Biomedical subjects
Publications and source records attributed to S R Orenstein.
We have described the first case of symptomatic magnesium deficiency in a patient with cystic fibrosis and have discussed its causes. Such deficiency probably occurs with significant frequency in cystic fibrosis and should be considered in such patients so that important morbidity can be prevented.
We describe an infant with stridor associated with gastroesophageal reflux (GER). This is the first report in which there is clear documentation by pH probe of a temporal association between individual episodes of GER and stridor. We review the literature and speculate on the relationship between these two phenomena. GER should be considered in patients with stridor.
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Five pediatric patients with stridor were evaluated to determine whether gastroesophageal reflux (GER) contributed to their stridor. Intraluminal esophageal acid perfusion (Bernstein test), pH probe, radiographic studies, laryngobronchoscopy, and esophageal histology were utilized. Thereafter, three of the five patients responded to therapy for GER; two did not. The Bernstein test proved to have greater diagnostic reliability than any other test employed, using response to antireflux therapy as the "gold standard" for diagnosing reflux-provoked stridor.
To investigate the effect of bethanechol on postprandial gastroesophageal reflux in children, and the relationship between its effect on the lower esophageal sphincter pressure and its effect on reflux, we studied 31 consecutive children with pathologic reflux, using manometry and pH probe, both before and after administration of bethanechol. The initial sphincter pressure was subnormal in only 35% of the patients. The bethanechol-treated sphincter pressure was increased in 97% of the patients (from 13.4 +/- 1.3 to 34.1 +/- 2.6 mm Hg) and was normal in 97% of the patients, yet bethanechol did not improve any measure of postprandial reflux in the patient group as a whole. Furthermore, the 20 patients with normal sphincter pressures had significant worsening of their percent of postprandial time with reflux (from 21.8 +/- 5.3 to 33.8 +/- 6.0%, p = 0.009). Thus, this study demonstrates a failure of the acute administration of bethanechol to improve postprandial gastroesophageal reflux and raises the issue of whether the widespread use of bethanechol to treat reflux in children is appropriate.
Gastroesophageal reflux is a disorder with well-characterized histopathological features in the adult, but the incidence and pathogenesis of epithelial injury in children are poorly understood. Esophageal suction biopsies from 80 infants exhibiting symptoms of reflux were studied by computer-assisted image analysis and the results compared to routine histological scoring. The histological features evaluated were the number of intraepithelial lymphocytes and eosinophils, papillary height, interpapillary basal cell height, and a novel measure "integrated basal cell height." We quantitatively evaluated these histological criteria by computer-assisted image analysis and compared these results to four subjective grades of esophagitis: low, mild, moderate and high. In this report we now describe this quantitative histopathologic method for the evaluation of pediatric esophageal biopsies. Utilizing this method we demonstrate that both inter- and intra-observer variability were sufficiently low to stratify the mucosal changes reliably into at least four categories. The reliability of this objective analytic technique will permit studies into the disease progression and regression in pediatric reflux esophagitis.
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