The relationship of gastroesophageal reflux (GER) and asthma is complex. It is not clear if GER is a concomitant finding in asthma, induces asthma, or exacerbates asthma. The prevalence of GER symptoms in adult patients with asthma is approximately 75% The prevalence of GER disease as measured by extended esophageal pH monitoring in adults with asthma ranges from 55 to 83%, and in children with asthma is approximately 50 to 63%.

Despite methodologic weaknesses, several controlled trials in adult patients, with varied designs but using proton-pump inhibitors for GER disease, have shown improvement in asthma outcomes as measured by decrease in symptoms, reduction in medication usage, and improvement in pulmonary-functions. Similar studies in the pediatric population are lacking. We therefore evaluated the effect of aggressive anti-GER therapy using proton-pump inhibitors on the requirement for asthma medications in older children with persistent moderate asthma before and after treatment of GER without the use of a placebo. The assessment of asthma severity and hence treatment rendered as well as the treatment for GER was uniform.

Colon interposition is the surgical procedure in which the right or left colon is used as an esophageal substitute. In young people, one of the common indications for this operation is caustic stricture following accidental or suicidal lye injury. The operation carries a significant complication rate due to attenuated arterial blood supply, because the interposed colon segment depends on a single vascular pedicle. We report five vaginal deliveries in two women following the operation, illustrating the dilemmas encountered in choosing the delivery method in these patients. Canadian generic viagra

The patient, a 26-year-old primigravida, underwent total esophageal replacement with left colon interposition because of a suicidal lye injury at the age of 20 years. Ten months and 12 months following the primary operation, balloon dilatations of the proximal anastomosis were performed due to strictures. The pregnancy follow-up was uneventful, and she had only mild “esophageal” reflux without the need for pharmacologic treatment. Near term, her thoracic surgeon suggested an elective cesarean section for the prevention of possible damage of the blood supply to the transposed colon during vaginal delivery.

In a subsequent telephone survey of the patients with colon interposition operated on by one of the authors , another woman who became pregnant following the operation was detected. This woman has had four uncomplicated pregnancies; all infants were born by uncomplicated vaginal deliveries at term, with birth weights of 3,000 to 3,500 g.

Colon interposition as an esophageal substitute was first reported in the early years of the 20th century. Since then, various surgical techniques were reported, aimed at decreasing complications. However, the operation carries a significant complication rate, mainly due to attenuated arterial blood supply, as the interposed colon segment by any technique depends on a single vascular pedicle, the ascending branch of the left colic artery or the right branch of the midcolic artery. HQ Viagra online pharmacy Canada Furthermore, obstetricians may have difficulties because of adhesions to the uterus due to previous peritonitis, even during primary cesarean section. Most patients who undergo colon interposition due to lye injury already have adhesions at the time of the operation due to the primary insult and the associated peritonitis and possible previous laparotomy.