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1.
Rev. Odontol. Araçatuba (Impr.) ; 44(2): 46-52, maio-ago. 2023. ilus
Article in Portuguese | LILACS, BBO | ID: biblio-1428069

ABSTRACT

O envelhecimento bucal precoce apresenta cada vez uma maior incidência nos consultórios odontológicos e sua degradação aos tecidos orais exige uma atenção por parte do cirurgiãodentista devido ao seu alto grau de complexidade. Esse envelhecimento precoce é causado principalmente por hábitos parafuncionais, dieta ou ambos. Suas consequências são desgastes patológicos dos tecidos dentários, extrusão passiva, perda de dimensão vertical e comprometimento estético e funcional. Por conta disso, o presente estudo teve como objetivo realizar um relato de caso clínico em um paciente jovem e com queixa estética como consequência de hábitos parafuncionais, aonde foram realizados uma reabilitação oral envolvendo aumento da dimensão vertical de oclusão através de Table Tops sem desgastes dentários e restaurações estéticas, ambas com resina composta. Essa reabilitação devolveu a DVO da paciente, trazendo conforto, contatos estáveis, guias de desoclusão e satisfação estética e funcional por parte da paciente(AU)


Early oral aging has an increasing incidence in dental offices and its degradation to oral tissues requires attention from the dentist due to its high degree of complexity. This premature aging is mainly caused by parafunctional habits, diet, or both. Its consequences are pathological wear of dental tissues, passive extrusion, loss of vertical dimension and aesthetic and functional impairment. Because of this, the present study aims to carry out a clinical case report in a young patient with an aesthetic complaint as a result of parafunctional habits, where an oral rehabilitation was carried out involving an increase in the vertical dimension of occlusion through Table Tops without dental wear and aesthetic restorations, both with composite resin. This rehabilitation returned the patient's OVD, bringing comfort, stable contacts, disocclusion guides and aesthetic and functional satisfaction on the part of the patient(AU)


Subject(s)
Humans , Female , Adult , Aging , Composite Resins , Dental Restoration, Permanent , Mouth , Sleep Wake Disorders , Stress, Physiological , Vertical Dimension , Bruxism , Gastroesophageal Reflux , Aging, Premature , Esthetics, Dental , Tooth Wear
2.
Chinese Journal of Gastrointestinal Surgery ; (12): 499-504, 2023.
Article in Chinese | WPRIM | ID: wpr-986818

ABSTRACT

The electrophysiological activity of the gastrointestinal tract and the mechanical anti-reflux structure of the gastroesophageal junction are the basis of the anti-reflux function of the stomach. Proximal gastrectomy destroys the mechanical structure and normal electrophysiological channels of the anti-reflux. Therefore, the residual gastric function is disordered. Moreover, gastroesophageal reflux is one of the most serious complications. The emergence of various types of anti-reflux surgery through the mechanism of reconstructing mechanical anti-reflux barrier and establishing buffer zone, and the preservation of, the pacing area and vagus nerve of the stomach, the continuity of the jejunal bowel, the original gastroenteric electrophysiological activity of the gastrointestinal tract, and the physiological function of the pyloric sphincter, are all important measures for gastric conservative operations. There are many types of reconstructive approaches after proximal gastrectomy. The design based on the anti-reflux mechanism and the functional reconstruction of mechanical barrier, and the protection of gastrointestinal electrophysiological activities are important considerations for the selected of reconstructive approaches after proximal gastrectomy. In clinical practice, we should consider the principle of individualization and the safety of radical resection of tumor to select a rational reconstructive approaches after proximal gastrectomy.


Subject(s)
Humans , Stomach Neoplasms/surgery , Gastrectomy , Gastroesophageal Reflux , Esophagogastric Junction/surgery , Pylorus/pathology
3.
Chinese Journal of Gastrointestinal Surgery ; (12): 389-395, 2023.
Article in Chinese | WPRIM | ID: wpr-986804

ABSTRACT

Gastroesophageal reflux disease (GERD) is one of the most common digestive diseases with high incidence, complicated clinical symptoms, difficulties in standard treatment, and heavy medical burden. At present, some GERD-relevant clinical practice guidelines (CPGs) have been issued by different countries and academic organizations, but some recommendations were inconsistent, which has caused some problems for the current clinical whole-course management of GERD. To summarize the relevant evidence among the CPGs on GERD and formulate the whole- course management strategies, we included GERD-relevant CPGs published or updated after 2010 by searching websites of guidelines, relevant professional societies, and electronic databases. We extracted the recommendations and summarized the evidence from the aspects of symptoms, epidemiology, diagnosis and treatment, which was presented in the form of evidence mapping. We included 24 CPGs, including three in Chinese and 21 in English. The clinical practice management strategies of GERD were formulated based on the evidence from the aspects of clinical symptoms, diagnostic methods, medical treatment, anti-reflux surgery and endoscopic treatment, psychological treatment, and traditional Chinese medicine treatment.


Subject(s)
Humans , Gastroesophageal Reflux/therapy
4.
West China Journal of Stomatology ; (6): 243-246, 2023.
Article in English | WPRIM | ID: wpr-981119

ABSTRACT

Dental erosion is characterized by progressively destroyed teeth, which has no relation to bacteria but to chemicals. Some internal factors, such as gastroesophageal reflux induced by bulimia, anorexia, gastrointestinal diseases, or drugs, and external factors, such as diet, drugs, and occupational acid exposure, are considered promotive factors for this disease. This article presents a patient suffering from severe dental erosion in the whole dentition, especially in the maxillary teeth, due to gastroesophageal reflux induced by glucocorticoid therapy for optic neuritis. This article discusses the mechanism between optic neuritis glucocorticoid therapy and dental erosion.


