Skip to main content
SpringerLink
Log in

Gastrointestinal hemorrhage in paralyzed and neurologically impaired patients: Contribution of reflux esophageal disease

  • Published:
Gastrointestinal Radiology Aims and scope Submit manuscript

Abstract

The role of gastroesophageal reflux (GER) and reflux esophagitis in the pathogenesis of gastrointestinal hemorrhage was assessed in 13 male patients with chronic paralysis or neurologic impairment. Nine of the 13 patients initially presented for barium meal examination to evaluate anemia, hematemesis, heme-positive stools, or melena. Six of the 9 had radiographic evidence, confirmed by upper gastrointestinal (GI) endoscopy, of esophagitis with or without stricture without other upper GI tract lesions. Notably absent were antecedent symptoms of GER such as heartburn or dysphagia. Careful examination of the esophagus, although difficult, must be an integral part of the evaluation for anemia and/or gastrointestinal blood loss in paralyzed patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

P, Q:

paraplegic, quadriplegic

Tr.:

trauma

MS:

multiple sclerosis

CP:

cerebral palsy

HOPA:

hereditary olivopontine atrophy

CHI:

closed head injury

Eso. str.:

esophageal stricture

Ulc. eso.:

ulcerative esophagitis

GU:

gastric ulcer

Def. bulb:

deformed duodenal bulb

Duod. str.:

duodenal stricture

References

  1. Djergaian RS, Staas WE Jr: Upper gastrointestinal bleeding in a quadriplegic patient.Arch Phys Med Rehabil 62:345–346, 1981

    CAS  PubMed  Google Scholar 

  2. Perret G, Solomon A: Gastrointestinal hemorrhage and cervical cord injuries.In Proceedings of the Seventeenth Veterans Administration Spinal Cord Injury Conference. September 29 – October 1, 1969, Bronx Veterans Administration Hospital, Bronx, New York, 106–110

    Google Scholar 

  3. Abrahams P, Burkitt BFE: Hiatus hernia and gastro-oesophageal reflux in children and adolescents with cerebral palsy.Aust Paediatr J 6:41–46, 1970

    CAS  PubMed  Google Scholar 

  4. Sondheimer JM, Morris BA: Gastroesophageal reflux among severely retarded children.J Pediatr 94:710–714, 1979

    CAS  PubMed  Google Scholar 

  5. Byrne WJ, Euler AR, Ashcraft E, Nash DG, Seibert JJ, Golladay ES: Gastroesophageal reflux in the severely retarded who vomit: criteria for and results of surgical intervention in twenty-two patients.Surgery 91:95–98, 1982

    CAS  PubMed  Google Scholar 

  6. Gore RM, Mintzer RA, Calenoff L: Gastrointestinal complications of spinal cord injury.Spine 6:538–544, 1981

    CAS  PubMed  Google Scholar 

  7. Walsh JJ, Nuseibeh I, El-Masri W: Perforated peptic ulcer in paraplegia.Paraplegia 11:310–313, 1974

    CAS  PubMed  Google Scholar 

  8. Nyquist RH: Mortality in spinal cord injuries. Preliminary report.In Proceedings of the Ninth Veterans Administration Spinal Cord Injury Conference. October 18–20, 1960, Long Beach Veterans Administration Hospital, Long Beach, California, 109–115

    Google Scholar 

  9. Griffiths HJ: The radiology of spinal cord injury: a review article.In Proceedings of the Eighteenth Veterans Administration Spinal Cord Injury Conference. October 5–7, 1971, Boston Veterans Administration Hospital, Boston, Massachusetts, 43–52

    Google Scholar 

  10. Charney KJ, Juler GL, Comarr AE: General surgery problems in patients with spinal cord injuries.Arch Surg 110:1083–1088, 1975

    CAS  PubMed  Google Scholar 

  11. Tanaka M, Uchiyama M, Kitano M: Gastroduodenal disease in chronic spinal cord injuries. An endoscopic study.Arch Surg 114:185–187, 1979

    CAS  PubMed  Google Scholar 

  12. Holmes TW Jr: Chalasia, peptic esophagitis, and hiatal hernia. A common syndrome in patients with central nervous system disease.Chest 60:441–445, 1971

    PubMed  Google Scholar 

  13. Pollock LJ, Finkelman I: The digestive apparatus in injuries to the spinal cord and cauda equina.Surg Clin North Am 34:259–268, 1954

    Google Scholar 

  14. Babka JC, Hager GW, Castell DO: The effect of body position on lower esophageal sphincter pressure (letter).Dig Dis 18:441–442, 1973

    CAS  Google Scholar 

  15. Dent J, Dodds WJ, Friedman RH, Sekiguchi T, Hogan WJ, Arndorfer RC, Petrie DJ: Mechanism of gastroesophageal reflux in recumbent asymptomatic human subjects.J Clin Invest 65:256–267, 1980

    CAS  PubMed  Google Scholar 

  16. Demeester TR, Johnson LF, Joseph GJ, Toscano MS, Hall AW, Skinner DB: Patterns of gastroesophageal reflux in health and disease.Ann Surg 184:459–470, 1976

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Radiology Service, V.A. Medical Center, 4500 S. Lancaster Road, 75216, Dallas, TX, USA

    Herbert J. Smith M.D.

  2. University of Texas Health Science Center, Dallas, Texas, USA

    Herbert J. Smith M.D.

Authors
  1. Herbert J. Smith M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Smith, H.J. Gastrointestinal hemorrhage in paralyzed and neurologically impaired patients: Contribution of reflux esophageal disease. Gastrointest Radiol 10, 7–10 (1985). https://doi.org/10.1007/BF01893062

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01893062

Key words

Search

Navigation