- Author
-
M.J. Smits
- Title
- Pediatric esophageal motility disorders: studies on (patho)physiology, diagnosis and management
- Supervisors
-
M.A. Benninga
- Co-supervisors
-
M.P. van Wijk
- Award date
- 11 June 2015
- Number of pages
- 283
- ISBN
- 9789090290478
- Document type
- PhD thesis
- Faculty
- Faculty of Medicine (AMC-UvA)
- Abstract
-
Pediatric esophageal motility disorders cover a wide spectrum of disorders, varying in prevalence, severity and symptom burden. This thesis comprises of studies on the (patho)physiology, diagnosis and management underlying gastroesophgeal reflux (GER) episodes, (presumed) GER related extraesophageal symptoms and the motility disorder achalasia. The value of novel diagnostic techniques in pediatric gastroesophageal reflux disease (GERD) and motility disorders and the treatment of pediatric GERD with acid suppression are explored. The final part of the thesis describes a study on the prevalence, characteristics and management of pediatric achalasia in the Netherlands. The results of the presented studies in this thesis indicate the need to rethink our current diagnostic and treatment approach towards pediatric GERD and the need to develop novel diagnostic tools and treatment strategies. We provided a basis for more clinical and laboratory-based research, looking further into the mechanisms behind triggering of the main mechanism underlying GERD: transient lower esophageal sphincter relaxations. Furthermore, we identified a relationship between protonpump inhibitor treatment and respiratory complications in patients admitted at the pediatric intensive care unit (PICU). Acid suppression therapy in pediatric patients might not prevent extra-esophageal reflux symptoms and potentially increases the risk of (secondary) respiratory infections, especially in PICU patients. Finally, the data on diagnosis and clinical management of a Dutch pediatric achalasia shows there is a need to internationally cooperate and ensure optimal management of this severe motility disorder at a pediatric age.
- Persistent Identifier
- https://hdl.handle.net/11245/1.476569
- Downloads
-
Thesis (complete)
Front matter
General introduction & Outline of the thesis
Chapter 1: Distension of the esophagogastric junction in healthy volunteers affects triggering of transient lower esophageal sphincter relaxation and belching following consumption of a carbonated soft-drink
Chapter 2: Effect of lateral positioning on gastroesophageal reflux (GER) and underlying mechanisms in GER disease (GERD) patients and healthy controls
Chapter 3: Association between gastroesophageal reflux and pathologic apneas in infants: a systematic review
Chapter 4: Gastric juice from pediatric patients after temporary and chronic treatment with proton pump inhibitors differentially modulate bronchial epithelial responses
Chapter 5: Diagnostic accuracy of tests in pediatric gastroesophageal reflux disease
Chapter 6: An expert panel-based study on recognition of gastroesophageal reflux in difficult esophageal pH-impedance tracings
Chapter 7: Inter- and intra-rater reliability of the Chicago Classification in pediatric high-resolution esophageal manometry recordings
Chapter 8: Efficacy of proton-pump inhibitors in children with gastroesophageal reflux disease: a systematic review
Chapter 9: Pediatric Achalasia in the Netherlands: prevalence, diagnosis, management, clinical course and quality of life
Summary and general discussion / Samenvatting en algemene discussie
Supplemental files
Back matter
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