Subject(s)
Humans , Glucocorticoids/therapeutic use , Tooth Erosion/therapy , Gastroesophageal Reflux/complications
5.
Article in Portuguese | LILACS, CONASS, ColecionaSUS, SES-GO | ID: biblio-1426235

ABSTRACT

Tecnologia: Esomeprazol e lansoprazol. Indicação: Tratamento de doença do refluxo gastroesofágico em adultos. Pergunta: Esomeprazol e lansoprazol são mais eficazes e toleráveis que o omeprazol já incorporado ao SUS para o tratamento de Doença do Refluxo Gastroesofágico (DRGE) em adultos? Métodos: Uma revisão rápida de evidências, uma revisão de revisões sistemáticas, com levantamento bibliográfico realizado na base de dados PUBMED, utilizando estratégia estruturada de busca. A qualidade metodológica das revisões sistemáticas foi avaliada com AMSTAR-2 (Assessing the Methodological Quality of Systematic Reviews). Resultados: Foram selecionadas três revisões sistemáticas com meta-análise, que atendiam aos critérios de inclusão. Conclusão: O esomeprazol era mais eficaz para cicatrização da lesão nos casos de esofagite erosiva, prevenção da mucosa do esôfago, maior controle de ácido no tratamento de curto prazo (4 e 8 semanas) de esomeprazol 40mg e tratamento de longo prazo (6 meses) de esomeprazol 20mg. A taxa de resposta no alívio dos sintomas, o esomeprazol 20mg e 40mg apresentou ser mais eficaz, especialmente, na azia e dor epigástrica. Quanto ao perfil de segurança, não houve diferença significativa entre as taxas de eventos adversos, todos medicamentos eram parecidos entre si


Technology: Esomeprazole and Lansoprazole. Indication: Treatment of gastroesophageal reflux disease in adults. Question: Are Esomeprazole and Lansoprazole more effective and tolerable than omeprazole already incorporated into SUS for the treatment of Gastroesophageal Reflux Disease (GERD) in adults? Methods: A rapid review of evidence, an overview of systematic reviews, with bibliographic survey carried out in the PUBMED database, using a structured search strategy. The methodological quality of systematic reviews was assessed using AMSTAR-2 (Assessing the Methodological Quality of Systematic Reviews). Results: Three systematic reviews with meta-analysis were selected, which met the inclusion criteria. Conclusion: Esomeprazole was more effective in achieving wound healing in cases of erosive esophagitis, prevention of esophageal mucosa, greater acid control in short-term treatment (4 and 8 weeks) of esomeprazole 40mg and long-term treatment (6 months) of esomeprazole 20mg. the response rate in symptom relief, esomeprazole 20mg and 40mg proved to be more effective, especially in heartburn and epigastric pain. As for the safety profile, there was no significant difference between the rates of adverse events, all drugs were similar to each other


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Omeprazole/therapeutic use , Gastroesophageal Reflux/drug therapy , Esomeprazole/therapeutic use , Lansoprazole/therapeutic use , Esophagitis/drug therapy , Comparative Effectiveness Research
6.
Psicol. ciênc. prof ; 43: e262262, 2023. tab
Article in Portuguese | LILACS, INDEXPSI | ID: biblio-1529218

ABSTRACT

As restrições impostas pela pandemia de covid-19 levaram os serviços de saúde a reorganizarem seu funcionamento, ajustando-se à modalidade remota. A transição repentina e sem o devido preparo técnico impôs desafios adicionais para usuários e profissionais. Para aprimorar as estratégias assistenciais, torna-se imprescindível dar voz aos usuários dos serviços, para que narrem suas experiências e possam manifestar suas facilidades e dificuldades com essa passagem. Este estudo tem como objetivo investigar como os principais cuidadores familiares de pessoas com transtornos alimentares vivenciaram a transição do grupo de apoio para o formato remoto e identificar vantagens e desvantagens percebidas nesse modelo. Estudo clínico-qualitativo, exploratório, realizado em um serviço de atendimento especializado de um hospital terciário. O cenário investigado foi o grupo de apoio psicológico aberto a familiares que, desde o início da pandemia de covid-19, passou a ser oferecido na modalidade online. Participaram do estudo cinco mães e três pais presentes em 13 sessões grupais consecutivas. Entrevistas individuais foram aplicadas com a Técnica do Incidente Crítico logo após o término de cada encontro grupal, totalizando 26 entrevistas audiogravadas, transcritas e submetidas à análise temática. A transição para o online foi vivenciada pelos participantes como um recurso válido para permitir que o grupo funcionasse em tempos de grave crise sanitária. Como vantagens, foram mencionadas: a continuidade do cuidado, maior acessibilidade e facilidade em relação à logística da participação. Como limitações do formato online, foram destacadas: nem todos os familiares contam com conexão de internet de qualidade e possível dificuldade para manusear a tecnologia digital. Apesar dos desafios impostos pela súbita mudança para a modalidade online, na perspectiva dos usuários do serviço os esforços de adaptação foram bem-sucedidos, possibilitando a continuidade do cuidado à saúde mental.(AU)


The constraints imposed by the COVID-19 pandemic led health services to reorganize their operation, adjusting to the online modality. The sudden and unprepared technical transition has imposed additional challenges for both users and professionals. To improve care strategies, it is essential to give voice to services users, so that they can narrate their experiences and express their facilities and difficulties with this transition. This study aims to investigate how main family caregivers of people with eating disorders experienced the transition of the support group to the remote modality and to identify perceived advantages and disadvantages in this model. This is a clinical-qualitative, exploratory study carried out in a specialized care service of a tertiary hospital. The investigated setting was the psychological support group open to family members, which since the beginning of the COVID-19 pandemic has been offered online. Five mothers and three fathers who attended 13 consecutive group sessions participated in the study. Individual interviews were carried out with the Critical Incident Technique shortly after the end of each group meeting with all members, totaling 26 audio-recorded interviews. Data were subjected to thematic analysis. Transition was experienced as a valid resource to maintain the group active in times of a severe health crisis. As advantages of the remote modality were mentioned: continuity of care, greater accessibility, and ease in relation to the logistics of participation. As limitations of the online format were highlighted: not everyone has a good-quality connection to the internet, and difficulty in handling the digital technology. Despite the challenges imposed by the sudden shift to the online modality, from the service users' perspective the adaptation efforts were successful, enabling continuity of mental health care.(AU)


