囊性纤维化：一个外科问题？

Cystic fibrosis: a surgical matter?

作者信息

Caldaro Tamara, Alghisi Federico, De Angelis Paola, Garganese Maria Carmen, Rea Francesca, Pizzoferro Milena, Villani Maria Felicia, Romeo Erminia Francesca, Torroni Filippo, Foschia Francesca, Gambitta Rosa Alba, Federici Giovanni, Lucidi Vincenzina, Dall'Oglio Luigi

机构信息

Digestive Surgery and Endoscopy Unit, Bambino Gesù Children's Hospital, Rome, Italy.

Cystic Fibrosis Unit, Bambino Gesù Children's Hospital, Rome, Italy.

出版信息

J Pediatr Surg. 2014 May;49(5):753-8. doi: 10.1016/j.jpedsurg.2014.02.089. Epub 2014 Mar 29.

DOI:10.1016/j.jpedsurg.2014.02.089

PMID:24851763

Abstract

BACKGROUND

Gastroesophageal reflux disease (GERD) is very common in patients with chronic lung diseases. We evaluated the incidence of GERD in young patients with cystic fibrosis (CF) and defined the characteristics of gastroesophageal reflux episodes analyzed by pH-multichannel intraluminal impedance (pH-MII) and esophagogastric scintigraphy.

PATIENTS AND METHODS

Since 2010, 31 patients with CF underwent pH-MII. Scintigraphy and upper endoscopy were performed in positive GERD patients. Forced expiratory volume in 1 second (FEV1%) predicted was detected.

RESULTS

pH-MII was positive in 17/31 (54.8%) patients (mean age: 12.4 years; range: 4-17 years). pH monitoring detected an average of 64.6 acid reflux events 4.4 episodes >5 minutes in duration. The DeMeester score was 38.5. Impedance identified a mean number of reflux episodes of 66 (65.2% acid; 32% weakly acidic; 2.8% nonacidic), 28% of which reached the proximal esophagus. Esophageal transit and gastric emptying were delayed in 6/13 (46.1%) and in 5/15 (33.3%) cases, respectively. No differences were found in lung function between positive and negative GERD patients (P=0.88).

CONCLUSIONS

Pediatric patients with CF have a high incidence of GERD with acidic events. These patients should be investigated with pH-MII and scintigraphy in order to make an early diagnosis and determine the most appropriate follow-up.

摘要

背景

胃食管反流病（GERD）在慢性肺部疾病患者中非常常见。我们评估了年轻囊性纤维化（CF）患者中GERD的发生率，并通过多通道腔内pH阻抗（pH-MII）和食管胃闪烁显像确定了胃食管反流发作的特征。

患者与方法

自2010年以来，31例CF患者接受了pH-MII检查。对GERD阳性患者进行了闪烁显像和上消化道内镜检查。检测了预计的第1秒用力呼气量（FEV1%）。

结果

31例患者中有17例（54.8%）pH-MII呈阳性（平均年龄：12.4岁；范围：4-17岁）。pH监测平均检测到64.6次酸反流事件，4.4次发作持续时间>5分钟。DeMeester评分为38.5。阻抗检测到反流发作的平均次数为66次（65.2%为酸性；32%为弱酸性；2.8%为非酸性），其中28%到达食管近端。13例中有6例（46.1%）食管转运延迟，15例中有5例（33.3%）胃排空延迟。GERD阳性和阴性患者的肺功能无差异（P=0.88）。