phenylephrine-hydrochloride and Gastroesophageal-Reflux

For three decades, ambulatory 24-hour intranasal pH monitoring has been the established gold standard for detecting acid reflux in patients with refractory gastroesophageal reflux disease. However, device-associated adverse events and unpleasant experiences, reported by patients during pH monitoring have led to the invention of more convenient pH monitors such as Bravo wireless capsule. To compare the interference with daily activities and major adverse events during pH monitoring with Bravo wireless capsule (Bravo) versus conventional intranasal catheter (catheter), PubMed, Cochrane Library, Clinical Trials.gov, and Google Scholar were searched up to March 20, 2015. Only randomized controlled trials in adult patients that compared the interference with routine daily activities and adverse events between Bravo and catheter pH monitors were included. After screening 574 articles, three unique studies with 167 patients met our inclusion criteria. The average age of patients enrolled in these studies was 51 years. Interference with normal daily activities was more in the catheter than Bravo group: 75 ± 5 versus 92 ± 2, P < 0.001 (Andrews et al, findings were reported as100 mm, mean visual analogue scale (VAS) ± standard error of the mean, 100 = completely normal); Wong et al. (mean ± standard error of the mean): 1.3 ± 0.2 versus 0.32 ± 0.1, P = 0.001 and Wenner et al. using 10 cm median VAS (Interquartile range),10 been the worst is 5.7 (2.3-8.0) compared to 0.7 (0.2-3.4), P < 0.0001, respectively. Overall adverse events were more in the catheter group than Bravo (39 ± 4 vs. 26 ± 4, P = 0.012 for Andrews et al. (100 been the worst) and 5.1 (2.0-6.6) vs. 2.1 (0.5-4.6), P < 0.001 for Wenner et al.). No overall adverse events recorded for Wong et al. Most patients in catheter group complained of nasal and throat symptoms. Significantly, runny nose in 24 out of 25 patients (96%) catheter versus 13 out of 25 (52%) Bravo, P = 0.001 and nose pain 15 out 25 (60%) versus 8 out of 25 patients (32%), P = 0.047, respectively for Wong et al. Andrews and Wenner et al also showed profound nasal discomforts in catheter group compared to Bravo (39 ± 3 vs. 10 ± 3, P < 0.001 and 6.5 (1.5-8.0) versus 0.2 (0.0-1.9), P < 0.0001, respectively. Throat symptoms reported in Wong et al. were mainly throat discomfort in catheter group 23 out of 25 patients (92%) versus Bravo 12 out of 25 (48%), P = 0.001 and throat pain catheter (12 out of 25 patients (48%) vs. Bravo 4 out of 25 (16%))

Topics: Activities of Daily Living; Adult; Capsule Endoscopy; Catheters; Chest Pain; Equipment Design; Esophageal pH Monitoring; Esophagoscopy; Female; Gastroesophageal Reflux; Humans; Male; Nose; Pharyngitis; Randomized Controlled Trials as Topic

Nasal obstruction is often multifactorial and knowledge of the contributing factors is critical to appropriate evaluation, diagnosis, and execution of a treatment plan. Recognizing and appropriately managing all components of nasal obstruction will increase the likelihood of symptomatic improvement and patient satisfaction.

Topics: Gastroesophageal Reflux; Nasal Obstruction; Nose; Rhinitis; Sensation Disorders; Smoking

Most studies agree that post-nasal drip syndrome (PNDS), asthma, gastroesophageal reflux disease (GORD), and laryngopharyngeal reflux (LPR) are the commonest causes of chronic cough in the immunocompetent, non-smoking patient who is not taking an angiotensin-converting enzyme inhibitor. No diagnostic test has been found to define those who are said to have PNDS other than a response to a first-generation antihistamine. Examining the available evidence suggests that mechanical stimulation of the pharynx by mucus is not an adequate theory for the production of cough. Inflammatory mediators in the lower airways are raised in PNDS, cough variant asthma and GORD, and the theory that an inflammatory process is affecting 'one airway' is a plausible one. Nasal disease is more likely to result in cough from the co-existing involvement of the lower airways through an as yet undefined pathway, and eosinophil and mast cell mediation appear a likely mechanism.

