Blecker U, de Pont S M, Hauser B, Chouraqui J P, Gottrand F, Vandenplas Y
Division of Pediatric Gastroenterology, Academisch Ziekenhuis, Vrije Universiteit Brussel.
Acta Gastroenterol Belg. 1995 Sep-Dec;58(5-6):348-52.
It has repeatedly been demonstrated that a correlation exists between gastroesophageal reflux and the presence of various "atypical" complaints, such as recurrent chest pain, apneic attacks in infants, and recurrent or chronic respiratory symptoms. Very recently it has been shown that gastroesophageal reflux is frequently associated with non-controlled asthma in children and that medical treatment for reflux can improve the further course of respiratory disease. The aim of the present study was to investigate a possible cause-relationship between recurrent respiratory symptoms in children and the presence of gastroesophageal reflux disease, and to investigate the value of continuous 24-hour esophageal pH-monitoring in the diagnosis and management of these complaints in 62 children with chronic respiratory disease. Continuous 24-hour pH-monitoring was abnormal in 39/62 patients (62.9%). However, no statistically significant correlation could be detected between the presence of gastroesophageal reflux and various anamnestic parameters (parental smoking, pet in household, sibling with gastroesophageal reflux disease), or concomitant atopy. All children that were found positive for gastroesophageal reflux (n = 39) were started on an antireflux therapy (cisapride 0.2 mg/kg q.i.d.). This treatment resulted in an improvement of the symptoms in 84.6%. We conclude that gastroesophageal reflux is an important (causative) factor in chronic recurrent respiratory disease. This entity is often resistant to "classical" respiratory treatment, but can be treated with an anti-reflux therapy. We, therefore, suggest to perform continuous 24-hour esophageal pH-monitorings as a standard procedure in all patients with recurrent respiratory complaints, independent of the severity of their symptoms.
反复的研究表明，胃食管反流与各种“非典型”症状之间存在关联，如反复胸痛、婴儿呼吸暂停发作以及反复或慢性呼吸道症状。最近有研究表明，胃食管反流在儿童中常与未得到控制的哮喘相关，且针对反流的药物治疗可改善呼吸道疾病的后续病程。本研究的目的是调查儿童反复呼吸道症状与胃食管反流病之间可能存在的因果关系，并探讨连续24小时食管pH监测在62例慢性呼吸道疾病患儿这些症状的诊断和管理中的价值。62例患者中有39例（62.9%）连续24小时pH监测结果异常。然而，在胃食管反流的存在与各种既往史参数（父母吸烟、家中养宠物、有胃食管反流病的兄弟姐妹）或同时存在的特应性之间未检测到统计学上的显著相关性。所有胃食管反流检测呈阳性的儿童（n = 39）均开始接受抗反流治疗（西沙必利0.2 mg/kg，每日4次）。该治疗使84.6%的患儿症状得到改善。我们得出结论，胃食管反流是慢性反复呼吸道疾病的一个重要（致病）因素。这种情况通常对“经典”的呼吸道治疗有抵抗性，但可通过抗反流治疗来处理。因此，我们建议对所有反复出现呼吸道症状的患者，无论其症状严重程度如何，均将连续24小时食管pH监测作为标准程序进行。
