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Gastrointestinal perforations in the newborn
1046
Esophageal pH Monitoring During Sleep Identifies Children With Respiratory Symptoms From Gastroesophageal Reflux. S. G. Jolley, J. J. Herbst, D. G. Johnson, M. E.
Matlak, and L. S. Book. Gastroenterology 80:1501-1506, (June), 1981. The authors studied 41 patients with symptomatic gastroesophageal reflux and divided these patients into those with respiratory symptoms (27) and those with nonrespiratory symptoms (14). Eight asymptomatie controls were also studied. All patients were 6 mo old or less. All were studied using the 18-24 hr esophageal pH probe. The authors looked at the number of reflux episodes per 12 hr, the number of reflux episodes more than 5 min in duration per 12 hr, the duration of the longest single reflux episode, the mean duration of reflux, and the percentage of time the esophageal pH was less than 4. Based on follow-up studies, the patients with symptomatic gastroesophageal reflux with respiratory symptoms were divided into three groups: (A) those with GER-related respiratory symptoms (17), (B) those with GER-unrelated respiratory symptoms (7), and (C) those with indeterminate respiratory symptoms (3). Of all the parameters studied, the mean duration of reflux during sleep provided the best separation between the respiratory and nonrespiratory symptom groups (7.3 min versus 3.6 min). In children with GER-related respiratory symptoms, 94% (16 of 17) had a mean duration of reflux during sleep greater than 4 rain; none of the seven children with GER-unrelated respiratory symptoms had a mean duration of reflux greater than 4 min. Therefore, the mean duration of reflux during sleep correlated directly with the presence of respiratory symptoms caused by gastroesophageal reflux in these patients. This important observation helps to identify those patients with respiratory symptoms and gastroesophageal reflux who may have a cause and effect relationship versus those patients with respiratory symptoms and reflux in which one is not related to the other.--Richard R. Ricketts
Gastroesophageal Reflux in Children: Radionuclide Gastroesophagography. J. D. Blumhagen, T. G. Rudd, and D. L.
Christie. Am J Roentgenol 135:1001-1004, (November), 1980. Sixty-five patients with symptoms related to gastroesophageal reflux (GER) underwent acid reflux tests, barium esophagrams, and radionuclide gastroesophagography. Thirty-eight patients revealed GER on both radionuclide and acid reflux tests while 10 had negative results on both. Four had negative acid reflux with positive radionuclide tests while 13 revealed reflux on radionuclide but had negative acid reflux tests. Using the latter as a standard, the sensitivity of radionuclide gastroesophagography was 75% and specificity was 71%. Radionuelide gastroesophagography and barium esophagography compared favorably with 39 patients revealing GER on both studies and four with negative results in beth. Nineteen patients showed GER on barium examination but no GER on radionuclide study while only three had negative barium studies with positive radionuclide studies. Ten patients with aspiration symptoms revealed no evidence of lung activity with prolonged scanning but all showed significant reflux. Advantages of the radionuclide study include easy performance, ability to monitor for reflux
ABSTRACTS
without increasing radiation exposure, opportunity to demonstrate aspiration, evaluation of gastric emptying, and low dose compared to barium esophagography, which becomes important when repeat studies are necessary to evaluate treatment. The main disadvantage is lack of anatomic detail.--Randall 14/.Powell Megaesophagus-Differential Diagnosis and Therapy. M.
