Effect Of Gastroesophageal Reflux Research Articles

A narrative review of gastroesophageal reflux in the pediatric patient.

Gastroesophageal reflux (GER) is the retrograde passage of gastric contents into the esophagus. It is a physiologic condition that is common in neonates, typically resolves spontaneously, and does not result in clinically significant complications. When pathologic, gastroesophageal reflux disease (GERD) can cause numerous complications including persistent emesis, failure to thrive, aspiration, and respiratory symptoms. While a diagnosis can often be made from a thorough history and physical, some patients may require further testing. In general, many clinicians will reserve extensive investigation such as multiple intraluminal impedance and pH monitoring for patients with a confounding clinical picture or relative contraindications to medical or surgical management. Whereas most pediatric GER resolves spontaneously, medical management including lifestyle changes, changes to feeds, and the use of H2-antagonists and/or proton pump inhibitors (PPIs) can be utilized to alleviate symptoms. Surgical treatment is reserved for patients who are refractory to medical management or have suffered significant complications as a consequence of GER. In this article we seek to provide a concise but detailed review of recent updates in the understanding, work up and management of GER in the pediatric patient. A summary of new technologies used in the diagnostic and therapeutic arms of this disease are included.

КАШЕЛЬ И ГАСТРОЭЗОФАГЕАЛЬНЫЙ РЕФЛЮКС: НЕПРОСТЫЕ ВЗАИМОДЕЙСТВИЯ (ЧАСТЬ 2)

For many decades, researchers have been interested in the problem of the relationship between cough and gastroesophageal reflux (GER) and gastroesophageal reflux disease (GERD). The question has not only theoretical, but also practical significance, since it determines the diagnostic and therapeutic, both for coughing and for GER, while uniting under their «banners» specialists of various profiles: physicians, pediatricians, gastroenterologists, pulmonologists and others. This article presents and discusses the data of domestic and international publications on this issue and, based on current knowledge, the concept of the relationship between GER, GERD and cough, including bronchoobstructive syndrome in bronchial asthma, is proposed, as well as recommendations for practical work of doctors in this clinical situation. Based on the available data, it can be argued that the relationship between GER (GERD) and cough is obvious, but many details of this interaction remain poorly understood. It should be noted the important role played by a hiatal hernia (HH) both in the development of GER and the cough associated with it. Children with chronic cough that do not respond to basic therapy are shown to be examined in order to identify the possible effect of GER on its formation. In this regard, it is important to identify HH in order to determine the tactics of patient management and resolve the issue of its surgical correction. On the other hand, patients with GERD are shown at least a minimal examination to clarify the state of the respiratory system, even in the absence of obvious respiratory symptoms.

The effect of gastroesophageal reflux and proton pump inhibitors on respiratory tract infections in patients with asthma

The effect of gastroesophageal reflux and proton pump inhibitors on respiratory tract infections in patients with asthma

Characterization of the nasopharyngeal and middle ear microbiota in gastroesophageal reflux-prone versus gastroesophageal reflux non-prone children

Otitis media (OM) is one of the most common pediatric infections worldwide, but the complex microbiology associated with OM is poorly understood. Previous studies have shown an association between OM and gastroesophageal reflux (GER) in children. Therefore, in order to bridge the gap in our current understanding of the interaction between GER and OM, we investigated the nasopharyngeal and middle ear microbiota of children suffering from GER-associated OM and OM only, using culture-independent 16S rRNA gene sequencing. Middle ear fluid, nasopharyngeal swabs, and clinical data were collected as part of a prospective pilot study conducted at the Department of Otorhinolaryngology of the Erasmus MC-Sophia Children’s Hospital, Rotterdam, the Netherlands. A total of 30 children up to 12 years of age who suffered from recurrent acute otitis media (AOM) (5), chronic otitis media with effusion (OME) (23), or both (2), and who were listed for tympanostomy tube placement, were included in the study. Nine children were included in the GER-associated OM cohort and 21 in the OM-only cohort. We found no obvious effect of GER on the nasopharyngeal and middle ear microbiota between the two groups of children. However, our results highlight the need to assess the true role of Alloiococcus spp. and Turicella spp. in children presenting with a high prevalence of recurrent AOM and chronic OME.

