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Çocuklarda pH Monitörizasyonu ile Gastroözofageal Reflü Hastalığının Değerlendirilmesi

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

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

Kaynakça

  • 1. Kawahara H, Dent J, Davidson G. Mechanisms responsible for gastroesophageal reflux in children. Gastroenterology 1997; 113:399-408.
  • 2. Rudolph CD, Mazrur LJ, Liptak GS, Baker RD, Boyle JT, Colletti RB et al. North American Society for Pediatric Gastroenterology and Nutrition. Guidlines for evaluation and treatment of gastroesophageal reflux in infants and children: recommendations of the North American Society for Pediatric Gastroenterology and Nutrition. J Pediatr Gastroenterol Nutr 2001; 32 (suppl 2):1-31.
  • 3. Nelson SP, Chen EH, Syniar GM, Christoffel KK. One-year follow-up of symptoms of gastroesophageal reflux during infancy. Pediatric Practice Research Group. Pediatrics 1998; 102:67.
  • 4. Nelson SP, Chen EH, Syniar GM, Christoffel KK. Prevalence of symptoms of gastroesophageal reflux during childhood: a pediatric practice-based survey. Pediatric Practice Research Group. Arch Pediatr Adolesc Med 2000; 154:150-4.
  • 5. Achem SR. Endoscopy-negative gastroesophageal reflux disease. The hypersensitive esophagus. Gastroenterol Clin North Am 1999; 28:893-904.
  • 6. El-Serag HB, Gilger M, Kuebeler M, Rabeneck L. Extra-esophageal associations of gastroesophageal reflux disease in children without neurologic defects. Gastroenterology 2001; 121:1294-9.
  • 7. Harding SM. Gastroesophageal reflux, asthma, and mechanisms of interaction. Am J Med 2001; 111 suppl 8A:8-12.
  • 8. Kahrilas PJ, Quigley EM. Clinical esophageal pH recording: a technical review for practice guideline development. Gastroenterology 1996; 110:1982-96.
  • 9. Colletti RB, Christie DL, Orenstein SR. Indications for pediatric esophageal pH monitoring. J Pediatr Gastroenterol Nutr 1995; 21:253-62.
  • 10. Chen PH, Chang MH, Hsu SC. Gastroesophageal reflux in children with chronic recurrent bronchopulmonary infection. J Pediatr Gastroenterol Nutr 1991; 13:16-22.
  • 11. Changing concepts of sudden infant death syndrome: implications for infant sleeping environment and sleep position. American Academy of Pediatrics. Task force on infant sleep position and sudden infant death syndrome. Pediatrics 2000; 105:650-6.
  • 12. Tighe MP, Afzal NA, Bevan A, Beattie RM. Current pharmacological management of gastro-esophageal reflux in children: an avidence-based systematic review. Pediatric Drugs 2009; 11:185-202.
  • 13. Tolia V, Bishop PR, Tsou VM, Gremse D, Soffer EF, Comer GM et al. Multicenter, randomized, double-blind study comparing 10, 20 and 40 mg pantoprazole in children (5-11 years) with symptomatic gastroesophageal reflux Disease. J Pediatr Gastroenterol Nutr 2006; 42:384-91.
  • 14. Suwandhi E, Ton MN, Schwarz SM. Gastroesophageal reflux in infancy and childhood. Pediatr Ann 2006; 35:259-66.
  • 15. Brecelj J, Orel R. P0866 Evaluation and management of children with gastroesophageal reflux disease in pediatric gastroenterology unit-A retrospective study. J Pediatr Gastroenterol Nutr 2004; 39:386-7.
  • 16. Ashorn M, Ruuska T, Karikoski R, Laippala P. The natural course of gastroesophageal reflux disease in children. Scand J Gastroenterol 2002; 37:638-41.
