A comparison between gastroesophagheal ultrasonography vs. barium swallow in determining the pattern of gastroesophageal reflux in a pediatric population

Background: Gastroesophageal reflux disease (GERD) is one of the most common gastrointestinal pathology in infants and young children. Ultrasonography (US) has been considered to be a reliable diagnostic tool for GERD but the severity of GERD and the clinical implications based on imaging findings has not been evaluated. Aims: To compare the diagnostic value of lower esophageal US with that of barium swallow in demonstrating the severity of GERD. Materials and methods: Fifty one pediatric patients, age between 1 month to 12 years, 34 male and 17 female with clinical suspicion of GERD were included. The patients were initially submitted to barium swallow (BS) and subsequently to transabdominal US. During BS, the number of gastroesophageal reflux episodes was documented in a 5-minute period. Transabdominal US documented the number and duration of reflux episodes during a 5-minute period, the angle of His, mucosal thickness, and intraabdominal esophageal length (IAEL). Results: Duration and number of reflux episodes in US were significantly higher in patients that had severe gastroesophageal refluxes at BS. At US the cutoff point of 9.5 seconds (sensitivity 80, specificity 60) for reflux duration and more than 2 episodes in 5 minute ultrasound study (sensitivity 75, specificity 58) were defined to correlate with severe gastroesophageal reflux at BS.The angle of His, the esophageal wall mucosal thickness, and the IAEL did not correlate with the severity of GERD detected in BS. Conclusion: US can predict the severity of GERD. Therefore, except in the case of specific patients in whom mechanical causes are suspected to be responsible for GERD, BS can be replaced by US

Barrett's esophagus: clinical features, obesity, and imaging

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/87127/1/j.1749-6632.2011.06044.x.pd

Prevalence of gastroesophageal reflux disease in patient with voice disorders

INTRODUCTION: Acid reflux is a common problem in 4-10% of patients coming to ENT out patient departments. A recent study of voice and reflux disorders revealed that 55% - 60% patients had laryngopharyngeal reflux.1 Anti-reflux therapy is usually used as an empirical treatment for patients with hoarseness, where no other cause has been identified by examination. Gastro-esophageal reflux disease (often abbreviated to GERD or GORD) is defined as the retrograde flow of gastric contents into the oesophagus or above. Gastro-esophageal reflux disease is characterized by symptoms and/or signs of mucosal injury of the oesophagus or upper aerodigestive tract secondary to this reflux. AIM OF THE STUDY: To determine the prevalence of gastro-esophageal reflux disease in patients with voice disorders. OBJECTIVES: 1. To determine the prevalence of gastro esophageal reflux disease (GERD) in patients with voice disorders. 2. To determine prevalence of laryngopharyngeal reflux (LPR) in patients with gastro-esophageal reflux disease by validating the following, in patients with gastro-esophageal disease: Kaufmann Reflux Symptom Index, Reflux Finding Score MATERIAL AND METHODS: Study Design: This was a prospective, descriptive cross sectional study. Subjects: The study patients were those who attended the ENT Out Patient Clinics of Christian Medical College & Hospital with history of change in voice for more than three weeks. Inclusion criteria: More than 18 years of age, Any gender. Exclusion Criteria: Laryngeal papillomatosis, Carcinoma larynx, Vocal cord palsy, Hypothyroidism, Neurological deficits causing change in voice, Have received proton pump inhibitors, Received H2 receptor antagonists, Receiving calcium channel blockers, Receiving anti dopminergic drugs like domperidone, Receiving α and β blockers, Allergic to any anesthetic agent, Chronic pulmonary disease, asthma, Heart disease, Scleroderma, Pregnancy. CONCLUSION: 1. The prevalence of gastro-esophageal reflux disease (GERD) in our patients with voice disorder was 36.7%. 2. There was no significant statistical co-relation between Koufman Reflux Symptom Index, Laryngopharyngeal reflux and GERD. 3. There appears to be some co-relation between Reflux Finding Score, Laryngopharyngeal reflux and GERD (p value- 0.063). Further evaluation including increase in the sample size may provide significant results. 4. Unlike other studies, GERD in voice disorder patients was predominant in males in our study. 5. Voice disorder in level II voice user was due to voice overuse and in level III & IV voice user were probably due to GERD. 6. There was no statistical co-relation between GERD, voice disorder, smoking and alcohol in our study

A Controversy That Has Been Tough to Swallow: Is the Treatment of Achalasia Now Digested?

Esophageal achalasia is a rare neurodegenerative disease of the esophagus and the lower esophageal sphincter that presents within a spectrum of disease severity related to progressive pathological changes, most commonly resulting in dysphagia. The pathophysiology of achalasia is still incompletely understood, but recent evidence suggests that degeneration of the postganglionic inhibitory nerves of the myenteric plexus could be due to an infectious or autoimmune mechanism, and nitric oxide is the neurotransmitter affected. Current treatment of achalasia is directed at palliation of symptoms. Therapies include pharmacological therapy, endoscopic injection of botulinum toxin, endoscopic dilation, and surgery. Until the late 1980s, endoscopic dilation was the first line of therapy. The advent of safe and effective minimally invasive surgical techniques in the early 1990s paved the way for the introduction of laparoscopic myotomy. This review will discuss the most up-to-date information regarding the pathophysiology, diagnosis, and treatment of achalasia, including a historical perspective. The laparoscopic Heller myotomy with partial fundoplication performed at an experienced center is currently the first line of therapy because it offers a low complication rate, the most durable symptom relief, and the lowest incidence of postoperative gastroesophageal reflux

Gastroesophageal Reflux Disease.

Gastroesophageal reflux (GER) is a normal physiologic process. It is important to distinguish GER from GER disease (GERD) since GER does not require treatment. Although a diagnosis of GERD can largely be based on history and physical alone, endoscopy and pH impedance studies can help make the diagnosis when there in atypical presentation. In children and adolescents, lifestyle changes and acid suppression are first-line treatments for GERD. In infants, acid suppression is not effective, but a trial of hydrolyzed formula can be considered, as milk protein sensitivity can be difficult to differentiate from GER symptoms