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Blondeau K.,Center for Gastroenterological Research | Pauwels A.,Center for Gastroenterological Research | Dupont Lj.,Adult Center | Mertens V.,Center for Gastroenterological Research | And 10 more authors.
Journal of Pediatric Gastroenterology and Nutrition | Year: 2010

Objectives: Increased gastroesophageal reflux (GER) is common in children with cystic fibrosis (CF). We studied the occurrence of acid, weakly acidic (WA), and weakly alkaline (WALK) reflux in children with CF and evaluated a possible surrogate marker for risk of gastric content aspiration. Patients and Methods: Twenty-four children with CF underwent impedance-pH monitoring for detection of acid (pH < 4), WA (pH 4-7), and WALK-GER (pH ≥7). In 11 children, cough was objectively recorded with esophageal manometry and the symptom association probability was calculated to determine the reflux-cough relation. Presence of bile acids (BA) was measured in the saliva of 65 patients with CF and 23 healthy children, respectively. Results: Sixteen of the 24 children had increased GER (esophageal acid exposure). The majority of reflux events were acidic in nature. WA reflux was less common and WALK reflux was rare. The sequence reflux-cough was found in 8 of the 11 children and 1 of 11 children had a positive symptom association probability for reflux-cough. The sequence cough-reflux was found in only 3 of the 11 children. Only a small fraction of the total esophageal acid and volume exposure was secondary to cough. Twenty-three of the 65 children with CF had BA in saliva compared with none of the healthy controls. Conclusions: Although WA-GER is uncommon, acid GER is prevalent in children with CF. It is a primary phenomenon and is not secondary to cough. One third of the children with CF have BA in saliva, which may indicate an increased risk for aspiration. However, the impact of salivary BA and potential aspiration on CF pulmonary disease needs further investigation. © 2010 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition. Source


Barriga-Rivera A.,Childrens Hospital Virgen del Rocio | Barriga-Rivera A.,University of Seville | Elena M.,University of Seville | Moya M.J.,Childrens Hospital Virgen del Rocio | Lopez-Alonso M.,Childrens Hospital Virgen del Rocio
Diseases of the Esophagus | Year: 2014

Summary: Gastroesophageal monitoring is limited to 96 hours by the current technology. This work presents a computational model to investigate symptom association in gastroesophageal reflux disease with larger data samples proving important deficiencies of the current methodology that must be taking into account in clinical evaluation. A computational model based on Monte Carlo analysis was implemented to simulate patients with known statistical characteristics Thus, sets of 2000 10-day-long recordings were simulated and analyzed using the symptom index (SI), the symptom sensitivity index (SSI), and the symptom association probability (SAP). Afterwards, linear regression was applied to define the dependency of these indexes with the number of reflux, the number of symptoms, the duration of the monitoring, and the probability of association. All the indexes were biased estimators of symptom association and therefore they do not consider the effect of chance: when symptom and reflux were completely uncorrelated, the values of the indexes under study were greater than zero. On the other hand, longer recording reduced variability in the estimation of the SI and the SSI while increasing the value of the SAP. Furthermore, if the number of symptoms remains below one-tenth of the number of reflux episodes, it is not possible to achieve a positive value of the SSI. A limitation of this computational model is that it does not consider feeding and sleeping periods, differences between reflux episodes or causation. However, the conclusions are not affected by these limitations. These facts represent important limitations in symptom association analysis, and therefore, invasive treatments must not be considered based on the value of these indexes only until a new methodology provides a more reliable assessment. © 2012, Wiley Periodicals, Inc. and the International Society for Diseases of the Esophagus. Source


Barriga-Rivera A.,Childrens Hospital Virgen del Rocio | Barriga-Rivera A.,University of Seville | Moya-Jimenez M.J.,Childrens Hospital Virgen del Rocio | Elena Perez M.,University of Seville | Lopez-Alonso M.,Childrens Hospital Virgen del Rocio
IFMBE Proceedings | Year: 2013

