Cases reported "Esophagitis, Peptic"

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1/151. Severe non-obstructive sleep disturbance as an initial presentation of gastroesophageal reflux disease.

    A 2.5-year-old child presented with a sleep disturbance initially diagnosed as a behavioral problem. The child had several atypical symptoms of gastroesophageal reflux disease (GERD). The sleep disturbance resolved quickly after treatment of GERD. GERD is a disease with protean manifestations which is becoming of greater interest to the pediatric otolaryngologist. We discuss diagnosis of this entity. ( info)

2/151. Esophagobronchial fistula following redo Nissen fundoplication.

    Gastrobronchial fistula is a rare complication of antireflux surgery, whereas esophagobronchial fistula as a complication of Nissen fundoplication has, to the best of our knowledge, not been reported previously. We report on a case of esophagobronchial fistula in a patient with left subphrenic abscess following redo Nissen fundoplication. Chest radiographs suggested an unresponsive pneumonia of the left lower lobe. Computed tomography (CT) of the abdomen showed partial consolidation of the left lower lobe and contrast filling of the left bronchial tree from a left subphrenic abscess. CT diagnosis of fistula originating from the region of fundoplication was confirmed by Gastrografin follow-through. ( info)

3/151. Symptom priority ranking in the care of gastroesophageal reflux: a review of 1,850 cases.

    BACKGROUND: Clinical history remains an important part of the medical evaluation of patients with gastroesophageal reflux disease (GERD). heartburn, regurgitation, and dysphagia are considered typical symptoms of GERD. Priority rankings of these symptoms can be determined with a standardized questionnaire. OBJECTIVE: To determine whether symptom priority ranking and symptom severity grading can provide useful information in the evaluation of patients with GERD. methods: From 1,850 patients that were analyzed retrospectively, patients with dysphagia unrelated to GERD were excluded. A standardized questionnaire was applied before each patient underwent any esophageal diagnostic study. Priority of symptoms was determined to be primary, secondary, tertiary, or none based on the patient response to the questionnaire. Presence of a stricture was determined either by endoscopy, esophagraphy, or both studies. Stationary esophageal manometry and 24-hour pH monitoring were performed on all patients. Through bivariate and multivariate analysis, the relationships among typical GERD symptoms, esophageal reflux-related stenosis, lower esophageal sphincter pressure, and composite score were established. RESULTS: High priority ranking of the symptom dysphagia is predictive of the presence of an esophageal stricture, but has a negative association with abnormal manometric and pH studies. In contrast, high priority ranking of the symptom heartburn and regurgitation are positively associated with abnormal manometric and pH results. CONCLUSIONS: Priority ranking can be a valuable adjunct to objective testing in the evaluation of GERD. In certain clinical situations it can obviate the need for 24-hour pH monitoring. ( info)

4/151. Treatment of reflux esophagitis resulting in massive esophageal bleeding.

    The complications that occur secondary to sliding hiatal hernia are reflux esophagitis with ulceration, stricture formation, and hemorrhage. We have treated seven patients for massive esophageal bleeding secondary to reflux esophagitis. All had endoscopic evidence of reflux esophagitis and a negative work-up for other sources of bleeding. All underwent Nissen fundoplication as the only mode of therapy for the bleeding esophagitis. No patient has bled again; healing of the esophagitis was evident six weeks after operation, as observed by gastrointestinal endoscopy. This operation prevents reflux, has minimal side-effects, and gives consistent results in the hands of the average trained gastrointestinal surgeon. ( info)

5/151. Complete dysphagia after thrombolytic treatment for myocardial infarction.

    An 82 year old man was admitted to hospital with unstable angina pectoris. There was a long history of minor symptoms suggesting reflux disease, with a small diaphragmatic hernia. One day after admission the patient complained of severe chest pain. An acute inferior-posterior myocardial infarction was diagnosed on ECG, and thrombolytic treatment with alteplase (rt-PA) was initiated. Within a few hours total dysphagia occurred, caused by haemorrhagic oesophagitis. The haematoma resolved spontaneously within about 10 days. The patient was discharged three weeks later after full resolution of the dysphagia. ( info)

6/151. An operation for the treatment of intractable peptic stricture of the esophagus.

    The current management of severe strictures of the esophagus resulting from reflux esophagitis is unsatisfactory. A new operation comprising esophagoplasty and intrathoracic fundoplication is described. This preliminary report records the results of this operation in 10 patients. There was one operative death. Of the nine survivors, followed for six months to three years, seven are completely free of symptoms. The remaining two have mild residual symptoms, but no dysphagia. ( info)

7/151. Esophageal inflammatory pseudotumor mimicking malignancy.

    A 54-year-old man with a complaint of dysphagia was found to have a prominent stricture in the proximal esophagus. A biopsy of the stenotic area indicated sarcoma, leading to subtotal esophagectomy. The surgically removed esophagus demonstrated a well-defined intramural mass, consisting of a mixture of fibroblastic cells with bland cytological appearances and inflammatory cells. Reflux esophagitis which was present distal to the stricture seemed to play a role in the development of this inflammatory pseudotumor. ( info)

8/151. esophageal perforation: a rare complication of zollinger-ellison syndrome.

    Spontaneous perforation of the esophagus is a rare manifestation of zollinger-ellison syndrome (ZES). Failure to recognize its existence can lead to an unsuccessful treatment of the esophageal perforation. We present a rare case of reflux esophagitis-induced esophageal perforation in a patient with ZES. Presence of a gastrinoma should be considered when recurrent or complicated reflux esophagitis is encountered. ( info)

9/151. adenocarcinoma in a Barrett oesophagus.

    A case of adenocarcinoma developing at the squamocolumnar epithelial junction of a Barrett oesophagus is reported. This rare tumour was remarkable because of the youth of the patient and because of the signet-cell cytological pattern of the neoplasm. It is postulated that both the columnar epithelial lining of the lower part of the oesophagus and the malignant change are a consequence of long-standing oesophageal reflux. ( info)

10/151. Reflux complaints, symptom score and the use of medication in patients with reflux esophagitis: results of a long term follow-up study.

    Reflux esophagitis requires maintenance treatment. A cross-sectional descriptive study was done to assess the use of medication and prevalence of complaints in patients with esophagitis more than 4.5 years after diagnosis. All patients diagnosed with reflux esophagitis in 1995 received a questionnaire on reflux complaints and use of medication. A symptom score was assessed. esophagitis was diagnosed in 173 patients; the questionnaire was sent to 130 patients, of whom 95 (74%) responded. Four groups of responders were identified: patients in clinical remission with (group 1, n=18) or without (group 2, n=20) maintenance therapy, and patients suffering from reflux complaints with (group 3, n=48) or without (group 4, n=9) medication. There was no statistically significant difference with respect to initial severity of esophagitis. Seventeen patients (94%) from group 1 and 32 patients (67%) from group 3 used medication on a daily basis (P=0.04). The mean symptom score /- SD, on a scale ranging from 0 to 80, was 7.8 /-5.3 in group 3 patients and 8.6 /-8.6 in group 4 patients (not significant). patients in group 3 had a higher prevalence of retrosternal pain and nocturnal heartburn. It is concluded that most patients still use acid suppressive therapy more than 4.5 years after diagnosis. Only a small number are in clinical remission, although the symptom score is rather low. ( info)
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