Baran Maşallah, Özgenç Funda, Arikan Çiğdem, Çakir Murat, Ecevıt Çiğdem Ömür, Aydoğdu Sema, Yağci Raşit Vural
Ege University Medical Faculty, Department of Pediatric Gastroenterology, Hepatology and Nutrition, İzmir, Turkey.
Turk J Gastroenterol. 2012;23(6):634-8. doi: 10.4318/tjg.2012.0454.
BACKGROUND/AIMS: Functional constipation and gastroesophageal reflux disease are two major and commonly encountered components of childhood functional gastrointestinal disorders. Epidemiological studies in the adult population support that there is a significant overlap between the different functional disorders of the digestive tract. Therefore, we aimed to investigate the frequency of gastroesophageal reflux disease in children with functional constipation and to compare clinical findings and 24-h esophageal pH monitoring with a group of patients with suspected gastroesophageal reflux disease.
Children between 4 and 16 years old with functional constipation (based on Rome III criteria, Group 1; n=38) were prospectively evaluated. A control group was composed of patients with symptoms suggesting gastroesophageal reflux disease (Group 2; n= 40). All patients included in the study were asked about reflux-related symptoms, and then all cases underwent 24-h esophageal pH monitoring analysis.
Delayed gastric emptying symptoms such as belching and hiccups were more common in patients in Group 1 (p=0.002, p=0.021, respectively), whereas chronic cough was more common in patients in Group 2 (p=0.012). According to the 24-h esophageal pH monitoring, pathologic acid reflux in the lower and/or laryngopharyngeal portion of the esophagus was determined in 39.5% of the patients in Group 1 and in 42.5% of the patients in Group 2 (p=0.96). No significant difference was found in terms of age, gender and duration of constipation in patients with and without acid reflux in Group 1 patients. Pyrosis (66.6 vs. 0%, p=0.00001)was more common in Group 1 patients with acid reflux, but hiccups (20 vs. 69.5%, p=0.007) and belching (33.3 vs. 60.8%, p=0.184) were more common in patients in Group 1 without acid reflux.
Gastroesophageal reflux disease should be considered in the treatment and monitoring of patients with functional constipation. Further studies are needed using 24-h pH multichannel impedance.
背景/目的：功能性便秘和胃食管反流病是儿童功能性胃肠病中两个主要且常见的组成部分。针对成年人群的流行病学研究表明，消化道不同功能性疾病之间存在显著重叠。因此，我们旨在调查功能性便秘患儿中胃食管反流病的发生率，并将临床症状及24小时食管pH监测结果与一组疑似胃食管反流病的患者进行比较。
对4至16岁符合功能性便秘诊断标准（依据罗马III标准，第1组；n = 38）的儿童进行前瞻性评估。对照组由有胃食管反流病相关症状的患者组成（第2组；n = 40）。研究纳入的所有患者均被询问反流相关症状，随后所有病例均接受24小时食管pH监测分析。
第1组患者中嗳气、打嗝等胃排空延迟症状更为常见（分别为p = 0.002，p = 0.021），而慢性咳嗽在第2组患者中更为常见（p = 0.012）。根据24小时食管pH监测结果，第1组39.5%的患者以及第2组42.5%的患者在食管下段和/或喉咽部存在病理性酸反流（p = 0.96）。第1组中，有无酸反流的患者在年龄、性别及便秘持续时间方面均未发现显著差异。烧心症状（66.6% 对0%，p = 0.00001）在第1组有酸反流的患者中更为常见，但打嗝（20% 对69.5%，p = 0.007）和嗳气（33.3% 对60.8%，p = 0.184）在第1组无酸反流的患者中更为常见。
在功能性便秘患者的治疗和监测中应考虑胃食管反流病。需要进一步采用24小时多通道pH阻抗监测进行研究。
