Gastro-esophageal Reflux and Dioscorea

An infant, N. 54 days old, was vomiting milk and could not retain milk even of small quantity. There was incessant and intractable vomiting.

He was seen by me on 1.5.2001.

A provisional diagnosis of gastro-esophageal reflux was made at the hospital and a scan was done to rule out aspiration.

Examination performed.

99mTc Phytate instilled into the stomach mixed with 50ml of milk. Serial dynamic images acquired for 30 minutes. Delayed images acquired at 30 minutes.

Good tracer accumulation seen in the stomach. Tracer seen to rise until the upper esophagus intermittently starting immediately following the radioactive meal.

Percentage of GER: 12%( >4% is considered significant)

Delayed images acquired till 24 hours shows no tracer accumulation in the lung fields.

Scan evidence of intermittent moderate Gastro-esophageal Reflux seen.
No scan evidence of Aspiration seen.

It was impossible to put the baby on its back for sleep for fear of aspiration and was advised to keep the baby in propped up position day and night.

The baby did not vomit so long it was in the propped up position. Baby was observed arching his back.

This modality was translated to > bending back which is so characteristic of Dioscorea. This was administered in 0/1 potency 4-to 5 times a day with improvement.

The remedy was continued till 6.8.2001 when the baby was able to sleep on his back or sides.

The baby is 2years 8 months now with no problem.

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