儿童和青少年食物不耐受方面的胃食管反流（GER）

Gastroesophageal reflux (GER) in children and adolescents with regard to food intolerance.

作者信息

Semeniuk J, Kaczmarski M

机构信息

III Department of Pediatrics, Medical Univesity of Białystok, ul. Waszyngtona 17, 15-274 Białystok, Poland.

出版信息

Adv Med Sci. 2006;51:321-6.

PMID:17357334

Abstract

PURPOSE

The hypothesis put forward in the current study was that food intolerance can be a cause of gastroesophageal reflux (GER) affecting children with this pathology at various age. In order to confirm or exclude this hypothesis, the study objective was to determine the frequency of the cause-and-effect relationship between allergy to cow milk proteins and/or other food products and gastroesophageal reflux found in the study group of patients, and to establish diagnostic differentiation guidelines in GER caused by food intolerance, i.e. secondary vs primary GER.

MATERIAL AND METHODS

A total of 735 children (428 boys--58.2% and 307 girls--41.8%; mean age x = 41.12 months +/- 25.03) with symptoms suggesting gastroesophageal reflux disease (GERD) were qualified for the study. The diagnostic procedure included a 24 h pH-metry of the oesophagus, which was performed in all the study children. In 703 patients (411 boys--55.9% and 292 girls--39.7%) upper gastrointestinal endoscopy was carried out. Manometric examination of the oesophagus was performed in 232 children (123 boys--16.7% and 109 girls--14.8%). Allergological and immunological tests were done in 170 children with suspected allergy (91 boys--12.4% and 79 girls--10.7%). Contrast radiography of the upper gastrointestinal tract was performed in 78 children with respiratory symptoms (42 boys--5.7% and 36 girls--4.9%). Oral challenge test was used to differentiate primary GER from GER secondary to cow milk proteins intolerance or other food allergy in 138 children (72 boys--9.8% and 66 girls--8.9%).

RESULTS

Based on the 24 h pH-metry of the oesophagus and endoscopic examination of the upper gastrointestinal tract, gastroesophageal reflux disease and/or reflux oesophagitis were diagnosed in 138 study subjects (18.8%); mean age x = 23.36 months +/- 22.53. Positive oral food challenge test confirmed pathological GER secondary to cow milk protein allergy/other food hypersensitivity in 62 children (8.4%).

CONCLUSION

The current study revealed the existence of the cause-and-effect relationship between allergy to cow milk protein/ /other food products and GER in the study children at various age.

摘要

目的

本研究提出的假设是食物不耐受可能是胃食管反流（GER）的一个原因，影响不同年龄段患有这种病症的儿童。为了证实或排除这一假设，研究目的是确定在研究组患者中发现的牛奶蛋白和/或其他食品过敏与胃食管反流之间因果关系的频率，并建立由食物不耐受引起的GER的诊断鉴别指南，即继发性GER与原发性GER。

材料与方法

共有735名有胃食管反流病（GERD）症状的儿童（428名男孩——58.2%，307名女孩——41.8%；平均年龄x = 41.12个月±25.03）符合研究条件。诊断程序包括对所有研究儿童进行24小时食管pH监测。703名患者（411名男孩——55.9%，292名女孩——39.7%）进行了上消化道内镜检查。232名儿童（123名男孩——16.7%，109名女孩——14.8%）进行了食管测压检查。对170名疑似过敏儿童（91名男孩——12.4%，79名女孩——10.7%）进行了过敏和免疫学检测。对78名有呼吸道症状的儿童（42名男孩——5.7%，36名女孩——4.9%）进行了上消化道造影检查。采用口服激发试验对138名儿童（72名男孩——9.8%，66名女孩——8.9%）的原发性GER与牛奶蛋白不耐受或其他食物过敏继发的GER进行鉴别。