Las limitaciones que impuso la pandemia de la COVID-19 llevaron a los servicios sanitarios a reorganizar su funcionamiento adaptándose a la modalidad remota. El súbito cambio y sin la preparación técnica adecuada implicó retos adicionales a los usuarios y profesionales. Para mejorar las estrategias de atención es fundamental dar voz a los usuarios de los servicios, para que puedan narrar sus experiencias y expresar sus facilidades y dificultades con esta transición. Este estudio pretende investigar cómo han vivido los cuidadores de personas con trastornos alimentarios la transición del grupo de apoyo presencial al formato remoto e identificar las ventajas y desventajas percibidas en este modelo. Se trata de un estudio clínicocualitativo, exploratorio. El escenario investigado fue el grupo de apoyo psicológico abierto a los familiares en la modalidad en línea. Cinco madres y tres padres participaron en 13 sesiones de grupo consecutivas. Se realizaron entrevistas individuales con la técnica de incidentes críticos inmediatamente después de cada reunión del grupo, con un total de 26 entrevistas grabadas en audio, transcritas y sometidas a análisis temático. La transición a la red fue experimentada como un recurso válido para permitir que el grupo funcione en tiempos de crisis sanitaria grave. Las ventajas de la modalidad remota fueron conexión segura en tiempos de confinamiento físico, continuidad, mayor accesibilidad y facilidad en relación con la logística de la participación. Las limitaciones del formato en línea fueron la falta de una conexión de calidad a Internet y la posible dificultad de manejo de la tecnología digital. A pesar de las dificultades impuestas por el cambio repentino a la modalidad en línea, desde la perspectiva de los usuarios del servicio los esfuerzos de adaptación fueron un éxito, lo que permitió seguir con la atención de salud mental.(AU)


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Parents , Self-Help Groups , Feeding and Eating Disorders , Caregivers , COVID-19 , Anxiety , Patient Care Team , Patients , Psychology , Psychopathology , Quality of Life , Rejection, Psychology , Respiratory Tract Infections , Self-Assessment , Self Concept , Social Isolation , Social Support , Stress, Physiological , Stress, Psychological , Therapeutics , Thinness , Vomiting , Women , Behavior Therapy , Body Image , Body Weight , Food and Nutrition Education , Adaptation, Psychological , Career Mobility , Biological Factors , Anorexia , Gastroesophageal Reflux , Bulimia , Anorexia Nervosa , Crowding , Efficacy , Adolescent , Employment, Supported , Suicide, Assisted , Interview , Compulsive Behavior , Privacy , Feeding and Eating Disorders of Childhood , Counseling , Cultural Characteristics , Death , Depression , Diagnosis , Diet , Diuretics , Educational Status , Environment and Public Health , Renal Insufficiency , Bulimia Nervosa , Laxatives , Family Conflict , Fear , Feeding Behavior , Ideal Body Weight , Binge-Eating Disorder , Pandemics , Social Networking , Patient Care Bundles , Nutritionists , Clinical Study , Perfectionism , Psychosocial Support Systems , Food Addiction , Systematic Review , Sadness , Information Technology Management , Avoidant Restrictive Food Intake Disorder , Gastrointestinal Diseases , Psychological Distress , Weight Prejudice , Teleworking , Physical Distancing , Psychotherapists , Orthorexia Nervosa , Social Structure , Sociodemographic Factors , Family Support , Guilt , Health Facility Moving , Learning , Mass Media , Mental Disorders , Neurotic Disorders , Obesity
7.
Psicol. USP ; 342023. ilus
Article in Portuguese | LILACS, INDEXPSI | ID: biblio-1443306

ABSTRACT

O presente artigo problematiza aspectos afetivos inerentes à relação materno-filial que podem estar associados ao surgimento e estabelecimento de sintomas psicossomáticos de refluxo gastroesofágico no bebê de até 1 ano de idade. Para tanto, apresenta-se estudo de caso de uma díade mãe-bebê auxiliado por entrevista semiestruturada, aplicação das pranchas 1, 2 e 7MF do teste de apercepção temática e observação naturalista. Cada instrumento foi analisado qualitativamente e teve seus resultados integrados e articulados à teoria psicanalítica. Os principais resultados apontaram certa fragilidade egóica e necessidade de apoio social por parte da mãe, compatíveis com o período do puerpério. São discutidas possíveis maneiras de funcionamento do psiquismo materno, por exemplo, quando sobrecarregado com afetos ansiosos, há sobredeterminação de sintomas psicofuncionais no bebê, os quais, por sua vez, causam efeitos no modo como a mãe se posiciona no exercício da maternagem suficientemente boa, marcando um interjogo relacional


This article discusses affective aspects inherent to mother-child relations that may be associated with the onset and establishment of psychosomatic gastroesophageal reflux symptoms in infants up to 1 year old. A case study of a mother-child dyad was performed by conducting semi-structured interviews, applying the 1, 2 and 7MF cards of the Thematic Apperception Test and using naturalistic observation. Instruments were analyzed qualitatively and their results were integrated and linked to psychoanalytic theoretical framework. Results pointed to a certain egoic fragility and the need for social support for the mother compatible with the puerperium. It also discusses possible ways in which the maternal psyche functions. When overloaded with anxious affections, for example, it overdetermines psychofunctional symptoms in the baby which, in turn, affects how the mother positions herself in the exercise of good maternity, marking a relational interplay


Cet article traite des aspects affectifs inhérents aux relations mère-enfant qui peuvent être associés à l'émergence et à l'installation de symptômes psychosomatiques de reflux gastro-œsophagien chez les nourrissons jusqu'à l'âge d'un an. Une étude de cas d'une dyade mère-enfant a été réalisée en menant des entretiens semi-structurés, en appliquant les planches 1, 2 et 7MF du Test d'Aperception Thématique et en utilisant l'observation naturaliste. Les instruments ont été analysés qualitativement et leurs résultats ont été intégrés et reliés au cadre théorique psychanalytique. Les résultats ont mis en évidence une certaine fragilité égoïque et le besoin d'un soutien social pour la mère compatible avec la puerpéralité. L'étude aborde également les modes de fonctionnement possibles de la psyché maternelle. Lorsque celle-ci est surchargée d'affections anxieuses, elle surdétermine des symptômes psychofonctionnels chez le bébé qui, à leur tour, affectent la façon dont la mère se positionne dans l'exercice d'une maternité suffisamment bonne, marquant une interaction relationnelle


Este artículo discute aspectos afectivos inherentes a la relación madre-hijo que pueden estar asociados con la aparición y establecimiento de síntomas psicosomáticos del reflujo gastroesofágico en el bebé de hasta 1 año de edad. Para ello, se realiza un estudio de caso de una díada madre-hijo, con la aplicación de entrevistas semiestructuradas, con el uso de los tableros 1, 2 y 7MF del Test de Apercepción Temática y una observación naturalista. Los instrumentos se analizaron cualitativamente, y sus resultados se integraron y vincularon al marco teórico psicoanalítico. Los principales resultados apuntaban a una cierta fragilidad egoica y la necesidad de apoyo social de la madre, compatibles con el puerperio. Se discuten posibles formas de funcionamiento de la psique materna, por ejemplo, cuando se sobrecarga de afectos ansiosos, sobredeterminando síntomas psicofuncionales en el bebé que, a su vez, provocan efectos sobre cómo se siente la madre en el ejercicio de una maternaje suficiente buena, marcando una interacción relacional


