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  • 1
    Electronic Resource
    Electronic Resource
    A proposition for the diagnosis and treatment of gastro-oesophageal reflux disease in children: A report from a working group on gastro-oesophageal reflux disease (1993)
    Springer
    European journal of pediatrics 152 (1993), S. 704-711 
    Details
    ISSN: 1432-1076
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract In this paper, a Working Group on Gastro-Oesophageal Reflux discusses recommendations for the first line diagnostic and therapeutic approach of gastro-oesophageal reflux disease in infants and children. All members of the Working Group agreed that infants with uncomplicated gastro-oesophageal reflux can be safely treated before performing (expensive and often unnecessary) complementary investigations. However, the latter are mandatory if symptoms persist despite appropriate treatment. Oesophageal pH monitoring of long duration (18–24 h) is recommended as the investigation technique of choice in infants and children with atypical presentations of gastro-oesophageal reflux. Upper gastro-intestinal endoscopy in a specialised centre is the technique of choice in infants and children presenting with symptoms suggestive of peptic oesophagitis. Prokinetics, still a relatively new drug family, have already obtained a definitive place in the treatment of gastro-oesophageal reflux disease in infants and children, especially if “non-drug” treatment (positional therapy, dietary recommendations, etc.) was unsuccessful. It was the aim of the Working Group to help the paediatrician with this consensus statement and guide-lines to establish a standardised management of gastro-oesophageal reflux disease in infants and children.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01953980
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  • 2
    Electronic Resource
    Electronic Resource
    Disorders of oesophageal motility in children with psychomotor retardation and gastro-oesophageal reflux (1991)
    Springer
    European journal of pediatrics 150 (1991), S. 638-641 
    Details
    ISSN: 1432-1076
    Keywords: Oesophageal motility ; Gastro-oesophageal reflux
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A group of 25 children affected by different degrees of psychomotor retardation (severe (n=13); mild-moderate (n=12)) and symptoms suggesting gastro-oesophageal reflux (GOR) underwent oesophageal manometry and oesophageal pH monitoring. Of these patients, 21 (84%) were affected by GOR. In all children with severe brain damage and GOR (12/13), oesophageal manometry showed marked motility abnormalities that persisted after cure of GOR. In patients with minor retardation and GOR (9/12), oesophageal manometry showed normal motility or a less severe degree of oesophageal motor dysfunction which improved after curing the GOR. These results suggest that oesophageal motor dysfunction is a frequent occurrence in children affected by severe psychomotor retardation and GOR.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02072624
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  • 3
    Electronic Resource
    Electronic Resource
    A critical appraisal of current management practices for infant regurgitation – recommendations of a working party (1997)
    Springer
    European journal of pediatrics 156 (1997), S. 343-357 
    Details
    ISSN: 1432-1076
    Keywords: Key words Regurgitation  ;  Vomiting  ;  Gastro-oesophageal reflux  ;  Infant  ;  Treatment
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Regurgitation is a common manifestation in infants below the age of 1 year and a frequent reason of counselling of general practitioners and paediatricians. Current management starts with postural and dietary measures, followed by antacids and prokinetics. Recent issues such as an increased risk of sudden infant death in the prone sleeping position and persistent occult gastro-oesophageal reflux in a subset of infants receiving milk thickeners or thickened “anti-regurgitation formula” challenge the established approach. Therefore, the clinical practices for management of infant regurgitation have been critically evaluated with respect to their efficacy, safety and practical implications. The updated recommendations reached by the working party on the management of infant regurgitation contain five phases: (1A) parental reassurance; (1B) milk-thick ening agents; (2) prokinetics; (3) positional therapy as an adjuvant therapy; (4A) H2-blockers; (4B) proton pump inhibitors; (5) surgery.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004310050613
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  • 4
    Electronic Resource
    Electronic Resource
    Domperidone is more effective than cisapride in children with diabetic gastroparesis (2002)
    Oxford UK : Blackwell Science Ltd
    Alimentary pharmacology & therapeutics 16 (2002), S. 0 
    Details
    ISSN: 1365-2036