Topics: Angiotensin-Converting Enzyme Inhibitors; Asthma; Bronchitis, Chronic; Chronic Disease; Cough; Eosinophilia; Esophagitis, Peptic; Gastroesophageal Reflux; Humans; Mucus; Nose; Syndrome

This article reviews problems associated with sedated endoscopy, and describes the rationale for unsedated endoscopy as an alternative. Costs, tolerability, potential for complications, and general patient and physician acceptance for unsedated endoscopy are reviewed. A new technique, the transnasal esophagogastroduodenoscopy (the Shaker technique), is described.

Topics: Conscious Sedation; Endoscopy, Digestive System; Gastroesophageal Reflux; Humans; Nose; Patient Satisfaction

Because neonates are obligate nose breathers, neonatal nasal obstruction may have serious consequences. Prompt diagnosis and appropriate treatment are essential to avoid severe hypoxia. The most common cause of neonatal nasal obstruction is rhinitis. However, it is essential to first rule out anatomical causes such as choanal atresia and stenosis, pyriform aperture stenosis, traumatic deformation or tumors, as these conditions may be life-threatening and require prompt surgical treatment.

Topics: Choanal Atresia; Gastroesophageal Reflux; Humans; Hypoxia; Infant, Newborn; Nasal Obstruction; Nose; Rhinitis

The employment of a ventilator adds flexibility to the treatment of hypoventilation and hypoxia in the emergency department. Understanding the advantages of spontaneous respiration, the effects of positive pressure ventilation and the use of CMV, IMV, and PEEP allows for optimal care for emergency respiratory problems.

Topics: Anesthesia; Emergencies; Emergency Medical Services; Gastroesophageal Reflux; Humans; Hypoxia; Inhalation; Injections, Jet; Intubation, Intratracheal; Nose; Oxygen; Positive-Pressure Respiration; Posture; Respiration Disorders; Respiration, Artificial; Succinylcholine

Topics: Adult; Anesthesia, Endotracheal; Anesthesia, General; Anesthesiology; Anesthetics; Arrhythmias, Cardiac; Blood Transfusion; Bronchoscopy; Child; Gastroesophageal Reflux; Humans; Inhalation; Intubation, Intratracheal; Ketamine; Laryngeal Edema; Nose; Postoperative Complications; Time Factors; Tracheitis

Several studies have shown that the nose-earlobe-xiphoid distance (NEX) is inadequate to estimate the insertion length of nasogastric tubes. An alternative approach tested in these studies, which leads to > 90% well-placed nasogastric tubes, used a corrected calculation of the NEX: (NEX × 0.38696) + 30.37. The primary aim of this study was to determine whether using the corrected NEX was more successful than the NEX in determining the insertion length. The secondary aim was to investigate the likelihood to successfully obtain gastric aspirate.. Adult patients in a general hospital (N = 215) needing a nasogastric tube were randomized to the control (NEX) or intervention group (corrected NEX). Tip positioning was verified using X-ray. Correct tip positioning was defined as between 3 and 10 cm under the lower esophageal sphincter (LES).. In >20% of all patients, both methods underestimated the required tube length for correct positioning. The NEX showed an overestimation (17.2%) of the insertion length (>10 cm under the LES) compared with the corrected NEX (4.8%). There was no difference (P = 0.938) between the 2 groups in obtaining gastric aspirate (55.6% vs 56%). However, correct tip positioning resulted in a fourfold increase of obtaining gastric aspirate.. Both methods resulted in a high risk of incorrectly placed tubes due to malposition of the tip near the LES or distal esophagus. This may increase the risk of reflux and pulmonary aspiration. Based on these results, the development of more reliable methods requires consideration.