Subject(s)
Humans , Male , Female , Infant , Adult , Psychosomatic Medicine , Gastroesophageal Reflux/psychology , Mother-Child Relations/psychology , Social Support , Thematic Apperception Test
8.
Braz. j. oral sci ; 22: e230282, Jan.-Dec. 2023. tab
Article in English | LILACS, BBO | ID: biblio-1510253

ABSTRACT

Aim: Evaluate the roughness, microhardness and color change of different Bulk Fill resins when submitted to the condition of gastroesophageal reflux and bulimia. Methods: 60 specimens (n = 10) of Bulk-Fill composite resins were made: M1 ­ Filtek™; M2 ­ Tetric N-Ceram and M3 ­ OPUS, through a matrix 2x6 mm and light cured by the VALO light source. After polishing, initial analyzes (48 hours - T0) of surface roughness (Ra), microhardness (VHN) and color change (ΔE) were performed. To simulate the oral condition of severe gastroesophageal reflux and bulimia, the specimens were immersed in hydrochloric acid (S1) (pH 1.7) 4 minutes a day, for 7 days. Control group specimens were immersed in artificial saliva (S2). Subsequently to immersions, mechanical brushing was performed for 3 minutes, three times a day, simulating 7 days of brushing. And again, the analyzes of Ra, VHN and ΔE were performed (7 days - T1). Thus, hydrochloric acid immersion, mechanical brushing and Ra analysis were repeated at 14 days (T2) and 21 days (T3); and T2, T3 and T4 (3 years) for VHN and ΔE. Results: After Shapiro-Wilk statistical test, ANOVA and Tukey test with Bonferroni adjustment (p>0.05), M3 showed the lowest Ra at all times compared to the other resins, while the highest Ra was at T0. M1 and T1 showed higher VHN. And M2 and T4 showed higher ΔE. Conclusion: Bulk Fill resins can be indicated for patients with Gastroesophageal Reflux and Bulimia, nonetheless, Tetric N-Ceram resin showed the worst results


Subject(s)
Color , Composite Resins , Hardness , Hydrochloric Acid , Gastroesophageal Reflux , Bulimia
9.
Article in Spanish | LILACS | ID: biblio-1418763

ABSTRACT

El término BRUE describe un evento en un lactante menor, repentino, breve, ya resuelto y sólo aplica cuando no existe una explicación para este episodio. Es escasa la literatura nacional e internacional sobre el estudio etiológico en BRUE. Objetivos: Caracterizar lactantes con episodio de BRUE y hacer un análisis etiológico. Métodos: Estudio retrospectivo, descriptivo lactantes hospitalizados por BRUE. Resultados: Se encontraron 50 lactantes con BRUE, la mayoría de ellos presentó un solo evento y ninguno requirió reanimación cardiopulmonar. Las características principales de los eventos fueron apnea, cianosis y tono disminuido. Las etiologías encontradas, más habituales, fueron reflujo gastro-esofágico, infección respiratoria, mala técnica alimentaria y crisis epilépticas. La evaluación clínica fue el principal elemento diagnóstico. Discusión: Nuestro análisis etiológico concuerda con la literatura nacional e internacional. La anamnesis y examen físico son la principal herramienta diagnóstica. Es fundamental contar con guías, adaptadas a la realidad nacional y local, que dirijan el estudio de lactantes con BRUE.


BRUE is an event occurring in an infant when the observer reports a sudden, brief, and now-resolved episode. BRUE is a diagnosis of exclusion and is used only when there is no explanation for the event after conducting an appropriate history and physical examination. There is little literature on the etiological study in BRUE. Objectives: To characterize infants with a BRUE episode and to carry out an etiological analysis. Methods: A retrospective study including infants who have experienced a BRUE between the years 2017 to 2020. Results: 50 infants with BRUE, most of them presented a single event and none required cardiopulmonary resuscitation. The main characteristics of the events were apnea, cyanosis and decreased tone. The most common etiologies found were gastroesophageal reflux, respiratory infection, poor feeding technique, and seizures. History and physical examination are the fundamental diagnostic tools. Discussion: Our etiological analysis agrees with the national and international literature. The clinical evaluation was the main diagnostic tool. It is essential to create local guidelines for the evaluation investigation and management of infants with BRUE.


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Brief, Resolved, Unexplained Event/etiology , Apnea/complications , Gastroesophageal Reflux/complications , Retrospective Studies , Epilepsy/complications
10.
Rev. cir. (Impr.) ; 74(1): 81-87, feb. 2022. tab
Article in Spanish | LILACS | ID: biblio-1388922

ABSTRACT

Resumen Durante las últimas 2 décadas se han desarrollado una serie de nuevos tratamientos endoscópicos para el tratamiento de la enfermedad por reflujo gastroesofágico (ERGE) como alternativas al tratamiento médico o funduplicatura quirúrgica. Estos dispositivos incluyen aplicación de tratamiento por radiofrecuencia (Stretta), plicatura endoscópica (EndoCinch, Plicator, Esophyx, MUSE) e inyección o implantación de biomateriales (Enteryx, Gatekeeper, Plexiglas, Duragel). Su objetivo es el alivio de los síntomas creando una barrera anatómica antirreflujo. En esta revisión del tema consideramos artículos indexados en Pubmed, Medline y Scielo en los últimos 10 años revisando un total de 55 trabajos. Evaluamos críticamente los resultados reportados, faltan datos a largo plazo superiores a 10 años. Estos procedimientos reducen el uso de inhibidores de la bomba de protones en cerca del 50%. Evaluaciones subjetivas reportan mejoría de la calidad de vida y satisfacción del paciente. Sin embargo, la evaluación objetiva con endoscopia, manometría, radiología y pHmetría son escasos y si los hay, no muestran cambios significativos. No existe evidencia convincente para adoptar estos métodos como tratamiento definitivo y, por lo tanto, la fundoplicatura por vía laparoscópica sigue siendo el estándar de oro para el tratamiento de la enfermedad por reflujo gastroesofágico.