241 Increased Reflux Severity on Impedance Predicts One-Year Pulmonary Function Decline in Pre-Lung Transplant Patients With Idiopathic Pulmonary Fibrosis

Background: Gastroesophageal reflux (GER) has been associated with pulmonary disease in pre-lung transplant patients, especially idiopathic pulmonary fibrosis (IPF) and chronic obstructive pulmonary disease (COPD). The mechanism of these associations remains controversial. Microaspiration of refluxate may lead to inflammatory changes and pulmonary fibrosis or airway disease. Worsening pulmonary function may also increase trans-diaphragmatic pressure gradient, magnifying GER. The association between GER and decline in lung function in these patients has not yet been demonstrated. Evaluating the relationship between objective reflux parameters and change in pulmonary function may help clarify pathophysiology and identify targets for treatment. Aim: To investigate the association between objective measures of reflux on multichannel intraluminal impedance and pH study (MII-pH) and change in pulmonary function testing (PFT) parameters over one year, in pre-lung transplant patients with IPF or COPD. Methods: This was a retrospective cohort study of adults with IPF or COPD who underwent pretransplant evaluation with MII-pH, off acid suppression, at a tertiary care center from 6/2010-14. Patients with fundoplication prior to MII-pH were excluded. PFT was performed within 1 month of MII-pH and at 12-month follow-up. Association between baseline reflux measures and change in PFT parameters over one year was evaluated using Student's t-test for continuous variables and Fisher's exact test for binary variables. Results: 57 subjects (mean age=60 yrs, 42% female, 37 IPF vs 20 COPD) met criteria for inclusion. Among IPF patients, abnormal bolus reflux on impedance was associated with a significant decline in forced expiratory volume in 1 second (FEV1) in 1 year (-0.048 L/sec vs +0.24 L/sec, p=0.041), as was increased acid exposure time (-0.195 L/sec vs +0.144 L/sec, p=0.05). Trends toward more severe decline in forced vital capacity (FVC) in 1year for both abnormal bolus reflux (-0.085 L/sec vs +0.25 L/sec, p=0.09) and increased acid exposure time (-0.28 L/sec vs +0.147 L/sec, p=0.10) were also observed. Among COPD patients, trends toward more severe decline in FEV1 in 1 year was noted for increased acid exposure time (-0.27 L/sec vs -0.035 L/sec, p=0.087). No other significant associations between change in PFT and abnormal MII-pH parameters were found (Table 1). Conclusion: Abnormal GER as measured on MII-pH predicts more severe decline in lung function in 1 year on PFT among pre-lung transplant patients with IPF. A similar association between GER and lung function decline was not found in COPD patients. GER may play a more significant role in the pathogenesis of IPF than COPD. Future long-term studies are needed to further characterize the effect of GER on severity and prognosis of pulmonary disorders. Association between measures of reflux severity and worse pulmonary function (FEV1) after 1 year in patients with IPF.

243 Comparison of Two Studies of the Upper Esophageal Sphincter (UES) Assist Device for the Treatment of Extraesophageal Reflux

