No abstract available.
Esophageal pH Monitoring* ; Gastroesophageal Reflux*

The purpose of this study was to determine aluminium (Al) concentrations in groundwater used for drinking and cooking and its related health risk among population of 28th Mile Orang Asli village in Jenderam Hilir, Selangor, Malaysia. A total of 100 respondents were recruited, comprising 51 (51.0 %) male and 49 (49.0 %) female residents. Inductively coupled plasma mass spectrometry (ICP-MS) was used to determine Al concentration, while the LAMOTTE TRACER ORP PockeTester was used to measure pH levels. Statistical Package for Social Science (SPSS) was used to analyze the data. Results showed that Al concentration ranged from 0.041 - 0.136 mg/L with a mean of 0.136 + SD 0.041 mg/L, hence the values obtained were below the standard value (0.2 mg/L). pH levels ranged from 3.82 to 5.84, with a mean of 4.163 + SD 0.411, which is acidic and below the range permitted by the health authorities. The acidic nature may have an impact on the Al concentration in the water. The Hazard Index (HI) was found to be less than 1, thus there was no health risk of Al exposure in drinking water for the respondents involved. The study area was considered safe from having health risk associated with Al exposure.
Aluminium ; Ph ; drinking water ; groundwater ; Hazard Index

BACKGROUND/AIMS: Impedance-pH monitoring allows detailed characterization of gastroesophageal reflux and esophageal activity associated with reflux. We assessed the characteristics of nocturnal reflux and esophageal activity preceding and following reflux. METHODS: Impedance-pH tracings from 11 healthy subjects and 76 patients with gastroesophageal reflux disease off acid-suppressive therapy were analyzed. Characteristics of nocturnal supine reflux, time distribution and esophageal activity seen on impedance at 2 minute intervals preceding and following reflux were described. RESULTS: Patients had more nocturnal reflux events than healthy subjects (8 [4-12] vs 2 [1-5], P = 0.002), with lower proportion of weakly acidic reflux (57% [35-78] vs 80% [60-100], P = 0.044). Nocturnal reflux was mainly liquid (80%) and reached the proximal esophagus more often in patients (6% vs 0%, P = 0.047). Acid reflux predominated in the first 2 hours (66%) and weakly acidic reflux in the last 3 hours (70%) of the night. Most nocturnal reflux was preceded by aboral flows and cleared by short lasting volume clearance. In patients, prolonged chemical clearance was associated with less esophageal activity. CONCLUSIONS: Nocturnal weakly acidic reflux is as common as acid reflux in patients with gastroesophageal reflux disease, and predominates later in the night. Impedance-pH can predict prolonged chemical clearance after nocturnal acid reflux.
Electric Impedance ; Esophageal pH Monitoring ; Esophagus ; Gastroesophageal Reflux ; Humans

OBJECTIVEAn unhealthy food consumption habit attributes to one of the etiology of gastro-esophageal reflux. The purpose of this article was to study the influence of food intake before going to bed on the nighttime gastro-esophageal reflux.

METHODSThirty-eight children with upper gastrointestinal symptoms were divided into two groups on the basis of taking (Group A, n=16) or not taking (Group B, n=22) food (non-stimulating) within 2 hrs before going to bed. All of them underwent 24 hr esophageal pH monitoring. The times of reflux episode, the longest duration of reflux, the times of reflux duration > 5 min, and the percentage of time of pH < 4 were compared between the two groups.

RESULTSThere were no significant differences in the parameters of pH monitoring between Groups A and B, with the times of reflux episode of 32 (21.5-43.5) vs 24 (15-37.3) , the longest duration of reflux of 6.6 (2.4-29.8) min vs 4.5 (2.5-13.2) min, the times of reflux episode longer than 5 min of 1.5 (0-3) vs 0 (0-3), and the percentage of time of pH < 4 of 4.3 (2.1-15.0)% vs 4.1 (2.0-7.2)% .

CONCLUSIONSNon-stimulating food intake before going to bed did not adversely affect the nighttime gastro-esophageal reflux.