During the last 2 decades, new endoscopic treatments have been developed for the treatment of gastroesophageal reflux disease (GERD) as alternatives to medical treatment or surgical fundoplication. These devices include application of radiofrequency treatment (Stretta), endoscopic plication (EndoCinch, Plicator, Esophyx, MUSE) and injection or implantation of biomaterials (Enteryx, Gatekeeper, Plexiglas, Duragel). Its objective is the relief of symptoms by creating an anatomical anti-reflux barrier. In this review, we consider articles indexed in Pubmed, Medline and Scielo in the last 10 years, reviewing a total of 55 papers, we analyse critically the reported results, although long-term data greater than 5 or 7 years are lacking. These procedures reduce the use of proton pump inhibitors by about 50%. Subjective evaluations report improvement in quality of life and patient satisfaction. However, objective evaluation with endoscopy, manometry, radiology and pHmetry are scarce and if there are, they do not show significant changes. There is no convincing evidence to adopt these methods as definitive treatment. Therefore, laparoscopic fundoplication is the gold standard for the treatment of gastroesophageal reflux disease.


Subject(s)
Humans , Gastroesophageal Reflux/diagnosis , Gastroesophageal Reflux/therapy , Fundoplication , Endoscopy , Endoscopic Mucosal Resection , Radiofrequency Therapy
11.
Braz. j. biol ; 82: 1-7, 2022. ilus, tab
Article in English | LILACS, VETINDEX | ID: biblio-1468448

ABSTRACT

Several studies emphasize the use of owl pellets in small mammal inventories in natural areas harboring high richness of rare species, but few Brazilian Atlantic forest localities have been surveyed by this method. The present study documents the species composition and abundance of small mammals in the diet of Tyto furcata in an urban area of the municipality of Campos dos Goytacazes, Rio de Janeiro, Brazil, remarking on a new record of the dwarf mouse opossum genus Cryptonanus in the Atlantic forest. We analyzed 265 pellets regurgitated by a pair of T. furcata from November 2016 to September 2017 found in a nesting box. Analysis of the samples enabled finding a total of 596 individuals of four small mammal species. Mus musculus was predominant among the prey items (98.3%), while the native rodents Necromys lasiurus (1.3%) and Holochilus brasiliensis (0,17%) were much rarer. A single specimen of Cryptonanus sp. was identified among the diet items based on distinctive dental characters. The identification of this genus in the present study represents the second record in the state of Rio de Janeiro, and the sixth in the Atlantic Forest biome, suggesting that this marsupial occupies a wider ecological and biogeographic range. The present study underscores the relevance of owl pellets for small mammal surveys, even in urban and highly disturbed areas.


Vários estudos enfatizam o uso de pelotas de coruja em inventários de pequenos mamíferos em áreas naturais com elevada riqueza de espécies raras, mas poucas localidades da Mata Atlântica brasileira têm sido inventariadas por esse método. O presente estudo documenta a composição de espécies e abundância de pequenos mamíferos na dieta de Tyto furcata em uma área urbana do município de Campos dos Goytacazes, Rio de Janeiro, Brasil, discutindo a relevância de um novo registro de um raro marsupial do gênero Cryptonanus na Mata Atlântica. Foram analisadas 265 pelotas regurgitadas por um casal de T. furcata entre novembro de 2016 e setembro de 2017, encontradas abaixo de uma caixa de nidificação. A análise das amostras permitiu encontrar o total de 596 indivíduos de quatro espécies pequenas de mamíferos. O roedor exótico Mus musculus foi predominante entre os itens alimentares (98,3%), enquanto os roedores nativos Necromys lasiurus (1,3%) e Holochilus brasiliensis (0,17%) foram bem mais raros. Um único espécime de Cryptonanus sp. foi identificado entre os itens com base em caracteres dentários. A identificação desse gênero no presente estudo representa o segundo registro no estado do Rio de Janeiro e o sexto no bioma Mata Atlântica, sugerindo que este marsupial ocupa uma ampla faixa ecológica e biogeográfica. O presente estudo destaca a relevância dos pellets de coruja para pesquisas com pequenos mamíferos, mesmo em áreas urbanas e altamente perturbadas.


Subject(s)
Animals , Diet/veterinary , Strigiformes , Marsupialia , Gastroesophageal Reflux/veterinary , Mice
12.
Philippine Journal of Health Research and Development ; (4): 20-30, 2022.
Article in English | WPRIM | ID: wpr-987204

ABSTRACT

Objectives@#This study aimed to determine the prevalence of gastro-esophageal reflux disease (GERD) in Filipino patients on maintenance hemodialysis (HD) and investigate the demographic, clinical, and renal profiles of HD patients with and without GERD. @*Methodology@#This was a cross-sectional, multicenter study using a validated GERD questionnaire (GERDQ) with a Filipino translation. Patients above 18 years-old undergoing hemodialysis as outpatients were included. A GERDQ score of ≥8 was regarded as having GERD. Logistic regression analysis was conducted using variables that exhibited a significant correlation coefficient on two group comparisons as factors, with the presence or absence of GERD as the dependent variable. @*Results@#Included in our analysis were 264 patients, from which 36 had a GERDQ score of ≥8 (13.64% 95%CI 9.98-18.35). Factors associated with having a score of ≥8 include the following: (1) having CHD (COR 4.041, 95%CI 1.89-8.64, p<0.001), (2) being on insulin (COR 2.599, 95%CI 1.25-5.42, p=0.011), (3) anemia (COR 4.508, 95%CI 1.91-10.64, p=0.001), (4) diagnosis of both HTNKD and DKD (COR 3.853, 95%CI 1.15-12.96, p=0.029), (5) previous diagnosis of GERD (COR 6.655, 95%CI 3.18-13.91, p<0.001), (6) previous intake of antacids (COR 2.622, 95%CI 1.17-5.89, p=0.020), (7) those employed (COR 2.332, 95%CI 1.15-4.75, p=0.020), (8) alcohol consumption (COR 2.477, 95%CI 1.23-5.01, p=0.012), and (9) smoking (COR 2.405, 95%CI 1.19-4.86, p=0.014). @*Conclusion@#The prevalence of GERD in Filipino HD patients from three centers in Tarlac City was 13.64% and may be associated with several clinical factors such as heart disease, insulin use, anemia, hypertensive and diabetic kidney disease, previous diagnosis of GERD, use of antacids, with employment, smoking, and alcohol use. A comprehensive understanding of the relationship among these clinical factors awaits further studies in a larger number of patients.