Topics: Aged; Aged, 80 and over; Ear; Enteral Nutrition; Esophageal Sphincter, Lower; Esophagus; Female; Gastroesophageal Reflux; Gastrointestinal Contents; Hospitalization; Humans; Intubation, Gastrointestinal; Male; Middle Aged; Nose; Respiratory Aspiration; Xiphoid Bone

The stomach contents become hypertonic after a meal and provide esophageal refluxate that is both acidic and hypertonic. This study examined the symptomatic response to esophageal exposure to hypertonic and acidic solutions in patients with gastroesophageal reflux disease (GERD) and Barrett's esophagus.. Symptom intensity and character were measured in double-blind fashion during esophageal instillation of water, hypertonic saline (osmolality 1030 mOsm/kg), hydrochloric acid (pH 1 and 2.5), and acidified hypertonic saline (pH 1 and 2.5). The studies were performed in healthy controls and GERD patients with and without Barrett's esophagus.. The GERD patients with Barrett's differed from the non-Barrett's GERD patients in being less sensitive to acid (mean intensity score, 2.3 vs 4.8, p < 0.05), more sensitive to hypertonic saline (1.3 vs 0.4, p < 0.05) and by showing an additive effect when the acid and hypertonic solutions were combined, resulting in similar scores in the two patient groups to the combination (4.4 vs 4.3). The frequency of nausea was higher in the Barrett's group compared to the other GERD patients after hypertonic saline (21% vs 0%, p < 0.05), acid (50% vs 21%, p < 0.05) and the acid hypertonic combination (71% vs 29%, p < 0.05).. Barrett's mucosa is associated with reduced symptomatic response to acid, increased response to hypertonic solutions, and a higher incidence of nausea in response to either stimulus.

Topics: Adult; Aged; Barrett Esophagus; Double-Blind Method; Esophagus; Gastroesophageal Reflux; Humans; Hydrochloric Acid; Hydrogen-Ion Concentration; Intubation; Middle Aged; Nose; Saline Solution, Hypertonic; Water

The objective of the study was to determine whether a naso-oesophageal probe modifies sleep and cardiorespiratory patterns in infants with repeated obstructive apnoeas. Two polygraphic recording sessions were conducted in random order for 2 nights on 35 infants suspected to have repeated obstructive sleep apnoeas. One sleep study was performed with a pH probe inserted through the nasal passage down to the distal portion of the oesophagus. The other session was conducted without any naso-oesophageal probe (the baseline study). For the 25 infants who presented repeated obstructive apnoeas during baseline studies, the presence of the probe was associated with a small, but significant, decrease in the number of central apnoeas (median frequency of 18.5 apnoeas per hour without a probe; 16.1 per hour with the probe; P=0.040), and obstructive apnoeas (median of 1.9 apnoeas per hour without a probe; 0.6 per hour with the probe; P=0.016). The presence of the probe was also associated with a small increase in percentage non-rapid eye movement (NREM) sleep frequency. The changes were statistically significant only for infants who had no obstructive apnoea during baseline studies (29 vs. 31%). The presence of a naso-oesophageal probe significantly modifies the infants' respiratory characteristics during sleep. These findings should be considered when reporting and interpreting sleep studies in infants.

Topics: Airway Obstruction; Electrocardiography; Electroencephalography; Electrooculography; Female; Gastroesophageal Reflux; Humans; Infant; Infant, Newborn; Male; Nose; Periodicity; Polysomnography; Random Allocation; Retrospective Studies; Sleep Apnea, Obstructive; Sleep, REM