Background: Gastroesophageal reflux (GER) has been associated with pulmonary disease in pre-lung transplant patients, especially idiopathic pulmonary fibrosis (IPF) and chronic obstructive pulmonary disease (COPD). The mechanism of these associations remains controversial. Microaspiration of refluxate may lead to inflammatory changes and pulmonary fibrosis or airway disease. Worsening pulmonary function may also increase trans-diaphragmatic pressure gradient, magnifying GER. The association between GER and decline in lung function in these patients has not yet been demonstrated. Evaluating the relationship between objective reflux parameters and change in pulmonary function may help clarify pathophysiology and identify targets for treatment. Aim: To investigate the association between objective measures of reflux on multichannel intraluminal impedance and pH study (MII-pH) and change in pulmonary function testing (PFT) parameters over one year, in pre-lung transplant patients with IPF or COPD. Methods: This was a retrospective cohort study of adults with IPF or COPD who underwent pretransplant evaluation with MII-pH, off acid suppression, at a tertiary care center from 6/2010-14. Patients with fundoplication prior to MII-pH were excluded. PFT was performed within 1 month of MII-pH and at 12-month follow-up. Association between baseline reflux measures and change in PFT parameters over one year was evaluated using Student's t-test for continuous variables and Fisher's exact test for binary variables. Results: 57 subjects (mean age=60 yrs, 42% female, 37 IPF vs 20 COPD) met criteria for inclusion. Among IPF patients, abnormal bolus reflux on impedance was associated with a significant decline in forced expiratory volume in 1 second (FEV1) in 1 year (-0.048 L/sec vs +0.24 L/sec, p=0.041), as was increased acid exposure time (-0.195 L/sec vs +0.144 L/sec, p=0.05). Trends toward more severe decline in forced vital capacity (FVC) in 1year for both abnormal bolus reflux (-0.085 L/sec vs +0.25 L/sec, p=0.09) and increased acid exposure time (-0.28 L/sec vs +0.147 L/sec, p=0.10) were also observed. Among COPD patients, trends toward more severe decline in FEV1 in 1 year was noted for increased acid exposure time (-0.27 L/sec vs -0.035 L/sec, p=0.087). No other significant associations between change in PFT and abnormal MII-pH parameters were found (Table 1). Conclusion: Abnormal GER as measured on MII-pH predicts more severe decline in lung function in 1 year on PFT among pre-lung transplant patients with IPF. A similar association between GER and lung function decline was not found in COPD patients. GER may play a more significant role in the pathogenesis of IPF than COPD. Future long-term studies are needed to further characterize the effect of GER on severity and prognosis of pulmonary disorders. Association between measures of reflux severity and worse pulmonary function (FEV1) after 1 year in patients with IPF.

Mo1837 Beneficial Effects of Diazoxide on Hepatic Ischemia/Reperfusion Injury

The pathognomonic feature of reflux esophagitis secondary to gastro-esophageal reflux disease is the presence of dilated intercellular spaces in the stratified squamous lining of the esophagus. Bile acid is a major constituent of gastro-esophageal refluxate. In our present study, we developed a novel in vitro transwell culture model for stratified esophageal squamous epithelium. We grew h-TERT transformed primary esophageal cell line EPC1 on polyester transwell surfaces, apically and basally supplemented with calcium enriched media, and observed that the EPC1 cells gradually stratify into a 11-layered squamous epithelium in 7 days. This epithelium also demonstrated well-formed cell junctions, essential for formation of the stratified epithelium. When the EPC1 cells on transwells were treated with a combination of bile acid and pH5, there was loss of epithelial barrier function. Electron microscopy and confocal imaging of the cell junctions showed disruption of adherens junction, tight junction and desmosomes, thus leading to dilated intercellular spaces. At the cellular level, the combination of bile acid and pH5 induced β-catenin phosphorylation and reduced SMAD-1/5/8 phosphorylation, both of which can lead to loss of cell junction proteins. In conclusion, combination of bile acid at low pH in our trasnwell culture model mimicked the effects of gastro-esophageal reflux in vivo, possibly by modulating WNT and BMP signaling pathways.

Effect of Gastroesophageal Reflux on Base of the Tongue

Objective: There are studies about the hypertrophy of the base of the tongue due to gastroesophageal reflux (GER), but there have been no reports explaining the effects of GER on the base of the tongue histopathologically. Therefore, we investigated the histopathologic changes of tongue base using an experimental model of reflux. Method: The randomized study was conducted at Haydarpasa Numune Hospital. Eighteen rats were divided into 3 groups according to exposure time, and 4 rats were examined as controls. An experimental model of gastroesophageal reflux was induced. The histopathological changes in the base of the tongue were observed under a light microscope. Results: At the end of the first week, only subepithelial edema was significantly different in the exposed group when compared to the control group. After 4 weeks in addition to subepithelial edema, submucosal gland hypertrophy was significantly different from the control group. When we assessed submucosal gland hypertrophy and subepithelial edema in the group exposed to refluxate for 12 weeks, they were found to be much increased compared with the 4-week group. Also, inflamation, vascular dilatation, and achantosis were determined to be significantly increased compared with the control group. Conclusion: The current study suggests that GER results in histopathological changes in the base of the tongue. Therefore, it suggests a new perspective to the relationship between GER and throat clearing, dry cough, and especially globus pharyngeus.

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

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

Does Acid Reflux Cause Cough?

