Cucchiara S, Campanozzi A, Greco L, Franco M T, Emiliano M, Alfieri E, Calabrese F, Numeroso V
Department of Pediatrics, University of Naples "Federico II," Italy.
Am J Gastroenterol. 1996 Apr;91(4):680-5.
The aim of the study was to evaluate, in 42 children with gastroesophageal reflux disease, the predictive value of both esophageal manometry and gastroesophageal intraluminal pH on the responsiveness of the disease to medical therapy.
Motility of lower esophageal sphincter and esophageal body was carried out through a perfused pediatric sleeve-probe; prolonged recording of the sphincteric profile was evaluated at the occurrence of reflux episodes as detected by an esophageal electrode; intraluminal pH of the esophagus and stomach was also measured for 24-h through portable equipment. Children were treated for 8 wk with cisapride and ranitidine and were classified as healed or refractory after endoscopy and clinical evaluation.
Twenty one children healed, and 21 were refractory. Compared with healed patients, refractory patients showed, at basal evaluation, an increased esophageal acid exposure (p < 0.05), a reduced basal sphincteric pressure and peristalsis amplitude (p < 0.01), an increased rate of sphincteric pressure drifts (p < 0.01), and a higher rate of transient lower esophageal sphincter relaxations (p < 0.01). The following parameters contributed significantly (p < 0.01) to a multivariate discriminant analysis: peristalsis amplitude, basal sphincter pressure, rate of transient relaxations of the sphincter, and rate of sphincteric pressure drifts. A correct classification of virtually all cases (97.62%) was reached.
Motor dysfunctions of both lower esophageal sphincter and esophageal body are the major factors predicting refractoriness of reflux disease in children to a standard medical treatment. Of the two main mechanisms of reflux, i.e., transient lower esophageal sphincter relaxation and lower esophageal sphincter pressure drift, the latter had the highest predictive value for the refractoriness of reflux disease.
本研究旨在评估42例胃食管反流病患儿中食管测压和胃食管腔内pH值对疾病药物治疗反应性的预测价值。
通过灌注式小儿袖套探头评估食管下括约肌和食管体部的运动功能；在食管电极检测到反流发作时，评估括约肌轮廓的长时间记录；还通过便携式设备测量食管和胃的腔内pH值24小时。患儿接受西沙必利和雷尼替丁治疗8周，在内镜检查和临床评估后分为治愈或难治性。
21例患儿治愈，21例难治。与治愈患者相比，难治性患者在基础评估时显示食管酸暴露增加（p < 0.05），基础括约肌压力和蠕动幅度降低（p < 0.01），括约肌压力漂移率增加（p < 0.01），以及短暂性食管下括约肌松弛率更高（p < 0.01）。以下参数对多变量判别分析有显著贡献（p < 0.01）：蠕动幅度、基础括约肌压力、括约肌短暂松弛率和括约肌压力漂移率。几乎所有病例（97.62%）都得到了正确分类。
食管下括约肌和食管体部的运动功能障碍是预测儿童反流病对标准药物治疗难治性的主要因素。在反流的两种主要机制中，即短暂性食管下括约肌松弛和食管下括约肌压力漂移，后者对反流病的难治性具有最高的预测价值。
