Bronchial asthma and acid reflux into the distal and proximal oesophagus

Article Abstract:

Studies show that asthma in adults and children is associated with gastroesophageal reflux, the backflow of stomach contents into the esophagus, but the prevalence of this disorder in asthmatic patients is not known. An asthma attack may be triggered by aspiration of small amounts of gastric contents or by exposure of the end portion of the esophagus to gastric acid, which may activate an automatic response called the esophagobronchial reflex. Gastroesophageal reflux is often studied by measuring the pH levels (an index of acidity) in the esophagus. The prevalence of gastroesophageal reflux in 42 asthmatic patients aged nine to 20 years was assessed by pH monitoring of the esophagus over a 24-hour period. The relation between symptoms of asthma and the reflux of contents into the esophagus was also examined. Gastroesophageal reflux was detected in 27 patients, including 21 with reflux into the distal esophagus and six with reflux into the beginning of the esophagus. Gastroesophageal reflux was associated with symptoms of asthma in nine patients, including four cases in which symptoms of asthma followed attacks of gastroesophageal reflux. Asthma developed after reflux into the distal esophagus in three cases and after reflux into the proximal esophagus in one case. These findings show that gastroesophageal reflux is common in adults and children with asthma, but triggers asthmatic attacks in only a small proportion. Symptoms of asthma were triggered more often by exposure of the distal (lower) portion of the esophagus to gastric acid rather than by aspiration of gastric juice. (Consumer Summary produced by Reliance Medical Information, Inc.)

Physiological aspects, Development and progression, Asthma in children, Childhood asthma

---

Surgery for gastro-oesophageal reflux

Article Abstract:

Gastroesophageal reflux is the backflow of stomach contents into the esophagus, and can be treated by surgery. One study showed that antireflux procedures in children increased from two in 1977 to 48 in 1981 at one medical center in Oklahoma. In the United Kingdom, surgery tends to be avoided in the management of gastroesophageal reflux. Antireflux procedures are only performed when nonsurgical methods of treating gastroesophageal reflux have failed or when complications of reflux develop. Conditions requiring surgery and complications of gastroesophageal reflux in children include life-threatening events; failure to thrive associated with persistent vomiting; respiratory problems, such as recurrent pneumonia or asthma; inflammation and constriction of the esophagus; and severe mental retardation or brain damage. Two antireflux procedures are described and include the Nissen and Thal operations, which eliminate reflux, and may or may not prevent belching and vomiting. Although the incidence of death is low during the operation, ranging from 0 to 1.4 percent, the risk increases to between 16 and 24 percent later due to pre-existing conditions or blockage by adhesions, or fiber-like bands. One study showed that 43 percent of patients developed complications from surgery and 12 percent of patients required another operation. Some reported complications of surgery include diarrhea and the dumping syndrome, characterized by sweating and weakness after eating. Surgery relieves symptoms in 74 to 94 percent of patients, and is particularly beneficial to severely retarded children. (Consumer Summary produced by Reliance Medical Information, Inc.)

Prognosis, Surgery

---

Diagnostic accuracy of pH monitoring in gastro-oesophageal reflux

Article Abstract:

Gastroesophageal reflux is often successfully treated with drugs, but surgery may be necessary in some cases. There is no standard procedure to follow to predict the failure of drug treatment and determine whether a child will require surgery. For two years (January 1985 to December 1987), 111 infants and children (aged 1 month to 13.5 years; median 9.3 months) received 24 hours of esophageal pH monitoring after hospital admission for gastroesophageal reflux. Sixty-six patients had normal acidity (pH) and were given no added treatment, while 45 had abnormal pH profiles and increased reflux time. A barium swallow examination or esophagoscopy (X-ray of the esophagus) verified that 41 of the 45 patients had the reflux condition; the other 4 patients had different illnesses. Drug treatment cleared up reflux symptoms in 21 of the 41 reflux cases (51 percent), but symptoms persisted in 15 patients. Parental consent for surgical treatment was obtained in 12 cases and, in all cases, the surgery restored esophageal pH and eliminated reflux symptoms. The authors suggest the esophageal pH monitoring be the first method of investigation, followed by barium tests and esophagoscopy when an abnormal pH profile is recognized in the treatment of gastroesophageal reflux. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, Measurement, Hydrogen-ion concentration, pH measurement

Similar abstracts:

• Abstracts: Peritoneal blood painting: an aid in the diagnosis of endometriosis. A case of splenosis masquerading as endometriosis
• Abstracts: Differential diagnosis of acute meningitis: an analysis of the predictive value of initial observations. Evaluating and optimizing outcomes of surgery for endocarditis
• Abstracts: Hematogenous metastases to the stomach: a review of 67 cases. Bone metastases in hypernephroma: frequency of scapular involvement
• Abstracts: Helicobacter pylori and gastric carcinoma: serum antibody prevalence in populations with contrasting cancer risks
• Abstracts: Implication of human papillomavirus in postirradiation dysplasia. Smokeless tobacco use and oral epithelial dysplasia

This website is not affiliated with document authors or copyright owners. This page is provided for informational purposes only. Unintentional errors are possible.