has a tendency to recur. Furthermore, due to the uncertain etiology of globus, it remains difficult to establish standard investigation and treatment strategies for affected patients. As a first step for managing globus, careful history taking and nasolaryngoscopy are essential. Given the benign nature of the condition and the recent notion that gastroesophageal reflux disease is a major cause of globus, empirical therapy with a high dose of proton pump inhibitors is reasonable for patients with typical globus. If patients are nonresponsive to this therapy, definitive assessments such as endoscopy, multichannel intraluminal impedance/pH monitoring, and manometry should be considered. Speech and language therapy, anti-depressants, and cognitive-behavioral therapy can be helpful in patients whose symptoms persist despite negative investigations.
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Hassall E, Shepherd R, Koletzko S, Radke M, Henderson C, Lundborg P. Long-term maintenance treatment with omeprazole in children with healed erosive oesophagitis: a prospective study. Aliment Pharmacol Ther 2012; 35:368-79. [PMID: 22176465 DOI: 10.1111/j.1365-2036.2011.04950.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Short-term studies show that PPIs heal erosive esophagitis in children. There are no prospective studies that examine long-term maintenance therapy of erosive esophagitis in children with and without underlying GERD-predisposing disorders. AIM To determine prospectively the dose of omeprazole needed to maintain remission of erosive oesophagitis and reflux symptoms in children. METHODS Patients aged 1-16 years with healed erosive reflux oesophagitis after omeprazole treatment (0.7-3.5 mg/kg/day) entered a 21-month maintenance phase where they initially received half the dose of omeprazole required to heal. Endoscopy was performed after 3, 12 and 21 months. The omeprazole dose was increased if erosive oesophagitis or reflux symptoms recurred. RESULTS A total of 46 patients entered the study and 32 completed it. Of these, 17 (53%) remained on the maintenance dose, 12 (38%) returned to their healing dose and 3 (9%) ended the study on a dose higher than their healing dose. Three-quarters of the completers (24/32) had no erosive oesophagitis relapse. Four patients (13%) had relapse of only erosive oesophagitis, 4 (13%) had relapse of erosive oesophagitis and symptoms, and 10 (31%) had only symptomatic relapse. Of the 46 patients, 48% had GERD-predisposing disorders (neurological impairment or oesophageal atresia). Overall, 62.5% (5/8) of patients who had an erosive oesophagitis relapse had a GERD-predisposing disorder versus 33.3% (8/24) of those who did not. CONCLUSIONS Remission of erosive oesophagitis is maintained with omeprazole treatment for at least 21 months in most children aged 1-16 years, and the drug is well tolerated. To maintain remission, some 60% of patients require more than half the dose required for healing. In children with GERD-predisposing conditions, GERD is often chronic and relapsing, and requires long-term management.
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Affiliation(s)
- E Hassall
- Division of Gastroenterology, British Columbia Children's Hospital/University of British Columbia, Vancouver, Canada.
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Roche WJ, Eicher PS, Martorana P, Berkowitz M, Petronchak J, Dzioba J, Vitello L. An Oral, Motor, Medical, and Behavioral Approach to Pediatric Feeding and Swallowing Disorders: An Interdisciplinary Model. ACTA ACUST UNITED AC 2011. [DOI: 10.1044/sasd20.3.65] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Feeding and swallowing problems are reported in 10-25% of all children, 40-70% in premature infants, and 70-90% in children with medical/developmental delays (Graham, 1985; Rogers & Arvedson, 2005; Sullivan et al., 2000). The etiologies of feeding disorders are as varied as the multiple disciplines, approaches, and interventions available. This paper illustrates, through case presentation, an interdisciplinary feeding team model that incorporates an oral, motor, medical, and behavioral approach to treating children with feeding disorders.
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Affiliation(s)
| | | | | | | | | | - Jessica Dzioba
- Center for Pediatric Feeding and Swallowing Paterson, NJ
| | - Louise Vitello
- Center for Pediatric Feeding and Swallowing Paterson, NJ
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Winter HS, Illueca M, Henderson C, Vaezi M. Review of the persistence of gastroesophageal reflux disease in children, adolescents and adults: does gastroesophageal reflux disease in adults sometimes begin in childhood? Scand J Gastroenterol 2011; 46:1157-68. [PMID: 21675820 DOI: 10.3109/00365521.2011.591425] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Understanding the natural history and outcomes of gastroesophageal reflux disease (GERD) in children could help to identify patients at risk of having GERD complications during adulthood. This review aimed to assess evidence of whether GERD in children or adolescents persists into adulthood. MATERIAL AND METHODS PubMed searches (1966-2010) identified longitudinal studies of GERD extending from childhood/infancy into adulthood, as well as longitudinal studies within pediatric age groups. RESULTS In one study, heartburn during childhood was more often recalled by adults with reflux symptoms than by those without (30% vs. 9%; p < 0.001), as was medication or surgery for GERD (both p < 0.01). Another study found that GERD symptoms were more common in adults diagnosed with reflux esophagitis during childhood/adolescence than in those who were not (46% vs. 30%). Regurgitation during infancy increased the risk of feeding problems after 1 year (odds ratio 4.2 (95% confidence interval: 1.4-12.0)) and of reflux symptoms at 9 years of age (relative risk 2.3 (95% confidence interval: 1.3-4.0)). In one study, abnormal esophageal histology persisted in infants after 12 months without reflux symptoms. A proportion (59-100%: three studies) of patients with reflux symptoms and/or reflux esophagitis during the pediatric years still required treatment after 1-8 years. In another study, however, just 7% of patients with healed reflux esophagitis relapsed after 9 months without treatment. CONCLUSION The limited available evidence suggests that some infants, children, and adolescents with GERD are more likely than those without GERD to have symptoms later in life.
