Çocuklarda pH Monitörizasyonu ile Gastroözofageal Reflü Hastalığının Değerlendirilmesi

Yıl 2010, Cilt: 8 Sayı: 1, 130 - 136, 01.06.2010

Gülin Erdemir , Taner Özgür Yakup Canıtez Bülent Kayık Ali Özboyacı Tanju B. Özkan

Öz

Giriş: Gastroözofageal Reflü GÖR , semptomatik olur, yaşam kalitesini etkiler ve morbiditeye neden olursa Gastroözofageal Reflü Hastalığı GÖRH olarak tanımlanır. Bu çalışmanın amacı, GÖRH’nı düşündüren yakınmalarla başvuran hastaların, demografik özelliklerini, 24 saatlik pH monitörizasyonu ile GÖR saptanma oranını belirlemek ve değişikilaç seçenekleriyle tedaviye yanıtlarını değerlendirmektir. Gereç ve Yöntem: Ocak 2008-Eylül 2009 tarihleri arasında GÖRH düşündüren yakınmalarla başvuran ve pH monitorizasyonu yapılan hastaların verileri retrospektif olarak incelendi. Başvuru yakınmaları, 24 saatlik pH monitörizasyonunda GÖR saptanma oranları,eşlik eden hastalık durumu ailenin eğitim düzeyi, uygulanan tedavi seçenekleri ve tedaviye yanıt oranları değerlendirildi. Bulgular: Doksan iki hasta çalışmaya alındı. Çalışmaya alınan olguların 37’si %40,2 kız,55’i %59,8 erkek ve ortalama yaşları 4,42±4,33 1 ay-18 yaş idi. Başvuruda en sık görülen yakınmalar öksürük %49,5 , kusma %47,3 ve karın ağrısı %22 olarak bulundu. Yirmidört saatlik pH monitörizasyonu sonuçlarına göre 21 olguda %22,8 GÖR saptandı. pHmonitörizasyonu ile GÖR saptanan olgularda en sık yakınmalar, öksürük n:15, %33,4 ,kusma n:11, %25,6 , karın ağrısı n:5, %22,3 olarak saptandı. Öksürük yakınması olanhastalarda, diğer yakınmaları olan olgulara göre GÖR saptanma oranı anlamlı olarak daha fazla bulundu p=0,041 . Eşlik eden ek hastalık olarak 12 %13,1 hastada kronik nörolojik hastalık, 12 %13,1 hastada immün yetmezlik ve 12 %13,1 hastada bronşial hiperreaktivite veya astım vardı. Hastaların %57,7’si anti-reflü tedaviden yarar gördü. Tedaviseçenekleri arasında PPI+prokinetik+yüzey ajanı, PPI+prokinetik, H2RB+yüzey ajanı,PPI+yüzey ajanı, H2RB+prokinetik, sadece prokinetik ve sadece PPI , tedaviye yanıtoranları açısından anlamlı bir fark saptanmadı p=0,068 . Sonuç: GÖRH’nın tanı ve tedavi yöntemleri üzerinde henüz tam bir görüş birliği yoktur. Buçalışmada, tedavi seçenekleri, eşlik eden hastalık durumu ve ailenin eğitim düzeyine göretedavi yanıtlarında fark saptanmadı. Yakınmalar göz önüne alındığında, 24 saatlik pH monitörizasyonu ile GÖR saptanma oranları incelendiğinde sadece öksürük şikayeti olan hastalarda anlamlı oranda daha yüksek oranda GÖR saptandı

Anahtar Kelimeler

Çocuk, gastroözofageal reflü, gastroözofageal reflü hastalığı, pH monitorizasyonu, tedavi

The Evaluation of Gastroesophageal Reflux Disease with Esophageal pH Monitorization in Children

Öz

Introduction: Gastroesophageal reflux disease is named when gastroesophageal reflux becomes symptomatic, influences the life comfort, and results in morbidity. In this study,we aimed to evaluate the patients admitted with GER-associated symptoms with demographic characteristics, 24-hour esophageal pH monitorization results, and responses to different treatment protocols. Materials and Method: The data of patients who admitted to Uludag University Pediatrics Outpatient Clinic between January 2008 and September 2009 with GERD-associated symptoms and underwent esophageal pH monitorization was collected retrospectively. The associations between initial symptoms, 24-hour esophageal pH monitorization results, presence of accompanying disease, sociocultural conditions, and therapy responses were evaluated. Results: Ninety-two patients 37 female, 55 male were included and mean age was 4.42±4.33 1 mo-18 years . The frequency of cough, vomiting and abdominal pain at admission were 49.5%, 47.3% and 22% respectively. Esophageal pH monitorization diagnosed GERD in 21 patients 22.8% . The frequency of symptoms in GERD patients who diagnosed with esophageal pH monitorization was; cough n:15, 33.4% , vomiting n:11, 25.6% , and abdominal pain n:5, 22.3% . Among all complaints, cough was found to be significantly associated with GERD p=0.041 . Accompanying neurological disease was present in 13.1% n:12 , immunodeficiency 13.1% n:12 and bronchial reactivity 13.1% n:12 . Therapy success was achieved in57.7% of patients. Therapy response were similar with different therapy protocols proton pump inhibitor+prokinetic+sucralfate, proton pump inhibitor+prokinetic, H2 receptor blocker+sucralfate, proton pump inhibitor+sucralfate, H2 receptor blocker+prokinetic, monotherapy with proton pump inhibitor or H2 receptor blocker p=0.068 .Conclusion: GERD is a common childhood disease. Currently, diagnosis and treatment of GERD in children is still controversial. The results of our study revealed no association with therapy success and different treatment regimens, sociocultural status or accompanying disease. The complaint of cough was found to be significantly in association with GERD

Anahtar Kelimeler

Children, gastroesophageal reflux, gastroesophageal reflux disease, pH monitorization, treatment

Kaynakça

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