Semeniuk Janusz, Kaczmarski Maciej, Uścinowicz Mirosława
Akademia Medyczna w Białymstoku, III Klinika Chorób Dzieci.
Pol Merkur Lekarski. 2008 Mar;24(141):212-8.
THE AIM OF THE STUDY was to assess the esophageal mucous membrane in children with pathological acid gastroesophageal reflux (GER) primary and secondary to cow's milk allergy and (or) food allergy (CMA/FA), dependent on the duration of the disease (prospective study).
264 children of both sexes suspected of GER were enrolled in the study. The age of examined children was 1.5-102 months (mean age 20.78+/-17.23 moths). Pathological acid GER was confirmed in 138 children (52.3%) with pH-monitoring. Taking into consideration complex differential diagnosis, including elimination of noxious nutrient and oral food challenge test (open or blind study), acid GER was differentiated into primary and secondary. Children were assigned into study groups 1 and 2. Group 1: 76 patients (28.8%) aged 4-102 months (mean age 25.2+/-27.28 months) with primary GER. Group 2: 62 patients (23.5%) aged 4-74 months (mean age 21.53+/-17.79 months) with GER secondary to CMA/FA. Endoscopic examination of the upper gastrointestinal tract was performed in 138 children: preliminary and control examination (after one year and two years of GERD diagnosis.
Esophagitis of different intensity (second - fourth degree) in macroscopic assessment was diagnosed in 25 children (32.9%) with group 1 and in 29 children (46.8%) with group 2 in preliminary study. Esophagitis was still present in macroscopic assessment after one year of conservative treatment in 13 children (17.1%) from group 1 and in 12 children (19.4%) from group 2. After two years of clinical observation and periodically administered conservative treatment mild esophagitis still persisted in 3 children (3.9%) from group 1, and in 3 children (4.8%) from group 2.
Esophagitis of various intensity (second - fourth degree) was diagnosed in preliminary endoscopic examination in about 33% of children with group 1 and 47% of children with group 2.
本研究的目的是评估原发性和继发性于牛奶过敏和（或）食物过敏（CMA/FA）的病理性酸性胃食管反流（GER）患儿的食管黏膜，该评估取决于疾病持续时间（前瞻性研究）。
264名疑似GER的男女儿童参与了本研究。被检查儿童的年龄为1.5 - 102个月（平均年龄20.78±17.23个月）。通过pH监测在138名儿童（52.3%）中确诊为病理性酸性GER。考虑到复杂的鉴别诊断，包括去除有害营养素和口服食物激发试验（开放或盲法研究），酸性GER被分为原发性和继发性。儿童被分为研究组1和研究组2。研究组1：76例患者（28.8%），年龄4 - 102个月（平均年龄25.2±27.28个月），患有原发性GER。研究组2：62例患者（23.5%），年龄4 - 74个月（平均年龄21.53±17.79个月），患有继发于CMA/FA的GER。对138名儿童进行了上消化道内镜检查：初步检查和对照检查（GERD诊断后一年和两年）。
在初步研究中，研究组1的25名儿童（32.9%）和研究组2的29名儿童（46.8%）在宏观评估中被诊断为不同程度（二级 - 四级）的食管炎。在保守治疗一年后，研究组1的13名儿童（17.1%）和研究组2的12名儿童（19.4%）在宏观评估中仍存在食管炎。经过两年的临床观察和定期进行的保守治疗，研究组1的3名儿童（3.9%）和研究组2的3名儿童（4.8%）仍存在轻度食管炎。
在初步内镜检查中，研究组1约33%的儿童和研究组2约47%的儿童被诊断为不同程度（二级 - 四级）的食管炎。
