Pediatric surgeons and gastroesophageal reflux

Tovar, Juan A.; Luis, A. L.; Encinas, José Luis; Burgos, Laura; Pederiva, Federica; Martínez, Leopoldo; Olivares, Pedro R.

doi:10.1016/j.jpedsurg.2006.10.025

Cited by 58 publications

(46 citation statements)

References 28 publications

(25 reference statements)

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“…It has been reported that transient lower esophageal sphincter (LES) relaxation is the predominant mechanism of reflux in symptomatic and asymptomatic children [1]. Excessive GER commonly manifests as regurgitation and emesis, and most children spontaneously outgrow these symptoms before the age of 12-18 months [2]. Only a fraction of symptomatic children end up suffering from GERD requiring medical or surgical therapy.…”

Section: Introductionmentioning

confidence: 99%

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Effects of rikkunshito on the clinical symptoms and esophageal acid exposure in children with symptomatic gastroesophageal reflux

et al. 2007

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Rikkunshito (TJ-43), a herbal medicine consisting of eight herbs, is used to treat chronic dyspepsia. Studies have shown that TJ-43 improves human gastric emptying. This study investigated the effects of TJ-43 on the clinical symptoms and esophageal acid exposure in children with symptomatic gastroesophageal reflux (GER). Eight children, aged from 2 months to 15 years (median age 4 years), were studied. Six of them had neurological impairment. TJ-43 (0.3 g/kg/day) was given orally or via nasogastric tubes in three divided doses before meals for 7 days. Their symptoms were frequent emesis in four, nausea in two, and hematemesis and stridor in one each. Twenty-four-hour esophageal pH monitoring was conducted using multichannel pH electrodes located at the distal esophagus (P1) and 10 cm proximal to P1 (P2). The clinical symptoms and esophageal pH were compared before and after TJ-43 therapy for 1 week. The frequency of emesis decreased in three patients. Other symptoms, including nausea, hematemesis, and stridor, were relieved in the remaining patients. Measured at the distal pH electrode, the percentage time of esophageal pH < 4.0 and the mean duration of reflux decreased significantly (P < 0.05). However, the number of acid reflux per hour did not change significantly, and no pH parameters measured at the proximal electrode differed significantly. The short-term administration of TJ-43 relieved symptoms and reduced the distal esophageal acid exposure through improved esophageal acid clearance.

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Section: Introductionmentioning

confidence: 99%

“…In recent review articles, influential pediatric surgeons emphasized that surgery for GERD should be performed after the failure of medical management [2,6]. The other potent therapeutic option for GERD is proton pump inhibitors (PPIs).…”

Section: Introductionmentioning

confidence: 99%

Effects of rikkunshito on the clinical symptoms and esophageal acid exposure in children with symptomatic gastroesophageal reflux

et al. 2007

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“…Gastroesophageal reflux (GER) is so frequent after neonatal repair of esophageal atresia (EA) [1][2][3][4][5] with tracheoesophageal fistula (TEF), that it became a component of this condition that often requires fundoplication [6][7][8]. Distorted gastroesophageal anatomy and the neonatal operation account in part for this phenomenon but malformative elements likely contribute to it.…”

Section: Introductionmentioning

confidence: 99%

Intrinsic esophageal innervation in esophageal atresia without fistula

et al. 2007

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Esophageal atresia and tracheo-esophageal fistula (EA + TEF) are often associated with malformations of neural crest origin. Esophageal innervation is also derived from the neural crest and it is abnormal in EA + TEF in which there is motor dysfunction. Our aim was to examine the intrinsic esophageal innervation in children with isolated EA in which different embryogenic mechanisms might be involved. Specimens from the proximal and distal esophageal segments of 6/35 patients who had esophageal replacement for isolated EA between 1965 and 2006 were suitable for the study. They were sectioned and immunostained with anti-neurofilament (NF) and anti-S-100 antibodies. The muscle and neural surfaces on each section were measured with the assistance of image processing software. The surface of the ganglia and the number of neurons per ganglion were determined at high power microscopy. The findings were compared with those of six autopsy specimens from newborns dead of other diseases by means of standard statistical tests and a significance threshold of P < 0.05. Unmatched age/size of babies in isolated EA and control groups precluded comparison of the relative surfaces occupied by neural elements. Patients with pure EA had denser fibrilar network and larger ganglia than controls. The number of neurons/ganglion were similar in both groups although the cells from EA patients were larger. The findings were similar at both esophageal levels studied. In spite of methodologic biases, it seems that intrinsic esophageal fibrilar network is denser and the intramural ganglia larger with larger cells in patients with pure EA than in controls on both esophageal ends of the organ. These neural anomalies are only in part reminiscent of those described in regular EA/TEF but may as well explain esophageal dysfunction in patients with repaired isolated EA.

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“…Laparoscopic approach is increasingly used for this purpose (95,96). in our experience, abnormal motility is not a major obstacle for electing a complete wrap-around provided that it is floppy enough (this can be difficult with a small fundus) (97). it is our impression that a progressively higher proportion of patients operated for EA + TEf undergo fundoplication some time during their life but the proportion varies widely in different institutions.…”

Section: The Problem Of Associated Gastroesophageal Reflux (Ger)mentioning

confidence: 93%

Current Controversies in the Surgical Treatment of Esophageal Atresia

Tovar

Fragoso

2011

Scand J Surg

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Background and Aims: esophageal atresia (ea) with or without tracheo-esophageal fistula (tef) is a rare condition that can be nowadays succesfully treated. the current interest therefore is focused on the management of the difficult cases, on thoracoscopic approach, and on some aspects of the long-term results.Methods: the current strategies for the difficult or impossible anastomoses in pure and long-gap ea, the introduction of thoracoscopic repair and the causes, mechanisms and management of post-operative gastro-esophageal reflux (ger) are reviewed.Results: methods of esophageal elongation and multi-staged repair of pure and longgap ea allow anastomosis but with functional results that are often poor. esophageal replacement with colon or stomach achieves at least similar results and often requires less procedures. thoracoscopic repair is a promising adjunct, but the difficulties for setting it as a gold-standard are pointed out. ger is a part of the disease and its surgical treatment, that is often required, is burdened by high failure rates.Conclusions: ea with or without tef can be successfully treated in most cases, but a number of unsolved issues remain and the current approach to difficult cases will certainly evolve in the future.

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Pediatric surgeons and gastroesophageal reflux

Cited by 58 publications

References 28 publications

Effects of rikkunshito on the clinical symptoms and esophageal acid exposure in children with symptomatic gastroesophageal reflux

Effects of rikkunshito on the clinical symptoms and esophageal acid exposure in children with symptomatic gastroesophageal reflux

Intrinsic esophageal innervation in esophageal atresia without fistula

Current Controversies in the Surgical Treatment of Esophageal Atresia

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