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Affiliation(s)
- Harland S Winter
- Department of Pediatrics , Massachusetts General Hospital for Children, Boston, Massachusetts 02114, USA.
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Pharmacokinetics and tolerability of rabeprazole in children 1 to 11 years old with gastroesophageal reflux disease. J Pediatr Gastroenterol Nutr 2011; 52:691-701. [PMID: 21478756 DOI: 10.1097/mpg.0b013e318207834d] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The pharmacokinetics of rabeprazole after a single oral dose and once-daily administration for 5 consecutive days was characterized in children 1 to 11 years old with gastroesophageal reflux disease (GERD). PATIENTS AND METHODS The initial 8 patients received rabeprazole sodium (hereafter referred to as rabeprazole) 0.14 mg/kg (part 1); the next 20 patients were randomized to receive 0.5 or 1 mg/kg (part 2) to target concentrations in plasma expected to be safe and effective. Pharmacokinetic parameters of rabeprazole and the thioether metabolite were calculated using noncompartmental methods. Subjective evaluations of GERD severity, rabeprazole short-term effectiveness, palatability, and safety were also characterized. RESULTS Rabeprazole concentrations increased in a dose-dependent manner. Little or no accumulation was observed after repeated administration. The results suggest that formation of the thioether is an important metabolic pathway in young patients, which is consistent with adults. Plasma area under the concentration-time curve values of rabeprazole and the metabolite were poorly correlated with individual age and body weight. Furthermore, oral rabeprazole clearance values (not adjusted for weight) were similar to historical adult data. However, weight-adjusted values were higher for the pediatric patients, and approximately 2 to 3 times the milligram per kilogram dose of rabeprazole in these children was necessary to achieve comparable concentrations in adults. Subjective evaluations demonstrated an improvement of GERD symptoms in most patients after rabeprazole treatment. CONCLUSIONS Palatability of the formulation was reported to be good or excellent. Rabeprazole was well tolerated, with no notable differences in safety among the dose groups.
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Blondeau K, Mertens V, Dupont L, Pauwels A, Farré R, Malfroot A, De Wachter E, De Schutter I, Hauser B, Vandenplas Y, Sifrim D. The relationship between gastroesophageal reflux and cough in children with chronic unexplained cough using combined impedance-pH-manometry recordings. Pediatr Pulmonol 2011; 46:286-94. [PMID: 20967945 DOI: 10.1002/ppul.21365] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2009] [Revised: 06/04/2010] [Accepted: 07/17/2010] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Assessment of the reflux-cough association in children is challenging. Esophageal (impedance) pH recording is sensitive to recognize reflux. However, cough recorded by an event marker, possibly lacks accuracy. We aimed to study the exact time relationship between reflux and cough in children with chronic cough. METHODS Twenty-six children (12 boys; 1-10.5 years) with chronic unexplained cough underwent ambulatory impedance-pH-manometry recordings. Manometry was used for precise cough recognition. Reflux was assessed with impedance-pH monitoring and defined as acid (pH <4), weakly acidic (WA) (pH 4-7), weakly alkaline (WALK) (pH ≥7), or acid only (pH <4 for ≥4 sec without impedance pattern). Cough was considered "induced by" reflux, if it started ≤2 min after reflux. The Symptom Association Probability (SAP) was calculated and considered positive if >95%. Cough-induced reflux if it occurred 30 sec before the reflux event. RESULTS Impedance-pH detected 30 (21-52) reflux episodes/patient (55.2% acid, 41.5% WA, and 3.3% WALK). Additionally 59 acid only events were identified [1 (0-21)/patient]. Manometry detected 47 (5-203) cough bursts/patient. Reflux-cough was found in 22/26 patients. Ten patients had a +SAP for reflux-cough (one acid, six WA, and three acid + WA gastroesophageal reflux [GER]), of which nine had a normal acid exposure. Six out of 10 patients with +SAP using manometry had a +SAP using the event marker. Cough-reflux was detected in 19 patients [3 (0-7)/patient]. Only a small fraction of the esophageal acid exposure [9.6 (0.4-31.8%)] was secondary to cough. CONCLUSION Both acid and WA GER may precede cough in children with unexplained cough, but cough does not induce GER. Objective cough recording improves symptom association analysis.
