Acid and weakly acid gastroesophageal refluxes and type of respiratory symptoms in children

被引:24
作者
Ghezzi, Michele [1 ]
Silvestri, Michela [1 ]
Guida, Edoardo [2 ]
Pistorio, Angela [3 ]
Sacco, Oliviero [1 ]
Mattioli, Girolamo [2 ]
Jasonni, Vincenzo [2 ]
Rossi, Giovanni A. [1 ]
机构
[1] G Gaslini Inst Children, Pediat Pulmonol & Allergy Unit, I-16147 Genoa, Italy
[2] G Gaslini Inst Children, Dept Surg, I-16147 Genoa, Italy
[3] G Gaslini Inst Children, Clin Epidemiol & Biostat Unit, I-16147 Genoa, Italy
关键词
Multichannel intraluminal impedance; Apnoea; Asthma; Respiratory manifestations; MULTICHANNEL INTRALUMINAL IMPEDANCE; COMMUNITY-ACQUIRED PNEUMONIA; PEDIATRIC-PATIENTS; ESOPHAGEAL PH; AIRWAY; RISK; ASPIRATION; REFLEXES; INFANTS;
D O I
10.1016/j.rmed.2011.01.016
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objectives: To evaluate the association between the frequency of acid reflux (AR) and weakly acid reflux (WAR) and specific respiratory symptoms (RS) in childhood. Study design: We retrospectively reviewed medical records of children with difficult-to-treat RS, not under acid suppressive therapy, and with a positive multiple intraluminal esophageal impedance (pH/MII) monitoring. To discriminate children with prevalent AR and WAR events, a ROC curve was designed and the distribution of the different RS in children with prevalent AR or WAR events was analyzed. Results: A higher number of AR over WAR events was detected (p < 0.0001) but the WAR-to-AR events ratio progressively decreased with the age of the subjects (p < 0.01). Similar total number of reflux events was found in the three age group and in children with a more prevalent WAR or AR. The most prevalent RS, equally distributed among the three age groups, were persistent and/or nocturnal cough, wheezy bronchitis/asthma, and recurrent lower respiratory tract infections (RLRTI). Apnoea was most frequent in infants (p = 0.036). A higher frequency of RLRTI, but not of nocturnal cough or wheezy bronchitis/asthma, was shown in WAR as compared with AR patients (p = 0.040), and specifically those in the school-aged group (p = 0.013). Age and WAR were respectively identified as independent predictors of apnoea and RLRTI (p < 0.05). Conclusion: WAR events are common in children with gastroesophageal reflux and difficult-to-treat RS and often associated with RLRTI. These findings support the role of pH/MII monitoring in the evaluation of these patients and may explain the disappointing clinical results often observed with anti-acid treatments. (C) 2011 Elsevier Ltd. All rights reserved.
引用
收藏
页码:972 / 978
页数:7
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