  • 17. Malaty HM, O’Malley KJ, Abudayyeh S, Graham DY, Gilger MA. Multidimensional measue for gastroesophageal reflux disease (MM-GERD) symptoms in children: a population: a population-based study. Acta Paediatr 2008; 97:1292-7.
  • 18. Bines JE, Quinlan JE, Treves S, Kleinman RE, Winter HS. Efficacy of domperidone in infants and children with gastroesophageal reflux. J Pediatr Gastroenterol Nutr 1992; 14:400-5.
  • 19. Carroccio A, Iacono G, Montalto G, Cavataio F, Soresi M, Notarbartolo A. Domperidone plus magnesium hydroxide and aluminium hydroxide: a valid therapy in children with gastroesophageal reflux. A double-blind randomized study versus placebo. Scand J Gastroenterol 1994; 29:300-4.
  • 20. Chiba N, De Gara CJ, Wilkinson JM, Hunt RH. Speed of healing and symptom relief in grade II to IV gastroesophageal reflux disease: a meta analysis. Gastroenterolgy 1997; 112:1798-810.
  • 21. Cucchiara S, Minella R, Iervolino C, Franco MT, Campanozzi A, Franceschi M et al. Omeprazole and high dose ranitidine in the treatment of refractory reflux oesophagitis. Arch Dis Child 1993; 69:655-9.
  • 22. Miller S. Comparison of the efficacy and safety of a new aluminium-free pediatric alginate preparation and placebo in infants with recurrent gastro-oesophagel reflux. Curr Med Res Opin 1999; 15:160-8.
  • 23. Del Buono R, Wenzi TG, Ball G, Keady S, Thomson M. Effect of Gaviscon infant on gastro-oesophageal reflux in infants assessed by combined intraluminal impedance/pH. Arch Dis Child 2005; 90:460-3.
  • 24. Forbes D, Hodgson M, Hill R. The effects of Gaviscon and metoclopramide in gastroesophageal reflux in children. J Pediatr Gastroenterol Nutr 1986; 5:556-9.
  • 25. Smith HJ. Gastrointestinal hemorrhage in paralyzed and neurologically impaired patients: contribution of reflux esophageal disease. Gastrointest Radiol 1985; 10:7-10.
  • 26. Debley JS, Carter ER, Redding GJ. Prevelance and impact of gastroesophageal reflux in adolescents with asthma: a population-based study. Pediatric Pulmonology 2006; 41:475-81.
  • 27. Corvo M, Ghiglioni D, Gemellaro L, Sarratud T, Fiocchi A. Gastrointestinal signs and symptoms of allergic diseases in children. Pediatr Med Chir 2009; 31:153-9.
  • 28. Lasser MS, Liao JG, Burd RS. National Trends in the use of antireflux procedures for children. Pediatrics 2006; 118:1828-35.
  • 29. Ersin NK, Onça¤ O, Tümgör G, Aydo¤du S, Hilmio¤lu S. Oral and dental manifestations of gastroesophageal reflux disease in children: a preliminary study. Pediatr Dent 2006; 28:279-84.
  • 30. Walker WA, Goulet O, Kleinman RE, Sherman PM. Pediatric Gastrointestinal Disease. Fourth edition. Hamilton, Ontario, Canada 2004; 73:1831-8.
  • 31. Tighe MP, Cullen M, Beattie RM. How to use: a pH study. Arch Dis Child Educ Pract Ed 2009; 94:18-23.
  • 32. Jung AD. Gastroesophageal reflux in infants and children. Am Fam Physician 2001; 64:1853-60.
  • 33. Vandenplas Y, Salvatore S, Hauser B. The diagnosis and management of gastro-oesophageal reflux in infants. Early Human Development 2005; 81:1011-24.
  • 34. Thompson JK, Koehler RE, Richter JE. Detection of gastroesophageal reflux: value of barium studies compared with 24-hr pH monitoring. AJR Am J Roentgenol 1994; 162:621-6.
  • 35. Hila A, Agrawal A, Castell DO. Combined multichannel intraluminal impedance and pH esophageal testing compared to pH alone for diagnosing both acid and weakly acidic gastroesophageal reflux. Clin Gastroenterol Hepatol 2007; 5:172-7.

