Waasdorp Hurtado Christine, Sheiko Melissa A, Gralla Jane, Kinder Sarah, Kramer Robert E
*University of Colorado Denver School of Medicine †Department of Pediatrics, Digestive Health Institute, Children's Hospital Colorado, Aurora, CO.
J Pediatr Gastroenterol Nutr. 2016 Aug;63(2):236-41. doi: 10.1097/MPG.0000000000001098.
Anesthesia can alter gastric and small intestinal motility, but its effect on gastroesophageal reflux (GER) is unclear. We set out to evaluate the effect of anesthesia on pH-multichannel intraluminal impedance (pH impedance) evaluation of GER.
Retrospective single-center analysis of 95 pH impedance probe studies performed in patients both with anesthesia exposure and esophagogastroduodenoscopy (n = 50) and without (n = 45).
Increased acid reflux per hour, nonacid reflux per hour, and total reflux per hour were observed in the first 4 hours, both overall and in children 1 year or older and in both sedation groups. This difference remained for the older children without sedation by multiple regression analysis for nonacid reflux per hour and total reflux per hour. Patients using proton pump inhibitors had more nonacid reflux events per hour and total reflux events per hour regardless of sedation.
Based on the results of the present study, there is no need to eliminate the data collected immediately after placement of the probe in children younger than 1 year of age, but in those who are 1 year or older without sedation, there may be a greater number of reflux events in the first 4 hours. The first 4 hours, therefore, should be carefully evaluated in patients older than 1 year of age. Further study is needed to provide normative data for the first 4 hours versus the later time period, both for those undergoing sedation and for unsedated patients, to validate the findings from the present study and to better understand the mechanism of GER.
麻醉可改变胃和小肠的蠕动，但它对胃食管反流（GER）的影响尚不清楚。我们旨在评估麻醉对GER的pH多通道腔内阻抗（pH阻抗）评估的影响。
对95例进行了pH阻抗探头研究的患者进行回顾性单中心分析，这些患者既有麻醉暴露经历且接受了食管胃十二指肠镜检查（n = 50），也有未接受麻醉暴露的（n = 45）。
在最初4小时内，无论总体情况、1岁及以上儿童还是两个镇静组中，每小时的酸反流、非酸反流和总反流均有所增加。对于1岁以上未镇静儿童，通过多因素回归分析每小时非酸反流和总反流情况，这种差异仍然存在。无论是否镇静，使用质子泵抑制剂的患者每小时的非酸反流事件和总反流事件更多。
基于本研究结果，对于1岁以下儿童，无需剔除探头放置后立即收集的数据，但对于1岁及以上未镇静的儿童，最初4小时内可能存在更多的反流事件。因此，对于1岁以上患者，应仔细评估最初4小时的情况。需要进一步研究以提供镇静患者和未镇静患者在最初4小时与后续时间段的规范数据，以验证本研究结果并更好地理解GER机制。