Barrett's esophagus (BE) screening is currently not considered to be cost effective in the general population but may be effective in high-risk subgroups, such as 50-year-old white men with chronic reflux disease (GERD). A new modality for screening is unsedated transnasal endoscopy using endosheath technology (uTNE), which has been shown to be safe and effective in clinical practice. In this study, we determined the cost-utility of uTNE in a high-risk subgroup compared with no screening or screening with standard endoscopy.. A Markov model was used to simulate screening of 50-year-old white men with symptoms of GERD with either uTNE or standard endoscopy compared with no screening, over a lifetime horizon. Input variables were based on the literature and recent data on uTNE screening for BE. The study was designed from a healthcare payer perspective by using direct costs. Primary outcome measures were costs, quality-adjusted life years (QALYs), and the incremental cost-utility ratio (ICUR) of uTNE and standard endoscopy compared with no screening. Sensitivity analysis was performed for several factors, such as prevalence of BE.. Costs of uTNE, standard endoscopy, and no screening were estimated at, $2495, $2957, and $1436, respectively. Compared with no screening, uTNE screening resulted in an overall QALY increase of 0.039 (95% percentile 0.018; 0.063) and an ICUR of $29,446 per QALY gained (95% confidence interval [CI], 18.516-53.091), whereas standard endoscopy compared with no screening resulted in a QALY increase of 0.034 (95% CI, 0.015-0.056) and an ICUR of $47,563 (95% CI, 31,036-82,970).. Both uTNE and standard endoscopy seem to be cost-effective screening methods in a screening cohort of 50-year-old white men with GERD at a willingness-to-pay cutoff of $50,000.

Topics: Barrett Esophagus; Cost-Benefit Analysis; Esophagoscopy; Gastroesophageal Reflux; Health Care Costs; Humans; Male; Markov Chains; Mass Screening; Middle Aged; Monte Carlo Method; Nose; Quality-Adjusted Life Years; White People

As gastroesophageal reflux disease is a "disease of the XXI century", the relevance of its diagnosis at early stages is high. Using transnasal fibroesophagogastroduodenoscopy, which is significantly better tolerated by patients, and the technology of intelligent color coding of pathology of the mucous membrane FICE, can diagnose the earliest manifestations of GERD in the form of inflammatory noerosive changes in the mucous membrane of the distal esophagus, to evaluate the failure of the lower esophageal sphincter; to make a prognosis for the disease, and to formulate a rational policy of conducting the patient.

Topics: Color; Endoscopy, Digestive System; Esophagus; Female; Gastroesophageal Reflux; Humans; Image Interpretation, Computer-Assisted; Male; Mucous Membrane; Nose; Patient Satisfaction

To prospectively calculate and validate a conversion factor in healthy volunteers that allows accurate nonsedated, transoral (TO) Bravo capsule placement after transnasal (TN) manometry, and to evaluate the ease and safety of nonendoscopic Bravo placement compared with endoscopic placement.. Part 1. Twenty-five healthy volunteers underwent sequential TN and TO esophageal manometry to measure the distance to the lower esophageal sphincter (LES). A TN to TO conversion factor was calculated from these measurements. Part 2. Twenty volunteers underwent TN manometry followed by unsedated TO Bravo capsule placement using the conversion factor calculated in part 1. TN endoscopy then measured the location of the Bravo capsule in relationship to the squamocolumnar junction (SCJ). Part 3. During an 18-month period, 370 consecutive patients referred for a Bravo procedure underwent nonendoscopic, unsedated TO placement (308 patients) or standard endoscopically assisted placement (62 patients).. Part 1. All 25 volunteers completed TN and TO manometry; a conversion factor of 4 cm was calculated. Part 2. Using the calculated conversion factor of 4 cm, a Bravo capsule was deployed TO 5 cm above the proximal border of the LES. The mean +/- standard deviation (SD) TN endoscopic distance to the capsule was 6.0 cm (+/-0.3 cm) above the SCJ. Part 3. A total of 333 patients completed the entire study (90%). Analysis of 48-h pH measurements did not reveal any significant differences between the two groups.. A reliable and valid conversion factor of 4 cm following TN manometry permits accurate TO placement of the Bravo capsule without endoscopy. TO, unsedated Bravo placement is safe, well tolerated, and may minimize costs and potential risks associated with endoscopy.