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

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

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

Kaynakça

  • 1. Kawahara H, Dent J, Davidson G. Mechanisms responsible for gastroesophageal reflux in children. Gastroenterology 1997; 113:399-408.
  • 2. Rudolph CD, Mazrur LJ, Liptak GS, Baker RD, Boyle JT, Colletti RB et al. North American Society for Pediatric Gastroenterology and Nutrition. Guidlines for evaluation and treatment of gastroesophageal reflux in infants and children: recommendations of the North American Society for Pediatric Gastroenterology and Nutrition. J Pediatr Gastroenterol Nutr 2001; 32 (suppl 2):1-31.
  • 3. Nelson SP, Chen EH, Syniar GM, Christoffel KK. One-year follow-up of symptoms of gastroesophageal reflux during infancy. Pediatric Practice Research Group. Pediatrics 1998; 102:67.
  • 4. Nelson SP, Chen EH, Syniar GM, Christoffel KK. Prevalence of symptoms of gastroesophageal reflux during childhood: a pediatric practice-based survey. Pediatric Practice Research Group. Arch Pediatr Adolesc Med 2000; 154:150-4.
  • 5. Achem SR. Endoscopy-negative gastroesophageal reflux disease. The hypersensitive esophagus. Gastroenterol Clin North Am 1999; 28:893-904.
  • 6. El-Serag HB, Gilger M, Kuebeler M, Rabeneck L. Extra-esophageal associations of gastroesophageal reflux disease in children without neurologic defects. Gastroenterology 2001; 121:1294-9.
  • 7. Harding SM. Gastroesophageal reflux, asthma, and mechanisms of interaction. Am J Med 2001; 111 suppl 8A:8-12.
  • 8. Kahrilas PJ, Quigley EM. Clinical esophageal pH recording: a technical review for practice guideline development. Gastroenterology 1996; 110:1982-96.
  • 9. Colletti RB, Christie DL, Orenstein SR. Indications for pediatric esophageal pH monitoring. J Pediatr Gastroenterol Nutr 1995; 21:253-62.
  • 10. Chen PH, Chang MH, Hsu SC. Gastroesophageal reflux in children with chronic recurrent bronchopulmonary infection. J Pediatr Gastroenterol Nutr 1991; 13:16-22.
  • 11. Changing concepts of sudden infant death syndrome: implications for infant sleeping environment and sleep position. American Academy of Pediatrics. Task force on infant sleep position and sudden infant death syndrome. Pediatrics 2000; 105:650-6.
  • 12. Tighe MP, Afzal NA, Bevan A, Beattie RM. Current pharmacological management of gastro-esophageal reflux in children: an avidence-based systematic review. Pediatric Drugs 2009; 11:185-202.
  • 13. Tolia V, Bishop PR, Tsou VM, Gremse D, Soffer EF, Comer GM et al. Multicenter, randomized, double-blind study comparing 10, 20 and 40 mg pantoprazole in children (5-11 years) with symptomatic gastroesophageal reflux Disease. J Pediatr Gastroenterol Nutr 2006; 42:384-91.
  • 14. Suwandhi E, Ton MN, Schwarz SM. Gastroesophageal reflux in infancy and childhood. Pediatr Ann 2006; 35:259-66.
  • 15. Brecelj J, Orel R. P0866 Evaluation and management of children with gastroesophageal reflux disease in pediatric gastroenterology unit-A retrospective study. J Pediatr Gastroenterol Nutr 2004; 39:386-7.
  • 16. Ashorn M, Ruuska T, Karikoski R, Laippala P. The natural course of gastroesophageal reflux disease in children. Scand J Gastroenterol 2002; 37:638-41.
  • 17. Malaty HM, O’Malley KJ, Abudayyeh S, Graham DY, Gilger MA. Multidimensional measue for gastroesophageal reflux disease (MM-GERD) symptoms in children: a population: a population-based study. Acta Paediatr 2008; 97:1292-7.
  • 18. Bines JE, Quinlan JE, Treves S, Kleinman RE, Winter HS. Efficacy of domperidone in infants and children with gastroesophageal reflux. J Pediatr Gastroenterol Nutr 1992; 14:400-5.
  • 19. Carroccio A, Iacono G, Montalto G, Cavataio F, Soresi M, Notarbartolo A. Domperidone plus magnesium hydroxide and aluminium hydroxide: a valid therapy in children with gastroesophageal reflux. A double-blind randomized study versus placebo. Scand J Gastroenterol 1994; 29:300-4.
  • 20. Chiba N, De Gara CJ, Wilkinson JM, Hunt RH. Speed of healing and symptom relief in grade II to IV gastroesophageal reflux disease: a meta analysis. Gastroenterolgy 1997; 112:1798-810.
  • 21. Cucchiara S, Minella R, Iervolino C, Franco MT, Campanozzi A, Franceschi M et al. Omeprazole and high dose ranitidine in the treatment of refractory reflux oesophagitis. Arch Dis Child 1993; 69:655-9.
  • 22. Miller S. Comparison of the efficacy and safety of a new aluminium-free pediatric alginate preparation and placebo in infants with recurrent gastro-oesophagel reflux. Curr Med Res Opin 1999; 15:160-8.
  • 23. Del Buono R, Wenzi TG, Ball G, Keady S, Thomson M. Effect of Gaviscon infant on gastro-oesophageal reflux in infants assessed by combined intraluminal impedance/pH. Arch Dis Child 2005; 90:460-3.
  • 24. Forbes D, Hodgson M, Hill R. The effects of Gaviscon and metoclopramide in gastroesophageal reflux in children. J Pediatr Gastroenterol Nutr 1986; 5:556-9.
  • 25. Smith HJ. Gastrointestinal hemorrhage in paralyzed and neurologically impaired patients: contribution of reflux esophageal disease. Gastrointest Radiol 1985; 10:7-10.
  • 26. Debley JS, Carter ER, Redding GJ. Prevelance and impact of gastroesophageal reflux in adolescents with asthma: a population-based study. Pediatric Pulmonology 2006; 41:475-81.
  • 27. Corvo M, Ghiglioni D, Gemellaro L, Sarratud T, Fiocchi A. Gastrointestinal signs and symptoms of allergic diseases in children. Pediatr Med Chir 2009; 31:153-9.
  • 28. Lasser MS, Liao JG, Burd RS. National Trends in the use of antireflux procedures for children. Pediatrics 2006; 118:1828-35.
  • 29. Ersin NK, Onça¤ O, Tümgör G, Aydo¤du S, Hilmio¤lu S. Oral and dental manifestations of gastroesophageal reflux disease in children: a preliminary study. Pediatr Dent 2006; 28:279-84.
  • 30. Walker WA, Goulet O, Kleinman RE, Sherman PM. Pediatric Gastrointestinal Disease. Fourth edition. Hamilton, Ontario, Canada 2004; 73:1831-8.
  • 31. Tighe MP, Cullen M, Beattie RM. How to use: a pH study. Arch Dis Child Educ Pract Ed 2009; 94:18-23.
  • 32. Jung AD. Gastroesophageal reflux in infants and children. Am Fam Physician 2001; 64:1853-60.
  • 33. Vandenplas Y, Salvatore S, Hauser B. The diagnosis and management of gastro-oesophageal reflux in infants. Early Human Development 2005; 81:1011-24.
  • 34. Thompson JK, Koehler RE, Richter JE. Detection of gastroesophageal reflux: value of barium studies compared with 24-hr pH monitoring. AJR Am J Roentgenol 1994; 162:621-6.
  • 35. Hila A, Agrawal A, Castell DO. Combined multichannel intraluminal impedance and pH esophageal testing compared to pH alone for diagnosing both acid and weakly acidic gastroesophageal reflux. Clin Gastroenterol Hepatol 2007; 5:172-7.
Toplam 35 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Bölüm Research Article
Yazarlar

