GASTROÖZEFAGEAL REFLÜ ŞÜPHELİ ÇOCUKLARDA pH METRE SONUÇLARININ DEĞERLENDİRİLMESİ [Results of the pH meter in children with gastroesophageal reflux]

Yıl 2014, Cilt: 45 Sayı: 1, 44 - 48, 01.03.2014

Cengiz Gül Ayşenur Cerrah Celayir Ceyhan Şahin Gökmen Kurt

Öz

Giriş ve Amaç: Gastroözefageal reflü şüpheli olgularda 24 saatlik pH metre analizi önemli bir tanı yöntemi olarak güncelliğini korumaktadır. Klinik olarak kuvvetle gastroözefageal reflü şüpheli olgularda, pH metre analizi sonuçlarının klinik bulgu ile korale olup olmadığını saptamak amacıyla bu çalışma planlandı.

Gereç ve Yöntem: Ocak 2006-Ocak 2008 yılları arasında gastroözefageal reflü şüpheli olgularımızda 24 saatlik çift kanalı kateter ile pH metre analizi yapıldı ve olguların tüm kayıtları değerlendirildi.

Bulgular: Kliniğimizde pH metre analizi yapılan yapılan 109 hastanın 70’i erkek, 39’u kız olup ortalama yaşları 22 ay (14 gün ile120 ay arasında) idi. pH metre ile reflü saptanan 31 olgunun 13’ü kız,18’i erkek idi. Reflü saptanan 31 olgunun 13’ü sık akciğer infeksiyonu, 5’i aralıklı kusma, 9’u kusma yakınması olan opere distal fistüllü özefagus atrezisi, 3’ü nörolojik defisitli olgu, 1’i ise diafragma hernisi nedeniyle opere olmuş idi.

Fistüllü özefagus atrezisi nedeniyle opere olmuş 14 hastada yapılan pH metre sonucunda 9’unda reflü saptandı (%64), sık akciğer enfeksiyonu tanısı alan 59 hastanın 13’ünde reflü saptandı (%22). Sol diyafragma hernisi nedeniyle opere olan 7 hastanın sadece 1’inde reflü saptandı (%14).

pH metre ile reflü saptanan 31 olgunun 8’inde reflü şiddeti ve süresi ameliyat gerektiren sınırlardaydı, bunlardan 6 yaşındaki kusma yakınmalı bir olgunun ailesi ameliyatı kabul etmedi, 7 olguda antireflü cerrahi girişim yapıldı. Bu olguların 5’i daha önce fistüllü özefagus atrezisi nedeniyle operasyon geçirmişti, diğer ikisi ise kusma yakınmalı olgulardandı.

Sonuç: Gastroözofageal reflü hastalığı olan çok az bir hasta grubunda ameliyat endikasyonu konulmasında pHmetrenin katkısı olmuştur. Dolayısıyla her ne kadar noninvaziv olsa da 24 saat boyunca özefageal kateterin takılmasının vereceği rahatsızlık göz önüne alınarak, özellikle sık ÜSYE geçiren çocuklarda pH metre yapılmasında daha seçici olunmalıdır.

Anahtar Kelimeler: Gastroözefageal reflü, pH metre, özefagus manometresi, reaktif hava yolları.

 

Abstract:

Introduction and Aim: 24 hours pH meter analysis in patient with suspected gastroesophageal reflux has a significant recognition as a method to date. It is planned to determine pH meters analysis of the results correlated with clinical findings in patients with susected gastroesophageal reflux.

 

Material and Method: Between January 2006 and January 2008 in patients with suspected gastroesophageal reflux investigement of the pH meter was made whit in the 24 hours period with a double-channel catheter, and all pH meter records were analyzed and evaluated.

 

Results: pH meter analysis was made of the 109 patents, 70 males and 39 females. The mean ages was 22 months, ranged between 14 days and 120 months. 14 patients with operated for esophageal atresia with fistula, 59 patients with frequent lung infections, 7 pateints who underwent surgery for left diaphragmatic hernia undervent pH meter investigements.

31 cases with gastroesophageal reflux were detected in 13 females and 18 males. 13 of 31 cases were with frequent lung infections, 5 of its were intermittent vomiting, 9 of its were with had operated esophageal atresia with fistula, 3 of its were with neurological deficit, 1 of the pateint was operated for diaphragmatic hernia.