Subject(s)
Prevalence , Gastroesophageal Reflux , Renal Insufficiency, Chronic , Renal Dialysis
13.
Philippine Journal of Internal Medicine ; : 278-286, 2022.
Article in English | WPRIM | ID: wpr-961140

ABSTRACT

Introduction@#Reflux is one of the most common gastrointestinal symptoms among dialysis patients. This may be associated with several clinical factors such as comorbidities and subsequent polypharmacy. However, this remains unrecognized and untreated.@*Objectives@# The objectives of this study were to determine the prevalence of Gastroesophageal Reflux Disease (GERD) in Filipino patients on maintenance hemodialysis (HD) and to investigate associated demographic, clinical, and renal profiles of HD patients with and without GERD.@*Methods@#This was a cross-sectional, multicenter study using a validated GERD questionnaire (GERDQ) translated into Filipino. Patients above 18 years old undergoing hemodialysis as outpatients were included. Several clinical factors such as demographic, clinical, and renal profiles were analyzed based on the absence and presence of GERD with a predetermined cut-off value of eight or above.@*Results@#Included in our analysis were 264 patients, from which 36 had GERDQ score of ≥ 8 (13.64% 95%CI 9.98-18.35). Factors associated with having score of ≥ 8 included the following: (1) having chronic heart disease or CHD (COR 4.041, 95%CI 1.89-8.64, p<0.001), (2) being on insulin (COR 2.599, 95%CI 1.25-5.42, p=0.011), (3) anemia (COR 4.508, 95%CI 1.91-10.64, p=0.001) (4) diagnosis of both hypertensive kidney disease and diabetes kidney disease (COR 3.853, 95%CI 1.15-12.96, p=0.029), (5) previous diagnosis of GERD (COR 6.655, 95%CI 3.18-13.91, p<0.001), (6) previous intake of antacids (COR 2.622, 95%CI 1.17-5.89, p=0.020), (7) being employed (COR 2.332, 95%CI 1.15-4.75, p=0.020) (8) alcohol consumption (COR 2.477, 95%CI 1.23-5.01, p=0.012), and (9) smoking (COR 2.405, 95%CI 1.19-4.86, p=0.014).@*Conclusion@#In our study, the prevalence of GERD in Filipino HD patients was 13.64% and may be associated with several clinical factors such as heart disease, insulin use, anemia, hypertension, diabetic kidney disease, previous diagnosis of GERD, use of antacids, being employed, smoking, and alcohol use. A comprehensive understanding of the relationships between these clinical factors awaits further studies in a larger number of patients.


Subject(s)
Gastroesophageal Reflux , Renal Insufficiency, Chronic , Renal Dialysis
14.
Annals of the Academy of Medicine, Singapore ; : 263-271, 2022.
Article in English | WPRIM | ID: wpr-927486

ABSTRACT

INTRODUCTION@#Infant gastroesophageal reflux disease (GERD) is a significant cause of concern to parents. This study seeks to describe GERD prevalence in infants, evaluate possible risk factors and assess common beliefs influencing management of GERD among Asian parents.@*METHODS@#Mother-infant dyads in the Singapore PREconception Study of long-Term maternal and child Outcomes (S-PRESTO) cohort were prospectively followed from preconception to 12 months post-delivery. GERD diagnosis was ascertained through the revised Infant Gastroesophageal Reflux Questionnaire (I-GERQ-R) administered at 4 time points during infancy. Data on parental perceptions and lifestyle modifications were also collected.@*RESULTS@#The prevalence of infant GERD peaked at 26.5% at age 6 weeks, decreasing to 1.1% by 12 months. Infants exclusively breastfed at 3 weeks of life had reduced odds of GERD by 1 year (adjusted odds ratio 0.43, 95% confidence interval 0.19-0.97, P=0.04). Elimination of "cold or heaty food" and "gas producing" vegetables, massaging the infant's abdomen and application of medicated oil to the infant's abdomen were quoted as major lifestyle modifications in response to GERD symptoms.@*CONCLUSION@#Prevalence of GERD in infants is highest in the first 3 months of life, and the majority outgrow it by 1 year of age. Infants exclusively breastfed at 3 weeks had reduced odds of GERD. Cultural-based changes such as elimination of "heaty or cold" food influence parental perceptions in GERD, which are unique to the Asian population. Understanding the cultural basis for parental perceptions and health-seeking behaviours is crucial in tailoring patient education appropriately for optimal management of infant GERD.


Subject(s)
Female , Humans , Infant , Infant, Newborn , Male , Gastroesophageal Reflux/epidemiology , Parents/psychology , Prevalence , Risk Factors , Singapore/epidemiology
15.
Chinese Journal of Gastrointestinal Surgery ; (12): 466-470, 2022.
Article in Chinese | WPRIM | ID: wpr-936104

ABSTRACT

With the increasing detection rate of early upper gastric cancer and adenocarcinoma of esophagogastric junction, the safety of proximal gastrectomy with clear indications has been verified, and function-preserving proximal gastrectomy has been widely used. However, proximal gastrectomy destructs the normal anatomical structure of esophagogastric junction, resulting in severe postoperative gastroesophageal reflux symptoms and seriously affecting the quality of life. Among various anti-reflux surgery methods, reconstruction of "cardiac valve" has always been the focus of relevant scholars because its similarity with the mechanism of normal anti-reflux. After years of development, evolution and optimization, the designed seromuscular flap anastomosis includes tunnel muscle flap anastomosis, Hatafuku valvuloplasty, single muscle flap anastomosis and double muscle flap anastomosis. The double muscle flap anastomosis has become a research hotspot because it shows good anti-reflux effect in clinical application. This paper reviews the history, research status and hot issues of seromuscular flap anastomosis of esophageal remnant stomach at home and abroad.


