H. Teichler (Halle)  

Viewable for logged on visitors (Log on)  

N/A  

N/A  

GI-Esophagus  

other  

Multiple signs are possible, i.e. reoccuring vomiting, loss of weight, reoccuring respiratory illnesses, esophagitis. An anemia through hemorrhagic esophagitis has been described, although seldom. Retrosternal pain ("heartburn").  

Incompetence of the cardiac orifice of the stomach (through low closing pressure, the severe form is designated as cardiochalasia).

Hernia (fixed or gliding), axial or paraaxial. The severest form of a paraaxial hernia is an upside-down stomach in the thorax, which we saw in connective tissue weakness (i.e. Arthrogryposis congenita) twice.

Brachyesophagus (innate or acquired due to an inflammation or acquired after surgery).

His-angle remains > 90° after surgery for the esophageal atresia  

<- view Ultrasound 1

Ultrasound 1: Representation of the normal anatomy when cardia is closed.





<- view Ultrasound 2

Ultrasound 2: B-image: Reflux of gastric contents (tea) in the distal esophagus.




<- view Ultrasound 3

Ultrasound 3: Color doppler: the flow towards the receiver (orthograde esophageal passage) is coded in red.





<- view Ultrasound 4

Ultrasound 4: Color doppler: Reflux of gastric contents in the esophagus is coded as blue. The use of the color doppler only brings advantages in devices with optimal settings. Normally the B-image representation suffices.



 

Total constellation (Consens)  

Secondary reflux in hypertrophic pylorus stenosis: Roviralta syndrome.
Brachyesophagus  

In infancy, often spontaneous improvement ("Cure")

In case of a fixated hernia, only surgical intervention is successful.  

Refluxes occur often, but are also often without significance.

We complete about 1-2 reflux sonographies per day. Only in higher staged reflux (>3 refluxes per 10 minutes) do we do an x-ray examination. The children must be very quiet. A gastric tube must be placed on the ward. It is used to give children an appropriate amount of tea.

Observation time: 10 minutes. The first minute after tube removal is not counted.

Hernias (x-ray) are in our clinic seldom (about 5 per year).

Classification:
0-2 Reflux periods in 10 minutes is normal to borderline = Grade I

3-5 Refluxes per 10 minutes = Grade II

More than 6 refluxes per 10 minutes = Grade III


X-ray: An x-ray representation can be used in Grade II or above (hiatal hernia?). If one doesn't have reflux in the 10 minutes, doesn't have a hernia, which can be shown in that short amount of time.

The number of necessary x-rays is therefore reduced.

In x-ray imaging, the hiatal hernia can be fixated or moveable. Careful: It is not the esophageal vestibulum that you should see as the hernia: it is the position of the schatzki ring and the diaphragmatic tightness.


 

N/A  

1. Medline:
Hirsch W, R Kedar, U Preiß
Color Doppler in the Diagnosis of the gastroesophageal reflux in children: comparison with pH measurements and B-mode ultrasound.
Pediatr Radiol 26 (1996), 232-235  

Reflux, Gastroesophageal, Esophagus, GERD, Gastroesophageal reflux disease, heartburn, recurrent vomiting, weight loss, recurrent respiratory illnesses, esophagitis, anemia, hiatal hernia, child, childhood, pediatric radiology  

H Teichler. Gastroesophageal reflux (1). PedRad [serial online] vol 1, no. 10.
URL: www.PedRad.info/?search=20011017191947