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Disorders of gastrointestinal motility are commonly detected in patients with insulin-dependent diabetes mellitus and are associated with significant morbidity. They contribute to poor metabolic control of diabetes.〈section xml:id="abs1-2"〉〈title type="main"〉Aim:To assess the effect of an 8-week course of domperidone or cisapride on gastric electrical activity, gastric emptying time and dyspeptic symptoms in children with insulin-dependent diabetes mellitus and gastroparesis.〈section xml:id="abs1-3"〉〈title type="main"〉Methods:Dyspeptic symptoms were assessed by a score system, gastric emptying time was measured by ultrasonography and gastric electrical activity was obtained by electrogastrography. Fourteen children received domperidone and 14 received cisapride. The median (range) ages were 11.6 years (5–15 years) and 12 years (6–16.9 years), respectively. Symptom assessment, ultrasonography and electrogastrography were repeated at the end of the trial. Fasting and fed (180 min after feeding) glycaemia and haemoglobin A, C (HbA1c) levels were also measured.〈section xml:id="abs1-4"〉〈title type="main"〉Results:At the end of the trial both groups showed a significant decrease in symptomatic score; however, the score was markedly lower in the domperidone group than in the cisapride group (P 〈 0.01). Domperidone was significantly more effective than cisapride in reducing the gastric emptying time (P 〈 0.05), normalizing gastric electrical activity (P 〈 0.05) and decreasing the prevalence of episodes of gastric dysrhythmia (P 〈 0.01). Domperidone was also more effective than cisapride in improving diabetic metabolic control. No potentially drug-related adverse effects occurred.〈section xml:id="abs1-5"〉〈title type="main"〉Conclusions:In children with insulin-dependent diabetes mellitus complicated by dyspeptic symptoms and gastroparesis, domperidone is superior to cisapride in reversing gastric emptying delay and gastric electrical abnormalities, as well as in improving dyspeptic symptoms and diabetic metabolic control.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1365-2036.2002.01240.x
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  • 5
    Electronic Resource
    Electronic Resource
    Azathioprine in paediatric inflammatory bowel disease: an Italian multicentre survey (2002)
    Oxford, UK : Blackwell Science Ltd
    Alimentary pharmacology & therapeutics 16 (2002), S. 0 
    Details
    ISSN: 1365-2036
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Aim : To assess the efficacy and safety of azathioprine in a paediatric population with inflammatory bowel disease.Patients and methods : One hundred and twenty-three Italian children treated with azathioprine were studied retrospectively. The treatment duration and causes of its discontinuation, side-effects and variation in corticosteroid dose were assessed.Results : The mean age at inflammatory bowel disease diagnosis was 9.8 ± 3.6 years, and at the start of azathioprine therapy 11.8 ± 4.3 years. The mean duration of treatment was 19 ± 16 months. Fifty patients (41%) stopped treatment due to surgery (12%), prolonged remission (11%), non-response (7%), severe side-effects (7%) and poor compliance (3%). Of the 73 patients (59%) remaining on azathioprine, 11 had never been treated with corticosteroids, 27 were able to stop them and 35 were still on a very low daily dose (91% 〈 0.3 mg/kg). The difference in the daily corticosteroid dose between the beginning of azathioprine treatment (1 ± 0.6 mg/kg) and the conclusion of the study (0.18 ± 0.16 mg/kg) was statistically significant. Side-effects were recorded in 48 of the 123 patients (39%), but only eight required discontinuation of azathioprine.Conclusions : Azathioprine was efficacious in 70% of patients, but ineffective in 20% and induced severe toxicity in 7%. Corticosteroids were stopped or markedly reduced in 62% of patients, but they were never given in 9%.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1365-2036.2002.01269.x
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  • 6
    Electronic Resource
    Electronic Resource
    The use of ciclosporin in paediatric inflammatory bowel disease: an Italian experience (2002)
    Oxford, UK : Blackwell Science Ltd
    Alimentary pharmacology & therapeutics 16 (2002), S. 0 
    Details
    ISSN: 1365-2036
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Aim : To asses the efficacy and safety of ciclosporin in a paediatric population with inflammatory bowel disease.Patients and methods : Twenty-three Italian children treated with ciclosporin were studied retrospectively. The indications for treatment were severe unresponsive colitis, chronic active colitis or severe fistulizing Crohn's disease. The treatment duration, follow-up and causes of drug discontinuation were assessed.Results : Sixteen patients were treated intravenously for a mean time of 10 ± 7 days (1–24 days) and 19 orally for a mean time of 133 days (17–660 days). The mean follow-up of all patients was 13.2 months. Ciclosporin was totally ineffective, being discontinued for surgery, in nine of 23 patients (39%); it was discontinued for partial response in three patients (13%). During treatment, clinical remission was achieved in eight children (35%) and maintained after drug withdrawal in four (17%). In severe unresponsive colitis, urgent colectomy was avoided in 12 (85%) of 14 patients who tolerated the drug. Side-effects appeared in six of 23 patients (26%), and three (13%) required ciclosporin to be discontinued due to neurotoxicity.Conclusions : Ciclosporin shows disappointing long-term results in the treatment of refractory inflammatory bowel disease, but can play an important role in preventing urgent surgery in unresponsive severe colitis. Severe side-effects can occur.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1365-2036.2002.01308.x
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  • 7
    Electronic Resource
    Electronic Resource
    Laparoscopic esophagomyotomy for the treatment of achalasia in children (2000)
    Springer
    Surgical endoscopy and other interventional techniques 14 (2000), S. 110-113 
    Details
    ISSN: 1432-2218
    Keywords: Key words: Esophagomyotomy — Achalasia — Children — Laparoscopy — Esophagus