Adolescent ; Child ; Esophageal pH Monitoring ; Feeding Behavior ; Female ; Gastroesophageal Reflux ; etiology ; Humans ; Male ; Time Factors

PURPOSE: We investigated the incidence of gastroesophageal reflux disease (GERD) by 24-hour esophageal pH monitoring in patients who had chronic cough for more than 3 weeks. METHODS: From January 1995 to August 1996, 33 patients with chronic cough which had lasted for more than 3 weeks were enrolled in the 24-hour esophageal pH monitoring. The result was interpreted with the standard value which was suggested by Yvan Vandenplas in 1991 for patients younger than 15 months and with the De Meester Score for patients older than 15 months. We performed esophagoscopy and lower esophageal biopsy for patients who proved to have gastroesophageal reflux disease by 24-hour esophageal pH monitoring. RESULTS: Among 33 cases, 13 cases (39.4%) were proved to have GERD. Comparing between the normal group and the GERD group, there was no difference of gastroesophageal reflux incidence according to meal or position. We performed esophagoscopy in 10 patients among 13 GERD cases. There were 3 cases of gross esophagitis. Papillary height was elongated by more than 50% of normal in 7 cases, and basal cell layer increased by more than 20% of normal in 6 cases. Neutrophil or eosinophil infiltration was found in 2 cases, and lymphocyte infiltration was found in 7 cases. CONCLUSION: We suggest that 24-hour esophageal pH monitoring and appropriate treatment should be considered in prolonged unexplained chronic cough.
Biopsy ; Child* ; Cough* ; Eosinophils ; Esophageal pH Monitoring ; Esophagitis ; Esophagoscopy ; Gastroesophageal Reflux* ; Humans ; Incidence ; Lymphocytes ; Meals ; Neutrophils

Esophageal pH monitoring is considered the gold standard for the diagnosis of gastroesophageal reflux disease because of the normal ranges across the pediatric age range. However, this method can only detect acid reflux. Multichannel intraluminal impedance-pH (MII-pH) monitoring has recently been used for the detection of bolus reflux in infants and children. This method allows for the detection of liquid, gas or mixed reflux in addition to acid, weakly acidic or weakly alkaline reflux. MII-pH monitoring can record the direction of flow and the height of reflux, which are useful parameters to identify an association between symptoms and reflux. However, the technique is limited by its high cost and the lack of normative data of MII-pH in the pediatric population. Despite certain limitations, MII-pH monitoring will become more common and gradually replace pH monitoring in the future, because pH monitoring is part of MII-pH.
Child* ; Diagnosis ; Esophageal pH Monitoring ; Gastroesophageal Reflux ; Humans ; Hydrogen-Ion Concentration* ; Infant ; Reference Values

BACKGROUND: Gastroesophageal reflux disease (GERD) is a common cause of chronic cough. Nevertheless the incidence of GERD is low in Korea. We evaluated the necessity of tests for GERD as a cause of chronic cough and treatment responses to proton pump inhibitors. METHODS: Patients with cough for more than three weeks were enrolled. Patients who were diagnosed as bronchial asthma, eosinophilic bronchitis, and posterior nasal drip were differentiated. Twenty four hour ambulatory esophageal pH monitoring was performed in patients with chronic cough of unknown causes or gastroesophageal reflux symptoms. Patients were diagnosed as GERD when DeMeester composite score was over 14.7 or symptom sensitivity index was over 10 percent. We prescribed proton pump inhibitors for patients diagnosed as GERD. RESULTS: Sixty seven of 531 patients supposedly needed 24-hour ambulatory esophageal pH monitoring. 24-hour ambulatory esophageal pH monitoring was performed in 34 patients and eight patients were diagnosed as GERD. Symptoms improved in 5 patients on taking omeprazole 20~40 mg/day single or combined with prokinetic agents. CONCLUSIONS: Among patients with chronic cough, not many cases needed to take 24-hour ambulatory esophageal pH monitoring. The incidence of GERD, diagnosed by 24-hour ambulatory esophageal pH monitoring, in chronic cough of unknown causes was low. The effect of omeprazole was similar to the previous reports.
Asthma ; Bronchitis ; Cough* ; Eosinophils ; Esophageal pH Monitoring ; Gastroesophageal Reflux* ; Humans ; Incidence* ; Korea ; Omeprazole ; Proton Pump Inhibitors

