Oesophogeal pH Monitoring for Gastro-Oesophogeal Reflux in Infants and Children

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Long-term oesophageal pH monitoring has become widely accepted as the principle investigation for the diagnosis of gastro-oesophageal reflux pathology, especially in infants and children. Due to the number of publications applying this investigation technique, it has become necessary to standardize the various methodologies. It begins with an account of the embryology, anatomy and innervation of the upper gastrointestinal tract followed by symptoms and pathogenesis as well as an overview of the advantages and ...
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Overview

Long-term oesophageal pH monitoring has become widely accepted as the principle investigation for the diagnosis of gastro-oesophageal reflux pathology, especially in infants and children. Due to the number of publications applying this investigation technique, it has become necessary to standardize the various methodologies. It begins with an account of the embryology, anatomy and innervation of the upper gastrointestinal tract followed by symptoms and pathogenesis as well as an overview of the advantages and disadvantages of different investigation techniques.
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Product Details

  • ISBN-13: 9780471933878
  • Publisher: Wiley, John & Sons, Incorporated
  • Publication date: 6/16/1992
  • Edition number: 1
  • Pages: 266
  • Product dimensions: 6.14 (w) x 9.29 (h) x 0.79 (d)

Table of Contents

Preface
Abbreviations
Introduction: Why monitor the pH in the oesophagus? 1
Ch. 1 Development of the upper gastrointestinal tract 3
1.1 Embryology, anatomy and physiology of the upper gastrointestinal tract 3
1.2 Innervation and motility 13
Ch. 2 Symptomatology of gastro-oesophageal reflux 27
2.1 Terminology 27
2.2 Incidence and natural history 27
2.3 Clinical presentation 29
2.4 Histological manifestations of GOR 37
Ch. 3 Pathophysiology of GOR and its symptoms 41
3.1 Vomiting 41
3.2 GOR 41
3.3 Reflux-induced pain 46
3.4 Respiratory symptoms 48
3.5 Oesophagitis 49
3.6 Other manifestations of GOR 50
Ch. 4 Investigation techniques: the place of pH monitoring 51
4.1 Radiology 51
4.2 Manometry 53
4.3 Endoscopy and oesophageal biopsy 56
4.4 Scintiscanning 59
4.5 Ultrasonography 62
4.6 Oesophageal pH monitoring 62
Ch. 5 Oesophageal pH monitoring: hardware and software 67
5.1 Commercial hardware 67
5.2 Hardware used in our work 77
5.3 Methodology proposed in the literature 79
5.4 Methodology developed in our centre 83
5.5 Software developed in our centre 85
5.6 Comparison between different recording devices and electrodes 92
5.7 Summary 100
Ch. 6 Oesophageal pH monitoring: patient-related factors 103
6.1 General introduction 103
6.2 Physiological incidence of GOR 103
6.3 GOR during periods of interest 119
6.4 Feeding 127
6.5 Evaluation of the influence of position 134
6.6 Reproducibility of pH monitoring data 140
6.7 Efficacy of treatment 145
6.8 Oesophageal pH monitoring in children with unusual manifestations of GOR 163
6.9 Other factors influencing GOR 179
Ch. 7 Parameters of interest for the future 183
7.1 Oscillatory index 183
7.2 Area of curve below pH 4.00 189
7.3 Conclusions 194
Ch. 8 A proposed therapeutic and diagnostic approach 197
8.1 Proposed therapeutic approach 197
8.2 Suggested diagnostic and therapeutic approach 198
8.3 Conclusions 202
Ch. 9 Conclusions 203
9.1 Are the aims achieved? 203
9.2 Recommendations 206
9.3 Conclusions 208
References 209
Appendix: A standardized protocol for the methodology of oesophageal pH monitoring and interpretation of the data for the diagnosis of gastro-oesophageal reflux 235
Index 245
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