Subject(s)
Humans , Anastomosis, Surgical/methods , Esophagogastric Junction/surgery , Gastrectomy/methods , Gastroesophageal Reflux/surgery , Quality of Life , Stomach Neoplasms/surgery
16.
Chinese Journal of Gastrointestinal Surgery ; (12): 447-453, 2022.
Article in Chinese | WPRIM | ID: wpr-936101

ABSTRACT

Objective: To investigate the functional outcomes and postoperative complications of Cheng's GIRAFFE reconstruction after proximal gastrectomy. Methods: A descriptive case series study was conducted. Clinical data of 100 patients with adenocarcinoma of the esophagogastric junction who underwent Cheng's GIRAFFE reconstruction after proximal gastrectomy in Cancer Hospital of University of Chinese Academy of Sciences (64 cases), Zhejiang Provincial Hospital of Chinese Medicine (24 cases), Lishui Central Hospital (10 cases), Huzhou Central Hospital (1 case) and Ningbo Lihuili Hospital (1 case) from September 2017 to June 2021 were retrospectively analyzed. Of 100 patients, 64 were males and 36 were females; the mean age was (61.3 ± 11.1) years and the BMI was (22.7±11.1) kg/m(2). For TNM stage, 68 patients were stage IA, 24 were stage IIA and 8 were stage IIB. Postoperative functional results and postoperative complications of radical gastrectomy with Giraffe reconstruction were analyzed and summarized. Gastroesophageal reflux disease questionnaire (RDQ) score and postoperative endoscopy were used to evaluate the occurrence of reflux esophagitis and its grade (grade N, grade A, grade B, grade C, and grade D from mild to severe reflux). The continuous data conforming to normal distribution were expressed as (mean ± standard deviation), and those with skewed distribution were presented as median (Q1, Q3). Results: All the 100 patients successfully completed R0 resection, including 77 patients undergoing laparoscopic surgery and 23 patients undergoing laparotomy. The Giraffe anastomosis time was (38.6±14.0) min; the blood loss was (73.0±18.4) ml; the postoperative hospital stay was 9.5 (8.2, 13.0) d; the hospitalization cost was (6.0±0.3) ten thousand yuan. Fourteen cases developed perioperative complications (14.0%), including 7 cases of pleural effusion or pneumonia, 3 cases of anastomotic leakage, 2 cases of gastric emptying disorder, 1 case of gastrointestinal hemorrhage and 1 case of anastomotic stenosis, who were all improved and discharged after symptomatic management. Patients were followed up for (33.3±1.6) months. Eight patients were found to have reflux symptoms by RDQ scale six months after surgery, and 11 patients (11/100,11.0%) were found to have reflux esophagitis by gastroscopy, including 6 in grade A, 3 in grade B, and 2 in grade C. All the patients could control their reflux symptoms with behavioral guidance or oral PPIs. Conclusion: Cheng's GIRAFFE reconstruction has good anti-reflux efficacy and gastric emptying function; it can be one of the choices of reconstruction methods after proximal gastrectomy.


Subject(s)
Aged , Female , Humans , Male , Middle Aged , Adenocarcinoma/surgery , Esophageal Neoplasms/surgery , Esophagitis, Peptic/etiology , Esophagogastric Junction/surgery , Gastrectomy/methods , Gastroesophageal Reflux/etiology , Laparoscopy , Plastic Surgery Procedures/methods , Recovery of Function , Retrospective Studies , Stomach Neoplasms/surgery
17.
Ethiop. j. health dev. (Online) ; 36(2): 1-7, 2022-06-07. Tables
Article in English | AIM | ID: biblio-1379849

ABSTRACT

Background:An abnormality that causes reflux is termed as Gastroesophageal reflux disease (GERD), which is symptomatic by nature and adds to the long-term effects.Objective:The aim of this study is to observe and monitor the effects of a herbal ttratment of GERD with SiniZuojin Decoction (SNZID)and to assess its mediation impacts regarding the use of the medication in patients with Gastrointestinal EBB ailment.Materials and Methods:The cohort research methodology was used inthe study.The research included 2581 individual patients who were older than 18 years of age and were suffering from Gastrointestinal ebbailment. The patients were selected from various government herbal clinics in eastern China, including the states of Anhui, Fujian, Jiangsu, Jiangxi, Shandong, and Zhejiangover, from 2008 to 2018. Results:The study was conducted with a total of 2581 patients. The thorough assessment indicated that Sini Zuojin Decoction (SZD)notwithstanding standard stomach remedies pack was more effective than the traditionalist stomach suppositories bundle (RR=1.34, with CI=95% [1.47, 1.38], and P-value = 0.008); Test packs including SZD was essentially better contrasted with traditional stomach medicines(TSM)gearshifts in developing dyspepsia, substernal chest plague, decreasing regurgitation, and vomiting (P < 0.0002); SNZJD plus traditional stomach medicines(SPTSM)could by and large lessen full-scale sign scores with liberal ampleness (P < 0.00002). The replication degree and antagonistic effects regarding Sacroiliac Joint Dysfunction(SJD)treatment were basic. As confirmed through the TSA regarding thorough assessment, the results were significant, yet repeat security consequences were uncertain. As shown by the computation of the Grading of Recommendations Assessment, Development and Evaluation(GRADE)strategy, the idea regarding verification was minimal. Moreover, Schizoaffective disorder(SZD)may treat Gastrointestinal ebb ailment by presenting the onsetof the infection and controlling factors that may contribute to Gastrointestinal ebb ailments.Conclusion:The research evaluated the efficiency of Sini Zuojin Decoction in treating patients suffering from Gastrointestinal Ebb Ailments. [Ethiop. J. Health Dev.2022: 36(2) (00-00)]Keywords:GERD, Esophagitis, Sini Zuojin Decoction(SZD), Gastrointestinal ebb ailment;


Subject(s)
Patients , Stomach Diseases , Gastroesophageal Reflux , Gastrointestinal Diseases , Vomiting , Esophagitis, Peptic
18.
Ethiop. j. health dev. (Online) ; 36(2): 1-7, 2022. tables
Article in English | AIM | ID: biblio-1380470

