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[Dysphagia] Respiratory and Reflux Connections
--- SuzMorris@aol.com wrote:
> The treatment options here just seem so limited and
> certainly, as you
> point out Irene, the treatment just of the lungs
> with a nebulizer and
> medications is "band-aiding". I will ask the
> parents whether anyone has
> talked to them about a fundoplication. I really
> doubt that this is an
Yes, I didn't think so either but I was desperate.
When they tried an NG tube
> when he was in the NICU,
> he became frantic and couldn't tolerate it when it
> was in place and hated
> the tape on the face.
Did they ever try gavage feeding?
The stomach muscles are
> still unattached,
> leaving the liver unprotected. He currently wears a
> binder to provide
> this protection and will undergo future surgery to
> attach the muscles.
> I see so many problems with kids who have had a
> fundoplication [i.e.
> retching, delayed gastric emptying, gas bloat,
> refusals to eat] and they
> don't have the already existing degree of
> gastrointestinal involvement
> and abnormality that this child has. I wonder if
> this would just
> increase his overall discomfort and feeding
> resistance if it were done.
I would agree but it may be worth while to investigate
laparoscpic partial fundoplication - a stretch, I
know, but we're in desperate waters here.
> I'm also concerned about the medications being used.
> . .especially the
> Reglan. Apparently he was initially highly
> overmedicated (Mom says he
> was given "2.5 times the recommended dosage" because
> he still refluxed
> and vomited when it was reduced.
> ask the parents about erythromycin as an
> alternative. Although it is
> being used in small doses to assist gastric
> emptying, I've been
> concerned about the wisdom of giving an antibiotic
> on a long-term basis
> because of its effect on the good bacteria in the
Also, its detrimental effect on the immune system if
used for long periods. Can't they find a doctor with
the guts to prescribe cisapride? It's still possible.
> I would like some added input on the mucus and its
> relationship to
> reflux. Irene, you commented that:
> >Your description below fits most cases while there
> are some rarer ones but
> >and mucus production are closely related for a
> number of reasons.
The following is pretty simplistic but it goes
something like this:
A mucous membrane is any membrane or lining which
contains mucous secreting glands. These membranes act
as physical barriers to prevent pathogens from
entering the body. There are mucous membranes that
line the gastrointestinal tract, mouth, nose and
lungs. The mucous membranes normally secrete mucus gel
mostly comprised of water, ions and mucin
glycoproteins. Moist mucous membranes are
particularly vulnerable to colonisation and
penetration by pathogenic organisms. Here, the
defensive 'front line' is the semi-adherent
supramucosal gel, mucus. Abnormalities of the
structure and turnover of this gel are associated with
a wide range of important epithelial pathologies. When
the tissue is attacked by pathogens (bacteria or
viruses) or irritated and inflamed by acid, its
response, in trying to maintain its protective
function is to produce even more mucus that often also
contains more debris, making it thicker. This is also
why persons with reflux affecting the hypopharynx and
larynx are constantly throat clearing because of extra
musus formation and patients with GER will tell you
that they have almost constant urge to clear the
> Bottom line question for me is: Are there ANY
> realistic options for this
> kid to deal with the reflux and lung damage issues?
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