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Volume 66 - 2003 - Fasc.4 - Original articles

Gastric perforation in neonates : Analysis of five cases

The aetiology of neonatal gastric perforation (NGP) remains unknown and the mortality rate is still very high. We have treated five cases of gastric perforation over the past 17 years, and analy- sed them retrospectively to present our experience. Clinical data included age, sex, weight, maternal complication, fetal complica- tion, gestational age, type of delivery, admission time, associated pathologies, localization of perforation, perforation age, operative procedures and outcome. There were four boys and one girl. Three of the infants were full-term, while two were premature. All of the infants were septic prior to rupture. Two infants had acute respi- ratory distress syndrome (ARDS) ; one due to prematurity and low gestational weight, and one due to meconium aspiration. Perforation was located at major curvature and anterior wall of the stomach in four patients, while it was located in minor cur- vature and anterior wall in one. The rupture was closed in two layers. Histopathology revealed local chronic inflammation and ischemia. Mortality rate was 60%. In conclusions, gastric perfora- tion is a life-threatening complication in neonates. In our limited series, sepsis, prematurity and corticosteroid treatment were like- ly to be predictive for development of NGP. Early diagnosis and prompt management before clinical deterioration of the metabolic status may improve the outcome of such infants with NGP. (Acta gastroenterol. belg., 2003, 66, 271-273).


The appropriate management of symptomatic gastro-oesophageal reflux disease (GORD) in primary care : a systematic analysis of expert opinion

Objective : To explore the appropriate indications for endoscopy and short-term anti-secretory treatment in patients with symp- toms of gastro-oesophageal reflux disease (GORD). Methods : The RAND Appropriateness Method (RAM) was used to systematically investigate the opinions of an expert panel (6 gastroenterologists and 6 general practitioners) on the appro- priateness of either endoscopy or short-term medication for 768 different patient scenarios (cases). Each case was defined by the unique combination of diagnostic characteristics considered to be relevant in treatment choice. Panel members firstly individual- ly rated the appropriateness of all indications using a 9-point scale (9 = extremely appropriate, 1 = extremely inappropriate). Sub- sequently, the panel discussed the results and re-rated some of the indications. Based on the median score and agreement figures, the individual ratings were converted to panel statements (appropri- ate, inappropriate, and uncertain) for each of the indications. Logistic regression was used to study the relationship between diagnostic characteristics and panel outcomes. Results : Disagreement was seen in only 18% of cases. Statistical analysis revealed consistent patterns that determined the panel judgements. The most pronounced patterns and regression results were used to indicate situations in which either medication or referral was considered appropriate by the panel. Conclusion : The RAND panel method proved to be useful in the systematic analysis of expert opinion on the appropriate management of symptomatic GORD. Nevertheless, as the recommendations still reflect the subjective opinion of the panel members, their validity and usefulness for daily practice should be the subject of further investigations. (Acta gastroenterol. belg., 2003, 66, 265-270).