Friesen C A, Streed C J, Carney L A, Zwick D L, Roberts C C
Department of Gastroenterology, Children's Mercy Hospital, Kansas City, MO 64108.
Pediatrics. 1994 Oct;94(4 Pt 1):541-4.
The current study was undertaken to determine the prevalence of abnormal intraesophageal pH monitoring, esophagitis, and oxygen desaturation after experimental esophageal acidification (modified Bernstein test) in patients with apparent life-threatening events (ALTEs).
Fifty patients admitted to the hospital with ALTEs were evaluated. Patients underwent 24-hour intraesophageal pH monitoring, esophageal suction biopsies, and modified Bernstein tests to document oxygen desaturation during experimental esophageal acidification.
Abnormal pH monitoring was present in 82%, esophagitis in 16%, and oxygen desaturation of at least 5% with experimental esophageal acidification in 22% of the patients. Esophagitis was present in only 3 of 11 patients with oxygen desaturation, which was not different from those patients without oxygen desaturation. Clinical history was not predictive of oxygen desaturation during experimental acidification except that patients with a history of an ALTE while awake were more likely to demonstrate oxygen desaturation with acid.
We conclude that 1) the prevalence of oxygen desaturation with experimental acidification in infants with ALTEs is significant and warrants further evaluation; 2) esophagitis is not a necessary predisposing condition to esophageal acid sensitivity in infants with ALTEs; and 3) ALTEs while awake are frequently associated with a positive modified Bernstein test.
本研究旨在确定明显危及生命事件（ALTEs）患者在实验性食管酸化（改良伯恩斯坦试验）后食管内pH监测异常、食管炎和氧饱和度降低的发生率。
对50例因ALTEs入院的患者进行评估。患者接受24小时食管内pH监测、食管吸引活检以及改良伯恩斯坦试验，以记录实验性食管酸化期间的氧饱和度降低情况。
82%的患者存在pH监测异常，16%的患者有食管炎，22%的患者在实验性食管酸化时氧饱和度至少降低5%。在11例氧饱和度降低的患者中，仅有3例存在食管炎，这与无氧饱和度降低的患者无差异。除了清醒时发生过ALTEs的患者更有可能在酸化时出现氧饱和度降低外，临床病史并不能预测实验性酸化期间的氧饱和度降低情况。
我们得出以下结论：1）ALTEs婴儿在实验性酸化时氧饱和度降低的发生率较高，值得进一步评估；2）食管炎并非ALTEs婴儿食管酸敏感性的必要诱发因素；3）清醒时发生的ALTEs常与改良伯恩斯坦试验阳性相关。