Gastroesophageal reflux may become pathologic when it produces symptoms resulting in complications. Apnea, cough, aspirative pneumonias, bradycardia, etc, are common associated cardiorespiratory complications. It is frequent in premature babies and may occur in healthy newborn, and its complications may require hospitalization and intensive care. Gastroesophageal impedance-pH monitoring is a usual method to diagnose what is known as gastroesophageal reflux disease. Multi-parametric studies include 24-hour impedance-pH recording and were complemented with cardiorespiratory monitoring in this study. It would ideally allow an early diagnosis reducing reflux-related morbimortality and shortening hospital stays, what would also lower hospital expenses and unnecessary treatments. Symptom association analysis was applied to determine the degree of temporal association between cardiorespiratory episodes and gastroesophageal reflux. Temporal lags between both events were computed and compared with the size of the window of association resulting the window larger than the lag. © 2013 Springer-Verlag. Source


Barriga-Rivera A.,Childrens Hospital Virgen del Rocio | Barriga-Rivera A.,University of Seville | Moya M.J.,Childrens Hospital Virgen del Rocio | Elena M.,University of Seville | Lopez-Alonso M.,Childrens Hospital Virgen del Rocio
Diseases of the Esophagus | Year: 2015

Previous contributions suggested that gastroesophageal reflux can be modeled in terms of a Poisson process. This study aims to provide empirical data to validate this statement in pediatric patients so that computational models can be broadly used as an alternative for research. A retrospective review of 63 pediatric patients who underwent 24-hour impedance-pH monitoring to discard gastroesophageal reflux disease was conducted in this study. Patients were grouped by age as preterm (21), infants (21), and children (21). All the tracings were analyzed by a trained physician who identified the reflux entry and the bolus clearance time of each episode. The time between reflux episodes was tested against three probability distributions (gamma, exponential and inverse Gaussian) whereas the bolus clearance time was tested against a normal probability distribution. Parameters were estimated using the maximum likelihood method. The Kolmogorov-Smirnov test and the Kullback-Leibler divergence were computed to evaluate the goodness of fit. One-way analysis of variance was applied to compare results along the three groups. Exponential fitting for inter-reflux time was successful in 90.48% of children older than 1 year. The overall reflux rate was 57.58 reflux episodes per day whereas the mean bolus clearance time ranged between 10.87 in preterm subjects and 12.05 in children, showing a good Gaussian fitting. The time between reflux episodes can be modeled in terms of a Poisson process in non tube-fed patients, whereas the bolus clearance time follows a normal distribution in all cases. © 2014 International Society for Diseases of the Esophagus. Source


Barriga-Rivera A.,Childrens Hospital Virgen del Rocio | Barriga-Rivera A.,University of Seville | Elena M.,University of Seville | Moya M.J.,Childrens Hospital Virgen del Rocio | Lopez-Alonso M.,Childrens Hospital Virgen del Rocio
Computer Methods and Programs in Biomedicine | Year: 2013

Gastroesophageal reflux (GER) disease is a serious complication of the upper gastrointestinal tract. Cardiorespiratory symptoms such as apnea, oxygen desaturation and bradycardia may be related to GER. Thus, the recommended diagnostic methodology in pediatric patients requires 24-h synchronized esophageal and cardiorespiratory monitoring. However, there is no computer tool available for this purpose and therefore, researchers and physicians are forced to seek for customized solutions. This paper presents an open source computer program for the analysis of symptom association. It allows a convenient visualization of the biological signals and implements the three main metrics for symptom association, that is, the symptom index, the symptom sensitivity index and the symptom association probability. This software represents a flexible solution and will facilitate caregivers an easy assessment of the existence of temporal association between GER and cardiorespiratory episodes. This would ideally reduce inappropriate medical and surgical treatments and would provide an early diagnosis of the medical condition. © 2013 Elsevier Ireland Ltd. Source

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