Research Article| February 01 2011 Does Acid Reflux Cause Cough? AAP Grand Rounds (2011) 25 (2): 15. https://doi.org/10.1542/gr.25-2-15 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Does Acid Reflux Cause Cough?. AAP Grand Rounds February 2011; 25 (2): 15. https://doi.org/10.1542/gr.25-2-15 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: cough, gastroesophageal reflux disease, chronic cough Source: Chang AB, Connor FL, Petsky HL, et al. An objective study of acid reflux and cough in children using an ambulatory pHmetry-cough logger. Arch Dis Child. Epub 2010 Jun 01; doi: https://doi.org/10.1136/adc.2009.177733 To examine the temporal relationship between cough and gastroesophageal reflux (GER), investigators at the Respiratory Centre of the Royal Children’s Hospital in Queensland, Australia recruited 22 children between 3 months and 14 years of age who were being considered for ambulatory 24-hour pH monitoring to evaluate suspected GER. Data were available for 20 children (10 boys and 10 girls) with a median age of 1.1 years (inter-quartile range [IQR] 0.66–4.2). Using a specifically built device to monitor ambulatory esophageal pH and cough, the relationship between 5,628 coughs, a median of 159 per child (IQR 57–402), and reflux events were determined over 24 hours. Most coughs (83.9%) were independent of a reflux event (defined as reflux not occurring within two minutes of the cough). When cough and reflux were temporally associated, cough preceded reflux as frequently as reflux preceded cough. Specifically, within the two-minute time frame, reflux followed by cough occurred in 13.3% of total coughs and cough followed by reflux occurred in 11.4% of coughs. When the association of reflux and cough was examined for shorter periods, reflux preceding cough was significantly less frequent than absence of cough following reflux. Similarly, reflux after cough was less common than no reflux after cough. The authors conclude that based on their data, any apparent temporal relationship between cough and acid reflux is unlikely to be causal. Dr Weinberger has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. Chronic cough is a frequent and troublesome disorder in children.1 While there is a recognized association between chronic cough and GER, the question of causality remains: does GER cause cough or does cough cause GER, or is there an etiological relationship at all?2 Despite the absence of convincing data, practitioners continue to use proton pump inhibitors (PPIs) to treat symptoms ranging from cough and wheeze to irritability thought to be the result of GER.3 Studies that have examined the effect of GER on the airway have not revealed airway inflammation, which would be expected if chronic cough were a result of GER.4 Moreover, in a controlled clinical trial of 162 infants with symptoms attributed to GER, 75% of whom had cough averaging 55% of days per week, there was no difference between lansoprazole and placebo with regard to relief of symptoms. In fact, lower respiratory tract infections occurred significantly more frequently among the infants treated with lansoprazole than with placebo5 (see AAP Grand Rounds, June 2009;21:62). In a prospective study of 150 children aged 9 months to 14 years undergoing elective esophagogastroscopy,6 69 had been coughing a median of 52 weeks and 81 were noncoughers. The frequency of esophagitis did not differ between those... You do not currently have access to this content.

Zenker's and epiphrenic diverticula in a patient with cutis laxa: should the surgical technique be modified?

Currently, most of esophageal diverticula arise as the result of a pulsion effect. Some esophageal motor disorders increase the intraluminal pressure and after some time, the diverticula grow through a weak point of esophageal wall. In these cases, the surgical treatment of choice is the myotomy associated with diverticulopexy or diverticulectomy. Adding a fundoplication is accepted to avoid the consequences of gastroesophageal reflux after myotomy in the epiphrenic diverticula surgery. There are other causes of esophageal diverticula that change the resistance of esophageal wall. Cutis laxa, a congenital or acquired connective disease, is a strange one. In our patient, a good result was reached modifying the standard technique accord to its ethiopathogenic mechanism.

Impact of prematurity and co-morbidities on feeding milestones in neonates: a retrospective study.

