Semeniuk J, Kaczmarski M, Uścinowicz M
III Department of Pediatrics, Medical University of Bialystok, Bialystok, Poland.
Adv Med Sci. 2008;53(2):283-92. doi: 10.2478/v10039-008-0034-8.
PURPOSE: The comparison of values of selected lower esophageal sphincter (LES) manometric parameters measured in children suspected of gastroesophageal reflux disease (GERD) (preliminary study) and in children with primary acid GER and acid GER secondary to cow's milk allergy and/or other food (CMA/FA) in relation to the duration of the disease (prospective study). MATERIAL AND METHODS: A 24-hour esophageal pH monitoring was performed on 264 children of both sexes suspected of GERD (mean age x=20.78+/-17.23 months). Pathological acid gastroesophageal reflux (GER) was diagnosed and divided into primary and secondary reflux in 138 children (52.3%). 76 patients (28.8%) (x=25.2+/-27.28 months) with primary GER made up Group 1. Group 2 consisted of 62 patients (23.5%) (x=21.53+/-17.79 months) with GER secondary to CMA/FA. 32 patients (12.1%) (x=23.7+/-12.63 months) with CMA/FA symptoms made up Group 3 (reference group). Prospective assessment of LES manometric parameters, i.e. resting LES pressure and LES length, was performed on 138 children with GER. Manometric parameters, resting LES pressure and LES length, measured at the preliminary study (0) and control studies (after 1, 2 and 8 years), were prospectively assessed in 138 children. The assessment resulted from clinical observation and/or conservative treatment. RESULTS: The mean value of resting LES pressure (mm Hg) before treatment was x=11.75+/-3.98 in Group 1, x=11.05+/-3.31 in Group 2, and x=14.17+/-3.86 in Group 3 (reference group). After 2 years of clinical observation, the mean value of resting LES pressure accounted for x=13.71+/-3.88 in Group 1, x=13.01+/-2.94 in Group 2, and x=17.92+/-3.36 in Group 3. The mean LES length (cm) before treatment accounted for x=1.68+/-0.72 in Group 1, x=1.78+/-0.70 in Group 2, and x=2.0+/-0.86 in Group 3. After 2 years of clinical observation, the mean LES length was x=2.80+/-0.40 in Group 1, x=2.76+/-0.40 in Group 2, and x=2.97+/-0.48 in Group 3. 12 children with persistent GERD (Group 1) and 8 children with persistent GERD and food allergy (Group 2) underwent manometric evaluation of LES after 8 years. No statistical differentiation of the mean values of resting LES pressure and LES length were shown in examined children of Groups 1 and 2 during prospective studies. CONCLUSIONS: Manometric studies of LES assessing only resting LES pressure and its length in the examined children with acid GER do not clearly differentiate GER into primary and secondary refluxes to food allergy.
目的：比较疑似胃食管反流病（GERD）儿童（初步研究）以及原发性胃酸反流和继发于牛奶过敏和/或其他食物（CMA/FA）的胃酸反流儿童中所选食管下括约肌（LES）测压参数值与疾病持续时间的关系（前瞻性研究）。 材料与方法：对264名疑似GERD的男女儿童（平均年龄x = 20.78±17.23个月）进行24小时食管pH监测。在138名儿童（52.3%）中诊断出病理性胃酸胃食管反流（GER），并分为原发性和继发性反流。76例原发性GER患者（28.8%）（x = 25.2±27.28个月）组成第1组。第2组由62例继发于CMA/FA的GER患者（23.5%）（x = 21.53±17.79个月）组成。32例有CMA/FA症状的患者（12.1%）（x = 23.7±12.63个月）组成第3组（参照组）。对138例GER儿童进行LES测压参数的前瞻性评估，即LES静息压和LES长度。在初步研究（0）和对照研究（1、2和8年后）测量的LES测压参数，即LES静息压和LES长度，在138名儿童中进行前瞻性评估。评估基于临床观察和/或保守治疗。 结果：治疗前，第1组LES静息压（mmHg）的平均值为x = 11.75±3.98，第2组为x = 11.05±3.31，第3组（参照组）为x = 14.17±3.86。经过2年的临床观察，第1组LES静息压的平均值为x = 13.71±3.88，第2组为x = 13.01±2.94，第3组为x = 17.92±3.36。治疗前LES平均长度（cm），第1组为x = 1.68±0.72，第2组为x = 1.78±0.70，第3组为x = 2.0±0.86。经过2年的临床观察，第1组LES平均长度为x = 2.80±0.40 cm，第2组为x = 2.76±0.40 cm，第3组为x = 2.97±0.48 cm。8年后，12例持续性GERD儿童（第1组）和8例持续性GERD及食物过敏儿童（第2组）接受了LES测压评估。在前瞻性研究中，第1组和第2组受试儿童的LES静息压和LES长度平均值无统计学差异。 结论：在受试的胃酸反流儿童中，仅评估LES静息压及其长度的LES测压研究并不能明确区分原发性反流和继发于食物过敏的反流。
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