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Albeit rare in children, achalasia is a disorder with severe symptoms that causes growth impairment. The treatment of choice in children is the esophagomyotomy, although there are variations in the surgical approaches available and differences of opinion regarding the inclusion of an adjunctive antireflux procedure. The recent advent of the laparoscopic approach has had a profound impact on the treatment of achalasia in both adults and children. Methods: In this report, we describe eight patients with severe achalasia who were treated by laparoscopic Heller's operation associated with a fundoplication according to either Dor's or Toupet's technique. The patients' ages ranged between 2 and 13 years. A five-port technique was used: a 10-mm port placed infraumbilically for the optics and four 5-mm ports. One was placed in the right abdominal quadrant for retraction of the left hepatic lobe, one in the left abdominal quadrant for the first operative instrument, one below the xyphoid appendix for the second operative instrument, and the last one to introduce a 5-mm cannula laterally to the umbilicus to retract the stomach below. A 7–8-cm laparoscopic Heller esophagomyotomy was completed, followed by an anterior Dor fundoplication in six cases and a Toupet in two. The longitudinal division of the anterior esophageal musculature was performed with a scalpel or scissors. The myotomy was made along the stomach, extending for ≥2–3 cm. Results: Mean operating time was 120 mins. Three complications were recorded. There were two perforations of the gastroesophageal mucosa; the first was sutured in laparoscopy and the second required a second operation. The third complication was a case of dysphagia resolved by dismounting a fundoplication that was too tight. At follow-up, which lasted from 6 months to 5 years, the children were all free of symptoms. Conclusions: Laparoscopic Heller esophagomyotomy appears to be a complex and difficult operation, but it is as safe and effective as laparotomy in children with achalasia. However, complications can be numerous and severe at the beginning of a surgeon's experience.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004640000077
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  • 8
    Electronic Resource
    Electronic Resource
    Epicardial oesophageal duplication with hiatal hernia in a case of Turner's syndrome (1983)
    Springer
    Pediatric radiology 13 (1983), S. 342-343 
    Details
    ISSN: 1432-1998
    Keywords: Oesophageal duplication ; Hiatal hernia ; Turner's syndrome ; Gastro-oesophageal reflux
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The authors of this paper report the first case of epicardial oesophageal duplication causing hiatal hernia in a patient afflicted with Turner's syndrome, and they discuss its possible etiology.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01625963
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  • 9
    Electronic Resource
    Electronic Resource
    Case Report: Primary Sclerosing Cholangitis Preceding Crohn's Disease in a Child with Down's Syndrome (1998)
    Springer
    Digestive diseases and sciences 43 (1998), S. 166-169 
    Details
    ISSN: 1573-2568
    Keywords: PRIMARY SCLEROSING CHOLANGITIS ; CROHN'S DISEASE ; DOWN'S SYNDROME
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1018800826608
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  • 10
    Electronic Resource
    Electronic Resource
    Effects of Omeprazole on Mechanisms of Gastroesophageal Reflux in Childhood (1997)
    Springer
    Digestive diseases and sciences 42 (1997), S. 293-299 
    Details
    ISSN: 1573-2568
    Keywords: GASTROESOPHAGEAL REFLUX ; ESOPHAGITIS ; LOWER ESOPHAGEAL SPHINCTER ; TRANSIENT RELAXATION
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Prolonged recordings of esophageal motility haveshown that dynamic changes of lower esophageal sphincter(LES) pressure such as transient LES relaxation and LESpressure drifts are the most common mechanisms underlying gastroesophageal reflux (GER). Thecoexistence of a delayed gastric emptying has also beenreported in a high proportion of patients with refluxdisease. However, not much information is available on the effects of antireflux therapy on thepathogenetic mechanisms of GER. The purpose of thisstudy was to determine in a group of children withsevere reflux disease the effect of omeprazole therapy on motor changes of LES underlying GER as wellas on gastric emptying time. Twenty-two children (medianage: 6.6 years) with GER disease, refractory to combinedranitidine and cisapride administration, entered into an eight-week omeprazole course.Ten subjects with moderate GER disease served ascontrols (median age: 6.0 years). Before and afteromeprazole administration, the following variables were assessed: esophagitis grading, fasting and fedsimultaneous prolonged recording of distal esophagealsphincter pressure (with a sleeve catheter) andintraesophageal pH, LES and esophageal peristalsisamplitude, and gastric emptying time of a mixedsolid-liquid meal (measured with gastric ultrasound). Ascompared to controls, patients showed a higher rate oftransient LES relaxation and LES pressure drift (P 〈0.01), a reduced amplitude of basal sphincter pressure(P 〈 0.01) and peristalsis (P 〈 0.05), and a moreprolonged gastric emptying time (P 〈 0.05). Afterending omeprazole, there was no significant change inany of the motor abnormalities of the esophagus and ingastric emptying time despite a marked improvement ofsymptoms and esophagitis in all patients. Sixteenpatients were symptomatic when reevaluated on a clinical basis two months after ending therapy. Weconclude that in children with severe GER disease, anabnormally high rate of both transient LES relaxationand LES pressure drift and slow gastric emptying are not affected by omperazole treatment, eventhough esophageal mucosal damage is markedly improved orcured. These abnormalities represent a primary motordisorder and can be implicated in the refractoriness of reflux disease.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1018853516206
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