Gülin Erdemir

Taner Özgür Bu kişi benim

Yakup Canıtez Bu kişi benim

Bülent Kayık Bu kişi benim

Ali Özboyacı Bu kişi benim

Tanju B. Özkan Bu kişi benim

Yayımlanma Tarihi 1 Haziran 2010
Yayımlandığı Sayı Yıl 2010 Cilt: 8 Sayı: 1

Kaynak Göster

APA Erdemir, G., Özgür, T., Canıtez, Y., Kayık, B., vd. (2010). Çocuklarda pH Monitörizasyonu ile Gastroözofageal Reflü Hastalığının Değerlendirilmesi. Güncel Pediatri, 8(1), 130-136.
AMA Erdemir G, Özgür T, Canıtez Y, Kayık B, Özboyacı A, Özkan TB. Çocuklarda pH Monitörizasyonu ile Gastroözofageal Reflü Hastalığının Değerlendirilmesi. Güncel Pediatri. Haziran 2010;8(1):130-136.
Chicago Erdemir, Gülin, Taner Özgür, Yakup Canıtez, Bülent Kayık, Ali Özboyacı, ve Tanju B. Özkan. “Çocuklarda PH Monitörizasyonu Ile Gastroözofageal Reflü Hastalığının Değerlendirilmesi”. Güncel Pediatri 8, sy. 1 (Haziran 2010): 130-36.
EndNote Erdemir G, Özgür T, Canıtez Y, Kayık B, Özboyacı A, Özkan TB (01 Haziran 2010) Çocuklarda pH Monitörizasyonu ile Gastroözofageal Reflü Hastalığının Değerlendirilmesi. Güncel Pediatri 8 1 130–136.
IEEE G. Erdemir, T. Özgür, Y. Canıtez, B. Kayık, A. Özboyacı, ve T. B. Özkan, “Çocuklarda pH Monitörizasyonu ile Gastroözofageal Reflü Hastalığının Değerlendirilmesi”, Güncel Pediatri, c. 8, sy. 1, ss. 130–136, 2010.
ISNAD Erdemir, Gülin vd. “Çocuklarda PH Monitörizasyonu Ile Gastroözofageal Reflü Hastalığının Değerlendirilmesi”. Güncel Pediatri 8/1 (Haziran 2010), 130-136.
JAMA Erdemir G, Özgür T, Canıtez Y, Kayık B, Özboyacı A, Özkan TB. Çocuklarda pH Monitörizasyonu ile Gastroözofageal Reflü Hastalığının Değerlendirilmesi. Güncel Pediatri. 2010;8:130–136.
MLA Erdemir, Gülin vd. “Çocuklarda PH Monitörizasyonu Ile Gastroözofageal Reflü Hastalığının Değerlendirilmesi”. Güncel Pediatri, c. 8, sy. 1, 2010, ss. 130-6.
Vancouver Erdemir G, Özgür T, Canıtez Y, Kayık B, Özboyacı A, Özkan TB. Çocuklarda pH Monitörizasyonu ile Gastroözofageal Reflü Hastalığının Değerlendirilmesi. Güncel Pediatri. 2010;8(1):130-6.