Topics: Adolescent; Adult; Capsule Endoscopy; Chi-Square Distribution; Esophageal pH Monitoring; Female; Gastroesophageal Reflux; Humans; Linear Models; Male; Manometry; Middle Aged; Monitoring, Ambulatory; Nose; Prospective Studies

The purpose of this study was to elucidate whether misdirected swallowing is an extra-laryngeal cause of hoarseness and investigate whether the prevalence of misdirected swallowing and hoarseness in patients with hiatal hernias differ from those with and without pathological gastroesophageal reflux (GER). One hundred and ninety eight patients with hiatal hernias diagnosed via esophageal manometry and pH-reflux test and 262 subjects in the general population who did not have a hiatal hernia at endoscopy, filled in a questionnaire about symptoms on hoarseness, misdirected swallowing, and heartburn. Hoarseness (35%), misdirected swallowing to the larynx (MSL; 35%), misdirected swallowing to the nose (MSN; 22%) and heartburn (85%) were significantly more common in patients with hiatal hernia than in controls (13, 5, 1, and 6%, respectively, P<0.001). MSL and MSN in the patient group were significantly interrelated (P<0.0001). Hoarseness and MSL were not significantly associated (P<0.076). Hoarseness and MSL were as common in the hernia group with normal GER, as in the group with pathological GER. There is a predisposition for hoarseness and MSL in patients with hiatal hernias, but the cause-and-effect relationship is unclear. Hoarseness does not seem to be caused by pathological GER.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Case-Control Studies; Deglutition Disorders; Female; Gastroesophageal Reflux; Hernia, Hiatal; Hoarseness; Humans; Larynx; Male; Middle Aged; Nose; Prevalence

The aim of the study was to evaluate the safety, feasibility, and efficacy of transnasal placement of the Medtronic Bravo capsule for wireless esophageal pH monitoring.. Forty patients with symptomatic gastroesophageal reflux disease were prospectively evaluated. All patients underwent upper gastrointestinal endoscopy and esophageal manometry. The Bravo capsule was then introduced transnasally and released 5 cm above the upper margin of the lower esophageal sphincter. Serial radiographs were performed weekly until capsule release.. Of the 40 patients who were evaluated, 38 (95 %) were eligible to undergo the procedure. Transnasal placement proved impossible in one patient (2.5 %). Overall, a total of 39 procedures were performed in 38 patients (the procedure was repeated in one patient because of accidental intragastric fixation). Esophageal placement was successful in 36/39 procedures (92.3 %). The mean duration of the procedure was 10 minutes (range 5 - 16 minutes). Adverse events were noted in five of the 39 procedures (12.8 %), mild epistaxis in two patients (5.1 %) and pharyngeal irritation in three patients (7.7 %). After the procedure, a slight "foreign body" sensation was reported by 20 of the 36 patients (55.5 %) who had undergone successful esophageal placement; two patients (5.5 %) experienced severe retrosternal pain necessitating endoscopic removal of the capsule. At the end of the study, 34 of the 38 patients (89.5 %) stated that they would be willing to undergo the test again if necessary.. Transnasal placement of the Bravo pH capsule is safe, well tolerated, does not require sedation, and avoids endoscopy and its complications.

Topics: Adult; Aged; Capsule Endoscopes; Equipment Design; Esophageal pH Monitoring; Esophagoscopy; Feasibility Studies; Female; Gastroesophageal Reflux; Humans; Male; Manometry; Middle Aged; Nose

