Biomedical subjects
Steven M Schwarz
Publications and source records attributed to Steven M Schwarz.
Gastroesophageal reflux in infancy and childhood.
GER is a common reason for pediatric office visits and referrals to a pediatric gastroenterologist. This condition frequently is benign, and it is self-limited in most infants. Although a thorough history and complete physical examination usually are adequate to diagnose GER, a high index of suspicion must be maintained for other diagnoses associated with recurrent emesis, including metabolic disorders, as well as for other gastrointestinal conditions, such as pyloric stenosis and abnormalities of intestinal rotation. Behavioral or lifestyle modification usually can be implemented empirically to diagnose and manage a suspected case of uncomplicated GER. When this fails, medical therapy can be initiated, employing either a step-up or step-down approach with a PPI or H2RA. With the proven efficacy of PPIs and their availability to children, medical treatment has become the mainstay of therapy in severely affected patients; nevertheless, anti-reflux surgery is still widely performed in children with GER. Pediatricians and other primary care providers often manage infants and children who have gastrointestinal complaints, prior to referral to a pediatric gastroenterologist. Hence, they have the responsibility to educate children and families about GER, its natural history, complications, and therapeutic options. A careful history and physical examination, informed use of diagnostic studies, and a consistent approach to medical treatment are important principles that are required to guarantee the success of GER management in infants and children.
Optimizing the diagnosis of gastroesophageal reflux in children with otolaryngologic symptoms.
OBJECTIVES: Although many children with otolaryngologic (ENT) symptoms are being treated for gastroesophageal reflux (GER), how to diagnose GER in children with primarily or exclusively ENT symptoms has yet to be determined. This study compares the incidences of pathologic GER in the upper verses the lower esophagus in a cohort of children with ENT symptoms that were screened for GER. METHODS: The results of extended dual channel intraesophageal pH probe monitoring obtained from 14 infants and 14 children with ENT symptoms were retrospectively analyzed. The percent of total monitoring time that the pH was less than 4, reflux index (RI) was determined. The upper limits of normal distal and proximal esophageal RI were based on published data. To evaluate our results, upper esophageal reflux (UER) was also determined in 27 infants and children without ENT or pulmonary symptoms, who had normal lower esophageal reflux (LER) values. RESULTS: Mean upper esophageal RIs in the infants and children with normal LER were similar to previously published values for control infants and adults. Four (29%) of the ENT infants, 11 (79%) of the older ENT children, and 54% of the entire cohort had increased esophageal acid exposure. However, nine (60%) of the 15 pediatric ENT patients with GER had pH abnormalities limited to the upper esophagus. CONCLUSIONS: Standard distal pH probe monitoring alone gives a false negative result in a substantial proportion of the infants and children with ENT symptoms being evaluated for GER. Beyond its value in clinical practice, UER testing should be employed in research studies that evaluate the impact of GER therapy on ENT symptoms.
Nutritional management of disabled patients--a new formula for success?
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