H~Hwarth, D. Graf, and R. Fotter. Z Kinderchir 32:37-46, 1981. The megaesophagus does not represent an independent entity but is rather the result of different chronic esophageal dysfunctions. These dysfunctions are achalasia of the cardia, congenital esophageal stenosis, gastroesophageal reflux, peptic stenosis, and stenosis secondary to esophageal burns. The authors recommend as therapy of choice Heller's operation with insertion of a fundus patch in achalasia, primary conservative treatment, or, if unsuccessful, fundoplication of gastroesophageal reflux, dilation in membranous, peptic and burn stenoses, and operative resection in fibromuscular narrowing of the esophagus. Examples of successful treatments restoring normal function and size of the esophagus are given for each of these esophageal dysfunctions.Thomas A. Angerpointner Gastrointestinal Perforations in the Newborn. K. E. Grund
and G. P. Dzieniszewski. Z Kinderchir 32:56-68, 198 I. The authors present a series of 48 neonates with gastrointestinal perforations. The rate of premature births amounted to 42% and perinatal complications such as asphyxia, shock, and respiratory distress syndrome were frequently observed. The first clinical symptoms were nonspecific. The "pathognomonic" sign of a pneumoperitoneum could be diagnosed in only 36% of the cases. The most common site of the perforation was the ileocecal region, the most common causes of perforation were intestinal obstructions (atresia, Hirschsprung's disease) and necrotizing enterocolitis. In almost 1/3 of the cases, the cause of perforation remained unclear. The operative procedures varied. Prematurity and the high rate of postoperative complications such as peritonitis and septicemia resulted in 63% mortality. An improvement in the results can only be attained by early diagnosis and operation.-- Thomas A. Angerpointner Spontaneous Linear Tears of the Stomach in the Newborn Infant. W. S. Houck, Jr., and J. P. Griffin. Ann Surg
193:763 768, (June), 1981. The authors present two full-term and one premature infant who developed gastric ruptures between the third and fourth days of life. Their protocol for management including the inclusion of gastroesophageal motility studies is included. Studies on cadaver stomachs and esophagi that were ruptured by inflation indicated that stomachs ruptured at pressures between 3.4 and 7 lb/sq inch and esophagi at 6.1-12 lb/sq inch. The authors review several theories pertaining to ruptured stomachs. They feel that air swallowed during feeding, abnormal peristalsis, and poor neurologic control of the upper gastrointestinal tract contributes to the occurrence of linear gastric tears which are usually seen within the first week of life. An excellent discussion by people
Esophageal pH Monitoring During Sleep Identifies Children With Respiratory Symptoms From Gastroesophageal Reflux. S. G. Jolley, J. J. Herbst, D. G. Johnson, M. E.
Matlak, and L. S. Book. Gastroenterology 80:1501-1506, (June), 1981. The authors studied 41 patients with symptomatic gastroesophageal reflux and divided these patients into those with respiratory symptoms (27) and those with nonrespiratory symptoms (14). Eight asymptomatie controls were also studied. All patients were 6 mo old or less. All were studied using the 18-24 hr esophageal pH probe. The authors looked at the number of reflux episodes per 12 hr, the number of reflux episodes more than 5 min in duration per 12 hr, the duration of the longest single reflux episode, the mean duration of reflux, and the percentage of time the esophageal pH was less than 4. Based on follow-up studies, the patients with symptomatic gastroesophageal reflux with respiratory symptoms were divided into three groups: (A) those with GER-related respiratory symptoms (17), (B) those with GER-unrelated respiratory symptoms (7), and (C) those with indeterminate respiratory symptoms (3). Of all the parameters studied, the mean duration of reflux during sleep provided the best separation between the respiratory and nonrespiratory symptom groups (7.3 min versus 3.6 min). In children with GER-related respiratory symptoms, 94% (16 of 17) had a mean duration of reflux during sleep greater than 4 rain; none of the seven children with GER-unrelated respiratory symptoms had a mean duration of reflux greater than 4 min. Therefore, the mean duration of reflux during sleep correlated directly with the presence of respiratory symptoms caused by gastroesophageal reflux in these patients. This important observation helps to identify those patients with respiratory symptoms and gastroesophageal reflux who may have a cause and effect relationship versus those patients with respiratory symptoms and reflux in which one is not related to the other.--Richard R. Ricketts
Gastroesophageal Reflux in Children: Radionuclide Gastroesophagography. J. D. Blumhagen, T. G. Rudd, and D. L.