Transnasal esophagoscopy (TNE) reveals a wide range of esophageal findings. TNE technique, indications, outcomes, advantages, limitations, and impact on patient care are described.. Retrospective chart review.. Charts of the first 30 patients to undergo TNE in an academic otolaryngology practice were reviewed. Technique details, patient demographics, and procedure indications and findings as well as the disposition of patients in this series are described. TNE limitations are discussed with areas for future development.. Thirty patients who underwent unsedated outpatient TNE by their otolaryngologist are described. TNE was directed toward select indications: dysphagia, screening esophagoscopy given long-standing gastroesophageal reflux (GER) or laryngopharyngeal reflux (LPR), and esophageal surveillance with a new diagnosis of head and neck squamous cell carcinoma. Positive findings included mucosal cobblestoning, Barrett's esophagus, esophagitis, gastritis, candidal esophagitis, esophageal diverticulum, postcricoid mass, patulous esophagus, and absence of secondary esophageal peristalsis. Outcomes included referral to a gastroenterologist for evaluation, with or without biopsy; direct laryngoscopy or esophagoscopy with biopsy by the otolaryngologist; planned cancer resection by the otolaryngologist; and medical management of GER/LPR by the otolaryngologist.. With appropriate selection criteria, TNE yields a high percentage of positive findings and wide range of esophageal abnormalities, directly impacting patient management. Available to otolaryngologists in the outpatient setting, TNE expedites interventions by providing a safe, effective alternative to rigid esophagoscopy under general anesthesia and flexible upper endoscopy with sedation. Patients will benefit from the integration of TNE into otolaryngologists' outpatient diagnostic armamentarium.

Topics: Adult; Aged; Aged, 80 and over; Ambulatory Care; Barrett Esophagus; Candidiasis; Deglutition Disorders; Diverticulum, Esophageal; Esophagitis; Esophagoscopy; Female; Gastroesophageal Reflux; Humans; Male; Middle Aged; Nose; Retrospective Studies

Topics: Antioxidants; Gastroesophageal Reflux; Humans; Nasal Obstruction; Nose; Oxidative Stress; Sleep Apnea, Obstructive; Treatment Outcome

KEYPOINTS: Transnasal fibreoptic oesophagoscopy (TFO) allows the upper aerodigestive tract, from the nasal vestibule to the gastric cardia to be examined in the outpatients department without sedation. This permits patients with symptoms of upper aerodigestive pathology to be investigated at the initial consultation without the need for inpatient endoscopy or swallow studies. The technique is easily learned, and is statistically comparable with standard flexible nasoendoscopy in respect of procedural pain and discomfort. It is highly cost-efficient, paying for itself within 1 year, and thereafter leading to cost savings of over 80%. Its role can be expanded to encompass investigating patients with potentially malignant disease processes, as well as outpatients "panendoscopy" and biopsy, and a number of therapeutic interventions.

Topics: Ambulatory Care; Cardia; Cost Savings; Cost-Benefit Analysis; Deglutition Disorders; Esophagoscopes; Esophagoscopy; Esophagus; Fiber Optic Technology; Gastroesophageal Reflux; Humans; Hypopharynx; Nasal Cavity; Nasopharynx; Nose; Pharynx; Pliability; Tongue; Vocal Cords

Topics: Adult; Biopsy; Chronic Disease; Esophagoscopy; Gastritis; Gastroesophageal Reflux; Gastroscopy; Helicobacter Infections; Helicobacter pylori; Humans; Male; Nose; Polyps; Vocal Cords

Apnea in the neonatal period frequently is associated with prematurity. Full-term infants who develop apnea usually have associated clinical conditions such as infection, shock, metabolic disorders, neonatal abstinence syndrome, intracranial pathology, and gastroesophageal reflux. Gastric ulcer also is a rare phenomenon in the neonatal period. We describe a full-term infant presenting with apnea. Upon investigation, a 6-channel pneumocardiogram revealed central apnea and multiple episodes of low esophageal pH (< 4), which is suggestive of gastroesophageal reflux. This was confirmed by an upper gastrointestinal series. A small antral ulcer crater also was demonstrated. When assessing the etiology of apnea in a full-term infant, gastroesophageal reflux and gastric ulcer should be considered.

