I Tapia

Universidad del País Vasco / Euskal Herriko Unibertsitatea, Leioa, Basque Country, Spain

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Publications (9)2.43 Total impact

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    ABSTRACT: Duodenogastric reflux (DGR) is a natural event, occurring occasionally and whose pathological significance is not well known. The accuracy of 24-hour gastric pH-metry for the DGR diagnosis has been tested in adults but not in children. For this purpose we measured the area under curve (AUC) at pH 4, 6 and 7 and the percentage of total time above pH 4 (%pH4), 6 (%pH6) and 7 (%pH7), excluding the 2-hours post-prandial period in 88 children suspected of having gastroesophageal reflux (GER). Forty were considered normal whereas 40 had acid GER and 8 with GER. In the control group %pH4 was 9.68 +/- 14.1, %pH6 3.4 +/- 8.7 and %pH7 1.0 +/- 2.4. The values for AUC were 101 +/- 112.8, 16.5 +/- 22.3 and 3.3 +/- 6.1 pH unit/min, respectively. Comparable results were found in the acid GER group. On the other hand alkaline refluxes had higher figures for all parameters: %pH4 22.1 +/- 13.9, %pH6 12 +/- 13 y %pH7 7 +/- 12, AUC at pH 4,406.5 +/- 410, 136.1 +/- 194 at pH6 and 48.2 +/- 85.1 at pH7 (p < 0.05). Because of the large dispersion of values in the control group we selected the 95 percentile, as the upper limit of normal values instead of the mean +/- SD. Therefore the upper limit were 27 for %pH4, 9 for %pH6 and 3.8 for %pH7. The AUC, 316, 64 and 16 pH/min, respectively. These results prove that DGR in children is a very common event and confirm that DGR definitely contributes to alkaline GER.
    Cirugía pediátrica: organo oficial de la Sociedad Española de Cirugía Pediátrica 07/1993; 6(3):114-6.
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    ABSTRACT: Alkaline gastroesophageal reflux (AGER) has been documented in adult subjects, but few in pediatrics. 24-hours double pH-monitoring was performed in 40 nonrefluxers (control group) and 69 gastroesophageal reflux (RGE) children to quantify AGER. Esophageal phmetric variables were measured at 4 and 7 levels; gastric variables were measured at 4. Forty cases were classified into acid GER, 15 into acid alkaline GER (mixed), 8 into AGER, and 6, with clinical, manometric or endoscopic evidence of GER into "silent" GER. The acid and mixed GER groups had longer periods of acid exposure in esophagus than control, AGER and "silent" GER groups. All groups had long periods of pH > 7 in esophagus. In conclusion, the double gastroesophageal pH monitoring, by verifying the source of alkaline reflux into the esophagus had advantage of better quantifying alkaline reflux over single pH monitoring. AGER might be more frequent in pediatrics than adults.
    Cirugía pediátrica: organo oficial de la Sociedad Española de Cirugía Pediátrica 01/1993; 6(1):19-22.
  • J Arana, I Tapia, J A Tovar
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    ABSTRACT: Gastroesophageal Reflux (GER) in children manifests itself by several clinical pictures. Its diagnosis is difficult and so are surgical indications. The search for prognostic parameters able to predict the need for surgery are therefore warranted. We have demonstrated in previous studies in children with GER a decrease in propulsive peristalsis and an increase in non-propulsive activity. We have also reported that patients able to respond to medical treatment correct their motor trouble when acid is instilled into the esophagus, whereas those unable to respond to it do not. Aiming at clarifying the prognostic value of this acid challenge test we have thus measured Esophageal Motor Efficiency (EME) (prop. waves/h multiplied by mean pressure) in basal conditions and after acid challenge in 52 children divided into two groups according to their response to medical treatment during periods exceeding 6 months. EME in basal conditions did not allow differentiation between both groups, but EME after acid challenge did so. Optimum threshold value was 565, sensitivity 0.76, specificity 0.75, positive predictive value 87%, and negative predictive value 60%. This test seems to have some prognostic value in pediatric GER.
    Cirugía pediátrica: organo oficial de la Sociedad Española de Cirugía Pediátrica 05/1990; 3(2):56-61.
  • J. A. Tovar, J. Arana, I. Tapia
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    ABSTRACT: Among the tests currently available for diagnosis of gastroesophageal reflux (GER), esophageal manometry is the hardest to perform in alert children because of their lack of cooperation. Therefore, it is usually performed under some form of sedation. In an attempt to investigate whether medication by itself modifies esophageal motility, we compared the manometric data of 18 children with pH-probe documented GER before and after sedation (meperidine 1.5 mg/kg, chlorpromazine 1 mg/kg, promethazine 1 mg/kg i.m.). Sedation induced the following changes in motor function compared to that in the unsedated state: (1) lower esophageal sphincter pressure decreased from 16.4 7.3 to 11.4 6.9 (P P P P P pump. If sedation is to be used for manometric studies in children, the results so obtained should only be compared to those of controls under the same conditions.