Objective:Feeding problems are an important area of neonatal morbidity that requires attention. We defined the feeding milestones related to transition to per oral feeding among premature infants based on gestational (GA) and postmenstrual ages (PMA), and elucidated the co-morbidity variables affecting with these skills.Study Design:Feeding progress was tracked during the first hospitalization in a retrospective study involving 186 infants. We measured the age at acquisition of first feedings, maximum gavage feedings and maximum oral feedings. Resource usage measures included the total length of hospital stay (LOS), duration of gavage tube and duration of respiratory support. Effects of perinatal and co-morbidity factors on the acquisition of feeding milestones were evaluated. ANOVA, t-test, Wilcoxon rank sum test, χ2 test, univariate and multivariate analysis, stepwise linear regression analysis and logistic regression analysis were applied as appropriate. Data were presented as mean±s.d., or as stated. P<0.05 was considered significant.Result:We stratified the data into three groups based on GA at birth: <28.0 weeks (group-1), 28.0 to 32.0 weeks (group-2) and 32.0 to 35.0 weeks (group-3). Compared with group-3, group-1 needed four-fold more ventilation and five-fold more continuous positive airway pressure (CPAP) duration (all P<0.001); whereas group-2 needed two-fold more CPAP duration. Age at first feed correlated with age at full gavage feedings and age at full oral feedings (r=0.53 and r=0.71, both P<0.0001). Age at full gavage feedings correlated with age at full oral feedings (r=0.81, P<0.0001). Univariate analysis was significant for GA age, hypotension, the effects of gastroesophageal reflux, and duration of ventilation and CPAP on the PMA at maximal oral feedings (all P<0.05); multivariate analysis for these variables was also significant (R 2=0.58, P<0.0001). The success rate for oral feedings at discharge accelerated with GA maturation and caffeine use; on the other hand, the need for respiratory support and management of positive blood culture were associated with failure rates (P<0.05).Conclusion:Infants < 28 weeks GA have significant feeding delays with respect to initiation and progression to maximal gavage and oral feedings, as well as prolonged LOS. Infants >28 weeks GA attained successful feeding milestones by similar PMA. Specific aero-digestive co-morbidities significantly affected maximal oral feeding milestone. Delays in achieving maximum gavage and maximum oral feeding milestones suggest delays with the development of control and regulation of foregut motility.

Manganese Superoxide Dismutase (MnSOD) Polymorphism, Alcohol, Cigarette Smoking and Risk of Oesophageal Cancer

Alcohol, tobacco smoke and Barrett's oesophagus as a consequence of gastro-oesophageal reflux are the main risk factors in oesophageal carcinogenesis. All risk factors may induce oxidative stress. Manganese superoxide dismutase (MnSOD) is one important repair enzyme for reactive oxidative stress (ROS)-induced damage. MnSOD polymorphisms in the -9 position of the signal sequence of the protein may lead to critical enzyme deficiency. The aim of the present study was to investigate the role of polymorphisms of MnSOD in patients with oesophageal cancer [n = 170, 61 patients with adenocarcinoma (AC), 109 patients with squamous cell carcinoma (SCC)] compared to heavy drinkers (n = 160) and healthy blood donors (n = 400). Genotyping was performed by PCR-RFLP analysis using genomic DNA extracted from whole blood. The Ala/Ala genotype was 27.7% in cancer patients (29.5% AC, 26.6% SCC), 23.1% in patients with heavy alcohol abuse and 12.5% in the group of healthy blood donors. These results were not statistically significant after multivariate analysis controlling for age, sex, alcohol, cigarettes and interactions (odds ratio 0.92, 95% confidence interval = 0.63-1.36, for cancer patients versus heavy drinkers; odds ratio 1.02, 95% confidence interval = 0.51-2.03, for cancer patients versus blood donors; analysis by logistic regression). Subjects with an Ala/Ala genotype (81.3 g/day) had a significantly higher alcohol intake than those with Val/Ala (63.9 g/day) or Val/Val (53.8 g/day) genotype (P < 0.00001 by the Kruskal-Wallis test). MnSOD polymorphisms play no role in the genetic predisposition to oesophageal cancer. However, our data suggest a complex gene-to-phenotype interaction between the MnSOD genotype and alcohol misuse.

