Arana J, Tapia I, Tovar J A
Universidad del País Vasco, Hospital Materno-Infantil Nuestra Señora de Aránzazu, Servicio de Cirugía Pediátrica, San Sebastián.
Cir Pediatr. 1990 Apr;3(2):56-61.
Gastroesophageal Reflux (GER) in children manifests itself by several clinical pictures. Its diagnosis is difficult and so are surgical indications. The search for prognostic parameters able to predict the need for surgery are therefore warranted. We have demonstrated in previous studies in children with GER a decrease in propulsive peristalsis and an increase in non-propulsive activity. We have also reported that patients able to respond to medical treatment correct their motor trouble when acid is instilled into the esophagus, whereas those unable to respond to it do not. Aiming at clarifying the prognostic value of this acid challenge test we have thus measured Esophageal Motor Efficiency (EME) (prop. waves/h multiplied by mean pressure) in basal conditions and after acid challenge in 52 children divided into two groups according to their response to medical treatment during periods exceeding 6 months. EME in basal conditions did not allow differentiation between both groups, but EME after acid challenge did so. Optimum threshold value was 565, sensitivity 0.76, specificity 0.75, positive predictive value 87%, and negative predictive value 60%. This test seems to have some prognostic value in pediatric GER.
小儿胃食管反流（GER）有多种临床表现。其诊断困难，手术指征也不明确。因此，有必要寻找能够预测手术需求的预后参数。我们在之前对GER患儿的研究中发现，推进性蠕动减少，非推进性活动增加。我们还报告称，能够对药物治疗产生反应的患者在向食管内注入酸时会纠正其运动障碍，而那些无反应的患者则不会。为了阐明这种酸激发试验的预后价值，我们对52名儿童在基础状态下以及酸激发后测量了食管运动效率（EME）（推进波数/小时乘以平均压力），这些儿童根据其在超过6个月的时间里对药物治疗的反应分为两组。基础状态下的EME无法区分两组，但酸激发后的EME可以。最佳阈值为565，敏感性为0.76，特异性为0.75，阳性预测值为87%，阴性预测值为60%。该试验似乎对小儿GER有一定的预后价值。
