Nation Javan, Kaufman Michael, Allen Meredith, Sheyn Anthony, Coticchia James
Wayne State University, Department of Otolaryngology-Head and Neck Surgery, United States.
Wayne State University, School of Medicine, United States.
Int J Pediatr Otorhinolaryngol. 2014 Feb;78(2):218-22. doi: 10.1016/j.ijporl.2013.10.057. Epub 2013 Nov 24.
Studies have shown that gastroesophageal reflux disease occurs more frequently than expected in children with chronic rhinosinusitis. The objective of this study is to further understand the relationship of pediatric chronic rhinosinusitis and gastroesophageal reflux disease in children with symptoms of rhinorrhea, nasal congestion, and chronic cough.
A retrospective chart review of 63 children, ages 6 months to 10 years old with rhinorrhea, nasal congestion, and chronic cough. The patients underwent maxillary cultures, adenoidectomy, and distal third esophageal biopsies. Children with esophageal biopsies showing esophagitis were classified as positive for gastroesophageal reflux disease, and maxillary antral swabs growing a high density of bacteria were classified as positive for chronic rhinosinusitis.
Six months to 5 years old children (n=43), 6 (14%) had simultaneous positive maxillary antral cultures and positive esophageal biopsies, 11 (26%) had positive esophageal biopsies alone, 23 (53%) had positive maxillary antral cultures alone, and 3 (7%) had neither. Six to 10 years old children (n=20), 9 (45%) had simultaneous positive maxillary antral cultures and positive esophageal biopsies, 1 (5%) patient had positive esophageal biopsies alone, 3 (15%) patients had positive maxillary antral cultures alone, and 7 (35%) patients had neither. Twenty-seven (42%) of the patients from the whole study had gastroesophageal reflux positive biopsies. The younger children were statistically likely to have chronic rhinosinusitis and gastroesophageal reflux disease independently of each other (p=0.0002). A direct group comparison found the younger group to have independent chronic rhinosinusitis and gastroesophageal reflux disease and the older group to have simultaneous chronic rhinosinusitis and gastroesophageal reflux disease (p=0.0006).
In children with the presenting symptoms of rhinorrhea, nasal congestion, and chronic cough, younger children tend to have either chronic rhinosinusitis or gastroesophageal reflux disease, whereas older children tend to have a more complicated etiology of chronic rhinosinusitis and gastroesophageal reflux disease or other. In all of these patients gastroesophageal reflux disease plays an important role, as over 40% of all patients had gastroesophageal positive biopsies.
研究表明，胃食管反流病在患有慢性鼻 - 鼻窦炎的儿童中比预期更为常见。本研究的目的是进一步了解患有流涕、鼻塞和慢性咳嗽症状的儿童中，小儿慢性鼻 - 鼻窦炎与胃食管反流病之间的关系。
对63例年龄在6个月至10岁之间、有流涕、鼻塞和慢性咳嗽症状的儿童进行回顾性病历审查。这些患者接受了上颌窦培养、腺样体切除术和食管远端三分之一活检。食管活检显示食管炎的儿童被归类为胃食管反流病阳性，上颌窦拭子培养出高密度细菌的被归类为慢性鼻 - 鼻窦炎阳性。
6个月至5岁的儿童（n = 43）中，6例（14%）上颌窦培养和食管活检同时呈阳性，11例（26%）仅食管活检呈阳性，23例（53%）仅上颌窦培养呈阳性，3例（7%）两者均为阴性。6至10岁的儿童（n = 20）中，9例（45%）上颌窦培养和食管活检同时呈阳性，1例（5%）仅食管活检呈阳性，3例（15%）仅上颌窦培养呈阳性，7例（35%）两者均为阴性。整个研究中的27例（42%）患者食管活检胃食管反流呈阳性。年龄较小的儿童在统计学上更有可能独立患有慢性鼻 - 鼻窦炎和胃食管反流病（p = 0.0002）。直接组间比较发现，较年轻组独立患有慢性鼻 - 鼻窦炎和胃食管反流病，而较年长组同时患有慢性鼻 - 鼻窦炎和胃食管反流病（p = 0.0006）。
对于有流涕、鼻塞和慢性咳嗽症状的儿童，年龄较小的儿童往往患有慢性鼻 - 鼻窦炎或胃食管反流病，而年龄较大的儿童慢性鼻 - 鼻窦炎和胃食管反流病或其他病因往往更为复杂。在所有这些患者中，胃食管反流病起着重要作用，因为超过40%的患者食管活检胃食管反流呈阳性。