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Affiliation(s)
- K Blondeau
- Center for Gastroenterological Research, K.U.Leuven, Leuven, Belgium
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Abstract
Dual pH-multichannel intraluminal impedance (pH-MII) is a sensitive tool for evaluating overall gastroesophageal reflux disease, and particularly for permitting detection of nonacid reflux events. pH-MII technology is especially useful in the postprandial period or at other times when gastric contents are nonacidic.pH-MII was recently recognized by the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition as being superior to pH monitoring alone for evaluation of the temporal relation between symptoms and gastroesophageal reflux. In children, pH-MII is useful to correlate symptoms with reflux (particularly nonacid reflux), to quantify reflux during tube feedings and the postprandial period, and to assess efficacy of antireflux therapy. This clinical review is simply an evidence-based overview addressing the indications, limitations, and recommended protocol for the clinical use of pH-MII in children.
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Affiliation(s)
- Ioana Bratu
- University of Alberta, Edmonton, Alberta, Canada.
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González Jiménez D, Díaz Martin J, Bousoño García C, Jiménez Treviño S. Patología gastrointestinal en niños con parálisis cerebral infantil y otras discapacidades neurológicas. An Pediatr (Barc) 2010; 73:361.e1-6. [DOI: 10.1016/j.anpedi.2010.03.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2009] [Revised: 02/07/2010] [Accepted: 03/07/2010] [Indexed: 12/27/2022] Open
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Reflux esophageal stricture--a review of 30 years' experience in children. J Pediatr Surg 2010; 45:2356-60. [PMID: 21129544 DOI: 10.1016/j.jpedsurg.2010.08.033] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2010] [Accepted: 08/12/2010] [Indexed: 11/22/2022]
Abstract
PURPOSE Strictures of the esophagus in children may have multiple etiologies including congenital, inflammatory, infectious, caustic ingestion, and gastroesophageal reflux (peptic stricture [PS]). Current literature lacks good data documenting long-term outcomes in children. This makes it difficult to counsel some patients about realistic treatment expectations. The objective of this study is to evaluate our institutional experience and define the natural history and treatment outcomes. METHODS A retrospective review of clinical data obtained from children who underwent dilation for PS was performed. RESULTS Over the past 30 years, 114 children and adolescents received 486 dilations. The most common indications for stricture dilation were PS (42%) and esophageal atresia (38%). Other lesser indications included congenital, foreign body, corrosive, cancer, radiation, allergic, and infectious. This review focuses on the 48 children with PS. Of the children with PS, a congenital anomaly was identified in 23 children; and 12 had neurologic impairment. Average age at presentation was 10.2 years (range, 0.5-18.3 years). Most patients had had symptoms for many months before diagnosis. Peptic stricture was most common in the lower esophagus (n = 39). However, middle (n = 8) and upper (n = 1) strictures were occasionally identified. Noncompliance with medical therapy was a challenge in 12% (n = 5) of children. Children with a PS received a median of 3 dilations, but a subset of 5 patients with severe strictures underwent up to 48 dilations (range, 1-48). Repeated dilations were required for a median of 20 months (range, 1-242 months). Among patients receiving esophageal dilation for PS, 94% required an antireflux procedure (19% required a second antireflux surgery). A subgroup of patients (n = 10) was identified who required extended dilations, multiple surgeries, and esophageal resection. This subgroup had a significantly longer period of symptomatic disease and increased risk of esophageal resection compared with those patients requiring fewer dilations. Surgical resection of the esophageal stricture was ultimately required in 3 children with PS after failure of more conservative measures. CONCLUSION Children and adolescents presenting with reflux esophageal stricture (PS) frequently require antireflux surgery, redo antireflux surgery, and multiple dilations for recurrent symptoms. We hope that these data will be of use to the clinician attempting to counsel patients and parents about treatment expectations in this challenging patient population.
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Abstract
Even though chest pain in children is a common complaint, an underlying gastrointestinal cause is rare. The four common gastrointestinal conditions that present with chest pain include eosinophilic esophagitis, gastroesophageal reflux disease, esophageal dysmotility, and foreign body ingestion. Other than ingestion of certain foreign bodies, most of these conditions are not life-threatening. Associated symptoms and history may be helpful in distinguishing these disorders, but further evaluation is often indicated to identify the precise cause.