Topics: Anti-Ulcer Agents; Apnea; Cisapride; Esophagus; Gastroesophageal Reflux; Humans; Hydrogen-Ion Concentration; Infant, Newborn; Male; Nose; Oxygen; Piperidines; Pulmonary Ventilation; Pulse; Ranitidine; Respiration; Stomach Ulcer

It has been shown that nasal continuous positive airway pressure (nasal CPAP) significantly reduces nocturnal reflux both in patients with sleep apnea and in patients without sleep apnea but consistent abnormal nocturnal reflux. The mechanism by which CPAP is thought to reduce reflux includes the elevation of the resting lower esophageal sphincter (LES) pressure. In this study, we tested the effect of nasal CPAP in two groups of patients with aperistaltic esophagus but with different resting LES pressure. Seven patients with scleroderma esophagus and six patients treated for achalasia were tested over a 48-h period. On the first night, the patients were untreated; on the second night, both groups received applied nasal CPAP at 8 cm H2O pressure. The percentage of time the pH < 4.0, the number of reflux events > 5 min, and the length of the longest reflux event were all significantly reduced in the patients with achalasia (p < 0.03), but not in the scleroderma group (p > 0.20). These results suggest that a residual resting LES pressure greater than that demonstrated by patients with scleroderma (> 10 mm Hg) may be necessary for nasal CPAP to affect nocturnal reflux.

Topics: Adult; Aged; Aged, 80 and over; Esophageal Achalasia; Esophagus; Evaluation Studies as Topic; Female; Gastroesophageal Reflux; Humans; Hydrogen-Ion Concentration; Middle Aged; Nose; Peristalsis; Polysomnography; Positive-Pressure Respiration; Raynaud Disease; Scleroderma, Systemic

To determine whether regurgitation might be a factor in the pathogenesis of apnea in certain infants, we compared the frequency of short and prolonged apnea immediately following regurgitation to that during control periods. Ten infants (nine preterm and one term) with histories of frequent regurgitation and also apneic spells were studied for 2 to 3 hours by monitoring nasal airflow, abdominal respiratory movements, electrocardiogram, pharyngeal pH, and pharyngeal pressure. In six of these infants additional observations were made without the intrapharyngeal recording devices. Fourty-four episodes of regurgitation were observed. Both prolonged apnea (P less than 0.05) and short apnea (P less than 0.01) occurred much more frequently during regurgitation than during the control period; however, the majority of prolonged apneic spells observed were unassociated with regurgitation. The increased frequency of apnea during regurgitation was not related to the presence of intrapharyngeal recording devices. Although nasal regurgitation was frequently associated with short apnea, no prolonged apnea was observed during the seven episodes of nasal regurgitation observed. The 14-fold increase in prolonged apnea frequency immediately following regurgitation supports the hypothesis for a causal relationship between apnea and regurgitation.

Topics: Apnea; Gastroesophageal Reflux; Humans; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature; Monitoring, Physiologic; Nose; Pulmonary Ventilation; Time Factors

Respiratory distress, apnea, and chronic pulmonary disease since birth were identified in 14 infants who also had symptomatic gastroesophageal reflux. Birth weights varied from 760 to 4,540 gm. All infants had radiographic changes similar to those in bronchopulmonary dysplasia. Cessation of apnea and improvement of pulmonary disease occurred only after medical (8) or surgical (6) control of gastroesophageal reflux. Simultaneous tracings of esophageal pH, heart rate, impedance pneumography, and nasal air flow in five infants demonstrated that reflux preceded apnea. Apnea could be induced by instillation of dilute acid, but not water or formula, into the esophagus. Prolonged monitoring of esophageal pH more than two hours after feeding in 14 other infants less than 6 weeks of age (birth weight 780 to 3,350 gm) without a history of recent vomiting indicated that reflux was not greater than in normal older children.

Topics: Apnea; Chronic Disease; Gastroesophageal Reflux; Heart Rate; Humans; Hydrogen-Ion Concentration; Infant, Newborn; Infant, Newborn, Diseases; Lung Diseases; Nose; Pneumonia, Aspiration; Pulmonary Ventilation; Respiratory Distress Syndrome, Newborn

Topics: Adolescent; Adult; Catheterization; Colonic Diseases; Conversion Disorder; Deglutition Disorders; Esophageal Achalasia; Female; Gastroesophageal Reflux; Heartburn; Humans; Male; Manometry; Middle Aged; Muscle Tonus; Nose; Pain; Pharynx; Pressure; Spasm