Christie. Am J Roentgenol 135:1001-1004, (November), 1980. Sixty-five patients with symptoms related to gastroesophageal reflux (GER) underwent acid reflux tests, barium esophagrams, and radionuclide gastroesophagography. Thirty-eight patients revealed GER on both radionuclide and acid reflux tests while 10 had negative results on both. Four had negative acid reflux with positive radionuclide tests while 13 revealed reflux on radionuclide but had negative acid reflux tests. Using the latter as a standard, the sensitivity of radionuclide gastroesophagography was 75% and specificity was 71%. Radionuelide gastroesophagography and barium esophagography compared favorably with 39 patients revealing GER on both studies and four with negative results in beth. Nineteen patients showed GER on barium examination but no GER on radionuclide study while only three had negative barium studies with positive radionuclide studies. Ten patients with aspiration symptoms revealed no evidence of lung activity with prolonged scanning but all showed significant reflux. Advantages of the radionuclide study include easy performance, ability to monitor for reflux
ABSTRACTS
without increasing radiation exposure, opportunity to demonstrate aspiration, evaluation of gastric emptying, and low dose compared to barium esophagography, which becomes important when repeat studies are necessary to evaluate treatment. The main disadvantage is lack of anatomic detail.--Randall 14/.Powell Megaesophagus-Differential Diagnosis and Therapy. M.
H~Hwarth, D. Graf, and R. Fotter. Z Kinderchir 32:37-46, 1981. The megaesophagus does not represent an independent entity but is rather the result of different chronic esophageal dysfunctions. These dysfunctions are achalasia of the cardia, congenital esophageal stenosis, gastroesophageal reflux, peptic stenosis, and stenosis secondary to esophageal burns. The authors recommend as therapy of choice Heller's operation with insertion of a fundus patch in achalasia, primary conservative treatment, or, if unsuccessful, fundoplication of gastroesophageal reflux, dilation in membranous, peptic and burn stenoses, and operative resection in fibromuscular narrowing of the esophagus. Examples of successful treatments restoring normal function and size of the esophagus are given for each of these esophageal dysfunctions.Thomas A. Angerpointner Gastrointestinal Perforations in the Newborn. K. E. Grund
and G. P. Dzieniszewski. Z Kinderchir 32:56-68, 198 I. The authors present a series of 48 neonates with gastrointestinal perforations. The rate of premature births amounted to 42% and perinatal complications such as asphyxia, shock, and respiratory distress syndrome were frequently observed. The first clinical symptoms were nonspecific. The "pathognomonic" sign of a pneumoperitoneum could be diagnosed in only 36% of the cases. The most common site of the perforation was the ileocecal region, the most common causes of perforation were intestinal obstructions (atresia, Hirschsprung's disease) and necrotizing enterocolitis. In almost 1/3 of the cases, the cause of perforation remained unclear. The operative procedures varied. Prematurity and the high rate of postoperative complications such as peritonitis and septicemia resulted in 63% mortality. An improvement in the results can only be attained by early diagnosis and operation.-- Thomas A. Angerpointner Spontaneous Linear Tears of the Stomach in the Newborn Infant. W. S. Houck, Jr., and J. P. Griffin. Ann Surg
193:763 768, (June), 1981. The authors present two full-term and one premature infant who developed gastric ruptures between the third and fourth days of life. Their protocol for management including the inclusion of gastroesophageal motility studies is included. Studies on cadaver stomachs and esophagi that were ruptured by inflation indicated that stomachs ruptured at pressures between 3.4 and 7 lb/sq inch and esophagi at 6.1-12 lb/sq inch. The authors review several theories pertaining to ruptured stomachs. They feel that air swallowed during feeding, abnormal peristalsis, and poor neurologic control of the upper gastrointestinal tract contributes to the occurrence of linear gastric tears which are usually seen within the first week of life. An excellent discussion by people