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Affiliation(s)
- Jose M Garza
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 2010, Cincinnati, OH 45229, USA
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Guimarães EV, Guerra PV, Penna FJ. Management of gastroesophageal reflux disease and erosive esophagitis in pediatric patients: focus on delayed-release esomeprazole. Ther Clin Risk Manag 2010; 6:531-7. [PMID: 21063463 PMCID: PMC2963162 DOI: 10.2147/tcrm.s14425] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE To review the literature on the treatment of gastroesophageal reflux disease (GERD) with emphasis on proton pump inhibitors (PPIs), particularly on delayed-release esomeprazole, and to identify properties and adverse effects of PPIs observed in the treatment of GERD in children and adolescents. SOURCES Electronic search of PubMed/Medline and Cochrane Collaboration databases, and of abstracts on DDW, NASPGHAN, and ESPGHAN. We focused on controlled and randomized studies published since 2000 and identified reviews that presented a consensual position, and directives published within the last 10 years. MAIN RESULTS PPIs are considered better antisecretory agents than H(2)-receptor antagonists. Although all PPIs are similar, they are not identical in their pharmacologic properties. For example, the acid-suppressive effect of esomeprazole, the S-isomer of omeprazole, persists for more than 16 hours after administration of the morning dose. Therefore, it can control acidity after night meals better than a single dose of omeprazole. Moreover, the onset of the suppressive effect of esomeprazole is faster. It achieves acid inhibition faster than other PPIs. CONCLUSION Currently, the mainstream treatment for GERD in children is a PPI. Although PPIs are safe drugs, effective in healing erosive esophagitis, and in relieving symptoms, studies with esomeprazole have shown that this drug has as powerful an ability to inhibit acid secretion as omeprazole. It also seems that some pharmacologic properties of esomeprazole are actually better for the treatment of GERD.
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Affiliation(s)
- Elizabet V Guimarães
- Department of Pediatrics, Medical School, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Ward RM, Kearns GL, Tammara B, Bishop P, O'Gorman MA, James LP, Katz MH, Maguire MK, Rath N, Meng X, Comer GM. A multicenter, randomized, open-label, pharmacokinetics and safety study of pantoprazole tablets in children and adolescents aged 6 through 16 years with gastroesophageal reflux disease. J Clin Pharmacol 2010; 51:876-87. [PMID: 20852004 DOI: 10.1177/0091270010377501] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Children with gastroesophageal reflux disease (GERD) may benefit from gastric acid suppression with proton pump inhibitors such as pantoprazole. Effective treatment with pantoprazole requires correct dosing and understanding of the drug's kinetic profile in children. The aim of these studies was to characterize the pharmacokinetic (PK) profile of single and multiple doses of pantoprazole delayed-release tablets in pediatric patients with GERD aged 6 to 11 years (study 1) and 12 to 16 years (study 2). Patients were randomly assigned to receive pantoprazole 20 or 40 mg once daily. Plasma pantoprazole concentrations were obtained at intervals through 12 hours after the single dose and at 2 and 4 hours after multiple doses for PK evaluation. PK parameters were derived by standard noncompartmental methods and examined as a function of both drug dose and patient age. Safety was also monitored. Pantoprazole PK was dose independent (when dose normalized) and similar to PK reported from adult studies. There was no evidence of accumulation with multiple dosing or reports of serious drug-associated adverse events. In children aged 6 to 16 years with GERD, currently available pantoprazole delayed-release tablets can be used to provide systemic exposure similar to that in adults.
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Affiliation(s)
- Robert M Ward
- University of Utah Pediatric Pharmacology Research Unit, 417 Wakara, Suite 3510, Salt Lake City, UT 84108, USA.
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Canadian Digestive Health Foundation Public Impact Series: gastroesophageal reflux disease in Canada: incidence, prevalence, and direct and indirect economic impact. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2010; 24:431-4. [PMID: 20652158 DOI: 10.1155/2010/296584] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The Canadian Digestive Health Foundation initiated a scientific program to assess the incidence, prevalence, mortality and economic impact of digestive disorders across Canada. The current article presents the updated findings from the study concerning gastroesophageal reflux disease - a condition that develops when the reflux of stomach contents causes troublesome symptoms and/or complications (Montreal definition).
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Bonnet C, Roubertie A, Doummar D, Bahi-Buisson N, Cochen de Cock V, Roze E. Developmental and benign movement disorders in childhood. Mov Disord 2010; 25:1317-34. [DOI: 10.1002/mds.22944] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Usefulness and safety of double endoscopy in children with gastroesophageal reflux and respiratory symptoms. Respir Med 2010; 104:593-9. [DOI: 10.1016/j.rmed.2009.11.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2009] [Revised: 11/10/2009] [Accepted: 11/10/2009] [Indexed: 01/10/2023]
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