Preventative effect of massage on gastric volvulus in infants with

1. Preventative effect of massage on gastric volvulus in infants with gastroesophageal reflux-induced pneumonia Department of Integrated Traditional Chinese and Western Medicine Yan Suqi

2. CONTENTS Research background Research contents

3. Research background

4. Research background 【Call in question】 What is the particularity of infant pneumonia？ —— Professor Dong Zongqi

5. Research background 【Previous retrospective study】 Time: from January 2008 to december 2010 Study population: 792 hospitalized infants with pneumonia (1-4 months) Analyses:a prevalence of 80.72% of gastric volvulus (GV) a prevalence of 67.22% of gastroesophageal reflux (GER)

6. Research background 【Characteristic of infant pneumonia complicated with GV and GER】 severe coughing recurrent respiratory infections refractory to antibiotic treatment

7. Research background 【Conclusion】 The complications of GER may be responsible for the ineffectiveness of antibiotic treatment in infant pneumonia. 【For further research】 Therapies designed to improve GV (GER)when treating infant pneumonia patients complicated with GV and GER.

8. Research contents

9. Research contents

10. Research contents METHODS

11. Research contents 【Study population】 Time: from March 2010 to March 2013 Cases: 180 infants admitted to the Department of Integrated Traditional Chinese and Western Medicine of Wuhan Children's Hospital (Hubei, China) Age: 1-6 months Diagnosis: GV with GER-induced infant pneumonia

12. Research contents 【Diagnostic criteria】 Infant pneumonia (including bronchiolitis) Hu YM, Jiang ZF, Zhu FT. Textbook of pediatrics (Volume One). 8th ed. Beijing: People's Medical Publishing House, 2012: 1139-1265. Gastric volvulus (GV) radiography of the upper gastrointestinal tract (UGT) using iodine-containing contrast (organoaxial, mesenteroaxial, combined volvulus) (stomach rotation of < 180°) Gastroesophageal reflux (GER) 24-h pH monitoring of the distal esophagus (DeMeester Score) radiography of the upper gastrointestinal tract (UGT) using iodine-containing contrast (angle of His became obtuse)

13. Research contents 【GV】 Gastric volvulus is consists of a pathological rotation of the stomach around the axis. A rotation of the stomach of <180°thatleads to only partial foregut. combined volvulus Porcaro F, Mattioli G, Romano C. Pediatric gastric volvulus: diagnostic and clinical approach. Case Rep Gastroenterol 2013; 7(1): 63-68.

14. Research contents 【GER】 Gastroesophageal reflux is a condition in which the stomach contents leak backwards from the stomach into the esophagus even to pharynx oralis. Physiological GER Pathological GER durative or frequent reflux angle of His 24-h pH monitoring of distal esophagus Upper gastrointestinal radiography

15. Research contents 【Inclusion criteria】 diagnosed with infant pneumonia (including bronchiolitis), GV and GER without kidney or hematologic diseases aged 1-6 months parents gave written informed consent for their infants to participate in the study transferred to the Intensive Care Unit for type-Ⅱrespiratory failure necessitating a tracheal cannula and mechanical ventilation had discontinued treatment had incomplete data 【Exclusion criteria】

16. Research contents 【General information and grouping】 Notes: "Others“ include cardiac failure and electrolyte disturbances.

17. Research contents 【Interventions】 Basic treatment For pneumonia: according to the Convention on the Diagnosis and Treatment of Infant Pneumonia and Bronchiolitis (Textbook of pediatrics (Volume One). 8th ed. ) For GV and GER:three types of therapy → postural + dietary + pharmacologic (omeprazole & domperidone)

18. Research contents 【Interventions】 Massage treatment To attenuate vomiting To promote digestion, strengthen enterokinesia, and improve flatus To strengthen the body, promote growth and remove etiologic factors

19. Research contents Step 2: push vicissitudinarily abdominal Yin and Yang Step 1: push from the palmar crease to Banmen Step 2: poking of Zhongwan (CV 12) / Tianshu (ST 25) Step 4: poke alternately bilateral Zusanli (ST 36)

20. Research contents 【Observational index】 Symptoms, physical signs and laboratory studies Score of symptoms and physical signs Criteria for evaluation of effects (Cure; Significant effect; Effect; Ineffective) Safety observations

21. Research contents RESULTS

22. Research contents 【Clinical effects】 Notes: aP < 0.05, bP < 0.01 vs BTG1; cP < 0.05 vs BTG2; dP < 0.01 vs BTG.

23. Research contents 【Symptoms】 Notes: aP < 0.05 , bP < 0.01 vs BTG1-after; cP < 0.05 vs before.

24. Research contents 【Symptoms】 Notes: aP < 0.05 , bP < 0.01 vs BTG2-after; cP < 0.05 vs before.

25. Research contents 【Clinical examinations】 Notes: aP < 0.05 vs BTG1. Total effect includes cure, significant effect and effect.

26. Research contents 【Clinical examinations】 Notes: aP < 0.05 , bP < 0.01 vs BTG2. Total effect includes cure, significant effect and effect.

27. Research contents 【Severe pneumonia】 Notes: aP < 0.05 vs BTG. 9 exclusion cases which were transferred to ICU for severe pneumonia are exclude in Tables 5 and 6 while those are include in Table 7.

28. Research contents DISCUSSION

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30. Research contents CASE REPORT

31. Research contents 2-month-old, female Coughing and dyspnea of 20-day duration (refractory to anti-infection therapy for 14 days at a local hospital) Diagnosed with infant pneumonia with emphysema (Figure 1), GV (organoaxial) with GER (Figure 2-3) Microbiologic culture of sputum showed growth of normal bacterial colonies in the upper respiratory tract. After 8 days of basic treatment and massage treatment, chest radiography showed absorption of inflammatory foci (Figure 4), and radiography of the UGT using iodine-containing contrast demonstrated correction of stomach rotation (Figure 5-6). She was discharged from hospital and did not show recurrence over a 1-week follow-up period.

32. Research contents Fig1. chest radiography showed infant pneumonia with emphysema (26th Feb) Fig4. chest radiography showed inflammatory focal absorbed and emphysema improvement (5th Mar)

33. Research contents Fig2-3. upper gastrointestinal iodine radiography showed GV (organoaxial) and GER (27th Feb) Fig5-6. upper gastrointestinal iodine radiography showed correction of stomach rotation and GER improvement (5th Mar)

34. 谢谢！ Thank you!