Esophagogastric separation and abdominal esophagostomy via jejunal interposition: a new operation for extreme forms of pathologic aerophagia

Fukuzawa, Hiroaki; Urushihara, Naoto; Fukumoto, Koji; Sugiyama, Akihide; Mitsunaga, Maki; Watanabe, Kentaro; Hasegawa, Shiro

doi:10.1016/j.jpedsurg.2011.05.024

Cited by 7 publications

(14 citation statements)

References 7 publications

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“…This study shows that in PA children with MR, clonazepam may achieve positive results in about 50% of patients treated. When patients with massive and persistent bowel distention are being considered for PEG [ 7 ] or surgical bowel reconstruction [ 8 ], a trial with clonazepam may produce satisfactory results and avoid the need for these invasive procedures. To the best of our knowledge, this is the first trial of clonazepam in PA children with MR.…”

Section: Discussionmentioning

confidence: 99%

“…To prevent massive and persistent bowel distention that could potentially result in surgical emergencies, the placement of a percutaneous endoscopic gastrostomy (PEG) [ 7 ] has been suggested. Fukuzawa et al [ 8 ] recently suggested a method of surgical bowel reconstruction (i.e., esophagogastric separation and abdominal esophagostomy via jejunal interposition) to evacuate swallowed air and prevent severe bowel distention.…”

Section: Introductionmentioning

confidence: 99%

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Clonazepam Treatment of Pathologic Aerophagia in Children with Mental Retardation

Lee

Jang

Hwang

2014

Pediatr Gastroenterol Hepatol Nutr

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PurposePathologic aerophagia (PA) may lead to bowel perforation or volvulus in mentally retarded patients. The authors investigated the effects of clonazepam on the management of PA in children with severe to profound mental retardation (MR).MethodsThis study was undertaken as a retrospective case analysis of 21 PA patients with MR who were followed for over 12 months and diagnosed as having PA. Patients were assigned to two management groups, that is, to a clonazepam randomized open-labeled, treatment group or a reassurance group. The following were recorded and analyzed; age, response, remission rate to clonazepam treatment, and the side effect of clonazepam. It was defined positive response (response+) as being symptom-free for a whole week within 1 month of commencing treatment and remission(+) as being symptom-free for a whole month within 6 months of treatment.ResultsThe average age of the 21 PA children with MR was 10 years and 13 patients were female. Symptom duration before diagnosis of PA was 7 months. Clinical features of the clonazepam-trial group (n=11) and the reassurance group (n=10) were non-significantly different. Response(+) was achieved by 2 patients (18.2%) in the clonazepam-trial group and by no patient in the reassurance group. Remission(+) was achieved by 6 patients (54.5%) in the clonazepam-trial group and by one patient (10%) in the reassurance group (p=0.040).ConclusionWhen PA children with MR with severe bowel distention are considered for surgical treatment to prevent acute abdomen, a trial of clonazepam could be recommended.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Clonazepam Treatment of Pathologic Aerophagia in Children with Mental Retardation

Lee

Jang

Hwang

2014

Pediatr Gastroenterol Hepatol Nutr

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“…Only our patient and two others reported cases 3,4 have been previously submitted to fundoplications, which may have exaggerated their pathological aerophagia, due to the impossibility of burping and belching. This standard may be problematic in mentally impaired children presenting constipation and previously submitted to fundoplication, both of which are common in this population.…”

Section: Discussionmentioning

confidence: 69%

“…3,7,8 All reported surgical complications attained mentally impaired patients. 3,7,8 All reported surgical complications attained mentally impaired patients.…”

Section: Discussionmentioning

confidence: 99%

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Pathologic aerophagia: a rare cause of chronic abdominal distension

Jesus

Cestari

Filho

et al. 2015

Revista Paulista de Pediatria (English Edition)

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Objective: To describe an adolescent with pathologic aerophagia, a rare condition caused by excessive and inappropriate swallowing of air and to review its treatment and differential diagnoses. Case description: An 11-year-old mentally impaired blind girl presenting serious behavior problems and severe developmental delay with abdominal distension from the last 8 months. Her past history included a Nissen fundoplication. Abdominal CT and abdominal radiographs showed diffuse gas distension of the small bowel and colon. Hirschsprung's disease was excluded. The distention was minimal at the moment the child awoke and maximal at evening, and persisted after control of constipation. Audible repetitive and frequent movements of air swallowing were observed. The diagnosis of pathologic aerophagia associated to obsessive---compulsive disorder and developmental delay was made, but pharmacological treatment was unsuccessful. The patient was submitted to an endoscopic gastrostomy, permanently opened and elevated relative to the stomach. The distention was resolved, while maintaining oral nutrition. Comments: Pathologic aerophagia is a rare self-limiting condition in normal children exposed to high levels of stress and may be a persisting problem in children with psychiatric or neurologic disease. In this last group, the disease may cause serious complications. Pharmacological and behavioral treatments are ill-defined. Severe cases may demand surgical strategies, mainly decompressive gastrostomy. Aerofagia patológica: uma causa rara de distensão abdominal crônica ResumoObjetivo: Descrever o caso de uma adolescente com aerofagia patológica, uma doença rara causada pela deglutição excessiva e inapropriada de ar, e revisar o tratamento e os diagnósticos diferenciais. Descrição do caso: Menina de 11 anos portadora de retardo mental e cegueira, apresentava problemas comportamentais associados a retardo do desenvolvimento, foi consultada por distensão abdominal persistente por oito meses. Sua história pregressa incluía uma fundoplicatura à Nissen. Tomografia e radiografias abdominais mostravam distensão difusa do trato digestivo por ar, incluindo cólon e delgado. Doença de Hirschsprung foi excluída. A distensão persistiu mesmo após o controle da constipação e era mínima de manhã e máxima à noite. Ruídos audíveis e repetitivos de deglutição de ar foram observados e auscultados. A criança foi tratada farmacologicamente com o diagnóstico de aerofagia patológica associado a distúrbio obsessivo compulsivo, sem sucesso. A paciente foi submetida a gastrostomia descompressiva endoscopia e manteve nutrição oral. Comentários: A aerofagia patológica é uma doença rara e autolimitada em crianças, mas pode ser um problema grave e persistente naquelas com problemas neuropsiquiátricos, nas quais pode causar complicações sérias. Os tratamentos comportamentais e farmacológicos têm pouco sucesso nesse grupo. Casos graves podem precisar de tratamento cirúrgico, principalmente gastrostomia descompressiva.

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Miscellaneous Upper Gastrointestinal Symptoms

Sultan

Lewis

2016

Practical Gastroenterology and Hepatology Board Review Toolkit

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Esophagogastric separation and abdominal esophagostomy via jejunal interposition: a new operation for extreme forms of pathologic aerophagia

Cited by 7 publications

References 7 publications

Clonazepam Treatment of Pathologic Aerophagia in Children with Mental Retardation

Clonazepam Treatment of Pathologic Aerophagia in Children with Mental Retardation

Pathologic aerophagia: a rare cause of chronic abdominal distension

Miscellaneous Upper Gastrointestinal Symptoms

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