ABSTRACT

Background:An abnormality that causes reflux is termed as Gastroesophageal reflux disease (GERD), which is symptomatic by nature and adds to the long-term effects.Objective:The aim of this study is to observe and monitor the effects of a herbal ttratment of GERD with SiniZuojin Decoction (SNZID)and to assess its mediation impacts regarding the use of the medication in patients with Gastrointestinal EBB ailment.Materials and Methods:The cohort research methodology was used inthe study.The research included 2581 individual patients who were older than 18 years of age and were suffering from Gastrointestinal ebbailment. The patients were selected from various government herbal clinics in eastern China, including the states of Anhui, Fujian, Jiangsu, Jiangxi, Shandong, and Zhejiangover, from 2008 to 2018. Results:The study was conducted with a total of 2581 patients. The thorough assessment indicated that Sini Zuojin Decoction (SZD)notwithstanding standard stomach remedies pack was more effective than the traditionalist stomach suppositories bundle (RR=1.34, with CI=95% [1.47, 1.38], and P-value = 0.008); Test packs including SZD was essentially better contrasted with traditional stomach medicines(TSM)gearshifts in developing dyspepsia, substernal chest plague, decreasing regurgitation, and vomiting (P < 0.0002); SNZJD plus traditional stomach medicines(SPTSM)could by and large lessen full-scale sign scores with liberal ampleness (P < 0.00002). The replication degree and antagonistic effects regarding Sacroiliac Joint Dysfunction(SJD)treatment were basic. As confirmed through the TSA regarding thorough assessment, the results were significant, yet repeat security consequences were uncertain. As shown by the computation of the Grading of Recommendations Assessment, Development and Evaluation(GRADE)strategy, the idea regarding verification was minimal. Moreover, Schizoaffective disorder(SZD)may treat Gastrointestinal ebb ailment by presenting the onsetof the infection and controlling factors that may contribute to Gastrointestinal ebb ailments.Conclusion:The research evaluated the efficiency of Sini Zuojin Decoction in treating patients suffering from Gastrointestinal Ebb Ailments. [Ethiop. J. Health Dev.2022: 36(2) (00-00)]


Subject(s)
Gastroesophageal Reflux , Duodenogastric Reflux , Therapeutics , Esophagitis , Esophagogastric Junction
19.
Article in Spanish | LILACS, COLNAL | ID: biblio-1413925

ABSTRACT

Introducción: el reflujo laringofaríngeo (RLF) se origina por el flujo retrógrado de contenido gástrico hacia la faringe, pero es una entidad diferente de la enfermedad por reflujo gastroesofágico (ERGE). El objetivo del estudio fue determinar la correlación entre los signos endoscópicos de la fibrolaringoscopia y la videoendoscopia digestiva alta (VEDA). Material y métodos: estudio observacional, retrospectivo y analítico. Se incluyeron pacientes que consultaron por sintomatología de RLF y ERGE. Los hallazgos visualizados por fibrolaringoscopia flexible, VEDA y biopsia de mucosa gástrica de cada paciente se compararon con la prueba de chi-cuadrado (χ²). Se consideró significativo un valor de p ≤ 0,05. Resultados: se incluyeron 318 pacientes entre 18 y 84 años. Se encontró que el 100 % de los pacientes con esofagitis tenía laringitis (p = 0,001); el 100 % de los pacientes con hernia hiatal tenían RLF (p = 0,001); el 97 % de los pacientes con Helicobacter pylori en la mucosa gástrica tenían RLF (p = 0.001). El 71 % de los pacientes con hernia hiatal tenían esofagitis (p = 0,001). Se encontró una asociación lineal entre la edad y la hernia hiatal con la edad y el RLF (p = 0,03). Conclusiones: en este estudio, los signos encontrados en la fibrolaringoscopia tuvieron una asociación estadística con la VEDA. Aproximadamente el 90 % de los pacientes con signos de laringitis tuvo una correlación con algún grado de esofagitis, esófago de Barrett, hernia hiatal y Helicobacter pylori. También se encontró que la laringitis por RLF y la hernia hiatal se relacionaron directamente con el incremento de la edad.


Introduction: Laryngopharyngeal reflux (LPR) is caused by the retrograde flow of gastric contents towards the pharynx, but it is a different entity from gastroesophageal reflux disease (GERD). The objective of the study was to determine the relationship between the endoscopic signs of fiber laryngoscopy and upper gastrointestinal video endoscopy. Material and methods: Observational, retrospective and analytical study. Patients who consulted for LPR and GERD symptoms were included. The findings visualized by flexible fiber laryngoscopy, upper gastrointestinal video endoscopy and gastric mucosal biopsy of each patient were compared with the Chi-square (χ²) test. A value of p ≤ 0.05 is estimated significantly. Results: 318 patients between 18 and 84 years old were included. A relationship was found in 100% of the patients with esophagitis had laryngitis (p = 0.001); 100% of the patients with hiatal hernia had LPR (p = 0.001); 97% of patients with Helicobacter pylori in the gastric mucosal have LPR (p= 0.001); 71% of patients with hiatal hernia had esophagitis (p = 0.001). A linear association was found between age and hiatal hernia with age and LPR. (p = 0.03). Conclusions: In this study, the signs found in fiber laryngoscopy had a statistical association with the upper gastrointestinal video endoscopy. Approximately 90% of patients with signs of laryngitis had correlation with some degree of esophagitis, Barrett's esophagus, hiatal hernia and Helicobacter pylori. It was also found that LPR and hiatal hernia were directly related to increasing age


Subject(s)
Humans , Gastroesophageal Reflux , Esophagitis , Laryngopharyngeal Reflux
20.
Arch. argent. pediatr ; 119(6): S222-S235, dic. 2021. tab, ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-1353097

ABSTRACT

El reflujo gastroesofágico es una situación frecuente en el primer año de vida. En ausencia de signos y síntomas de alarma, se lo considera fisiológico. No requiere estudios y puede ser abordado por el pediatra con medidas no farmacológicas. La enfermedad por reflujo (definidaporsíntomasmolestosocomplicaciones) debe ser manejada por el gastroenterólogo. Los exámenes complementarios tienen indicaciones precisas y el tratamiento incluye medidas no farmacológicas, farmacológicas y quirúrgicas (si fuera necesario). Nuestro objetivo es describir los diferentes métodos diagnósticos, sus indicaciones y limitaciones, así como los recursos terapéuticos disponibles, incluidas las indicaciones y los efectos adversos


Gastro esophageal reflux is a frequent condition in infants. In the absence of warning symptoms and signs, it is considered physiologic. No exam is required and a non-pharmacologic approach can be instituted by pediatricians. Gastro esophageal reflux disease is characterized by troublesome symptoms or complications and should be managed by a pediatric gastroenterologist. Diagnostic tests have accurate indications and treatment includes pharmacologic and non-pharmacologic measures as well as surgery. Our objective is to describe the different diagnostic methods, their indications and limitations as well as the therapeutic resources available, including indications and adverse effects.


Subject(s)
Humans , Infant , Child, Preschool , Child , Adolescent , Gastroesophageal Reflux/diagnosis , Gastroesophageal Reflux/therapy
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