As a results of pH meter; gastroesophageal refluxes were determined in 9 of 14 patients with esophageal atresia with fistula (%64), and 13 of 59 patients with frequent lung infections (%22), and only 1 of 7 patients who underwent surgery for left diaphragmatic hernia (%14). Intensity and duration of reflux which detected by pH meter were required surgery in 8 cases of 31 patients. A parent of a 6 years old girl which had vomiting didn’t accept surgery. Antireflux surgery procedures were performed in 7 patients, 5 of these patients had undergone previous surgery because of esophageal atresia, among the other two cases had vomiting.

 

Conclusions: As a results of pH meters, indication for reflux surgery was placed in a small group of patients in our series. Although it seems to be noninvasive investigements especially in patients with frequent upper respiratory tract infections; while making a decision for doing of the pH meter should be more selective due to unconfortable of catheterisation.

 

Key Words: Gastroesophageal Reflux, pH meter, esophagus manometer, reactive airway

Anahtar Kelimeler

Gastroözefageal reflü, pH metre, özefagus manometresi, reaktif hava yolları.

Kaynakça

• Aldo JF, Giselia AP, Pedro AC, et al. Prevelans of pathologic in gastroesophageal reflux in regurgitant infants. J Pediatr 2004; 80: 291-5.
• Nielson DW, Heldt GP, Tooley WH. Stridor and gastroesophageal reflux in infants. Pediatrics 1990; 6: 1034-9.
• Campanozzi A, Boccia G, Pensabene L, et al. Prevalence and natural history of gastroesophageal reflux: pediatric prospective survey. Pediatrics 2009; 123: 779-83.
• Pocts CF. Gastroesophageal reflux: A critical review of its role in preterm infants Pediatrics 2004; 113: 128-32.
• Ewer A, Durbin G, Morgan M, et al. Gastric emptying and gastro-oesphageal reflux in preterm infants. Arch Dis Child 1996; 75: 117–21.
• Omari TI, Barnett CP, Benninga MA, et al. Mechanisms of gastro-oesophageal reflux in preterm and term infants with reflux disease. Gut 2002; 51: 475-9.
• Barker SS, Roach CM, Leonard MS, et al. Infantile gastroesophageal reflux in a hospital setting. BMC Pediatrics 2008; 8: 11.
• Ravelli AM, Panarotto MB, Verdoni L, et al. Pulmonary aspiration shown by scintigraphy in gastroesophageal reflux-related respiratory disease. Chest 2006; 130: 1520-6.
• Mezzacappa AM. Clinical predictors of abnormal esophageal ph monitoring in preterm infants. Arg Gastroenterol 2008; 45: 1374.
• Kang Kil S, Kyoung Kim J, Hyun Ahn S, et al. Relationship between silent gastroesophageal reflux and food sensitization in infants and young children with recurrent wheezing. J Korean Med Sci 2010; 25: 425-8.
• Balli F, et al. Comparison of long-term pH-metry and radiological studies in the diagnosis of gastroesophageal reflux. Pediatr Med Chir 1986; 8: 617-3.
• Da Dalt L, Mazzoleni S, Montini G, et al. Diagnostic accuracy of pH monitoring in gastro-oesophageal reflux. Arch Dis Child.1989; 64: 1421-6.
• Da Dalt L, Mazzoleni S, Riello D, et al. Comparison of radiology and 24-hour esophageal pH-monitoring in the diagnosis of gastro-esophageal reflux in various pediatric age groups. Pediatr Med Chir 1991; 13: 369-72.
• Milocco C, Salvatore CM, Torre G, et al. Sonography versus continuous 24 hours oesophageal pH-monitoring in the diagnosis of infant gastroesophageal reflux. 1997; 19: 245-6.
• Koumanidou C, Vakaki M, Pitsoulakis G, et al. Sonographic measurement of the abdominal esophagus length in infancy: A diagnostic tool for gastroesophageal reflux. AJR 2004; 183: 801-7.
• Lopez Alonso M, , Moya MJ, Cabo JA, et al. 24 hour esophageal impedance pH monitoring in healthy preterm neonates. Pediatrics 2006; 118: e299-e308.
• Güner YS, Elliott S, Marr CC, Greenholz SK. Anterior fundoplication at the time of congenital diafragmatic hernia repair. Pediatr Surg Int 2009; 25: 715-8.
• Steven LL. Long-term antireflux medication use following pediatric nissen fundoplication. Arch Surg 2008; 143: 873-6.