A MCh Test Pre-post Esophageal Acidification in Detecting GER-related Asthma

The direct effect of gastro-esophageal reflux (GER) on lung function is still debated. Objective. To investigate the role of esophageal acidification in affecting airway response to MCh in GER-related versus atopic asthmatics and to assess specificity and sensitivity of events. Subjects. A total of 56 never-smoking, mild asthmatics: 27 non-atopic asthmatics and acid GER (GER+ve) and 29 atopic asthmatics without any GER (GER–ve). Methods. Each subject performed an MCh challenge in baseline (MChb), and 30 minutes after an acid drink (125 mL at pH = 2; MChac), one day apart. PD20FEV1 MChb and MChac were compared by estimating the area under the ROC curve (AU-ROC). Results. GER+ve and GER-ve subjects (well matched in baseline) had a different duration of esophageal acid contact (24-hour monitoring; pH-24h AU4), and PD20FEV1 MChac (both p < 0.001). AU-ROC was 86.3% (76% to 97%, 95%CI). Sensitivity and specificity of changes were 82.8% (72.9% to 92.7%, 95%CI) and 85.2% (75.9% to 94.5%, 95%CI), respectively. The difference in MCh threshold that maximized both the sensitivity and specificity level was 100 μ g. Conclusions. The esophageal acidification identified GER-related asthma with a good level of both sensitivity and specificity by enhancing the MCh response only in the presence of acid GER. Data are supporting the effectiveness of this procedure for clinical purposes.

Role of Gastroesophageal Reflux Symptoms in Exacerbations of COPD

The impact of gastroesophageal reflux disease (GERD) on exacerbations of COPD has never been evaluated. The aims of this investigation were to determine the prevalence of gastroesophageal reflux (GER) symptoms in COPD patients and the effect of GER on the rate of exacerbations of COPD per year. A questionnaire-based, cross sectional survey was performed. Subjects were recruited from the outpatient pulmonary clinics at the University of Florida Health Science Center/Jacksonville. Included patients had an established diagnosis of COPD. Exclusion criteria were respiratory disorders other than COPD, known esophageal disease, active peptic ulcer disease, Zollinger-Ellison syndrome, mastocytosis, scleroderma, and current alcohol abuse. Those meeting criteria and agreeing to participate were asked to complete the Mayo Clinic GERD questionnaire by either personal/telephone interview. Clinically significant reflux was defined as heartburn and/or acid regurgitation weekly. Other outcome measures noted were frequency and type of COPD exacerbations. Statistical analysis was performed using the Fisher exact test for categorical data and the independent t test for interval data. Eighty-six patients were enrolled and interviewed (mean age, 67.5 years). Male patients accounted for 55% of the study group. Overall, 37% of patients reported GER symptoms. The mean FEV(1) percentage of predicted was similar in those with or without GER. The rate of exacerbations of COPD was twice as high in patients with GER symptoms compared to those without GER symptoms (3.2/yr vs 1.6/yr, p = 0.02). The presence of GER symptoms appears to be associated with increased exacerbations of COPD.

The Effect of Gastroesophageal Reflux on Upper Airway Functioning in Patients with Obstructive Sleep Apnea

The Effect of Gastroesophageal Reflux on Upper Airway Functioning in Patients with Obstructive Sleep Apnea

Apnea Is Not Prolonged by Acid Gastroesophageal Reflux in Preterm Infants

To examine the temporal relationship between apnea and gastroesophageal reflux (GER) and to assess the effect of GER on apnea duration. A total of 119 preterm infants underwent 12-hour cardiorespiratory monitoring studies using respiratory inductance plethysmography, heart rate, oxygen saturation (SaO2), and esophageal pH. The studies were scored for GER (pH <4 for > or =5 seconds) and apnea > or =15 seconds or > or =10 seconds that occurred within 30 seconds of GER. Apnea > or =10 seconds was used to assess whether GER would prolong apnea duration. There were 6255 episodes of GER. Only 1% of GER episodes were associated with apnea > or =15 seconds, and there was no difference in apnea rate before, during, or after GER. There was also no difference in rate of apnea > or =10 seconds before versus during GER; however, there was a decrease in apnea rate immediately after GER. The presence of GER during apnea did not prolong apnea duration, and GER had no effect on the lowest SaO2 or heart rate during apnea. There is no evidence of a temporal relationship between acid-based GER and apnea in preterm infants. In addition, GER does not prolong apnea duration and does not exacerbate the resultant decrease in heart rate and SaO2.