    Pediatric Surgery International 01/1990; 5(6):418-421. · 1.22 Impact Factor
  • J Arana, J A Tovar, I Tapia
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    ABSTRACT: We have investigated manometrically wether esophageal motor response (in terms of frequency and mean pressure of propulsive and non-propulsive waves) to the instillation of saline and 0.1 N HCl into the lumen was different in normal (n = 18) and refluxing (n = 66) patients. Instillation of saline induced bursts of non-propulsive waves both in normal and refluxing patients. Additionally, it induced in the latter an increase in propulsive waves. Instillation of acid did not induce in normal subjects changes different from those generated by saline but stimulated considerably the refluxing esophagus which responded with an increased number of more powerful waves. This results suggest that refluxing esophagus is hypocontractile as compared with the healthy one and that it is awaken by acid as if it tried to improve its motor efficiency.
    Cirugía pediátrica: organo oficial de la Sociedad Española de Cirugía Pediátrica 08/1989; 2(3):123-8.
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    ABSTRACT: Reflux esophagitis is believed to be related to acid exposure, and it is tempting to assume that the extent of mucosal damage should correlate with pH-metering values. In order to test this hypothesis we studied 151 children with gastroesophageal reflux (GER) documented by X-ray manometry, and pH studies fiberendoscopically. Biopsies taken from each child were assigned to one of four grades according to degree of leukolyte infiltration, basal layer thickening, and papillary lengthening. Histologic esophagitis was demonstrated in 59% of cases, but was severe in only 4%. The histologic grade was independent of endoscopic evaluation, which, in addition, upgraded the lesions (73% esophagitis with 19.2% severe grades). It was also independent of the eventual need for surgery. On the other hand, esophagitis grade significantly correlated with percentage of time at pH below 4 (Spearman's r = 0.18, P < 0.05)="" and="" number="" of="" ger="" episodes="" (spearman's="">r = 0.28, P < 0.01).="" fiberendoscopic-histologic="" assessment="" of="" esophagitis="" has="" been="" useful="" in="" our="" hands="" as="" a="" complement="" to="" other="" diagnostic="" ger="" studies,="" but="" its="" value="" as="" an="" isolated="" procedure="" is="" questionable:="" it="" is="" probably="" very="" reliable="" in="" the="" relatively="" rare="" severe="" cases,="" but="" the="" clinical="" picture="" is="" so="" revealing="" in="" these="" cases="" as="" to="" make="" it="" unnecessary.="" in="" mild="" and="" moderate="" grades,="" which="" are="" much="" more="" frequent="" in="" children,="" it="" was="" not="" a="" suitable="" method="" for="" evaluating="" the="" severity="" of="" ger="" and="" did="" not="" assist="" in="" the="" establishment="" of="" surgical="">
    Pediatric Surgery International 06/1988; 3(5):326-330. · 1.22 Impact Factor
  • Cirugía pediátrica: organo oficial de la Sociedad Española de Cirugía Pediátrica 02/1988; 1(1):12-8.
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    ABSTRACT: Sixteen among the 129 children operated upon for GER in the last 9 years had neurologic diseases with psychomotor retardation. Average age at diagnosis was advanced (90 months) although most patients vomited since infancy and more than 50% had haemorrhage as a sign of oesophagitis which was endoscopically confirmed in 10 cases. Prolonged acid exposure as proven by extended pH-metry was due to motor failure with incompetence of the LES and abnormal peristalsis (aside with other minor factors) as we could demonstrate manometrically. Surgical treatment achieved good results in almost all cases and we think that there is no reason not to offer its benefits to this group of patients. GER is more frequent and severe in brain damaged patients than it can be judged by the scarce number of them operated upon in our country. It must be looked after in them and treated appropriately whenever complications make it advisable.
    Anales espanoles de pediatria 08/1986; 25(1):29-34.
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    ABSTRACT: Aiming to evaluate the participation of oesophageal motor troubles in the pathogeny of gastro-oesophageal reflux in brain-damaged children, we have studied 16 of these patients. Most of them had a more or less severe esophagitis due to excessive acid exposure. We have found a decreased LESP as compared to normal subjects (8.84 +/- 6.20 vs. 18.33 +/- 6.55 mmHg (p less than 0.001)), and high percentages of non-propulsive waves in basal conditions (70 +/- 29.66 vs. 6.25 +/- 9.16 (p less than 0.001)) as well as after serum (66.33 +/- 28.06 vs. 16.66 +/- 13.66 (p less than 0.001) and acid instillation (58.33 +/- 28.91 vs. 26.41 +/- 12.04 (p less than 0.05)). These results demonstrate that motor disturbances are responsible for the severity of GER in this group of patients.
    Chirurgie pédiatrique 02/1986; 27(3):134-7.