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Gastroesophageal Reflux Disease II: Clinical Features and Management01:29

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Gastroesophageal reflux disease, or GERD, is a persistent medical condition that affects many individuals worldwide. Its clinical manifestations can vary greatly, making diagnosis and management challenging for healthcare professionals. The following is a comprehensive overview of the clinical manifestations, assessment, and management strategies for GERD.
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Patients with esophageal strictures often experience a range of symptoms. Initially, they may have difficulty swallowing solid foods, which can progress to include liquids. Additional symptoms may involve chest pain or discomfort, regurgitating food and fluids, heartburn, unintentional weight loss, coughing or choking during meals, and hoarseness.
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Gastroesophageal Reflux Disease (GERD) involves the recurrent backflow of the stomach or duodenal contents into the esophagus, leading to troublesome symptoms and potential esophageal mucosal damage. Although GERD is often referred to as a disease, it is more accurately described as a syndrome, as it encompasses a range of symptoms and complications rather than a singular pathological entity, impacting a large number of individuals as the most prevalent upper gastrointestinal problem. Roughly...
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Pediatric rumination subtypes: A study using high-resolution esophageal manometry with impedance.

R Rosen1, L Rodriguez1, S Nurko1

  • 1Center for Motility and Functional Gastrointestinal Disorders, Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA, USA.

Neurogastroenterology and Motility
|December 22, 2016
PubMed
Summary

High-resolution esophageal manometry with impedance (HRM-MII) accurately diagnoses pediatric rumination, a condition often mistaken for reflux. This study identifies three primary rumination subtypes, aiding in diagnosis and potential treatment strategies.

Keywords:
high-resolution esophageal manometryimpedancepediatricsrumination

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Area of Science:

  • Pediatric Gastroenterology
  • Diagnostic Technologies
  • Functional Gastrointestinal Disorders

Background:

  • Rumination syndrome is a differential diagnosis for intractable pediatric reflux.
  • Traditional antroduodenal manometry for diagnosis is invasive, costly, and requires anesthesia.
  • High-resolution esophageal manometry with impedance (HRM-MII) offers a less invasive alternative.

Purpose of the Study:

  • To validate HRM-MII as a diagnostic tool for pediatric rumination.
  • To describe and classify subtypes of pediatric rumination.

Main Methods:

  • Retrospective review of HRM-MII tracings from 21 children with suspected rumination.
  • Analysis of intraluminal esophageal pressures, gastric and thoracic pressures, and R wave timing relative to LES relaxations and bolus flow.
  • Statistical comparison of proportions and means.

Main Results:

  • 3 types of primary rumination identified: LES relaxation without retrograde flow (51%), LES relaxation after R wave (20%), and R waves with no LES relaxation (29%).
  • 41 primary and 33 secondary rumination episodes observed.
  • 60% of rumination episodes occurred during standard HRM-MII.

Conclusions:

  • HRM-MII is an accurate method for diagnosing rumination in children.
  • Identification of three primary rumination subtypes may inform therapeutic approaches.