Apnea Is Not Prolonged by Acid Gastroesophageal Reflux in Preterm Infants

Objective. To examine the temporal relationship between apnea and gastroesophageal reflux (GER) and to assess the effect of GER on apnea duration. Methods. A total of 119 preterm infants underwent 12-hour cardiorespiratory monitoring studies using respiratory inductance plethysmography, heart rate, oxygen saturation (SaO 2 ), and esophageal pH. The studies were scored for GER (pH <4 for ≥5 seconds) and apnea ≥15 seconds or ≥10 seconds that occurred within 30 seconds of GER. Apnea ≥10 seconds was used to assess whether GER would prolong apnea duration. Results. There were 6255 episodes of GER. Only 1% of GER episodes were associated with apnea ≥15 seconds, and there was no difference in apnea rate before, during, or after GER. There was also no difference in rate of apnea ≥10 seconds before versus during GER; however, there was a decrease in apnea rate immediately after GER. The presence of GER during apnea did not prolong apnea duration, and GER had no effect on the lowest SaO 2 or heart rate during apnea. Conclusion. There is no evidence of a temporal relationship between acid-based GER and apnea in preterm infants. In addition, GER does not prolong apnea duration and does not exacerbate the resultant decrease in heart rate and SaO 2 .

Current status of esophageal cancer ? West versus East: the European point of view

Esophageal cancer and its treatment differ largely between the West and the East because West and East are concerned – at least in part – with different diseases: squamous cell cancers are the prevailing tumor type in Japan and other parts of Asia whereas this entity is now clearly outnumbered in Europe and North America by esophageal adenocarcinoma. The latter are mostly Barrett’s cancers, arising within the precancerous Barrett’s esophagus, promoted by the chronically damaging effect of gastro-esophageal reflux. The epidemiological differences entail differences in treatment concepts: esophageal cancer in principle is a “surgical disease” in Japan, with a high prevalence of early tumor stages in everyday clinical practice. In the West, a majority of esophageal cancers are seen in an advanced stage. Many tumors, in which R0 resection by primary surgery is unlikely, are approached with neo-adjuvant protocols that aim at downsizing of the tumor/downstaging of the disease before subsequent surgical resection. In Japan, by contrast, multimodal therapy is preferentially used in the adjuvant setting, in patients regarded at risk for recurrence. There have also been several very similar developments in the West and the East, especially the improved prognosis after esophageal cancer resection. Better long-term results (prolonged survival) are closely related to improved short-term results (decrease of morbidity and mortality) after esophagectomy. Both effects are multifactorial in nature and are attributable to better patient selection (risk analysis, improved staging), standardization of surgical techniques, and concentration of treatment in specialized high-volume centers.

Anti-reflux surgery for the neonatal intensive care-dependent infant

Aim: The benefit of anti-reflux surgery for gastro-oesophageal reflux (GOR) in early infancy is uncertain. The aim of this study was to assess the value of Nissen fundoplication in a group of infants with severe GOR. Methods: 10 infants underwent Nissen fundoplication for gastro-oesophageal reflux following a failure of medical management. All had suffered life-threatening respiratory episodes as a consequence of gastro-oesophageal reflux, and were neonatal intensive care-dependent. Median (range) birth weight was 1.26 kg (0.48–3.8 kg), gestation 30 weeks (25–38 weeks); at surgery, weight was 3.25 kg (2.5–6.1 kg) at a corrected age of 11.5 weeks (term-22) weeks. For each infant, the success of enteral feeding and the level of support required pre- and post-operatively was compared, and where appropriate, the facilitation of palliative feeding was assessed. Median follow-up was 14 (3–36) months. Results: No infant suffered intra-operative morbidity or mortality. One infant died within 1 month of surgery from a collapse unrelated to surgery. Eight of nine surviving infants were discharged from intensive care following extubation and the establishment of enteral feeding. One patient died of severe bronchopulmonary dysplasia 3 months post-surgery. One infant developed a gastrostomy site infection, and two required gastrostomy tube replacement within 6 months of surgery. All were thriving at follow-up. Two infants with a congenital myopathy died as a result of their muscle disease at 9 and 11 months post-operatively. Conclusions: Nissen fundoplication is a feasible, effective and safe operation in severe gastro-oesophageal reflux unresponsive to medical treatment in term and pre-term infants. It has an additional important role in facilitating safe palliative enteral feeding in infants with a diagnosis incompatible with survival into adulthood.