Pulmonary Unit, G. Gaslini Institute, Largo G. Gaslini 5, 16147 Genoa, Italy.
Respir Med. 2010 Apr;104(4):593-9. doi: 10.1016/j.rmed.2009.11.007. Epub 2009 Dec 1.
Management of children with gastroesophageal reflux disease (GORD) and difficult-to-treat (D-T-T) respiratory symptoms may include double fiberoptic, airway and oesophago-gastro-duodenoscopies (DE). A study was performed to evaluate the usefulness and safety of DE in children with severe GORD and D-T-T respiratory symptoms.
A 3-year retrospective review of records of children who underwent DE under general anaesthesia was performed: the relevant clinical information obtained and the occurrence of complications in the 72h following the DE.
Inflammatory changes of the airways were found at bronchoscopy in 40 out of the 60 children: bronchoalveolar lavage (BAL) demonstrated positive lipid-laden alveolar macrophages (LLAM), neutrophilic inflammation or both, respectively in 9, 12 and 16 patients. BAL bacterial cultures were positive in 2 patients with elevated airway neutrophilia. Structural airway abnormalities, explaining not GOR-related D-T-T respiratory symptoms were identified in 11 patients. Oesophagoscopic findings supporting GORD were detected in 32/60 children and confirmed by consistent histological changes in oesophageal mucosal biopsies (OEB) in 27. The frequency of complications, all minor, was low during the procedure and in the following 72h. They included mild desaturation, stridor or bronchospasm, vomiting, dysphagia and hyperthermia requiring antibiotic treatment in 1 patient. No "new onset" complication was observed after 48h following DE. The time-dependent hazard of complications was significantly higher for patients with a history of onset of respiratory symptoms early in life (</=2 years of age) (p=0.038).
DE can be useful in the clinical evaluation of children with D-T-T respiratory symptoms and GORD and is associated with low frequency of mild complications when performed by appropriately trained and experienced personnel.
胃食管反流病（GORD）和治疗困难（D-T-T）的儿童呼吸道症状的管理可能包括双光纤、气道和食管胃十二指肠镜检查（DE）。进行了一项研究，以评估 DE 在严重 GORD 和 D-T-T 呼吸道症状的儿童中的有用性和安全性。
对接受全身麻醉下 DE 的 60 例儿童的记录进行了为期 3 年的回顾性分析：获得相关临床信息，并在 DE 后 72 小时内发生并发症。
40 例儿童在支气管镜检查中发现气道炎症改变：支气管肺泡灌洗（BAL）分别在 9、12 和 16 例患者中显示阳性脂质负荷肺泡巨噬细胞（LLAM）、中性粒细胞炎症或两者兼有。2 例气道中性粒细胞增多的患者 BAL 细菌培养阳性。在 11 例患者中发现了解释与 GOR 无关的 D-T-T 呼吸道症状的结构性气道异常。在 60 例儿童中，32 例发现支持 GORD 的食管镜检查结果，并在 27 例儿童的食管黏膜活检（OEB）中发现一致的组织学变化得到证实。在手术过程中和接下来的 72 小时内，并发症的频率都很低，所有并发症都很轻微。其中包括轻度低氧血症、喘鸣或支气管痉挛、呕吐、吞咽困难和需要抗生素治疗的发热 1 例。DE 后 48 小时后未观察到“新出现”并发症。有生命早期（<=2 岁）起病的呼吸道症状史的患者并发症的时间依赖性危险明显更高（p=0.038）。
DE 可用于 D-T-T 呼吸道症状和 GORD 儿童的临床评估，并且在由经过适当培训和经验丰富的人员进行时，并发症的频率较低。