PURPOSE: The aim of this study was to determine clinical significance of dual-probe esophageal pH monitoring and to compare four pH monitoring parameters between proximal and distal esophagus in pathological gastroesophageal reflux disease with recurrent respiratory symptoms. METHODS: Among the thirty-four patients who were performed 24 hr pH monitoring, seventeen patients with pathological distal reflux were classified into two groups: Group I (n:12) had recurrent respiratory symptoms and Group II (n:5) hadn't recurrent respiratory symptoms. The ambulatory dual-probe esophageal pH monitoring was performed for 18~24 hr. A pathologic GER was defined when reflux index (percent of the investigation time a pH<4) exceeded the 95th percentile of normal value. RESULTS: Among the sixteen patients with recurrent respiratory symptoms, twelve patients (75%) have pathological distal reflux. Whereas among the eighteen patients without recurrent respiratory symptom, five patients (28%) have pathological distal reflux. In the Group I, the significant differences between proximal and distal esophageal pH recordings persisted for all parameters, but didn't persist in group II except for longest episode. Comparing esophageal pH four parameters between group I and group II at the proximal esophageal site, all parameters didn't show statistically significant differences. CONCLUSION: Regardless of respiratory symptoms, patients with pathological distal reflux didn't show statistically significant differences in the all parameters at the proximal esophageal site. Therefore we may reconsider usefulness of dual probe pH meter in patients with recurrent respiratory symptoms.
Esophageal pH Monitoring* ; Esophagus ; Gastroesophageal Reflux* ; Humans ; Hydrogen-Ion Concentration ; Reference Values

PURPOSE: The aim of this study was to determine how much acid exposure would occur in the proximal esophagus, both in normal and in patients with abnormal distal esophageal acid exposure. METHODS: Fourty-six patients with suspected GER were classified into two groups, 24 patients with pathological distal reflux (group II); 22 patients with normal distal reflux(group II). The ambulatory dual-probe esophageal pH monitoring was performed for 18-24hr. The abnormal reflux was defined when the percent of time that pH was below 4.0 exceeded the 95th percentile of normal value. RESULTS: The siginficant differences between distal and proximal esophageal pH recordings in group I persisted for all parameters except for the longest episode, but didn't persist in group II. At the distal esophageal site, the median percent time with pH<4.0 in group I was 19.3 and significantly higher than at proximal site. Half of patients with pathological distal reflux also had proximal acid reflux. Correlation coefficients between the distal and proximal esophageal sites in group I of the number of reflux episodes and time of the longest episode were 0.451 and 0.646 respectively. CONCLUSION: The 50 percent of patients with pathological distal acid reflux also had abnormal acid exposure in the proximal esophageal site. Therefore, we recommand simultaneous pH recordings from dual probe esophageal sites in children with gastroesophageal reflux.
Child* ; Esophageal pH Monitoring ; Esophagus ; Gastroesophageal Reflux* ; Humans ; Hydrogen-Ion Concentration* ; Reference Values

Fundoplication is a common surgical procedure for gastroesophageal reflux disease (GERD). Recently the procedure has been performed with increased frequency laparoscopically. The aim of this study is to review our 11 years experience with fundoplication in infants and children. From October 1994 to December 2005, 59 fundoplications in 55 patients were performed at Sungkyunkwan University Samsung Medical Center. Medical records and laboratory results of these children were retrospectively reviewed for sex, age, symptoms and signs, coexisting disease, diagnostic methods, treatment modalities and length of operative time. Open fundoplication was performed in 41 cases and laparoscopic fundoplication in 18 cases. Simultaneous gastrostomy was done in 27 cases. Recurrent GERD symptom occurred in four patients (7.2 %) within 2 years after first fundoplication and all 4 patients had re-do fundoplication. There were no intra- and immediate post-operative complications. Gastrointesitnal symptoms were the most common indication for fundoplication in neurologically normal patients. The most frequent diagnostic studies were upper gastrointestinal series (76.3 %) and 24 hour esophageal pH monitoring (78.2 %). Fundoplication had been increased since 2004 and mostly done laparoscopically. In conclusion, our 11 years' practice of open and laparoscopic fundoplication indicates that both approaches are safe and effective in the treatment of GERD for infants and children.
Child ; Esophageal pH Monitoring ; Fundoplication ; Gastroesophageal Reflux ; Gastrostomy ; Humans ; Infant ; Medical Records ; Operative Time ; Retrospective Studies